Children and young people in secure settings are entitled to receive healthcare of an equivalent standard to that in the community, and have the same rights as patients in the community to dignity, privacy, confidentiality and consent.
Doctors should be aware of the limits of the assessment tools used for reception health screenings, and ensure that a full and in depth health assessment is carried out.
In secure settings, the aims of security and health can come into conflict. Doctors can be put under pressure by competing obligations to their patient and their employer.
It is only by acknowledging that these pressures exist, and being sensitive to the human rights of children and young people, that these conflicts can be properly managed and doctors can focus on their primary duties to patients.
Advocating for patients
In addition to their role in providing healthcare, doctors are patient advocates.
They have an important role to play in raising standards of healthcare and in highlighting concerns about the treatment of children and young people, and a positive obligation in working with senior management to ensure conditions are in place to enable young people to make healthy choices.
Practitioners should consider how best to encourage involvement and interaction with healthcare services, in a manner that is appropriate to the needs and concerns of children and young people in custody.
The doctor's role
Doctors should make it clear that they are independent from prison officers and should not carry out custodial officer tasks or be directly involved in disciplinary proceedings.
Doctors are in prison to act in a clinical and welfare capacity, and acting outwith this can erode trust, undermining the willingness of a young person to access healthcare and damage the doctor-patient relationship.
Doctors should only carry out intimate body searches with the consent of the detainee. The only exception to this is where a patient lacks capacity and an intimate examination is thought to be in his or her best interests.
Doctors should not be involved in solitary confinement procedures, other than those necessary for therapeutic reasons, or for prevention of harm, such as where a young person poses a suicide risk.
The new healthcare structures enable greater engagement with a variety of colleagues across different sectors in the community.
Doctors should take advantage of the opportunities for joint working these new structures, in order to alleviate much of the professional isolation often reported by those working in secure settings.
Plans for release
To ensure effective resettlement in the community, doctors working in secure settings must ensure that a young person’s healthcare plan takes into account and plans for release from the outset.
Children and young people leaving custody should be equipped with the necessary information, in plainly accessible form, for accessing healthcare services in the community.
A summary record of a young person’s health, including recommendations for future treatment should be sent to the young person’s GP.
Doctors may also wish to consider the sharing of other relevant information where appropriate. Information must be shared with the consent of the young person in question.