It was on a late-night bus home from a shift at Rikers Island, the then notorious New York super-penitentiary, that Peter Mason realised prison healthcare was the job for him. "The bus was usually full of black and Hispanic women and children coming home from visiting," he recalls. "But there were also these two black guys in hoods. They asked if I was a correction officer? I said, 'No, I'm a nurse,' and one said to the other, 'He's cool'. I realised then that the organisation I was working for was there for the prisoners. We didn't take pubic hair clippings from convicts to use as forensic evidence, we aren't part of the correction system - we are just there to do what we are trained to do, without prejudice."
Mason is the founder and chief executive of Secure Health Care (SHC), an old-fashioned industrial and provident society that ploughs earnings back into the service, and has some new ideas about tackling the horrendous state of health in UK prisons.
Mason talks of employing offenders within the prison healthcare system, fining mental health trusts that keep mentally ill prisoners inappropriately in prison, and paying a bounty to GPs to care for ex-offenders to cut overdose deaths following release. He feels that offender healthcare must develop as a specialism in itself, like elder care or community care, and wants to set up an SHC college to make it happen.
In July, SHC won the bid to provide NHS care for Wandsworth prison, south London, one of the largest in Europe.
The prison population harbours astounding levels of physical and mental illness. Two-thirds of the 82,000-plus prisoners have a mental illness, many with the complication of drug or alcohol addiction and/or a learning difficulty. HIV, tuberculosis and hepatitis are rife. These factors, plus overcrowding, were cited as part of the reason for a startling 37% increase in self-inflicted deaths among convicts, from 67 in 2006 to 92 last year. But it isn't just what happens inside prison that concerns Mason. When inmates leave prison, they fall off the radar of health services, he says. A shocking 160 ex-prisoners die each year due to drug overdose within 14 days of discharge.
Wandsworth is a vast Victorian recreation of a medieval castle, built in 1851. The wings radiate from a central hub so that prisoners can be observed without knowing they are being watched. It holds more than 1,400 men, but is due to be extended to hold 100 more.
Mason, a trained NHS psychiatric nurse and an academic who has worked and studied in US prisons, is emphatic about the growing problem of mental illness in prisons. "It's almost immoral that the [medical] profession should stand back and allow mentally ill patients to be caged in prisons at the rate they do," he says.
He complains about the problem of prisoners unable to be discharged because there are no suitable psychiatric beds.
His solution? Fining mental health trusts, just as local authorities are fined if an elderly patient is stuck in a hospital bed because there are no care home spaces. "I think fining them £300 a day to keep somebody in prison is a way to focus minds," he argues.
The government has just launched a cross-departmental consultation setting out its vision of the future of offender healthcare, both inside and outside the prison, and it almost looks as if Mason wrote the document. Mason's approach to improving services is via an organisation that puts profits back into the service and that is membership-led and employee-owned, where everyone - clinicians, prison officers and prisoners - is to varying degrees a member and can have a say in what it does.
SHC was introduced to Wandsworth via the prisoners' newsletter, The Landing, and Mason quickly set up a prisoner forum to ask the men what they felt about the quality of healthcare and how it could be improved. He introduced a prisoners' health charter, which spells out roles and responsibilities. "We promise that prisoners will get a level of care that is equivalent to that in the community, and that all care we provide is evidence-based," Mason says. "They have a right of confidentiality - we aren't prison officers - and they have a right to continuity of care when they leave. As part of the rights and responsibilities, prisoners are also informed that they should turn up for appointments, rather than going to the gym or saying they have something better to do."
The forum revealed that the prisoners, just like people on the outside, want faster access to appointments and a better attitude among staff. They feel that people never listen to them.
Some changes seem to be taking time for the prisoners to get used to, such as senior nurses providing more care. SHC has employed an advanced nurse practitioner as lead nurse, but Mason says prisoners still think they should be seeing a doctor. And it has introduced a foundation course for all staff giving them the principles of prison healthcare. Prisoners no longer turn out for "sick parade" or, if they are really unwell, report "special sick". "The vocabulary needed to change," Mason says. "It's all part of the normalisation process."
Just 13% of Wandsworth inmates come from south London, and Mason says he wants to set up a local contact centre so that men leaving prison can find out where to get a GP and where to find a 24-hour pharmacy. He also wants it to be available for people coming back to the area after leaving any prison in the UK. "People are so vulnerable during those first few weeks after leaving," he stresses.
SHC has introduced iris recognition methadone pumps to speed up dispensing. The prisoner looks into a retinal scanner, which identifies him, and then dispenses the required dose of heroin substitute. Other hi-tech plans include the introduction of tele-healthcare, linking the prison to consultants in local hospitals, cutting down on the need for expensive and time-consuming escorted trips. Digital x-rays will also speed up diagnosis, with images sent by computer to specialists for interpretation.
Mason also wants to develop more mental health services to tackle the stress, anxiety and depression generated by prison. "Prisons aren't great for your health," he says. "They aren't meant to be lovely places, so people need to know of ways of surviving."
What about personal safety? "Security and safety are of course important features," he says. "Prisons are relatively safe places for doctors and nurses because prison officers are so skilled at handling prisoners and diffusing difficult situations. But healthcare staff are the champions of prisoners - we are not the enemy."
He also sees nothing wrong with employing ex-offenders, subject to the selection procedures. "We have set up a health trainee course for prisoners to help them learn about fitness and how they can signpost other prisoners to care if they need it. A lot of prisoners show a very caring instinct and want to give something back. Some could become care assistants. It's an ideal opportunity. I don't see why ex-offenders couldn't become call handlers, drivers, porters or admin workers, and work in their own organisation."
Mason says it was pure serendipity that saw the creation of SHC. Primary care contracts had become more flexible and the NHS was being opened up to a wider range of providers, including the private sector and social enterprises. At the same time, the responsibility for prison health was handed over to the relevant local NHS primary care trust. SHC inherited 64 existing prison health workers under transfer, and has also brought in a lot of its own senior nursing, managerial and medical staff. It tries to recruit locally where possible. "We wanted to get local people involved because we are a local employer, and to open up the place and dispel some myths," he explains.
But SHC's status as a contractor means that it does not come under the protective wing of the NHS indemnity scheme. Mason is concerned that social enterprise companies such as this have to stump up their own clinical negligence insurance - and the premium for working with prisoners comes to £160,000 a year.
What about the problem of ensuring prisoners stay in touch with health services on discharge, particularly during that crucial period immediately after release when overdose is most likely? He feels that the NHS could follow an example from a programme at Rikers Island that paid a fee to substance misuse clinics that took on ex-prisoners. "GPs could be paid a bounty to ensure ex-prisoners aren't excluded when they are released."
Mason says he is happy with the direction of travel set out in the consultation on the future of offender care, but is clear about who shouldn't be involved. "I am opposed to private healthcare providers working in prisons," he says. "I don't think it's right that they should be making money out of incarcerated people."
Education: Chalvedon comprehensive school, Essex; Leicester University, BSc health science studies; Maudsley hospital and Institute of Psychiatry, diploma in behavioural psychiatry; Bethlem and Maudsley School of Nursing, registered mental nurse; Barking and Havering chool of Nursing, state registered nurse.
Career: 2007 to present: chief executive, Secure Health Care; 2000-07 chief executive, Centre for Public Innovation; 1993-2000: director, PDM Consultancy; 1992-93: Harkness fellowship, Columbia University, US; 1989-92: regional development manager, substance misuse services, North West Thames Regional Health Authority; 1977-80: various nursing and nurse management posts in mental health.
Interests: Jogging, tending allotment, sailing, music.