SCOTLAND'S top nurse has warned that there is "little evidence" that health gap between prisoners and the general population has narrowed since the NHS took over responsibility for inmates five years ago.

Theresa Fyffe described the findings of the first major review into the transfer of prisoner care from the Scottish Prison Service to the NHS as "uncomfortable reading", adding that the ambitions behind the shake-up "have not been achieved".

In a wide-ranging report, published today [fri], the Royal College of Nursing Scotland highlights "significant concerns" over plummeting morale among prison nurses and failings in mental health and the management of long-term conditions such as dementia and cancer, which are becoming increasingly common with one in 10 prisoners now aged over 50.

Ms Fyffe, director of RCN Scotland, said: "The outcomes set before the transfer have not all been met. We're on a journey and everyone understands that, but we had hoped to say that it had done more than it has - but that doesn't mean it can't do more.

"We hope the report will stimulate proactive action going forward."

Ms Fyffe said mental health care was a "grave concern". Statistics show that 36 per cent of female prisoners and nine per cent of male prisoners suffer from schizophrenia, compared to 0.5 per cent of the population. Depression is also five times more common among inmates than average and two thirds of prisoners have personality disorders compared to just five per cent of the general population.

The report, based on feedback from prison nurses, management and inmates, found that only a third of nurses who had been employed by SPS prior to the transfer thought that mental health services had improved under the NHS and 22 per cent thought they had deteriorated. Staff and investment shortages were "consistently raised as a challenge", and long waiting times were also criticised. The report notes that while health boards are required to meet certain waiting time standards for psychological therapy, prisoners are not included in the statistics.

The "availability and willingness" of prison escorts from contractor, G4S, to accompany prisoners to hospital appointments was a "particular issue". In one case, a prisoner "had their appointment rescheduled four times due to G4S being a no show".

The number of prisoners aged over-50 have increased 50 per cent in five years due to a trend towards longer sentences, people living longer and convictions for historic sex offences. Nearly half of these inmates have a long-term condition, such as cancer or dementia, but the report found that prison care is "falling short". Palliative and end-of-life care is also "increasingly a reality" in Scottish prisons.

Although the report praises leaps in dentistry, drug therapy and blood-borne virus treatments, Ms Fyffe said she was "dismayed" by deteriorating morale among prison nurses.

The vast majority (72 per cent) previously employed by SPS said sickness absence was higher under the NHS, and high vacancy rates were reported by some prisons. Fewer than two thirds (63 per cent) of criminal justice nurses said it was a rewarding career compared to 90 per cent in 2011.

Respondents also complained that spending on prison healthcare was a "low priority" for the NHS and "bottom of the funding point".

Ms Fyffe said it "was not a vote winner", but stressed that tackling health problems in prison benefitted society in the long-run.

"It's a subject that nobody wants to talk about because people say 'don't spend money on them - throw away the key'," said Ms Fyffe. "But when you have someone you've treated with a mental health condition leave prison and the next minute they're back in again with the same or more problems - the 'revolving door' - that's not the best use of resources either."

Health Secretary Shona Robison said: “The National Prisoner Healthcare Network is supporting improvements in healthcare for prisoners to reduce health inequalities, as well as reduce reoffending. This includes work on throughcare, substance misuse and mental health and we have already seen improvements, such as a decrease of smoking.

“NHS boards are developing mental health services in prisons, modelled as closely as possible to those available in the community. Telehealth is being used to improve access to services including Living Life – a cognitive behavioural therapy service for people who are feeling depressed or anxious, and use of video-conferencing for specialist consultations.

“A successful transition from custody back to the community is key to reducing reoffending, and ensuring basic needs are met for issues like healthcare and welfare is essential to that reintegration.”