What's it like working in a prison?

09 Feb 2023
by Francesca Allsop

Francesca Allsop is a Registered Dietitian who works in the UK’s largest prison, HMP Berwyn in Wrexham. She discusses her role and how she got into working in a prison environment.

Tell us a bit about your role.

I work part time at the prison, three days per week. Within this role I manage a complex caseload of prisoners. I do this in a face-to-face clinic setting. I see a huge range of conditions from nutrition support, diabetes, weight management right through to IBD, high output stomas, pancreatic enzyme replacement and coeliac disease.

The men in the prison often present with multiple co-morbidities, mental health diagnoses and learning disability diagnoses are high. I have had to learn how to make my care more trauma-informed and have taken steps away from being medical model heavy to support the holistic care needs of the men.

In this environment there is also an abundance of poor health literacy and illiterate populations, so much of my work is going right back to basics.

How did you get into the role?

Working in a prison was never something I imagined I’d be doing on my career path. During the COVID-19 pandemic I began feeling exhausted with the demands of acute ward work and was looking for a new challenge. This was sure it!

Very few prisons in the UK have NHS service provisions; luckily NHS Wales funds the majority of prison health, so I was lucky enough to see a job on NHS Jobs, apply for it and get it!

I didn’t grow up with money, I have fought hard for everything I have achieved. I feel that due to this I have a personal understanding of hardship and feeling failed by the system. I personally wanted to do anything I could to support marginalised members of society, and how better to do it than by incorporating my dietetic role into this?

Did you have any apprehensions, or preconceived ideas?

Yes, embarrassingly I thought that when I met my first murderer it would be obvious what crime they’d committed (this is not the case). I also believed as a female member of staff in a male prison that I may be vulnerable or not respected. In fact, it’s the complete opposite, women get far more respect and healthcare is a greatly appreciated service.

I’ve been so surprised how polite the majority of prisoners are!

What's it like working in the prison?

I love my role; it is such a rewarding place to work. Many of these men have never had someone advocate for them, so to be the person that gets them the right diagnosis and treatment is worth every second.

Alongside my clinical dietetic role, I work with catering to ensure safe and adequate provision of ‘’special diets’’ and I work alongside the health promotion strategy team, to support systemic prison changes to reduce rates of obesity and engage prisoners in meaningful activity to support their overall health.

Sadly, there is no published evidence base for dietetics in prisons in the UK at present, as it’s a rare role. Therefore, my ongoing work behind the scenes is developing and publishing research to support why we should care more about working in prison environments. Watch this space!