6. HEALTH-CARE 15 By diagnosing health problems, or potential health problems, as soon as possible after admission, prison administrations can save financial resources by preventing illness or deteriorating health conditions, and by preventing communicable diseases from spreading to other prisoners or staff. 16 By knowing the health situation of each prisoner, prison administrations can also better plan for individualized rehabilitation programmes, including appropriate training and work opportunities. It may be that those who have health problems are unable to participate in established work programmes or such programmes may need to be tailored to their needs. 17 A healthy prison environment provides a healthier work place for staff, which, in turn, helps to improve relationships between prisoners and staff. CONTEXT: FUNDAMENTAL PRINCIPLES OF HEALTH-CARE PROVISION IN PRISONS [6.1] Protection Imprisonment should not increase the health risk of prisoners. Equivalence of care The health-care available in prison should be equivalent to that available in the community outside prison. The right to the highest attainable standard of health To meet this fundamental right of all human beings, health facilities, medical goods and services have to be available in sufficient quantity, be accessible to everyone without discrimination, be in line with medical ethics principles and be culturally appropriate. They must also be scientifically and medically appropriate and of good quality.341 Independence Health-care staff must be able to act with full clinical independence, basing treatment on patients’ needs. Clinical decisions must be taken based on medical grounds only and may not be overruled or ignored by non-medical prison staff (Rule 28(2)). This includes decision-making on the need for emergency or specialized treatment or surgery. Non-discrimination Rule 24(1) notes that prisoners should have access to necessary health-care services without discrimination on the grounds of their legal status. The principle of non-discrimination set out in Rule 2 also applies in relation to the provision of health-care. This does not mean that all prisoners should receive the same treatment, rather, it means that different groups of prisoners should receive appropriate health-care based on their needs, including gender-sensitive treatment. Confidentiality Prisoners should be able to access health-care services in full safety and confidentiality. Informed consent The principle of free and informed consent to treatment and medication must apply equally in detention. State responsibility The state is responsible for providing prisoners with free medical treatment and to protect and promote their physical and mental health and wellbeing. 6 Links to community health services and continuity of care Health-care service providers should have a close relationship with the public health administration to ensure continuity of treatment and care. 341. General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12), Twenty-second Session of the Committee on Economic, Social and Cultural Rights, 11 August 2000, E/C.12/2000/4. Guidance document on the Nelson Mandela Rules 147