Rebel Justice - changing the way you see justice

E. 76: Grace Colbourne part 2 - The Right to Dignified Cancer Care

• Rebel Justice - The View Magazine • Episode 76

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In this powerful episode of Rebel Justice, hosted by The View Magazine, we continue the story of Grace Colbourne, a 37-year-old Antiguan woman and former military officer currently on remand at HMP Bronzefield, a private women’s prison in the UK. Grace is undergoing treatment for breast cancer, but instead of receiving proper medical care, she has faced disturbing delays, neglect, and dehumanising treatment while incarcerated.

Experts Jo Armes, a registered oncology nurse, and Professor Rachel Hunter, a health economist from UCL, join the conversation to explore the systemic failures that prevent incarcerated women from receiving cancer care equivalent to what’s available in the community.

Together, they uncover how communication breakdowns, lack of on-site medical staff, missed appointments, and prison transfers disrupt diagnosis and treatment pathways—factors that significantly reduce survival rates for incarcerated cancer patients. 

This is not just Grace’s story—it’s a broader indictment of how the UK prison system fails some of the most vulnerable women in its care.

Content warning: This episode contains descriptions of medical trauma, abuse, and institutional neglect.

Credits

Guests: Jo Armes and Professor Rachael Hunter 

Producer: Charlotte Janes

Soundtrack: Particles (Revo Main Version) by [Coma-Media] 


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Grace Colbourne (Actress):

I booked the prison GP in November but I didn't see him until late January. There isn't a prison GP on site at HMP Bronzefield. In early March I was taken to St Peter's Hospital. The consultation could see the lump and he sent me to do a biopsy and have blood taken. They said I was positive for cancer but I didn't know, and I still don't know, what type of cancer I had. I was handcuffed in the operating theatre. There was a large drain on one side under my arm to collect the pus from the operation.

Grace Colbourne (Actress):

I was returned to the prison the very same day with the drain still in me, still in pain and still woozy from the anesthetics. In the cell I tried to take off the very tight t-shirt but I still had drains attached to me. I couldn't do it. At 7.30pm the nurse came and asked if I needed painkillers. I asked for an extra pillow to rest my arm. 30 minutes after, I started bleeding everywhere. I managed to get to the cell bell and ring it, but I wasn't given a panic alarm, which I should have been given. Two officers came and they were just staring at the blood through the window on the cell. It was everywhere on the duvet, on the sheet, on the clothes, on the pillow, on my underwear. They were shocked. The nurse came and said I don't know why they sent you back from the hospital. What am I supposed to do?

Host:

Welcome to Rebel Justice, a podcast by the View magazine, a platform by and for women in the justice system. In part one, we heard the story of Grace Colbourn, a 37-year-old Antiguan woman, a former military officer and currently on remand at HMP Bronzefield, a private prison in West London. Grace is battling breast cancer, but instead of receiving care, she's under a delay, confusion and what can only be described as medical neglect, all while incarcerated. In part two, we will be talking to Jo Armes, a registered nurse who worked clinically in haematology and medical and clinical oncology before moving to St Bartholomew's and Homerton hospitals to undertake psycho-oncology research. Joe has studied incidence and survival rates for people diagnosed with cancer in the English prisons, and patients' experiences of cancer care. We also speak to Professor Rachael Hunter, a health economist at UCL, who has done extensive research on healthcare within prisons.

Host:

With cancer patients being in prison, how can we make sure that they can access the support such as breast cancer nurses or 24 hour GPs or alternative therapies which they would be able to access if they were in the community?

Jo Armes:

I don't know if they're 24-hour, but there should be GP services within the prison setting, even if it's a 12-hour period, obviously, things like alternative therapies and access to breast care nurses and potentially counselling. I think women need to think about the things that they would like and make sure that the next time they're at an appointment at the cancer centre that they say "next time I come, I'd really like to have an appointment with this person, this person and this person, because I'm not able to access those things when I'm not attending for this visit" and I know that we interviewed a few people who specifically asked for those kind of services and they were set up within the cancer centre. Because the biggest issue is the issue of escort out of the prison, and that seems to be a limiting factor in terms of what is available to people - they should be seen by a breast care nurse as part of their treatment pathway.

Host:

The prison that Grace is in Bronzefield, they don't have a GP on site so it's quite hard for her to get her check-ups and everything. So I was just wondering how do you think the way in which they'd be able to access this support, as if they were living in the community?

Rachael Hunter:

Yeah, I think that's a really tricky question because, first principle, people in prison should have access to what is available in the community. That's set out legally and that's set out as also an ethical and moral aspect of when someone goes into prison. They are a warden of the state and it's the responsibility of the state to provide them with care. So they should have that care available. For each prison though, the way that they commission or pay for or contract their healthcare can differ. So my understanding of Bronzefield being a private prison, they can obviously make decisions about how they contract it. Sometimes they might contract the NHS itself to provide that healthcare. Sometimes they might go to a private contractor and set it up that way.

Rachael Hunter:

But overall, within their process they should make sure that it's set up so that people can access healthcare the same way they would in the community. They need a process for highlighting if they feel something isn't right and then a process for once that's identified, the same way that you go to your GP in the community. The GP then has a look and says, okay, you need to be referred through to the correct services, and the processes should work the same. But obviously within the prison estate there are bits and pieces where that starts to fall over in regards to security, sharing information, and then the ability for people to have control over their own health and their own access to health care is obviously limited, in that they need both the health care workers to work with them, but also the security staff and just the whole prison estate to be able to access those services, whereas you and I might be able to obviously call up a GP and then, if we need to go, we're able enough to go and take ourselves there.

Host:

So we know there are very long delays for women accessing initial scans and biopsies, which doesn't align with the NHS two weeks pathway, what effect can this have on the patients?

Jo Armes:

I think it can create a lot of uncertainty for patients. Obviously, you know, the fact that people have identified something suspicious is going to arouse anxiety for people and they'll want to kind of make sure that they're getting specialist advice about their condition. So ideally people should be referred to cancer services promptly. There's a 62-day target from referral to first treatment and ideally within that time people should have their investigations be seen by the oncology team and their case discussed at a multidisciplinary team meeting. Obviously, for breast cancer they'll also want to discuss what kind of surgery they're going to do. Should they do a lumpectomy? Are they doing a mastectomy? And then, if they are doing a mastectomy, are they going to go for reconstruction, and that can either be immediate, at the same time as having the mastectomy, or delayed, but women should be given the option around reconstruction.

Speaker 2:

Considering what Jo has just said, we want to remind you of Grace's story.

Grace Colbourne (Actress):

I wanted to have both breasts removed, but they refused. I didn't want just the nipple removed. They kept saying to me you don't have a choice.

Host:

And in terms of the research that you've done about cancer in prisons, obviously it shows that people with cancer are way more likely to die in prison after a cancer diagnosis than people who live in the community. How would you say a proper diagnosis can make this better?

Rachael Hunter:

So I think one of the tricky things when you do research like what we did using observational data. The problem is we know that there's a problem, but we don't know exactly where it is. So there could be a whole range of things going on, from how timely that diagnosis is. So are people getting diagnosed at the later stage? Are there more complications?

Rachael Hunter:

Are there other things going on in these people's lives besides partially what's happening in prison, but also a lot in the community, because what we don't know is are they diagnosed in prison and then they move into the community and that communication link is lost. So that could be what's happening or is it part of the prison process? So there needs to be more work to find out what is the missing link here and why is it falling over. And it might be that actually there's a range of things around timely diagnosis, around them getting the follow-up care. The other thing we found as well was that people in prison that had fewer interventions as well, so their planned care there was less of it, but their emergency care was higher, which would suggest that a lot of the planned care is being left out and then it's falling into an emergency situation where obviously your outcomes are not as good. So ensuring that that care pathway and how people move through the system is lined up for prisons and again that's about the communication thing as well, getting that right is important.

Jo Armes:

One of the things we found was that part of the decreased survival rate was because people were less likely to be diagnosed through screening or through the two-week wait referral. So I think a key way to improve survival in that population is to kind of more earlier diagnosis, so improving uptake of screening. That's not an easy thing to do, though. There are lots of reasons why people don't go for screening. They might be scared, they might have had very poor experiences of going for healthcare appointments, and therefore the approach needs to be modified so it's trauma-informed and that people can get used to the idea, because some of the screening methods, particularly for cervical screening, are quite invasive. Having a smear done is a personal, intimate investigation, isn't it - An examination? If you've experienced any trauma previously, you're less likely, I think, to want to go and do it.

Jo Armes:

I don't think some of the prison systems really help with the screening programmes though, because of the churn within the prison system. You know people being moved around a lot, so they might start the screening process, require an extra investigation, but in the meantime they've been moved to another prison and the whole process has to start again or it doesn't get picked up again. So it's about how can we adjust that screening pathway to make sure that doesn't happen to them, that they don't get moved before they've had the investigation? You know, some of those things are beyond the control of, say, the screening services or prison healthcare. The women themselves are not in control of that.

Rachael Hunter:

And in general. I mean one of the key things is it's hard for people in prison to get to the appointments. So appointments are set, and if they're in an open prison they can take themselves. If they're in a closed prison, they have to wait for, obviously, prison officers to get set up to then take them to the appointment. And we know that you get a lot more do not attend for people from prison going into hospital compared to in the community. So it could also be that they're missing crucial appointments because of the lockdowns, lack of available staff, unable to find the right time as well to get that, that appointment, to happen.

Host:

So, for example, in Grace's case, after her surgery, the hospital didn't take responsibility for the post-medical care that she should have received, and neither did the medical team at the prison. So who is ultimately responsible for this healthcare, and how can we make sure that this is enforced the way it needs to be?

Rachael Hunter:

I mean technically it is the hospital.

Rachael Hunter:

It's like with any other care, if you or I had poor care, it would be the hospital that we'd take it back to.

Rachael Hunter:

It's the responsibility as well of the government to ensure that there are processes in place to check the quality of care being provided by hospitals. So are hospitals doing the right thing for people to check that people are getting timely care, that they're getting checked up on, and that should occur for people in the community and people in prison, and obviously there might be extra systems that need to be put in place to ensure that those quality things are happening across people in the community, different to people in prison, but overall, yes, the the hospital same as us. The hospital is responsible for our care, the prison is responsible for ensuring security concerns and they are also responsible for the care and welfare of the person. So they should still be ensuring that information is exchanged in a reasonable way, but ultimately the care falls down to the hospital reasonable way, but ultimately the care falls down to the hospital, apart from taking care of her and her breast cancer.

Host:

In terms of mental health, Grace was saying that she felt dehumanised, she was handcuffed, she wasn't allowed to wash herself, she wasn't getting any help to go to the bathroom, for example, and she had no support in general. So h ow do you think getting a cancer diagnosis in prison can affect someone's mental health, and what support do they need, and are they usually getting it?

Jo Armes:

I think it's quite difficult for people who are diagnosed in prison, partly because you know you're quite isolated anyway. Normally people here attending for cancer care appointments, particularly at the beginning when they're going to be effectively potentially receiving bad news, they would normally come with someone who you know, a family member or a friend who can be there to support them, and I think for people in prison that's lacking. So I think it's quite lonely. You know, people describe to us what to me sounded like a very lonely and isolated kind of experience of being told that they have a life-threatening disease and with very limited support. And I think we should be trying to work towards at least making sure that the family of people being diagnosed with cancer in prison are involved in some way in supporting that person, whether be it via kind of virtual means, even if it if they're not able to be in the room.

Jo Armes:

Some people we interviewed haven't told their family members that they've been diagnosed with cancer because they didn't want to worry them. So they were also trying to protect their family from, you know, from the bad news. So I think it's really that which can really affect someone's mental health to be that on your own with something. Obviously that's not an ideal situation for people. As a cancer nurse, I would always have said to people you know you've got this appointment, make sure you bring someone with you. We don't want you to be on your own. Or if friends are talking to me about appointments they've got, I'll always say to them make sure you take someone with you, because you don't know what you're going to hear. So it's always good to have someone to support you through that.

Host:

And is there anything else that can be done to provide health care for women in prison, to make sure that they get their treatment and their follow-up and their medical care that they should be receiving and that they would if they weren't in prison?

Jo Armes:

So much that needs to be done. I think the biggest issue is communication between the prison healthcare team and the oncology team about what the plan is and how to facilitate making sure that women get their treatment as planned and that they're given priority when it comes to things like escort, that they are provided with enough information about their condition for them to be able to feel empowered to ask for things that they need.

Rachael Hunter:

That is tricky, but I think also it's about educating and people knowing that they have a right to speak up and say actually I need this information and it's your responsibility to provide it again.

Speaker 2:

After what Jo and Rachel have both said, we want to remind you of Grace's story.

Grace Colbourne (Actress):

They said I was positive for cancer, but I didn't know, and I still don't know, what type of cancer I had.

Jo Armes:

But I think there is a slight issue that if you don't work in prison healthcare and you don't work in prisons, people have a very limited understanding of what's possible within the prison setting. So I think there needs to be a better kind of appreciation on both sides for the kind of things that are important and the things that are feasible to do, adjusting it so that you get round all the challenges and there are challenges, you know.

Host:

We all know what they are in terms of you know how little control people have over what happens when in a prison. So us as researchers or journalists or just as part of the general public, is there anything we can do to help push for those changes or to help improve these conditions? That's a really good question.

Rachael Hunter:

I mean my personal research is I look at the costs and the outcomes of care. So I look at where the system might be falling, apart from where there's ways that we could invest money better to get better outcomes for people. So I push very much from the the cost angle in general. I mean things like what you're doing with the podcast, uh, communicating to people that there's a problem because a lot of people don't understand the prison environment. They've never had any exposure to it. They see what they see in the media and they don't. They don't connect up that these are people who, for whatever reason, have ended up in this situation and they still have a right to an access to care.

Jo Armes:

I think they're just such a hidden population. You know, raising awareness is really, really important. We know the chief medical officers writing a report about the healthcare of people in prison. So looking out for that report coming out and then raising awareness about the health care of people in prison, because it should be equivalent to what people get in the community, and making sure that something equivalent is not saying what I do in the community I do for people in prison, Because sometimes you need to do more to make it equivalent, if you see what I mean, because the circumstances are quite difficult but we can do it. It just takes everybody putting in a lot of effort to do that. I mean, it's a national problem and it's not just in prisons, which is about recruitment and retention of staff. I don't think that helps. Within prison healthcare settings, there's so many locum and bank staff use that there's no continuity of care, which is a significant challenge. But it's the same in community settings as well.

Speaker 2:

The Rebel Justice podcast asks external organisations and stakeholders to respond to serious concerns about the treatment of women with cancer at HMP Bronzefield. Specifically, we asked whether the prison is equipped to meet the medical and emotional needs of women with cancer, why women are reportedly missing hospital appointments or facing delays in receiving essential treatment, why cancer patients are not being provided with medically required special diets despite clinical guidelines. And why women with cancer are being restrained, handcuffed or chained during hospital visits even after surgery, which contradicts prison policy and NHS guideline on compassionate care. Sodexo, who operate and manage HMP Bronzefield under contract, declined to comment. It is important to note that the CQC regulate healthcare providers in prison.

Speaker 6:

A spokesperson for the Department of Health and Social Care said these claims are shocking and we expect the CQC to take action when healthcare provision is not adequate. We recognise that many women in prison have complex needs and there is work to be done to address health issues for prisoners. The Chief Medical Officer's report on the overall health in prisons is due to be published this year and we will consider the recommendations and what action may be needed to improve care.

Speaker 2:

That was part two of Grace Colbourne's story. What happened to Grace isn't just a failure. It's a warning. It's a story that demands reflection and action. It's a warning. It's a story that demands reflection and action. If you've been affected by anything in today's episode or you want to learn more about rights and present health care, we've included resources in the show notes. If you'd like to support our work and receive four digital editions and one print issue a year, subscribe to the view for just 20 pounds a year. Make sure to follow us on our social media. We're on instagram @the_view_ magazines, and you can also find us on linkedin x and tiktok. Thank you for listening and please share this story.