Prison population: physical health care needs

Introduction

Prison populations experience a wide range of physical health conditions at a far higher rate than non-prison/community populations (e.g. Binswanger et al., 2009; Gillies et al., 2012; Graham, 2007; Hockings et al., 2002; Mathew et al., 2005; Michie, 2017). Furthermore, the prison environment itself can heighten the impact and prevalence of certain illnesses, for example, by facilitating transmission of disease (via shared cells, overcrowding etc.), by encouraging lifestyle choices that impact on disease prevalence (e.g. poor diet and lack of exercise), and due to poor health care provision (e.g. Garcia-Guerrero & Marco, 2012; House of Commons, 2018). Moreover, with an ageing prison population (e.g. HMIPS, 2017, 2020), these health challenges are likely to continue (and even worsen) in future years.

It is, therefore, a priority that stakeholders develop an in-depth understanding of the physical health challenges facing people living in prison and that effective policies and practices are developed for managing these challenges within the unique environment posed by prisons. The last national physical health needs assessment within prisons in Scotland was conducted some 15 years ago (Graham, 2007). Since then, a number of significant changes to health care needs, delivery and policy have occurred that necessitate an updated needs assessment.

There is evidence to suggest that health care needs in Scotland may have changed over time. The Scottish Health Survey (Scottish Government, 2020) has indicated that health within the general Scottish population has declined since 2007. Given the lack of available data, it is unclear whether this trend is replicated in the Scottish prison population. It is reasonable to expect, however, that the physical health needs of people living in Scotland's prisons have shifted over recent years particularly considering the varied impacts of Covid-19 on physical health, including a reduction in food quality and nutrition available to people living in prison, reduced physical activity and access to gym facilities, reduced access to running water and toilets, and significantly depleted health care provision (e.g. HMIP, 2020; Suhomlinova et al., 2021).

In relation to changes in health care delivery, the responsibility for prison health care was transferred from the Scottish Prison Service (SPS) to NHS Scotland in November 2011. A critical review of the transfer in 2016 by the Royal College of Nursing (RCN, 2016) and the Health and Sports Committee's report on Healthcare in Prisons (HSC, 2017) both identified areas for improvement which included the need for more knowledge of the physical health needs of the prison population in Scotland.

A further, more recent development in health care delivery, the rollout of which was expedited due to Covid-19, is the introduction of the Near Me video consulting service within prisons which was completed in October 2020. Near Me allows for health care providers to offer video call access to their services to people in prison. The utility and impact of this facility on health provision within Scotland's prison is yet to be determined, however.

In addition to the changes in health care need, delivery and policy outlined above, there are further developments on the horizon likely to have a significant impact on health and social care provision in Scottish prisons. These developments also require updated evidence to ensure they are designed in an evidence-based and person-centred way. These future developments include:

1) the establishment of a new National Care Service (by 2026), which will be responsible for the planning and delivery of care in custodial settings, including prisons.

2) the development of a new Health and Wellbeing strategy by SPS.

3) the development of a new strategy for women in custody.

To meet the need for updated evidence, the Scottish Government has commissioned a comprehensive assessment of social care and health needs in prison. This assessment is comprised of 4 separate needs assessment sub-projects, including assessments of: physical and general health (the current project), mental health, substance use, and social care and support needs, which will feed into a synthesis report, in summer 2022.

The current project contributes by:

1. Highlighting the particular physical health challenges faced by the prison population;

2. Describing physical health care provision in Scottish prisons, identifying areas of good practice, and capturing the experiences of stakeholders, people with experience of prison and family members of people in prison; and

3. Comparing the health challenges identified in Scottish prisons with relevant benchmarks (e.g. in the wider Scottish population and in prison populations from other UK countries).