The impact of coronavirus on people in prison

Work with offenders looks at a new report by the Health Foundation

A new report by the Health Foundation provides an overview of the experience and impact in prisons of the pandemic during its first year (March 2020 to March 2021).

During the pandemic, the prison population experienced increased risk of transmission because of the nature of the confinement in prisons. There were concerns that prisons could become potential high-risk settings for outbreaks and amplifiers of infection in the community – particularly when offenders were released homeless and were therefore unable to socially isolate.

In March 2020, prison systems across the UK were quick to introduce a full lockdown, with control measures remaining largely in place for the first year. This rapidly imposed and stringent regime was an important measure for rigorous infection control at the outset of the pandemic and likely reduced infections and saved lives. Yet, even with these highly restrictive control measures, prisoners still experienced higher cases and mortality rates than the wider population.

By April 2021 – a full year after England announced its first national lockdown – the prison regime had yet to fully unlock. Prisoners remained isolated in cells for an average of 22.5 hours per day, with meaningful activities mostly suspended, along with family visits. Delivering education remained a challenge and concerns around social distancing and interpersonal mixing raised questions about how to return to classroom-based education.

At this point, the Ministry of Justice suggested that when prisons could safely move to less restrictive regimes, visits from family members could recommence, dependent on infection levels in the community.

The Foundation, along with many criminal justice commentators, argues that the impact of the pandemic on prisoners could have been reduced through a greater focus on reducing the size of the prison population (in other words, through the early release scheme) and by prioritising prisoners and staff for early COVID-19 vaccination.

In September 2021, 18 months on from the start of the pandemic, the landscape in prisons has evolved. Vaccination and asymptomatic testing have been rolled out in line with community guidance and many rehabilitation programmes have been reinstated. Prisons are starting to return to a normal regime, although always aware that the risk of transmission and possible outbreaks remains high.

Double lockdown

The report details the impact on people in prison of the withdrawal or reduced access of key services – drug and alcohol treatment and education and work – and of the loss of face-to-face contact with their family members.

Telemedicine

One of the most interesting parts of the report looks at the way the pandemic acted as a catalyst for the roll-out of telemedicine across the prison estate. Across a five month period all prisons, immigration removal centres and parts of the children and young people secure estate in England were supported to develop telemedicine capabilities, within the rules set by Her Majesty’s Prison and Probation Service (HMPPS).

As part of this programme, HMPPS also swiftly changed the policy to support the use of 4G tablets within secure and detained settings. These devices were approved for two purposes: telemedicine consultations and live mobile access to electronic health records. This offered opportunities to make efficiencies and improvements to the way medication was delivered and respond to acute incidents.

There are strong (and reasonable) hopes that these changes will affect the way some health care services are delivered permanently, providing an alternative way to offset security and care in prisons with benefits felt beyond the pandemic.

The report points out that although telemedicine has nominally been ‘implemented’ across the prison estate as a result of the pandemic, this is not the same thing as being fully adopted. It is relatively straightforward for prison health care providers to organise telemedicine clinics within their own services, such as primary care. However, establishing telemedicine clinics with outside providers, such as hospitals, is burdensome because of the bureaucracy, IT challenges and security considerations involved.

As most readers will know from their own lives, since the pandemic hospitals now routinely run video consultations. However, often they operate on different platforms to those approved for people in prison and are likely to be reluctant to run two different system.

Conclusions and Recommendations

The report highlights key priority areas for the future, recommending:

  • Investment in mental health support services to try to mitigate the impact of the pandemic and long periods locked down.
  • That prisons build on the digital progress they have made throughout the pandemic while ensuring that digital services do not replace, as opposed to enhance, face-to-face ones.
  • More inter-agency co-operation between health care, criminal justice bodies and government.
  • That lessons are leant in order to better manage future pandemics.
  • A focus on healthy prisons which acknowledges that most people in prison suffer from a range of entrenched health inequalities.