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The impact of Covid-19 on the delivery and receipt of prison healthcare in England: A mixed methods study

Background

People from groups disproportionately impacted by Covid-19 (minority ethnicities, chronic health conditions, deprived backgrounds) are overrepresented in the prison population which has a higher disease burden and proportion of complex health needs than the general population. Emerging evidence from frontline clinicians and people living and working in the UK prisons suggests that since the onset of Covid, prison healthcare has changed irrevocably. Healthcare services have been rapidly reconfigured, demonstrably disadvantaging some patients (e.g. referrals to acute care for emergencies only), and conversely providing opportunities for long-term benefits for patients and staff (e.g. rapid implementation of tele/video-consulting, increased use of ‘in-possession’ medication).
Recently published statements have focused on the prison population’s vulnerability to contracting Covid-19, the preparedness of the prison estate for a pandemic, and proposed/actual practical responses (e.g. temporary cells, early release). The impact of Covid-19 on mental and physical healthcare in prison has been acknowledged, but virtually nothing is known about how it has impacted the delivery and receipt of ‘everyday’ prison healthcare, particularly routine primary care and chronic condition management. Moreover, it is not known how this may widen existing health inequalities.

Objectives

1. Identify early insights into the national impact of Covid-19 on prison healthcare by examining existing publications and online material to identify what is known already about Covid-19 and prison healthcare.
2. Explore perceptions of the impact of Covid-19 on the provision, delivery and receipt of prison healthcare in the England and examine its potential contribution to health inequalities using in-depth qualitative interviews with purposive sample of ~45 participants across the North of England who have either received or delivered healthcare in a prison since March 2020 and commissioners, policymakers and senior management.
3. Assess and compare changes in prison healthcare activity before, during and potentially after Covid-19 by conducting an interrupted time series (ITS) analysis based on anonymised prison healthcare records from 13 prisons in the North of England.

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