What was the impact of Covid-19 on primary care in prisons in England?

Problem

Concerns expressed at the start of the pandemic about the impact of Covid-19 on the prison estate focused on the vulnerability of the prison population to the virus and managing infection control. Despite the disproportionate burden of disease and proportion of complex health needs amongst the prison population, little attention was paid to how measures introduced to reduce the risk of Covid-19 infection might affect routine healthcare in prisons. This study aimed to understand how the pandemic impacted the delivery and receipt of prison healthcare and to reflect on the implications for health inequalities. This presentation will provide an overview of the integrated findings, with a focus on the sometimes unexpected consequences of implementing well-intentioned innovations.

Approach

This mixed-methods study comprised: an international scoping review of 12 sources; a nationwide environmental scan of grey literature summarising 52 sources; an interrupted time series analysis of ~25,000 anonymised prison healthcare records from 13 prisons in the North of England for the period 2018-21; and a nationwide qualitative interview study with a purposive sample of 44 participants (decision-makers, healthcare staff and prison leavers). For the ITS analysis, Covid-19 was considered the interruption (beginning March 2020); 24-months prior to March 2020 was the ‘pre-interruption’ phase. Data up to July 2021 were analysed. Data collected for the scoping review, environmental scan and qualitative interview study were subject to thematic analysis. Integration of the findings from each component was undertaken in a workshop attended by all members of the research team. A triangulation protocol was used to identify where findings converged or complemented each other, and where there was disagreement or silence (absence of data). Individuals with lived experience of imprisonment were involved in a variety of ways throughout the study.

Findings

The triangulated findings indicated an overall initial sharp fall in healthcare provision in prisons at the start of the pandemic followed by gradual reinstatement. Throughout the pandemic access to and delivery of healthcare were severely compromised, often restricted to urgent or high-risk cases. There was considerable variation in the extent of disruption across different types of services and between individual prisons, particularly in the implementation of strategies to minimise harm and the introduction of innovations such as telehealth. Both the environmental scan and the qualitative interviews revealed evidence of unmet needs, increased risk to safety and emotional distress.

Consequences

Our findings suggest that well-intentioned restrictions and innovations may have unintended consequences. The extent of disruption and subsequent unmet need identified across services and the prison estate illuminate the potential for the pandemic to widen health inequalities already experienced by people in the prison system.