In the early days of the Covid-19 pandemic, there were serious concerns that without intervention it would spread rapidly in prisons. Modelling estimations by Public Health England made available in late April suggested that, without action, there could be as many as 77,800 cases and 2,700 deaths from a prison population of around 81,000. The prison estate consequently implemented its own version of lockdown – which most notably meant the majority of prisoners remaining locked in their cells for at least 23 hours a day.
The prison estate has not yet seen the numbers of cases that were initially feared. Up to June 15th, there have been 502 confirmed positive cases of prisoners with Covid-19, with 971 staff also testing positive. 23 prisoners and 9 staff are reported to have died as a result of the virus.
As in the wider population, the actual numbers of cases are likely to be much higher than those identified through formal testing. PHE estimated 1,385 ‘possible/probable cases’ based on confirmed numbers within prisons, but the numbers are still significantly less than the worst-case scenario.
With a framework now in place outlining the plans to ease lockdown restrictions in prisons, we consider here the future for people in prison while Covid-19 remains a threat, as well as the impact on access to health care.
Ongoing management of Covid-19 in prisons
Life for people in prison is currently severely restricted. As well as having to spend more hours in their cells, Covid-19 has meant that education and most employment have been all but halted, and there are no face-to-face family visits taking place.
Measures have also been introduced to reduce the flow and spread of new cases into prisons. That is challenging from the outset, however, as there isn’t space to put everyone in single cell accommodation. At some prisons, temporary cells have been added outside in an attempt to alleviate the pressure on existing cell space.
Many of the current restrictions will remain to a greater or lesser extent while Covid-19 is in general circulation, and will exacerbate the challenges in prisons caused by outdated facilities and overcrowded conditions.
Scrutiny visits by HM Inspectorate of Prisons during the pandemic have highlighted the difficulties of following public health guidance in prisons – and where conditions are not what we might expect in 2020. A visit to three category C training prisons, for instance, noted that at one prison – Coldingley – people were having to use buckets in their cells as toilets at night, as the cells did not have built-in sanitation. They otherwise had to wait to be let out to go to communal toilets, which could take up to two hours.
Management of the virus also needs to be considered alongside the mental and physical health impact on prisoners. Prior to Covid-19, self-harm rates in prison were high, and increasing. There were over 63,000 incidents of self-harm in 2019, which was a rise of 14% on the previous year. Self-harm rates have been a point of concern in HMIP scrutiny visits – with higher levels now than before the pandemic.
The impact on prisoners of having very little time outside their cells, and little or no meaningful contact with others, cannot be understated. As a possible sign of the pressure that restrictions have had, in May there were five suicides in prisons over a six-day period.
The impact of Covid-19 on prisoners’ access to health care
Even under ‘normal’ circumstances, prisoners face poorer access to hospital services than the general population do. In 2017/18, prisoners had 24% fewer inpatient admissions and outpatient attendances than the equivalent age and sex demographic in the wider population, and 45% fewer attendances at A&E departments.
While Covid-19 remains a threat, access is likely to be further restricted. That raises concerns about both unmet need and a further widening of the gap between how often and why prisoners and those in the general population access services.
Access to hospital services for prisoners is dependent on initial triage in prison. With most prisoners only out of their cells for short periods each day, being physically seen by health care staff in prison is likely to be more difficult.
Demand for limited access to secondary health care will also increase, as people may need to go to hospital due to symptoms of Covid-19. However, prisons will still need to manage the care needs of patients who require unavoidable hospital care, such as dialysis. That means the threshold (how sick people need to be) to go to hospital will invariably increase.
Crucially, staff also need to be available to escort prisoners to hospital. Some staff will have Covid-19 themselves or be self-isolating, and this may affect escort capacity.
Maintaining social distancing in prison means everyday tasks take longer, as people can only be let out of their cells in small groups. Staff are more stretched to maintain even a basic regime where people can shower or make a phone call. That cumulatively means fewer staff being available and more to physically do for the staff who are there.
Easing lockdown in prisons
The framework criteria that have to be met in order to ease restrictions in prisons make it clear that change is likely to be slow and that there will be local-level variation.
This inherent flexibility, alongside very little publicly available information about what is happening in prisons, means it would be very easy for the status quo to be maintained.
In reality, conditions in some prisons were poor before the coronavirus and there is therefore a real risk that managing Covid-19 becomes an excuse to do nothing.
Over the coming months it is crucial that, alongside stopping the spread of the virus in the prison population, there is a concerted effort to understand and publicly report on the impact of regime changes on the lives of people living and working in prison. Prisoners and their families, as well as those working in prisons, should not be forgotten.
Davies M (2020) “Covid-19: how is it impacting on prisoners’ health?”, Nuffield Trust comment.