Us and them: the impact of prejudice on prisoners’ health care

What’s it like to be in prison? At the Nuffield Trust we have recently started a new piece of work exploring the health of prisoners. When I talk to people about it, I am sometimes asked “so, is it true that prisons are like hotels?”

While poor conditions in prisons – such as those identified in the recent inspection of HMP Liverpool – are widely reported, equally there are regular news stories that imply prisoners receive unwarranted luxuries such as TVs and computer access, which may explain why some continue to believe that prison is like a holiday camp.

For our research, it is important to acknowledge the impact of what people think about prisoners on how prisons are prioritised politically and in terms of spending – and what this means for how health care is delivered.

What perceptions do people have about prisoners?

While there are passionate advocates for prison reform, a lot of people simply don’t consider prison issues at all, as they aren’t directly affected. The limited exposure that people do have to stories and information about prisons and prisoners, however, gives a clear indication of the perceived ‘deservingness’ of those in prison.

In March 2018, following an inspection of HMP Altcourse (a Category B local prison) that highlighted the majority of prisoners were able to contact their families using in-cell phones, Good Morning Britain ran a Twitter poll titled: “Are we too soft on prisoners?” Of the 3,675 votes made, 87% answered “Yes”.

People have preconceptions about prisoners, both in who they are and what they are like as individuals. In an article about the new HMP Berwyn prison in Wales, when justifying the cost MP David Davies was quoted as saying that “most people who go into prison are already on benefits anyway”. Even if that is true, and no evidence was provided in the article, it is an example of how prisoners are characterised in blanket terms, with no thought to what such prejudices say about the wider system within which prisons operate.

It also seems there are expectations about what prisoners deserve in their day-to-day conditions, whether that be access to perceived luxuries like telephones, or even time outdoors. A Guardian article about the amount of time children spend outdoors led with the headline that “children spend less time outdoors than prison inmates”. Regardless of how much time it is believed children should spend outdoors, the implication here is that prisoners are not expected to spend more time outdoors than others.

What is prison for?

In his first keynote speech as Secretary of State for Justice, MP David Gauke talked about the purpose of prison. As well as the rehabilitation of prisoners and the importance of protecting the general public, punishment was highlighted – specifically deprivation of liberty, but also “certain freedoms”.

The health care prisoners receive should not be an aspect of the punishment of prison, but for our research it is interesting to consider if there are expectations about the health care prisoners deserve and subsequently receive, as well as the perceived liberties the prison regime allows, such as time outdoors.

In theory, prisoners have the same rights to health care as those not in custody – health services should be accessible and of a comparable quality. This may be at odds with what some think they deserve, so there is a challenge for those delivering prison health care to meet the expectations of them as health professionals while in a system and society advocating punishment.

It is important to remember that the vast majority of prisoners in England and Wales are not serving whole life sentences, and so prison theoretically presents an opportunity to positively address health care needs, both for the individual and the wider population – an example being the positive wider impact of blood-borne virus immunisation programmes in prisons.

Do prisoners receive equal health care?

Part of our research will explore how prisoners’ use of secondary health care services compares to those not in prison. While this will not give us direct information about the experience of health care within prison walls, it will ask questions about the care received in prison and if it’s similar to what might be expected for the general population. For instance, if prisoners require emergency hospital care for conditions that could normally be treated in a primary care setting, it raises questions about what services are available and any access issues that prisoners face.

Setting prejudices aside, many prisoners have complex health care needs. Mental ill health, drug or alcohol addiction, and multiple problems arising from an ageing prisoner population are a few specific healthcare challenges.

The challenge for our research is to identify the health care that prisoners receive, and consider what this tells us on whether they are getting the level of care they need.

*The project is funded by The Health Foundation, an independent charity committed to bringing about better health and health care for people in the UK.