Title: The impact of Covid-19 on the delivery and receipt of prison healthcare in England: a mixed methods study
Funder: Economic and Social Research Council

Abstract: 1. To understand the impact of Covid-19 on the provision, delivery and receipt of prison healthcare in the UK since March 2020. 2. To capture how and in what ways prison healthcare has changed and/or been reconfigured in response to Covid-19 (at micro, meso and macro levels). 3. To assess whether the pandemic has exacerbated known health inequalities in the prison population and to understand how and in what ways. 4. To define what can be learned broadly from the impact of Covid-19 and how this may influence the commissioning and delivery of prison healthcare in the future.

Lay abstract: People from ethnic minorities, living in poverty or with long-term health conditions are more heavily impacted by Covid-19. Many people in prison share these characteristics. People in prison often have worse health than the general population. Healthcare professionals working in prisons and prisoners themselves have stated that since the Covid-19 pandemic began, healthcare in prisons has changed significantly. The changes have been both positive and negative. For instance, there is a much greater use of telephone or video medical appointments and there have been beneficial changes to the ways in which medications can be distributed to, and held by, people in prison. A negative change is that referrals to acute hospital care outside the prison have become for emergency treatment only, meaning that non-emergency symptoms may not be investigated in some circumstances. There has been some research on the vulnerability of people in prison in terms of their greater risk of being infected with Covid-19 and also about the impact of Covid-19 on mental health. But there is virtually no research about the impact of Covid-19 on day-to-day prison healthcare such as screening for serious conditions or managing long-term health problems. And we do not know whether this has resulted in the health of people in prison getting worse than the health of people in the community. Because of all the rapid changes to prison healthcare due to Covid-19, the people who commission and provide healthcare services urgently need to understand what has happened. If the health of people in prison has gotten worse, academics and prison healthcare researchers will need to understand the exact reasons for this. Our 12-month study has three stages that each take a different approach: First, we will examine existing publications and online material to identify what is known already about Covid-19 and prison healthcare. We will look for previous academic research but also blogs, new reports, policy documents etc. Second, we will interview people who have been in prison, prison healthcare staff and prison decision-makers to explore their observations and beliefs about how and in what ways the pandemic has affected prison healthcare. We will speak to around 45 people in total. We will talk to people mostly over the phone or a video call. The researcher will ask different questions depending on which group of participants they are talking to but will cover the following topics: access to healthcare, quality of care, testing, medication, use of technology (e.g. telephone, video etc), relationships and communication. The researcher will speak to people who have been recently released from prison rather than people who are still in prison. This is because the prison service is currently under a lot of pressure and we can gain people's thoughts about the topic without needing to go into prisons. Third, we will conduct a statistical analysis of anonymous healthcare records from 13 prisons in the North of England. We will examine these records from before, during and (potentially) after Covid-19 to see how prison healthcare activity may have changed. We will look specifically at the following kinds of healthcare activity: the number of referrals to hospital made by prison doctors; the number of GP and nurse consultations in each prison; rates of hepatitis C, hepatitis B, and HIV testing; number of mental health screenings and assessments; rates of screening for bowel, breast and cervical cancer. Towards the end of the study, the research team will discuss the findings from all three stages in a workshop to help us to make sense of what they mean when looked at together as a whole.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE;INFECTION