Deterioration, drift, distraction, and denial: How the politics of austerity challenges the resilience of prison health governance and delivery in England

Ismail, Nasrul

doi:10.1016/j.healthpol.2020.09.004

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…Funding and provision of prison health services tends to be in the public sector. However, budget cuts resulting in reductions in staff and competitive pressure to contain costs, has seen an increase in privatization of prison care in some countries (Ismail, 2020). This has raised concerns about excessive cost reductions at the expense of quality of care, a lack of transparency and problems of oversite (Moore, 1998).…”

Section: Introductionmentioning

confidence: 99%

Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time

et al. 2021

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Background This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events. Results In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care. Conclusions The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners’ penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.

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Section: Introductionmentioning

confidence: 99%

Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time

et al. 2021

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“…The fundamental foundation of every healthcare service is its workforce but the current findings have demonstrated that the prison healthcare workforce is severely depleted. Prison healthcare provision in the UK is provided by a fragmentation of third-sector and for-profit companies, with healthcare staff employees often receiving terms and conditions that are viewed as inferior to those of their peers in the community 10 coupled with a lack of career development. Prison healthcare careers should be made more attractive with clear career trajectories, better terms and conditions, protected time for training, and investment in upskilling of current staff.…”

Section: Discussionmentioning

confidence: 99%

“…9 There is little research that focuses on the organisational factors influencing primary care in prisons and even less literature that pays attention to how these factors have an impact on quality and access. A notable exception are two papers by Ismail 8,10 that concentrate on macroeconomic conditions, governance structures, and the impact of austerity. Further, most prison healthcare studies tend to prioritise discrete areas of health such as communicable diseases, mental health, or drug treatment services to the exclusion of routine healthcare conditions encountered every day in primary care such as asthma, hypertension, or diabetes.…”

Section: Introductionmentioning

confidence: 99%

Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study

Sheard,

Bellass,

McLintock

et al. 2023

Br J Gen Pract

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BackgroundPrimary care for routine healthcare conditions is delivered to thousands of people in the English prison estate every day but the prison environment presents unique challenges to the provision of high-quality health care. Little research has focused on the organisational factors that affect quality of and access to prison health care.AimTo understand key influences on the quality of primary care in prisons.Design and settingThis was a qualitative interview study across the North of England from 2019 to 2021.MethodInterviews were undertaken with 43 participants: 21 prison leavers and 22 prison healthcare professionals. Reflexive thematic analysis was undertaken.ResultsThe overarching organisational issue influencing quality and access was that of chronic understaffing coupled with a workforce in flux and dependence on locum staff. This applied across different prisons, roles, and grades of staff, and was vocally discussed by both patient and staff participants. Intricately related to understaffing (and fuelled by it) was the propensity for a reactive and sometimes crisis-led service to develop that was characterised by continual firefighting. A persistent problem exacerbated by the above issues was unreliable communication about healthcare matters within some prisons, creating frustration. Positive commentary focused on the characteristics and actions of individual healthcare professionals.ConclusionThis study highlights understaffing and its consequences as the most significant threat to the quality of and access to prison primary care. Strategies to address health care affecting prison populations urgently need to consider staffing. This issue should receive high-profile and mainstream attention to address health inequalities.

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“…Early identification and support for SLCN and the positioning of this within L&D is not without its challenges. The criminal justice system and the NHS in England are both under a great deal of financial strain and there are competing needs for access to available resources (Ismail, 2020). Increased SLCN provision does carry an additional resource implication; however, the net economic gain in terms of ‘savings for health and social care services, improved quality of life, and productivity gains – exceed the costs’ (Marsh et al, 2010, p.5).…”

Section: Recognising Slcn Support In Police Custodymentioning

confidence: 99%

The importance of screening for speech, language and communication needs (SLCN) in police custody

Holland

Hutchinson

Peacock

2023

Howard J Crime Justice

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People who have speech, language and communication needs (SLCN) are more prevalent in criminal justice settings than in the wider population. Previous research focusing primarily on young people and the prison population has led to calls for early interventions and screening, particularly in youth justice settings. NHS Liaison and Diversion (L&D) referrals in a single police force region in England were screened for SLCN over a period of three months. The results indicate a need for early identification of SLCN for all age groups, and for those with no previous SLCN‐related diagnoses.

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Deterioration, drift, distraction, and denial: How the politics of austerity challenges the resilience of prison health governance and delivery in England

Cited by 6 publications

References 16 publications

Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time

Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time

Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study

The importance of screening for speech, language and communication needs (SLCN) in police custody

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