Empirical evidence reviewed within this report suggests that people residing in prison suffer from health inequalities relative to the general population. The prevalance of many physical health conditions and the co-morbidity of physical health conditions, mental health conditions, and substance use is also high. It is therefore necessary to ensure a prison-based physical health care system which engages, supports and provides appropriate health care to people in prison. To ensure resources are appropriately targetted, it is necessary to understand the physical health care needs of the population.
Developing robust estimates of the physical health needs in Scotland's prison population was problematic, however, due to a lack of robust data and the complicated health data landscape in Scotland. Relevant data are stored on multiple, unconnnected systems that are managed by different authorities with no established data sharing protocols. If the physical health needs of Scotland's prison population are to be identified, understood and addressed, it is imperative that more coordinated, joined up data sources/systems are created (the PHS-PCLS study utilised in the current study is an example of how such data linkage can be achieved). Establishing such datasets would enable research to address important questions regarding the correlates of physical and mental health in prison populations, which (amongst many other things) would help to identify particularly at-risk sections of the prison population. Such information can guide the prioritisation of limited resources and early intervention with those groups most at risk from poor mental and physical health outcomes in prison. Moreover, such datasets would provide important insight into the equivalence of outcomes for prison populations (i.e. do people in prison with chronic diseases experience better or worse outcomes than comparable populations living outside prison?).
Despite the limitations of the available data, it is possible to draw some tentative conclusions regarding the physical health needs of the Scottish prison population (notwithstanding the limitations discussed previously). Specifically, worse physical health was observed amongst White persons living in prison in Scotland, females and individuals aged 50+. Furthermore, the data suggest that persons living in prison in Scotland experience greater prevalence of some (but not all) physical health conditions examined in this study when compared to the general, non-prison population (particularly: epilepsy, asthma, COPD, hepatitis C, oral health and Covid-19).
Professional stakeholders, individuals with lived experience of prison, and family members of people in prison reflected on how a prison sentence should be an opportunity to address the health inequalities of those residing within the prison estate. Several barriers to physical health service provision were identified, however. These included prison-based NHS workforce shortages and low retention rates, the reactive nature of health care within an environment which insufficiently engages those for whom health is not routinely prioritised, gaps and inconsistencies in health care provision at points of transition in the prison journey (e.g. reception, liberation and inter-prison transfer), issues with information sharing between community and prison-based services, and missed secondary care appointments due to the unavailability of transfers.
A number of recommendations concerning physical health care governance, monitoring, and provision have been produced based on the findings of this assessment of physical health needs and health care provision (these are outlined on the next page). Some of these recommendations have been offered in previous reports around health care provision in prisons (e.g. RCN, 2016; HSC, 2017). This physical health needs assessment would suggest that insufficient progress has been made towards addressing the previous recommendations and that action is now required to ensure service equity and improved health outcomes for people in prison in Scotland.
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