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Director of Public Health annual report (2020-21)

Prisons

People in prison are more likely to experience multiple, sometimes more complex physical and/ or mental health conditions compared with the overall population.

These issues are often further complicated by wider health determinants such as homelessness, unemployment, financial problems or insecurity, social isolation and poor access to health services appropriate to their needs. The very nature of close quarter living in prisons further increases the risk of transmission of communicable disease within the prison setting.

COVID-19 in the national prison estate

In the last two decades, the proportion of older prisoners has increased significantly. Adult prisoners are at heightened risk of not only contracting COVID-19 due to living in close proximity, but also experiencing complications as a result of pre-existing poor health, particularly in the older age ranges.

In April 2020, modelling conducted by HM Prison and Probation Service (HMPPS) and Public Health England (PHE) suggested that over 2,000 prisoners might die as a result of COVID-19 if no action was taken nationally to reduce contact in prisons (7). To limit the spread of the virus within the prison estate and protect those living and working in these environments, significant restrictions on daily prison life were imposed nationally that had not been seen in England and Wales for many years. These restrictions meant that at the beginning of the pandemic, most adult prisoners were locked in their cells for an average of twenty-two hours a day, seven days a week. Face-to-face visits from family and friends were stopped altogether and opportunities for training, rehabilitation and work experience were suspended indefinitely. While some lockdown measures were relaxed in the wider community during the summer of 2020, most restrictions remained in prisons, meaning that prisoners lacked both interaction with and support from other prisoners, staff and their family and friends.

HMP Erlestoke

Wiltshire is home to HMP Erlestoke, a Category C establishment holding adult male sentenced offenders with an operational capacity of 524 men. Since July 2018, the prison has been dual registered and now also accepts up to thirty young adults. HMP Erlestoke accepts all Category C prisoners, however, offenders are primarily serving sentences of four years or more. The focus of the establishment is to reduce reoffending by preparing offenders for their release through accredited intervention programmes, skill and vocational based training and education in a pro-social environment. Whilst the prison provides health care services, it does not have in-patient facilities.

Throughout 2020, HMP Erlestoke experienced very few cases of COVID-19, however this changed in February and March 2021 when a large outbreak occurred at a time when overall cases were rising both locally and nationally. Managing the outbreak was complex and presented several challenges. In February 2021, not many prisoners or staff had been vaccinated as they were not, at that time, nationally identified as a priority group for receipt of the vaccine. Prisoners were also reluctant to disclose symptoms or get tested, as a positive test resulted in further isolation when they had already been on an enhanced lockdown regime since March 2020.

Wing-based testing was initially undertaken by Public Health England, however the scale of the increase in positive cases meant it was necessary to undertake whole prison testing. As the national testing programme did not permit the deployment of mobile testing units onto prison estates, working closely with colleagues from HMP Erlestoke, the Wiltshire Public Health Team arranged for whole prison testing to be conducted locally to help manage and contain the outbreak.

It was important to provide effective support to the prison, as residents are some of the most vulnerable in our population. While Wiltshire Public Health assisted with testing and outbreak management to protect the physical wellbeing of prisoners, HMP Erlestoke implemented a lockdown library service to help improve mental health. This began in April 2020 and enabled prisoners to request books and films during enhanced lockdown.

References

(7) Ministry of Justice and PHE, 2020, COVID-19 Population management strategy for prisons (opens new window).

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