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Health inequalitiesNov 19, 2021

Physiotherapy services could face a 'backlog' of cases as prisons return to 'business as usual'

Physiotherapists who found their access to prisons was barred during the Covid-19 lockdown and its aftermath could face higher demands as a ‘business as usual’ approach gradually becomes the norm.

That is the conclusion of a Health Foundation working paper, titled Covid-19 and the prison population, which was published this month. It reports that the ‘full lockdown’ that was rapidly implemented in all the 117 prisons in England and Wales from March 2020 led to external visits being stopped and prisoners being isolated in their cells for 23 hours a day.

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Physiotherapy services are likely to face a 'backlog' of prisoners with health issues


Addressing health inequalities

Health inequalities are rife among prisoners, who face an increased exposure to disease and find it hard to access health services and support, the paper stresses.

‘Prison is increasingly considered one of the place-based social institutions that determines health status and health outcomes,’ it notes.

Measures intended to lessen the spread of Covid-19 had some unintended negative consequences, the paper suggests: 'The prolonged prison lockdown affected prisoners’ ability to maintain their own physical health. Opportunities to exercise and eat healthily were limited, leading to inactivity, reported weight gain and low mood, and exacerbating existing health conditions.'

Written by a 11-person team led by public health consultant Chantal Edge, the paper points out that prisoners are generally taken to hospitals for secondary-care appointments.

As these services [including physiotherapy] become fully restored, with a more 'business as usual' approach implemented, they are likely to see increased demand, to address the backlog [Chantal Edge et al.]

Physiotherapy in-reach services

However, it notes that some in-reach services – such as physiotherapy, optometry and sexual health – have traditionally been offered in prisons.

‘During the pandemic, some of these had difficulty entering prisons due to infection-control restrictions and were able to provide assessments only remotely, if at all.

‘As these services become fully restored, with a more “business as usual” approach implemented, they are likely to see increased demand, to address the backlog.'

The Health Foundation paper points out that community-based services could find themselves picking up the slack once prisoners whose needs have not been met during their incarceration are released.

Telemedicine and other technological advances

Before the onset of the pandemic, the use of telemedicine – primarily video-based health consultations – in English prisons was confined to ‘small pockets of innovative practice’. But the pandemic prompted NHS England, NHS Improvement, and the prisons and probation service to provide software and equipment for video consultations.

‘This offered opportunities to make efficiencies and improvements to the way medication was delivered and respond to acute incidents. These changes are likely to affect the way some health care services are delivered permanently, providing an alternative way to offset security and care in prisons, with benefits felt beyond the pandemic,’ the paper notes.

Other technological advances included supplying prisoners with continued positive airway pressure machines and pulse oximeters'

The paper forms part of the Health Foundation’s Covid-19 impact inquiry, which focuses on the factors that contributed to the death toll associated with the pandemic.

The first author Chantal Edge is a consultant in public health and a specialist clinical adviser at NHS England/Improvement, and the UK Health Security Agency. Dr Edge led a team of 10 other experts in the field.

To download a copy of the working paper, titled Covid-19 and the prison population, visit: https://www.health.org.uk/publications/covid-19-and-the-prison-population

It was produced as part of the Health Foundation’s Covid-19 impact inquiry. For more information about this work, visit: https://www.health.org.uk/what-we-do/a-healthier-uk-population/mobilising-action-for-healthy-lives/covid-19-impact-inquiry

Author: Ian A McMillan
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