Prisoners cannot wait: acting now will save lives

Yesterday, the Scottish Government has released a Covid-19 related Bill. Amongst other issues, the Bill set out (inSchedule 4, Part 9, subsection 4) provisional rules on the early release of prisoners in Scotland and was debated in Parliament yesterday.

Within the Bill it stated that Ministers should be able to sanction the early release of people residing in prison if they deem it a “necessary and proportionate” action to help mitigate current or future impacts of the coronavirus. Early release would be enacted, if necessary, to firstly: protect the security and running of prisons and secondly: safeguard the health, safety, and welfare of people living and working in the prisons.

After the debate on this legislation, SPARC are stunned that Government have refused to make prisoners a priority and to treat them as equal human beings. The necessary legislation required to reduce the prison population and save lives is still seen as ‘a measure of last resort’, revealing the limits and meaning of justice in Scotland.

From our understanding, it’ll be three weeks at the earliest before the necessary secondary legislation to release prisoners can be considered. Over the last three weeks, the UK went from 8 deaths to 2,352, and there have been dramatic changes in public life. To leave prisoners waiting this long is to ignore everything we now know about this virus. This inaction verges on being reckless: It will mean a death sentence for some.

This also ignores the fact that viruses spread more rapidly in confined environments. This means that prisoners and prison staff health is being put at risk if we do not reduce the levels of incarceration in Scotland. For justice to mean anything the release of prisoners needs immediate action.

The Government noted that these are “extraordinary measures required to respond to an emergency situation” and explicitly stated, within the policy memorandum, that new legislation was necessary because existing mechanisms for releasing people in custody are not appropriate. However, we would argue that there are still existing options which need to be considered and acted upon now. For example, current legislations state that bail can currently be granted in Scotland for any remand prisoner at any stage pre-trial without the need for additional legislation. Given that remand prisoners account for almost 20% of the prison population and 54% of these individuals are being held for non-violent offences we urge the government to begin looking at their release.

We also know that despite overly cautious and risk averse guidance to the use of Home Detention Curfew (HDC) this is an option that would allow SG to act now. The Scottish Government should be doing everything in their power to increase its use. We know that over 20,000 people have been released on HDC licences since 2006 with a successful completion rate of around 80%. In this current time of crisis, that this mechanism has not been expanded is inexplicable.

The Scottish Government has also rejected the use of temporary release on the grounds that people liberated in this way cannot access the benefits system. This is undoubtedly an important point: releasing people with no means to support themselves is not in their interests, or in the interests of their families and communities. Making early release contingent on family support risks placing considerable pressure on families at home. However, Castle Huntly, Scotland’s only open prison, has a capacity of 285 men. The majority of these will already be receiving regular home leave, they will have been thoroughly risk assessed and have ongoing social work involvement. SPARC advocate a targeted use of resources to extend these periods of release of people in Castle Huntly, which will free up desperately required space inside the prison system.

This is urgent. But what are the barriers to making the necessary releases possible? The only risk being accounted for right now is the risk to the public and community from crime. The Scottish Government must move their thinking forward, to see people in prison not only in terms of the risk they create for others, but the risk they are forced into because of Scotland’s overcrowded prison conditions. People cannot wait, acting now will save lives.


SPARC statement on COVID 19 – Friday 27 March 2020

  1. SPARC is deeply troubled about the lack of speed and clarity about the response to Covid 19 in Scottish prisons. While the pandemic is evolving rapidly, we remain concerned that the response from the SPS and Scottish Government has not. There appears to have been little meaningful progress since our statement of Tuesday 17th March, where we outlined serious concerns and made a number of urgent recommendations, not least the call for publication of a clear, detailed plan.
  1. We would view a satisfactory plan as one that includes: information for families about testing, isolation protocols for the unwell (including how family can receive updates on those isolated); details of modes and frequency of maintaining family contact; appropriate and specific policies applying to different prisons given distinct populations (such as much older age groups in Glenochil, mixed gender and ages in other prisons); accessible and accurate information about crowding and issues in establishments, such as the availability of phones, soap, hand sanitiser and other toiletries for all prisoners regardless of income.
  1. The need for action could not be more urgent given the current crisis inside Scottish prisons, which provides a perfect environment for the virus to spread. Prisons are overcrowded, and prison numbers significantly above the estate’s operational capacity. Many people held in Scottish prisons suffer poor health, and are consequently more likely to be vulnerable to the virus. Yet, there is little space to self-isolate, as many prisoners are already sharing a cell.
  1. Further, self-isolating in a prison environment may be detrimental to mental health, which is already a particular concern in prison, as we know contact with family and other supportive individuals can protect against the risk of suicide. This point has been unaddressed in official responses to date.
  1. On Monday 23rd, it was announced that visits would be suspended from the following day. However, other than publicising that a help-line for families would be available from Friday 26th, there has been no information shared with families as to how they can keep in contact. On Tuesday 24th, the Justice Secretary noted that family contact is “crucial” and acknowledged that: “We know that technology exists elsewhere in relation to mobile phones that have restricted call lists, and we are looking at other measures such as videoconferencing.” Yet despite this acknowledgement that the technology exists, there has as yet been no action here. Meaningful measures to support family contact must be introduced urgently.
  1. There are short-term low risk prisoners, as well as long-term prisoners at the end of their sentence, all of whom could be released on HDC. And this would free up space needed to reduce the harm caused by Covid 19 inside Scottish prisons. Both prison staff and families of prisoners have contacted SPARC to express their distress at the current handling of the situation. The Scottish government need to make the brave but also the socially just decision to release these prisoners. A prison sentence should not be a death sentence.

Too late, too vague – where is the detailed transparent COVID-19 plan for Scottish prisons? A disaster waiting to happen

Yesterday it was confirmed that two people in prison at HMP Kilmarnock were in self-isolation with the first suspected cases of Coronavirus in prisons in Scotland. Meanwhile, down south a prison officer at HMP High Down was diagnosed with the virus. This is terrifying for those who are trapped inside and for their families and friends outside.

A late plan, and poor communication for prisoners and their families, staff or the public. For those watching the rapid spread of the coronavirus, both from within and outwith prison walls, this moment was inevitable. However, despite its clear inevitability, there is currently no clear transparent plan in place from the Scottish government regarding how people living and working in prison will be protected. Until today there had been a deafening silence from the Scottish Prison Service both publicly and internally. Reports from those inside suggest that information for both people living and working in prison has been very poor, which adds to the fear. When a statement was finally released today, this offered only vague assurances, which fail to address the specifics of the prison setting.

Scottish prisons are among the most crowded, creating ‘perfect’ conditions for rapid spread of Covid-19. At 150 people per 100,000 of the population, Scotland’s incarceration rate is one of the highest in Europe. As of the 13th March there were 8,094 people in Scottish prisons (SPS, 2020), significantly higher than the operational capacity of 7,676 (Audit Scotland, 2019). When the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT, 2019) visited Scottish prisons in 2018, they found that people living in Barlinnie had less then 3m2 each of living space, and in HMP Grampian mattresses had been placed on the floors under bunk beds, to turn double cells into triple occupancy. Conditions in the cells in Barlinnie, especially in the Admissions Unit, were described as dirty and cramped (pp.30-32).

Those in prison are especially at risk of worse outcomes of Covid-19. It is well-established that people in prison experience poorer physical health than the general population. The UK government guidance published on 16th March identifies a number of ‘vulnerable’ groups, and people in prison find themselves over-represented within some of these groups. Data from 2007 identified 12% of people in Scottish prisons as having asthma, compared to 5% of the general population (Graham, 2007). The same report estimates a high proportion of Hepatitis C among people in prison (20%), and a higher rate of liver problems due to alcohol use. While HMP Low Moss yesterday asked volunteers not to come into the prison for at least three weeks, in others it appears to have been business as usual, with education and other events which involve the flow of people back and forth through the prison gates continuing as normal.

Self-isolating is difficult and particularly dangerous for those in prison. The physical and emotional toll of isolation within prison is well-established, so the Government advice given to those in the community presents risks to those in prison. People in prison are at increased risk of death from suicide, and there have been a number of high profile deaths of young people in Scottish prisons in recent years. Recent research emphasised that less isolation and more access to family were crucial for the wellbeing of young people in custody, but both of these are likely to be highly limited in the current context (Armstrong and McGhee, 2019). Without any clear strategies for managing the pandemic in prison, the default approach likely is to just bang up people in their cells.

Reducing visits risks prison order. With the likelihood of reduced or cancelled visits, this is hugely concerning and dangerous. Family visits are precious, and both the direct and indirect impact of limiting these can be significant. In Italy, when significant restrictions were placed on visits as part of measures to limit the spread of coronavirus, this contributed to riots within the prisons, which resulted in the death of 12 people (The Independent, 13 March 2020). The risk of instability inside the prison is yet another concern for those in prison and their families.

Staffing levels and sick leave in Scottish prisons are critical. As well as direct measures taken by the prison to limit these, there will also be knock-on effects of staff shortages as a result of self-isolation and sickness. SPS is not well-equipped to manage this, as sickness absence has already been identified by Audit Scotland as one of key pressures placing the estate at increasing risk of failure. There has been a rise in sickness absence of over 60% in the last three years (Audit Scotland, 2019), with 40,522 working days lost to sickness between 1 January and 24 July 2019 alone (SPS, 2019).

Without action, court delays could increase the time people spend in prison. There are currently well over a thousand (1,317) untried people in Scottish prisons, with another 311 awaiting sentence. These people ‘on remand’ in prison are rightly concerned that any court closures will mean substantial delays to their cases, which could significantly extend the period of time that they spend in prison, despite not having been convicted or sentenced. As well as those on remand, there are a number of people in Scottish prisons who are awaiting removal or deportation. At end of December 2019, there were 42 people being held in Dungavel immigration removal centre (SDV, 2020). These people are not serving a sentence for any crime.

We are seeing now the cost of high prison populations. Now is the time to urgently reduce the prison population. In Ireland, we understand that consideration is being given to early release for some groups (RTE, 13th March 2020). Similar rumours have also emerged about England and Wales, with the head of the Prison Officers’ Association reported by Sky News as saying that everything was on the table (Sky News, 15th March 2020). It has been reported by the BBC today that in England and Wales, the Home Detention Curfew scheme will be extended so that people can spend the final six months of the custody part of their sentence in the community on tag (up from the current arrangements of four and a half months).

The SPS and Scottish Government need to offer clear, effective and supportive positions, and SPARC demands, at a minimum:

A clear and detailed statement from the SPS on its Covid-19 policy, available to the public and communicated immediately to all staff and all imprisoned people and their families.

Urgent and maximum expansion of HDC release for prisoners including automatic HDC for anyone in the last six months of their sentence, as is under consideration in England and Wales.

Presumption of bail for all those accused; immediate release of those on remand as default excepting only those charged with murder, rape and domestic abuse.

Immigration authorities and the UK government should exercise powers to release those in immigration detention, and support should be provided for those with nowhere to go.

Postponement of all community sentences, following the lead of the Netherlands to modify community sentences.

End the mobile phone ban now – emergency suspension of criminal prohibition on phones, and until this is implemented, prisoners should be given unlimited credit to make phone calls to loved ones.

No questions asked policy and immediate access for prisoners to speak by phone to qualified mental health professional or service.

Acquire and make use of iPads and tablets for video visits in all prisons and for all prisoners.

Free stamps and stationery provided to prisoners and families.

Continued access to exercise and outdoors for all those in prison.

A clear protocol for emergency medical attention for those unwell in prison.

Direct involvement of prisoners co-creating strategies to support wellbeing – this may involve letting prisoners suggest ideas, self-organise their own staggered access to activities and association.


Health Inequalities in Scottish Prisons

SPARC recently responded to the Health and Sport Committee’s call for responses to contribute to their current inquiry into healthcare provision in Scotland.

  1. What do you consider are the current pressures on health and social care provision in prisons?
  2. How well do you consider that these pressures have been responded to?

In general, the move from SPS healthcare provision to the NHS has been a positive development as it moves Scotland towards a vision of the person imprisoned as a full and equal member of Scottish society, with the same rights to care as anyone else. However, evidence to date suggests that in practice this commitment has not been realised. Here we refer to the Royal College of Nursing Scotland’s comprehensive review of this transfer Five Years On (2016). We are sure the Committee is fully aware of this report but we wish to be added to the voices of those seeking for its powerful findings to be taken into account. We find its method and approach robust in flagging up key issues in provision of health and social care for those in prison.

The key pressures this report identifies, and which is consistent with our own experiences and awareness of the research relate to:

  • An inability to adopt a prevention focus due to extensive staff time devoted to medication management of those in prison;
  • Lack of continuity in care before, during, and following a prison sentence impacting on the cost effectiveness and efficiency of health care delivery in prison;
  • Relatedly, this finding suggests more than coordination issues between SPS and NHS staff but a more fundamental need to understand and address possible organisational culture differences between health and punishment sectors – from experience we have seen ‘prison security’ and prison personnel staffing issues affect medical delivery (for example, the timings of medication rounds is a direct function of prison and NHS staff shift times and prisoners may receive an evening dose at 4 in the afternoon on weekends, when prison staff levels means after this many are locked in cells). In addition, NHS staff should never, under any circumstances, be required to provide medical interventions to primarily support SPS security and control, this violates the principles of equitable medical care and erodes trust between prisoners and medical staff. Nor should medical staff prescriptions or treatment plans be amended post hoc by SPS. Instances of both have been seen or experienced by members of this group;
  • Finally, staffing levels and pressure generally on staff emerged as a consistent finding and one which requires consideration to maximise optimising health care, outcomes, prevention focus and effectiveness and efficiency issues; however, a core concern of our collective is to ensure that problems within the prison system do not become arguments for expanding the prison system or expanding the prison’s budget compared to other settings where health and other outcomes (i.e. the community) are better supported. Hence, we express concern about the repeated use in the RCNS report of the idea that ‘prison offers the best chance of catching people’ and addressing their health needs. Prison is never the best place to work with people, all other factors remaining equal.
  • Lack of data and understanding of health issues and provision gaps: The RCN wrote that: ‘It is not possible to evidence the impact that the transfer has made on tackling health inequalities and addressing the health care needs of people in prison. This is because there are still some gaps in our understanding of people’s health needs in the criminal justice system and a lack of national reporting and quality outcomes data for prison health care’. An annual prison health report on the existing health inequalities, systemic improvements and kinds of provisions that make up the NHS work, e.g. budgets, would be useful to ensure continual prioritisation and awareness of the issues. The Government needs also to demonstrate more explicitly how prison healthcare is integrated in their national vision of stronger, safer, fairer and healthier Scotland. Therefore, prison healthcare must be recognised as a distinct area of service provision within the long-term strategic plans for Scottish health. Finally, the lack of data reflects wider gaps and progressive loss in knowledge: for example, the most recent published statistics on the prison population date from 2013-14 (with significant disinvestment of resource in producing official statistics on prison populations in Scotland in the past 10-15 years). Effective policy making and transparent democracies require clear and open understandings of who is imprisoned, where, why and for how long. We are concerned that prison healthcare will fall under the same opaque reportage and loss of public oversight.

The fact that 66 deaths in prison custody since 2013 remain undetermined (SPS website) receives far too little Government and policy scrutiny despite extensive recent media coverage:

Staffing and other resource issues likely play into this, but we challenge those concerned with the health and social care of those in prison to prioritise explaining, resolving and providing closure to families of people who die in state custody.

We are not aware of national reporting on prison healthcare and would welcome some mechanism for this. However, we also worry about the emphasis in the RCN report on inadequate assessment of health needs. While we welcome better understanding of these needs, it is important to set this in the context of extensive, almost relentless and often dehumanising assessment processes in prison where people are regularly required to recount multiple times issues of deep personal concern such as personal traumas, drug and alcohol issues, literacy issues, abuse issues and more. We urge a focus on care, prevention and positive, supportive relationships with professionals over endless inquiries (often in front of multiple strangers) in order to achieve perfect recordkeeping.

  1. To what extent do you believe that health inequalities are/could be addressed in the prison healthcare system?
  2. What are the current barriers to using the prison healthcare system/ improve the health outcomes of the prison population?

Health inequalities cannot be addressed effectively when health is viewed as a factor in reduced offending: The new NHS model of prison healthcare has sometimes been presented and justified as an improved form of medical provision primarily because it will help with reducing reoffending[1]. This directly undermines an agenda of reducing health inequalities because it implicitly values NHS provision in prison mainly in terms of its contribution to crime reduction. Healthcare, whether in prison or anywhere else, should be discussed only in terms of treating people who are in need, supporting citizens and improving health and wellbeing in Scotland in general. Prison healthcare should be motivated by the same ethos and vision as the recent National Clinical Strategy for Scotland which stated that: ‘Quality must be the primary concern – all developments should seek to ensure that there is enhancement of patient safety, clinical effectiveness and a person-centred approach to care’[2]. A key challenge to rectifying health inequalities, therefore, is the dominant ethos of the prison system in which all services delivered in this setting are assessed instrumentally in terms of reoffending outcome measures.

Health inequalities cannot be effectively addressed without recognising the harms of prison itself: Prisons, no matter how well they are run or designed, are innately damaging. Reviews of research suggest that time in prison is itself damaging to cognitive function[3]. Research on Scotland by Prof Lesley Graham has further established that those who are in prison have higher mortality rates, of two to more nearly six times higher, than those in the general population, even when controlling for social deprivation[4]. Such work establishes, unsurprisingly, that confinement of human beings is deeply damaging, and this damage should be carefully considered. A discourse has emerged of talking about people in prison as having lower cognitive function, greater health needs, more chaotic lives and so on; and while this may have some evidential support, it diminishes those in prison as a damaged ‘them’ and obscures the extent to which being in prison itself is a health risk and a mortality risk.

Importantly, this risk to health and wellbeing extend beyond the person in custody.  Drawing on large-scale US survey data, Wakefield and Wildeman found that the prison has become an institution which creates and reinforces deep social inequalities, increasing the risks of poor mental health, homelessness and infant mortality for children of an incarcerated parent[5].  While imprisonment rates in Scotland are not comparable with America’s “prison boom”, it is nonetheless clear that supporting a person in custody requires large investments of time, emotional support and financial resources from some of Scotland’s poorest families and communities.  Positioning families as a source of support to render prisons more “survivable” is therefore at odds with adopting a prevention focus or reducing wider health inequalities.

Health inequalities, therefore, cannot be addressed effectively until the harms of prison are addressed, and this includes taking into account Scotland’s high imprisonment rates in policy making and reform. This point also emphasises why we should never talk about prison as ‘being the best chance’ to deliver any public service. If the prison system operated adopted a Hippocratic oath, we would have strong doubts that it is achieving this.

[1] E.g. Michael Matheson: ‘However, factors outside of the control of the criminal justice system affect reoffending. The work of this group has found that reoffending is a complex social issue and there are well established links between persistent offending, poverty, homelessness, addiction and mental illness. When transitioning from custody to the community, gaps in access to vital support services and basic needs can hamper attempts to desist from offending’

[2] National Clinical Strategy for Scotland, February 2016:2

[3] Meijers J, Harte JM, Jonker FA and Meynen G (2015). Prison brain? Executive dysfunction in prisoners. Front. Psychol. 6:43. doi: 10.3389/fpsyg.2015.00043

[4]Justice Committee, Transfer of prison healthcare to the NHS Written, submission from Dr Lesley Graham:

[5] Wakefield, S. and Wildeman, C. 2014 Children of the prison boom: Mass incarceration and the future of American inequality. New York, NY: Oxford University Press