Families Outside response to national COVID 19 vaccination accessibility survey

Families Outside has responded today to the COVID 19 vaccination accessibility survey run by Voluntary Health Scotland, to help ensure equitable distribution of the COVID-19 vaccine.

Families Outside has an interest in ensuring that people involved in the criminal justice system, people in prison, and those recently released from prison and their families do not face barriers to accessing the COVID 19 vaccination programme.

People in Scotland who are involved in the criminal justice system and those making up the prison population face well-documented health inequalities and barriers to accessing all types of healthcare. The prevalence of physical and mental health conditions among the prison population is high, especially when compared to the non-prison population. According to Fitzpatrick and Bramley (2019), offending is likely to co-occur with at least one other severe and multiple disadvantage (SMD), including homelessness, substance dependency, mental health issues, and domestic violence and abuse. In particular, over a year, 5,700 people in Scotland suffer simultaneously from 3 forms of SMD (offending, homelessness, and substance misuse). Whilst data suggests a correlation between both deprivation and vulnerability to severe illness with COVID-19 as well as deprivation and vaccine hesitancy, homelessness, offending, and substance misuse are all likely to present barriers to accessing the vaccine programme.

Many people face barriers to registering with a GP when they leave prison. At present, Families Outside understands that Health Boards are contacting those eligible for the vaccine directly by letter or phone to make an appointment. However, access to a GP has never been more difficult. A person leaving prison is not able to walk in to a GP practice to receive the necessary forms, and in a number of practices across Scotland, there are restrictions on the number of new patients GP practices are accepting. If a Health Board does not have personal details of someone recently released from prison, this will hinder access to the vaccine.

Families Outside also understands that an on-line booking system is in development, which will be rolled out after the JCVI 9 priority groups have received their vaccination. While this is understandable, it will move responsibility to booking an appointment on to the individual. Building on our points above, families affected by imprisonment already face well-documented health inequalities for a number of reasons. Lack of access to a digital device, poor language skills, mental ill health, substance misuse, and domestic violence could result in poor uptake of the vaccine amongst families affected by imprisonment.

Families Outside advocate rolling out the vaccine to both prison staff and the prison population at scale in recognition of

  • ┬Ěthe health inequalities experienced by this demographic
  • the communal institutional environment in which prisoners are held making outbreaks difficult to contain
  • the inevitable exposure of prison staff, whilst working, to COVID-positive prisoners in order to meet their day-to-day basic needs and maintain security and order
  • people coming out of prison back to communities with high levels of vaccine hesitancy are in a position to positively impact peer views on vaccine take-up.

Families Outside acknowledges that current resources are being targeted towards the JCVI 9 priority groups. However, in the next phase we would support both the prison population and prison staff receiving the vaccine quickly. We would also suggest that it is more efficient and cost-effective to

vaccinate the entire prison population and staff at the same time rather than the possible further segmentation by age of people under 50. This would also have a positive impact to support wider health and mental wellbeing of people in prison, which has been severely impacted as a result of infection control measures.

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