Prisons In England Research Articles

Antibiotic prescribing in health and justice settings (HJS)-surveillance and opportunities for quality improvement

Abstract Introduction Improving surveillance of antibiotic prescribing and reducing health inequalities in antimicrobial resistance (AMR) are priorities in the new 5 year AMR national action plan (2024-2029)1. People in contact with the justice system are one of the inclusion groups in the CORE20plus5, a national NHE England approach to support reduction of health inequalities.2 Aim This project aimed to collate and analyse all antibiotic prescribing data from English prisons in order to identify opportunities for quality improvement. Method This project analysed antibiotic prescribing data from September 2022 to current date for the first time in HJS from the IT system used in all prisons in England. No ethical approval is required as surveillance is of anonymised data only. Data was broken down by age band (18 and under, 19-49, 50 and over), category of prison, region, ICB, individual prison and antibiotic type. The dashboard allows benchmarking across sites and comparison with primary care, as prisoners in HJS are considered to have similar infections to primary care patients. Results The majority of prescribing is in male prisoners, reflecting the male/female population split. The most frequently prescribed antibiotics are those used for: skin and soft tissue (including acne), respiratory tract, dental and urinary tract infections. A number of focus areas for quality improvement have been identified, including: Broad spectrum antibiotics (Cephalosporins, Co-amoxiclav and Quinolones), target of <10% total antibiotic prescribing in primary care, in HJS, currently 11%. Appropriate quinolone prescribing is a target in all settings due to recent MHRA alert3. Acne prescribing represents a significant proportion of antibiotic prescribing in HJS. Lymecycline 12%, whereas in primary care <3%. Duration of Antibiotic Courses: In primary care there is a medicines optimisation opportunity ambition to achieve 75% prescribing amoxicillin 500mg as 5 day duration. In HJS only 27% is for 5 days. When prescribing 100mg doxycycline for respiratory infections, NICE guidance recommends a 5 day course, but in HJS only 3% is prescribed as a 5 day course. For UTI in female prisons, nitrofurantoin 100mg MR is most commonly prescribed, NICE guidance for UTI in women is for 3 days; 47% in HJS are for 3 days, but 35% are 7 day courses. Discussion and Conclusion This dashboard provides insight into antibiotic prescribing data allowing opportunities for quality improvement opportunities to be identified and antimicrobial stewardship interventions to be evaluated. This work will progress to tackle the focus areas identified. Next steps are to work with antibiotic champions from HJS to co-produce intervention plans, share patient safety messages, trial available resources, rollout interventions and monitor impact via the dashboard. Limitations Indications are not available from the data but extrapolated from the antibiotic prescribed. The dashboard is currently an excel spreadsheet in NHSE. It will be moved to a platform that enables access by individual prisons.

The inefficiency of centralised control and political short-termism: the case of the Prison Service in England and Wales

A paradox of the New Public Management reform – an influential school of thought in the management of public services in some countries – is that, despite its rhetoric of discretion for public managers, governments frequently reassert direct input controls at the expense of managerial freedoms to deliver – and be held accountable for – agreed output/outcome objectives. The existing literature explains this by highlighting elite incentive structures and institutional norms, but often neglects the wider implications for public managers beyond the centre. Addressing this gap, we trace the effects of public spending control from allocation to delivery through a detailed case study of prisons in England and Wales. We show how ‘top-down’ public spending control, hyper-centralised governance arrangements and ministerial activism combine to subvert managerial freedom and undermine ongoing service improvement. The overriding importance of year-by-year fiscal performance results in short-term, poorly evaluated decision making and limited capacity for strategic policy implementation. This case points to wider lessons regarding performance budgeting regimes in the UK and elsewhere.

A review of general cognitive-behavioral programs in English and Welsh prisons and probation services: Three decades of quasi-experimental evaluations.

For over 30 years, general cognitive-behavioral programs have contributed to the rehabilitation services offered within His Majesty's Prison and Probation Service in England and Wales. There is an extensive body of international evidence that demonstrates the effectiveness of such interventions as a correctional strategy. However, there is widespread variability of program effects associated with the standards of implementation. Over the last 3 decades, British researchers have produced a steady output of quasi-experimental program evaluations that have contributed to the evidence base. The most recent additions are some of the largest and most rigorous available worldwide. This review documents those evaluations and provides a meta-analysis that statistically aggregates the effects of programs delivered in His Majesty's prisons in England and Wales. We suggest there is sufficient evidence from evaluations of acceptable scientific rigor to conclude that general cognitive-behavioral programs delivered in prisons during the last decade and a half (circa 2006 to 2019) have had a small statistically significant mean reductive effect on general reoffending (odds ratio = 0.91). Program characteristics and implementation factors, including program dose, the scale of service delivery and program integrity, are discussed as possible factors associated with the size of the effect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Peer mentoring and identity transformation in a women’s prison

Purpose This study examined the impact of peer mentoring on identity transformation amongst women in prison, exploring how peer mentoring roles develop non-offender identities, contributing to the desistance process. Design/methodology/approach A qualitative, interpretative approach was adopted. The research was undertaken at a female prison in England and Wales. Data was collected through semi-structured interviews with peer mentors, mentees, project workers and prison officers, alongside focus groups. Thematic analysis was used to analyse the findings. Findings Being a peer mentor contributes positively to identity transformation for women in prison, fostering a legitimate, non-offender identity critical to the desistance process. Mentors view their role as a desistance signal through their interactions with prison staff. However, it can lead to role conflict and tension with other women in prison and prison staff. Research limitations/implications Future studies should consider longitudinal approaches to capture the long-term effects of peer mentoring upon desistance. Practical implications Recommendations include leveraging peer mentoring as a rehabilitative intervention, providing ongoing support for mentors and educating prison staff on programme benefits to foster a supportive environment. Social implications Enhancing peer mentoring programmes can improve the well-being of women in prison and support their reintegration into society. Originality/value This study examined identity transformation in female peer mentors in prison through the lens of social identity and group membership. To the author’s knowledge, no previous studies have focused centrally on identity or applied social identity theory to explore the psychological mechanisms behind these transformations.

Short report: Prison-reported rates of autism in female prisons in England

Short report: Prison-reported rates of autism in female prisons in England

The ubiquity of gender and the hiddenness of agency: looking inside women’s prisons in England

In the United Kingdom (UK), individuals in women’s prison account for only 4% of the total prison population. Existing research stresses the detrimental consequences of institutionalisation that, in female prison spaces, seems to employ femininity as a primary mode of social control. Through document analysis, this study investigates 75 governmental and non-governmental documents related to women’s prisons in England, where most UK women’s prisons are located, to identify recurring themes associated with women’s imprisonment. The two themes that emerged point to, on the one hand, the ubiquity of binary gender differences, through which healthcare, education and vocational opportunities reproduce notions of subordinate femininity, and, on the other hand, the hiddenness of agency, as prisoners’ autonomy over their body and their space is concealed by the institution to ensure their docility. Although geographically specific, the results of this study contribute to existing criminological research on women’s prisons by emphasising how the institutional refeminisation and the responsibilising agenda that permeate female prison spaces normalise a unidimensional display of femininity, one that is subjugated, passive and bound to the domestic. The consequences of this can have detrimental effects not only for gender non-conforming individuals, but for all those who experience imprisonment.

The experience of stress, coping and support for prison officer negotiators in His Majesty’s Prison and Probation Service

Purpose Negotiation is an established strategy used by the police and His Majesty’s Prison and Probation Service to manage serious incidents. Whilst the literature acknowledges the role of the negotiator to be stressful, little is known about the experience of stress and the coping strategies used by negotiators when undertaking this role. This is particuarly true for negotiators who work in prisons. As such, the purpose of this study was to explore the experience of negotiators working in a prison setting. Design/methodology/approach The study adopted a qualitative methodology. Semi-structured interviews were conducted with 14 prison officer negotiators based in public sector prisons in the North West of England. The data were analysed using thematic analysis. Findings Four overarching themes were identified relating to stressors; the experience of stress; use of coping strategies; and use of support. An underlying theme was identified relating to negotiating within the structure of a prison regime. Practical implications People involved in the management of serious incidents should be familiar with the negotiator role. Debriefing negotiators after a lone deployment and offering support to negotiators in the days following an incident is critical for staff well-being. Further, record keeping from the perspective of the negotiator should become formalised. Originality/value This paper contributes new insights into the management of serious incidents and the negotiator experience in prisons in England and Wales.

Prisoner Health and Well-Being in Historical Perspective, 1850–1900: Exploring Experiences of Illness and Disability in the Victorian Convict System

Using historical and archival methodological approaches, this article provides an interdisciplinary empirical study of health experiences of prisoners in the Victorian convict prison in England and Wales. It explores the challenges of doing historical criminological work on prisoner health and disability. The article examines the health of long-term prisoners, those serving sentences of penal servitude and their interactions and treatment by the Prison Medical Officers in the system. Reflecting society outside, the prison population was drawn from populations that had experienced childhood illness, workplace accidents and war and therefore had to accommodate those suffering from both short- and long-term health issues. Using historical documentation and case studies of individual prisoners, this article highlights not only the deep scepticism the system had for those they saw as ‘malingerers’, but also the recognition that some people could not endure the full force of the prison labour regime.

Healthcare governance in prisons in England: prisoners’ experiences of changes over time

ABSTRACT According to international law, prisoners should have access to healthcare on an equivalent basis to the rest of the population, and the UK Government has stated its commitment to such equivalence. Healthcare provision in English prisons has seen several reorganisations, notably in 2006 and 2013, with the stated intentions of improving healthcare provision in prisons. This article focuses on prisoners’ reported experiences over the periods of changes in healthcare governance, with the aim of identifying whether there are improvements from their perspectives. Survey data from a sample of prisoners has been collected by HM Inspectorate of Prisons for over 20 years, and these data have been used for secondary analysis of prisoners’ health needs and experiences of healthcare in English prisons. Despite the reorganisations of healthcare governance, the trends from 2003 to 2019 are of increasing health needs of prisoners and decreasing initial access, ongoing access, and quality of healthcare provision. There is little indication of any improvements experienced by prisoners from the 2006 or 2013 reorganisations. Prisoners are widely recognised as having distinct healthcare needs, but the data analysis reveals demographic differences in health needs and health access within the prison population, and an overall decline in quality and accessibility of healthcare provision in English prisons.

Therapeutic gardening in English prisons post-pandemic: implications for health and wellbeing

PurposeGreener on the Outside for Prisons (GOOP) is a therapeutic horticulture programme targeting the high levels of complex health and social care needs in prisons in England. The COVID-19 pandemic and resulting lockdowns led to unprecedented disruption in prisons in England. This paper examines the experiences of prisoners both during and post-lockdowns in four prisons, to understand the effects of participation in GOOP on health and wellbeing after the disruption of restrictions, and identify implications for developing this programme further.Design/methodology/approachThe paper is based on original qualitative data gathered from in-depth narrative-based interviews and focus groups with prisoners and staff in four English prisons. Audio data was transcribed and subject to a thematic analysis, drawing from a realist-informed lens.FindingsThematic analysis revealed five key themes: reimagining the GOOP context; increasing empathy between participants; building sense of coherence; reconnecting with nature and a joined-up connection with provider services. The main arguments centre on horticulture in prisons remaining under-utilised as a means of promoting good health and wellbeing, although there is enthusiasm from staff to provide green spaces for the most vulnerable prisoners and develop a range of mechanisms to connect people in prison with nature.Originality/valueThis paper focuses on new knowledge arising from an unprecedented situation in English prisons, from key stakeholders on the frontline of garden activities. Accounts demonstrate the extent of the health and wellbeing benefits of participation in such activities in this challenging environment, which has implications for practice for prisons more widely.

Cancer incidence, treatment, and survival in the prison population compared with the general population in England: a population-based, matched cohort study

The growing and ageing prison population in England makes accurate cancer data of increasing importance for prison health policies. This study aimed to compare cancer incidence, treatment, and survival between patients diagnosed in prison and the general population. In this population-based, matched cohort study, we used cancer registration data from the National Cancer Registration and Analysis Service in England to identify primary invasive cancers and cervical cancers in situ diagnosed in adults (aged ≥18 years) in the prison and general populations between Jan 1, 1998, and Dec 31, 2017. Ministry of Justice and Office for National Statistics population data for England were used to calculate age-standardised incidence rates (ASIR) per year and age-standardised incidence rate ratios (ASIRR) for the 20-year period. Patients diagnosed with primary invasive cancers (ie, excluding cervical cancers in situ) in prison between Jan 1, 2012, and Dec 31, 2017 were matched to individuals from the general population and linked to hospital and treatment datasets. Matching was done in a 1:5 ratio according to 5-year age group, gender, diagnosis year, cancer site, and disease stage. Our primary objectives were to compare the incidence of cancer (1998-2017); the receipt of treatment with curative intent (2012-17 matched cohort), using logistic regression adjusted for matching variables (excluding cancer site) and route to diagnosis; and overall survival following cancer diagnosis (2012-17 matched cohort), using a Cox proportional hazards model adjusted for matching variables (excluding cancer site) and route to diagnosis, with stratification for the receipt of any treatment with curative intent. We identified 2015 incident cancers among 1964 adults (1556 [77·2%] men and 459 [22·8%] women) in English prisons in the 20-year period up to Dec 31, 2017. The ASIR for cancer for men in prison was initially lower than for men in the general population (in 1998, ASIR 119·33 per 100 000 person-years [95% CI 48·59-219·16] vs 746·97 per 100 000 person-years [742·31-751·66]), but increased to a similar level towards the end of the study period (in 2017, 856·85 per 100 000 person-years [675·12-1060·44] vs 788·59 per 100 000 person-years [784·62-792·57]). For women, the invasive cancer incidence rate was low and so ASIR was not reported for this group. Over the 20-year period, the incidence of invasive cancer for men in prison increased (incidence rate ratio per year, 1·05 [95% CI 1·04-1·06], during 1999-2017 compared with 1998). ASIRRs showed that over the 20-year period, overall cancer incidence was lower in men in prison than in men in the general population (ASIRR 0·76 [95% CI 0·73-0·80]). The difference was not statistically significant for women (ASIRR 0·83 [0·68-1·00]). Between Jan 1, 2012, and Dec 31, 2017, patients diagnosed in prison were less likely to undergo curative treatment than matched patients in the general population (274 [32·3%] of 847 patients vs 1728 [41·5%] of 4165; adjusted odds ratio (OR) 0·72 [95% CI 0·60-0·85]). Being diagnosed in prison was associated with a significantly increased risk of death on adjustment for matching variables (347 deaths during 2021·9 person-years in the prison cohort vs 1626 deaths during 10 944·2 person-years in the general population; adjusted HR 1·16 [95% CI 1·03-1·30]); this association was partly explained by stratification by curative treatment and further adjustment for diagnosis route (adjusted HR 1·05 [0·93-1·18]). Cancer incidence increased in people in prisons in England between 1998 and 2017, with patients in prison less likely to receive curative treatments and having lower overall survival than the general population. The association with survival was partly explained by accounting for differences in receipt of curative treatment and adjustment for diagnosis route. Improved routine cancer surveillance is needed to inform prison cancer policies and decrease inequalities for this under-researched population. UK National Institute for Health and Care Research, King's College London, and Strategic Priorities Fund 2019/20 of Research England via the University of Surrey.

‘In This Prison We Have Our Main Meal at 11:30 AM’. The Significance of ‘Time’ For Food Among People Serving Custodial Sentences in England and Wales

In this article, I am thinking through the social life of time for food in prison from a practice theory perspective. I draw upon empirical data from in-depth qualitative interviews with people serving custodial sentences or recently released from prison in England and Wales who have been on placement at a prisoner resettlement charity (RC). These support findings from Her Majesty’s Inspectorate for Prisons report on Life Inside: Food from 2016, and I consider two aspects from the report, (i) an exploration of the standards and conditions in which food is consumed and (ii) the timings of mealtimes. For people in prison, disruptions to the usual rhythms of everyday life, or chrono-normative expectations, serve as stark reminders of a lack of agency and worth. People in prison are forced to adapt and work within temporal spaces that are subject to flux due to the systemic demands of an under-resourced prison system. These constitute a contravention of social and cultural norms and reinforce the notion of the prison as a place of punishment, and degradation. These temporal shifts contribute to the transformation of civilian to prisoner and form part of a process of de-synchronising with life outside.

What is a ‘good enough’ prison? An empirical analysis of key thresholds using prison moral quality data

Performance thresholds and minimum standards in prison have preoccupied policy makers and practitioners alike for some time. These standards are based on widely accepted statements of principle, but benchmarks are rarely set or explored empirically. Nor has there been any attempt to describe or define higher-end thresholds; the point at which outcomes become positive, or stated principles are achieved. In this study, we provide an empirical demonstration of how quality of life thresholds may be determined using data from 518 Measuring the Quality of Prison Life (MQPL) surveys conducted in prisons in England and Wales (2009–2020) and examine their relationship to five violence outcomes: serious prisoner on prisoner assaults, serious assaults on staff, self-harm incidents requiring hospital treatment, self-inflicted deaths, and homicides. The results suggested that thresholds exist for most of the MQPL dimensions. A set of lower ‘unsafe’ and higher ‘minimally safe’ thresholds were produced. We found that the scores of prisons below the lower threshold had a very strong relationship with each of our five serious forms of violence in prison. Similarly, prisons that did not manage to cross the ‘minimally safe’ threshold also had strong relationships with incidents of violence in their prison but were at slightly lower risk of those incidents occurring. Striking differences in mean incidents rates were found when comparing prisons below the lower threshold to prisons above the ‘minimally safe’ threshold. Our findings suggest that to operate a safe enough (and therefore legitimate) prison, a combination of harmony, security and professionalism dimensions above a certain threshold should be achieved.

Service provision for older adults living in prison with dementia/mild cognitive impairment in England and Wales: a national survey

ABSTRACT Older adults are the fastest growing age sub-group in prison. Prison, health and social work staff are required to provide support for complex health and social care issues including Dementia and Mild Cognitive Impairment (MCI). Dementia care for those living in the community is a national priority. There is, however, a lack of empirical evidence regarding service provision for those living in prison. This study was the first national survey of England and Wales to establish current service provision. Questionnaires were distributed to heads of healthcare and governors of all prisons in England and Wales. Our response rate was 85 (78%) for governors and 77 (71%) for healthcare managers. Reported prevalence of dementia/MCI from respondents was well below prevalence estimates from research. Furthermore, only 23 prisons (30%) had routine screening, and the majority reported that they did not have a defined care pathway (53; 69%) for dementia/MCI. Overall, the provision of services for those experiencing symptoms of dementia and MCI in prison is sub-optimal; however, many respondents reported aspirations to enhance services for this group. The forthcoming Ministry of Justice’s national strategy for ageing prisons should include recommended care pathways for dementia and MCI to strive towards equivalence of care to community settings.

Responding to ‘wicked problems’: policy and governance on drug-related deaths in English and Welsh prisons, 2015-2021

BackgroundPrison settings have been neglected in the growing literature on drug-related deaths. This paper explores policy and practice issues regarding the governance of drug-related deaths in prisons in England and Wales from 2015-2021. MethodsThematic documentary analysis was conducted on national level policy documents published between 2015-2021 (e.g. drug strategies, prison policy documents, Her Majesty's Inspectorate of Prisons and Prison and Probation Ombudsman (PPO) annual reports and guidance for staff). At the local (prison) level, all of the PPO fatal investigation reports and their associated action plans relating to 171 drug-related deaths from 2015-2021 were analysed thematically. Various modes of governance were identified using Head's ‘wicked problems’ conceptual framework including avoidance and denial, coercive controls, compartmentalised micro-management, incremental and pragmatic adjustment and technocratic problem-solving. ResultsThere was strong evidence of the dominance of denial of the problem of drug-related deaths, coercive controls, micro-management and reliance on technological solutions in the early years (2015-2018). In some prisons, there developed a move towards the adoption of more pragmatic and incremental policies and push towards comprehensive policies over time. In others, remnants of denial and coercion remained. In our analysis, the focus on new psychoactive substances came to dominate attention, to the relative neglect of other substances and of the contribution of mental and physical illness to these deaths. Staff are not equipped, supported or resourced adequately to deal with the two ‘wicked problems’ of increasing rates of drug use and mental illness which collide in the prison setting. ConclusionThe PPO investigations repeatedly recommend reducing supply and improving monitoring and surveillance and the emergency response. There is less focus on prevention and reducing demand or improving the wider environmental context and culture in which the deaths occur. Policy needs to pay more attention to the fundamental issues driving the current deterioration in conditions in prisons.

Toxic Prisons? Local Environmental Quality and the Wellbeing of Incarcerated Populations

A growing body of scholarship draws attention to prisons and environmental justice, pointing out the propensity for prisons to be located on contaminated sites and to be in close proximity to polluting industries, as well as for prisons themselves to contribute to local environmental degradation. Prisoners’ immobility renders them unable to relocate away from harmful environments, and there are now numerous suggestions that their wellbeing suffers as a result of the poor quality of many local environments. However, since a relationship between environmental quality and prisoner wellbeing is yet to be robustly demonstrated, there is currently no firm evidence base from which to argue for positive change. This paper therefore examines the effect of the environmental quality of the locations of prisons, approximated as the presence of greenspace in the immediate vicinity of prisons, local species biodiversity and local levels of air and noise pollution, on wellbeing outcomes in a set of prisons in England and Wales. It finds that good environmental quality, in the form of high biodiversity and/or low air pollution, enhances the already-recognized positive effects of greenspace on the wellbeing of incarcerated populations. On the basis of these findings, this paper makes evidence-based policy recommendations intended to enhance the wellbeing of incarcerated populations.

‘Sedative Coping’, Contextual Maturity and Institutionalization Among Prisoners Serving Life Sentences in England and Wales

Abstract Based on a longitudinal study of life-sentenced prisoners in England and Wales, this article seeks to make sense of what it characterizes as ‘sedative coping’. In doing so, it brings together analytic conclusions from the existing research literature that appear highly inconsistent, but which indicate the centrality of emotion in the experience of serving a long prison sentence. Specifically, it highlights the forms of emotion management and suppression involved in coping with the trauma of such circumstances, and the post-release impact of sustained forms of emotional self-preservation. This focus helps us better understand the connection between ‘mature coping’ in custody and the post-release difficulties that life-sentenced prisoners often describe.

‘Connection Rather Than Output’: Reflections on the Role of Art Workshops in Qualitative Research With Women in Prison

This paper offers a reflective account of delivering art workshops in women’s prisons in England, as one method in a larger, qualitative study around the role of food in prisons. We present reflections around the role of art workshops in building relationships and community between the researcher and the participants, and the participants themselves. We found that building connection through art workshops, in a hostile and challenging environment like prison, enabled us to gather richer and deeper data during the qualitive interviews that succeeded the art workshops. We propose that attention from researchers to the ‘unintended consequences’ can contribute to research projects which are impactful for both the participants and researchers. This paper addresses gaps in literature around the use of visual art as method in women’s prisons and the role of arts-based methods in larger qualitative research projects in secure settings.

Who's holding the trauma? RE-ACT: increasing prison officer insights and reducing violence in prisons

According to Ministry of Justice data, violence in prisons in England and Wales is increasing. It is important to consider the impact that exposure to violent incidents can have on prison officers involved. An exposure which could influence how an individual will respond to future violent incidents. Every relational interaction can be therapeutic, and empowering, or destructive, and lead to a sense of hopelessness. To increase an understanding in prison officers' decision-making when responding to violence, the authors have developed a workshop (named RE-ACT) to increase awareness around decision-making when responding to violence. These psychologically underpinned, trauma-aware reflective workshops explore decision-making during violent incidents and are co-delivered by psychologists and security managers/operational staff. This article will discuss the rationale, development, design, delivery, and evaluation, of the workshops.

Accessing opioid agonist treatment in prison in England and Scotland remains problematic – the views of people with lived experience

PurposeThe purpose of this paper is to examine lived experiences of opioid agonist treatment (OAT) during and immediately following release from detention in prisons in England and Scotland.Design/methodology/approachSurveys were completed by serving prisoners in both countries and by those recently released from prison (England only). The survey findings were discussed in focus groups of people with lived experience. The combined findings from the surveys and focus groups were shared with an expert group of prison OAT providers and people with lived experience with the purpose of making recommendations for more accessible and effective OAT in custodial environments and continuity of OAT on releaseFindingsThe quality and accessibility of OAT varied considerably between establishments. It was reported to be harder to access OAT in Scottish prisons. It was often hard for people in prison to get the dosage of OAT they felt they needed and it was generally harder to access buprenorphine than methadone in English prisons. Only Scottish people in prison were aware of long-lasting forms of buprenorphine. People in English prisons had mixed experiences of the help available in prison, with no improvement recorded since a 2016 study. People in Scottish prisons were more likely to rate the help available as poor.Research limitations/implicationsThe number of people accessed while actually in prison (73) was reduced by the impact of the pandemic, making it more difficult to access people in prison and because some were resistant to participating on the basis that they had already been consulted for a wide variety of research projects focused on the impact of COVID. The Scottish cohort (a total of 19 individuals comprising 14 survey respondents and five focus group members) is clearly too small a number on which to base robust claims about differences in OAT provision between the English and Scottish prison systems..Practical implicationsThe study identifies key barriers to accessing OAT in prisons and suggests key components of more user-friendly approaches.Social implicationsThis study provides an overview of the recent lived experiences of people accessing OAT in prison and on release and offers valuable recommendations on how to make service provision more effective and consistent.Originality/valueThis study provides an overview of the recent lived experiences of people accessing OAT in prison and on release in England and Scotland and offers valuable recommendations on how to make service provision more effective and consistent.