1st Edition

The English Prison Health System After a Decade of Austerity, 2010-2020 The Failed Political Experiment

By Nasrul Ismail Copyright 2023
    216 Pages 10 B/W Illustrations
    by Routledge

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    Austerity has reconfigured and scaled back the governance and delivery of public services and negatively affected society’s most vulnerable groups. This book opens up the closed world of English prisons to examine its impact on prison health governance and healthcare delivery. It argues that austerity has been a decade-long, large-scale political experiment that has caused debt to balloon, eroded the prison health system and perpetuated a cycle of punishment resulting in sicker prisoners. In short, austerity has violated prisoners’ human rights.

    Drawing on interviews and data from existing longitudinal and economic analyses, the book demonstrates how austerity has resulted in high rates of recidivism, diminished what remains of the welfare state, and increased inequality and punitiveness. Despite a decade of failure, there is a marked political reluctance to dispense with austerity, and the governmental juggernaut continues to produce the same result. As the spectre of recession increases, caused in part by Brexit and COVID-19, these failures are ever more perilous.

    This book blends the interdisciplinary perspectives of criminology, public health, sociology, law, social policy, politics, and economics to enable greater understanding of the impact of austerity on health governance, prison healthcare, the prison workforce, and prisoners’ health and safety. It challenges current policy, practice and thinking, and is a must read for anyone who wants to reflect on how the political economic structure can affect the governance and delivery of healthcare services in marginalised settings, beyond prisons, and indeed beyond England.

    1 Introduction; 2 The spell of neoliberalism and austerity; 3 The governance and delivery of prisons and prison healthcare services in England; 4 Current state of health in English prisons; 5 Deconstructing the experimental nature of austerity; 6 Deterioration in rehabilitative prison environment; 7 Destabilisation of prisons and prison health governance; 8 Deflection of political responsibility; 9 The failure to scrutinise; 10 Ending austerity; 11 Conclusion; 12 Methodological appendix


    Nasrul Ismail is Lecturer in Criminology at the University of Bristol. He has published widely on the impact of political economy on prison health and prisons.

    "This is an important new contribution, examining how a decade of austerity policy has impeded the governance and delivery of healthcare in English prisons. Drawing on detailed health statistics, interviews with key stakeholders, and official publications, the author unravels the complex relationships between economics, prison management, and the decline in health and safety in prisons since 2010."

    Professor Alison Liebling, University of Cambridge, United Kingdom

    "How has it come to this? The prisons crisis is most acute in the prison healthcare system and this author uses that focus to argue that the crisis is a consequence of an ideologically constructed austerity programme. Based on interviews with 87 policy makers and ranging across sociological, legal, political and economic literature, Nasrul Ismail provides a sharp and distinctive analysis of the prisons crisis that should be on the reading list of everyone trying to understand the origins of the prisons crisis and the problems that beset prison healthcare."

    Professor Nick Hardwick, Royal Holloway, University of London, United Kingdom

    "Drawing on an impressively wide range of sources and inter-disciplinary approaches, Nasrul Ismail has provided us with an analysis which is both urgently needed and deeply grounded. By demonstrating the pernicious effects and roots of austerity on the governance and delivery of healthcare in prisons, this book provides critical insights into the ways in which care is fundamentally undermined by the structures for its delivery and governance. This book is essential reading not only for those seeking to understand healthcare systems in prisons, but how prisons operate more generally."

    Dr Mary Rogan, Associate Professor, School of Law, Trinity College Dublin, Ireland

    Austerity was a choice. When the global financial crisis hit, governments could decide how to respond. The historical evidence, especially FDR’s New Deal, argued strongly for a stimulus. Instead, in the UK, we saw a contraction of public spending. In this excellent forensic analysis, Nasrul Ismail reveals what this has meant for the prison system, whose occupants are so often the casualties of government failures.

    Professor Martin McKee, Professor of European Public Health, London School of Hygiene & Tropical Medicine