Austerity as a political paradox: A study of its impact on prison health governance and the delivery of prison healthcare services in England

Ismail, Nasrul

Abstract

There is a consensus in extant scholarship that austerity has had profound, harmful effects on vulnerable and marginalised populations. However, research on its impact on the governance and delivery of health structures intended to support individuals within prison settings remains sparse.

This thesis draws upon the interdisciplinary contributions of critical social science theories to provide an in-depth, qualitative study exploring the impacts of 10 years of austerity (and counting) on prison health governance and the delivery of prison healthcare services in England. The research approach follows a constructivist grounded theory methodology and uses the perspectives of 87 prison health experts to illustrate how austerity unravels through a series of six political paradoxes—i) the need for austerity and cost-saving measures; ii) delivering prison health within a punishment structure; iii) the stability of a structured, top-down control of prison service; iv) the political rhetoric of ‘tough on crime’ and ‘we are all in this together’; v) neoliberal responses of the government towards prison instability; and vi) continued scrutiny of prisons and prison health, which has shaped and constrained prison health governance and the delivery of prison healthcare in England.

This study, the first of its kind in England, confutes political claims that portray fiscal cuts and the increasing use of privatisation as requisite to prevent economic profligacy and reduce costs. It problematises how the prison health system in England operates within a regressive neoliberal structure that prioritises top-down hierarchies and punishment over collaboration and rehabilitation. Concurrent with the implementation of austerity since 2010, it explores the participants’ perceptions of how the transient political leadership of prison services, as well as the rampant growth of prison gangs and serious organised crime groups across English prisons, challenge both the governance and delivery of prison regime and health.

This study also reveals that, although the United Kingdom is the fifth-largest economy globally, the poor continue to bear the burden of austerity—as study participants observed—via the withdrawal of welfare services from the community and a deindustrialisation process that has forced penal institutions to become first responders for some individuals. Building additional prisons, recruiting more prison officers, and blaming psychoactive substances for existing prison instability merely augments the UK government’s neoliberal vision. Finally, continual monitoring by prison oversight mechanisms fails to hold the government accountable for the deterioration in governance and delivery of healthcare across English prisons.

Overall, this study underscores the important and yet unarticulated phenomenon that austerity has failed to reduce the burgeoning national debt, govern prison health, deliver prison healthcare services effectively and efficiently, and improve prisoner health in England over the last decade. Alongside the research’s empirical, conceptual, theoretical, methodological, and policy contributions to interdisciplinary prison health studies, seven radical, upstream solutions are proposed to effect change and untangle a decade of political paradoxes that have shaped and constricted prison health governance and healthcare delivery in England.

• Thesis Type: Thesis
• Deposit Date: Mar 30, 2021
• Publicly Available Date: Sep 21, 2021
• Public URL: https://uwe-repository.worktribe.com/output/7240931
• Award Date: Sep 21, 2021