Health at the heart of prison reform

Health and justice annual review

No health without justice, no justice without health

That is the slogan of the Health and Justice team from Public Health England who have just (25 October 2016) published their Health and Justice annual review for 2015/16.

PHE says it is working alongside the Ministry of Justice, the Department of Health and NHS England to ensure that health is at the heart of prison reform and that the benefits include improved health outcomes as well as reduced reoffending.

They state that they are committed both to improving the quality of care in custody and to ‘diverting’ people away from prison if their needs and that of wider society are better served by addressing underlying health needs like drug dependence or mental health problems. They also state that they are working together to improve care after custody, which they believe will contribute significantly to reducing reoffending.

PHE acknowledges that the challenges are significant – rising levels of violence, self-harm and suicide in prisons and the impact of new psychoactive substances. The report reflects on work undertaken during 2015-16 but also sets out their plans for the coming year to improve health and reduce reoffending as part of wider prison reform and reconfiguration.

PHE priorities

The report highlights ares of health which need improvement:


Like most other organisations involved in prison work at the moment, PHE highlights the current difficulties in delivering even a basic service:

developing a whole prison approach was recognised as important in addressing the health and wellbeing of prisoners as well as staff. But, concerns were expressed about how prison staffing levels and security/operational issues (eg lock down/time in cell) impacted on prisoner access to healthcare as well as wider education, training and work programmes or access to health care, including secondary care services in the community.

New Psychoactive substances

Although the report makes frequent mention of the scale and intensity of the problematic use of new psychoactive substances in prison (see my summary of the User Voice report here), there is limited information about the PHE response beyond a prison version of its toolkit and a training programme for staff to deal with acute issues of NPS use.


The MoJ is in the process of rolling out its smokefree policy in all prisons in Wales (from January 2016) and in four early adopter sites in England. The PHE report says that health and justice teams have been supporting NOMS and the NHS in this process but provides no other information other than a link to the guidance issued in May 2015.


The tone of the report is technical and somewhat bureaucratic and I found it difficult to clarify exactly what PHE is doing “to put health at the heart of prison reform”. I think this is mainly because, in my opinion, PHE appears to put too much emphasis on how well systems and processes are working and how we are a world leader in prison healthcare, rather than a more direct assessment of the scale of the health challenges in the prison, and indeed whole criminal justice, system. (Please see the RSA’s Future Prison report for a more realistic assessment of the problems of a fragmented commissioning system).

It may be that I have not fully decoded the language in the report, so will leave you to judge. The graphic below is the final section of the report and provides an overview of the focus of PHE’s Health and Justice work for 2016/17:


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