Prison healthcare
It’s been a year of landmark reports (the Independent Sentencing Review and the Leveson Review of Criminal Courts, to name but two) but yesterday’s (6 November 2025) publication of The health of people in prison, on probation and in the secure NHS estate in England certainly meets that definition. Led by the Chief Medical Officer for England, Professor Chris Whitty (yes, that Chris Whitty, presenter of all those Downing Street COVID briefings), the 451 page report is a comprehensive overview of the healthcare of people in prison, on probation or in a secure hospital.
I can’t begin to do the report justice in even the longest series of blog posts so this article aims merely to tell you of its existence, highlight the key areas covered and to implore you to download it and refer to it for the rest of your working life.
Contents
The report contains 18 detailed chapters, which can be read together but, for those interested in specific aspects of prison and probation health, are each designed to stand alone, and include some more specific or detailed recommendations.
Each chapter is thoughtfully organised and includes positive practice examples as well as key recommendations for improving the often failing prison healthcare system.
The only topic that I can see is left out is that of drug and alcohol use. But that is not an omission, merely a decision by Prof Whitty not to duplicate last year’s excellent report by Dame Carol Black. Bizarrely, this was not published by the Government, but Dame Carol demonstrated her political nous once more by getting it into the public domain by submitting it in full as evidence to the Justice Select Committee. You can find it here.
The 18 chapters are:
- Setting the scene on historical and current prison health and care
- Pregnancy, birth and the postnatal period in prison and on probation
- Children and young people in custody or at risk of custody
- Women and families
- Older people in prison
- Palliative care and end of life in prisons
- Data and information sharing
- Mental health of people in prison and in contact with the criminal justice system in the community
- Supporting neurodivergent people and those with neurodevelopmental conditions within prison and on probation
- Self-harm and suicide in prison
- Complex care in the criminal justice system
- Health protection in prisons and probation
- National screening programmes in prisons
- Health promotion and improvement in prisons
- Prison leavers
- The health needs and barriers experienced by people on probation
- A health and care workforce for the future criminal justice population
- Health research with people in prison and on probation in England
Each chapter is covered at length in the full report and is summarised helpfully year in the 52-page Executive Summary.
Recommendations
The report makes 3 sets of high level recommendations and several more specific recommendations. It emphasises the fact that the substantial remedial work need will require a response from multiple government departments and agencies. The high level recommendations are:
There will be an increasing need to prioritise preventive health and healthcare for chronic diseases within prisons as the prison population ages.
The report recommends an expansion of telemedicine; on site healthcare for chronic diseases with attendance incentivised (by not losing prison wages if you attend) and the expansion of health promotion work.
Health data are essential for safe, high-quality care, research, surveillance and planning of health services inside and outside prison. In particular it is important that NHS data from care outside of prison can be shared in and out of prison and other secure settings to allow continuity of care. There are also many IT systems that sit across multiple government departments and organisations relevant to healthcare and many of these systems cannot communicate with one another.
The report recommends that the national partnership agreement for health and social care should prioritise improving data and data information sharing. Data should inform the strategic priorities of this group and be used to report accurate oversight of progress. This should be reviewed at an annual high level accountability meeting, with appropriate external oversight.
People on probation often have high health needs compared to the general population and this is often not recognised by the NHS, public health and other provider organisations.
The report notes that the number of people on probation is going to grow and recommends that Integrated Care Boards and Directors of Public Health should work with probation services in their area to understand health needs and design local pathways. It also recommends that health and justice partners pay attention to the healthcare needs of people on probation and develop specific health initiatives such as neighbourhood health models.
Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here
