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Tackling health inequalities in the justice system

Report from Revolving Doors Agency provides guidance for local commissioners tackling health inequalities in the justice system.

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Rebalancing Act

A new (11 January 2017) report from the Revolving Doors Agency aims to support a broad range of stakeholders at local, regional and national level, to understand and meet the health and social care needs of people in contact with the criminal justice system and through this engagement reduce offending and improve community safety.

Rebalancing Act (an update of a 2013 report unsurprisingly called Balancing Act) argues that only effective collaboration at a local level can make an impact on the many people within the CJS with multiple and complex needs.

The importance of the issue is acknowledged by Government (both the Home Office and Public Health England contributed to the research underlying the report) although the situation on the ground has deteriorated rapidly over recent years following the sustained cuts to all health and social care services.

The report has been updated to reflect the number of recent changes in local commissioning arrangements including the introduction of Police and Crime Commissioners, the transfer of responsibility for drugs and alcohol to local authorities and the associated introduction of Health and Wellbeing Boards.  There is also a general move towards devolution of powers to the local level (one of the few policy issues which appears to have cross-party support), the latest example of which is the commitment by the Ministry of Justice to devolve more commissioning powers to prison governors.

Three stage process

The report sets out a straightforward and widely agreed process for local multi-agency commissioning:

  1. build understanding of the specific health needs of people in contact with the criminal justice system locally;
  2. engage with communities, including service users and those with lived experience;
  3. commission and deliver programmes jointly with partners across the system, including developing early intervention and prevention programmes; and monitor and evaluate progress and change.

Understanding need

The report does an excellent job presenting data about the health and social care needs of people in contact with the criminal justice system as you can see from the graphics throughout this post.

However, the report also highlights that much of the available data is incomplete, out of date, unpublished, or otherwise problematic. It is also widely dispersed, across Government statistical releases and reports, academic journals, and a host of other stakeholders including the police, probation, Jobcentre Plus, health services and local authorities.

Revolving Doors argues that this limited and fragmented data and intelligence means that local partnerships are central not only to the place-based delivery of services but also to the place-based assessment of need and planning of services.

Integrated commissioning

The rest of the report identifies key local commissioners and sets out principles for their collaboration:

  • The importance of engaging with communities and service user involvement
    • prisoners and offenders can be partners in public health;
    • health needs assessments, joint strategic needs assessments and health service evaluations need to take account of prisoners’ and offenders’ voices if they are to be truly useful in delivering effective and efficient care;
    • prisoners and offenders can be part of the solution in designing and delivering health promotion and health improvement programmes
    • peer educators can be a much more effective means of engagement, and peer-modelling can promote more effective uptake of positive health
      behaviours, such as smoking cessation;
    • sustaining change beyond the prison gate is possible, and positive change can be driven by actions of ex-prisoners.
  • The value of joint commissioning
    • Integrated care pathways
    • Calculating return on investment

The report concludes with a number of examples of effectively commissioned local multi-agency partnerships including the Pan Essex Health and Justice Commissioning Scheme and the West Midlands Violence Prevention Alliance.


This is a valuable, if generalist, look at the key processes for addressing offender health inequalities at a local level. Given the emphasis on place-based systems, it is not possible for the advice to be over-prescriptive.

The Revolving Doors Agency aims to follow up this useful document with a series of further policy guides.



Blog posts in the Criminal Justice category are kindly sponsored by Get the Data which provides Social Impact Analytics to enable organisations to demonstrate their impact on society. GtD has no editorial influence on the contents of this site.

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