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Physical health in prison
The third briefing from Nacro's justice exchange looks at physical health in prison

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The Better Futures Project

The Nacro Justice ExChange is a network of people who have been in contact with the criminal justice system and received support from Nacro with their resettlement journey, including people who are currently in prison, or have previously served a prison sentence. They share the same goal: Using their experiences to inform those in power of what the issues are, and to influence the development of criminal justice policy to ensure that it works better for society, communities, families, and the individuals caught up in the system.

The Justice ExChange proposes practical solutions based on lived experience of the system. Earlier this week (21 January 2025), they published their third briefing – on physical health in prison.

Poor health

As most readers will know, people in prison are generally in poorer health compared to the general population. In fact, HMPPS has adopted the age of 50 as the start of ‘old age’ in the prison population, based on evidence that the health-related needs of people in prison are brought forward by around 10 years, relative to people in the general population.

The report

The report is based on the views of 101 people with experience of prison via a survey completed between May and October last year.

Key findings

  • Two in five (40%) waited for a month or longer for a GP appointment, and a further one in 13 (7%) said they never got an appointment.
  • More than one in three (38%) waited longer than three months for a dentist appointment, with a further one in four (24%) saying they never got an appointment. One third of people (34%) were aware of people who had resorted to doing dentistry on themselves or others because they were unable to see a dentist.
  • Over a third of people (35%) who needed to see an optician said they never got an appointment.
  • Almost half of people (45%) had appointments at a hospital outside prison during their sentence. Of those, a third (34%) were not able to attend the appointment.
  • More than four in 10 (43%) said they did not get the treatment they needed from the medical professionals they saw.
  • Six out of 10 (60%) said they had a longer period of pain and discomfort because they did not get the treatment they needed, and almost one in eight (12%) said that because they did not get the treatment they needed, they were then not able to work when they were released from prison.
  • Seven out of 10 people (70%) said they were aware of people not getting medical help while they were in prison. Three quarters of people (75%) said they were aware of people not able to get the medication they needed while in prison and more than six out of 10 (65%) said that they saw people using other people’s medication. More than six in 10 (64%) said that they knew people who used illegal substances because they couldn’t get the medication they needed.

Recommendations

The report makes a series of recommendations to limit the impact on physical health from being in prison:

  • Time out of cell and purposeful activity: People should be unlocked for at least the HMIP minimum of 10 hours each day. Time out of cell has an important role to play in supporting good physical and mental health, and prison regimes should be built around the wellbeing of people in prison.
  • Activities: A wide range of activities in association time should be available, with enough facilities, or a rota system, to enable fair access. This should include a range of physical activity, including access to gym equipment.
  • Diet: A review of the prison diet (and budgets) is particularly important in view of the cost of living crisis in order to ensure that prisons are adequately funded to provide a varied and healthy diet that caters to all dietary restrictions.
  • Healthy living: There must be renewed efforts to ensure that people in prison have the tools available to them to make healthy living choices. This includes diet and exercise as well as to focus on harmful behaviour such as substance misuse.
  • Physical environment: All future maintenance and development of the prison estate and the planning of prison regimes should consider the impact on people’s physical and mental health, and ensure that the physical environment in prisons adequately takes account of the needs of people with disabilities and the growing older population.
  • Staff relationships: It is important to ensure that relationships between staff and people in prison are built on mutual understanding and respect, and that the prison regime provides the protected time needed for prison officers to undertake the keyworker role, and that private spaces are available for prison officers and other staff to carry out one-to-one meetings with the people in their care. Creating an environment where relationships between staff and people in prison are based on mutual respect will help to ensure that people in prison have their healthcare needs taken seriously.

 

Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here

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