Resources for Secure Environments

• The RCGP Secure Environments Group was established in 2004. It is committed to the delivery of health care of the highest possible standards to patients in the health and justice system.
• The RCGP Position statement on equivalence of care in secure environments asserts that prison health is public health and that people living in secure environments have a right to receive care that is of an equitable standard (but not necessarily the same) to people living in the community.
• The Worldwide Prison Health Research and Engagement Network (WEPHREN) is a global, open access collaborative forum for people interested in prison health. It brings together key stakeholders from across professions, disciplines and nations and supports professional development, equitable collaborative multi-centre research and health service growth initiatives. Through doing so, it aims to improve the health of people in prison.
• The NHS England Health and Justice commissions healthcare for children, young people and adults across secure and detained settings, including in prisons, secure facilities for children and young people, police and court Liaison and Diversion services and immigration removal centres, via 10 Health and Justice teams across 4 regions (North, Midlands, London and South).
• The NHSE Health and Justice Clinical Reference Group provides clinical oversight for Health and Justice commissioned services, championing best practice and evidence based approaches to healthcare provision. It represents the Health and Justice clinical body across the sector and makes links with all professions involved in service delivery, together with service users, their families and impacted communities.
• Public Health England has produced resources for 'public health in prison and secure settings' to track, treat and prevent single infections and outbreaks in prisons, secure settings and health services (see ‘Infections/Communicable diseases’ section)
• The Five Nations Health and Justice Collaborative Group provides a forum for health and justice partners in England, Scotland, Wales, Northern Ireland and the Republic of Ireland to debate and collaborate. The group aims to address health, well-being and social care issues relating to people in contact with the criminal justice system (CJS), particularly those in prisons. It informs the work of PHE as the UK Collaborating Centre for Health in Prisons and facilitates sharing of best practice. It also addresses health inequalities in order to reduce people offending and re-offending.NICE Guidelines for Assessment, diagnosis and management of Physical and Mental Health in prisons.

NICE Guidelines for Assessment, diagnosis and management of Physical and Mental Health in prisons

• NICE guideline (NG57) Physical health of people in prison (2016): This guideline covers assessing, diagnosing and managing physical health problems of people in prison. Recommendations include health assessments when people come into prison, promoting health and wellbeing in prison, managing medicines and managing health emergencies and rapid deterioration.
• NICE Quality standard (QS156) Physical health of people in prisons (2017): This quality standard covers assessing, diagnosing and managing physical health problems of adults aged 18 years and older in prisons or YOIs. There are five quality statements covering: medicines reconciliation, secondary screening, BBV and STI testing, lead care co-ordination for people with complex health and social care needs, and provision of TTOs or FP10 on transfer or discharge from prison.
• The 'NICE guideline (NG66) Mental health of adults in contact with the criminal justice system (2017)' covers the assessment, diagnosis and management of mental health problems in adults (aged 18 and over) in contact with the criminal justice system. It includes recommendations on psychological and pharmacological interventions, co-ordinated care planning and service organisation.
• The 'NICE Quality standard (QS163) Mental health of adults in contact with the criminal justice system (2018)' covers the recognition, assessment and management of mental health problems in adults (aged 18 and over) in contact with the criminal justice system. There are four quality statements which refer to: police response towards people with mental health problems, their referral for mental health assessment and appropriate information sharing of care and risk management plans between services.

Prison Healthcare Services in Wales

• The UK government is currently responsible for criminal justice in Wales but responsibility for healthcare (including prison healthcare) is devolved to the Welsh government. NHS Wales has accountability for prison health service planning and at a local level, Prison Health Partnership Boards, jointly chaired by Local Health Boards and the Governors of the prisons, have responsibility for the governance of prison health services. 

There are five prisons in South Wales and one in North Wales, with a total population (all adult male) of 4,291 (figure for end April 2018). Each prison has a different profile, function and security category. HMP/YOI Parc is the only private prison in Wales and houses most 18-24 year olds serving custodial sentences, together with adults. Female and high-risk ‘Category A’ prison residents from Wales have to be housed in England. The nearest female establishments are HMP Eastwood Park, Gloucestershire and HMP Styal, Cheshire.

 More information is contained in this 'Imprisonment in Wales: A Factfile'

• Public Health Wales has information produced by Public Health Wales about infectious diseases and prison specific outbreak planning. Other content  includes the recently published adverse childhood experiences study and population level health interventions and policies.
• Healthcare provision in prisons in Wales: The Health, Social Care and Sport Committee of the National Assembly for Wales held an inquiry into health and social care provision in Welsh prisons and evidence was received from a number of organisations. It was delivered in 2021.
  

The Welsh Affairs House of Commons Committee has reviewed prison provision in Wales and produced the Prison provision in Wales report with recommendations for the government, including areas impacting on healthcare provision. These include: creating a central unit to facilitate NHS Wales/HMPPS healthcare delivery liaison and collaboration; appropriate substance misuse treatment; adequate funding and policies to support resettlement and ensure housing provision on release from prison.   

This Partnership Agreement For Prison Health in Wales outlines agreed priorities between Her Majesty’s Prison and Probation Service (HMPPS) in Wales, the Welsh Government, Local Health Boards and Public Health Wales to drive improvements in the health and wellbeing of those held in Welsh prisons. The document recognises the unique statutory obligations of each partner organisation and builds on the shared objective of ensuring those in prison can live in environments that promote health and well-being and where health services can be accessed to an equivalent standard of those within the community. This supports the overarching aim that prison should be a place where an individual can reform their lives. To achieve this all parties have agreed to work toward the three objectives of the Welsh Government ‘Prosperity for All: The National Strategy for Wales’, ensuring that prisons and health services in prisons:

• Deliver quality health and care services fit for the future
• Promote good health and well-being for everyone
• Build healthier communities and better environments

Prison Healthcare Services in Scotland

• In Scotland, responsibility for criminal justice and prisons is devolved to the Scottish Government and responsibility for healthcare provision in prisons lies with NHS Scotland. In 2018, the government set up the Health and Social Care in Prisons Programme Board with the aim of driving health and social care improvement in prisons.

There are 15 prisons in Scotland, two of which are privately run. There is one dedicated women’s prison, HMP & YOI Cornton Vale, while women are also held in units at HMP Greenock, HMP Edinburgh and HMP & YOI Grampian. The total prison population in Scotland on 28/02/2020 was 8059. The female prison population in Scotland is one of the highest in Northern Europe and it has more than doubled since 2000. 

• The Health in Custody Network is a national network in Scotland that aims to support the health inequalities agenda and reduce re-offending by working with partners in the Health and Justice sector, and with Public Social Partnerships and voluntary agencies in the Third Sector.
• Turas Learn is NHS Education for Scotland’s platform for learning and support resources. There is a page for health and social care professionals working in prisons that is due to be launched. It will provide a single point of access to take people out through links to different directorates.
• Information about healthcare in Scottish prisons has been published by the Scottish Public Health Observatory.
• NHS inform is Scotland's national health information service which provides links to patient health information.

Prison Healthcare Services in Northern Ireland

• In Northern Ireland, responsibility for criminal justice and prisons is devolved to the Northern Ireland Executive. Its Department of Health, Social Services and Public Safety has overall authority for health and social care services. The NHS in Northern Ireland is referred to as Health and Social Care Northern Ireland (HSCNI). The Public Health Agency HSCNI (PHA) is responsible for improving health and well-being and health protection and the PHA and HSC Board are responsible for the development of a fully integrated commissioning plan for health and social care across Northern Ireland.

Prison healthcare is delivered by South Eastern and Health and Social Care Trust (one of six HSC Trusts) across the three prison sites: Maghaberry Prison (high security, adult male, long term sentenced and remand); Magilligan Prison (medium to low security male, sentenced to six years or less); Hydebank Wood College and Ash House Women's Prison (education, learning and employment focus, young adults 18-21 years, unit for remand and sentenced female).