Organisation of health care
Ministry in charge
Department of Health and Social Care
The National Health Service (NHS), a non-governmental public body, is responsible in England for the provision of care units in prisons. Local Health Boards (LHB) are responsible in Wales for the provision of care units in public prisons (including detoxification).
Every prison facility has a health care unit
Number of medical staff (FTE)
The National Health Service provides the following services:
- general medicine
- nursing care
- psychological care
- specialist education
- withdrawal services
- pharmacy and drug management
- stopping smoking 1
Medical teams vary from prison to prison. Most medical teams are composed of:
- nursing staff (24 hours a day or during the day)
- general practitioners (full-time or part-time)
- mental health professionals (full-time or part-time)
- addiction professionals (in most institutions)
Permanent specialists can be found in facilities according to specific needs.
National Health Service of England, Standard annex to health and justice specifications, March 2018. ↩
Hospitals do not have dedicated units for prisoners. Two prison officers accompany the patient to hospital and monitor them.
Access to health care
Health care is free
A medical examination is performed upon admission
All prisoners are received by a member of the medical team when they arrive at their ward. The health professionals question them about their medical background, treatment, addictions and psychological state. 1 A second medical assessment, carried out by another professional, is mandatory within seven days of admission. 2 This second examination is usually an opportunity, in women’s facilities, to address issues of pregnancy, parental responsibility, domestic violence, sexual violence and sex work. 3
HM Inspectorate of Prisons, Expectations: Criteria for assessing the treatment of and conditions for men in prisons, criteria for assessing treatment needs for male prisoners , 2017, p. 31. ↩
Michael Spurr, “Women in prison in England and Wales”, in Piet Hein van Kempen and Maartje Krabbe (éds.), Women in Prison: The Bangkok Rules and Beyond, Intersentia, 2017. ↩
A medical file is opened upon admission
SystmOne is the hospital information system used in all English prisons.1
Data cannot be disclosed without patient consent, except:
- legal obligation (court order, legal prescription)
- existence of an overriding public interest (to protect a third party from serious harm…)
- other legal reason
Patient consent is not required if the data is anonymous.2
National Health Service, Standard Annex to Health and Justice Service Specifications: Adult Prison Estate, March 2018, p. 8. ↩
Prisoners can access health care units after
- written request
- oral request
The process depends on the facility. The presence of a telephone in the cell allows an oral request to be made.
Medical examinations are carried out on a confidential basis
in most cases
Prison staff attend medical examinations when they consider the situation to be at risk.
Continuity of care is ensured during incarceration. All 118 prisons use the same SystmOne software1. Professionals are required to “maintain, through the hospital information system, an adequate and complete medical record for each prisoner. If necessary, health professionals may share information with services outside the institution: rehabilitation services, community service, probation services, social services…” 2
National Health Service, Standard Annex to Health and Justice Service Specifications: Adult Prison Estate, March 2018, p. 7. ↩
Eye appointments were suspended for prisoners at the Swansea facility in Wales in March 2020 and were not made available again until January 2022. Around 60 prisoners were waiting for a consultation. The same is true for dental care, with 80 prisoners on the waitlist. The demand for mental health care is increasing, and 60% of prisoners at the facility stated that it was not easy to access mental health care. A report from the Healthcare Inspectorate Wales issued 29 recommendations to improve medical care for prisoners.
A report by the Prisons and Probation Ombudsman, released in May 2022, investigated the circumstances surrounding the death of an inmate who died of cardiac arrest at age 54 in Leeds prison. He was found in his cell on 25 September 2021. The inmate had high blood pressure, heart problems and was taking medication for high cholesterol. He also had a history of paranoid schizophrenia. According to health care staff, the inmate refused to take his medication on 13 occasions against medical advice and there was no formal action taken to address his mental health. The study pointed out that a Do Not Attempt cardiopulmonary resuscitation (DNACPR) order was enacted while Mr. Alexis was in hospital in June 2021, which Mr. Alexis stated that he did not request upon his return to prison. The report stated that the DNACPR was not reviewed for ten days. At the time that Mr. Alexis went into cardiac arrest, a staff member waited one to two minutes for her colleagues to arrive before entering the inmate’s cell out of fear of his aggressive behavior, which was found to be an acceptable decision. The Ombudsman’s office deplored the poor treatment of the deceased during his incarceration. It recommended that a personalised care plan to address his heart disease and a mental capacity assessment should have taken place. The report concluded that the inmate did not receive care equivalent to that provided outside of prison.
Some treatments cannot be done inside the facility. The prisoner can access these in three ways:
- a specialist is invited to examine the patient
- the patient is transferred to another facility
- the patient is taken to the hospital 1
The Care Quality Commission notes in its annual report 2017-2018 that “ care provided is of lower quality: poor medical environment, partnerships and services not adapted to people’s needs…. The lack of prison staff may also limit prisoners’ access to the care and treatment they need“. 2.
Hospitalisation is subject to the opinion of the medical team. Admission must be made within 14 days of their decision.
Physical health care
Patients are guaranteed access to all types of treatment. For some patients, registration on a waiting list is necessary. Their quality must be equivalent to that offered outside.
Measures to prevent epidemic or communicable diseases must be implemented. They must be comparable to measures taken externally.
A report by [SAGE]((https://www.theguardian.com/society/2021/apr/23/sage-warns-jails-unleash-covid-variants-wider-community)(Scientific Advisory Group for Emergencies) indicated, in April 2021, that even if the prevalence of coronavirus decreased in the general population, prisons would still be exposed to a greater risk of infections and might act as “a potential reservoir and amplifier of infection for the community”. Public health experts recommended they be given priority for vaccinations. Universal“ vaccination for prisoners and prison staff was thus recommended to mitigate the risk of spreading the COVID-19 variant outside of prison.
According to the Howard League, “the need for risk reduction measures is widely recognised, but the measures themselves are not compelling”.
- Condoms, dental dams and lubricants are widely available to prisoners in some institutions. In other facilities, condoms are distributed only on request. 1
- Health professionals use substitution treatment to treat addiction.
- No institution operates a needle exchange.
Howard League, “Consensual sex among men in prison: Briefing paper 1”. ↩
Mental health care
Generally, people suffering from mental health disorder are not held in special facilities butsome prisons do have such. Severely mentally unwell prisoners may be admitted to them. Otherwise, they are transferred to another institution or hospitalised.
Guards are inadequately trained in caring for people with mental health disorders.
Addicts receive special follow-ups. They are examined within five days of admission to prison. They can be placed in a special unit if there is one available. Nicotine and opiate therapies and substitutes are offered in most facilities. The prisoner may be transferred if necessary.