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United Kingdom: England & Wales

Capital city — London

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Panorama

Health

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

yes

Number of medical staff (FTE)

-

Health services are struggling to recruit enough staff. They have a shortage of psychological health specialists, particularly those offering therapeutic counselling.1
Staff shortages, including of healthcare workers, at HMP Aylesbury are heavily impacting prisoners’ access to health care, time out of cell, education and work. HM Inspectorate of Prisons stated that the healthcare situation is so dire that the prison service does not send prisoners over the age of 40 to Aylesbury, as they cannot be adequately cared for there.

  1. Jeanette HALL, Nancy LOUCKS, Nicola PADFIELD, “Le système pénitentiaire anglais et gallois”, Centre de Recherche sur la Justice Pénale et Pénitentiaire (CRJ2P/IFTJ), 2024, p. 5 (in French). ↩

The National Health Service provides the following services:

  • general medicine
  • dentistry
  • nursing care
  • psychological care
  • specialist education
  • withdrawal services
  • optometry
  • chiropody
  • 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.

  1. 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

yes

A medical examination is performed upon admission

yes

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

  1. Department of Justice, PSI 07/2015 on the first days in prison, p. 8. ↩

  2. 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. ↩

  3. 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

yes

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

  1. The Guardian, Prisons linked to single health record IT, April 2011. ↩

  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

The CPT observes that examinations carried out in the care units of Liverpool Prison are carried out in the presence of prison officers. The Committee has stated that this practice undermines the confidentiality of consultations1. The CPT notes that medical confidentiality is generally respected in juvenile establishments2.

  1. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), Report to the United Kingdom Government on the visit carried out from 13 to 23 May 2019, April 2020, p. 47. ↩

  2. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), Report to the United Kingdom Government on the visit carried out from 13 to 23 May 2019, April 2020, p. 72. ↩

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

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.3

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.

  1. The Guardian, Prisons linked to single health record IT, April 2011. ↩

  2. National Health Service, Standard Annex to Health and Justice Service Specifications: Adult Prison Estate, March 2018, p. 7. ↩

  3. Healthcare Inspectorate Wales, Local Review of the Quality Governance Arrangements in place within Swansea Bay University Health Board, for the delivery of Healthcare Services to Her Majesty’s Prison Swansea, 2022 ↩

  • A study on cancer incidence and treatment in detention states that incarcerated individuals with cancer are 9% more likely to die than cancer patients in the general population. Diagnosis and treatments are less widely available in detention than outside of it.

    i
    30/04/2024
    / The Guardian

  • The National Confidential Enquiry into Patient Outcome and Death published a report on access to care. The report included the following recommendations: improve monitoring of long-term conditions, plan for emergency transfer of prisoners to hospital, train staff to perform CPR and improve palliative care.

    i
    26/01/2024
    / National Confidential Enquiry into Patient Outcome and Death

-

  • The prison service announced in January that prison staff could volunteer to receive training on administering naloxone, which can be used to treat opioid overdoses. The national chair of the Prison Officers’ Association pointed out that this new skill would not result in additional remuneration. He stated that only fully qualified medical professionals should administer this treatment.

    i
    02/04/2024
    / Inside Time

Hospitalisation is subject to the opinion of the medical team. Admission must be made within 14 days of their decision.

  • The Inspectorate of Prisons published a report on waiting periods for hospital transfers for prisoners with mental health disorders. It criticised the average length of these waiting periods: 85 days. The longest wait reached 462 days.

    i
    19/02/2024
    / BBC

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 (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.

  1. Howard League, “Consensual sex among men in prison: Briefing paper 1”. ↩

Mental health care

One in four prisoners have attention-deficit hyperactivity disorder (ADHD), with or without hyperactivity, according to a report published by the ADHD Foundation. The report asserts that, if the disorder was properly recognised in prisons, criminality could be reduced by 32% for men and 41% for women. The Foundation’s doctors recommend that prisons systematically screen newly-arrived prisoners for ADHD.1

  1. ADHD Foundation, ADHD in the Criminal Justice System: A case for change, 2022 ↩

  • The Chief Inspector of Prisons noted that no provision was made for psychological treatment at Morton Hall.

    i
    26/02/2024
    / HM Inspectorate of Prisons

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.
Prisoners with substance dependencies cannot be transferred to general psychiatric hospitals.