In April 2013 NHS England became responsible for commissioning all health services for people in prison in England. Healthcare in prison has a very important role in identifying significant health needs, maintaining health and detecting chronic conditions. This guideline supports equivalence of healthcare in prisons, a principle whereby health services for people in prisons are provided to the same standard, quality and specification as for patients in the wider NHS. Providing equivalence of care aims to address health needs, reduce health inequalities, prevent deterioration, reduce deaths from natural causes and ultimately assist rehabilitation and reduce reoffending.

The guideline population includes adults overĀ 18 in prisons or young offender institutions. The prison population includes highly vulnerable groups such as:

  • people with learning disabilities who find it difficult to understand the prison regime and what is happening to them

  • older people and those serving longer sentences whose physical health often deteriorates or is exacerbated by previous lifestyle choices during imprisonment

  • people serving short sentences, making it difficult for prison healthcare staff to achieve any sustainable change in their health

  • people who have particular healthcare needs, such as:

    • people with physical disabilities

    • people with a history of substance misuse

    • pregnant women.

Since 2006 there have been considerable changes in prison health services. But barriers to delivering health services in custodial settings still exist. These barriers make providing healthcare equivalent to what is available in the community a significant challenge. There are many recognised areas that the prison and healthcare systems need to address to manage the overall safety of people in prison. Key areas of focus for this guideline include:

  • The initial reception assessment and subsequent general health assessments. This includes liaison and communication with external health organisations for the benefit of people's care while in prison or hospital, between establishments and on release.

  • Continuity of healthcare for those moving around the prison estate, including continuity of medicine, a coordinated approach between prison health services, and visiting health services and prison staff.

  • Effective communication between teams, in particular when dealing with complex needs and sharing information to support people's care in the wider prison.

  • Managing emergency situations, which can include high levels of complex needs within the prison population, the staff skills needed to work with this client group and the large numbers of people in prison moving across the prison estate.

  • Procedures and methods to support people in transit between custodial settings or on release to the community.

This guidance should be read together with the NICE guideline on the mental health of adults in contact with the criminal justice system. People in prison often have a mix of physical and mental health issues during their sentence. Healthcare professionals working in prisons need a range of skills to assess, diagnose and manage physical health, mental health and addiction problems, as well as underlying complex social and behavioural issues.

  • National Institute for Health and Care Excellence (NICE)