Offender Healthcare

Sector Summary

The roots of contemporary prison health development can be traced back to 1981 when the World Health Organisation published the Health for All Policy. This argues that all citizens had a right to expect equal access to health care and health promotion. 

In 1992 the UK government published its Health of the Nation strategy . This document set out for the first time a specified aim of promoting health in prisons. This document and its recommendations were the start of a process that would shift the responsibility for the delivery of healthcare in prisons from the prison service to the NHS.

Changing the Outlook was published in 2001. It was a policy that set out a new approach of partnership in the delivery of health care in prisons. The focus on mental health was in part a response to the growing numbers of prisoners with mental health needs, but was also a forerunner to later initiatives to promote partnership and joint working at all levels between the prison services and the NHS.

The Bradley Report was published in 2009. This independent review was commissioned by the Secretary of State for Justice in December 2007. It examines the extent to which offenders with mental health problems or learning disabilities could, in appropriate cases, be diverted from prison to other services and the barriers to such diversion. The recommendations include the establishment of criminal justice mental health teams in every locality and improvements in the delivery and effectiveness of court diversion for offenders with mental health problems.

The current context for commissioning in offender health is influenced by a range of factors, including current and emerging policy, innovations in practice and new regulatory and delivery standards. The publication in July 2010 of the government’s White Paper, Equity and Excellence – Liberating the NHS set out a range of proposals for changes to the way in which services are commissioned and paid for. The new NHS Commissioning Board (NHSCB) will be an independent statutory authority, accountable to the Secretary of State for Health for:

• Managing the overall commissioning revenue limit

• Delivering improvements measured on health outcomes

Among its main functions the NHSCB will support the new GP consortia and hold them to account for outcomes, stewardship of NHS resources, involving patients and the public and working in partnership with local authorities. The NHSBC will be responsible for a range of direct commissioning which is likely to include prison mental health services (as well as other prison health care services).

Our Work and Expertise

Steve Appleton was a member of the Sainsbury Centre for Mental Health Expert Reference Group on mental health and criminal justice and when working for NHS South Central had responsibility for offender health. As part of that role he oversaw the transfer of health care commissioning from the Prison Service to NHS across Thames Valley, Hampshire and the Isle of Wight.

Steve has recent experience of conducting strategic reviews of prison mental healthcare services, in particular at HMP Woodhill - (Category A High Secure prison) and HMPs Aylesbury, Grendon and Springhill in Buckinghamshire. He has also recently completed a review of the feasibiity of talking therapies for prisoners with mental health problems who have a history of violence.

Links and Examples

See our samples page for examples of our own work and our contribution to other reports, including one for the Sainsbury Centre for Mental Health (now The Centre for Mental Health) regarding convergence between the NHS and Prisons in healthcare commissioning and delivery