Prison Safety and Reform: A Perspective From Health Commissioning

Prison Safety and Reform: A Perspective From Health Commissioning

  • Christine Kelly
  • 15 June 2017
  • Posted in: Planning & Development, Management & Leadership, Healthcare

NHS England, as commissioners of healthcare in the secure and detained estate are committed to securing  fit for purpose  health services for this patient population, working to the principle of equivalence and  ensuring  an individuals’ access to  health services that meet their  needs are not compromised by their period in custody.

There are national health specifications that provide a template for regional health and justice commissioners to develop to meet the needs of their local establishment populations. These specifications are contracted and performance managed against by regional commissioning teams.

NHS E, PHE and HMPPS have collaborated since the creation of NHS E in 2013 and developed a tripartite partnership agreement which identified delivery priorities that each agency recognised needed a requirement for collaborative working  to achieve improved outcomes. This partnership agreement is being revised for 2017/20 updating developments and organisational changes and the significant drivers behind improvements in  services for people in prisons who have mental ill health.

This is a significant time for this tripartite partnership and the opportunities that prison reforms and co-commissioning relationships can bring to establishments and the development of the services delivered within them.

The current positive messages of prison reform and the recognition of prisons adhering to a rehabilitative culture bring developments that  will address the challenges we are currently facing, in a time where many prisons  are overcrowded, understaffed and have an ageing  infrastructure.

Delivering Healthcare in another organisation’s ‘home’ brings additional challenges to those already described. Health care providers provide services in environments that are challenging, in the majority of prisons they are dependent upon prison officer staff being available to support the delivery of their services and to escort people in prisons to outpatient appointments, many of which are cancelled due to lack of available escort resource.

 A rise in mental health presentations is also adding to the burden of timely and appropriate treatment and the levels of self- inflicted deaths,  incidents of self –harm and incidents of violence between prisoners and violence involving prison staff are at unprecedented levels.[1]

We are also seeing a significant change in the prison demographic with an increase in the number of ageing individuals in prisons and the attendant increased demand in health and the social care of these people, resulting in a rise in natural cause deaths (Safer Custody Stats [2])

It is in the context of all the above and 4 years after the creation of NHS England that health is reviewing and revising the national mental health specifications and designing an optimal prison based trauma informed  MH  service to be delivered across the estate. The excellent opportunities to identify and highlight need that the roll out of the Liaison and Diversion services[3] are delivering is particularly effective in ensuring that even where a custodial disposal is made an individual will be entering custody  with information of their needs shared with the establishment.

Healthcare and the prison regime are working hard to manage the challenges that psycho-active substances are presenting and which are serving to de-stabilise the safety and health of the patient population.

NHS England, PHE and HMPPS have  a symbiotic approach to support the strategic approach to managing this area of work . Operational developments by the secure estate maintain vigilance in managing the supply of substances and Healthcare, working with  custodial staff, enable them to recognise signs and symptoms of use, raising confidence in the appropriate management of individuals who have taken psycho-active substances.

Specific work has driven up the quality and safety networks between NHS England, PHE and HMPPS with a focus on strategic management of the reduction in suicide and self- harm across the estate and developing a  gender specific approach to delivery.

Importantly, the prison reform agenda, irrespective of whether this is focusing on established buildings or as part of the new build programme, acknowledges that Health must be at the centre of developments.  Environment matters to improved health and behaviours and where physical health and mental health is improved so too are the outcomes for the prison population and the workforce recruited to engage with them.

[1] HMIP Annual report 2015-16


[3] Bradley report 2010 and Bradley 5 years on CMH 2015


  • prison
  • prison reform
  • safety
  • health
  • health care
  • health services
  • mental health
  • physical health
  • transforming health
  • better health outcomes
  • healthcare services
  • Article Author

About Christine Kelly

Chris Kelly is Assistant Head of Health and Justice for NHS England National Team, a post she has held since 1st April 2013.

Chris had a long career in the National Probation Service serving in Lincolnshire and Nottinghamshire (1988-2004) moving from a management position in Nottinghamshire Probation Area in 2004 to commission the Drug Interventio…