Public Health England (PHE) has recently published its annual review outlining current data and evidence in relation to key public health concerns of people in contact with the criminal justice system, both in custody and in the community.

The report references the significant impact of this year’s White Paper on Prison Reform leading the way for a new approach to co-commissioning of healthcare in prisons, which has been introduced in a phased implementation programme since April 2017. The new approach includes joint working between PHE, the Ministry of Justice, Her Majesty’s Prison and Probation Service and NHS England to develop a set of metrics to monitor the impact of these changes, whilst also acknowledging that healthcare services delivered in prison are impacted by the prison regime.

The report outlines current evidence and data in respect of the following key public health concerns for this population:

  • Infectious diseases – for example, the TB incident rate in prisons is nearly five times that of the general public. To tackle this there has been collaborative action to improve monitoring of vaccine uptake in the prison estate and the development of guidance to help prison healthcare teams improve active TB detection through the use of digital x-ray or other clinical means.
  • Substance use – 6% of prisoners cited new psychoactive substances as one of their problems. In 2015/16 59,927 adults were in contact with drug and alcohol treatment services in prisons. The Integrated Drug Treatment Service in prisons aims to increase the volume and quality of drug treatment services in prisons.
  • Mental health needs – the number of self-inflicted deaths in prisons has doubled since 2011. The report highlights the importance of:
    • embedding health and justice priorities within the scope of mainstream national work programmes on mental health, suicide and self-harm
    • implementation of the Suicide and Self-Harm Programme in custodial settings
    • the development of an integrated mental health care pathway for those in the criminal justice system
  • Older prisoners (50 years and over) – are the fastest growing population in prison and have doubled in size over the last decade. The prevalence and morbidity of chronic physical conditions is estimated to be high in prisoners, including cardiovACSular disease, musculoskeletal and respiratory diseases. How is this being tackled?
    • The Physical Health Checks Prison programme, an extension of the NHS Health Checks Programme, is targeting the top seven causes of premature mortality: high blood pressure, smoking, cholesterol, obesity, poor diet, physical inactivity and alcohol consumption
    • In 2017/18 PHE will produce a toolkit to facilitate the process of undertaking health and social care needs assessments of older prisoners
    • In collaboration with partner organisations, PHE has developed national pathways for delivering disease screening programmes in prison

The report acknowledges the importance of SystmOne for providing a significant amount of health data in the criminal justice system, whilst recognising the limitations of this system in being unable to extract data at a national level, and the inconsistency in the use of codes and templates from one provider to another. It is hoped that the new system being developed by NHS England, the Health and Justice Information Service, will address many of these issues.

The pervasiveness of mental ill health and an epidemic in the use of new psychoactive substances were also major themes within the Prison and Probation Ombudsman’s annual report for 2016/17. It is expected that this will be a significant focus in the forthcoming 12 months.