This work focuses purely on health care service use by prisoners in England, due to the division of health care organisation between England and Wales. For this report we used Hospital Episode Statistics (HES) data from 2016/17 to 2019/20 to identify prisoners’ use of hospital services. HES data provide a record of admitted patient care and outpatient appointments. 

Use of psychoactive substances

There were more than 9,000 incidents where psychoactive substances were found in prisons in the 12 months ending March 2021 – more than any other type of drug (Ministry of Justice, 2021a). Because prisoners’ use of harmful psychoactive substances remains a key concern, we looked at how often this was recorded as a diagnosis when prisoners were admitted to hospital in 2019/20 (see report table 2.4).

In 2019/20, there were 201 prisoner hospital admissions with a primary diagnosis of psychoactive substance use. We looked at how this compared to the general population by calculating age- and sex-standardised admission rates for psychoactive substance use. Prisoners’ admissions where there was a primary diagnosis of mental and behavioural disorders due to psychoactive substance use were higher than those seen in the general population (1.74 per 1,000 compared with 1.07 per 1,000), but looking across all diagnosis codes (that is, where psychoactive substance use may have been a secondary or subsidiary diagnosis) the rates were higher in the general population (43.7 per 1,000 compared with 37.3 per 1,000).

In 2017/18, psychoactive substance use was the primary reason for admission in 47 instances, whereas in 2019/20 this figure had risen to 201. While caution should be taken when comparing data from different years because more data were available in 2019/20 due to improved data recording, this level of increase raises concerns that there are more prisoners having serious reactions to psychoactive substances that necessitate an inpatient admission. In roughly 10% of these admissions (n = 21) patients had a head scan while in hospital. We then looked at the specific diagnoses within mental and behavioural disorders due to psychoactive substance use to learn more about which substances were more frequently coded in hospital admissions (see report table 2.5).

The prison estate has theoretically been smoke free since 2018, but nicotine dependency was coded in 14% of all hospital admissions by prisoners in 2019/20 (although it was rarely the primary reason for admission). It is estimated that around 80% of prisoners are smokers on arrival to prison, compared with just under 15% of people in the general population. The extent to which prisoners are still smoking despite the smoking ban is unclear. But a study of air quality in prisons before and after implementation of the ban reported that while air quality was much improved, there was evidence that some smoking was still taking place.