Is good-quality health care being provided for women in prison? As the government proceeds with plans to build 500 more prison places for women, this new Nuffield Trust analysis uses HES data to look at women prisoners' use of hospital services, finding that they face a series of challenges and risks in prison because of barriers to accessing health and care services. For this report we used Hospital Episode Statistics (HES) data to look at female prisoners’ use of hospital services including admitted patient care and outpatient services in England. Although the prison estate covers England and Wales, there are no prisons for women in Wales and therefore Welsh women are all located in England

Hospital data highlight the complex needs of women in prison, particularly around trauma and substance misuse.

Meeting the health care needs of women in prison requires targeted support and recognition of the impact of previous trauma. Our work shows that the experiences women have had before prison, such as domestic abuse, directly impact on their health. We found hospital admissions as a result of brain injury and violence, which may be linked to experiences of domestic abuse before prison. In 2019/20 there were 28 hospital admissions by 25 women where diaphragmatic hernia (which in adults is often a result of blunt force trauma) was recorded as a diagnosis.

Substance misuse plays a part in a significant proportion of hospital admissions by women in prison.

In 2019/20 just under 30% (356) of inpatient admissions by women in prison had a diagnosis of substance use recorded. In the male prison estate there was a much higher number of admissions where substance use was recorded (2,680), but as a proportion of all admissions by male prisoners, substance use had less of an impact, making up under 20% (19.8%) of admissions. Stakeholders raised concerns that the management of substance misuse may lead to other health care needs being overlooked.

We found that admissions linked to psychoactive substance use and mood (affective) disorders were the most common mental health diagnoses (see report table 7). See page 32 for section on substance use.