This report by Professor Chris Whitty, the Chief Medical Officer for England, aims to improve the health outcomes of people in prison, on probation and in the secure NHS estate by supporting professionals, practitioners and policymakers in health and justice. It was produced in collaboration with Ministry of Justice, HM Prison and Probation Service, NHS England and the Department of Health and Social Care and involved engagement with:

• frontline health and justice professionals working in prison, probation and secure NHS hospitals
• people with lived experience of the justice system

On average, people in prison and on probation start from poorer physical and mental health than the general population, and the prison environment can exacerbate this. In addition, the prison population is aging, and age-related health problems which were once rare in prison, are becoming more common. There have been recent improvements in several areas of health provision for this population, delivered by healthcare and prison staff but there are also areas which can improve. There are still barriers to prevention and care, such as:

• gaps in provision
• poor data flows
• significant risk points when people transition into, out of and between prison and probation

Some of the areas identified where improvement is needed and realistic are the health of specific groups including:

• pregnant women
• prisoners with chronic or preventable infections
• prisoners with mental health issues
• prisoners needing palliative care

Many health regions and prison estates are already taking positive action and are improving health of their prison and probation populations. However, there are many opportunities identified in the report to implement these actions across more settings and prioritise these often medically vulnerable groups in future health service developments. This requires joint action by healthcare and justice policymakers and professionals.

Summary report p.22 Prison leavers
In 2024 57,277 people were released from custody. There are many factors that have an impact on subsequent health on release from prison, including:
■ stable, safe accommodation
■ employment
■ reconnecting with family and children
■ continuity of health services
■ substance treatment services

In 2024, nearly 1 in 7 people were released without any accommodation, a proportion that has remained similar for the last 5 years. In the year to March 2024, less than 1 in 5 of people whose employment status was known were in employment 6 weeks after release from custody, increasing to roughly 1 in 3 at 6 months after release from custody. Both of these have improved significantly since 2020. Both housing and employment have a significant impact on mental and physical health, as well as the risk of reoffending. Leaving prison can be an acutely vulnerable time for those with mental health issues and substance use, which often co-exist. One-third of adults leaving drug and alcohol treatment in prison were transferred for further treatment in the community. [See Figure 8: proportion of adults with substance use treatment need who successfully engage in community based structured treatment following release from prison from 2015 to 2016 to 2023 to 2024]

P.24 There are also challenges with mental health community provision as described earlier. People with both mental health (MHTR) and drug or alcohol treatment (DRR/ATR) requirements are often required to engage with drug and alcohol treatment first, due to shorter waiting times and perception of readiness to engage with mental health services. This, however, fails to address the high proportion of drug and alcohol use because of trauma and poor mental health.