Prison health Contents

1The state of health and care in English prisons

1.Persistent concerns have been raised over a number of years about the overcrowded, unsafe and unsanitary conditions inside some of England’s prisons. Evidence collected and presented by Her Majesty’s Inspectorate of Prisons (HMIP), the Care Quality Commission (CQC) and others has shown a system struggling to cope with budget reductions, staffing shortages and outdated establishments. There are signs that the Government is beginning to address some of these problems, but also that it needs to go further. During the course of the inquiry which has led to this report, we have heard examples of good practice across the prison estate, but the scale of the challenge is immense.

2.The Justice Committee in 2015, and again in 2016, warned that available indicators pointed to a rapid deterioration in safety.1 Rates of deaths, suicides, incidents of self-harm and violence inside prisons have risen considerably, reaching record highs over recent years.2 There have also been reports of prisoners living in unacceptably poor conditions (e.g. at HMP Liverpool).

3.Deteriorating standards within English prisons followed significant reductions in public spending, which resulted in staffing levels falling substantially (from almost 25,000 in 2010 to just over 18,000 in 2014). These numbers remained low for a sustained period of time (the number of prison officers in post remained below 19,000 until September 2017). During this period thousands of experienced prison officers left the prison service, which further diminished the quality of staffing provision.3

4.During this time the prison population, which the Government had projected would fall, remained historically high.4 The prison service has simultaneously been grappling with the rising use and impact of new psychoactive substances. These drugs, in particular spice,5 are harmful not only to users, but to staff, who have to deal with the consequences. Widespread access to spice and other drugs has increased violence within prisons and contributed to the deterioration in safety.6

5.Our main concerns about the current state of health and care in English prisons are set out below.

6.Many prisons remain unsafe. Whilst deaths in prison have fallen slightly including self-inflicted deaths, since reaching a peak in 2016,7 incidences of self-harm continued to rise during 2017 and 2018 and, according to the latest safety indicators, remain at a record high.8,9 Levels of violence are of great concern too. The number of assaults and serious assaults in prison, including prisoner on prisoner assaults and assaults on staff, are also at record highs.10 Her Majesty’s Inspectorate of Prisons consistently finds safety levels declining between inspections, and has reported that many institutions are failing to address safety concerns relating to violence, suicide and self-harm and the supply of illicit drugs.11

7.Even the most basic needs of people detained, such as their diet and living conditions, continue to be compromised in some English prisons. HMIP’s most recent annual report noted that inspections over the last year have identified poor, and even squalid, conditions in several prisons. Prison establishments frequently struggle, according to the inspectorate, to provide meals of sufficient quantity and quality on £2 per day per prisoner.12

8.Short-staffed, overcrowded prisons severely limit access to healthcare and the ability of prisoners to lead healthy lives. Prisoners spend the vast majority of their time in their cells, limiting their opportunity to move and engage in adequate levels of physical activity, and their access to healthcare, inside and outside prison, is restricted. Only 16% of prisoners report being unlocked for the recommended minimum of 10 hours per day. A third of people detained in local prisons13 and almost 40% of people held in young adult prisons report spending less than 2 hours out of their cell a day.14 Low staffing levels, excessive waiting times for some services and inadequate management of prisoners with chronic conditions are three recurrent concerns HMIP and CQC have about the delivery of healthcare in prisons, based on the findings of their joint inspections over the last year.15

9.Governments, according to the World Health Organisation, have “a special duty of care for those in places of detention which should cover safety, basic needs and recognition of human rights, including the right to health.”16 The Government is failing in this duty of care towards people detained in prisons in England. Too many prisoners remain in unsafe, unsanitary conditions that fall far short of the standards we should expect. The Government must urgently fulfil its special duty of care for prisoners.


1 Justice Committee, Sixth report of Session 2015–16, Prison Safety, HC 625

2 UK Prison Population Statistics, House of Commons Library Briefing Paper,
Number CBP-04334, 23 July 2018 p15–16;

3 Institute for Government and the Chartered Institute of Public Finance and Accountancy, Performance tracker: A data driven analysis of the performance of government, Autumn 2017 p54–55

4 Q200 Digby Griffiths

5 Spice is a brand name for synthetic cannabinoids. These synthetic drugs aim to mimic the main active ingredient found in cannabis. They are sold in herbal smoking mixtures which means it can be difficult to know which substances are being consumed. The Psychoactive Substances Act, which passed in May 2016, made it illegal to produce, supply and import of synthetic cannabinoids for human consumption. For more information visit: https://www.talktofrank.com/drug/synthetic-cannabinoids).

6 Royal College of GPs (PRH0023)

7 UK Prison Population Statistics, House of Commons Library Briefing Paper,
Number CBP-04334, 23 July 2018 p16

8 UK Prison Population Statistics, House of Commons Library Briefing Paper,
Number CBP-04334, 23 July 2018 p15–16;

9 Her Majesty’s Inspectorate of Prison for England and Wales, Annual report 2017/18, July 2018, HC1254

11 Her Majesty’s Inspectorate of Prison for England and Wales, Annual report 2017/18, July 2018, HC1254

12 Her Majesty’s Inspectorate of Prison for England and Wales, Annual report 2017/18, July 2018, HC1254

13 “Local prisons” serve courts and receive remand and post-conviction prisoners, prior to their allocation to other establishments.

14 Her Majesty’s Inspectorate of Prison for England and Wales, Annual report 2017/18, July 2018, HC1254

15 Her Majesty’s Inspectorate of Prison for England and Wales, Annual report 2017/18, July 2018, HC1254

16 World Health Organisation, Prisons and Health, 2014




Published: 1 November 2018