Analysis Healthcare in Prisons

Prison environment and health

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5921 (Published 17 September 2012) Cite this as: BMJ 2012;345:e5921

This article has a correction. Please see:

  1. Stephen Ginn, Roger Robinson editorial registrar
  1. 1BMJ, London WC1H 9JR, UK
  1. mail{at}stephenginn.com

In the first article in his series on prison healthcare, Stephen Ginn looks at British prisons and at the unique difficulties of providing effective care to prisoners

Prison is a difficult place in which to provide health services, and concerns about the health of prisoners and the quality of healthcare available to them are long standing.1 In 2006 prison health services in England and Wales were transferred to the National Health Service. Scotland and Northern Ireland recently followed suit. In this first of a series of articles on prison health I examine the landscape of British prisons and the obstacles faced by prison health services.

Prison population

Imprisonment is a growing problem. During the past 20 years, the number of prisoners in England and Wales has nearly doubled (fig 1). The Scottish and Northern Irish prison populations have also substantially increased. Prison capacity has struggled to keep up, and 60% of prisons are officially overcrowded.2 These increases are not explained by changes in criminal behaviour, as recorded crime is falling,3 but by more frequent use of custodial punishment and lengthier sentences.

Fig 1 Prison population England and Wales,1900-20114

The prison population of England and Wales is nearly 87 000.5 This is a rate of imprisonment of 154 people/100 000 population,6 one of the highest in western Europe (fig 2). Scotland’s prison population is just over 8200 (154/100 000)7 and Northern Ireland’s 1700 (99/100 000).8 There are 131 prisons in England and Wales, 14 of which are privately run.7 Women make up just 5% of prisoners, and there are 13 women’s prisons in England, but none in Wales. Scotland and Northern Ireland each have one dedicated women’s prison and there are also two Scottish male prisons with small female prisoner units. The prison budget was £2.18bn …

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