Intended for healthcare professionals


Prison healthcare in England and Wales is in perpetual crisis

BMJ 2024; 384 doi: (Published 11 March 2024) Cite this as: BMJ 2024;384:q562
  1. Kate McLintock, NIHR clinical lecturer in general practice1,
  2. Laura Sheard, associate professor2
  1. 1Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  2. 2Department of Health Sciences, University of York, York, UK
  1. Correspondence to: K McLintock k.l.mclintock{at}

Reform and investment are urgently needed to improve outcomes and save lives

The global prison population totals around 11.5 million people,1 and over 30 million people move between communities and prisons each year.2 Prisoners experience a disproportionate burden of ill health, including high levels of long term physical and mental illness, bloodborne virus infections, and substance misuse.3 Healthcare delivery is difficult in overcrowded, often outdated prison estates facing security, staffing, and funding challenges.4 Prisoners experience variable healthcare quality,5 delays to assessment and treatment,6 stigma and discrimination,7 and poorer health outcomes, including excess mortality.8 People in contact with the justice system often experience health inequalities, including social exclusion, whether they are living in custody or the community.9 The principle of equivalence—that prison healthcare “should be of the same scope and quality” as services in the community—is well established2 but remains aspirational.

Two organisations that review standards of care recently published hard hitting reports on healthcare in prisons in England and Wales. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) review of “natural” and “non-natural” deaths (cause …

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