Healthcare provision in prisons: needs assessments and disability access

HM Prison and Probation Service (HMPPS) is grateful for this feedback and HMPPS and DHSC/NHSE accepts the recommendation. Whilst processes are currently in place to communicate changes in prison population to healthcare colleagues, the gaps identified in the report are recognised and communication structures will require review to reflect the changes taking place with DHSC and NHSE. In this context, the Custodial Capacity team with DHSC officials will agree revised governance and communication structures as part of the preparations for the merger of NHSE with DHSC. However, some underlying issues may persist, for example the mismatch between the speed at which HMPPS adapts to prison population trends by changing cohorts held at individual prisons and healthcare service planning and contractual constraints at establishment level. Governance and communication structures will require review to reflect upcoming NHS England governance changes. In that context, the HMPPS Custodial Capacity team will review with national healthcare colleagues whether any improvements can be made to improve communications. Actions planned to deliver safety recommendation: Review and agree governance arrangements for planned capacity and population changes with DHSC, by Autumn 2027. Other dependencies identified: Activity dependent on outcomes from DHSC/NHSE merger. Additional comments: HMPPS will discuss the requirements for governance structures and information sharing related to capacity planning once the DHSC structures and prison policy leads are identified. Response received on 24 June 2026.

We agree with the findings of this report and the recommendation made. NHS England recognise the importance of a comprehensive and up-to-date assessment of the health and social care needs of people in prisons in order to ensure the commissioning and provision of high-quality care that is accessible to improve outcomes and reduce inequalities for people on prison. In response to the recommendation made, we propose the following actions and indicative timeframes. Actions planned to deliver safety recommendation: Sign off and publication of the women’s health and social care needs assessment toolkit, by end Sept 2026. Resources in place to deliver actions: Pilot of toolkit across four women’s prisons and commissioning teams, including PH and local authority leads. Other dependencies identified: UKHSA agreement to publish toolkit on their website. ICB population health leads. Additional comments: Communication to include ICB and local authority engagement. Undertake a review and consultation with prison healthcare teams, commissioners, ICB population health leads, local authority representatives, ADASS Care and Justice Network, by mid-late 2027. Resources in place to deliver actions: Policy Leads and commissioning teams, ADASS Care and Justice Network, public health leads. Other dependencies identified: The Health Bill and DHSC Target Operating Model. Additional comments: To include a review of March 2026 ICB population needs assessments for prison inclusion. Confirmation of where the responsibility for H&SCNA policy sits post passing of The Health Bill 2026. Develop an action plan to outline the requirements. To include: • redesign of the Health Needs Assessment (HNA) Model • strengthen data sharing and population health intelligence • clarify system roles and accountability (including local authorities) • ensure direct link between needs assessment and commissioning response, by late 2027. Resources in place: Policy Leads and commissioning teams, ADASS Care and Justice Network, public health leads. Digital and data teams. Other dependencies identified: Digital and data reporting to support the completion, including local authority data. Response received on 29 June 2026.

HM Prison and Probation Service (HMPPS) is grateful for this feedback and accepts the recommendation. A joint HMPPS/NHSE task and finish group continues to operate to develop and implement a National Allocation Process to improve access to existing adapted accommodation and to agree a national approach to the development and operation of specialist accommodation for those with increased health and social care needs. The group is using existing information sources to explore how population management and placement decisions could make better use of the accessible accommodation. HMPPS is also exploring how digital systems may be utilised to improve recording of specific health related flags without breaching health information sharing requirements. However, it is noted that while adapted cells within mainstream residential accommodation can support people with disabilities with a degree of independence, through aids, adaptations, social care packages and peer support, they are broadly equivalent to supported housing in the community and are not suitable for individuals with significant health or social care needs, given additional vulnerability, nursing and safeguarding requirements. Longer term solutions are needed to address the needs of those with increased and longer-term health and social care needs and these are being taken forward by Ministry of Justice colleagues as part of the development of an Older People’s Strategy. Actions planned to deliver safety recommendation: Develop reporting functionality to identify demand and supply for adapted accommodation, by Autumn 2026. Other dependencies identified: Resource capacity during implementation of Sentencing Act changes. Additional comments: Additional analytical resource has been identified to support with this work. A Task & Finish Group is in place to oversee activities. Develop a National Allocation Protocol to improve access to adapted accommodation, by April 2027. Other dependencies identified: Resource capacity during implementation of Sentencing Act changes. Additional comments: A Task & Finish Group is in place to oversee activities. Agree a national approach to the development and operation of specialist accommodation for those with increased health and social care needs, by April 2027. Other dependencies identified: Resource capacity during implementation of Sentencing Act changes. Operation of specialist accommodation for those with increased health and social care needs will require additional funding. Additional comments: Linked to the MoJ Older Peoples Strategy (see below). Task & finish group in place to oversee activity. Complete the drafting of an Older People’s Strategy, by Autumn 2026. Other dependencies identified: Engagement with NHS England, DHSE and Local Authority social care partners. Alignment with wider prison estate investment plans. Input from HMPPS operational leads and inspectorates. Potential future consideration of funding and cross government priorities. Additional comments: Engagement with stakeholders and people with lived experience is underway to inform this work. Response received on 24 June 2026.