The briefing - drawing on research and insights from academics at The University of Manchester- finds that healthcare in prisons is fragmented across the health and justice departments, with responsibility split between multiple agencies and service providers and no single body in charge. Poor coordination between the Department of Health and Social Care, the Ministry of Justice and healthcare providers continues to undermine the quality and continuity of care available to prisoners.
This lack of joined-up working is compounded by severe pressures in the prison system itself. Overcrowding, staff shortages and an ageing, crumbling prison estate are making it harder to deliver basic healthcare and are contributing to poor health outcomes among prisoners. On average, people in prison have a life expectancy more than 20 years lower than the general population. While around 70% of prisoners are estimated to need mental health support, only around 10% are recorded as receiving treatment.[1]
Supporting people's underlying health needs has been identified as a critical component of reducing reoffending. Chief Medical Officer for England, Professor Chris Whitty, highlighted offending and reoffending are strongly linked to health, with the greatest risks occur at moments of transition: entry into prison, transfers between facilities, and after release.[2]
The pressures within the system are only set to get worse, due to an ageing prison population. Nearly 1 in 4 prisoners is now aged 50 or over, a group with complex and chronic health needs that prisons were never designed to meet.[3] Deaths from natural causes among older prisoners have increased over the past decades, yet access to appropriate care, including palliative and end-of-life support, remains inconsistent.
The SMF warns that without reform, the prison health system will continue to miss the chance to break cycles of ill health, disadvantage and crime.
To address these challenges, the Social Market Foundation sets out four key priorities for government, including:
- establishing a sustainable, long-term funding settlement for prison healthcare;
- improving coordination and integration between health services, justice agencies and service providers;
- prioritising prevention and early intervention; and
- strengthening cross-government oversight of prisoner health.
Jake Shepherd, Senior Researcher at the Social Market Foundation, said: "Healthcare is a human right - that includes people in prison. Many prisoners enter custody in poor health, and weaknesses in the system mean health outcomes in prison are consistently worse than in the wider population. While investing in prison health may not be politically popular, it brings wider public health benefits and can help reduce reoffending, leading to long-term savings. Prison health is therefore not just a moral issue, but a practical one".
"The Government should start by investing more, focusing on prevention, and improving how organisations work together on prisoner healthcare, to make prisons safer places that support healthy lives and rehabilitation."
Dr Katrina Forsyth, Senior Research Fellow in Social Care and Society at The University of Manchester said: "This report from Policy@Manchester and the Social Market Foundation identifies the systemic barriers that prevent people living in prison from accessing the health and social care they need. Health and social care in prisons should be on an equivalent footing to services provided in the community, but research at The University of Manchester shows this is consistently not the case.
"Poor health amongst people living in prison is the product of overstretched systems, deteriorating environments, and long‑standing inequalities that follow people into prison. Crucially, this work highlights the growing health needs of older people and women of all ages living in prison. Addressing these issues will deliver benefits far beyond the prison walls, and policymakers should act on the evidence-led recommendations this report provides."
- The SMF report will be published at https://www.smf.co.uk/publications/prisoner-health/
[1] Mental Health in Prison.
[2] The Health of People in Prison, on Probation, and in the Secure NHS Estate in England (Department of Health and Social Care and Ministry of Justice, 2025).
[3] cx The Health of People in Prison, on Probation, and in the Secure NHS Estate in England.
