Healthcare for offenders

How offender healthcare is managed in prisons and in the community.

Applies to England and Wales

Helping offenders to recover from addiction and illness can significantly reduce reoffending and cut crime in local communities.

It also helps to tackle some of the most significant health inequalities in communities as offenders are more likely to smoke, misuse drugs and/or alcohol, suffer mental health problems, report having a disability, self-harm, attempt suicide and die prematurely compared to the general population.

Health and justice services therefore work closely together to achieve these shared aims.

Arrangements for policy, commissioning and funding healthcare services for offenders differs between England and Wales and between custody and the community.

Healthcare in prisons in England

From April 2013, responsibility for commissioning all healthcare services for prisoners (including drug and alcohol services but excluding emergency and out of hours services) rests with NHS England.

The Ministry of Justice (MOJ), the Department of Health and Social Care, HM Prison and Probation Services (HMPPS), NHS England and Public Health England have set out how we align, enable and support health and substance misuse, and social care services in prisons in England in a National Partnership Agreement.

The impact of the National Partnership Agreement for England upon those with protected characteristics has been assessed in line with the Public Sector Equality Duty (PSED)

Healthcare for offenders in the community in England

Offenders in the community are generally expected to access the same healthcare services as the rest of the local population. From April 2013 Clinical Commissioning Groups (CCGs) are responsible for commissioning the majority of these healthcare services (including mental health services) with local authorities responsible for commissioning public health services, including drug and alcohol services. Health and Wellbeing Boards develop Joint Strategic Needs Assessments (JSNAs) to inform Health and Wellbeing Strategies which in turn inform local commissioning of services. It is important therefore that these include an understanding of the needs of those in contact with the criminal justice system.

More information: Guidance on Joint Strategic Needs Assessments and Health and Wellbeing Strategies

More information on engaging criminal justice agencies in local healthcare commissioning, building effective engagement (NHS Confederation):

Health and wellbeing boards and criminal justice system agencies: building effective engagement

Healthcare for offenders in Wales

Local Health Boards (LHBs) commission healthcare services in public sector prisons (including clinical drug treatment services), and are responsible for commissioning mainstream healthcare services which offenders in the community will access.

More information: Healthcare Services for Prisoners (NHS Wales) and Prison Health in Wales (Public Health Wales)

For more information about how HMPPS works together with partners in health please contact:

Community Sentence Treatment Requirements

Courts are able to order mental health, drug or alcohol treatment as part of a community sentence. Such treatment requirements allow offenders to access treatment in the community which tackles underlying problems related to their behaviour. In terms of reducing reoffending, treatment orders may be more effective than a short prison sentence.

The 3 types are Mental Health Treatment Requirements (MHTR), Drug Rehabilitation Requirements (DRR) and Alcohol Treatment Requirements (ATR). These aim to address an individual’s mental health and/or substance misuse issues which may be the underlying cause of their offending behaviour.

MOJ, Department of Health and Social Care (DHSC), NHS England, Public Health England and HMPPS have developed a protocol to support the greater use of community sentences with treatment requirements (CSTR) in courts. The protocol is operating across 5 sites within England; Milton Keynes, Northamptonshire, Birmingham, Sefton and Plymouth.

CSTR Process Evaluation

DHSC led a process evaluation of the implementation of the protocol. This was to:

  • understand the mental health and substance misuse needs of offenders, and whether existing health arrangements accommodate for these needs
  • understand any barriers to an individual being given a CSTR, and if so, what these are
  • find out whether the protocol works and whether changes are needed ahead of any further roll out

CSTR process evaluation report (PDF, 1.5 MB, 82 pages)

CSTR process evaluation summary report (PDF, 497 KB, 13 pages)

National Partnership Agreement for Prison Healthcare in England 2018-2021

This document sets out the partnership agreement between the Ministry of Justice, Her Majesty’s Prison and Probation Service, Public Health England, the Department of Health & Social Care, and NHS England.

A partnership agreement has been in place to support the commissioning and delivery of healthcare in English prisons since 2013.

This revised agreement adds the Ministry of Justice and the Department of Health and Social Care to the original tripartite partnership - marking the establishment of an even stronger level of co-operation and cohesiveness between all of those who can impact on the policy, commissioning and delivery of health and social care services in both public and private sector prisons in England. It will remain a live document updated as required and routinely reviewed once a year. It is overseen by the National Prison Healthcare Board.

The National Partnership Agreement for Prison Healthcare in England sets out:

  • the defined roles of the five partners
  • our commitment to working together and sharing accountability for delivery through our linked governance structures
  • our core objectives and our priorities for 2018-21
  • how we are working together to improve our data and evidence so that we can better understand the health needs of people in custody and the quality of health and social care services delivered to people in prisons.


This Workplan sits under the National Partnership Agreement for England and outlines the details of the activities being undertaken to deliver it’s ten priorities. These priorities, and the activities described in the Workplan, collectively contribute to the three shared objectives detailed in the National Partnership Agreement.

The National Partnership Agreement workplan will be subject to review and updates as the work of the National Prison Health Partnership for England progresses.

National Partnership Agreement for Prison Healthcare in England 2018 to 2021 (PDF, 747 KB, 14 pages)

National Partnership Agreement: Commissioning delivery of Healthcare in Prisons 2015 - 2016 (PDF, 436 KB, 46 pages)

National Partnership Agreement: Joint extension letter 2016 (PDF, 72.6 KB, 1 page)

National Partnership Agreement for Prison Healthcare in England: Workplan (PDF, 305 KB, 25 pages)

NPHB Equivalence of Care principle (PDF, 437 KB, 5 pages)

NHS England holds similar agreements with co-commissioners of healthcare services in other secure settings such as Immigration Removal Centres and the Children and Young People’s secure estate.  Further details of these agreements may be found on the NHS England Health and Justice webpages.

Published 1 July 2014
Last updated 9 October 2019 + show all updates
  1. Added NPHB Equivalence of Care principle powerpoint

  2. CSTR process evaluation report and summary report published.

  3. Updated National Partnership Agreement for Prison Healthcare in England 2018 to 2021 document

  4. Updated content and added NPA workplan.

  5. National Partnership for Prison Healthcare in England, 2018 to 2021 published.

  6. National Partnership Agreement: Joint extension letter 2016 added.

  7. New version (July 2015) of Drug Testing and Drug Appointment Licence and Post-Release Supervision Conditions: Guidance on Supporting Integrated Delivery

  8. Update to National Partnership Agreement

  9. Guidance document Mental Health Treatment - Supporting Integrated Delivery guidance added to page.

  10. First published.