Healthcare for offenders

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

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 our of hours services) rests with NHS England.

NOMS, NHS England and Public Health England have set out how we align, enable and support health and substance misuse services in prisons in a National Partnership Agreement.

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 NOMS works together with partners in health please contact:

Community Order Treatment Requirements

Community Orders were introduced as a sentencing option in April 2005 as one of the provisions of the Criminal Justice Act 2003. The Act provides for twelve possible requirements to be made as a condition of a community order. This document explores the delivery of three of the requirements as part of a community order or a suspended sentence order:

  • The Mental Health Treatment Requirement (MHTR)
  • The Drug Rehabilitation Requirement (DRR)
  • The Alcohol Treatment Requirement (ATR)

This guidance builds on previous advice from the National Offender Management Service (NOMS) on the implementation of the LASPO Act 2012, updated to reflect the changes to responsibility for probation services in England and Wales from 2014 which have resulted from the Government’s Transforming Rehabilitation reforms:

Supporting Community Order Treatment Requirements - February 2014 (PDF, 1.04MB, 28 pages)

Mental Health Treatment - Supporting Integrated Delivery guidance

Drug Testing and Drug Appointment Licence and Post-Release Supervision Condititions: Guidance on Supporting Integrated Delivery (PDF, 561KB, 22 pages)

National Partnership Agreement

National Partnership Agreement between the National Offender Management Service, NHS England and Public Health England for the co-commissioning and delivery of healthcare services in prisons in England, 2015/16.

This Agreement sets out the shared strategic intent and joint commitments in co-commissioning, enabling and delivery of healthcare services in adult prisons in England. 

The agreement sets out:

  • respective roles and objectives of  each organisations  in commissioning, enabling and delivering prison healthcare services (including public health and substance misuse services)
  • shared principles and objectives
  • shared development objectives
  • joint governance arrangements

This revised Agreement (first published in 2013) reflects the reforms to the health system for England that came into effect from April 2013 and replaces the previous National Partnership Agreement between the Department of Health and HM Prison Service (2007). It will remain a live document updated as required and routinely reviewed once a year. It is overseen by a shared Prison Healthcare Board (England).

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

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

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 15 August 2016 + show all updates
  1. National Partnership Agreement: Joint extension letter 2016 added.
  2. New version (July 2015) of Drug Testing and Drug Appointment Licence and Post-Release Supervision Conditions: Guidance on Supporting Integrated Delivery
  3. Update to National Partnership Agreement
  4. Guidance document Mental Health Treatment - Supporting Integrated Delivery guidance added to page.
  5. First published.