Health Inequality Cannot Be Addressed Without Including the Criminal Justice System 

The Fit for the Future: 10-Year Health Plan for England sets out a bold ambition to reduce health inequalities, shift to more preventative models of care, and improve access to underserved groups. It commits to integrating services at a neighbourhood level, improving population health outcomes, and reducing pressure on acute services through early intervention and joined-up care. However, it makes no mention of the health needs of people in contact with the criminal justice system (CJS), despite many being among the most marginalised and medically underserved in the country. This omission is stark and undermines the plan’s credibility as a truly inclusive health strategy. People in the CJS Face Some of the Worst Health Outcomes 

There is robust evidence to show that people in prison, on probation, or otherwise in contact with the CJS experience severe and overlapping health inequalities, in addition to additional, systemic inequalities. These include: 

• Mental Health: 70% of people in prison have two or more mental health conditions. Suicide rates among male prisoners are nearly four times higher than in the general population
• Substance Misuse: Over 60% of people entering prison report problematic drug or alcohol use. Many face treatment gaps upon release, increasing overdose risk 
• Chronic Conditions: Long-term conditions such as diabetes, heart disease, and asthma are significantly more prevalent within the prison populations 
• Neurodivergence: Around 50% of people in prison are estimated to be neurodivergent, often undiagnosed before entering the system 
• Racial Inequality: Black and minoritised groups are overrepresented in prisons and experience worse health outcomes, reflecting systemic racism in both health and justice systems
• These figures highlight the scale of unmet need and make it clear that a national health plan that excludes this population cannot claim to address health inequality. 

Current Policy Landscape 

The omission is especially concerning given the policy context. The live NHS England Health and justice framework for integration 2022‑2025 sets out shared a strategic ambition and principles for improving outcomes in secure and justice settings. Yet the 10-year health plan fails to reference this work or any aspect of health and justice.  

The Chief Medical Officer, Sir Chris Whitty, is in the process of compiling a report on the health of people in prison and on probation, which is due to be published in the Autumn of this year. It is hoped that this will provide a basis for pursuing an evidence-based approach to improving health outcomes for people in custody and on probation. However, its value will depend on how actively government departments, working in a collaborative manner, choose to integrate it into national planning. Cross-departmental coordination is essential given the often overlapping needs that people in the justice system present with, as well as the health inequalities faced by different sub-sections of the prison population.  

For example, older people make up a substantial, and growing, number of people in prison. Over the past two decades, there has been a rise of 243% in the prison estate’s over-60 population, and this cohort face particularly stark health inequalities. The Independent Sentencing Review’s final report acknowledge the need to address these inequalities, recommending a national strategy for older people in prison as well as measures to meet their distinct health and social care needs.  

For now, the absence of any reference to the justice system in this long-term strategy represents a missed opportunity to align efforts across health and justice. 

Community-Based Care Must Include Justice-Involved People 

The plan’s welcome focus on neighbourhood and preventative care is a welcome one, but to be a success, must acknowledge and then incorporate a focus on integrating health and justice. We know that when people leave prison, or are on probation, they can face additional barriers to healthcare, whether that’s accessing GP services, mental health support, or addiction treatment—resulting in costly cycles through emergency services and custody.  

Bringing these services into community health hubs, and designing them with inclusion at their core, would not only align with the ambitions of the 10-Year Health Plan but also create a more accessible, equitable, and person-centred model of care. This approach has the potential to reduce health inequalities by reaching individuals who are often excluded from mainstream services — including those with experience of the criminal justice system, homelessness, addiction, and trauma. It would also help to shift away from the current focus of criminal justice-based interventions for what are often health-based issues. However, realising this vision requires more than policy intent; it also requires sustained investment, cross-sector collaboration, and meaningful involvement of people with lived experience in the co-design and delivery of services. Without this, the risk is that community health hubs replicate the barriers found in existing systems rather than dismantle them. 

Conclusion

For this plan to meet its stated aims, the needs of people in contact with the criminal justice system cannot be ignored. To ensure these needs are met, we are calling on the Government to: 

• Acknowledge the specific health inequalities experienced by people in contact with the CJS. 

• Build on the forthcoming Chief Medical Officer review looking at healthcare for people in prison and on probation, including by strengthening partnership working across Government departments, executive agencies and other, arms-length bodies  

• As part of the new Civil Society Covenant, enable extensive collaboration between statutory stakeholders and the voluntary sector in order to leverage the significant expertise of voluntary organisations supporting people in the community  

• Embed health-justice considerations in neighbourhood care planning and health inequality strategies. 

• Identify gaps in provision for people leaving prison and ensure continuity of care for people on release  

Failing to do so risks further leaving behind a population that is already disproportionately affected by poor health outcomes, structural disadvantage, and systemic neglect.