Chandraa Bhattacharya is the national lead for Core20PLUS5 and the wider healthcare inequalities agenda for those in contact with the criminal justice system. Chandraa works across NHS England’s Healthcare Inequalities Improvement Team and His Majesty’s Prison and Probation Service (HMPPS). Chandraa explains how the NHS is supporting those in the criminal justice system to stay healthy.

Those in contact with the criminal justice system (in prison and under supervision of probation services), a key ‘PLUS’ group of the Core20PLUS5 approach, are likely to experience healthcare inequalities worse than other disadvantaged groups.

There is approximately 25 years life expectancy gap between those in prison and the general population. This inclusion health group experience higher rates of cardiovascular disease with a third living with heart problems. More than 1 in 10 have lung problems like asthma and chronic respiratory diseases. Cancer is also prevalent, with those incarcerated and formerly incarcerated likely to have higher risk of deaths from cancer than the general population. This is due to multiple risk factors including delayed access to cancer screening programmes.

This population is also more likely to experience poor mental health, often exacerbated by drug or alcohol dependence.  The three most common diagnoses are anxiety, depression and personality disorder. 65% of the prison population is diagnosed with personality disorder and 50% of individuals on probation caseloads are found to be diagnosed with anxiety, depression and/or personality disorder.

The new NHS England framework for NHS action on inclusion health outlines five key principles to help NHS systems plan, develop and improve health services to meet the needs of people in inclusion health groups:

1. Commit to action
2. Understand the characteristics and needs of people in inclusion health groups
3. Develop the workforce for inclusion health
4. Deliver integrated and accessible services
5. Demonstrate impact and improvement through action on inclusion health

Aligning with the above and whole-system priorities, I am working with internal and external partners, nationally and regionally, to develop an evidence-based programme of work to support those in the criminal justice system.

The purpose of this work is to fill the current gap in evidence, raise awareness of health risks, improve health literacy, improve uptake of health checks and screenings and provide resources to enable regions to effectively support this inclusion health group.

The work includes development of:

• A suite of evidence reports based on surveys conducted with adults in the criminal justice system
• A national prison radio campaign in adult male and female prisons to raise awareness of health risks and encourage healthy behaviours
• An interactive poster campaign for adults under supervision of probation services with information on common health issues for the population (see the animation that is accessible via a QR code on the posters below)
• A report based on a survey of prison officers which will provide useful data on how best to engage people in prisons

We have also piloted a virtual ‘Directory of Help’ in two men’s prisons. The Directory is a digital platform where prisoners can find out more about health conditions  without requiring access to the internet and use it to book appointments if required. The findings from its evaluation are being embedded within the five domains of the Inclusive digital healthcare: a framework for NHS action on digital inclusion.

By the end of this year, we will be publishing a report based on the lived experience of those in contact with youth justice which will embed our Children and Young People’s Core20PLUS5 approach. This will inform a national prison radio campaign in the youth offending institutions across the country to address their healthcare inequalities. This follows the success of the campaign running in adult prisons which increased awareness of mental health and cancer issues and was scored ‘useful’ by 80% of prisoners surveyed.

I hope that health and justice partners nationally, regionally and in the systems use these resources to plan, develop and improve health services to meet the needs of people in this inclusion health group and narrow their health inequalities gap.