Health and justice


NHS England Health and Justice is responsible for commissioning healthcare for children, young people and adults across secure and detained settings, which includes prisons, secure facilities for children and young people, police and court Liaison and Diversion services and immigration removal centres. It is responsible for commissioning £503 million of services to meet a wide range of health and care needs across detained and secure settings and also sexual abuse/assault services.

NHS England Health and Justice teams commission to the ‘principle of equivalence’ which means that the health needs of a population constrained by their circumstances are not compromised and that they receive an equal level of service as that offered to  the rest of the population.

NHS England health and justice commissioning supports effective links with Integrated Care Systems (ICS) and Local Authorities to support the delivery of social care within secure settings and the continuity of care as individuals move in and out of them. The Health and Justice services are commissioned via 10 Health and Justice teams across 4 regions (North, Midlands, London and South).

Our ‘Strategic direction for health services in the justice system: 2016 – 2020’ is the health & justice strategic document which sets out the ambition of NHS England to improve health and care outcomes for those in secure and detained settings, support safer communities and social cohesion. This was developed in collaboration with health and justice commissioning leads, service users, clinicians, providers, the third and independent sector as well as our partners in HMPPS (Her Majesty’s Prison and Probation Service) and Public Health England.

The ambition is to narrow the health inequalities gap between those in the criminal justice system and the rest of the population and improve their outcomes. We support a reduction in the number of people who are detained as a result of undiagnosed and untreated mental health issues and also support continuity of care after release.

The following seven priority areas have been selected as key to meeting this ambition between now and 2020.  Improving quality and reducing variation are at the heart of each one.

  1. A drive to improve the health of the most vulnerable and reduce health inequalities
  2. A radical upgrade in early intervention supported by effective Liaison and Diversion services
  3. A decisive shift towards person-centred care that provides the right treatment and support
  4. Strengthening the voice and involvement of those with lived experience
  5. Supporting rehabilitation and the move to a pathway of recovery
  6. Supporting continuity of care, on reception and post release, by bridging the divide between healthcare services provided in justice, detained and community settings
  7. Greater integration of services driven by better partnerships, collaboration and delivery

The commissioning of Health and Justice Healthcare works to ensure high quality services in:

The national clinical oversight for Health and Justice commissioned services is given through the Health and Justice Clinical Reference Group and strategic governance is delivered through assurance groups relating to each area of commissioning responsibility and an overarching national Health and Justice Oversight Group, which reports to NHS England’s Commissioning Committee.

For useful resources visit the Health and Justice resources page.

Prison healthcare and young offender institutions

NHS England is responsible for commissioning healthcare for people in prisons and young offender institutions in England (with the exception of emergency care, ambulance services and out-of-hours services).

The range of services which are directly commissioned for prisons include primary (GP) and secondary (hospital) care services (hospital care), public health (including substance misuse services (under a section 7a agreement with the Department of Health), dental, ophthalmic (eye care) services and mental health services.

There are currently 118 prison establishments in England, each with a healthcare centre for prisoners. NHS England works very closely with key partners to ensure the delivery of high quality services for all in need.

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 a National Partnership Agreement.

NHS England have developed a new service specification for prison mental health services, as well as a new service specification for prison based substance misuse services, these will be commissioned against from April 2018 with a gradual implementation in existing contracts. All Health and Justice service specifications from April 2018, should be read in conjunction with the standard annex.

The 2017 NHS Benchmarking Audit of Prisoner s waiting for MHA assessment, transfer and remissions

This report summarises the results of an audit that has taken place across Health and Justice Commissioning services, Her Majesty’s Prison and Probation Service (HMPPS), and NHS England Specialised Commissioning to quantify the extent of prisoners waiting for assessment and for transfer and remission  to and from mental health facilities (secure and non-secure services).

Immigration removal centres

A three-year National Partnership Agreement between NHS England, Home Office Immigration Enforcement and Public Health England (2018-21) sets out the shared strategic intent and joint commitment to work together for the purposes of setting out shared strategic intentions, joint corporate commitments and mutually agreed developmental priorities for NHS England, Public Health England and Home Office Immigration Enforcement. The agreement sets out that these organisations will work together to commission and deliver healthcare services in Immigration Removal Centres (IRCs) across England.

The national summary report, Health and Wellbeing Needs Assessment (HNA) Programme – Immigration Removal Centres and Residential Short Term Holding Facilities, commissioned by the Home Office and supported by NHS England, aims to provide a national baseline for both organisations to inform future service commissioning for healthcare in Immigration Removal Centres.

Children and young people’s secure settings

NHS England Health and Justice are delivering the Health and Justice Specialised Commissioning Workstream of the Five Year Forward View for Mental Health.  This looks at the needs of some very vulnerable children and young people whose particular mental healthcare requirements can be hard to meet through conventional services, as a result of their unique and complex circumstances.

You can read more about the work of the Children and Young People programme on their webpage.

Care of women who are pregnant and post-natal in detained settings service specification

NHS England is committed to supporting the improvement of health services for women in prison and ensuring equivalence of care with women in the community. An important element of this is maternity service provision, which is supported by the Care of women who are pregnant and post-natal in detained settings service specification. This sets out information on the expectations and standards required for commissioning bespoke pregnancy and post-natal services for the women’s detained setting in England. In particular, it supports recommendations arising from the Ockenden Review and maternity specific recommendations from the Prisons and Probation Ombudsman.  As of June 2022, it is expected that health and justice commissioners follow this service specification when commissioning maternity services within prisons.

Liaison and Diversion

The Liaison and Diversion (L&D) service aims to identify, assess and refer people with mental health, learning disability, substance misuse and social vulnerabilities when they first come into contact with the police and criminal justice system. You can find more information and useful resources about the Liaison and Diversion programme on their webpages.

Public Health initiatives

NHS England Health and Justice is responsible for commissioning public health services for children and adults in secure and detained settings in England. This is part of NHS England’s public health responsibilities and involves working closely with Public Health England.

People in prisons and other places of detention often experience significant health inequalities compared with their peers in the community. We have several areas of work to address public health type inequalities. These include:

  • Helping adults in the prison estate to quit smoking and working with Her Majesty’s Prison and Probation Service to roll out of the national ‘Smoke Free Prison’ programme.
  • Developing a new service specification for the treatment of adult’s with substance misuse issues in the prison estate. This emphasises recovery, lived experience, ‘Through the Gate’ care, dealing with psychoactive substances, reducing drug-related deaths, reducing reoffending and improving outcomes.
  • Supporting the national Drug Recovery Prison pilot which is a cross-government approach to enhancing recovery from substance misuse, being piloted at HMP Holme House.
  • Ensuring the effective and consistent delivery of both Health Checks and blood borne virus screening, including Hepatitis B and C and HIV, and access to treatment pathways.
  • Work to ensure more effective recording of public health activity in the secure estate.
  • Reviewing the delivery of other public health screening and vaccination programmes within the secure estate, including HPV vaccination, bowel screening, retinal screening, abdominal aortic aneurism screening.

Health and Justice Clinical Reference Group (CRG)

This group works to support ‘what good looks like’ across the Health and Justice clinical care sector. It aims to promote the implementation of quality standards across England and is a two-way resource linking into regional and area teams. You can find out more about the Clinical Reference Group on their webpage.