The recent publication of the Chief Medical Officer’s report, the health of people in prison, on probation and in the secure NHS estate in England, marks a significant contribution to the health and justice landscape. It brings together evidence, clear analysis, and a strong focus on the realities that people in the system face. 

One of the most notable strengths of the Chief Medical Officer’s report is the central role of lived experience in shaping its priorities, analysis and recommendations. Rather than being included as an add-on, the voices of people in prison, on probation and in secure settings are woven throughout the document. Their first-hand accounts help illuminate the issues that matter most to those using health services such as difficulties accessing healthcare, managing long-term conditions, and coping with the emotional pressures of imprisonment. 

The report also reflects insights from voluntary sector organisations working closely with people every day, ensuring that long-standing barriers in the system are clearly understood and directly addressed. Feedback from lived experience groups has helped refine the tone and focus of key sections, particularly those relating to trauma, inequality and women’s health needs. 

For those of us who work alongside people with lived experience, this approach is significant. It demonstrates the impact of meaningful engagement with those who understand the system from the inside and shows how their perspectives can lead to more compassionate, realistic and effective health recommendations. 

A powerful acknowledgement of inequality 

The report reinforces what many of us working in health and justice have long known and what the evidence has consistently highlighted: people in the criminal justice system experience significantly poorer health than the general population. These inequalities are shaped by trauma, poverty, exclusion, and a lifetime of unmet needs. 

The report doesn’t shy away from stark truths. It highlights record levels of self-harm, the high prevalence of long-term conditions, and the reality that our current systems are struggling to respond. By presenting these challenges clearly and grounding them in the real experiences of people in prisons and on probation, the CMO has created a document that is difficult to ignore. 

A major step forward for women’s health in the criminal justice system 

One of the most powerful aspects of this report is its focus on women. For years, women’s health needs, especially those of pregnant and postnatal women, have been under-researched, misunderstood, or overshadowed by a system built around the needs of men. This report changes that narrative. 

Key points include: 

• Serious risks to pregnant women and infants in custody, reinforcing the medical consensus that imprisonment should be avoided wherever possible for pregnant and postnatal women. 

• Exceptionally high levels of trauma, with most women in prison and on probation having experienced domestic abuse or childhood trauma. 

• Self-harm rates nine times higher than men, reflecting deep emotional distress linked to past harm and systemic failings. 

• A recognition that most existing research in prisons has been centred on men, leaving critical gaps in understanding women’s needs. 

These findings reflect what Clinks is exploring through our ongoing women’s self-harm research project, which seeks to understand why self-harm rates continue to rise and to centre the voices of women with lived experience to identify solutions. 

This level of clarity, combined with the lived experience woven throughout the narrative, feels like a turning point. Organisations such as Birth Companions and Women in Prison have welcomed the report precisely because it articulates what they and women themselves have been saying for years: the system must become trauma-informed, gender-responsive, and rooted in dignity. 

Older people in prison - ‘an increasing health issue’ 

The CMO is also right to highlight the challenges of a prison population that is growing significantly older. The numbers are stark - between 2011 and 2024, the number of people in prison aged 50 and over has increased from 11% to 24%. This creates numerous difficulties in the running of effective prison regimes. Prisons, in their current state, are not set up to cater for the older population. There is limited adaptation to cope with immobility, and there is insufficient training for staff in supporting those suffering from dementia.  

A strategy dedicated to meeting the needs of this cohort, as recommended by the Independent Sentencing Review, is therefore much needed. We look forward to working with officials on developing this strategy and will be facilitating a re-constituted older people in the criminal justice system network to feed in voluntary sector expertise.  

A call to action for all of us 

The report makes clear that awareness alone is not enough. We now have the evidence, the testimony, and the insight. 

The question is: what will we do with it? 

For the voluntary sector, for NHS partners, and for government, this is a moment to move from acknowledgement to implementation, to build trauma-informed pathways, gender-responsive services, and health systems that recognise people’s lives, not just their diagnoses. 

At Clinks, we see this as a shared challenge and a shared opportunity. The voluntary sector has always played a crucial role in supporting people in prison, on probation and in the community. This report reinforces the value of that role and the need for continued collaboration, investment, and leadership. 

This report is a powerful foundation for progress. Now we must build on it.