Health and care for people in the criminal justice system is influenced by a wide spectrum of different policy areas and developments: Prison Safety and Reform; the NHS Five Year Forward View for Mental Health implementation plan; NHS strategic directions for health services in the justice system; Sustainability and Transformation Plans; the government-wide Suicide Prevention Strategy (which this year refers specifically to people in the criminal justice system for the first time), to name just a few …
It was helpful, therefore, to attend a recent event exploring different areas of health and justice strategy and next steps for health in the justice system.
With 12 speakers in less than 4 hours, from all different sectors and backgrounds, the ‘Next steps for healthcare in the justice system’ event had a packed agenda and I left with my head spinning from the sheer volume of information. But it was interesting to reflect on some of the common themes which emerged from the various presentations and discussions.
Prison reform and governor autonomy…
…was seen as a key opportunity for reform – but also a risk.
Naturally a key focus for much of the morning was the planned programme of prison reform, and how healthcare can both influence, and will be influenced by, these changes.
Since 2013, healthcare in prisons has been commissioned by NHS England, and governed by a National Partnership Agreement between National Offender Management Service, NHS England and Public Health England. Under the prison reform plan, NHS England will sign a co-commissioning agreement with each prison governor, to guide the commissioning of healthcare for each establishment.
This greater involvement for governors has the potential to overcome some of the current barriers to improving healthcare by improving integration with the wider prison. However, some participants felt it should carry a health warning of the dangers of inconsistent provision and of missing the opportunity to drive through cultural change.
Health in the justice system needs to be understood in its wider context
Different speakers raised a range of issues which add to the challenges for health in the justice system—from the fragmented commissioning and delivery of healthcare in custody and the community, to pressures on related services such as mental health, social care and housing. Yet they also saw opportunities for improving coordination and continuity of care, such as through liaison and diversion services in police custody and courts, or local authority initiatives to support improved access to housing or GP services.
People with lived experience
There was strong, welcome support for listening to the voice of lived experience from both speakers and delegates.
Kate Davies (Head of Health and Justice at NHS England) was absolutely clear that both current and former service users need a place at the table in shaping prison reform if it is to be effective. Several speakers mentioned the need to listen to groups such as older offenders to design services which respond to the needs of all.
It was fantastic to hear several of Inspirit Training’s Commissioning Technicians, all people with recent lived experience, speaking up and getting involved in the discussions too.
Radical cultural change
The need for radical cultural change was also raised a number of times, with speakers advocating for a therapeutic approach throughout the criminal justice system, to ensure both staff and patients’ health needs are appropriately considered and supported.
Lord McNally, outgoing chair of the Youth Justice Board (YJB), was clear that promoting holistic, cross-disciplinary approaches to care in the youth justice system, was key to the YJB’s achievements in reducing the numbers of young people in custody. Although he also thought that a further revolution in health and mental health services for young people is still needed.
Whether the current raft of policy changes and strategy documents will succeed in delivering these changes remains to be seen—but it was at least heartening to hear themes which are close to the heart of the voluntary sector being reflected by such a wide range of speakers.