Specialised knowledge and skills to ensure the safety and well-being of both staff and those in their care.
Note:
This is intended as an introductory overview and not as specific or direct clinical advice. It does not substitute for the clinical and legal responsibilities of the clinician, as outlined by regulatory bodies and laws.
Healthcare in secure settings involves working with a population with complex needs, requiring resilience and communication skills in a challenging environment. The challenge stems from addressing the mental and physical health needs of individuals living in a distinct setting with a fixed regime, complicated by multiple stakeholders and competing demands on time.
Across England & Wales, Scotland, and Northern Ireland
As of December 2024
Operated by the Home Office
Represent the prison population in England and Wales (84,234 individuals).​
High security prisons that house male prisoners who, if they were to escape, pose the most threat to the public, the police or national security.
Either local or training prisons. Local prisons house prisoners taken directly from court in the local area (sentenced or on remand), and training prisons hold long-term and high-security prisoners.
Training and resettlement prisons where most prisoners are located. They provide prisoners with the opportunity to develop their own skills so they can find work and resettle back into the community on release.
Open prisons with minimal security that allow eligible prisoners to spend most of their day away from the prison on license to carry out work, education or for other resettlement purposes.
Categorized and held in either closed conditions or open conditions, according to their risks and needs. High-risk individuals are categorized as 'restricted status'.
Young Offender Institutions (YOIs) house prisoners aged 18-21, while Youth Custody establishments house young people under 18 who have been remanded or sentenced to detention.
Prison staff assess prisoners when they're first sentenced and also throughout their time in prison, to identify whether or not they're still in the right prison category.
These prisons primarily hold prisoners who are remanded awaiting trial or convicted and awaiting sentence, often located near the court area.
These prisons focus on providing training and educational opportunities to help prisoners develop skills and prepare for release.
These prisons prepare prisoners for release, offering programs and support to help them adjust to life outside of prison.
Immigration Removal Centres (IRCs) are facilities where individuals, who are subject to immigration control, are detained while their immigration status is being determined or while awaiting removal from the UK. The UK currently has seven Immigration Removal Centres.
The Home Office currently operates one Pre-Departure Accommodation, three residential Short Term Holding Facilities (STHFs), seven Immigration Removal Centres (IRCs) and 13 In-Use Short-Term Holding Facilities which can be used to detain individuals under Immigration Act Powers.
Independent oversight is provided by HM Inspectorate of Prisons, Independent Monitoring Boards, the Prisons and Probation Ombudsman and the Independent Chief Inspector of Borders and Immigration.
NHS England Health and Justice is responsible for commissioning a range of healthcare services that support children and adults throughout the youth justice and criminal justice systems in England.
Provide a wide range of healthcare services, including primary care, mental health support, and substance misuse treatment.
Offer primary care services to prisoners, often working alongside other healthcare professionals.
Address the mental health needs of prisoners, providing assessment, treatment, and support.
Manage medication and ensure safe and effective drug dispensing.
Provide essential support to nurses and other healthcare professionals, assisting with patient care.
Provide specialized dental and foot care services.
Offer rehabilitation and emergency medical care.
Provide advanced nursing care and may have expanded roles in primary care and mental health.
I am a GP. I have been a GP for 13 years and I have worked in Secure environments for the last 10 years.
I think it fair to say I didn't think I would end up working in Prisons and I don't think my friends at medical school and even along my early years thought for one second I would either.
My first secure job shift was a GP locum shift in HMP Norwich but I think more regular work started in Harmondsworth IRC.
Working as a GP in Secure environments is "Working as a GP". Prisoners are people and people have healthcare needs and the same physiology and a GP works in the same way with all people, irrespective of the environment.
In Prisons and IRCs, the Healthcare is an NHS commissioned Service. This means that the prisoners/inmates/residents have the same access to services/care as in the community. They can access emergency care, routine primary care and secondary care.
There are differences or nuances to working in Healthcare:
- There is a regime in the prison
- The GP works as part of a wider team
- The populations have a greater demand of healthcare and there is a greater proportion of mental health issues due to many reasons which include underlying mental health, trauma and the nature of the prison system and environment.
In Healthcare we treat the patient not the crime, so I don't know what crime the individuals have committed, nor can I directly access it. It would not be true to say that I am completely unaware of the nature of the crime but it is sometimes helpful not to know to maintain impartiality.
Psychiatrists in secure environments face unique challenges dealing with complex mental health needs. We manage severe conditions often complicated by substance misuse and trauma histories, while navigating security protocols and multidisciplinary coordination.
Medication management in secure environments requires careful consideration of security risks while ensuring patients receive necessary treatments. We manage medication administration safely while addressing challenges like medication diversion and abuse potential.
Nursing in secure settings involves balancing healthcare delivery with security considerations. We provide comprehensive care including physical health assessments, mental health support, and substance misuse services within strict institutional protocols.
Dental care in secure environments addresses significant accumulated dental needs. We balance emergency treatment with preventative care while adapting to security limitations on instruments and materials.
Prison officers work closely with healthcare teams to ensure patients safely attend appointments. We help manage security considerations while supporting health professionals to deliver care effectively.
There are a number of requirements (in addition to the expected professional qualifications, professional registrations and competencies of the specific healthcare role, and indemnity).
There is a need to assess an individual's suitability for working within the criminal justice system, ensuring the safety of staff and prisoners, and complying with relevant legislation. United Kingdom Security Vetting (UKSV) is the main UK government provider of security clearances.
Security training is undertaken as part of orientation and will have components specific to certain sites. It is especially important for those new to the Secure environment but provides an overview of the legal obligations of the worker and also challenges of the environment.
This resource outlines common challenges faced by healthcare professionals working in secure environments such as prisons and other secure facilities.
