Blog

About the Author
Dr Rory Wilson is the Public Health Education Fellow for 2025-2026. His fellowship is split between the Public Health Team and the Medical Education Department. This project aligns with his focus on addressing health inequalities through education.

About the Project

British law establishes the principle of equivalence in prison healthcare. In plain English, this means that prisoners should receive the same range and quality of healthcare as the general population. In reality, this can be rarely achieved due to structural constraints within the prison system, and operational challenges for prisoners when accessing and using NHS services. Clinical staff are often unaware of these challenges until they encounter them first-hand.

At Northumbria Healthcare NHS Foundation Trust, we are a secondary and tertiary care provider for HMP Northumberland, the only prison within our catchment area. HMP Northumberland is a Category C prison currently holding approximately 1,348 male prisoners. Many of our clinical staff, either in clinics, on wards or in emergency departments will care for prisoners at some point in their careers, and yet until recently, there was no structured training to prepare staff on how to provide healthcare to prisoners.

That is why we have developed a new e-learning module on prisoner healthcare, now available to all Trust staff on Kallidus, our internal training platform. 

Prisoner Healthcare
Prisoners have poorer health outcomes than the general population, including lower life expectancy and a higher rate of substance misuse and mental illness, often compounded by reduced access to healthcare services. Prisoners have been identified by the NHS as an ‘inclusion health’ group, which are specific populations experiencing significant health inequalities.

One clear inequality is healthcare access. Nationally, prisoner non-attendance at hospital outpatient appointments is 40.2%, compared to 7.6% in the general population. At Northumbria Healthcare Foundation Trust, our rate is slightly lower than the national average, but it remains significantly higher than our general population's. The reasons are multifactorial, including limited capacity for prison officer escorts and other security considerations.

What the training module covers
The training module walks staff through the realities of providing healthcare to prisoners. It explains why prisoners often experience poor health outcomes and the specific role of Spectrum Healthcare, the commissioned primary care provider at HMP Northumberland.

It provides practical guidance for clinical staff on how to best care for prisoners as patients.

Key topics covered in the module include:

• Guidance on interacting with and treating prisoners who are handcuffed to prison officers. This impacts confidentiality and the ability to conduct examinations.
• Best practice on working with the prison during a prisoner’s inpatient stay.   
• Communication strategies for prisoners:this is important as recent data shows that 57 per cent of adult prisoners have literacy levels below those expected of an 11-year-old.
• Safe prescribing including guidance on medications that are suitable for prisons.
• Discharge planning which covers the logistical considerations around discharging patients back into a highly controlled environment.
  
  
  The module also highlights the ongoing partnership between the Trust and Spectrum Healthcare, the in-house medical service within HMP Northumberland, to improve prisoner healthcare.

Current quality improvement projects include:

• Piloting in-reach (in the prison) hepatology and colorectal clinics.
• Training Spectrum staff in hospital procedures, such as fitting 24-hour ECG tapes.
• Expanding the use of virtual outpatient appointments.
• Improving communication pathways.

How we built it
The Public Health team initiated this project then developed it through a collaborative process. We worked closely with specialty teams across the Trust to review and refine the clinical content, and with Spectrum to ensure it accurately reflects the practical realities of prisoner healthcare. The Learning and Education team were instrumental in building the final module on Kallidus.

What staff can do
We encourage all staff to complete the training module and consider their role in improving prisoner healthcare.

Practical steps include:

• Understanding the specific challenges prisoners face when attending appointments or as inpatients.
• Treating prisoners with the same respect as any other patient.
• Raising concerns through Datix reporting if prisoner healthcare is compromised by operational issues.
• Undertaking quality improvement projects to tackle identified issues in prisoner healthcare. The Public Health team is available to support this work.

Looking ahead
With HMP Northumberland due to expand its capacity in early 2027, the number of prisoners accessing Trust services will rise. Embedding this training now ensures our staff are prepared to deliver equitable care as demand grows.