The system and the cell: A systems perspective on prisoner health

This report, produced in partnership with the Social Market Foundation, highlights systemic issues within the prison healthcare system and makes key recommendations for policymakers.

The System and the Cell is a new report from Policy@Manchester and the Social Market Foundation, exploring the deep-rooted challenges in delivering health and care to people in prison. Drawing on research and interviews from academics at The University of Manchester, as well as insights from practitioners, the report provides an overview of physical health, mental health, women’s health, and the needs of older prisoners. It highlights the consistent and underlying causes of poor health in prison: chronic under‑resourcing, a deteriorating estate, fragmented services, and weak coordination between health and justice systems.

The report argues that improving health in prison is not only a legal obligation, grounded in the principle of equivalence, but also vital for reducing the cost to taxpayers of untreated poor health, and reducing reoffending. It offers high-level policy recommendations aimed at strengthening the foundations of prison healthcare, through sustainable funding, preventative approaches, better integration of services, and stronger cross-government leadership.

Key themes and recommendations:

• People in prison experience worse physical and mental health than the general population, with widespread long‑term conditions, high self‑harm, and significant unmet need.
• This is driven by both the prison environment, and the conditions faced by many prisoners before entering custody.
• Women and older prisoners in particular face acute, often overlooked, health needs that current services are not equipped to meet.
• Improving prisoner health is essential for public health and reducing reoffending, requiring coordinated, system‑level action.
• Recommendations focus on sustainable funding and staffing; prioritising prevention and practical interventions; improving coordination and integration across health and justice systems; and strengthening cross-departmental oversight of prison health.