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Reform and investment are urgently needed to improve outcomes and save lives The global prison population totals around 11.5 million people,1 and over 30 million people move between communities and prisons each year.2 Prisoners experience a disproportionate burden of ill health, including high levels of long term physical and mental illness, bloodborne virus infections, and substance misuse.3 Healthcare delivery is difficult in overcrowded, often outdated prison estates facing security, staffing, and funding challenges.4 Prisoners experience variable healthcare quality,5 delays to assessment and treatment,6 stigma and discrimination,7 and poorer health outcomes, including excess mortality.8 People in contact with the justice system often experience health inequalities, including social exclusion, whether they are living in custody or the community.9 The principle of equivalence that prison healthcare “should be of the same scope and quality” as services in the community is well es

Laura sheardKate mclintockNational confidential enquiryPatient outcome