Who is responsible for healthcare in prisons
In shortIn England NHS England commissions prison healthcare; the governor runs the prison, and healthcare staff answer to their own provider and regulators.
NHS England says there are currently 118 prison establishments in England. The principle it applies is 'equivalence': people in custody should receive care consistent in range and quality with what they would get in the community.
NHS England commissions healthcare for prisons on a prime provider model: it contracts with a lead provider, which can deliver care itself or subcontract specialist parts.
A 2021 Nuffield Trust explainer, dated October 2021, notes that NHS England has commissioned prison health services directly since 2013, with clinical commissioning groups responsible for emergency and out-of-hours care, and integrated care systems able to take on commissioning from April 2022. Check current arrangements before relying on any structural detail.
- Primary (GP) and secondary (hospital) care
- Public health services including substance misuse
- Dental and eye care
- Mental health services
The roles in a prison healthcare team
In shortThere is no national list of prison healthcare jobs, and the team on site depends on the prison.
The best picture comes from the way services describe themselves in job adverts. A typical NHS trust advert describes an integrated model delivering mental health, physical health, pharmacy and clinical substance misuse care.
A large local prison with a busy reception, an inpatient unit and a big substance misuse population will have a different team from a small open prison. The table below describes roles in general terms using the wording of NHS England's service description and typical adverts; it is not a staffing standard.
- General nurses and mental health nurses
- Substance misuse practitioners and advanced nurse practitioners
- GPs, psychiatrists and paramedics
- Physiotherapists, dentists, opticians and podiatrists
| Role | What the work generally covers | Where this comes from |
|---|---|---|
| GP and advanced nurse practitioner | Primary care: assessing, diagnosing and treating physical health problems | NHS England primary care description; NHS adverts |
| General nurse | Everyday clinical care, long-term condition management and medicines | NHS adverts |
| Mental health nurse or practitioner | Specialist mental health care, often in an in-reach team | NHS England mental health services; adverts |
| Substance misuse nurse or practitioner | Clinical and psychosocial support for people dependent on drugs or alcohol | NHS England public health services including substance misuse; adverts |
| Dentist, optician, podiatrist, physiotherapist | Dental, eye, foot and musculoskeletal care | NHS England dental and eye care; adverts |
| Psychiatrist and psychologist | Specialist assessment and treatment for mental illness | NHS adverts; Northern Ireland trust description |
| Paramedic and healthcare assistant | Urgent assessment and support for the clinical team | NHS adverts (varies by provider) |
Compiled from NHS England's health and justice page and examples of NHS adverts seen on 3 October 2026. Check the specific advert for the real structure.
How the law and policy join officers and healthcare together
In shortThe wing officer's first role is relay, not diagnosis, and policy sets three hand-offs to healthcare.
Under rule 20 of the Prison Rules 1999, a prisoner's request to see a doctor, nurse or other healthcare professional is recorded by the officer who receives it and passed promptly to the medical officer. After that the officer's job is to keep the prisoner safe and make sure clinicians can do theirs.
HMPPS use of force policy says where a registered healthcare professional is on site they must attend any use of force incident as a priority, must be briefed on what force has been used, and must be expected to take an active role in the prisoner's wellbeing.
Clinical advice given must be adhered to by the supervisor and team.
Where no registered healthcare professional is available, for example in a prison without 24-hour healthcare, the framework says a member of staff trained in PAVA and its aftercare fulfils the PAVA-related obligations and completes an observation sheet. Our PAVA and body-worn camera guide covers the equipment side.
Use of force framework requirements
- In a medical emergency all force must cease, the recovery position and first aid are used and a healthcare professional is requested immediately
- Prisoners must see a registered healthcare professional within 24 hours of force being used
- They must be examined and recorded as seen even if there is no visible injury
Self-harm, mental capacity and consent
In shortSelf-harm is a major area where staff and clinicians work in step, and capacity decisions sit with a qualified medical professional.
- Self-harm incidents70,63212 months to March 2026
- Rate812 per 1,00010% lower than a year earlier
- Samaritans (free)116 123
The Ministry of Justice's Safety in Custody statistics report 70,632 self-harm incidents in the 12 months to March 2026, a rate of 812 per 1,000 prisoners, 10% lower than a year earlier; the rate in the women's estate was over nine times the male rate.
If you need support, Samaritans can be reached free on 116 123.
After an incident in which PAVA was used to manage someone at serious risk to themselves or others, the use of force framework says an Assessment, Care in Custody and Teamwork (ACCT) plan must be opened if there is not one already. ACCT is the safer custody process run by prison staff with healthcare input.
Mental Capacity Act 2005
The framework says that where a prisoner lacks capacity, the decision on capacity and treatment is taken and directed by a qualified medical professional who has carried out an assessment and recorded the decision. The Deputy Governor must authorise the use of force for the purpose of administering medication.
Restraint can be used only to protect the person from harm and must be a proportionate response, meaning the least intrusive type and minimum amount for the shortest time. Staff should seek legal advice if in doubt, per the framework. If a use of force is later questioned, see use of force allegations.
Hospital escorts and bed watches
In shortOfficers meet the healthcare system outside the prison on hospital escorts and bed watches, with specific kit rules.
When a prisoner needs hospital care, prison officers or contracted escort staff take them and may remain at the bedside. Prison officers on bed watches are paid at the Payment Plus rate, which is £23 an hour from 1 April 2026 and is non-pensionable; see Payment Plus explained.
The PSPRB 2026 report noted that HMPPS was reviewing the scope of escort and bed watch work with NHS England, with reporting due in April 2026. We could not find the outcome, so do not assume the rules have changed.
Kit rules in the use of force framework
- PAVA cannot be taken on bed watches, escorts or external perimeter checks
- Batons and fish knives can be carried outside the establishment when an officer is detailed to a hospital bed watch or other escort
- Rigid bar handcuffs must be carried on bed watches and escorts for adult male estate officers who hold them
- Escort work by contracted staff is described in prison escort officer
Inspection and standards: how healthcare is checked
In shortHM Inspectorate of Prisons and the CQC inspect prison healthcare jointly in England; read the prison's latest report rather than a headline rating.
The two bodies have a formal agreement on how they work together. CQC publishes reports for prison healthcare services and uses regulatory powers where it finds breaches.
For officers, inspection reports are useful context (the wider estate picture is in prison staffing and attrition): they show how local healthcare access and staffing can affect the wing. Many findings concern the healthcare provider, not the prison, and vice versa.
Recent examples on CQC's pages
- July 2025HMP Leeds joint inspection
Healthcare required improvement, with action plan requests on safe care and treatment and staffing.
- June 2025HMP YOI Rochester joint review
A warning notice was issued.
- 13 to 15 April 2026HMP Bullingdon
Focused inspection of healthcare.
Wales, Scotland and Northern Ireland
In shortHealthcare is devolved: NHS Wales boards, local NHS boards in Scotland and a single trust in Northern Ireland.
In Wales, responsibility for public sector prison healthcare is devolved to the Welsh Government, and since April 2006 services have been provided by NHS Wales through local health boards. Primary healthcare at the private HMP and YOI Parc is commissioned by HMPPS in Wales, according to Public Health Wales.
In Scotland, responsibility for prison healthcare moved from the Scottish Prison Service to the NHS on 1 November 2011, and services are now provided by local NHS boards.
In Northern Ireland, the South Eastern Health and Social Care Trust delivers healthcare across Maghaberry, Magilligan and Hydebank Wood through its Healthcare in Prison service, with a multidisciplinary team covering GP, nursing, allied health, psychology, pharmacy, radiography and dentistry.
- Aneurin Bevan
- Usk and Prescoed
- Cardiff and Vale
- Cardiff
- Swansea Bay
- Swansea
- Betsi Cadwaladr
- Berwyn
| Nation | Responsible body | Note |
|---|---|---|
| England | NHS England commissions; prime provider delivers | 118 establishments per NHS England; emergency, ambulance and out-of-hours excluded |
| Wales | Welsh Government; local health boards | Private Parc primary care commissioned by HMPPS Wales |
| Scotland | Local NHS boards (since 1 November 2011) | Social care in prisons stays with SPS |
| Northern Ireland | South Eastern Health and Social Care Trust | Healthcare in Prison service across three prisons |
Working in prison healthcare, and comparing it with the officer job
In shortClinical roles are advertised by NHS trusts and providers on Agenda for Change terms, not HMPPS pay bands, so compare the whole package.
Prison healthcare jobs are advertised by the NHS trusts and providers that hold the contracts, usually on NHS Agenda for Change terms with the NHS Pension Scheme. Adverts often welcome newly qualified nurses with preceptorship as well as experienced nurses.
Professional registration (for example with the NMC for nurses) is required for registered roles, and the HMPPS vetting policy lists enhanced checks and DBS checks for those working in healthcare settings. Read each advert's vetting section carefully; timescales can be long.
Compare a clinical role with a Band 3 officer post
- Hours and shift pattern
- Unsocial hours or enhancement
- Pension scheme and leave
- Travel to the site
- What happens during incidents
- Officer pay structure: see our prison officer pay bands guide; set two offers side by side in the job offer comparator, or check entry standards with the can I be a prison officer checker
Frequently asked questions
Are prison nurses prison officers?
No. Prison nurses are healthcare professionals employed by the NHS or other healthcare providers commissioned to run prison health services. They are not HMPPS prison officers and do not hold the officer's powers. Prison officers and healthcare staff work alongside each other under HMPPS policies such as the use of force framework.
Who pays for healthcare in prison?
In England NHS England commissions healthcare for prisons and YOIs, with a prime provider delivering it. In Wales the Welsh Government and NHS Wales health boards are responsible, in Scotland local NHS boards since 2011, and in Northern Ireland the South Eastern Health and Social Care Trust.
Does a prison officer have to call healthcare after using force?
Yes. The HMPPS use of force framework says prisoners must see a registered healthcare professional within 24 hours of force being used, even if there is no visible injury, and that healthcare should attend incidents on site as a priority. Following PAVA, observations apply until the effects subside.
Can prison officers give medication?
We did not find a published rule in the sources used for this guide on officers handing out medication, so we do not state one. Medicines are a clinical responsibility, and local protocols apply. Ask your establishment what officers are required to do on medication queues.
What happens if a prisoner has a medical emergency during restraint?
The use of force framework says all force must cease, the prisoner is placed in the recovery position, first aid is given and a registered healthcare professional is requested immediately. Rigid bar handcuffs must be removed immediately if a medical emergency occurs while they are applied.
Is prison healthcare work paid like prison officer work?
Not generally. Healthcare roles are normally NHS or provider contracts, often Agenda for Change, with the NHS Pension Scheme. Prison officers are on HMPPS pay bands and the Civil Service pension. Compare full packages with the job offer comparator.
Who inspects prison healthcare?
In England, HM Inspectorate of Prisons and the Care Quality Commission inspect prison healthcare, usually jointly. CQC can set action plan requests and warning notices where it finds regulatory breaches. Wales, Scotland and Northern Ireland have their own inspectorates and regulators.
Sources
- england.nhs.ukNHS England, Health and justice
- nuffieldtrust.org.ukNuffield Trust, How prison health care in England works (October 2021)
- gov.ukHMPPS, Use of Force Policy Framework (re-issued 11 September 2025)
- legislation.gov.uklegislation.gov.uk, Prison Rules 1999
- sps.gov.ukScottish Prison Service, Healthcare
- publichealthwales.nhs.walesPublic Health Wales, Prison health in Wales
- setrust.hscni.netSouth Eastern Health and Social Care Trust, Healthcare in Prison
- gov.ukMinistry of Justice, Safety in custody statistics to March 2026
- cqc.org.ukCare Quality Commission, prison healthcare location reports