The health of people in prison, on probation and in the secure NHS estate in England

On Thursday the 6th November 2025 the Department of Health and Social Care and the Ministry of Justice published a landmark report by the Chief Medical Officer for England. It covered healthcare in prisons, probation and the secure NHS estate (executive summary and whole report).

The core messages of the report will be read with interest by all in the CJS healthcare community. As the CMO’s report has outlined, people in prison and on probation tend to experience higher levels of physical and mental ill-health when compared to the wider population. This is partly as a result of prevailing health inequalities and partly because of the systemic barriers which make treatment and prevention more difficult. Professor Whitty highlighted the ageing prison population as this group is continuing to rise at a higher rate than other age groups and who have additional health and social care needs which are not able to be fully addressed in the current environments. While commissioned healthcare remains the responsibility of the NHS, this report highlights that prison and probation regimes can themselves have a great impact on health. As the report concludes: “Health cannot be improved by healthcare alone” (p.32).

For those of us at SONAR, the report’s findings on the issues relating to healthcare data and information-sharing, and the associated lack of integration and interoperability, hit hardest. As our followers will know, it is precisely these concerns that have led to the SONAR project, with the belief that enabling and facilitating healthcare information to be shared in real time across all CJS settings and the NHS will improve patient outcomes.

The report said:

• “There is currently no mechanism by which the relevant essential individual data in the person’s clinical record can be routinely or directly shared with other relevant health or justice providers. This includes community mental health teams, substance misuse services or social care providers, as well as justice organisations, including probation services.”

  
  

• “There are many IT systems that sit across multiple government departments and organisations, including: the Department of Health and Social Care (DHSC); Ministry of Justice (MoJ); Home Office; NHS and UK Health Security Agency (UKHSA). Many of these systems cannot communicate with one another.”

  
  

• “Despite Caldicott principle 7 {“The duty to share information for individual care is as important as the duty to protect patient confidentiality”), the duty to share information, the sharing of information between different healthcare providers and across the legal and commercial boundaries is hindered by lack of staff confidence and lack of clarity on what should be shared and with whom. This persists despite the improvements to the technical capabilities.”

One of the three key recommendations of the report focused specifically on information sharing:

• “Health data are essential for safe, high-quality care, research, surveillance and planning of health services inside and outside prison. In particular it is important that NHS data from care outside of prison can be shared in and out of prison and other secure settings to allow continuity of care … The national partnership agreement for health and social care should prioritise improving data and data information sharing. Data should inform the strategic priorities of this group and be used to report accurate oversight of progress. This should be reviewed at an annual high level accountability meeting, with appropriate external oversight.”

Finally, as the report concludes, ensuring that healthcare systems are procured to common standards – a key principle of SONAR’s design – will lead to progress:

• “System interoperability by design will assist in ensuring data can be shared. This could be addressed by ensuring that all IT systems are developed to sufficient national interoperability standards as part of their non-functional requirements. The Health and Justice Information Service is already compliant with modern NHS interoperability standards. Subject to procurement, there will be a specific focus on the development of further interoperability capabilities within the new solution with one aim being better interoperability with justice data systems.”

The CMO’s report is a timely and important contribution to the evidence base for the further improvement and development of the health of people in contact with the criminal justice system. Its findings will rightly influence the development of policy for years to come – and at SONAR, we welcome the opportunity to strive to address some of the barriers highlighted in this report.

John White

Founder and CEO