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In the last four years health services in public sector prisons in England have undergone a period of rapid reform and modernisation. Before this, prisoners' health care was characterised by over‐medicalisation, isolation from the NHS, and lack of education and training for health care staff. As part of this process of reform, responsibility for funding and commissioning these services has moved from the Prison Service to the National Health Service (NHS). The results so far seem encouraging. Services are better funded, standards have improved and there is significant progress in developing a strong partnership between the key partners ‐ the Prison Service and the NHS ‐ at national and local levels. These reforms address human rights and the aim of the Prison Health Unit, that prisoners should be able to expect their health needs to be met adequately by services that are broadly equivalent to services on offer in the community. Some learning points for other countries are considered. An equivalent strategy for the modernisation of public sector prisons in Wales is being developed by the Welsh Assembly Government.

The numbers of psychologists employed in HM Prison Service have doubled in the past three years to over 600 staff. HM Prison Service is the largest single employer of applied psychologists. With a governmental focus firmly on ‘joined up’ services in the criminal justice field (Boateng, 1999), the launch of the National Probation Service (NPS) in April 2001 has set the scene for closer partnership working between the two organisations. There has not historically been a national structure for the employment of psychologists in the probation service. With the creation of the NPS and an increased emphasis on partnership working, a national integrated role for psychologists is ripe for development. This presents both organisations with some significant partnership challenges and opportunities (Towl, 2000).

This paper describes the current levels of ‘self‐harm’, suicide and violence in prisons in England and Wales, outlines key high‐risk groups within the prison population and gives relevant national targets on self‐inflicted deaths and serious assaults ‐ now included in the National Offender Management Service (NOMS) national targets for 2005‐06. It outlines the case for Safer Custody Group to continue to provide on‐going services to tackle ‘self‐harm’, suicide and violence, as part of health and offender partnerships. The link with the ‘health agenda’ is explored, and concrete examples are given of successful collaborative work with the Department of Health and others. The delivery of services intended to promote and mainstream safety, health and well‐being in both public and private prisons is described, as are current and future projects aimed at delivering better services to prisoners, staff and bereaved families.

There are significant numbers of prisoners with complex substance misuse, health and mental health needs. Although there have been substantial developments in drug and mental health services within prisons and the wider criminal justice system, this has occurred with little inter‐agency collaboration. To gauge the level of involvement and inter‐agency collaboration for prisoners with complex needs, a brief questionnaire was circulated to mental health and substance use teams in East Midlands prisons. There are limits to the conclusions drawn, but the findings suggest that there is a lack of a dual diagnosis strategy, very little collaborative work, and an urgent need for training and service development.

Industrial relations problems in the UK Prison Service are part of the wider crisis within the penal system over the past 30 years, from the era of the Mountbatten Report of 1966 to the Woolf Report of 1990, and beyond. Incidents and disputes, concerning both industrial relations and the problems of prison regimes, attract wide media reporting, not all of it accurate. Attempts to redress this selectivity, and to demonstrate the complex linkages between industrial relations and the administration, management and reform of the penal system. Focusing mainly on the Home Office Prison Service (HOPS), and on the three main trade unions, highlights the differing political goals of the prison service, and the perpetual turmoil without clear purpose in which the principal actors seem to be enmeshed.

Stemming from substantial criticism during the late twentieth and early twenty‐first century, the UK government and HM Prison Service developed a number of policies and protocols aimed at improving the state of prison mental healthcare. While it is difficult to fault the purpose of the government's intentions, criticism has continued relating to problems with the implementation of government led change within the prison system. Existing research leads people to question whether policies are being implemented as intended; and if not, why not? The only clear way to answer these questions is to ask those involved in the actual implementation of these recommendations within the prison service. This paper aims to answer these questions.

This paper documents findings from a national survey of senior mental healthcare staff working in prisons in England and Wales. Staff were surveyed about their views on the implementation of recommendations from recent key government documents, their perceptions of prison mental healthcare versus community mental healthcare, and their views on the relationship between HM Prison Service and the National Health Service.

While many staff report improvements in prison mental healthcare, many have struggled with the implementation of new ways of working and the findings here suggest there is still some way to go towards providing offenders in prison with effective and appropriate care. Where effective ways of implementing change were identified, these are discussed.

Listening to the experiences of the staff involved in prison healthcare has helped identify where implementation of changes could be improved and thus highlights where support might best be targeted in future.

This paper examines the social and institutional context of barriers to drug service throughcare and aftercare for prisoners in England and Wales, including those that specifically affect Black and minority ethnic prisoners. A research project in 2004 reviewed relevant literature and statistical data, mapped prison drug services, and sought the perspectives of relevant stakeholders: in total, 334 individuals were recruited to the study. The methodology facilitates analysis of the structure of services and the agency prisoner in accessing them. Recommendations are made for changes to the structure and delivery of prison drug services.

This paper proposes a model for a dual diagnosis service within a male local prison. Dual diagnosis can be considered usual rather than exceptional within the establishment and indeed within the prison estate. For a variety of reasons, it is found that effective dual diagnosis service delivery represents core business for a range of stakeholders. The dual diagnosis definition preferred is ‘a mental disorder and substance misuse problem in the same person at the same time’. Analysis of the strengths of current service provision and the risks to the development of a new service model are explored through a strengths, weaknesses, opportunities and threats (SWOT) analysis. Current literature and policies inform the model, and it is concluded that a dual diagnosis service can be implemented mostly within existing resources. An implementation schedule highlights one such pathway. Stakeholders were consulted and generally found to be receptive.

This paper aims to describe the strategies being put in place to develop blood borne virus (BBV) services across prisons in Wales, UK, in response to the recommendations for prisons within the Welsh Government's Blood Borne Viral Hepatitis Action Plan for Wales.

A task and finish group was established to ensure multidisciplinary engagement between healthcare and custody staff. A service improvement package was developed focusing on awareness raising and/or development of clinical services for prisoners, prison officers and prison healthcare staff.

Prison healthcare staff have undergone training in BBVs and are being supported to deliver clinical services to prisoners. Training has been delivered in pre/post test discussion and dried blood spot testing; care pathways have been established between prison and community specialists for treatment referrals. An e‐learning module is being rolled out to raise awareness amongst custody staff and encourage occupational hepatitis B vaccination. Literature on “liver health” has been produced to be given to every prisoner across Wales.

It is envisaged that BBV services will become a routine part of prison care in Wales. Data on activity are being collected for evaluation and it is hoped that tackling BBVs in prisons will help reduce rates of infection both within prisons and in the wider community.

This paper describes new initiatives that have been established to tackle BBVs across Welsh prisons and will be relevant to any prison healthcare staff looking to develop similar services.

The primary purpose of this paper is to collect reliable information to characterize the pharmacy services in Portuguese prisons. The secondary purpose is to develop a set of suggestions for improving these services and, therefore, improve the health services provided to the inmate population.

A three pages survey was developed that included questions covering the characterization of prison health teams, pharmacy services and pharmacy activities. This survey was sent to all Portuguese prisons, with capacity higher than 50 prisoners. The response rate was of 87.5 per cent.

It was found that only 6.1 per cent of prisons had pharmacists and that in 63 per cent the guards still participated in pharmacy activities. There were not Pharmacy and Therapeutics Committees in 94 per cent of prisons and 94.4 per cent did not present adequate storage conditions for drugs. Only 51.7 per cent of prisons had computers in the pharmacy and only 3.4 per cent had access to the internet. This study found that there is a gap between public and prison pharmacy services, since most prison pharmacies in Portugal are solely locals of storage and distribution of drugs, with no effective management nor promotion of drug rational use.

This paper is the first study about pharmacy services in Portuguese prisons. The information collected could be very useful to improve the Portuguese prison pharmacy services provided to prisoners.