Half of prisoners in England face drug problems and underfunded health services, making incarceration a serious risk to their wellbeing.
Readers of the latest National Audit Office report on drug harms in prison may begin to wonder whether sentencers should be required to include this statement in their remarks, as a candid acknowledgement of what the sentence means. The National Audit Office report does not spare any details about the rising impacts of neglectful prison policies.
Drugs in prisons
No less than 50 per cent of prisoners had an identified drug problem in 2025; two recent years of investigations by the Prisons and Probation Ombudsman revealed that 136 deaths were drug-related.
The physical decline of the prison estate has left open many avenues for penetration and importation. Drones are increasingly able to convey drugs and evade security. The harms of drugs extend to the promotion of debt-related extortion.
Services are failing to match need, with 35 percent of substance misuse appointments recorded as not attended in 2024-25.
Spending on mental health and substance misuse treatment in English prisons was five percent lower in real terms in 2024-25 than it was in 2020-21. It is implied that the spend has been affected by requirements to make efficiency savings. The allocation of drug strategy funding for 2022-23 to 2024-25 was significantly underspent.
Provision of drug services should be of the highest quality but reliance on failing market systems appears to blight improvement attempts: service commissioners are not able to demonstrate that treatment services are improving or providing best value for money.
Dysfunction on a wide scale
The NAO report is just one more piece of evidence about the dysfunctions apparent in the prison system, especially around health.
The extent of the health needs of prisoners does not require great elaboration. The Chief Medical Officer has stated that they are at higher risk of premature chronic illness and death compared to the general population.
Neurodisabilities are found in abundance, which call for much more informed responses across treatment and practice. The Welsh prison study showed the high prevalence of Adverse Childhood Experiences among prisoners, leading to a variety of early health problems including addiction.
However, policy has ignored the significance of evidence. The deterioration of prison health services in the heyday of austerity has led us to this point.
Regimes post-pandemic have not recovered sufficiently to provide the activity which would stimulate and engage prisoners. Instead, too many seem to get by on a diet of drugs and TV.
Getting real
Official descriptions of prison sentences appear mealy-mouthed when set alongside the evidence of harm and neglect. An alarming picture of prisoners managed and led into passivity and despair emerges, which can be laid at the door of policymakers of various leanings. All talk of ‘tougher’ sentencing should come with a warning that prisoners’ health is at risk. When will we see a grown-up debate about prison policies? Only when policymakers are obliged to heed -and act on- reports of this kind.
