People under supervision of the Probation Service face stark health inequalities linked to complex and inter-related socio-economic disadvantage. They have significant health and care needs compared to the general public, face significant barriers to access and yet compared to those in prison, there is comparatively little available data on their healthcare needs.  

This scoping report explores these issues and sets out recommendations for commissioning and delivering a national health needs assessment to address that data gap and support local health needs assessments for the probation population.

The probation population is approximately three times the size of the prison population (240,497 people in England and Wales as of September 2024). The probation population can be divided into three groups: pre-release supervision, post-release supervision, and those on court orders (community orders or suspended sentence orders). Those on community orders or suspended sentences may never be held in prison, they do not have access to specialised commissioned healthcare and therefore their health needs are less visible to the NHS, and local authority public health.

People in contact with the criminal justice system, especially those in non-custodial community settings, are one of the priority health inclusion (‘PLUS’) groups in the NHS England Core20PLUS5 approach and Inclusion Health Framework, which contains high proportions of people from other target groups in the Core20PLUS5¹ approach:

• People from the most deprived 20% of the national population
• People with a learning disability and autistic people
• People experiencing homelessness and rough sleeping
• People with drug and/or alcohol dependence
• Sex workers

The NHS England Health Inequalities Improvement Programme (HiQiP) team commissioned the Strategy Unit to undertake this scoping study to inform the production of a national Health Needs Assessment (HNA) for adults under probation services supervision in England because of their high health need and relative invisibility to the NHS.

This study found that there is no reliable data on the prevalence and incidence of health conditions in the probation population, and very limited research on people on probation’s access to healthcare and experience of healthcare.

HMPPS and MoJ hold demographic data on the probation population which could support production of prevalence estimates, in conjunction with new data on health conditions in the probation population. 

This study identified a small number of recent data linkage and survey projects on the health of people on probation. The report recommends that a national HNA should build on this work to produce national data on the prevalence and incidence of health conditions in the probation population, and complement it with qualitative research on the lived experience of accessing and using health services of people on probation. 

Improving the health of people on probation is expected to reduce re-offending and increase economic activity in this population group. Unmet health and social care needs prevent this group from engaging effectively with probation services and this impedes their rehabilitation.