NHS Health Scotland



D. Evidence for a holistic, whole-systems approach for person- centred care and management of offenders (Enforcement model)


International and UK evidence-informed policy directives support the link for a person-centred holistic approach to improve outcomes for offenders.


In the literature and policy review conducted for the Better Health, Better Lives for Prisoners framework the authors cite the WHO (2007) definition of health promoting prison that includes a holistic approach:

The phrase health promoting prison is used to cover the prisons in which: the risks to health are reduced to a minimum; essential prison duties such as the maintenance of security are undertaken in a caring atmosphere that recognises the inherent dignity of every prisoner and their human rights; health services are provided to the level and in a professional manner equivalent to what is provided in the country as a whole; and a whole- prison approach to promoting health and welfare is the norm.’

The authors also cite a narrative review by De Viggiani (2006) that sees the whole-prison approach as a public health prevention model that could benefit society by tackling exclusion and inequality, as determinants of health and acknowledged precursors to criminal behaviour. In this vein, a whole-prison approach is described as necessary for prisons to meet standards of safety, purposeful activity, effective resettlement and respect [HM Inspectorate of Prisons for England, Wales and Northern Irelands tests for a healthy prison]. [1]

Scottish policy and practice note

In November 2011, responsibility for prison healthcare was transferred to the NHS. The three quality ambitions of NHSScotland Quality Strategy (2010) [2] are:

  • Safe: There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time.
  • Person-centred: Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making.
  • Effective: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

Better Health, Better Lives for Prisoners: A framework for improving the health of Scotland’s prisoners (2012) [3] supports a new partnership between the Scottish prisons and NHS Scotland. It sets out priorities for health improvement, advocates for a whole-prison approach and recognises that the inter-related risk factors are best tackled through comprehensive, integrated programmes.

In 2013, the Healthier People, Safer Communities report [4] was published with recommendations to the Offender Health Collaborative (OHC)* to assist in the development of a strategic response to improving offender health and wellbeing. As part of the personalisation agenda, a medium-term recommendation was to ‘consider how a universal model for an offender personal wellbeing plan can be promoted, integrated into current and future case management procedures and support the concept of one offender/one plan incorporating the elements of prison in-reach and relationship building with a key worker’.

* The OHC currently has membership from SPS, NHS Health Scotland, Scottish Public Health Network (ScotPHN), Scottish Health Promotion Managers Group (SHPMG), local NHS Health Promotion Services and the Community Justice Authorities (CJAs).

Recommendations for a broader framework adapted for offenders are also developed. A second phase is proposed: Improving the Health of Offenders in the Community, with opportunities for implementation through community planning processes and the drive to improve community re-integration. A wider public-health approach to reducing re-offending is identified within the context of strengths-based and asset-based approaches, with guidance on personal planning for health and wellbeing. The report states:

‘Offending is a determinant of health, however, poor health and the many inter- related social and economic problems experienced by communities in Scotland are also known determinants of offending. Greater collaboration between health and criminal justice through a public health-based approach could allow for more joined-up working with support and interventions targeted and delivered throughout the life course, addressing broad determinants and risk factors and enabling those in contact with the criminal justice system to get the personalised support they require. It could facilitate greater crossover at an operational and strategic level between health and criminal justice to deliver on shared outcomes around alcohol, illegal drugs, mental health, blood-borne viruses, smoking, engagement with primary care, learning disabilities, parenting and family support, education skills and employability, desistance and workforce development.’ 

The Commission on Women Offenders [5] was established by the Scottish Government in June 2011 to look at ways to improve outcomes for women in the criminal justice system. The Scottish Government published its response accepting 33 of the 37 recommendations and set out plans for taking these forward in the short and long term, while considering the remaining four in more detail.

In its final report, the Commission acknowledged that many women in the criminal justice system are frequent reoffenders with complex needs that relate to their social circumstances, previous histories of abuse and mental health and addiction problems. Recommendations encompass service redesign, alternatives to prosecution, alternatives to remand, sentencing, prisons, community reintegration and leadership, structures and delivery.

Service redesign recommendations include the development of a multidisciplinary approach with a named key worker for women at risk of reoffending or of custody as a single point of contact as they move through the criminal justice system, including any periods in custody, to coordinate the planning and delivery of interventions. In addition to support compliance with court orders, intensive mentoring for practical support on a wide range of issues related to offending behaviour should be available to women.


  1. Brutus, L. Mackie, P. Millard, A. Fraser, A. Conacher, A. Hardie, S. McDowall, L. Meechan, H. (2012) Better Health, Better Lives for Prisoners: A framework for improving the health of Scotland’s prisoners. Volume 2: Supporting material for the framework.

  2. Scottish Government (2010) Healthcare Quality Strategy for NHS Scotland. Edinburgh : Scottish Government. More information on the approach from (external link): http://www.gov.scot/Topics/Health/Policy/Quality-Strategy or to read the strategy document look at (external link, 445.39KB): http://www.gov.scot/Resource/Doc/311667/0098354.pdf

  3. Better Health, Better Lives for Prisoners: A framework for improving the health of Scotland’s prisoners. Edinburgh: ScotPHN, 2012. Available from (external link) : :http://www.scotphn.net/projects/previous_projects/health_improvement_in_prisons

  4. Healthier People, Safer Communities report, ScotPHN, 2013 Available from (external link, 358.34 KB): ww.scotphn.net/pdf/Offender_Health_Report_2013.pdf

  5. The Commission on Women Offenders (2011-12) Available from (external link): : www.scotland.gov.uk/About/Review/commissiononwomenoffenders