The Health and Social Care committee have echoed INQUEST’s concerns in their report into prison healthcare released today (Thursday 1 November).

Drawing on INQUEST’s written and oral evidence, the committee makes strong recommendations to address the unacceptable number of deaths as a result of poor healthcare in prison.

The committee recognises that ‘so-called natural cause deaths too often reflect serious lapses in care’ and that ‘too many prisoners die in custody or shortly after release’. The committee commented that ‘no one establishment stood out as a model of a healthy prison that could be replicated’.

Rebecca Roberts, Head of Policy at INQUEST said: “We welcome the recognition that prisons are unsafe and prisoners are experiencing serious ill health and premature death. Failure to treat prisoners with decency, humanity and compassion is a consistent feature of deaths in prison.

Findings from inspectorate bodies and post-death investigations repeatedly demonstrate that many deaths in prison are preventable. Recommendations are made time and time again yet are frequently ignored. Action to address the persistent failure of the prison service to rectify dangerous practices and systemic failings is well overdue. 

This is the first time a parliamentary committee has recognised the alarming number of deaths of people after release from prison, and the urgent need for oversight and investigation behind this growing problem. 

Given the committees’ admission that a healthy prison does not exist, the focus must be directed towards reducing the prison population and taking a public health approach to tackling ill-health in the community.”

INQUEST submitted written evidence to the inquiry and recommended that:

  1. Prison staff, including healthcare staff, require improved training to meet minimum standards to ensure the health, well-being and safety of prisoners.
  2. Improve standards of post-death investigations so that failures are identified and changes can be made.
  3. Ensure access to justice and learning for bereaved families through the provision of non-means tested legal aid to bereaved families.
  4. Create a national oversight mechanism to monitor deaths in custody and the implementation of official recommendations arising for post death investigations.
  5. Ensure accountability for institutional failings that lead to deaths in prison
  6. Halt prison building, commit to an immediate reduction in the prison population and divert people away from the criminal justice system.

INQUEST’ s oral evidence to the inquiry also highlighted the need for investigations into the deaths of people on post-release supervision to understand how people are dying and why the number of deaths is increasing.

For further information please contact Lucy McKay and Sarah Uncles on 020 7263 1111 or

  • INQUEST’s Head of Policy, Rebecca Roberts, gave oral evidence the inquiry in July 2018.
  • The report highlights the ‘unacceptable’ failure of the prison service to implement recommendations from serious incident and inspection reports and recommends the HM Inspectorate of Prisons is granted implementation powers.
  • The committee recommended that the government undertakes a thorough investigation of deaths during post-release supervision in the community, where responsibility for oversight lies, and a plan to reduce the rising death rate.

INQUEST is the only charity providing expertise on state related deaths and their investigation to bereaved people, lawyers, advice and support agencies, the media and parliamentarians. Our specialist casework includes death in police and prison custody, immigration detention, mental health settings and deaths involving multi-agency failings or where wider issues of state and corporate accountability are in question, such as the deaths and wider issues around Hillsborough and Grenfell Tower. Our policy, parliamentary, campaigning and media work is grounded in the day to day experience of working with bereaved people.

Please refer to INQUEST the organisation in all capital letters in order to distinguish it from the legal hearing.