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If two of Britain’s major institutions have an identical problem…
…it must tell us something... maybe we need to be smarter at looking for solutions?
Prisons and hospitals… they’re full.
- In June there were 85,858 prisoners against an operational prison capacity of 89,120, ~96% full.
- General and acute beds were running at ~92.5% occupancy in the final quarter of 25/26.
When prisons run out of cells, government releases people earlier, tags them and sends them home.
When hospitals run out of beds, patients are discharged earlier, monitored at home and put onto virtual wards.
Different departments. Different language. Remarkably similar policy. Move the institution into yer front room.
The prisoner is outside the prison but remains monitored and liable to recall.
51,419 prisoners were recalled to jail in the year ending March 2026, an 28% increase from the previous year.
The patient is outside the hospital but remains monitored and liable to readmission.
~7% to 20% of virtual ward patients are recalled or escalated back to a physical hospital.
One is effectively a virtual prison… the other we actually call a virtual hospital.
Both may be sensible. Neither deals with what filled the building in the first place.
Peter Senge, the management thinker, calls this Shifting the Burden...
... faced with a difficult underlying problem, organisations reach for a quicker symptomatic solution...
... it relieves the immediate pressure and makes it easier to postpone the harder, fundamental solution.
We see this, right now in HMG policy.
Full prison? Release someone. Pretend they are in prison
Full hospital? Discharge someone. Pretend they are still in hospital.
This is pretend government.
Which raises a much bigger question. If this is so obvious, why do governments keep doing it?
Perhaps because the machinery of government is organised in almost exactly the wrong way to deal with problems like these.
There are six reasons.
First, urgency beats importance.
The Health Secretary gets into trouble because someone's on a trolley.
The Justice Secretary gets into trouble because a judge has nowhere to send a prisoner. Scramble for corridors. Send men to woman’s prison.
Second, the department that spends the money is often not the department that saves it.
Housing improves someone's damp home and health may save the hospital admission. Education, youth services and addiction treatment spend the money; Justice saves by get fewer prisoners, years later.
Third, prevention is almost invisible.
Open a hospital and there's a ribbon to cut.
Build a prison and there are cells to count.
Prevent a heart attack, a burglary or a prison sentence and that achievement celebrates something that never happened.
Fourth, double-running.
You can’t close today's hospital beds while waiting for tomorrow's prevention policy to work.
You can’t empty the prisons while waiting for rehabilitation, education and addiction services to reduce offending.
For a while, you have to pay for both.
The Institute for Government identifies precisely this problem;
'...preventative services are squeezed to fund acute demand, creating still more acute demand and requiring a period of double-running to escape the cycle.'
Fifth, accountability is vertical.
Secretary of State.
Government Department.
Permanent Secretary.
Budget.
Select committee, but …
… people’s lives are horizontal.
A troubled teenager doesn't experience Education, Housing, Health, DWP, the Home Office and Justice as separate departments.
They experience a life.
And sixth… politics is short; causation is long.
Governments think in spending reviews and elections.
Obesity, poor housing, educational failure, addiction, chronic illness and offending can take decades to appear in the government's accounts.
Other countries have at least tried to organise themselves differently.
New Zealand's Wellbeing Budget deliberately required agencies to break down silos, work across government and consider outcomes for both current and future generations.
Finland pioneered Health in All Policies. Recognising that health is made as much in housing, transport, education and employment policy as it is in hospitals.
Singapore has a Strategy Group inside the Prime Minister's Office specifically charged with identifying medium and long-term, cross-cutting problems and organising government around them.
Interestingly, Whitehall knows all this…
…last month HMG launched five Place-Based Budget pilots, explicitly acknowledging that public services have been organised around the departments funding them rather than the people using them. The upshot… duplication, fragmentation and late intervention.
We know the diagnosis is already written. The question is; whether five pilots will change a system of government built around departmental silos.
Prisons and hospitals aren't failing institutions at all. They are simply the places where the failures of everything upstream finally become visible.
Crime eventually arrives at the prison gate. Ill-health eventually arrives at the hospital door.
Then ministers are left managing beds, cells, discharges and releases.
The problems are horizontal, and…
… government remains vertical.
Until that changes, we'll continue getting better at managing the hopelessness of consequences…
… instead of preventing the reality of causes.
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