Proposals for managing prison healthcare have shied away from shifting accountability to the NHS.
Recommendations put forward this week by a joint Prison Service and NHS Executive working group call for new structures instead.
The plans include a national taskforce - to be appointed by July - and a prison service health policy unit to replace the directorate of healthcare. At local level, health authorities and prison governors would develop prison health improvement programmes to plan and commission care jointly.
The working group was set up following a 1996 report by chief inspector of prisons Sir David Ramsbotham, which urged full integration of prison healthcare with the NHS.
Launching the report, health minister Baroness Hayman said the plans would give 'shared responsibility' to the prison service and the NHS.
But the recommendations make clear the limitations of 'formal partnership' with 'funding and departmental accountabilities remaining broadly as at present'.
Prison service head of healthcare Mike Longfield said the working group believed the prison service should retain accountability so that governors 'meet their wider duty of care' towards prisoners.
The report warns the government that 'to bring all prisons to standards of good practice... might need up to a further£30m for which no provision currently exists' from prisons funding. It gives little indication of the likely cost to the NHS of partnership proposals. Baroness Hayman admitted: 'We really don't know the scale of what needs to be done. This is part of the problem.'
She said the financial implications of the changes would not be known until work on local health needs assessments - due to begin by autumn - was complete. But she suggested that there were 'a lot of inefficiencies' in the way present services were run.
Chris Duffin, prison overcrowding monitor at the Prison Reform Trust, said 'years of under-investment in prison healthcare' could only be addressed by 'new money'.
The British Medical Association also expressed 'great concern' at the lack of commitment to closing the£30m 'funding gap'.
But NHS Confederation associate director, health policy, Cathy Hamlyn said the report's findings were 'very welcome and long overdue'. She said it was both 'appropriate' and 'inevitable' that accountability should remain with 'the people who are there all the time, in the prison.'
The Future Organisation of Prison Health Care: report by the joint prison service and NHS Executive working group. Fax orders: 01937-845381. Free.