Health and justice

NHS England Health and Justice is responsible for commissioning a range of healthcare services that support children and adults throughout the youth justice and criminal justice systems in England.

To inform this work, NHS England has published the Health and justice framework for integration 2022-2025 improving lives – reducing inequality.

This document sets out a strategic vision for the delivery of health and justice services and provides a framework for NHS commissioners, service providers, those with lived experience and cross departmental partners to work collaboratively to improve health and wellbeing outcomes for those in contact with the youth justice and criminal justice systems.

This is fundamental in effectively tackling, at a local level, the health inequalities this vulnerable patient group faces, along with improving their life chances as individuals move through the criminal justice system.

The framework sets out the following 12 commitments:

  1. Putting the patient voice at the centre of everything we do
  2. Working in partnership to commission high quality care
  3. Supporting people with neurodiversity and complex health needs
  4. Providing evidence-based treatment as alternatives to custodial sentences
  5. Improving the health and wellbeing of vulnerable children
  6. Improving the health and wellbeing of people in custody
  7. Ensuring good mental health for adults in custody
  8. Reducing early and avoidable deaths
  9. Connecting people leaving custody to health services on release
  10. Improving the health of people detained in immigration removal centres
  11. Improving quality through learning and technology
  12. Ensuring an inclusive and representative workforce.

The Health and justice framework for integration 2022-2025 improving lives – reducing inequality builds on and replaces the Strategic direction for health services in the justice system: 2016 – 2020.

The national clinical oversight for health and justice commissioned services is undertaken through the Health and Justice Clinical Reference Group and strategic governance is delivered through assurance groups relating to each area of commissioning responsibility.

This is in addition to an overarching national Health and Justice Delivery and Oversight Group, which reports to NHS England’s Specialised Commissioning National Commissioning Group.

NHS England health and justice teams commission to the ‘principle of equivalence’ which means that the health needs of a population constrained by their circumstances are not compromised and that they receive an equal level of service as that offered to the rest of the population.

The ambition is to narrow the health inequalities gap between those in the criminal justice system and the rest of the population and improve their outcomes.

We support a reduction in the number of people who are detained as a result of undiagnosed and untreated mental health issues and also support continuity of care after release.

National partnership agreements

The following national partnership agreements set out the basis of a shared understanding of, and commitment to, the way in which we work with our partners across different organisations.

These succeed the previous national partnership agreements, which are available via the links below:

Adults

NHS England is responsible for commissioning healthcare for people in prisons.  There are currently 118 prison establishments in England, each with a healthcare centre for prisoners.

NHS England works very closely with key partners to ensure the delivery of high quality services for individuals within these settings.

Non-custodial (pre-custody)

Liaison and diversion services

Liaison and diversion (L&D) services aim to identify, assess and refer people with mental health, learning disability, substance misuse and social vulnerabilities when they first come into contact with the police and criminal justice system.

These services can then support people through the early stages of the criminal system pathway, refer them for appropriate health or social care or enable them to be diverted away from the criminal justice system into a more appropriate setting, if required.

More information on liaison and diversion services can be found on our website.

Criminal courts healthcare

NHS England and the Ministry of Justice co-commission healthcare services for individuals in criminal court settings.

The purpose of this provision is to provide proportionate, effective and quality healthcare for those temporarily detained in court cells.

Anyone who is detained in a criminal (magistrates or crown) court in England is supported to manage and maintain their health and wellbeing during their time in the Court setting.

Access to healthcare for those detained in a criminal court setting is via a medical advice helpline, which can be contacted by prisoner escort and custody services (PECS) staff managing detainees.

Community sentence treatment requirements (CSTRs)

Community sentence treatment requirements (CSTRs) are a collective name for the three treatment requirements available in the Judiciary for sentencing within a community or suspended sentence order.

These are mental health treatment requirement (MHTR), drug rehabilitation requirement (DRR) and alcohol treatment requirement (ATR):

  1. Mental health treatment requirements (MHTRs)

An MHTR may be used to address a full range of mental health issues from low level depression and anxiety to more severe issues requiring secondary care support.

  1. Drug rehabilitation requirements (DRRs)

A DRR can be added to a community sentence where an individual’s drug misuse is contributing to their offending.

Treatment is carried out at an appropriate community location and often includes regular drug testing and court reviews.

  1. Alcohol treatment requirements (ATRs)

An ATR provides access to a tailored treatment programme that can last between six months and three years.

The intention is to reduce the individual’s offending by addressing the underlying wellbeing issue that is contributing to their offending behaviour.

Custodial

Prison healthcare

NHS England is responsible for commissioning healthcare for people in prisons and young offender institutions in England (with the exception of emergency care, ambulance services and out-of-hours services).

The range of services which are directly commissioned for prisons include:

  • primary (GP) and secondary (hospital) care services
  • public health services (including substance misuse services (under a section 7a agreement with the Department of Health and Social Care)
  • dental services
  • ophthalmic (eye care) services
  • mental health services.

Immigration removal centres

NHS England is responsible for commissioning health services for people who are detained in immigration removal centres (IRCs).

This includes primary care, dental, mental health and substance misuse services.

Post-custody

RECONNECT

RECONNECT is a holistic care after custody service that seeks to ensure that individuals with identified health needs who are leaving prison or an IRC receive access to ongoing care and support.

The service works with them before they leave to help them transition to community-based services and ensure any health gains made whilst in prison or an IRC are maintained.

While not a clinical service, RECONNECT offers liaison, advocacy, signposting and support to facilitate engagement with community based health and support services.

Please visit the RECONNECT page of our website for more information.

Enhanced RECONNECT

Enhanced RECONNECT (ER) is a pilot scheme which builds on the RECONNECT service and is available for high risk offenders with complex health needs.

The ER pilot uses a collaborative approach working with partner organisations in supporting offenders who are high risk and have complex health needs.

Enhanced RECONNECT will work with partner organisations to improve the continuity of care of people with high complex health needs leaving prison.

Service specifications and initiatives

Specifications for each of the services providing in secure and detained settings are available via the following links:

Public health services and initiatives

NHS England health and justice is responsible for commissioning public health services for children and adults in secure and detained settings in England.

This is part of NHS England’s public health responsibilities and involves working closely with the UK Health Security Agency and Office for Health Improvement and Disparities.

People in prisons and other places of detention often experience significant health inequalities compared with their peers in the community.

To help address these inequalities, NHS England is responsible for the following public health services and initiatives:

  • Helping adults in the prison estate to quit smoking and working with HM Prison and Probation Service (HMPPS) to roll out of the national ‘Smoke Free Prison’ programme.
  • Developing a new service specification for the treatment of adult’s with substance misuse issues in the prison estate. This emphasises recovery, lived experience, ‘through the gate’ care, dealing with psychoactive substances, reducing drug-related deaths, reducing reoffending and improving outcomes.
  • NHS England is supporting the development of HMPPS drug recovery wings (DRWs) that provide dedicated support for those who clinicians have assessed to be ready to stop receiving on site treatment but need more intensive support to sustain this compared to what is available on an incentivised substance free living unit.
    DRWs provide group and individual psychosocial treatment and activities, with an abstinence-based programme of interventions and an enhanced offer of dedicated activity separate from the general prison population.
  • Ensuring the effective and consistent delivery of both Health Checks and immunisations, blood borne virus screening, including Hepatitis B and C and HIV, and access to treatment pathways.
  • Work to ensure more effective recording of public health activity in the secure estate.
  • Reviewing the delivery of other public health screening and vaccination programmes within the secure estate, including HPV vaccination, bowel screening, retinal screening and abdominal aortic aneurism screening.

Useful information