Section 15 of the Health and Social Care Act 2012 gave the Secretary of State the power to require NHS England to commission certain services instead of clinical commissioning groups (CCGs). These include ‘services or facilities for persons who are detained in a prison or in other accommodation of a prescribed description’.
Health and Justice services are commissioned by 10 Health and Justice host area teams on behalf of the 27 area teams across England.
The commissioning of Health and Justice healthcare will ensure high quality services in:
- Strategic direction for health services in the justice system: 2016 – 2020
- Prison healthcare (including youth offender institutions)
- Immigration removal centres
- Children and young people’s secure settings
- Liaison and Diversion
- Sexual Assault Referral Centres across England
- Health and Justice Clinical Reference Group (CRG)
- Police custody healthcare remains the responsibility of Police & Crime Commissioners with support from NHSE Health and Justice
Developed in collaboration with health and justice leads, service users, clinicians, providers, the third and independent sector and other partners the Strategic Direction for Health Services in the Justice System is a commissioning strategy which sets out the ambition of NHS England to improve health and care outcomes for those in secure and detained settings, support safer communities and social cohesion. The ambition is to narrow the gap between those in the criminal justice system and the rest of the population, in terms of health and care outcomes, reducing the number of people who are detained as a result of untreated health problems and ensuring continuity of care after release.
The following seven priority areas have been selected as key to meeting this ambition between now and 2020. Improving quality and reducing variation are at the heart of each one.
- A drive to improve the health of the most vulnerable and reduce health inequalities
- A radical upgrade in early intervention
- A decisive shift towards person-centred care that provides the right treatment and support
- Strengthening the voice and involvement of those with lived experience
- Supporting rehabilitation and the move to a pathway of recovery
- Ensuring continuity of care, on reception and post release, by bridging the divide between healthcare services provided in justice, detained and community settings
- Greater integration of services driven by better partnerships, collaboration and delivery
Across parts of the country we already have services in place that are improving care across elements of the priority areas, including the roll out of Liaison and Diversion services, Through the Gate, early intervention services and community crisis teams. As well as work on Children and Young People criminal justice and mental health transformation pathways, prisons and Immigration Removal Centre health and social care service review and reform developments and also the substance use national service specification review.
We need to ensure such approaches are sustainable and happening everywhere. By extending availability of these approaches, we will do more to address the specific needs of this particular population group, break the cycle of offending and improve the quality of care and experience of individuals. This will also deliver better value for money and furthermore may cut costs for both health and justice systems.
From April 2013, NHS England became responsible for commissioning of all health services (with the exception of emergency care, ambulance services and out-of-hours services) for people in prisons (including youth offender institutions) in England. Ten of the 27 area teams have the responsibility for the commissioning of healthcare services in these settings.
The range of services which are directly commissioned for prisons include secondary care services (hospital care), public health, including substance misuse services (under a section 7a agreement with the Department of Health) in addition to the continued commissioning of medical, dental and ophthalmic services.
There are currently 118 prison establishments in England and NHS England works very closely with key partners to enable and assure against the delivery of high quality services for all.
A partnership agreement between NHS England, National Offender Management Service (NOMS) and Public Health England is in place on the strategic intend and joint commitment to work together for the purposes of co-commissioning and delivery in health care services.
National Partnership Agreement between NHS England, Home Office Immigration Enforcement and Public Health England 2015-17
This two year agreement sets out the shared strategic intent and joint commitment for the respective organisations to work together for the purposes of setting out shared strategic intentions, joint corporate commitments and mutually agreed developmental priorities for NHS England and the Home Office Immigration Enforcement. This updated agreement now includes Public Health England working with the Home Office and NHS England to commission and deliver healthcare services in Immigration Removal Centres (IRCs) across England.
Health and Wellbeing Needs Assessment (HNA) Programme – Immigration Removal Centres and Residential Short Term Holding Facilities
This national summary report, commissioned by the Home Office and supported by NHS England, aims to provide a national baseline for both organisations to inform future service commissioning for healthcare in Immigration Removal Centres.
NHS England works in partnership with Youth Justice Board and local authorities to fulfil the following outcomes that drive our Commissioning Intentions across children and young people’s secure settings to include four secure training centres for children and young people and 16 children’s secure homes.
- Develop the understanding of the healthcare needs of young people in the secure estate with particular attention to girls and young women across the estate and a review of inpatient facilities
- Review the current arrangements for the provision of social care services of children and young people by addressing inequalities in healthcare. To ensure their physical, substance misuse and mental health care needs continue to be met
- Work collaboratively to commission future secure provision and where necessary decommission existing provision following the conclusion of the Transforming Youth Custody Green Paper
- Support the role out and delivery of the Royal College of Paediatrics intercollegiate Healthcare Standards for Children and Young People in Secure Settings, the Comprehensive Health Assessment Toll (CHAT) in custody, AssetPlus (an end-to-end youth justice assessment framework) and SystmOne to secure training centres. Also put in place procedures to manage children and young people requiring clinical interventions including detox in secure training centres and secure children’s homes
- Work collaboratively to support commissioning of interventions services for children and young people in the secure estate with sexual offences
- Develop Liaison and Diversion services in police custody and courts that are suitable to meet the needs of children and young people
The Liaison and Diversion (L&D) service aims 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.
The L&D Programme was created in 2010 and had developed into a strong cross-government initiative. The Programme came about as a consequence of the Bradley Report published in April 2009. In December 2007, Lord Bradley was asked by the Government to consider ways to divert people with mental health problems and vulnerabilities away from the criminal justice system. He undertook a 12 month review of which he recommended that the government should develop and improve L&D services.
The Programme produced and developed the first national model for commissioning L&D services as well as working extensively with L&D service providers to build an active network.
From 1 April 2014, the Programme transitioned from Department of Health to NHS England to reflect the move into its implementation phase. During this time, the Programme will work significantly with NHS England commissioners and L&D service providers to ensure that roll out of the programme is delivering as scheduled and ten trial schemes, announced in January 2014, are operating to a high quality.
Following a successful pilot with Dorset police, a national programme inviting police forces to enter into a two year initial partnership with Department of Health (now NHS England, Health & Justice) began in 2011. The aim of the partnership was to establish a position of readiness to transfer the commissioning responsibility for all police healthcare in custody.
The first year saw 10 police forces join up, followed by 23 more in year 2 and the final tranche saw the remaining English forces, including British Transport Police and Border Force, join the programme totaling 40 police forces across England.
Partnerships boards sought to deliver several outcomes including completing estates audits, infection control audits, health needs assessments, compliance against national standards, the formation of local partnership agreements and a new service specification for any future commissioning of services.
Despite a decision from the Home Secretary not to transfer any budget to NHS England, thereby cancelling the anticipated transfer of legal commissioning responsibility, there is an undertaking, encouraged by the Home Secretary and Secretary of State for Health, for continued partnership work between the Police and NHS England. The legal responsibility for commissioning police healthcare services in custody is that of the Police and Crime Commissioners for each force.
A co-commissioning arrangement with NHS England is already in place for Sexual Assault Referral Centre (SARC) services.
NHS England took over the lead commissioning role for sexual assault service commissioning on the 1 April 2013 as part of a larger body of responsibilities transferred to NHS England under the Public Health Section 7a agreement. A Section 7a sexual assault service specification has been developed to inform the standard of service provision. The commissioning responsibility is now led by the 10 area teams for Health and Justice supporting 36 Sexual Assault Referral Centres (SARCs).
Whilst NHS England has the lead commissioning responsibility for sexual assault services, this will be reliant on a co-commissioning relationship between NHS England, police healthcare, clinical commissioning groups and local authorities to ensure the continued existence of care pathways for victims and referrals at a time of crisis support.
In 2014/15, the Public Health 7a allocation for sexual assault services will be increased to support the increased commissioning of service provision, consideration to ensure clinical standards and the service required for adults, children and young people.
The Health and Justice Clinical Reference Group is made up of a chair and members whose core vision and mission is as follows:
To operate as a catalyst to support ‘what good looks like’ across the Health and Justice clinical care sector and promote consistent and sustained implementation of quality standards across England focussing on outputs and outcomes. This must be a two-way resource linking into regional and area teams.
- To promote the highest quality and consistent standards of treatment and care for offenders and those in detention.
- To deliver a strong and consistent clinical voice championing the needs of individuals suffering significant health inequity in order to successfully close the health inequalities gap for this specific population.
- Advocating for ‘joined up’ services in Health and Justice where agencies work toward removing the risk of people ‘falling through the gaps’ in services and where care is truly seamless including information and data flows.
- Promotion of equivalence of care built on the delivery of evidence-based and clinically-effective interventions and pathways.
Health and Justice services will be commissioned to improve care by the 5 domains of the NHS outcome framework.
Domain 1 – Preventing people from dying prematurely
Domain 2 – Enhancing quality of life for people with long term conditions
Domain 3 – Helping people to recover from periods of ill-health or following injury
Domain 4 – Ensuring that people have a positive experience of care
Domain 5 – Treating people in a safe and caring environment and protecting them from avoidable harm