NHS England has statutory responsibility for the direct commissioning of health services in secure settings in the children and young people estate in England.

In practice, this means that the NHS England commissioned provider works alongside the provider of the secure setting to provide a health service to children held in the setting. This includes all the same health services that might be provided to children in the wider community, for example primary care (GP) services, dental and optical services, and mental health and substance misuse services where these are needed.  It does not include emergency services which are run by community health services, however children in secure settings have access to these in the same way as their peers do when needed.

Health services in the children and young people secure estate are commissioned locally by regional Health & Justice commissioners. A placement in this estate is temporary, and part of a broader care journey for the child or young person in question. Therefore, the NHS England Health & Justice Children Programme also considers the needs of those who are at risk of entering these settings and on transition back to their community.

Children and young people secure estate

The children and young people secure estate (CYPSE) in England holds a small cohort of children (c700 at August 2023), often with complex needs. It is made up of:

1. Four young offender institutions (YOIs) (holding under 18s).
2. Thirteen secure children’s homes (SCHs) where the Department for Education (DfE) has policy responsibility, but not operational responsibility, for these homes. They are run by local authorities, except one which is run by a voluntary sector provider.
3. One secure training centre (STC), Oakhill, which is currently outside NHS England regulations.

In 2024, the estate will also include a secure school sited in Kent (Oasis Restore).

Children held in the CYPSE can be held on different grounds. However, the two groups often have very similar needs. Children in the CYPSE who are placed there on justice grounds are sentenced or remanded according to the Powers of Criminal Courts (Sentencing) Act 2000.

A child can also be placed in the CYPSE on welfare grounds, under section 25 of the Children Act 1989.

Children with complex needs

Children with complex needs often have multiple needs in multiple domains, which may span many services including mental health, neurodisability, substance misuse and physical health. They experience some of the highest levels of health inequality and their needs are defined as ‘complex’ in that they are often multiple, persistent, severe, and framed by family and social contexts.

In more detail, a complex needs child is defined as:

• having multiple complex needs across several domains (mental/physical health, social care, education), requiring integrated, co-commissioned care
• having severe/high levels of distress
• may have been referred for mental health assessment and/or there may have been questions about whether the child’s mental health conditions are such that they require admission to hospital for their care and treatment
• having history of significant/adverse childhood trauma
• may have neurodevelopmental needs such as autism, learning disability and ADHD.

Health and Justice Children Programme national partnership agreement 2023-25

A national partnership agreement has been in place to support the commissioning and delivery of healthcare in secure settings for children since NHS England became the statutory agency responsible for health commissioning in 2013.

The latest version, the Health and Justice Children Programme national partnership agreement 2023-25, has progressed to support a whole pathway approach for children with complex needs, helping to prevent children entering welfare and/or youth justice detention. This agreement provides our core objectives and priorities for 2023-2025 and sets out NHS England’s commitment to fully integrated working with shared accountability for delivery.

Healthcare standards for children and young people in secure settings

The Healthcare standards for children and young people in secure settings help healthcare professionals, commissioners, service providers, regulators, managers, directors, and governors ensure that children receive excellent healthcare that meets their individual need.

The standards take a pathway and multi-professional approach, following the child’s journey through a secure setting. They apply to children and young people aged between 10-17 (inclusive) on both welfare and justice placements in secure settings, including YOIs, SCHs, STCs, and in the future the secure school.

Healthcare specifications for the children and young people secure estate

The healthcare specifications, which are benchmarked by the Healthcare standards for children and young people in secure settings, define the standard of care that all children and young people in secure settings receive.

The suite of specifications includes the overarching, physical health, mental health and neurodevelopmental conditions, substance misuse, and dental and oral health specifications.

The framework for integrated care

The concept of the Framework for integrated care is that it acts as a joined-up systems approach to intervention, planning and care for children that is evidence based and trauma informed.

Variations of the framework for integrated care

In the existing children and young people secure estate, the Framework for integrated care (SECURE STAIRS) allows for a trauma informed, collaborative approach to assessment, sentence/intervention planning and care, including input from mental health staff regardless of previous diagnosis, as well as from social care professionals, education professionals and the operational staff working on a day-to-day basis at the setting. It also seeks to ensure that staff have the right skills and support to care for the children and young people appropriately. Co-produced formulation (planning) for each child through the understanding of the child’s background story (‘My Story’) sits at the centre of the framework.

An independent national evaluation was commissioned by NHS England to evaluate the implementation and impact of the Framework for integrated care (SECURE STAIRS) that was published in May 2022.

NHS England agreed to continue to support the implementation and sustainability of the framework. In partnership with YCS and DfE,

The Framework for integrated care (community) has been developed by NHS England to invest in additional support and care for vulnerable children and young people with complex needs in the community. The Framework, and the services that it underpins, have been created in response to the NHS Long Term Plan commitment to this cohort of children and young people, aged 0-18. The Framework provides a set of guiding principles and practices that act as a template for genuine co-production and integration of services for children and young people presenting with the most complex needs.

Selected areas known as ‘vanguards’ operate across integrated care system (ICS)/provider collaborative footprints and will develop and deliver their services in line with the principles of the Framework. The ways in which each area will do this may vary, depending on the specific needs of their local cohort.