NHS England » Specification 29 Section 7A: public health services for children and adults in secure and detained settings in England, 2023-2024

Service Specification No.29 (SS29)

This is a Service Specification to accompany the NHS public health functions agreement 2023-2024.

This Service Specification is to be applied by NHS England in accordance with the 2023-2024 public health functions agreement. This service specification is not intended to replicate, duplicate, or supersede any other legislative provisions that may apply.

This service specification should be read in conjunction with the published Methods: National Service Specifications document which describes the methods process for the development, amendment and approval of national service specifications for directly commissioned policies. The process was updated and re-published in April 2022 [please note that as of May 2022 this document has been updated and is awaiting publications approval]. The document also describes the process for making changes to specifications via the Service Specification Expanded Change Process.

Where a specification refers to any other published document or standard, it refers to the document or standard as it existed at the date when the 2023-2024 agreement was made between the Secretary of State and NHS England unless otherwise specified. Any changes in other published documents or standards may have effect for the purposes of the 2023-2024 agreement in accordance with the procedures described in Chapter 3 of the 2023-2024 agreement.

Service specifications should be downloaded in order to ensure that commissioners and providers refer to the latest document that is in effect.

The 2023-2024 agreement is available at www.gov.uk (search for ‘commissioning public health’).

All current service specifications are available at www.england.nhs.uk (search for ‘commissioning public health’).

1. Purpose of Service Specification 29 (SS29)

1.1 The purpose

This document is primarily for commissioners and providers of Secure and Detained Settings, including the Children and Young People Secure Estate (CYPSE), and Immigration Removal Centres (IRCs). Public health programmes in these settings aim to reduce health inequalities and improve lives by promoting a long-term recovery trajectory.

The specification seeks to reduce the health gap between people in Secure and Detained Estates and the wider population, to meet the legal duty that NHS England have to the service commissioning requirement for the equivalent of services in the community. Healthcare services provided to people in Secure and Detained Estates should be equivalent to that available to people in the wider community. Secure and Detained Estates should be an opportunity to address previous unmet healthcare needs as well as contributing to addressing health inequalities in the wider community through ensuring ongoing access to health and social care on release.

This document sets out required Public Health outcomes to support accountability and assurance. This document should be read in conjunction with the National Public Health Service Specifications. The information contained within this document is to support the requirements for Secure and Detained Public Health Recovery.

This specification and the requirements must be read in conjunction with the equality health impact assessment and local health and social care needs assessments.

1.2 Quality

This document sets out a shared commitment to quality in Secure and Detained Settings. It is intended to provide a consistent approach to quality and to our priorities. Working together to celebrate and share examples of high-quality care to ensure quality and community equivalence of care is central to everything we do.

In line with the Shared commitment to quality from the National Quality Board, this document has been informed by the areas which matter most to people who use services:

Safety: people are protected from avoidable harm and abuse. When mistakes occur lessons will be learned.
Effectiveness: people’s care and treatment achieves good outcomes, promotes a good quality of life, and is based on the best available evidence.
Positive experience
- Caring: staff involve and treat you with compassion, dignity and respect
- Responsive and person-centred: services respond to people’s needs and choices and enable them to be equal partners in their care.

1.3 Safeguarding

NHS England is dedicated in ensuring that the principles and duties of safeguarding children, young people, and adults at risk are holistically, consistently and conscientiously applied with the wellbeing of all, at the heart of what we do (NHS England » About NHS England Safeguarding). We are dedicated to ensuring that the principles and duties of safeguarding children and adults are embedded across all Secure and Detained Settings.

2. Scope of secure and detained settings

2.1 Adult prisons

There are currently 112 prisons in England. His Majesty’s Prison and Probation Service (HMPPS) is responsible for commissioning and delivering adult offender services, in custody and in the community in England.

2.2 Immigration removal estate

The Home Office Immigration Enforcement Directorate (HOIE) commissions 6 Immigration Removal Centres (IRCs) and 2 short-term holding facilities in England, with plans in place for 2 additional estates in 2024. NHS England are responsible for commissioning equivalent care for those in the immigration removal estate to that which is available in the community, this includes, primary and secondary care, dental, public health services, and section 7A, elements of IRCs (NHS England » Service specifications for primary (medical and nursing) and dental care provision in prisons and immigration removal centres in England).

2.3 The children and young people secure estate (CYPSE)

The Children and Young People Secure Estate (CYPSE) includes 4 Young Offender Institutions under 18 (YOIs), 1 Secure Training Centre (STC) (not currently within NHS England Commissioning regulations), 13 Secure Children’s Homes (SCHs), and in future will also include a new Secure School.[7] . Placement into YOIs or STCs is commissioned by the Youth Custody Service (YCS), who also place into Secure Children’s Homes for justice reasons. Secure Children’s Homes may be run either by Local Authorities or by the voluntary sector. Local Authorities refer to the Secure Welfare Coordination Unit for placement of children under Section 25 of the Children Act 1989 on welfare grounds into these homes.

2.4 Sexual Assault and Abuse Services (SAAS)

Partnering with the Office of the Police and Crime Commissioner (OPCCs), NHS England co-commissions Sexual Assault Referral Centre (SARC) Services. NHS England is responsible for commissioning the public health services, section 7A, elements of SARC services and has a separate specification; Service Specification No. 30 Sexual Assault and Abuse Services (Annex B – Indicators). This is a separate specification to Specification No. 29. The Specification No. 30 document additionally outlines the public health functions to be exercised by NHS England in regard to the commissioning of Sexual Assault Referral Centres (SARCs) as well as ensuring that service parity is achieved across England, through specifying what core services need to be in place as well as providing regional population-based considerations.

SARCs are commissioned with contracts for provision held across 7 NHS England regional teams which includes London, South East, East of England, Midlands, North East and Yorkshire, South West and North West.

3. Understanding and meeting health needs

Public Health programmes are changing to meet the needs of the communities at large, with the development of new technological advances and a renewed focus on collaborative working, NHS England is working towards a more person-centred approach to service delivery.

There have been several recent changes to how services are provided, and these changes include ongoing recovery and protection from Covid, along with legislative changes brought about by the introduction of the Health and Care Act 2022.

Secure and Detained Settings hold a concentrated cohort of some of the most complex and vulnerable individuals in society. Individuals within these settings are more likely to have additional healthcare needs, such as neurodevelopmental disorders, substance misuse and mental health disorders.

3.1 Health needs assessment

NHS England must commission care for individuals in Secure and Detained Settings informed by a rigorous assessment of needs identified through formal health needs assessments (HNAs).

In partnership with NHS England, His Majesty’s Prison and Probation Service (HMPPS), Youth Custody Service (YCS), Ministry of Justice (MoJ); Department for Education (DfE); UK Health Security Agency (UKHSA); Office for Health Improvement and Disparities (OHID); Home Office Immigration Enforcement (HOIE) and Police Crime Commissioners (PCC), various toolkits have been developed to inform the health needs of the population, including those in Secure and Detained Settings. These toolkits also provide information on data sources, evidence-based guidelines, and best practice.

NHS England is working with UKHSA to develop a Health and Wellbeing Needs Assessments (HWBNAs) tool kit and will undertake a pilot of the HWBNA within the Children and Young People Secure Estate (CYPSE) – Autumn 2023

NHS England have also commissioned and published a summary document of Heath Needs Assessment (HNA) for IRCs and short-term holding facilities, including the current issue of modern slavery [9]which can be used to inform health service provision in the immigration detention estate.

3.2 Partnership work

NHS England are committed to work in partnership with a variety of internal and external organisations including, but not limited, to: HMPPS; YCS, MOJ; DfE, UKHSA; OHID; HOIE. By working in partnership, we will build better and more sustainable approaches if they are informed by the needs, experiences and aspirations of the people and communities they serve. It helps address health inequalities by understanding communities’ needs and developing joint solutions.

National Partnership Agreements (NPAs) were updated and will be published by NHS England in 2023. The NPAs outline the different justice and welfare partners and described joint shared priorities for health improvement for the respective populations as well as agreed ways of working together, including governance structures.

3.3 Patient and public participation

NHS England is committed to ensuring the design and delivery of our services include the perspective of the Childs Voice and lived experience (Recovery Needs Assessment (RNA) (publishing.service.gov.uk), irc-hna-brand.pdf (england.nhs.uk).

We value the unique insights that the Childs Voice and lived experience provides and through multi-disciplinary collaboration we recognise the benefits in shaping, improving and delivering our services and meeting health needs.

This document builds on existing resources and good practice to ensure that patients and the public have a voice throughout Secure and Detained Settings and NHS England including the formally constituted Heath & Justice Lived Experience Network (LEN).

Secure and Detained Commissioners and providers must uphold NHS England key principles of Patient and Public participation (NHS England » Patient and Public Participation Policy ), to maximise the benefits and impact of involvement. Our approach to patient and public participation is constantly evolving. Commissioners and Providers must continuously learn from and share experience of participation, to maximise its impact within Secure and Detained Settings.

All health needs assessments should include the views of patients and individuals accessing services (NHS England » Patient and public voice partners (PPVs) and people with lived experience). Providers need to make available information on complaints and inform individuals accessing services how to make a complaint and allow individuals to express their concerns, criticisms of service protecting individuals confidentiality appropriately and avoiding ‘deductive disclosure’.

4. Performance and standards

4.1 Health and Justice Information System (HJIS)

Under the previously outlined agreement, the two core objectives that underpin NHS England’s responsibilities are to ensure the high quality and efficient resources are commissioned to prevent avoidable ill health whilst promoting equality. The second objective centres around the operational delivery of these service, ensuring defensible decisions are made in collaboration with other public health experts.

In addition, the Health and Justice Information System (HJIS) dataset contains specific measures of user involvement to ensure the populations accessing services are consulted, considered, and informed in respect of planning, development, and delivery of healthcare services in Secure and Detained Settings (NHS commissioning » Health and justice (england.nhs.uk).

4.2 Intercollegiate healthcare standards for CYPSE

The Intercollegiate Healthcare Standards for Children and Young People in Secure Settings published by The Royal College of Paediatrics and Child Health in 2013 (Refreshed in 2019 and 2023) have been designed in order to help plan, deliver and quality assure the provision of children and young people’s health services in secure settings. This document is the standard against which NHS England should commission healthcare in the CYPSE and it informs the Core Outcome Specifications for CYPSE and Children and Young People Indicators of Performance (CYPIPs).

4.3 Performance indicators 2023-2024

The Global Burden of Disease (GBD) study measures and ranks the contribution of various risk factors that can contribute to premature deaths in England. The top five are: smoking, poor diet, high blood pressure, obesity, substance misuse. These priorities will guide the NHS prevention programme and Core 20plus5 to achieve community equivalence of care. These factors, along with others have been highlighted in the NHS Long-term plan. Evidence suggests that the programmes should focus more on prevention, education, and risk management as opposed to reactive approach. To support this a new service model was developed providing more options including better support, and ‘joined up care’.

4.4 Public health programmes for adults and children

Adults and Children across Secure and Detained Settings experience greater health problems than the rest of the population. Evidence shows that compared with their peers in the community these individuals often experience higher rates of associated health issues This document aims to reduce health inequalities in Secure and Detained Settings by achieving recovery trajectory to ensure equivalence of care within community. Helping to support fair and equal access for the most complex and vulnerable groups within the NHS.

All public health programmes in Secure and Detained Settings are informed by:

the principle of equivalence especially that being in prison or other Secure and Detained setting should not exclude people from access to healthcare including screening and immunisation programmes and should seek to achieve the same outcomes as community provision.
the need to tackle health inequalities, especially in relation to ‘care deficits’ which people may experience due to lack of access to health services prior to detention.
evidence-based practice, informed by a rigorous assessment of need and delivered in a way which is accessible and acceptable to the population concerned, and taking account of the setting in which, it is offered (NHS commissioning » Health and justice (england.nhs.uk).

These three objectives form the basis of the Core20plus5 approach to reducing healthcare inequalities nationally. Based on the index of multiple deprivation and associated health needs assessment tools to first target populations before identifying precise clinical areas that require specific focus.

This approach, which was initially focussed on healthcare inequalities experienced by adults, has been adapted to apply to children and young people (NHS England » Core20PLUS5 – An approach to reducing health inequalities for children and young people).

4.5 Substance misuse services for adults in secure and detained settings

In 2021, the Government announced a 10-year Drug Strategy entitled ‘From hope to harm’ outlining the importance of multi-agency working and specific objectives for Health and Justice health provision:

Increase early days screening and assessment of substance misuse harms and pathways of care.
Targeted and joint support for complex individuals and intensive intervention care planning (including those with a neurodivergent condition, individuals with autism, traumatic brain injury (TBI), attention deficit hyperactivity disorder (ADHD), physical harm, learning disability and some learning difficulties, mental health risk including self-harm and suicide, perinatal and maternity).
With evidence-based interventions and engagement treatment options including digital and psychosocial solutions and incentivised drug free living
Increased focus on substance misuse, treatment models supporting health inequalities including NHS England’s Core 20PLUS5 cohort and considerations around ethnicity, race, religion, belief and all protected characteristics.
Increasing continuity of care and prison leaver substance misuse pathways with community substance misuse providers and RECONNECT.

N.B – A distinct substance misuse service is available to meet the needs of children and young people and delivered within The Children and Young People Secure Estate (CYPSE).

4.6 Smoking cessation service

The implementation of a smoke free requirement in Secure and Detained settings is a significant driver behind the optimisation of smoking cessation services and service modelling for Prisons, IRCs and CYPSE.

For people in Secured and Detained Settings, they are more likely to be from a background of deprivation, which could involve some problematic drugs and alcohol use. In addition to possibly having a diagnosed or undiagnosed mental health issue. All these factors are associated with increased use of tobacco, where they have taken part in several interventions to reduce their use.

4.7 Drugs and alcohol services

NHS England is responsible for commissioning substance misuse services for people in Secured and Detained Settings. There is evidence that effective drug and alcohol interventions can lead to improved outcomes in relation to re-offending, deaths and exposure to blood borne viruses in some cases. These services include therapeutic management and treatment for challenging and dependant use (NDTMS: reference data – GOV.UK (www.gov.uk) in terms of continuity of care, which contributes to good treatment outcomes. The Long-Term plan has supported the introduction of the RECONNECT service for adults leaving secure settings. These programs will contribute to resettlement and collaborative working going forward.

5.4 Vaccinations programmes for children and adults in secure and detained settings

Primary prevention is an important public health principle and immunisation against infectious diseases is a cornerstone of good preventive practice. Many British-born people miss out on routine childhood immunisations and other required vaccines. All children and adults in Secure and Detained Settings should be having their vaccination history investigated and then offered vaccinations appropriate to their age and need as defined in the UK immunisation policy as outlined in “Immunisation against infectious disease ‘The Green Book’”.

5.5 Screening programmes (cancer and non-cancer)

People in Secure and Detained Settings are entitled to access appropriate cancer and non-cancer screening programmes for their age and sex, taking into account other risk factors. Early detection and treatment remains the priority.

5.6 Sexual and reproductive health

Addressing the sexual health of children and adults in Secure and Detained Settings supports the strategy for the prevention of the spread of communicable diseases, offering harm minimisation information and treatment.

The national Sexual Health and Human Immunodeficiency Virus (HIV) strategy by the Department of Health, states that some groups need targeted sexual health information and HIV/Sexually Transmitted Infections (STI) prevention because they are at higher risk, are particularly vulnerable or have particular access requirements; within this group, they identified adults in prisons.

Secure and Detained settings create an opportunity to meet Sexual Health standards. NHS England should commission sexual health services including Bloodborne Virus (BBV), HIV and Sexual Transmitted Disease (STD) support for representation of need with the patient group. NHS England should ensure that all people in Secure and Detained Settings, have adequate access to resources to prevent the spread of communicable disease.

Annex A – health and justice indicators of performance

Performance Indicators

Efficiency Standard/ Acceptable Level

Optimal Performance Standard/ Achievable Level

Adult Estate

Immunisations and Vaccinations

1. Covid vaccination primary course coverage (among total population)

Not nationally set

2. Seasonal flu vaccination booster coverage (among eligible population) (September-March).

Standard origin: National flu immunisation programme 2022 to 2023 letter (standard for clinically at-risk group used, although our eligibility will include eligibility based on age also).

52.90%

Not nationally set

Screening

Standard origin: All derived from national NHSE quality standards and service objectives

Breast Screening

3. BSP-S02: Breast screening coverage

The proportion of eligible women who had a technically adequate screen at least once in the previous 36 months.

70.0%

80.0%

4. BSP-S03: Breast screening uptake

The proportion of eligible women who have a technically adequate screen ≤6 months of date of first offered appointment. This standard is reported in 2 parts: S03a (routine screening) and S03b (very high-risk screening).

S03a – routine screening

70.0%

S03b – very high-risk screening

85.0%

S03a – routine screening

80.0%

S03b – very high-risk screening

95.0%

Cervical screening

5. CSP-S01: Cervical screening coverage under 50 years

The proportion of women in the resident population eligible for cervical screening aged 25 to 49 years at end of period reported who were screened adequately within the previous 3.5 years.

80.0%

Not yet nationally set

6. CSP-S02: Cervical screening coverage 50 years and above

The proportion of women in the resident population eligible for cervical screening aged 50 to 64 years at end of period reported who were screened adequately within the previous 5.5 years.

80.0%

Not yet nationally set

Bowel screening

7. BCSP-S01: Bowel cancer screening coverage

The proportion of eligible men and women in line with the below age’s invited for screening who had an adequate faecal occult blood test (FOBt) screening result in the previous 30 months.

Based on advice from the UK National Screening Committee (UKNSC), NHS England (NHSE) committed in the Long-Term Plan, to extend the age range of people eligible for the NHS Bowel Cancer Screening Programme (NHS BCSP).

People aged between 50-59 will become eligible for the programme in the year that their local screening centre goes live with their age cohort. Screening centres will go live at different dates throughout the year.

Cohort age at first invitation	Year invitations start
Age 56	2021/22
Age 58	2022/23
Age 54	2023/24
Age 50 and 52	2024/25

55.0%

60.0%

8. BCSP-S02: Bowel cancer screening uptake.

The proportion of men and women aged 60 to 74 invited to participate in bowel cancer screening who adequately participate (within 6 months of the invitation).

52.0%

60.0%

AAA Screening

9. AAA-S01: completeness of the initial AAA initial screen offer.

Proportion of eligible men who are offered screening (offered an initial appointment date which occurs within the screening year plus an additional 2 months).

An offer is assumed if a letter for invitation is generated on the Screening Management and Referral Tracking (SMaRT) database.

95.0%

99.9%

10. AAA-S04: AAA coverage: initial screen.

Proportion of eligible cohort men who are tested (conclusive screen result within the screening year plus an additional 2 months).

75.0%

85.0%

11. AAA-S08: AAA uptake: initial screen.

Proportion of eligible cohort men offered screening who are tested (conclusive screen result within the screening year plus an additional 2 months).

75.0%

85.0%

DESP Screening

12. DES-S02: DESP screening invitation/offer for first routine digital screening appointment.

Proportion of people with diabetes newly added to the register offered a first RDS appointment that is due to occur ≤ 89 calendar days of the provider being notified of their diagnosis or registration.

90.0%

95.0%

13. DES-S03: Timely offer for routine DESP digital screening (timely recall for routine digital screening).

Proportion of eligible people offered an appointment for RDS occurring ≤ 6 weeks after their RDS recall due date (Routine digital screening should operate on a 12-month screening interval)

95.0%

98.0%

14. DES-S07: DESP screening uptake: routine digital screening.

Proportion of those offered RDS who attend a routine digital screening event where images are captured.

(For those with an RDS event due to take place within the reporting period).

75.0%

85.0%

Smoking

Standard origin: DHSC/ UKHSA targets

15. Stop smoking services referral on reception (as a % of the eligible population)

80%

100%

Physical Health Checks

Standard origin: DHSC/ UKHSA targets

16. Physical health checks screening coverage (among eligible pop.)

50%

BBV and TB

Standard origin: DHSC/ UKHSA targets – N.B. BBV targets currently being reviewed by UKHSA.

17. HIV testing uptake upon reception (among eligible pop.)

50%

80%

18. Hep C Ab testing coverage upon reception (among the eligible pop.)

50%

80%

19. Hep C screening offer upon reception

50%

80%

20. Hep B screening coverage upon reception (among eligible pop.)

50%

80%

21. TB screening coverage upon reception

100%

22. TB Referral (among eligible pop.)

Proportion of patients screening positive for symptoms of TB referred for a specialist TB assessment within 7 days.

100%

Substance Misuse

Standard origin: DHSC targets

23. The proportion of individuals in secure environments that engage in structured drug and alcohol treatment interventions who at the point of departure from that establishment either:

–

24. Successfully completed a treatment intervention in custody and did not represent to treatment (either in custody or the community) within 6 months of release; or

50%

75%

25. Successfully engaged in community-based drug and alcohol treatment interventions following release (within 21 days); or

50%

75%

26. Where they were transferred to another prison/C&YPSE, successfully engaged in structured drug and alcohol treatment interventions at the receiving establishment within 21 days.

60%

85%

27. % of new treatment entrants starting treatment in the establishment within 3 weeks of arrival (from community or another custodial setting)

70%

90%

28. % of the treatment population receiving clinical treatment who are also receiving concurrent psychosocial interventions to address substance misuse.

80%

95%

Children and Young People Secure Estate

Immunisations and Vaccinations

29. Population vaccination coverage – COVID-19 (primary – two doses; booster – seasonal)

C19C01-C19C13: Percentage of population in CYPSE on the last day of the month that have received a vaccination.

10%

Not nationally set

30. Population vaccination coverage – Flu (seasonal, September-March)

VACB01: The percentage of the population on the last day of the month that have received a flu vaccination (includes vaccinations before admission to the CYPSE).

15%

Not nationally set

31. Population vaccination coverage – Hep B (three doses: 8, 12, 16 weeks)

VACB03: The percentage of the population on the last day of the month that have received a Hep B vaccination (includes vaccinations before admission to the CYPSE).

35%

Not nationally set

32. Population vaccination coverage –HPV for Females (two doses, 13-14 years)

VACB04: The percentage of the female population on the last day of the month that have received a HPV vaccination (includes vaccinations before admission to the CYPSE).

60%

Not nationally set

33. Population vaccination coverage – HPV for Males (two doses, 13-14 years)

VACB05: The percentage of the male population on the last day of the month that have received a HPV vaccination (includes vaccinations before admission to the CYPSE).

10%

Not nationally set

34. Population vaccination coverage – Men ACWY (13-14 years)

VACB06: The percentage of the population on the last day of the month that have received a MenACWY vaccination (includes vaccinations before admission to the CYPSE).

50%

Not nationally set

35. Population vaccination coverage – MMR (two doses: 1 year and 3 years 4 months)

VACB07: The percentage of the population on the last day of the month that have received a MMR vaccination (includes vaccinations before admission to the CYPSE).

75%

Not nationally set

36. Population vaccination coverage – Pertussis (three doses: 8, 12, 16 weeks)

VACB08: The percentage of the population on the last day of the month that have received a pertussis vaccination (includes vaccinations before admission to the CYPSE).

80%

Not nationally set

37. Population vaccination coverage – Td/IPV (14 years)

VACB10: The percentage of the population on the last day of the month that have received a Td/IPV vaccination (includes vaccinations before admission to the CYPSE).

50%

Not nationally set

Indicators to consider only for 2024/25 (Immunisations and Vaccinations) (Adult Estate)

38. D03k: Population vaccination coverage – PCV booster (2 years old)

Standard origin: WHO/ DHSC coverage target