Health and justice commissioning

Within the Direct Commissioning directorate, the Health and Justice team is responsible for commissioning health care for children, young people and adults across secure and detained settings, which include prisons, secure facilities for children and young people, police and court Liaison and Diversion services and immigration removal centres.

In prison settings, they commission a GP-type service, in a heavily controlled and secure environment, to a group of people who have significant co-morbidity and who often present significantly high levels of mental health and substance misuse. The team also commissions specialised services in courts and police custody suites to advise justice decision makers on appropriate healthcare recommendations and sexual assault referral centres together with Police and Crime Commissioners to support victims of sexual abuse.

SARCs

Collaboratively commissioned by NHS England and NHS Improvement (NHSEI), the Offices of the Police and Crime Commissioners (OPCCs) and the Police, Sexual Assault Referral Centres (SARCs) provide social, psychological and medical support to adults and children who have experienced sexual assault and abuse. As part of this co-commissioning relationship, NHSE&I South West work closely with partners and stakeholders to secure and sustain crisis support across health and criminal justice pathways in the region.

There are seven SARCs across the South West, including two Paediatric Centres of Excellence. Staffed by doctors, nurses and crisis workers, SARCs work closely with therapeutic services and Independent Sexual Violence Advisors who can support people for months, even years, after the assault. They operate 24/7 referral and advice lines and also offer consultation phonelines, staffed by paediatricians, where professionals can discuss concerns where child abuse is suspected.

During lockdown, the number of reports of recent sexual assault decreased, but the number of people contacting services about past sexual assault or historical child abuse increased. Being at home, 24 hours a day, has been a trigger for people who are dealing with past trauma and the demand for therapeutic and emotional support has increased dramatically.

From Spring 2021, NHSE&I South West’s Health and Justice team are recommissioning this service. The service requirements will have a focus on borderless provision to ensure consistently high-quality services across the region. For service users, this means that whichever SARC they choose to attend, they will receive the same quality of care tailored to their individual needs for immediate support and aftercare.

All sexual assault and abuse services in the South West can be found in this online directory.

Recommissioning of Prison Health Services

In 2021 the Health and Justice team started work to re-commission healthcare services in prisons. Across our region, there are 11 prisons and a population of just over 5,000 men and women. Of the 11 prisons, ten are male prisons, and one is a female prison. Our aspiration is to transform healthcare services through continuous improvement and innovation, and to provide bespoke healthcare for individual settings. There is an ambition to focus on improved psychological wellbeing, promoting good health and ensuring the quality-of-care people receive in our secure settings is at least consistent with that outside the prison. The healthcare provided will help contribute to a reduction in reoffending by ensuring that people leave prison healthier and better prepared for their release.

This work will lead to new healthcare contracts, which are due to come into effect from October 2022. A number of individuals have been engaged with as part of designing the new specification. The charity, User Voice, gathered views from people with lived experience of prison healthcare. Their report – alongside an online survey for wider stakeholders – fed into a series of market engagement workshops that were held for stakeholders and prospective partners.

Oximetry Work

Health and Justice and Community team colleagues are working together to bring Oximetry into our detained settings.

A national standard operating procedure (SOP) has been published for all secure and detained healthcare providers to support the implementation of a ‘Covid-19 oximetry’ model. The aim of this model is to support the earlier detection of silent hypoxia (low oxygen levels) and further help the reduction in mortality and morbidity for Covid-19 for those in prison. People detained in secure settings should receive the same standard of care as someone in the community. They often have poorer health outcomes than the general population with lots of co-morbidities.

Our Health and Justice team have worked with five prisons in the north of the patch, ordering Oximeters and implementing local operating procedures, while the six prisons in the south adopted a similar model, in line with their organisational policy.

Patients entering the pathway are provided with a pulse oximeter and a paper diary. They will record readings three times a day. Through a shared decision-making conversation, they should be given the option of prompts and check-in visits and are instructed to alert healthcare if their saturation reading is 92% or less. Patients will be given clear instruction regarding the recognition of deterioration and instructions on the appropriate course of action, with 24/7 access to advice and support.

This will be rolled out across the seven South West systems.

Vaccine Rollout

The Health and Justice team have worked hard to ensure that the vaccination rollout in our prisons across the South West moved at the same pace as it did out in the community. Within the region, there are 11 prisons and a population of just over 5,000 men and women.

As a region, we had the highest number of people in England vaccinated in priority order, meeting national deadlines. This is due to the hard work and dedication of both the healthcare providers, prison service and the support of the wider operational leads.