Future Offender Health Commissioning

From April 2013, the NHS Commissioning Board (NHSCB) will commission directly health services or facilities – to equivalent standards of care to those in the wider community - for persons of all ages who are detained in prison or in other secure accommodation and for victims of sexual assault. The NHSCB will work through its national, regional and local area teams to discharge these responsibilities.

Overview

  1. Section 15 of the Health and Social Care Act 2012 gives the Secretary of State the power to require the NHSCB to commission certain services instead of CCGs. These include ‘services or facilities for persons who are detained in a prison or other accommodation of a prescribed description.’ Regulations will be laid to allow the NHSCB to assume these powers from April 2013.
  1. The NHSCB will be responsible for planning, securing and monitoring an agreed set of services for:
  • Prisons
  • Young Offender Institutions (YOIs)
  • Immigration Removal Centres
  • Secure Training Centres
  • Secure Children’s Homes
  • Police Custody Suites
  • Court Diversion Services and
  • Sexual Assault Referral Centres (SARCs)
  1. The NHSCB will be responsible for ensuring that services are commissioned in ways that support consistently high standards of quality across the country, promote the NHS Constitution and deliver the requirements of the Secretary of State’s Mandate with the NHSCB.
  1. Healthcare in some secure accommodation is currently commissioned by other government bodies, such as the UK Borders Agency (Immigration Removal Centres), Youth Justice Board (Secure Children’s Homes and Secure Training Centres) and Police Authorities (Police Custody Suites).
  1. These commissioning responsibilities will move to the NHS and many pilot schemes are already in place with PCTs commissioning healthcare. Regulations will transfer of most of these responsibilities to the NHSCB as the responsible NHS commissioner from April 2013.
  1. The NHS is responsible for all public sector prison health services currently in scope as well as specific health services in contracted prisons (private) which may vary by the type of contracts held with prison operators for individual establishments by NOMS. The direction of travel is for the NHSCB to be responsible for commissioning healthcare in all new establishments irrespective of provider and seek to migrate health commissioning responsibilities in existing contracts as they expire and are re-tendered.
  1. Section 22 of the 2012 Act inserts a new power in section 7A of the NHS Act 2006, which will enable SoS to delegate commissioning of public health services to the NHSCB by mutual agreement.
  1. The NHSCB is structured with 4 regions and 27 Local Area Teams (LATs). 10 LATs are being designated to build the expert capacity necessary to undertake the NHSCB’s commissioning role in respect of persons detained in prison or in other secure accommodation.
  1. The 10 LATs will enter in to local agreements with other partners (in particular Local Authorities (LA’s) and Clinical Commissioning Groups (CCGs)) to maximise the efficient use of resources and concentrate expert commissioning (eg for substance misuse, mental health or children’s services).
  1. The relationship between the local NHSCB team, local clinicians, the local authorities, prisons and other prescribed accommodation is central to the operating model. This will be a new way of working and will need clinical support and expertise along with high quality management and systems.
  1. There are a number of interdependencies still being considered as part of the overall design and future responsibilities of Commissioning of services for people in prison or other secure settings and victims of sexual assault. The scope of health commissioning for prisoners, detainees and children and young people in secure settings transferring to the NHSCB will need to be set out in new regulations.
  1. Clause 13(3)(1C) of the 2012 Act makes Clinical Commissioning Groups responsible for providing services or facilities for emergency care (ambulances, A&E, walk-in and 111 services) ‘for any person present in its area’. This legal responsibility cannot be delegated for particular groups of the local population, e.g. prisoners or young persons in secure settings who require emergency care.
  1. However, apart from emergency care services as described above, the commissioning model proposes that the NHSCB will be responsible for commissioning all the healthcare needs for people in prison or other secure accommodation (primary care, mental health services, other community health services and secondary care (physical and mental health).
  1. In collaboration with offender health leads and other key stakeholders, common operating policies and principles are being developed to support local area teams. Thesewill be available from Sept–Dec 2012 and will cover:
  1. Secondary Care Commissioning
  2. Interface with Local Authorities and Public Health England
  3. Standard quality principles for areas of new responsibility eg Liaison and Diversion & SARCs
  4. Children and young people in secure settings
  5. Death In Custody Reviews
  6. IT & Performance Management
  1. In the coming months the NHSCB will provide more details about the operating arrangements including:

a)The design and structure of the local area teams;

b)Fully explore interdependent relationships critical for the operating model and take any action to ensure they work effectively;

c)Continue to work with stakeholders to identify risks and manage the transition;

d)Test standard operating models and where necessary make adjustments;

e)Refine the scope and requirements for commissioning support services.