Source · Select Committees · Justice Committee
Recommendation 199
199
Accepted in Part
Complex and fragmented commissioning structure compromises prison substance misuse and healthcare services.
Conclusion
The commissioning structure for substance misuse and healthcare services is complex and fragmented. This compromises the efficacy of treatment outcomes and continuity of care for prisoners. The current healthcare model, where a single contractor covers all health services and then subcontracts drug treatment, means that commissioners are distant from substance misuse services. (Conclusion, Paragraph 126)
Government Response Summary
The government partially accepts the observation of commissioning complexity, stating NHS England is developing a new commissioning structure for Health and Justice services, and is revising the National Substance Misuse Service Specification to ensure consistency, with a publication target of Summer 2026. They also commit to strengthening Local and National Partnership Agreements.
Government Response
Accepted in Part
HM Government
Accepted in Part
Partially accept NHS England is responsible for the delivery of healthcare services in prisons under the Health and Care Act 2012. This includes substance misuse services, ensuring health services in prison are integrated to build recovery outcomes and improve overall health. NHS England has a National Substance Misuse Service Specification which is used to commission all substance misuse services into every prison in England and is incorporated into Standard NHS Contracts between NHSE regional teams and providers. This is a well-established and robust approach to commissioning. All seven NHSE regional teams have robust partnership meetings and Boards in place with individual providers, and prisons, aligned to and replicative of the national partnership agreement across NHSE, HMPPS, MoJ, UK Health Security Agency (UKHSA) and DHSC. NHSE partially accepts this recommendation and is in the process, alongside DHSC, of developing a new commissioning structure for Health and Justice services as required by the Prime Minister’s announcement to abolish NHSE. It is expected when the integration of NHS England into DHSC completes by April 2027, subject to legislation passage through parliament, commissioning for healthcare in prisons will be done by integrated care systems (ICBs). This will likely be through offices for Pan-ICB commissioning in regional footprints, and will include full consideration of how we strengthen existing local partnership working, including with His Majesty’s Prison and Probation Service, and Prison Governors in particular. To improve integrated working arrangements between commissioners, providers and governors, and assure availability of specialised and focused resource, NHSE is revising the National Substance Misuse Service Specification to ensure that there is consistency in the design, delivery and oversight of substance misuse services. This is being revised in partnership with system stakeholders from Prison Governors, operational and national policy leads, providers, Collective Voice and colleagues with lived experience. The revised service specification will be published by the end of Summer 2026. To improve integrated working arrangements with Governors, we will strengthen the Local and National Partnership Agreements to ensure a whole system approach to improve health outcomes, as recommended in the recently published Chief Medical Officer for England report, ensuring there are clear lines of responsibility.