Healthcare provision in prisons: continuity of care

HM Prison and Probation Service (HMPPS) is grateful for this feedback on the Prison Service Order 3050 Continuity of Healthcare for Prisoners. We are working with health partners, including NHS England (NHSE), The Welsh Government, OHID, Association of Directors of Adult Social Services (ADASS) and the Association of Ambulance Chief Executives (AACE) to improve access to health and social care services for people who encounter and move through the criminal justice system. This includes at court, in the community, in custody and returning to the community. A multi-agency Continuity of Care Steering Group has been considering the changes necessary to PSO3050 and agreement reached to extend the remit of the current policy to include people under probation supervision and pre and post custody transitions. The Steering Group oversaw 10 workshops between October 2023 and April 2024 involving a range of internal and external stakeholders. The policy will include an agreed definition for Continuity of Care for those in touch with HMPPS services, mandatory actions, as well as supporting guidance and a chapter specific to continuity of care for women. The policy will cover requirements in relation to transition points from court, community, custody and back to the community, including unplanned releases, including via court appearances. It will strengthen existing guidance in relation to information sharing between prison and healthcare services at transition points, including transfer between prisons and on release. Additionally, the policy will reference the partnership working required to support NHS pre and post release services and reinforce the expectation that prison and healthcare staff follow required pre-release processes designed to support Continuity of Care. The detailed findings in the report will further inform the development of the revised Continuity of Care policy. Actions planned to deliver safety recommendation: Establish a Steering Group to review PSO3050 identifying updated practices and instructions to include those on probation and update to a Policy Framework. By when: completed. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place. Draft new policy framework considering Steering Group advice, instruction and direction. By when: April 2025. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place. Consult draft with internal and external partners and stakeholders. By when: August 2025. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place. Submit policy to HMPPS governance gateway. By when: November 2025. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place. Publish and promote policy framework. By when: March 2026. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place. Response received on 21 February 2025.

A comprehensive review of escort provision, including longer term hospital admissions is currently being jointly undertaken between HMPPS and NHSE (and Wales). A priority of the review is to improve prisoner / patient access to health services, considering demand and understanding how this is influenced by factors such as age or gender. This work will also consider how to optimise appointment times, factoring in prison regimes, the timings of clinics, and the geographical proximity of health facilities. Separate work is underway to improve standardisation of resource allocation across the estate across a range of service areas including escort provision, in the longer term this work will support greater consistency of provision. The review recognises the need to reduce demand through improved access to (and uptake of) telephone and video consultations, and telemedicine services, drawing on best practice from across the health sector and beyond. Actions planned to deliver safety recommendation: Model actual demand for outpatient escorts. By when: February 2026. Organisational lead: Head of Workforce Modelling. Resources in place to deliver actions: Joint working arrangements between HMPPS and NHSE, with identified leads from each department. Other dependencies identified: Access to anonymised patient data. Qualitative research and analysis. Other data sets. Improve access to (and uptake of) telemedicine. By when: February 2026. Organisational lead: Head of Workforce Modelling. Resources in place to deliver actions: Joint working arrangements between HMPPS and NHSE, with identified leads from each department. Other dependencies identified: Qualitative research and analysis. Secondary Care engagement. Preventative action (recommendations). By when: February 2026. Organisational lead: Head of Workforce Modelling. Resources in place to deliver actions: Joint working arrangements between HMPPS and NHSE, including the Health & Wellbeing team. Other dependencies identified: Qualitative research and analysis. Sufficient evidence supporting ‘what works’ to consider whether the need for medical appointments might be reduced, through tackling the root causes of poor health and the use of Social Prescribing. Escorts - Workforce Delivery Model. By when: April 2026. Organisational lead: Workforce Delivery Project Senior Lead. Resources in place to deliver actions: Limited project team. Other dependencies identified: Assurance and testing of all WDMs, including affordability. Response received on 21 February 2025.

NHS England is committed to continuing to identify opportunities to create equal and improved access and reduce barriers to telemedicine adoption for all patients. A great deal of work has been undertaken to identify the barriers to using telemedicine for outpatient appointments within the Secure and Detained Estate (SDE). This includes engagement with NHS providers and prison senior managers led by the NHS England South East regional team and the subsequent development of guidance to address implementation challenges. NHS England will continue to build on this work and remain engaged with His Majesty’s Prison and Probation Service (HMPPS) to further scale and spread adoption and good practice. NHS England will update all existing implementation materials for using telemedicine in the SDE, these have already been developed and trialled in the NHS England South East region. We will also ensure this includes clear guidance on best practice when transferring responsibility for patients from the SDE between NHS trusts, to ensure the receiving trust can take required action immediately. The guidance will make clear to healthcare teams that a patient’s position on the waiting list should not be affected. It will also make clear that this transfer of care should be communicated to the patient in an accessible format. NHS England has produced a detailed remote consultation toolkit to support remote consultation implementation and improvement. The toolkit will be updated to include specific actions for using remote consultations in the SDE. The use of telemedicine in the SDE is more suitable for some specialties and pathways, NHS England’s Outpatients Technology Enabled Improvement team will work with national clinical leads and analytics teams to identify the areas in which telemedicine would be most appropriate and impactful. This will be reflected in our updated guidance and resources. Once the guidance and the toolkit have been updated, national communications will be shared to ensure NHS trusts are aware of and have access to the resources. The resources will also be shared directly with Health and Justice regional commissioners for onward sharing with all relevant stakeholders, including healthcare providers in the SDE and NHS acute and community providers. NHS England’s Health and Justice team, including regional commissioners will lead work and engage other national and regional colleagues to continue to support local NHS providers to improve their relationships with local SDE healthcare teams. Encouraging them to establish formal arrangements to improve remote appointment bookings and other key processes. This will include the creation of local directories of services, so NHS trusts can understand the capabilities, staffing and suitable timings to schedule remote appointments for patients in the SDE they are responsible for. Actions planned to deliver safety recommendation: Update the existing implementation guidance. This will include: Standard Operating Procedure (SOP) Implementation checklist Implementation flowchart HMP Healthcare chaperone on the day processes flowchart Prison activity data - Metrics script Patient information leaflet and consent form Patient questionnaire. We will ensure documents are updated with key information such as guidance on the transfer of care when patients are moving between trusts, by January 2026. 2. Work with national clinical leaders and analytic teams to identify the specialties and pathways that are most suitable for telemedicine in the SDE and reflect this in relevant national resources, by January 2026. 3. Share all updated guidance with regional Health and Justice commissioners to circulate with SDE healthcare provider leads, by January 2026. 4. Share national communications to promote updated resources and showcase existing good practice, by April 2026. 5. Support formal arrangements between the SDE and their local hospitals, creating local directories of services, by April 2026. 6. Provide learning and advice to trusts about best practice about the transfer of care for patients moving between trust locations, to prevent waiting times from being negatively impacted, by April 2026. Response received on 24 July 2025.