Healthcare provision in prisons

HM Prison and Probation Service is committed to equipping staff to respond appropriately when they encounter a medical emergency. All new Foundation Prison Officers are now required to complete Emergency First Aid at Work as part of the Foundation Course. We recently issued a new training video on ‘Responding to emergency situations’ designed to help staff to understand what they need to do in a medical emergency, including when they find a prisoner who has ligatured. The video has been viewed over 2,000 times on the HMPPS intranet and is also available on the ‘My Learning’ platform which can be accessed by staff from partner organisations and contracted prisons. We have worked with St John Ambulance to produce five training films for staff who are first on scene. These are available on the ‘My Learning’ platform, which can also be accessed by staff from partner organisations and contracted prisons. The films have been sent to Governors and Directors who have been informed that it would be advantageous for all Prison Officers and other front line staff to view them and for them to be used to supplement annual refresher training for emergency first aiders. We are committed to updating the films to include the same content as the redesigned medical emergency response cards, which identifies to staff the information they will need to share with the control room about the condition of the prisoner. Actions planned to deliver safety recommendation: Launch first on scene training films. By: Completed. Update the films to include the content from the redesigned medical emergency response cards. By: 31 March 2025. Response received on 3 December 2024. --------------------------------------------------- May 2026: HSSIB has been notified by HM Prison and Probation Service that all actions have been completed.

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.

We agree with this recommendation. NHS England and DHSC recognise the importance of supporting patients in prison to make fully informed choices about their healthcare registration. Following a review of current policy options and operational dependencies, we propose the following actions and indicative timeframes. Actions planned to deliver safety recommendation: Initial scoping review completed, with engagement of healthcare providers, clinicians, and patient representatives to understand current challenges, by Mid 2026. Resources in place: Existing policy and commissioning teams including NECS and support from prison healthcare providers. Other dependencies identified: Coordination with DHSC, HMPPS, and digital registration systems. Additional comments: This review will inform future policy development and operational changes. Updated guidance issued, supported by the development of staff training resources on informed consent, by late 2026/27. Resources in place: Policy and clinical teams. NECS and collaboration with DHSC and HMPPS. Other dependencies identified: Dependent on completion of scoping review and stakeholder input. Additional comments: Guidance will reflect best practice and legal standards. Evaluation of implementation and patient feedback to ensure consistency across the estate, by 2028. Resources in place: Policy and commissioning teams. Other dependencies identified: Requires integration with future policy cycles and operational planning. Additional comments: Findings will inform future updates to guidance and training. Our long-term aspiration is to establish a fully consistent, patient- centered registration process in every prison, ensuring that informed consent is embedded as a principle of care. Response received on 20 October 2025.

We agree with this recommendation. We recognise the unique challenges associated with the remand population, where frequent transfers and shorter stays often disrupt continuity of care. We recognise the need for a consistent and patient-centred approach to registration for remand prisoners. Actions planned to deliver safety recommendation: Conduct targeted review of GMS registration processes for remand populations in collaboration with healthcare providers and patient representatives, by early 2026. Resources in place: Policy and commissioning teams. Legal team Input from remand-holding establishments. Other dependencies identified: Coordination with DHSC, HMPPS, and prison healthcare teams. Additional comments: Review will focus on unique needs and challenges of remand populations. Explore the best way to enable functionality that would provide access to the full Electronic Patient Record through technical changes or access to other digital products, by 2026/27. Resources in place: GPIT programme teams; collaboration with digital teams and prison healthcare providers. Other dependencies identified: Dependent on digital infrastructure, interoperability standards, and stakeholder engagement HMPPS – sentencing review. Additional comments: Aims to improve continuity of care and reduce administrative burden for short-term prisoners. Undertake a consultation process with professional bodies, prison healthcare teams, and patient representatives to explore the Scottish model of mandatory registration after six months, by end 2026. Resources in place: Policy and commissioning teams. Legal oversight support from DHSC and external stakeholders. Other dependencies identified: Regulatory implications; technical enablers; alignment with existing NHS registration frameworks. Additional comments: Primary Care team to assist with coordination and stakeholder engagement. Continue development of a digital pathway for pre-release registration to support continuity of care post-release, by end 2026. Resources in place: Online Registration Team, NHS England (Primary Care to assist). Other dependencies identified: Digital development teams; collaboration with prison healthcare and commissioning teams. Additional comments: Integration with prison release planning systems and NHS registration platforms. Consider the technical requirements and possibilities for temporary care information following release to be held in the National Data Repository, by end 2026. Resources in place: Digital architecture and data governance teams; support from Primary Care. Other dependencies identified: Dependent on national data strategy, IG compliance, and system capabilities. Additional comments: Exploration will inform future data integration and continuity of care improvements. The long-term ambition is to reduce disruption to patient care and ensure that GMS registration processes for remand prisoners are consistent, equitable, and support seamless continuity of treatment. Response received on 20 October 2025.

We agree with this recommendation. Work to embed interoperability requirements has already been completed and is included within the healthcare IT procurement roadmap. Actions planned to deliver safety recommendation: Work in partnership with HMPPS to align priorities for interoperability with the Digital Prison System, by end 2026. Resources in place: Joint working groups; digital strategy and infrastructure teams from NHS England and HMPPS. Other dependencies identified: Dependent on HMPPS digital roadmap and NHS system capabilities. Additional comments: Alignment will support seamless data sharing and continuity of care. Engage suppliers (if new supplier procured) and design system specifications that reflect interoperability requirements as standard, by end 2026. Resources in place: Procurement and digital architecture teams; supplier engagement processes. Other dependencies identified: Dependent on procurement outcomes and alignment with NHS and HMPPS digital strategies. Additional comments: Specification will embed interoperability as a core requirement to support continuity of care. Incorporate interoperability as a contractual requirement in any future system procurement, by end 2026. Resources in place: Procurement frameworks; legal and technical advisory support. Other dependencies identified: Dependent on procurement timelines and supplier engagement outcomes. Additional comments: Will ensure interoperability is embedded from the outset to support continuity of care and data sharing. Deliver a modern, integrated digital system across the detained estate. Resources in place: National digital infrastructure programmes; collaboration with HMPPS and NHS stakeholders. Other dependencies identified: Dependent on funding, procurement, and interoperability alignment. Additional comments: System will support continuity of care, data sharing, and patient safety across the estate. The long-term aspiration is to reduce duplication, improve data quality, and strengthen both operational and clinical decision-making through modern, connected digital systems. Response received on 20 October 2026.