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Healthcare provision at court

There is a legal requirement under The Health and Social Care Act (2013) for NHSE/I to commission healthcare in criminal court settings to the extent it considers reasonable.

Although responsibility for commissioning healthcare in criminal courts sits with NHSE/I, it is currently partly delegated to the Ministry of Justice via the Prisoner Escort and Custody Service (PECS) reflecting NHS standards and commissioning responsibilities.

These healthcare services are managed by PECS suppliers, Serco (South) and GEOamey (North), through sub-contracted healthcare providers.

Service Outcomes

  • Prisoner Custody Officers (PCOs) working in the court setting receive training, which enables them to identify the signs of significant illness or deterioration in health and how to respond appropriately (including physical health, mental health and substance misuse).
  • PCOs working in the court setting receive accredited training to enable them to deliver first aid and basic life support.
  • PCOs have access to a healthcare telephone triage advice line should they have a query or concern regarding a prisoner’s health.
  • Once triaged, a healthcare professional (paramedic, nurse or doctor) may be dispatched to attend court to access a prisoner for a further in person assessment.
  • PCOs can access 999 or community mental health crisis services where it is considered that a prisoner has an urgent or emergency health need.
  • Prisoners will receive an assessment of their health (including mental ill health, substance misuse, including alcohol withdrawal and physical health) where this is clinically indicated, as assessed by the court healthcare service.
  • Prisoners can access appropriate, limited treatment within the court setting, where this is clinically indicated and can be safely and appropriately delivered in a court setting, by the court healthcare service.
  • Prisoners can access a range of homely remedies, supported by safe systems for the administration of medication, including under a Patient Group Direction where appropriate.
  • Subject to approval by a healthcare professional, prisoners can access their own medication, where this is appropriately packaged and labelled, which they can self-administer during their time in the court setting.
  • Systems are in place:
    • should a prisoner attend court without their medication.
    • to assess and clinically support prisoners who exhibit signs of alcohol or opiate withdrawal.
    • to enable timely access to rescue therapies including Naloxone/Narcan or medication to reverse other conditions, such as hypoglycaemia or GTN for angina for example.
    • to ensure the relevant flow of healthcare information into and out of the court setting, including from and to police and prison healthcare and community services.
  • Where appropriate, prisoners are referred to their community GP or the local Liaison and Diversion service, where an ongoing healthcare need is identified.
  • Information sharing arrangements are in place with both criminal justice and healthcare partners.
  • Officers of the court will be advised of cases where they may wish to consider whether a prisoner is well enough to take part in court proceedings, based upon the presenting healthcare needs of the prisoner.
  • The court healthcare service will work collaboratively and proactively with HMPPS, PECS, Youth Custody Services, Local Authorities, Liaison and Diversion services, Police, and HM Courts & Tribunal Service staff and officers of the court.

Service Description

The PECS suppliers will ensure:

  • The healthcare service is available whilst prisoners remain in detention within the court setting for Prison Custody Officers to make referrals to or seek advice. This may be using telephone or video technology.
  • Custody and healthcare staff are appropriately trained and competent to undertake their roles. For non-healthcare staff, this will include as a minimum, mental and physical first aid, risk assessment and management.
  • A dedicated risk assessment, as provided by the Commissioner, for prisoners attending court off-bail must be undertaken as soon as possible and in a confidential space so that meaningful completion can be undertaken. Custody staff require training in its use and to appreciate the importance of comprehensive and meaningful completion. Should the risk assessment highlight any concerns, the supplier must have a system to enable the identification and monitoring of any deterioration in the prisoner.
  • Healthcare staff are qualified, receive accredited training, relevant DBS compliance and are registered with the appropriate professional body and discharge their professional responsibilities in line with professional standards, regulations and code of practice and conduct.
  • Access to the appropriate emergency equipment including AED (Automated External Defibrillator), to be agreed between the supplier and Commissioner, which should be available within each court building. The supplier will ensure its staff are aware of the location of the AED in each building.
  • Provision to receive contact from court custody staff on behalf of prisoners via a telephone and/or video triage system, or other virtual means as alternative access channels emerge, should staff have a query or concern regarding a prisoner’s health is in place. All prisoners referred for a clinical assessment will be assessed and triaged by a trained clinician.
  • When a face-to-face consultation is required, it is conducted in an environment most appropriate to patient safety, confidentiality and needs where possible.
  • Medicines policies and procedures are overseen by a pharmacist and medical/clinical lead and be responsible for enabling access to any urgent medicine using the current medicines regulations, community pharmacy services and taking account of national guidance.
  • Custody staff and prisoners are aware of how to access the service and this is continuously promoted and assessed, to ensure equitable access based on need across all court settings.
  • Custody staff will maintain close dialogue with their local Liaison and Diversion service and other related services and facilitate access in the least bureaucratic way possible when an assessment is agreed.
  • Systems are in place to ensure the relevant flow of healthcare information into and out of the court setting, including from and to police and prison healthcare and community services, including referrals to their community GP where appropriate. The supplier should obtain the written and informed consent of the individual before sharing information with agencies. There may be circumstances when a person may lack capacity for consent which must be taken into consideration and additionally normal exclusions for sharing information without consent will also apply as per GDPR and DPA information sharing legal frameworks.
  • Reasonable endeavours are used to ensure that all prisoners understand the outcome of the consultation and are left with clear information as to what further self-care they may need to undertake.
  • They are able to flex service provision within the resource model in response to variation in demand on the service.