Improving health services for people living in secure accommodation

Prison gates


From April 2013, the NHS Commissioning Board will take on more responsibility to ensure that all patients receive better outcomes from the NHS. As part of this, they will be responsible for planning, securing and monitoring health services for victims of sexual assault, and people in prison and other secure settings, including children’s homes and young offender institutions. Their aim is to deliver high quality services in these settings, based on local knowledge and shared nation values, and contributing to the following key improvement areas:

  1. Reducing health inequalities;
  2. Ensuring services are integrated; and
  3. Reducing health risk factors.

VulnerableTo guide this work, the NHS Commissioning Board has published this operating model, outlining how it will go about commissioning high quality services for this vulnerable population.

The document starts with a clear outline of purpose, followed by an overview of the current situation, including greater detail about the types and numbers of institutions that the model is aimed at. It also explains the background of the NHS Commissioning Board, and lists the main characteristics that the commissioned health organisations should possess, including “a clear sense of purpose focused on improving quality and outcomes” and “a commitment to putting patients, clinicians and carers at the heart of decision-making.”

Young man sitting on the pavement wearing handcuffsSecure accommodation

There is a useful description of all the aspects of England’s secure estate; there are 120 prisons, 16 secure children’s homes, 4 secure training centres, and 12 immigration removal centres, in addition to the police custody suites and the courts’ Liaison and Diversion Services, which ensure that offenders with mental health problems receive the treatment that they need to stop their issues escalating. There is a table which shows which organisations are currently responsible for commissioning these services. The NHS Commissioning Board will take over these responsibilities from the Youth Justice Board, UK Borders Agency, and individual police forces. The table also provides an overview of the budget available for commissioning health services for this patient group.

There is a section in this document, which highlights the fact that people in secure settings often have poorer health compared with the average population. Examples include higher rates of drug abuse, mental illness and serious maltreatment of children.

Cartoons building a wallCooperation

The NHS Commissioning Board will integrate with other public sector partners and child development experts, including educational establishments, police forces, prisons, and housing associations, and will share information in order to reduce crime, such as domestic violence. They will also work with the Department of Health, Clinical Commissioning Groups, and local authorities. The Tasks and Functions table, towards the end of the document lists all the activities that need to be carried out together with the various local and national teams that will have responsibility for these areas of work.

This document is useful because it explains why the NHS Commissioning Board is taking on these responsibilities, and the model it is going to apply in order to carry them out. In clear detail, it talks about how this work will be carried out in partnership with local public sector organisations, sharing out the activities between local and national groups, with patient needs being at the heart of decision-making.


This document has been written for people working in prisons, children’s homes, secure training centres, immigration removal centres, police custody suites, and courts; secure environments responsible for offenders and vulnerable youngsters.

Reading through, think about how it will affect your organisation, and whether your staff will need further training. Perhaps share this report with your team as it is a relatively short document, structured in easy-to-scan bullet points, with clear explanations about commissioning and its importance in offender healthcare.


Securing excellence in commissioning for offender health (PDF 817KB)
A Whitfield
NHS Commissioning Board
February 2013

Related links

Securing excellence in commissioning for offender health – Frequently Asked Questions (PDF 82KB)
Securing Excellence in Commissioning for Offender Health: Key Facts (PDF 65KB)

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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