Health and well-being

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Effective partnership working between the establishment and health care providers ensures that health, social care and substance misuse services meet the assessed needs of detainees.
• Effective leadership and governance systems provide good outcomes for detainees.
• Health, substance misuse and social care provision meet the required regulatory standards.
• Service delivery is informed by effective detainee consultation which leads to service improvements.
• Local and serious incidents are reported and investigated within national detainee safety guidelines. Duty of candour is applied, and lessons are learned and shared with staff.
• Staffing levels and skill mix throughout the 24-hour day meet detainee need.
• Health care staff are easily recognisable, appropriately trained and supported; this includes regular reflective practice, recorded clinical and managerial supervision and annual appraisal.
• Every detainee has a single clinical record which meets contemporary record-keeping standards.
• Information is shared within the bounds of medical confidentiality to promote continuity of care and maintain detainee safety.
• Detainees whose health is likely to be injuriously affected by their detention are safeguarded.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• All detainees have equal access to health, well-being and social care services regardless of location, regime, disabilities or language barriers.
• Staff are professional and treat all detainees with dignity, respect and compassion.
• There are enough equipped clinical rooms to provide a full range of health services. Rooms are well maintained and managed in line with national infection prevention and control measures.
• All clinical equipment is logged, appropriately maintained and serviced.
• Detainees are seen in private, except in clearly documented exceptional circumstances.
• Detainees can see a doctor or practitioner promptly, of their own sex if they prefer. They are aware that they can request this service.
• Children can access health services which meet their specific needs.
• There are comprehensive clinical audit programmes in place. Audit action plans are monitored within agreed timelines.
• Joint emergency response plans are in place to respond to medical emergencies. Competent staff respond promptly to medical emergencies with appropriate emergency equipment.
• Arrangements to gain and review detainee consent are appropriate and in line with national guidance. When detainees lack mental capacity to make decisions, health professionals make ‘best interests’ decisions in accordance with legislation.
• Detainees are kept safe, are safeguarded from abuse and have access to independent advocacy services if required.
• Detainees can complain about their treatment in confidence, without recrimination. Responses are timely, easy to understand, address all the issues raised and are apologetic when required.
• Any detainees with social care and support needs are identified and receive assessment, care packages, adaptations and advocacy services that continue on release or transfer.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• There is a joint approach across the establishment to improving the health and well-being of detainees.
• Admissions processes include health promotion advice and signposting.
• Information about available health services and current national health campaigns is easily accessible in all required formats and languages.
• Detainees can easily access health checks, disease prevention, screening programmes and mental health promotion.
• Detainees can confidentially access contraception and sexual health services. Barrier protection and related health advice is freely available.
• Detainees can access community-equivalent smoking cessation support.
• There are robust systems to prevent, identify and manage communicable diseases.
• Detainees receive individual harm minimisation and health promotion advice on release.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Detainees are screened for sexual health and reproductive needs on arrival and referred onwards as appropriate.
• Sexual health services are confidential and provided by suitably qualified staff.
• Detainees can access pregnancy testing and emergency contraception within 24 hours of arrival if required.
• Pregnant women have access to community-equivalent antenatal care in line with national standards, including access to midwifery advice by telephone whenever they need it.
• Pregnant detainees can prepare for childbirth and parenting in line with national standards.
• Detainees who experience a miscarriage shortly before or during their detention have access to appropriate physical and emotional care, including counselling.
• Detainees considering termination of a pregnancy can access appropriate services and follow-up care.
• Counselling services are available for those who have experienced loss or bereavement, including post-adoption.
• Post-natal care is equivalent to that available in the community.
• Detainees who disclose they have been the victim of sexual assault have access to a sexual assault referral centre and associated follow-up care.
• Where a child is separated from its mother before the mother’s release date, the mother is provided with emotional and practical support in making the arrangements for separation.
• Detainees experiencing the menopause are supported to the same level as those in the community.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• A competent health professional screens all new detainees on arrival to identify their immediate needs and make appropriate onward referrals.
• Relevant risk and care planning information is shared between health care staff and establishment staff, both on reception and while a detainee is held at the establishment.
• With consent from the detainee, medical records other than those held by Defence Medical Services are obtained.
• Immediate substance misuse needs are identified and managed, including overnight monitoring and medicine titration.
• Immediate social care needs not previously identified are managed through local protocols and urgent referral processes. Care packages for those already identified are continued.
• Medicines are reconciled and prescribed to ensure continuity of care. Detainees who arrive without expected medicines are managed with an emergency or out of hours prescription.
• Detainees arriving with acute mental health problems or at risk of self-harm are managed through a multidisciplinary care planning process.
• Decisions to place detainees in quarantine or medical isolation are made by health care staff. Safeguards are in place to ensure the health and well-being of these detainees, including necessary treatment, time outdoors, and meaningful human contact.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Detainees can access all necessary primary care services, including pain management support services and effective out-of-hours GP services, within community-equivalent waiting times.
• There is a confidential and effective appointments system.
• Detainees with long-term conditions and complex health needs receive appropriate joined-up care in line with national standards. Up-to-date and evidence-based care plans demonstrate detainee involvement and continuity of care.
• Detainees receive secondary care services within community-equivalent waiting times and care is not disrupted by a lack of escort staff.
• Security measures during hospital escorts are proportionate and are based on an individual risk assessment, which includes an appropriate contribution from health staff.
• All partners involved in the planning of health care, access to it and treatment work together effectively to make sure continuity of care is maintained during custody and on release.
• Detainees receive relevant pre-release assessments and interventions. Discharged detainees are supported to register with community health services.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Detainees’ immediate mental health needs are assessed during their initial health screening and appropriate onward referrals are made.
• Establishment staff receive training to recognise when a detainee requires referral for mental health assessment, and there is a clear referral pathway.
• Referrals are reviewed promptly and appointments are allocated on clinical need/risk.
• Sufficient skilled practitioners meet the mental health needs of the population. Provision is psychologically informed and evidence based.
• Specialist support for those who have been sexually assaulted, bereaved or require antenatal and post-natal mental health support is accessible.
• A community-equivalent range of evidence-based interventions are available in a timely manner.
• Prescribing reviews and related physical health checks occur in line with national guidelines.
• Detainees are assessed using a standardised format and additional information is obtained from other sources as required.
• Detainees have written care plans which are regularly reviewed with their mental health practitioners.
• Liaison and joint working with other teams across the establishment is effective.
• Detainees with severe and enduring mental illness are supported within the Care Programme Approach.
• Detainees who require assessment or treatment under the Mental Health Act are assessed and transferred according to national guidance.
• Effective discharge planning and liaison with community mental health services ensures continuity of care when detainees are released.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Effective joint working between the establishment, treatment providers and other relevant stakeholders embeds a dynamic drug and alcohol strategy.
• A regular and comprehensive needs assessment informs the strategy and action plans.
• Establishment staff receive training to enable them to recognise when a detainee requires referral to substance misuse services, and there is a clear referral pathway.
• Psychosocial and clinical services meet the needs of detainees. Detainee feedback and outcomes inform service delivery.
• Psychosocial and clinical substance misuse treatment services are well integrated with each other, the establishment and all health services.
• Sufficient competent staff provide effective evidence-based psychosocial and clinical services.
• Detainees have personalised recovery plans which are regularly quality assured.
• Detainees with both mental health and substance-related problems have prompt access to joined-up, comprehensive support.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Newly arrived drug and/or alcohol-dependent detainees receive appropriate first night treatment without delay, and regular monitoring until they are stable.
• All detainees have prompt access to appropriate clinical, psychological and harm-reduction interventions.
• All prescribing is individualised and in line with national guidelines, prescribing is undertaken by a suitably qualified clinician and complex cases such as pregnant women are managed through multidisciplinary teams involving psychiatric, midwifery and addiction specialists.
• Detainees are involved in decisions about their care. Care plans are flexible, meet individual needs and are reviewed regularly.
• Newly arrived detainees receive harm reduction information about illicit substance use in detention and substance misuse treatment services.
• Detainees can easily access family support services, self-help and mutual aid.
• All interventions are gender-informed, evidence-based and suitable for those in crisis, stabilisation or recovery.
• Effective discharge planning within the establishment and with community services ensures continuity of support after detainees leave the establishment. Care plans accompany detainees continuing in service, discharged detainees and detainees transferring to prison.
• Detainees receive information on how to avoid drug- or alcohol-related overdose, injuries and death on release or transfer. Where clinically indicated, detainees receive an emergency reversal agent to prevent overdose on release.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Detainees’ medication histories, including allergies, are recorded during the initial reception screening and a full medicines reconciliation is completed within 72 hours of admission.
• Any disruption in prescribing regimens is minimised and urgent/critical medicines can be accessed promptly.
• Detainees have direct access to clinical pharmacy services and advice.
• All medicines are handled, transported and stored legally, safely and securely with effective pharmaceutical stock management and use.
• There are robust governance processes to ensure safe and effective medicines management, including monitoring of medication incidents and prescribing trends.
• Detainees’ medicines are prescribed safely in line with evidence-based practice and formularies, reviewed regularly and administered at clinically appropriate times.
• Detainee’ adherence to medication is monitored. Detainees are promptly reviewed when adherence is poor and/or diversion is suspected.
• Subject to a regularly reviewed in-possession risk assessment, detainees can store their medicines securely and self-administer.
• Detainees can access basic self-care medicines safely and easily, including out of hours.
• Medicines are administered from a secure and respectful environment.
• Detainees receive information about their medicines in a format they understand and have regular clinical prescribing reviews.
• Detainees going to court or being released or transferred receive adequate supplies of medication or a community prescription to meet their needs.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Detainees have timely access to the full range of NHS-equivalent treatment that can be reasonably delivered while they are detained.
• All detainees have timely access to emergency dental services based on clinical need. Detainees continuing in service, discharged detainees and detainees transferring to prison have treatment plans to support any ongoing care they require after they leave the establishment.
• Detainees receive evidence-based interventions in oral health promotion and disease prevention.
• Detainees have prompt access to required medicines following dental interventions.
• Dental care meets contemporary professional standards.