Children are cared for by services that assess and meet their health, social care and substance use needs and promote continuity of health and social care on release. The standard of health service provided is equivalent to that which children could expect to receive elsewhere in the community.

Strategy, clinical governance and partnerships

49. Children are cared for by services that accurately assess and meet their health, social care and substance use needs and which promote continuity of health and social care on release.

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 prison, commissioners and providers ensures that health, social care and substance use services meet the assessed needs of children.
  • Effective leadership and governance systems ensure good patient outcomes.
  • Health, substance use and social care provision meet the required regulatory standards, including the duty of candour.
  • Health staff work closely with staff in other areas of the establishment to ensure effective, integrated, child-focused care.
  • Service delivery is informed by effective consultation with children and by lessons learned (for example, from adverse incidents and complaints).
  • Health staff are easily recognisable. Staffing levels and skill mix throughout a 24-hour period meet patients’ needs.
  • Staff are well trained and supported; this includes regular clinical and managerial supervision.
  • Every patient 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 patient safety.

50. Children receive treatment, which is sensitive to their diverse needs, from competent staff in an environment that promotes dignity and maintains privacy.

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

  • All children have equal access to health, well-being and social care services, regardless of location, regime, disabilities or language barriers.
  • Patients are treated with dignity, respect and compassion.
  • There are sufficient rooms to provide a full range of health services.
  • Infection prevention and control measures are robust.
  • Patients are seen in private, except in clearly documented exceptional circumstances.
  • Competent health staff respond promptly to medical emergencies with appropriate emergency equipment.
  • All clinical equipment is appropriately maintained and serviced.
  • Arrangements to gain and review children’s consent are effective, with appropriate consideration of their capacity to understand. Children are helped to exercise their ability to consent, including by making reasonable adjustments and by allowing them to be supported by a third party. If competence to provide informed consent is absent, arrangements are made to obtain consent from parents/carers. If this is not possible health professionals make ‘best interests’ decisions in accordance with legislation.
  • Patients are kept safe, are safeguarded from abuse and have access to independent advocacy services if required.
  • Patients can complain about their treatment in confidence, without recrimination. Responses are timely, easy to understand and address all the issues raised.

Cross reference with: security; equality and diversity.

Promoting health and well-being

51. Children are supported and encouraged to optimise their 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.

  • There is a whole-prison approach to promoting health and well-being.
  • Information about available health services and current national health campaigns is accessible in all required formats and languages.
  • Children can easily access age-appropriate health checks, disease prevention and screening programmes.
  • Children can access sexual health services and are provided with barrier protection. Related health advice is easily available, including on release.
  • Children who smoke can access community-equivalent smoking cessation support.
  • There are robust systems to prevent, identify and manage communicable diseases.

Primary care and inpatient services

52. Children’s immediate health, substance use and social care needs are recognised on reception and responded to promptly and effectively.

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 children on the day of arrival to identify their immediate needs and make appropriate onward referrals.
  • Relevant risk and care planning information is shared between prison and health staff on reception and throughout the child’s detention.
  • With consent, the child’s community clinical records are obtained promptly.
  • Children receive timely secondary health assessments from health and substance misuse professionals.

Cross reference with: early days in custody; substance misuse.

53. Children’s individual, ongoing health care needs are addressed through an appropriate range of care services. Continuity of care is maintained on transfer or release.

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

  • Children can access all necessary primary care services, including effective out-of-hours GP services, within equivalent waiting times to the community.
  • Children have access to a health professional of their gender and/or a chaperone if desired.
  • Patients with long-term conditions and complex health needs receive appropriate joined-up care. Recorded care plans demonstrate patient involvement and support continuity of care.
  • There is an effective appointments system.
  • Health services staff provide community-based services on the wings when required.
  • Health staff complete a restraint handling plan for all children with a medical condition who may be adversely affected by restraint. All staff are aware of the content of restraint handling plans and use this information during restraint.
  • Patients receive secondary care services within community-equivalent waiting times and care is not disrupted by prison transfers.
  • Security measures on hospital escorts are proportionate and are based on an individual risk assessment, which includes a detailed contribution from health care professionals who know the child.
  • Timely joint working with relevant internal and external departments and services supports continuity of care.
  • Children receive relevant pre-release assessments and interventions and are supported to register with community health services.

54. Patients requiring 24-hour nursing care are supported by a regime, facilities and health care staff to meet their individual needs.

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

  • Admission and discharge is based on agreed clinical criteria. Staffing numbers and skills mix meet the patients’ needs.
  • Patients receive a comprehensive assessment of their care needs and, wherever possible, are involved in developing their own care plans.
  • Patients have decent living conditions and access to a normal prison regime, alongside therapeutic and constructive activities to maintain well-being and encourage recovery.
  • Appropriate arrangements are made for patients to continue their education, wherever possible.
  • Patients’ ongoing care needs are met following discharge from the inpatient unit.
  • Arrangements are made for the early release or transfer to a hospital or hospice of children who are dying or who have life-limiting conditions.

Cross reference with: daily life – residential services; purposeful activity.

Mental health

55. Children with mental health problems are identified promptly and supported by community-equivalent services to optimise their mental well-being during their detention and on transfer or release.

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

  • Children’s immediate mental health needs are assessed during their reception health screening and appropriate onward referrals are made.
  • Custody staff receive training to enable them to recognise when a child requires referral for mental health assessment. There is a clear referral pathway.
  • Referrals are reviewed promptly and appointments allocated on clinical need and risk.
  • Competent practitioners deliver a community-equivalent range of evidence-based interventions and support for primary and secondary mental health problems. Support is also available for children with learning disabilities, autistic spectrum disorders and for speech, language and communication difficulties.
  • Prescribing reviews and related physical health checks occur regularly.
  • Patients are assessed using a standardised format and additional information is obtained from other sources as required.
  • Patients have written care plans which are regularly reviewed with their mental health practitioners. Parents and carers are involved if the patient requests it.
  • Liaison and joint working with other prison departments and health providers, including substance use treatment services, is effective.
  • Patients with severe and enduring mental illness are supported by specialist children and adolescent mental health services.
  • Patients who require assessment or treatment under the Mental Health Act are assessed and transferred promptly. Children understand why they are being transferred and are given information about their destination.
  • Effective discharge planning and liaison with offender managers, community rehabilitation companies (CRCs) and community mental health services ensures continuity of care following release.

Cross reference with: education, skills and work activities; daily life – residential services; substance misuse; resettlement.

Substance misuse

56. A whole prison strategic approach to drugs and alcohol ensures supply and demand reduction and that treatment is integrated, effective and meets children’s individual needs.

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 prison departments, treatment providers and other relevant stakeholders embeds a dynamic, whole-prison drug and alcohol strategy.
  • A regular and comprehensive needs assessment informs the strategy and action plans.
  • Sufficient competent staff provide effective, evidence-based psychosocial and clinical services which meet the needs of the population.
  • Psychosocial and clinical substance use treatment services are well integrated with each other, the prison and all health services.
  • All new arrivals receive prompt assessment of their substance use and specialist clinical support, prescribing and monitoring in line with national guidance.
  • All new arrivals receive relevant harm reduction information to help them stay safe.
  • Service users have personalised recovery plans which are regularly quality-assured.
  • Patients with both mental and substance-related problems have prompt access to joined-up, comprehensive support.
  • Consultation with and feedback from children using drug and alcohol services informs service delivery.
  • All children receive harm reduction advice prior to release.
  • Effective discharge planning and liaison with other departments and community services ensures post-release continuity of care.

Cross reference with: health services, training planning and remand management; children, families and contact with the outside world.

Medicines optimisation and pharmacy services

57. Children receive community equivalent, patient-centred medicines optimisation and pharmacy services.

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

  • Patients’ 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.
  • Patients can access clinical pharmacy services and advice.
  • All medicines are handled, transported and stored legally, safely and securely with effective pharmaceutical stock management and use.
  • Robust governance processes are in place to ensure safe and effective medicines management, including monitoring of medication incidents and prescribing trends.
  • Patients’ medicines are prescribed safely in line with evidence-based practice and formularies. They are reviewed regularly and are administered at clinically appropriate times.
  • Patients’ adherence to medication is monitored. Patients are promptly reviewed when adherence is poor and/or diversion is suspected.
  • Children are supported to take responsibility for their own medication and to engage effectively in required prescribing reviews. Subject to a regularly reviewed in-possession risk assessment, patients can store their medicines securely and self-administer.
  • Medicines are administered from a secure and respectful environment and medication administration queues are managed effectively.
  • Children going to court or being released or transferred receive adequate supplies of medication or a community prescription to meet their needs.

Dental services and oral health

58. Children receive timely, community-equivalent dental services, including oral health promotion.

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

  • Children have timely access to dental checks, oral health promotion and any necessary treatment, including orthodontic treatment where necessary, regardless of their sentence.
  • Emergency dental cover is well organised, responsive and effective.
  • Patients have prompt access to required medicines following dental interventions.
  • Dental care meets contemporary professional standards.

Human rights standards

Health services
In relation to all health services expectations: Everyone has the right to the enjoyment of the highest attainable standard of physical and mental health, see CRC 3(3), 24; ICESCR 12. Human rights standards require that children be provided with the same standard of health care as available in the community and that places of detention should safeguard and improve the health of those in their care. See ERJO 28, 69–75; HR 28, 49–52, 55; SMR 24, 25; EPR 39, 40.

It is important that the impact of detention on children is monitored. See ERJO 70; HR 52.

Strategy, clinical governance and partnerships
In relation to expectations 49–50: Human rights standards emphasise the role of health care staff in evaluating, promoting, protecting and improving the physical and mental health of children, paying particular attention to those with special health care needs. There should be an interdisciplinary team with full clinical independence. There must be prompt access to medical care in urgent cases and referral to external care when needed. See ERJO 69, 73, 74, 102.1; HR 49, 51, 81, 84; SMR 25–27, 31; EPR 40–42, 46.

Promoting health and well-being
In relation to expectation 51: Activities and interventions should promote children’s physical and mental health and children should be provided with health information. See ERJO 50.1, 71; HR 1, 12.

Primary care and inpatient services
In relation to expectations 52–54: Human rights standards require children’s health care needs to be assessed on arrival, including identifying all health care needs, the risk of self-harm and any previous ill-treatment. See ERJO 62.2, 62.5; HR 21, 31, 50; EPR 40; SMR 30. Standards require health needs to be monitored and met throughout detention. See HR 49, 51, 52; EPR 39–43, 46, 87(d); SMR 24, 27, 31–34.

Mental health
In relation to expectation 55: Human rights standards require places of detention to monitor and meet children’s mental health needs and to ensure referrals are made to external care when needed. See ERJO 70.2; HR 49, 51, 81, 85; EPR 39–43, 46, 47.2; SMR 24–27, 31–34.

Substance misuse
In relation to expectation 56: Human rights standards provide that initial health assessments should include an assessment of symptoms of withdrawal resulting from the use of drugs, alcohol or medication, and note the need for continuity of care for drug dependence. See ERJO 62.2, 62.5, 72; HR 54; SMR 24.2, 30; EPR 42.3.

Medicines optimisation and pharmacy services
See the standards under health services heading above.

Oral health
In relation to expectation 58: Human rights standards require children to have access to dental services. See HR 49; SMR 25.2; EPR 41.5.