Report evidence summary
Stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised. 22
NHS England Review postponed hospital appointments clinically, prioritise attendance by need and risk, and automatically rebook cancellations with hospital trusts.
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NHS England Audit healthcare-record requests to verify that the records-request process is effective.
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NHS England Review relevant clinical-review findings, implement lessons learned and identify further staff training requirements.
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NHS England Commission prison healthcare through a Prime Provider model using a single contract, provider and database.
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NHS England Mobilise Care UK to begin delivering prison healthcare services from April 2020 through monthly multi-provider mobilisation boards.
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NHS England Provide governance oversight through Contract Review Meetings, Partnership Boards and Local Delivery and Quality Boards after the new contract begins.
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NHS England Run regular SystmOne reports checking whether newly arrived prisoners’ healthcare records have been requested.
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NHS England Check that newly arrived prisoners receive a full health assessment and care plan within seven days, recording checks for healthcare staff.
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NHS England Require multidisciplinary review and risk assessment for each cancelled appointment, with providers reporting outcomes to contract meetings.
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NHS England Serve contract notices on providers for poor performance and require satisfactory completion of related action plans.
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NHS England Request community medical records for newly arrived prisoners within one week.
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NHS England Assign prisoners with chronic conditions to a named clinician.
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NHS England Monitor cancelled-appointment handling through monthly contract meetings and escalate concerns through partnership and quality boards.
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NHS England Provide enhanced healthcare quality surveillance and support through newly created regional Health and Justice Quality and Safety Manager posts.
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HM Prison and Probation Service Provide resources for three external hospital escorts each weekday.
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Department of Health and Social Care Publish a Principle of Equivalence to guide decisions on appropriate and equitable prison healthcare provision and access.
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Department of Health and Social Care Input into health and justice policy development so prisoners’ health and social care needs and shared objectives are properly considered.
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Department of Health and Social Care Work with analysts and scrutiny bodies to identify useful and feasible indicators for evidencing equivalence of prison healthcare.
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Department of Health and Social Care Revise the tripartite prison healthcare partnership agreement to add the Department of Health and Social Care and Ministry of Justice for greater oversight and accountability.
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Department of Health and Social Care Publish and operate the National Partnership Agreement for Prison Healthcare 2018–21 as a joined-up framework for collaborative prison healthcare delivery.
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Department of Health and Social Care Improve prison healthcare data and intelligence collection and enable information-sharing before, during and after incarceration to support continuity of care.
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Department of Health and Social Care Review and improve commissioning links across health, justice, local authorities, probation and community services to align provision before, during and after custody.
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× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to identify and diagnose cancer
Wider context from the report “(3) The deceased died of cancer but this had never been diagnosed and opportunities to have discovered his condition were missed .
” Is this part of a recurring concern? No recurring-concern membership is currently published.
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to obtain previous medical history
Wider context from the report “(1) The prison never obtained his previous medical history. No proper care plan was drafted for him and there was no single clinician responsible for his care.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Lack of a system for arranging external hospital visits
Wider context from the report “(2) A number of external hospital appointments were cancelled at short notice because of lack of resources (no available escorts etc.) and there was no system available for arranging such visits .
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Lack of a single clinician responsible for patient care
Wider context from the report “(1) The prison never obtained his previous medical history. No proper care plan was drafted for him and there was no single clinician responsible for his care .
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to draft proper care plans
Wider context from the report “(1) The prison never obtained his previous medical history. No proper care plan was drafted for him and there was no single clinician responsible for his care.
” Is this part of a recurring concern? Yes — Unreliable care-planning processes .
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Lack of resources for attending external hospital appointments
Wider context from the report “(2) A number of external hospital appointments were cancelled at short notice because of lack of resources (no available escorts etc.) and there was no system available for arranging such visits.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Fragmented responsibility for prison healthcare
Wider context from the report “(5) The underlying problem was that healthcare in the prison was the responsibility of three different organisations , namely the prison service, the local mental health NHS Trust (who were given the responsibility of dealing with all physical health matters and running the healthcare centre), and a separate organisation who supplied GPs. These three organisations had entirely separate database systems.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure of healthcare organisations to use integrated database systems
Wider context from the report “(5) The underlying problem was that healthcare in the prison was the responsibility of three different organisations, namely the prison service, the local mental health NHS Trust (who were given the responsibility of dealing with all physical health matters and running the healthcare centre), and a separate organisation who supplied GPs. These three organisations had entirely separate database systems.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to involve family in obtaining important patient information
Wider context from the report “(4) There was no involvement of the family and so a source of important information was missed .
” Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review postponed hospital appointments clinically, prioritise attendance by need and risk, and automatically rebook cancellations with hospital trusts.
Verbatim wording from the response “Regional commissioners are aware that there is an ongoing shortage of trained officers at HMP Lewes which can result in a restricted regime resulting in less access to healthcare and attendance at external hospital appointments. There also continues to be issues with the re-booking of appointments and commissioners are working with Sussex Partnership Foundation Trust (SPFT) to resolve this.” Source location 2019-0491-Response-by-NHS-England
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Audit healthcare-record requests to verify that the records-request process is effective.
Verbatim wording from the response “• an audit of healthcare record requests in March 2017 to ensure the process was effective and efficient. As a result of your report I can confirm commissioners have asked SPFT to undertake a further audit which was completed in November with the outcome due to be shared by the end of December 2019. A CQC focus visit took place on 21 and 22 October 2019 and it was reported to the commissioners that record keeping and care planning in particular had significantly improved with the input of additional resources to support this process.” Source location 2019-0491-Response-by-NHS-England
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review relevant clinical-review findings, implement lessons learned and identify further staff training requirements.
Verbatim wording from the response “Commissioners agreed a Service Development Plan with the healthcare providers (SPFT and Medco), which included the introduction of a named clinician for all patients with chronic illnesses; reinforcement of the requirement for a clinician to be involved in any decision to postpone out-patient appointments; and a work plan to reduce the number of cancelled appointments. Commissioners recognised the need for improved clinical oversight and scrutiny and this takes place via the local governance arrangements. The process is that SPFT and Medco revisit the findings of Mr Haines Clinical Review and” Source location 2019-0491-Response-by-NHS-England
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Commission prison healthcare through a Prime Provider model using a single contract, provider and database.
Verbatim wording from the response “In 2017, NHS England (NHSE) reviewed the model of commissioning in Kent, Surrey and Sussex as it was becoming increasingly apparent that the model was not delivering the benefits anticipated and services were not integrating effectively. In line with other prison groups in England, NHSE made the decision to commission services using a Prime Provider model. I can confirm that this model ensures a single contract and provider, and therefore better accountability for the delivery of integrated healthcare in a prison (or group of prisons). This will negate any communication issues and the single provider will use one database system only.” Source location 2019-0491-Response-by-NHS-England
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Mobilise Care UK to begin delivering prison healthcare services from April 2020 through monthly multi-provider mobilisation boards.
Verbatim wording from the response “The current healthcare contracts with existing providers end in March 2020 (SPFT and Medco) and October 2020 (Forward Trust) respectively. NHSE have undertaken a procurement process for the provision of these services after those dates.” Source location 2019-0491-Response-by-NHS-England
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide governance oversight through Contract Review Meetings, Partnership Boards and Local Delivery and Quality Boards after the new contract begins.
Verbatim wording from the response “Once the contract starts the NHSE governance process will have oversight via Contract Review Meetings, Partnership Boards and Local Delivery Quality Boards.” Source location 2019-0491-Response-by-NHS-England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Run regular SystmOne reports checking whether newly arrived prisoners’ healthcare records have been requested.
Verbatim wording from the response “• the running of a regular report via SystmOne to ensure that healthcare records have been requested; and” Source location 2019-0491-Response-by-NHS-England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Check that newly arrived prisoners receive a full health assessment and care plan within seven days, recording checks for healthcare staff.
Verbatim wording from the response “• a nominated member of staff checking that all newly arrived prisoners have been offered a full general health assessment to include the drafting of a care plan within 7 days of arrival. The checks to be noted on an internal document which is shared with all healthcare staff.” Source location 2019-0491-Response-by-NHS-England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Require multidisciplinary review and risk assessment for each cancelled appointment, with providers reporting outcomes to contract meetings.
Verbatim wording from the response “ensure all lessons learned have been implemented and identify any further training requirements for staff. This will include GPs discussing the case with their RO. Commissioners now also make it a requirement that cancelled appointments are reviewed at a multi-disciplinary team meeting and a risk assessment completed for each prisoner. Provider(s) will be required to submit a report to contract meetings to ensure full oversight by the prison governor and commissioners. In addition, in 2018 Commissioners introduced enhanced quality surveillance and support for providers. This was achieved through newly created Health and Justice Quality and Safety Manager posts in South East Region. These posts are clinical roles that bring additional oversight and support to the quality of healthcare delivery.” Source location 2019-0491-Response-by-NHS-England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Serve contract notices on providers for poor performance and require satisfactory completion of related action plans.
Verbatim wording from the response “Commissioners have monitored the implementation of these recommendations and since 2017, have served Contract Notices in June 2018 and November 2018 to SPFT relating to poor performance. These notices have included the potential for financial penalties if action plans were not completed satisfactorily but were not required on either occasion.” Source location 2019-0491-Response-by-NHS-England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Request community medical records for newly arrived prisoners within one week.
Verbatim wording from the response “The Clinical Reviewer recommended that the Head of Healthcare at HMP Lewes should ensure that the past medical history is obtained for new prisoners with chronic conditions, and that their care should be assigned to a named clinician. I can confirm an action plan was implemented with all actions achieved by 1 April 2017 which included:” Source location 2019-0491-Response-by-NHS-England
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Assign prisoners with chronic conditions to a named clinician.
Verbatim wording from the response “The Clinical Reviewer recommended that the Head of Healthcare at HMP Lewes should ensure that the past medical history is obtained for new prisoners with chronic conditions, and that their care should be assigned to a named clinician. I can confirm an action plan was implemented with all actions achieved by 1 April 2017 which included:” Source location 2019-0491-Response-by-NHS-England
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Monitor cancelled-appointment handling through monthly contract meetings and escalate concerns through partnership and quality boards.
Verbatim wording from the response “I can confirm SPFT have implemented a revised process to ensure there is a clinical review of any appointments which are postponed. This includes a review by the GP to assess clinical need and risk. Where the demand for external escorts exceeds availability, the GP will prioritise appointment attendance based on clinical need and any appointment cancelled is to be automatically re-booked with the hospital trust. This revised process including clinical review will suitably prioritise and prevent future failings to re-arrange cancelled appointments. The monitoring of this by the commissioners will take place at monthly Contract Review Meetings (CRM) and any concerns will be reported to the monthly Partnership Board (PB) and if further escalation is required it will be dealt with at the monthly Local Delivery and Quality Board (LDQB).” Source location 2019-0491-Response-by-NHS-England
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide enhanced healthcare quality surveillance and support through newly created regional Health and Justice Quality and Safety Manager posts.
Verbatim wording from the response “ensure all lessons learned have been implemented and identify any further training requirements for staff. This will include GPs discussing the case with their RO. Commissioners now also make it a requirement that cancelled appointments are reviewed at a multi-disciplinary team meeting and a risk assessment completed for each prisoner. Provider(s) will be required to submit a report to contract meetings to ensure full oversight by the prison governor and commissioners. In addition, in 2018 Commissioners introduced enhanced quality surveillance and support for providers. This was achieved through newly created Health and Justice Quality and Safety Manager posts in South East Region. These posts are clinical roles that bring additional oversight and support to the quality of healthcare delivery.” Source location 2019-0491-Response-by-NHS-England
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide resources for three external hospital escorts each weekday.
Verbatim wording from the response “The Governor of HMP Lewes is committed to providing resources for external escorts to medical appointments. Currently, sufficient escorting staff are made available for three external hospital escorts each weekday, and appointments are prioritised by the healthcare team. In the event that there are inadequate resources because of other operational pressures and it is necessary to consider the cancellation of an external appointment, the Duty Governor contacts the healthcare team for advice on the potential medical impact. If this results in a decision to cancel an escort, the healthcare team cancels and rearranges the appointment. Where possible, emergency escorts are facilitated in addition to scheduled appointments, but where this is not possible healthcare staff are asked to consider the priority with which the scheduled appointments are required and one is proposed to a later date.” Source location 2019-0491-Response-by-HM-Prison-and-Probation-Service
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Publish a Principle of Equivalence to guide decisions on appropriate and equitable prison healthcare provision and access.
Verbatim wording from the response “You may be aware that the Health and Social Care Select Committee conducted an inquiry into prison health that reported in November 2018³. The Government’s response, published in January 2019⁴, outlined a range of actions, including those in the National Partnership Agreement, that will be taken to support the delivery of high-quality health services in prisons. We remain committed to working collaboratively across Government to achieve those aims. For example, in response to one of the recommendations, the National Prison Partnership Board published a Principle of Equivalence in October 2019. This states that the co-chairs of the National Prison Healthcare Board affirm that:” Source location Response from Department of Health and Social Care
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Input into health and justice policy development so prisoners’ health and social care needs and shared objectives are properly considered.
Verbatim wording from the response “The Agreement sets out a joined-up, strategic approach to meet the complex nature of offender health care needs and provides the partnership members with an overarching framework for collaborative working at all levels. The Agreement has three shared core objectives to be delivered through ten high level priorities. These priorities are underpinned by the Agreement’s 2018 Workplan, which includes a commitment to deliver on three key issues that relate to the responsibilities of all organisations involved in prison care. These commitments are to:” Source location Response from Department of Health and Social Care
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with analysts and scrutiny bodies to identify useful and feasible indicators for evidencing equivalence of prison healthcare.
Verbatim wording from the response “The Board is working with analysts and scrutiny bodies to understand the extent to which available indicators could help evidence the achievement of equivalence of care and what would be both useful and feasible.” Source location Response from Department of Health and Social Care
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Revise the tripartite prison healthcare partnership agreement to add the Department of Health and Social Care and Ministry of Justice for greater oversight and accountability.
Verbatim wording from the response “At a national level, the National Audit Office report into Mental Health in Prisons¹, published in June 2017, made a recommendation in relation to the way that NHS England, Her Majesty’s Prison and Probation Service and Public Health England manage their joint working on prison healthcare.” Source location Response from Department of Health and Social Care
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Publish and operate the National Partnership Agreement for Prison Healthcare 2018–21 as a joined-up framework for collaborative prison healthcare delivery.
Verbatim wording from the response “The National Partnership Agreement for Prison Healthcare in England 2018-21², published in April 2018, acknowledges the need for health and justice partners to work together to ensure “safe, legal, decent and effective care that improves health outcomes for prisoners, reduces health inequalities (particularly for those with protected characteristics), protects the public and reduces reoffending”.” Source location Response from Department of Health and Social Care
Open published response
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Improve prison healthcare data and intelligence collection and enable information-sharing before, during and after incarceration to support continuity of care.
Verbatim wording from the response “The Agreement sets out a joined-up, strategic approach to meet the complex nature of offender health care needs and provides the partnership members with an overarching framework for collaborative working at all levels. The Agreement has three shared core objectives to be delivered through ten high level priorities. These priorities are underpinned by the Agreement’s 2018 Workplan, which includes a commitment to deliver on three key issues that relate to the responsibilities of all organisations involved in prison care. These commitments are to:” Source location Response from Department of Health and Social Care
Open published response
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review and improve commissioning links across health, justice, local authorities, probation and community services to align provision before, during and after custody.
Verbatim wording from the response “The Agreement sets out a joined-up, strategic approach to meet the complex nature of offender health care needs and provides the partnership members with an overarching framework for collaborative working at all levels. The Agreement has three shared core objectives to be delivered through ten high level priorities. These priorities are underpinned by the Agreement’s 2018 Workplan, which includes a commitment to deliver on three key issues that relate to the responsibilities of all organisations involved in prison care. These commitments are to:” Source location Response from Department of Health and Social Care
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The recurrence was not an undiagnosed cancer: the cancer had previously been diagnosed and treated.
Verbatim wording from the response “The Clinical Reviewer’s report states that Mr Gallagher had been diagnosed with laryngeal cancer 2 years prior to reception at HMP Lewes, and that Mr Gallagher died from events caused by the recurrence of a laryngeal tumour that had been treated the previous year with radiotherapy.” Source location 2019-0491-Response-by-NHS-England
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Existing escort staffing, appointment prioritisation and cancellation procedures are considered sufficient to manage external medical appointments.
Verbatim wording from the response “The Governor of HMP Lewes is committed to providing resources for external escorts to medical appointments. Currently, sufficient escorting staff are made available for three external hospital escorts each weekday, and appointments are prioritised by the healthcare team. In the event that there are inadequate resources because of other operational pressures and it is necessary to consider the cancellation of an external appointment, the Duty Governor contacts the healthcare team for advice on the potential medical impact. If this results in a decision to cancel an escort, the healthcare team cancels and rearranges the appointment. Where possible, emergency escorts are facilitated in addition to scheduled appointments, but where this is not possible healthcare staff are asked to consider the priority with which the scheduled appointments are required and one is proposed to a later date.” Source location 2019-0491-Response-by-HM-Prison-and-Probation-Service
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation NHS England and NHS Improvement are responsible for commissioning healthcare in English prisons and are providing a separate response.
Verbatim wording from the response “As you know, the commissioning of health care in English prisons is the responsibility of NHS England and NHS Improvement, (NHSE/I), and HMPPS ensures access to healthcare services within establishments and, where required, at external healthcare facilities. I understand that NHSE/I is providing a separate response, and I will address matters (2) and (5) in your report, as these are within the responsibility of HMPPS.” Source location 2019-0491-Response-by-HM-Prison-and-Probation-Service
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Clinical-record access is restricted, while daily prison-healthcare meetings and database updates are considered sufficient for information sharing.
Verbatim wording from the response “With regard to the sharing of information between the organisations involved in the management and care of prisoners, you will appreciate that it is not appropriate for prison staff to have access to clinical records on SystmOne. At HMP Lewes, there is a daily” Source location 2019-0491-Response-by-HM-Prison-and-Probation-Service
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Healthcare providers are responsible for the quality and safety of care provided at HMP Lewes.
Verbatim wording from the response “Providers of healthcare services are responsible for the quality and safety of the care they provide. I expect the healthcare providers at HMP Lewes to look into the care provided to Mr Gallagher and to consider where improvements can be made. This includes how they work with the prison authorities and other relevant organisations, including NHS England which is responsible for commissioning healthcare services for prisoners. Given its role in monitoring, inspecting and regulating the providers of health and social care in prisons, my officials have brought your reports to the attention of the Care Quality Commission (CQC).” Source location Response from Department of Health and Social Care
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation NHS England is responsible for commissioning healthcare services for prisoners, including at HMP Lewes.
Verbatim wording from the response “Providers of healthcare services are responsible for the quality and safety of the care they provide. I expect the healthcare providers at HMP Lewes to look into the care provided to Mr Gallagher and to consider where improvements can be made. This includes how they work with the prison authorities and other relevant organisations, including NHS England which is responsible for commissioning healthcare services for prisoners. Given its role in monitoring, inspecting and regulating the providers of health and social care in prisons, my officials have brought your reports to the attention of the Care Quality Commission (CQC).” Source location Response from Department of Health and Social Care
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