Safety recommendation
HSSIB recommends that NHS England, via regional commissioning teams, works with HM Prison and Probation Service to identify barriers to using telemedicine for outpatient appointments, and then implements local solutions to promote and enhance the capability and usability of telemedicine. This aims to reduce the burden on prisons of providing escorts and the likelihood of patients not attending appointments.
Response:
NHS England is committed to continuing to identify opportunities to create equal and improved access and reduce barriers to telemedicine adoption for all patients.
A great deal of work has been undertaken to identify the barriers to using telemedicine for outpatient appointments within the Secure and Detained Estate (SDE). This includes engagement with NHS providers and prison senior managers led by the NHS England South East regional team and the subsequent development of guidance to address implementation challenges. NHS England will continue to build on this work and remain engaged with His Majesty’s Prison and Probation Service (HMPPS) to further scale and spread adoption and good practice.
NHS England will update all existing implementation materials for using telemedicine in the SDE, these have already been developed and trialled in the NHS England South East region.
We will also ensure this includes clear guidance on best practice when transferring responsibility for patients from the SDE between NHS trusts, to ensure the receiving trust can take required action immediately. The guidance will make clear to healthcare teams that a patient’s position on the waiting list should not be affected. It will also make clear that this transfer of care should be communicated to the patient in an accessible format.
NHS England has produced a detailed remote consultation toolkit to support remote consultation implementation and improvement. The toolkit will be updated to include specific actions for using remote consultations in the SDE.
The use of telemedicine in the SDE is more suitable for some specialties and pathways, NHS England’s Outpatients Technology Enabled Improvement team will work with national clinical leads and analytics teams to identify the areas in which telemedicine would be most appropriate and impactful. This will be reflected in our updated guidance and resources. Once the guidance and the toolkit have been updated, national communications will be shared to ensure NHS trusts are aware of and have access to the resources. The resources will also be shared directly with Health and Justice regional commissioners for onward sharing with all relevant stakeholders, including healthcare providers in the SDE and NHS acute and community providers.
NHS England’s Health and Justice team, including regional commissioners will lead work and engage other national and regional colleagues to continue to support local NHS providers to improve their relationships with local SDE healthcare teams. Encouraging them to establish formal arrangements to improve remote appointment bookings and other key processes. This will include the creation of local directories of services, so NHS trusts can understand the capabilities, staffing and suitable timings to schedule remote appointments for patients in the SDE they are responsible for.
Actions planned to deliver safety recommendation:
- Update the existing implementation guidance. This will include:
Standard Operating Procedure (SOP)
Implementation checklist
Implementation flowchart
HMP Healthcare chaperone on the day processes flowchart
Prison activity data - Metrics script
Patient information leaflet and consent form
Patient questionnaire.
We will ensure documents are updated with key information such as guidance on the transfer of care when patients are moving between trusts, by January 2026.
2. Work with national clinical leaders and analytic teams to identify the specialties and pathways that are most suitable for telemedicine in the SDE and reflect this in relevant national resources, by January 2026.
3. Share all updated guidance with regional Health and Justice commissioners to circulate with SDE healthcare provider leads, by January 2026.
4. Share national communications to promote updated resources and showcase existing good practice, by April 2026.
5. Support formal arrangements between the SDE and their local hospitals, creating local directories of services, by April 2026.
6. Provide learning and advice to trusts about best practice about the transfer of care for patients moving between trust locations, to prevent waiting times from being negatively impacted, by April 2026.
Response received on 24 July 2025.