Safety recommendation
HSSIB recommends that the Department of Health and Social Care undertakes assessment of the capital requirements of the built environments across high-secure services in England and develops plans to ensure the long-term safety of patients, staff and the public.
Response:
The Department accepts this recommendation.
High secure hospitals play an important role within the wider mental health system and it is important that the needs of the high secure estate are understood. As part of the Department’s oversight and NHS England’s commissioning role for high secure hospitals, we continue to keep the physical environment under review.
We commit to continue engaging with high secure hospital stakeholders across government and locally to establish the current physical condition and requirements of each hospital estate and the impact on staff, patients and public protection. This engagement will continue via official governance and at a working level. The assessment of high secure estate needs will be informed by the Estates Return Information Collection, an annual survey of NHS estates conducted by NHS Trusts which is reported to NHS England. This includes an assessment of the level of backlog maintenance, including critical infrastructure risks, and maintenance costs.
We will work with high secure hospital commissioners (who will work with providers) to collaboratively develop a range of options for the high secure built environment, which ensure the safety of staff, patients and the public. We will work with criminal justice partners to ensure these options meet the needs of high secure hospital patients and align with prison estate security. The options will be used to inform future fiscal events and outcomes will be dependent on future funding settlements.
Actions planned to deliver safety recommendation:
- Work with NHS England, who will engage hospital commissioners and providers to establish the work each high secure hospital built environment would benefit from. This will be informed by data on the high secure estate from the annual Estates Return Information Collection submitted to NHS England by NHS trusts. The data collection includes an assessment of the level of backlog maintenance (including critical infrastructure risks) and maintenance costs. By when: Spring 2025. Organisational lead: DHSC. Resources in place to deliver actions: DHSC and NHS England staff, Broadmoor, Ashworth and Rampton commissioners and providers, Safety and Security Directions, High Secure Service Specification.
- Work with cross government criminal justice partners to understand current security arrangements and future security planning for the Category A and B prison estate. By when: Autumn 2025. Organisational lead: NHS England. Resources in place to deliver actions: DHSC and NHSE teams, Prison Building Standards. Other dependencies identified: Cross government criminal justice partners. Additional comments: High Secure Hospitals are the same level of security as Category B prisons, but have to be equipped for patients from Category A prisons.
- Work with commissioners for the high secure hospitals to understand the numbers of and needs of the high secure patient group. This information will be used as part of NHSE five year capacity planning undertaken in collaboration with commissioners and providers, with the next update due to begin in 2026. By when: Autumn 2025. Organisational lead: NHS England. Resources in place to deliver actions: NHSE, DHSC and cross government criminal justice teams and Hospital staff and commissioner capacity. Other dependencies identified: Available data, Prison capacity data, Impact of reforms.
- Work with NHS England and each hospital commissioner to establish a set of options for addressing needs of the high secure estate, with patient, staff and public safety as the priority. Use information gathered from actions 1-3. The options will be used to inform future fiscal events and outcomes will be dependent on future funding settlements. By when: Winter 2025. Organisational lead: DHSC and NHSE. Resources in place to deliver actions: DHSC and NHSE staff (policy, analysis and finance teams), Broadmoor, Rampton and Ashworth hospital commissioners, Architectural planning. Other dependencies identified: Approach to future capital funding bids within DHSC and NHSE, Broadmoor rebuild lessons learnt report will inform options development, Architectural input and funding. Additional comments: Will also require engagement with criminal justice partners.
Response received on 3 February 2025.