Guidance

Management of incidents and outbreaks of communicable disease in secure settings in England

Published 23 September 2024

Applies to England

© Crown copyright 2024

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This publication is available at https://www.gov.uk/government/publications/management-of-incidents-and-outbreaks-of-communicable-disease-in-secure-settings/management-of-incidents-and-outbreaks-of-communicable-disease-in-secure-settings-in-england

Main messages

This guidance is intended to support the collaborative arrangements that are already in place between agencies with managing health protection incidents and outbreaks. This guidance provides a framework which partners can use in response to cases of an infectious disease or another health protection incident.

This guidance is based on expert opinion from within the United Kingdom Health Security Agency (UKHSA) and its partners, and it will act as a basis for consistent practice in England while also accounting for local resources and needs. This guidance covers multiple settings which are listed in section: ‘Who is this guidance for’, below. These settings will collectively be known as ‘secure settings’. Those who are resident in these settings  (which include prisoners,  detainees, and children and young people) will be collectively known as ‘residents’.

This document must be signed off locally by appropriate senior leaders representing the specific secure setting, the NHS England Health & Justice Commissioner and the Deputy Director for Health Protection for the corresponding UKHSA Centre.

This guidance describes measures to prevent and manage cases and outbreaks of communicable diseases and other public health hazards whilst recognising that operational practices may vary due to setting specific considerations. Other specialist teams and guidance will specifically reference other health protection hazards such as chemical, biological, radiological, and nuclear threats, and will therefore not be covered in detail within this guidance. Some of this specialist guidance is listed in useful references section.

Throughout this guidance the word ‘incident’ is used as a generic term to cover all health protection hazards. Where guidance is specific to outbreaks, the term ‘outbreaks’ will be used. Similarly, to align with language used across different agencies incident management teams (IMTs) will be used in reference to outbreak control teams (OCTs).

All secure settings should ensure that any cases of a notifiable disease or evidence of any incidents that may have the potential to affect the health of its residents, are reported to the local Health Protection Team (HPT).

Find your local HPT: Find your local health protection team in England - GOV.UK (www.gov.uk)

What has changed?

The following changes have been made to this guidance:

  • updated links throughout document
  • updated names of organisations where changes to governance structures have occurred
  • updated prose for introduction
  • inclusion of approved premises (APs)
  • updated outbreak definitions to include incidents
  • inclusion of a section on the Children and Young People Secure estate (CYPSE)
  • inclusion of a section on Immigration removal centres (IRCs)
  • updated preliminary risk assessment and outcomes of IMT list
  • updated the list of potential members of an incident management team (IMT) to Appendix 1
  • updated the roles responsibility of the IMT and its members
  • included a section on common pathogens in secure settings

Who is this guidance for?

This guidance provides recommendations to assist governors, directors, centre managers, responsible individuals, and healthcare staff carry out their legal duty with regards to outbreak management in secure settings. These secure settings include:

Prisons, young offender institutions (YOIs), and a secure training centre (STC) for which His Majesty’s Prison and Probation Service (HMPPS) is responsible (under the Youth Custody Service (YCS) for YOI under 18 units, and the STC).

Immigration removal centres (IRCs) for which the Home Office is responsible.

Secure children’s homes (SCHs) for which DfE has policy, but not operational responsibility, and which are commissioned by local authorities and run by local authorities or the third sector.

Secure schools which are co-commissioned by the Ministry of Justice and NHSE and are dual registered as secure age 16 to 19 academies and secure children’s homes. They are run by a Secure Academy Trust and have both a Registered Manager and Principal Director. For the purposes of this document these roles will be referenced as the ‘Responsible Individual’.

This guidance also covers adults on probation in approved premises (APs). APs are governed by HMPPS; however, access to healthcare is provided differently to other secure settings, and in the same way as to anyone else in the community.  Any confirmed or suspected cases of a notifiable disease that occur in APs should be notified in the same way as set out below.

Background

Secure settings typically have large populations of adults and children living in proximity who frequently transfer to and from the community and between other secure settings. Adults and children residing in secure settings are more likely to have more complex medical needs than those of similar age in the community and tend to be more socially vulnerable, and as such are included as a priority inclusion health group within  the  Core20PLUS5 frameworks for adults and for children. Furthermore, staff, visitors, and other professionals from a variety of contexts enter these settings on a regular basis which increases the chance of the introduction of an infectious disease.

Outbreaks of infectious disease therefore present a unique challenge and require close liaison between stakeholders and effective pre-planning to ensure a robust and equitable response which aims to minimise harm as well as disruption to the operations of the secure setting.

This document should be read and used alongside other guidance, such as pathogen specific and wider public health guidance and as such interventions should be proportionate to the risk (for example, the affect isolation has on psychosocial wellbeing). Links to these useful resources can be found in section 10.

Adults and children living in secure settings should receive healthcare equivalent to those living in the community. Minimising the impact of an outbreak on the operational effectiveness of secure settings is also essential to preserving a fully functional criminal justice, immigration and welfare system as well as resident and staff wellbeing. This includes reducing the impact of infectious disease on court appearances and visits to the setting. To reduce the impact of an outbreak, both in terms of public health and the operational capability of secure settings, a whole setting approach should be enacted. This means involving everyone in the setting in outbreak management and addressing prevention, as well as early identification, notification, and treatment of communicable disease/infection.

The governor or director or centre manager or responsible individual of each secure setting has a statutory responsibility to ensure the health and safety of residents, visitors and staff in their care, and a duty to co-operate with appropriate agencies to ensure that any threats to health are identified and effectively managed.

The Department of Health and Social Care (DHSC), the Home Office (HO), NHS England (NHSE) UKHSA, the Department of Education (DfE) and HMPPS have 3 national partnership agreements (NPAs) which sets a framework of collaboration between agencies one for prisons, one for immigration removal centres and one for the CYPSE.

Roles and responsibilities of partner agencies.

Department of Health and Social Care (DHSC)

DHSC is responsible for promoting continuity of care and ensuring that agencies, such as the UKHSA, deliver on its commitments. DHSC provides an overview of mental and physical health policy, including for infectious diseases and health protection incidents, by identifying needs, advising on the evidence base and developing effective governance.

Other responsibilities include:

  • supporting and advising our ministers: DHSC help them shape and deliver policy that delivers the government’s objectives
  • setting direction: DHSC anticipate the future and lead debate ensuring we protect and improve global and domestic health
  • accountability: DHSC make sure the department and our arm’s length bodies deliver on our agreed plans and commitments
  • acting as guardians of the health and care framework: DHSC make sure the legislative, financial, administrative and policy frameworks are fit for purpose and work together
  • troubleshooting: in the last resort, the public and Parliament expect us to take the action needed to resolve crucial and complex issues

United Kingdom Health Security Agency (UKHSA)

Under the Health and Social Care Act 2012, the Secretary of State has a duty to protect the health of the population and carry out activities as described in the Health Protection Agency Act 2004.

In practice these functions will be carried out by UKHSA and include:

  • the protection of the community against infectious disease and other dangers to health
  • the prevention of the spread of infectious disease
  • the provision of assistance to any other person who exercises functions in relation to above

UKHSA also has a duty as a category 1 responder (within the scope of the Civil Contingencies Act 2004) to respond to emergencies on behalf of the Secretary of State for Health.

National Health Service England (NHSE)  

NHS England is responsible for the commissioning of health services for people who are in prison or in other secure settings (including IRCs and courts and those that hold children such as SCHs, YOIs, SSs)[1]. This is discharged through their regional teams: NHS commissioning » Health and justice (england.nhs.uk).

NHSE commissioning activity also includes specific continuity of care services, covering pre and post custody including Liaison and Diversion services, court-based services, mental health treatment requirements, RECONNECT and the pilot service Enhanced RECONNECT.

His Majesty’s Prison and Probation Service (HMPPS)

It is the responsibility of HMPPS to work with its partners to carry out sentences given by the courts in both custody and in the community.

HMPPS reduces reoffending by rehabilitating the people in its care through education and employment. The agency is made up of the HM prison service, probation service, youth custody services and a headquarters focused on creating tools and learning.

HMPPS’ responsibilities include:

  • running prison and probation services
  • rehabilitation services for people in our care leaving prison
  • making sure support is available to stop people reoffending
  • contract managing private sector prisons and services such as the prisoner escort service or electronic tagging

Home Office

The Home Office is the lead government department for immigration passports, drugs policy crime fire, counter-terrorism, and police.

The Home Office is responsible for implementing a fair and humane approach to immigration in the UK, including the management of IRCs. Part of the role of the Home Office in the management of IRCs, in addition to providing a safe and secure environment for detained individuals with as much purposeful activity as possible, is to support detained individuals prior to their removal.

The welfare provision in IRCs should, as a minimum:

  • help detained individuals prepare for their removal from the United Kingdom
  • provide information on the benefits of Voluntary Return
  • provide information on accessing legal services
  • assist detained individuals who are released, by signposting them to services and organisations which may be able to offer them support and assistance with any aspect of resettlement into the community
  • offer detained individuals support and guidance to ease their experience of being in detention

Department for Education (DfE)

The DfE works to provide children’s services, education and skills training that ensures opportunity is equal for all, no matter their background, family circumstances or need.

The CYPSE in England holds a small cohort of children (c700 in August 2023). The DfE has the policy responsibility, but not the operational responsibility, for 13 SCHs in England.  

Considerations for the children and young people secure estate (CYPSE)

The secure settings within the CYPSE, which includes SCHs, the STC, SSs and YOI under 18 units, vary greatly in size, population density, staffing ratios and building design. This in turn leads to significant variation in the risk of large outbreaks of infectious diseases and associated harms. Previously healthy children and young people in these settings have a much lower risk of harm from a number of infectious diseases (including flu and COVID) than older adults with underlying conditions in the prison estate and may be particularly vulnerable to the negative impact of certain control measures such as isolation on their mental health and wellbeing.

In addition, these settings manage a number of significant competing risks of harm, including risks of serious self-harm and violence, which can be exacerbated by isolation and cohorting. Measures put in place to respond to outbreaks in these settings need to balance these competing risks through defensible decision-making and be proportionate to the likely risk of harm to the children, young people, and staff in these settings. For further information regarding the coordination of outbreaks in the CYPSE please see Appendix 7.

HPTs should be consulted early in an infectious disease incident in the CYPSE, including to discuss a single case of an infectious disease which would usually require exclusion from communal settings, so that an appropriate risk assessment can be conducted to inform control measures.

When following this guidance, SCHs need to ensure that they are continuing to operate in line with CHR2015 and the quality standards. More information is available via: NHS commissioning » Children and young people.    

Considerations for immigration removal centres (IRCs)

If an outbreak is declared at an IRC, the director or centre manager must also notify the on-site Home Office Detention Services team who will send an initial notification email to an agreed distribution list.

IRCs present unique challenges compared to those of prisons. The population within IRCs are more transient and they generally have more freedom of movement within the setting. Residents of IRCs also have different living conditions compared to those in prisons, such as more dormitory style accommodation, which will affect their levels of contact with other residents and their ability to isolate effectively. Individuals may only be in an IRC for a short period before removal to another country or returning to the community. These factors present challenges for contact tracing and data quality and sharing. It is important that a national Home Office representative, as well as the centre manager and IRC healthcare team, are present at the IMT to implement public health actions recommended with clear lines of accountability

The UK is a signatory to the International Health Regulations 2005 (IHR) which provide the legal framework for countries’ obligations in handling public health events that have the potential to cross borders. The HPT should be notified of any cases of a notifiable disease, as described above. IRC leads should provide information on whether cases or contacts are due to be deported or to leave the UK for another country. The HPT will then factor this into their risk assessment and provide the appropriate public health advice within an IMT. If the Home Office decide to remove individuals who have been diagnosed with an infectious disease from the UK, UKHSA’s International Health Regulations team should be notified on  [email protected], who will in turn inform the receiving country to allow them to plan for future public health and clinical management.

The Home Office will take the lead on communications for outbreaks or other situations in IRC settings. All IMTs should include consideration of translation or other language support required for effective communications.

Prevention

Routine actions secure settings can take to reduce the risk and severity of outbreaks include:

  • healthcare teams in partnership with governors or directors or centre managers or responsible individuals should prioritise ensuring residents are up to date with both routine and seasonal immunisations
  • all staff working in secure settings should be encouraged to take up the offer of seasonal vaccinations offered by occupational health and NHSE and to follow relevant NHS community guidance to stay off work if they are ill
  • infection prevention and control (IPC) leads should ensure that routine cleaning is taking place with enhanced cleaning measures activated in response to cases of infectious disease
  • to prevent the introduction of infectious diseases, healthcare teams, with the support from governors or directors or centre managers or responsible individuals, should implement any screening for infectious disease as recommended by UKHSA and core NHS service specification
  • interventions such as barrier contraceptives (to reduce the risk of transmission of STIs) and bleach tablets (to reduce the risk of transmission of blood-borne viruses) should be available where required in the setting

Infection prevention and control (IPC)

Services commissioned by the NHS must rigorously adhere to established guidelines for infection prevention and control. This includes strict compliance with the National Infection Prevention and Control manual and adherence to the National Standards of Healthcare Cleanliness 2021.

All staff members should be well-informed about their role-specific responsibilities concerning IPC, including the proper use of Personal Protective Equipment (PPE). Effective communication channels should be established to ensure continuous awareness and understanding among the staff.

All staff should adhere to all relevant controls and mitigation measures, including the use of PPE.

Senior leads within each organisation should ensure that staff comply with the Health and Safety at Work Act 1974 and are in line with the Health and Safety Executives approach to risk management.

Secure settings should be able to implement IPC recommendations that come either directly from HPTs or via IMTs. These could include:

  • implement isolation or cohorting of probable/confirmed cases as appropriate
  • reminders on hand hygiene
  • establish and enforce regular and thorough environmental cleaning protocols, particularly in high-touch areas and shared spaces
  • ensure staff adhere to all relevant controls and mitigation measures, including the use of personal protective equipment (PPE)
  • ensure an adequate and accessible supply of PPE and provide training on correct usage and disposal
  • where possible, optimise ventilation systems to improve air circulation within the facility
  • develop specific isolation strategies for vulnerable populations, such as older residents or those with underlying health conditions
  • proportionate changes to visiting policy

Definitions

An outbreak is defined as:

  • an incident in which 2 or more people affected by the same infectious disease are linked by time, place, or common exposure
  • a greater than expected rate of infection compared with the usual background rate for the place and time where the outbreak has occurred

Other incidents that should be managed in a similar way to outbreaks include:

  • a single case of certain rare or high-consequence diseases, including, but not limited to, diphtheria, botulism, rabies, viral haemorrhagic fever, and polio
  • a suspected, anticipated, or actual event involving microbial contamination of food or water

A cluster is defined as:

  • two or more cases of infectious disease with symptom onset (or laboratory testing dates if onset dates are not available) close in time and/or place. Whilst distinct from outbreaks, cluster investigation can lead to outbreak identification.

Required actions

Governors or Directors or Centre Managers or Responsible Individual

Governors or directors or centre managers or responsible individuals (or named deputy) should contact the relevant UKHSA HPT for advice if they have concerns or have seen:

  • a case of a notifiable disease (Notifiable diseases and causative organisms: how to report - GOV.UK (www.gov.uk))
  • a suspected or confirmed outbreak – defined as an incident in which 2 or more people experiencing a similar illness are linked in time or place
  • a higher than previously experienced and/or rapidly increasing number of people with similar symptoms and/or the same diagnosed infection
  • more than 1 infection circulating in the same group of people, for example COVID-19 and influenza.

A detailed algorithm for this process can be found in Appendix 6.

UKHSA

Following initial risk assessment by the HPT with the secure setting, HPTs will decide on a course of action which may include providing public health advice or convening an IMT to support with coordinating the incident response.

The UKHSA consultant in health protection (CHP) will take responsibility for initiating the use of the outbreak plan and convening the IMT. The initial steps, potential members, contact lists and outbreak record and situational report template are outlined in Appendices 1, 2, 3a, 3b and 4.

Contact tracing

It is the role of the UKHSA HPT to decide whether contact tracing is required, to define what constitutes a contact specific to that incident and how this will be assessed, and to advise what actions need to be taken once a contact is identified.

Responsibility for identifying contacts will depend on the contact definition and which organisation holds, or is able to obtain, the relevant information (supporting documents can be found in Appendix 4a and 4b). In circumstances in which the contact definition is based on time spent in a shared space, the governor or director or centre manager or responsible individual for the setting will have lead responsibility for identifying contacts within the setting. Settings should keep accurate records about shared accommodation (for example, cells, bedrooms or dorms) and opportunities for close contact (for example, work, religious activities, social activities and visiting) to enable effective contact tracing. Where identification of a contact requires information best obtained by other organisations, they would take lead responsibility (for example, healthcare staff are likely to be best placed to identify sexual contacts).

The timeframe for completing contact tracing will vary by infection to ensure preventative measures can be delivered in time, for example post exposure prophylaxis or immunisation. The HPT will advise governors or directors or centre managers or responsible individual of the exact timeframe required. To support preparedness they should be confident they can stand up and undertake contact tracing within 48 hours when devising local plans.

Responsibility for the actions taken once a contact is identified will depend on the action required. The governor or director or centre manager or responsible individual for the setting will be responsible for implementing actions within their remit (for example, isolating contacts or restricting movements) and healthcare will be responsible for implementing actions within its remit (for example, vaccination or provision of post-exposure prophylaxis).

Framework of the plan

Establishment of the incident management team (IMT)

It is the duty of the chair to ensure that the IMT is managed properly and in a professional manner. The UKHSA HPT is usually responsible for ensuring that all meetings have a written agenda, minutes (with decisions) and clearly assigned action points.

Responsibility for managing outbreaks or incidents is shared by all of the organisations who are members of the IMT. This responsibility includes the provision of sufficient financial and other resources necessary to bring the outbreak/incident to a successful conclusion.

Core IMT members are responsible for ensuring that all relevant organisations are co-opted on to the IMT. Others can make a request to join the IMT if there is a case to do so, but the final decision on membership resides with the chair.

Responsibility for operational management of   the outbreak must be given to the IMT by the secure setting. The representatives must be of sufficient seniority to make and implement decisions and to ensure that adequate resources are available to undertake outbreak management.

Membership of the IMT

A representative of the HPT will usually chair the meetings of the IMT. The governor or director or centre manager or responsible individual will advise on all the operational issues pertaining to the effective functioning of the setting while the consultant in health protection (CHP) will lead on the expert management of the specific incident or outbreak.

Governors or directors or centre managers or responsible individual of settings under the responsibility of HMPPS may be required to submit a dynamic risk assessment to their local HPT, Population Management Unit, or equivalent at regional or national level, to advise on any impact of public health advice on operation of the prison or secure setting (see Appendix 1).

Membership of the IMT will vary dependent on the circumstances. For more information, please see: Appendix 2 for a list of potential attendees, Appendix 3 for a list of roles and responsibilities, and the communicable disease operational guidance.

If an outbreak or incident is likely to lead to significant numbers of individuals needing hospital care, professional and management representation from the local hospital trusts is likely to be needed within the IMT as there may be complexities in arranging transport or secure accommodation within the hospital (for example, bed watch). This will also have operational impacts for the secure setting.

Where an outbreak crosses the border and affects people living in one or more of the devolved administrations, the IMT arrangements may differ. However, the principles of this plan should still apply, and the response should be guided by the requirement to protect the public’s health. Other authorities will be invited to participate at an appropriate level and to provide resources at a proportionate level. The CHP and chair of the IMT can escalate the situation to national UKHSA incident structures via the senior medical advisors (SMAs) if, for example, the incident becomes more complex or significant.

Role of the IMT

Outbreak management actions for the IMT:

  • review the evidence and establish whether a significant outbreak/incident really exists
  • conduct a public health risk assessment to include health and operational/custodial considerations
  • on advice of IMT, settings under the responsibility of HMPPS complete the operational dynamic risk assessment (see Appendix 1) which should be submitted by the governor or director or centre manager or responsible individual to the National Incident Management Unit and population management unit (PMU) for their decision making of any operational restrictions: IRC managers should continue to notify the on-site detention team as described above
  • decide on appropriate public health actions such as isolation, testing, vaccinations, contact tracing or movement restrictions
  • determine the resource implications of the outbreak/incident and how they will be met, including the costs and routes for access for testing cases or contacts, and other diagnostic interventions - the costs associated with producing communication materials should also be included
  • collect the contact details within and out of working hours for all agencies involved
  • agree on when the outbreak or incident can be declared over
  • develop systems and procedures to prevent further occurrences of similar episodes and to enhance preparedness, including conducting a post-outbreak report and identifying lessons learned
  • ensure there is a proportionate response to outbreak management that balances the health protection risk and the potential, unintended risk to psychosocial wellbeing in implementing control measures
  • address legal and ethical considerations, encompassing inmate rights, privacy, and medical confidentiality to maintain ethical standards and compliance
  • upon decision from the IMT, complete a full outbreak report (appendix 5)

Clinical considerations for the IMT:

  • ensure that arrangements are in place for the appropriate treatment for those affected by the outbreak or incident including consideration of transfers out to acute hospitals
  • liaise with local hospitals where there may be increased demand on hospital services
  • consider the need for and, if necessary, arrange long-term follow up of those affected
  • ensure testing is carried out appropriately
  • in outbreak situations, samples should be sent to the relevant UKHSA lab and an ILOG should be obtained to enable all samples from the outbreak being grouped together to allow for efficient case management.
  • ensure arrangements are made for continuity of access to healthcare and medicines during the outbreak
  • provision of required prophylactic treatment where needed

Operational considerations for the IMT:

  • ensure systems are in place to provide information to ensure teams can contract trace effectively
  • make sure contingency plans are up to date to ensure people can isolate safely, and in the event that movement restrictions are put in place the secure setting can continue operating effectively
  • ensure the processes for acquiring and administering vaccines/prophylaxis/tests at scale are understood
  • ensure access to healthcare, medicines and other essential activities are available for people isolating isolated people and other residents

Contact tracing and management of cases actions for the IMT:

  • agree activities for tracing and managing contacts if appropriate, to include those no longer in the secure setting where the outbreak is currently occurring
  • agree an appropriate active case finding strategy which includes consideration of both clinical and laboratory diagnoses among residents and staff - this may include people who have been recently released or transferred

Epidemiological actions for the IMT:

  • agree a case definition, including possible, probable, and confirmed case definitions
  • monitor epidemiological progress of the incident/outbreak including production of epicurves or other datasets to inform (may be undertaken by Field Epidemiology Services)
  • give due consideration to the nature of population movements within the setting, between settings, and between the setting and community, including staff and cross border movements with Wales or other nations

Communication actions for the IMT:

Ensure that adequate communication arrangements are in place, these will include:

  • nominating a lead person to be the point of contact with the Ministry of Justice (MoJ) Press Office (for prisons, YOIs, STC), the Home Office press office (for IRCs) or the relevant local authority or third sector organisations (for SCHs) who will lead on briefing the news media throughout the duration of the outbreak/ incident - this should include UKHSA and NHSE communications representatives
  • if there is a significant incident requiring press office involvement within a secure school the prisons press desk office [email protected] should be contacted, copying in the YCS communication inbox [email protected] and Relationship Manager at [email protected].
  • accurate and consistent information for residents, staff, visitors, families/carers/guardians of children and young people and other internal and external agencies

Population management

For settings under the responsibility of HMPPS, if an IMT is convened the governor or director or manager and the consultant leading the IMT should complete a dynamic risk assessment form (Appendix 1).

The IMT can consider recommending restricting transfers to other secure settings, restricting new receptions, or both. Before recommending changing the operational status of the secure setting, the IMT should consider whether it is proportionate and helpful to the management of the outbreak.

The IMT should consider:

  • whether there is an unaffected part of the secure setting that can be used so it can continue to accept new arrivals
  • whether full or partial movement limitation is necessary

The IMT can ask for a governor/director/responsible individuals’ advice on the potential impacts of any change.

Specific considerations on population management for prisons

HMPPS will consider recommendations from the IMT to restrict transfers out of, and new receptions into, prisons at a regional level with reference to national population management and other HQ functions as required. HMPPS is responsible for deciding how to respond to an IMT recommendation to limit or stop receptions and transfers. HMPPS has oversight of the wider prison estate and how any such decisions will affect overall prison population management.

Specific considerations on population management for YOIs, STC, SSs and SCHs

When considering population management as a mitigation for the spread of infectious disease the IMT should:

Obtain an impact assessment of limiting arrivals or transfers from the YCS head of placements. The impact assessment should consider how restrictions on arrivals or transfers will affect the rest of the CYPSE and placing authorities’ ability to source other accommodation for CYP; the risks to individual CYP and others if admissions into secure welfare placements are paused, and how long the restrictions are sustainable.

Consider the impact assessment before they decide whether to recommend to the YCS head of placements or the local authority/charity that operates the SCH or the Secure Academy Trust that operates the secure school, to limit movement or close. The YCS head of placements or SCH or SS responsible individual will work with the IMT to consider outbreak status and mitigation.

Ultimately, decisions about closing a SCH or SS to new admissions or transfers are made by  the SCH registered manager or SS responsible individual, consulting with the YCS where relevant and notifying the Secure Welfare Coordination Unit (SWCU) about any decision taken on new welfare admissions.

For YOIs and STCs only, if the IMT and YCS head of placements want to limit movement, change activity, or close the secure setting for a longer period than might be considered sustainable (in some circumstances, these actions might not be deemed sustainable for any time at all) their recommendation must be escalated to the YCS executive director for a final decision.

If an urgent out-of-hours decision is required, it should be made by the appropriate senior director on duty.

If a decision to limit movement, change activity or close is taken, a further impact assessment of continuing closure must be obtained from the YCS placement team at least every 3 days. The assessment should be provided to the YCS executive director and the SWCU kept informed (for SCHs with welfare beds) along with up-to-date information about the current status of the outbreak. The YCS executive director or responsible individual should then maintain or withdraw their decision to limit movement, change activity or close the establishment to receptions and transfers.

Restricting transfers to other secure settings

Transfers of residents out to other secure settings may be restricted to avoid starting new outbreaks in other secure settings. The priority should be to avoid transferring symptomatic residents.

It may not be possible to limit transfers out for several reasons, including:

  • security issues in prisons/YOIs/STCs to ensure that HMPPS can continue to accommodate adults or children remanded by the courts
  • to safely manage population or stability pressures

If transfers out cannot be avoided, the receiving secure setting should be notified of the outbreak.

Communication

Communications will be led by the lead responsible organisation depending on the governance structure of the secure setting (MOJ for those under the responsibility of HMPPS, the Home Office for IRCs, and the relevant local authority or third sector organisation for SCHs). No other member of the IMT or the participating agencies will release information to the press or arrange press conferences without the agreement of the IMT and full knowledge of the lead organisation press office.

It is essential that effective communication be established between all members of the team and maintained throughout the outbreak. The use of communication through the media may be a valuable part of the control strategy of the outbreak. The IMT should consider the risks and benefits of pro-active versus reactive media engagement in any outbreak. The IMT should endeavour to keep the residents, visitors, the public and media organisations as fully informed as necessary, without prejudicing the investigation and without compromising any statutory responsibilities or legal requirements and without releasing the identity of any patient/case.

Reporting

The chair of the IMT should ensure that processes are in place to log, record and co-ordinate decisions on the investigation and control of the outbreak using relevant systems (for example HPZone or CIMS). The chair should also ensure that actions are implemented by allocating responsibility to specific individuals who will then be accountable for acting.

A record of proceedings will be circulated to a distribution list agreed by IMT members. In the event of a significant outbreak, a report will be circulated to stakeholders including the National Health and Justice Team in UKHSA.

Data sharing between organisations

For prisons, a tripartite data sharing agreement between the MoJ, Public Health Wales and UKHSA has been developed for use where personal identifiable information is required as part of monitoring or managing an incident or outbreak. This agreement enables the three organisations to access and share necessary data about prisoners between themselves for the purpose of public health investigations concerning notifiable diseases under the Public Health (Control of Disease) Act 1984 and the Health Protection (Notification) Regulations 2010, S.I 2010/659.

The process is activated by sending a request to the UKHSA National Health and Justice Team at [email protected]

There is also a data sharing agreement in place with the Home Office to cover IRCs

Useful references

Publications

Websites 

Guidance on the management of common infections in secure settings

[1] NHS England. Securing Excellence in Commissioning for Offender Health. First published: February 2013 http://www.england.nhs.uk/2013/03/07/offender-health/

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