Guidance

Appendix C: Screening in secure and detained settings

Updated 23 May 2025

The main aim of the NHS Abdominal Aortic Aneurysm (AAA) Screening Programme is to reduce aneurysm-related mortality through the early detection, appropriate monitoring and treatment of aortic aneurysms.

The NHS AAA Screening Programme invites men for an abdominal ultrasound scan during the year (1 April – 31 March) they turn 65. The screening scans are performed by qualified screening technicians who follow a scanning protocol developed by the NHS AAA Screening Programme. This requires measurement of the aorta in transverse and longitudinal planes. People in Secure and Detained Settings are entitled to access appropriate cancer and non-cancer screening programmes for their age and sex.^{[footnote 1]} This section describes the process for identifying and offering screening for eligible men.

Men coming into the secure and detained estate are invited to register with the healthcare GP service. This is patient choice in line with the NHS Constitution. On entry to the detained estate all patients have their residential address changed on the spine (through PDS) regardless of whether they have registered with the healthcare GP or not.

Procedure for screening men in detained settings

The NHS Abdominal Aortic Aneurysm (AAA) Screening Programme’s Screening Management and Referrals Tracking (SMaRT) national IT system, SMaRT, attributes Screening Due Dates for all men eligible for screening. Men in secure and detained estates are included, however, there are differences between these men and the general population as far as screening is concerned:

• access to screening relies on the support of healthcare staff to provide the local AAA screening service with the names of those eligible, and the men with information and support that allows them to make an informed choice
• as men in detained estates can only access screening with the help of a third party, they must give consent to their involvement and the sharing of demographic and clinical information
• screening services will visit prisons to screen the men, and they should ensure that security arrangements are robust. They would be expected to follow appropriate security protocols and have their own local risk assessments in place, (see section 3)

Step 1

The local co-ordinator/manager will identify a named member of the healthcare team to provide demographic and other information to enable screening to take place. The frequency of the contact is subject to agreement with the detained setting healthcare team.

Step 2

The local screening service and healthcare team should discuss:

• practicalities and risk assessments for undertaking the screening in the estates (access, rooms, height adjustable couches, security of staff etc)
• the process for selection for screening
• the information requirements
• the arrangements in the event of any men in the setting requiring ongoing surveillance, ensuring rigorous processes are in place to prevent any man being ‘lost’ in the system
• issues of confidentiality and security
• consent

These points should be included in local standard operating procedures agreed by the trust and health care provider.

Step 3

The healthcare team within the detained setting in conjunction with the local service will identify men in their 65th year and over (for self-referrals) and provide them with the appropriate screening information in the form of national screening information leaflets (see ref.13 in programme guidance.

Where the man wishes to be screened, his signed consent form will be provided to the local screening service with the following details:

• NHS number
• title, forename, surname
• date of birth
• correspondence address for the prisoner
• details of their GP practice or prison health service

If a person in a detained setting does not have an NHS number, the Healthcare teams are able to request one.

Step 4

Some men may already exist on SMaRT as they will have registered at their home address and GP practice. In these cases, the coordinator may need to ask the ‘home’ local service to transfer the men to their service to enable them to be screened.

If the men do not already exist on SMaRT, they should be added by the local service using the practice code for the detained setting should be used if the men have registered. If men have not registered with the detained estate GP practice a dummy GP practice code may need to be assigned. This can be done by NEC Software Solutions’ AAA Helpdesk.

If the man does not consent an entry should be recorded on SMaRT and on the clinical record held by the detained setting. It should be clear if the man is declining or deferring the invitation.

Step 5

The local service arranges screening sessions for the men added in Step 4. The screening clinics should be booked, and appointment letters and leaflets sent to the men at the prison or via the contact at the detained setting.

Step 6

The men are screened at an appropriate location in the detained setting or at another venue (for example following non-vis) with prior agreement and given their results at the screening appointment as per normal screening procedures.

If there are operational challenges (such as enablement issues/cannot be brought to the appointment) on the day of the clinic that prevents men who have consented from being screened, the record should be marked as ‘cancelled by xxx’ and a further appointment offered.

Step 7

Result letters are produced and sent to the detained setting healthcare team, and the man’s GP. Men will only receive a result letter if an aneurysm has been detected.

Step 8

For men who require surveillance, it is important that the man knows when he is next due for surveillance.

Men in detained settings are often moved around the country, therefore it is important that any surveillance men are aware of this to be able inform their next healthcare team or community GP. It is important that the prison healthcare team are also aware so they can support recording this for continuity of care. For men on three-month surveillance, it may be possible at the discretion of the detained setting to place a man on ‘medical hold’ as a failsafe, so they are not moved. This is not responsibility of the screening service.

It is essential that, as mentioned in Step 2, rigorous processes are in place to prevent any man being ‘lost’ in the system, therefore it should be made clear that any man being transferred out, the detained settings healthcare team should inform the local screening service of such change.

Step 9

Referrals will need to be made as soon as possible and should be with the co-operation of healthcare staff within the detained setting.

Once the man has been referred, normal local procedures should be followed to enable the man to attend hospital for review. It may be possible at the discretion of the prison to place a man on ‘medical hold’ as a failsafe so that they are not moved. Services should track referrals for these men in line with national guidance.

Transfers

SMaRT requires manual intervention by the local service to confirm that the transfer in or out must go ahead. The system does not carry out any transfers automatically. When a record is flagged for transfer, the following information is available for the local service to review before confirming the record is to be transferred:

• the record clearly states that the man transferring out is in a detained setting
• the clinic name and location of previous appointments within the appointment history screen
• clinical location where screening sessions have taken place within the screening history screen

Any man appearing on the SMaRT alert screen under ‘transfer out’ under the heading of ‘secure unit candidates’ should NOT automatically be actioned. In all instances, check that the transfer out is appropriate i.e. contact the healthcare team at the detained setting to confirm. If the accepting local service is in any doubt, contact should be made with the service transferring out. SMaRT will be updated to confirm appropriate checks have been undertaken.

As set out in the introduction section men entering a detained setting have the residential address updated on the spine (via PDS). This consequently creates a SSPI change to generate a transfer between screening services.

Risk assessment for the screening service

Services should put measures in place to mitigate risks to the screening staff during clinics, which should be described in a local standard operating procedure. The following are suggestions that may be included, accepting there may be specific arrangements required for each detained setting:

• screening technicians will comply with all requirements deemed necessary, including the use of handcuffs
• screening technicians will always work in pairs and never conduct a screening appointment alone. Whilst in the secure and detained estate staff will comply with all local security arrangements and acquaint themselves with methods for summoning help
• screening technicians will only take approved items into the secure unit and will comply with security checks on arrival
• screening technicians will follow all normal processes for screening including checking the man’s ID and confirming consent before commencing the scan
• during screening the man will be asked to place his hands across his chest. The technician acting as administrator will not turn their back on their colleague whilst the scan is conducted. All unnecessary equipment is stored away and out of sight or reach
• results are given in the normal manner, verbally to the man and in writing to the healthcare team
• if an incidental finding is identified, following the quality assurance review of images, the detained setting healthcare team will be informed and asked to arrange further investigation if necessary

1. Specification 29 Section 7A: public health services for children and adults in secure and detained settings in England, 2023-2024. ↩