Guidance

Appendix 3: Responsibilities of system partners

Updated 9 October 2025

Applies to England

3.1 Responsibilities of secure setting healthcare team

The responsibilities of the secure setting healthcare team are:

• systematic verbal TB symptom screening and detection of social risk factors for TB for all new entrants
• early identification of residents who develop TB symptoms
• inform the local NHS TB service of any person with presumed or confirmed TB within 24 hours, where possible
• inform the local HPT of any person with presumed or confirmed TB as soon as possible (Find your local health protection team in England)
• identify a lead TB link nurse or designated individual for the secure setting
• development, with the local NHS TB service, of a comprehensive care plan for residents in the secure setting to encompass all aspects of TB management to encompass diagnosis, treatment follow-up and support services
• support the governor or manager and secure setting staff in identifying and providing information about healthcare contacts in contact tracing activities
• send diagnostic samples to the local microbiology lab, and where appropriate, flag important samples for prompt communication and action of results
• administration and recording of administration of TB medications, reporting any missed doses to the local TB service
• a risk assessment and delivery of the provision of appropriate infection prevention and control (IPC) measures
• day-to-day management of residents with TB, as agreed in consultation with the local NHS TB service
• in the event of an incident or outbreak of TB, provision of representation at incident management team (IMT) meetings, with the required clinical and epidemiological information
• inform the local NHS TB service in advance if an individual with TB is due to be released to the community or transferred to a different secure setting
• arrange occupational health services and TB screening for healthcare staff, if required following a TB incident or outbreak
• education to all healthcare staff on the signs and symptoms of TB, importance of treatment adherence, directly observed therapy (DOT) processes and management of complications or disruptions to the patient pathway
• support health promotion and communication campaigns within the secure setting to raise awareness and educate all residents and staff about TB prevention and control
• support latent TB infection (LTBI) screening where indicated
• liaison between the local NHS TB service and the gate or reception staff at the secure setting to enable appropriate access or clearance for site visits

3.2 Responsibilities of secure-setting governor, manager or director

The responsibilities of the secure-setting governor (in prisons), centre manager or director (in IRCs) and manager (in APs) are:

• deliver education to all secure setting staff on signs and symptoms of TB, importance of treatment adherence, DOT processes and management of complications or disruptions to the patient pathway
• provide staff to escort residents to hospital and to remain on bed watch if they are admitted to hospital
• ensure security risk assessments for escorts and/or bed watch, which informs the level of PPE required, taking into account the individual vulnerabilities of staff and ensuring staff undertaking such duties are fully briefed about the risk of TB transmission during such activities
• ensure isolation can be implemented effectively for residents with infectious TB
• ensure appropriate PPE is available for HMPPS staff as required
• support incident or outbreak response measures by attending IMTs and providing information to the HPT as soon as possible (within 72 hours of the request) to inform contact tracing in the secure setting
• provide verbal and written communication to secure setting staff and residents in outbreak or incident response about risk of TB transmission
• commission TB screening for secure setting staff through occupational health services or equivalent, if required following a TB incident or outbreak
• inform visitors about risk of TB transmission as appropriate
• ensure members of the NHS TB service team have appropriate access/clearance for site visits to the secure setting, in liaison with the secure setting healthcare team

3.3 Responsibilities of local NHS TB team or broader respiratory service

The responsibilities of the local NHS TB team or broader respiratory service are:

• establish partnership working with the secure setting healthcare teams
• (further) clinical investigation of all individuals with presumed or confirmed TB in the secure settings (may have been initiated by secure setting healthcare team)
• support the IPC risk assessment, including decision making regarding infectiousness of a resident and when they can safely deisolate from respiratory isolation
• notify the case on the National TB Surveillance (NTBS) system
• referring  the patient (written and verbal) to the relevant NHS TB services when a resident is to be transferred or released to a different area prior to discharge from TB services, and updating their record on the NTBS system
• prescribe and supply TB medicines (aligned with NHS commissioned policy and local contracts or arrangements), and liaison with the secure setting pharmacy team to maintain an adequate supply of medication
• support the secure setting healthcare team to monitor for treatment adherence, medication side effects and treatment response
• communicate future appointments to the secure setting healthcare team and where able provide these by in-reach including telemedicine
• screen of any identified resident close contacts where there is no indication for in-reach or bespoke services
• screen of any identified close contacts who are not residents or staff for example visitors or ex-residents who are now residing in the community
• prompt action of microbiology samples sent for TB diagnostics from secure settings that should be flagged as important
• prompt communication of sample results or issues (for example, inadequate sample) to the secure setting healthcare
• send TB cultures to the reference laboratory for whole-genome sequencing
• phone and/or email the secure setting healthcare team where samples are positive, in addition to routine electronic notification, to enable prompt public health action
• expedite access to TB-PCR for all samples from prisoners either in-house or by sending to appropriate referral laboratory

3.4 Responsibilities of HPT, UKHSA

The responsibilities of the HPT, UKHSA are:

• lead the management of all TB incidents or outbreaks in the secure setting including, where indicated, to convene and chair an IMT, in collaboration with the secure setting Head of Healthcare and the Governor or manager
• coordinate contact tracing and, where indicated, high-volume screening as part of incident or outbreak response, inclusive of ensuring referral to services for residents who have been transferred or released prior to contact tracing or testing
• regularly audit TB management pathways in secure settings, in partnership with the Regional H&J commissioner and other relevant stakeholders.

3.5 Responsibilities of local Integrated Care Board (ICB)

As the commissioners of NHS-funded local community and secondary care services, ICBs should following NHSE guidance[1] to prepare their response to infectious disease threats.

3.6 Responsibilities of NHSE H&J commissioners (regional)

The responsibilities of the NHSE H&J commissioners (regional) are:

• commission routine healthcare services in secure settings
• where indicated, commission TB screening for residents following a TB incident or outbreak via bespoke or in-reach services depending on local incidence, resident turnover, and resource
• if indicated, commission routine or enhanced latent TB screening outside of outbreak response if local epidemiology supports this and following agreement with the ICB and/or TB Control Board

3.7 Responsibilities of National NHSE H&J Team

The responsibilities of the National NHSE H&J Team are:

• standardise TB screening questions in the reception and secondary screening templates on the Health and Justice Information Service (HJIS)
• report against section 7A TB verbal symptom screening targets

3.8 Responsibilities of national HMPPS Public Health team and Home Office Safer Detention team

The responsibilities of the national HMPPS Public Health team and the Home Office Safer Detention team are:

• provide national support to their respective secure settings where required
• assist in the coordination of incident or outbreak response across multiple sites where required
• consider population management in the system, including restricting resident transfers to other secure settings where required and possible
• provide feedback to senior leaders regarding health protection issues across the national HMPPS estate

3.9 Responsibilities of National Health and Justice Team, UKHSA

The responsibilities of the National Health and Justice Team, UKHSA are:

• provide national guidance and support to HPTs where required
• retain oversight of TB incidents in secure settings nationally with support from the UKHSA TB Unit
• facilitate coordination of cross-regional TB incidents or outbreaks between HPTs

References

1. NHS England. Clinical response to local incidents and outbreaks of infectious disease: Commissioning guidance for ICBs