PCTs will not take on escort and bedwatch roles from Prison Service until April

A letter from Department of Health head of offender health Richard Bradshaw to PCTs and strategic health authorities reveals that PCTs will now not take on the costs until next April.

Plans to transfer responsibility and funding for healthcare escorts and bedwatches from the prison service to PCTs were first discussed in April 2003 and a date was later set for April this year.

HSJ has learned that PCTs are still thrashing out an agreement with the government and are wary of taking on the extra burden at a time when they are balancing growing public expectations against tightening budgets.

NHS Confederation PCT Network director David Stout said: 'I'm not entirely convinced it's a good idea for PCTs to take this on. The task of a PCT is very broad and every time you add something, it's another burden. Cost pressures may just transfer to PCTs, which certainly won't be welcomed.'

Prison health services, originally under the Home Office's brief, have been the Department of Health's responsibility for the past four years.

Bedwatches and healthcare escorts were excluded from the arrangement pending further investigation and a final decision by ministers in both departments. It was decided in March this year to transfer the£16.9m of activity to PCTs, initially on an historical spend basis.

The letter from Richard Bradshaw said this would 'help ensure that decisions to provide treatment outside of the prison are based on clinical imperatives' and 'support improvements in managing offenders' health while in custody'.

Responsibility for managing security services would remain with the prison service and any efficiency savings would be ploughed back into prison health services.

Liam Knight, senior commissioning manager at Islington PCT, had doubts over the scheme: 'I can see merit in the idea because the aim behind it is to reduce hospital attendance. But there's a question over whether PCTs should be commissioning escort services. We're not the experts on that.

'We've had some concerns over the costs being allocated, and the financial risks being transferred to PCTs.

'Part of the delay is because we're still working out an agreement between the Ministry of Justice and the DoH on appropriate charging. There was going to be a tariff but last I heard they were changing to per-hour payments.'

An NHS Alliance spokesman agreed PCTs would need to develop 'a lot of skills' to take on the new task. He also questioned prisons' willingness to hand over the responsibility and work in partnership with PCTs on security issues.