Date of publication: 14 May 2019
Report type: Prison and YOI inspections
Background and Context.
HMP Lewes is a medium sized Cat B male Local/resettlement prison. The last inspection was in January 2016. Since then there have been 5 self inflicted deaths and reported incidents of self harm have increased 300%.
On the positive side, 78% of prisoners told the HMIP Inspectors that staff treated them with respect. This finding in itself attracted the notable remark of this statistic being an “unusually high figure for this type of prison.”
A recognition surely of the challenges faced within the local/resettlement prisons across the estate?
Healthy Prison Outcomes:
- Safety = 2 (2)*
- Respect = 2 (3)*
- Purposeful Activity = 1 (2)*
- Rehabilitation & Release Planning = 2 (3)*
Summary – Health, well-being and social care:
Many prisoners were very negative about the health services, with two-thirds of prisoners in the survey responding that the overall quality was quite or very bad. Services had deteriorated since the previous inspection, most notably mental health services and the provision of nurse-led primary care.
Over half of prisoners said they had mental health problems. Waiting lists were lengthy and the under-resourced integrated mental health team could not meet the level of need.
The range of primary care services was limited and the oversight of prisoners with long-term conditions was poor. The application process for health appointments was very poorly managed. Inspectors found 143 outstanding applications, presenting significant risks to prisoner care.
Managers did not have accurate data on waiting times.
The inpatient unit continued to provide good quality care for some of the most seriously ill patients. However, it still lacked a therapeutic regime and some of the cells were in poor condition. There were five prisoners receiving funded social care packages, and they received good quality care.
In relation to Substance Misuse services, The Forward Trust provided good clinical and psychosocial services for prisoners requiring substance use treatment.
Prison officers did not always manage medication queues effectively, which continued to compromise confidentiality and increased the opportunity for medication diversion.
Dental care was good but some aspects of governance needed immediate attention, particularly the maintenance of fixed equipment.
The CQC issued 3 Requirement Notices against Regulation Standards.
Recommendations – Health, well-being and social care:
- Health governance structures should be robust enough to identify and effectively address key risks and concerns, and should ensure that prisoners have prompt access to all health services.
- All health care staff should receive regular clinical and managerial supervision, and be up to date with mandatory training.
- All health care should be delivered in a clinically appropriate setting that meets infection control standards.
- There should be a prison-wide strategy and approach to support health promotion and well-being activities.
- Waiting times for patients should be regularly monitored to ensure prompt access to care.
- Applications for health care appointments should be reviewed and actioned without delay.
- The reasons for prisoner non-attendance at health care appointments should always be recorded and reviewed.
- Prisoners with long-term health conditions should receive regular reviews by trained staff, informed by an evidence-based care plan.
- External hospital appointments should not be cancelled. (Repeated recommendation)
- The prison should work with key stakeholders to produce an updated memorandum of understanding and information-sharing agreement for social care provision.
- Prisoners referred to the service should be reviewed and assessed promptly, and offered a suitable range of mental health interventions within agreed timescales.
- There should be a regular substance use strategic meeting to support the implementation and development of the strategy.
- In-possession medication should be prescribed, reviewed and administered by health care professionals adhering to an up-to-date policy and risk assessment that reflects the range of medications prescribed, up-to-date prescribing guidelines, robust risk assessment of patient and medication, and appropriate storage of such medicines/doses. (Repeated recommendation)
- Custody officers should manage queues during medication collection times to maintain confidentiality and minimise potential bullying and diversion of supplies (Repeated recommendation)
- Prisoners should have access to routine dental appointments within six weeks.
- All dental equipment, including the x-ray machine, should be regularly serviced and certified.
- The provider should maintain an up-to-date file to document local arrangements for radiation protection.
Good Practice – Health, well-being and social care:
CQC Requirement Notices Issued:
- Regulation 9 – Person-centred care
- Regulation 17 – Good governance
- Regulation 18 – Staffing