This report was on the announced inspection of HMP Stocken (22 January 2019 – 8 February), and was published 29 May 2019.
Points To Note.
The use of illicit drugs, particularly new psychoactive substances (NPS), remained a serious problem. In the survey, nearly half of prisoners said that it was easy to get drugs at the prison. The mandatory drug testing (MDT) positive rate was high, at around 26% over the previous six months, and almost exclusively for NPS.
There had been two self-inflicted deaths since the previous inspection (in July 2015). Prisons and Probation Ombudsman (PPO) recommendations were not always implemented or embedded. Levels of self-harm had increased substantially since the previous inspection and were now comparable with those at similar prisons. Over half of the 184 incidents in the previous six months had concerned just eight prisoners, which is a telling statistic.
For the same six month period, there were a total of 115 Assessment, Care in Custody and Teamwork (ACCT) case management documents had been opened, which represented an increase since the previous inspection. This was noted as being below the number HMIP inspectors usually find at similar prisons.
Several aspects of health provision had deteriorated since the previous inspection and, overall, the service required improvement. There was a lack of robust governance for several areas of health care. The management of medicines had deteriorated, in terms of poor oversight of medicines management, poor stock control and unsafe storage that needed immediate attention. Some patients requiring nursing care did not always receive the treatment they needed, which left patients at risk of their health deteriorating. Care plans were not always followed or regularly reviewed, and primary care staff did not receive regular managerial or clinical supervision. Waiting times for most primary care services were acceptable, apart from long waits to see the physiotherapist and for a routine GP appointment.
Long-term health conditions were managed effectively. However, a lack of oversight of some patients with complex nursing care needs led to poor outcomes. A social care pathway was in place but the recording of planned care was poor. Staff shortages had had an impact on the delivery of some mental health services, including delays in routine assessments, but urgent referrals were seen promptly.
The drug recovery unit provided a positive environment, with a wide range of psychosocial support available. Not all patients on opiate substitution therapy received regular and timely clinical reviews.
Healthy Prison Outcomes:
- Safety = 3 (2)*
- Respect = 3 (3)*
- Purposeful Activity = 2 (4)*
- Rehabilitation and Release Planning = 2 (3)*
Note: *Previous inspection outcomes in brackets (from July 2015)
Summary: Health, Well-Being and Social Care:
No patient consultation forums had been established and there was no embedded system to gather patient feedback for primary care services.
Mandatory training was well managed, with some opportunities for professional development. Managerial and clinical supervision was in place for mental health and psychosocial staff but there were gaps in primary care managerial supervision, and clinical supervision was not offered.
The health centre was clean and treatment rooms generally met clinical requirements, including regularly checked and calibrated equipment. However, some of the wing-based medication administration rooms did not meet Infection Prevention and Control (IPC) standards. Daily cleaning checks for clinical rooms were not consistently completed. An IPC audit completed in September 2018 had identified some deficits.
Smoking cessation support was available for those who wished to stop nicotine vaping. Two peer health orderlies had been involved in this with health services staff, but these posts had recently become vacant.
Health care applications were triaged by non-clinical staff, so inspectors could not be sure that patients needing an urgent appointment would be identified, posing a potential clinical risk. Waiting times were adequate for most primary care services, but too long for physiotherapy, dental and routine GP appointments. There were urgent appointment slots available in each GP clinic.
There was an effective system to manage the booking of external hospital appointments. There were sufficient prison officer escorts, which meant that few hospital appointments were cancelled for operational reasons.
Health care release and transfer planning arrangements were effective, when health services staff were given sufficient notice. However, there had been occasions when the transfer of a patient’s care had been arranged only after the patient had left the prison, and when prisoners on release had received only a limited supply of medicines.
45% of prisoners reported to inspectors that they had mental health problems, and 58% of these said that they had been helped with these at the prison. During the inspection, the MH team had 60 patients on their caseload, including six with severe and enduring mental health needs.
The MH team received approximately 50 referrals per month from reception, self-referral, and health services and custody staff.
The waiting time for a routine Mental Health assessment was six weeks, which was too long. The manager triaged referrals each morning, prioritising them on clinical need. The team responded to urgent referrals promptly. There was an effective weekly team meeting and good interaction with prison staff.
There was only one psychiatry session per week, which meant that some patients waited too long for a routine appointment and medication reviews.
23% of prisoners reported an alcohol problem, and 33% a drug problem, on arrival; of these, 61% and 63%, respectively, advised inspectors that they had been helped with this while at the prison.
The Inclusion team, although stretched because of staff absence, was actively engaged with 279 prisoners (33% of the population). Eighty-one prisoners (10% of the population) were prescribed methadone, which was the only opiate substitution therapy available at the time of the inspection and limited patient treatment options. A third were on reducing doses. The prison did not receive any prisoners on buprenorphine (a heroin substitute), which needed to be reviewed.
The CQC issued 3 Requirement Notices against Regulation Standards.
Recommendations: Health, Well-Being and Social Care:
- Effective and robust (clinical) governance structures should be in place, to ensure that all aspects of health delivery meet the needs of prisoners and are safe, including effective oversight of patient care and the immediate implementation of robust and secure medicines management arrangements.
- Local partnership board meetings should occur more frequently, to provide strategic oversight and effective governance of the service.
- Screening, immunisation and vaccinations should be offered and implemented in a timely fashion.
- Specialist sexual health services should be available within the prison, to ensure privacy and dignity.
- There should be clinical oversight of the appointment system, to ensure that patients are appropriately booked into clinics.
- Waiting times for some primary care services, including physiotherapy, the GP and dental services, should not exceed clinically acceptable waiting times in the community.
- Prisoners should have timely access to mental health services, including routine mental health assessments.
- Prisoners needing treatment for their condition in hospital under the Mental Health Act should be transferred within the timescales established by the Department of Health.
- Wider options for clinical treatment should be available, in line with national clinical guidance.
- Joint clinical and psychosocial reviews should be timely, to support effective management and care of prisoners on opiate substitution therapy.
- Medicines should be prescribed and administered at clinically appropriate times, to ensure optimal treatment.
- Medication administration should be supervised effectively by prison staff, to ensure confidentiality and compliance, and reduce the risk of bullying and diversion.
- The medicines management quorate should ensure that medicines storage and oversight are in line with legal and professional standards, and deficits should be immediately resolved.
Good Practice: Health, Well-Being and Social Care:
CQC Requirement Notices Issued:
- Regulation 9 – Person-centred care
- Regulation 12 – Safe care & treatment
- Regulation 17 – Good governance