This report was on an unannounced inspection of HMP/YOI Moorland between 11–21 February 2019, and was published 11 June 2019.
General Points of Note.
Levels of violence had not only stabilised, but had actually decreased, which was noted as bucking the national trend over that period. However, despite this overall reduction, assaults against staff had doubled and were higher than at similar prisons.
Use of force by staff had increased since the last inspection, consistent with the levels at other category C prisons. There had been 202 uses in the six months leading up to the inspection, compared with 110 uses in the same period before the previous inspection.
Levels of NPS use had decreased since the last inspection. drug testing positive rate was 15%, including the positive rate for NPS, which on its own was 11%.
Self-harm was described as being “very high” and these levels were reported as being 50% higher than the average for category C prisons. In the previous six months, there had been 423 incidents of self-harm, involving 195 prisoners.
The quality of assessment, care in custody and teamwork (ACCT) case management for prisoners at risk of suicide or self-harm was considered to be mostly good, and staff training and quality assurance were driving improvement in care. Assessments were consistently good, and mental health workers regularly attended case reviews.
The most serious concern for inspectors was the lack of effective public protection measures. Over half the population, 530 men, were assessed as presenting a high risk and about a third were convicted sex offenders.
Healthy Prison Outcomes:
- Safety = 3(2)*
- Respect = 3(2)*
- Purposeful Activity = 3(3)*
- Rehabilitation and Release Planning = 2(2)*
Note: *(Previous inspection outcomes from February 2016 are stated in brackets)
- = Outcomes for prisoners are poor.
- = Outcomes for prisoners are not sufficiently good.
- = Outcomes for prisoners are reasonably good.
- = Outcomes for prisoners are good.
Key Points of Interest: Health, Well-Being and Social Care:
Leadership and accountability arrangements were considered as being robust. A culture of reporting serious untoward incidents and of learning from them was established, including learning from Prisons and Probation Ombudsman recommendations. Prisoner health representatives were now in place on most house blocks, and inspectors saw evidence of consultation about service delivery.
The training available to staff was impressive, with good access to clinical supervision and opportunities for professional development.
Clinical records captured the care provided and were subject to audit. We found equity of access to services for all prisoners. Infection prevention audits had been undertaken and clinical rooms were generally suitable and clean.
The management of health complaints had improved. We saw evidence of effective face-to- face resolution, and the quality of responses to concerns and complaints was generally good. However, complaint forms were not freely available and often had to be requested directly from health services staff, which potentially limited their use and submission.
A strategic approach to health promotion had been developed and bespoke events took place throughout the year. Patients who arrived at the establishment needing smoking cessation support were supported effectively.
Some secondary care was available onsite, including ultrasound scans and telemedicine. Out-of-hours support was delivered through the NHS 111 telephone line.
A complex case meeting took place fortnightly and was attended by a range of health care professionals. Patients’ care needs were discussed, and planned interventions were monitored and reviewed during the meeting. The management of long-term conditions was good and patient care was appropriately reviewed. Care plans were detailed and informed ongoing care provision.
Urgent mental health support was good. A duty worker was available seven days a week for prisoners experiencing acute distress, and they operated an initial gate-keeping assessment, which was impressive. This support included input into the segregation unit, and the team routinely contributed to all initial ACCT processes and subsequent case reviews, where appropriate.
All routine MH referrals were generally seen and assessed within a week.
Most custody staff had undertaken mental health awareness training, which was a positive development, particularly given the importance attached to the new key worker role.
The integrated substance misuse team provided well-led and coordinated clinical management, seven days a week. Currently, 115 patients were receiving opiate substitute treatment, compared with 66 at the time of the previous inspection, but prescribing input had not increased with this rising demand. The team appropriately prioritised 13-week reviews, and met weekly to discuss the care of the large number of patients with complex needs. A dual diagnosis nurse, who was part of the primary mental health team, provided support to patients with substance- as well as mental health-related problems.
There was a comprehensive in-possession (IP) policy, but inspectors found that not all IP risk assessments were reviewed in line with it. The use of IP medication had increased from 30% at the time of the previous last inspection to 65% in January 2019, which was positive. About a third of the population (330 patients) was prescribed supervised or controlled medication, which included a number of tradable medicines. Officers were now consistently available to supervise the process, which had improved safety and reduced the likelihood of diversion.
The CQC issued 1 Requirement Notice against Regulation Standards.
Recommendations: Health, Well-Being and Social Care:
- Automated electronic defibrillators should be easily accessible to prison staff, particularly when nurses are not on site.
- Patient information should be readily accessible in a range of formats and languages.
- Prisoners with identified mental health needs should be able to access a full range of individual and group psychological interventions.
- Patients requiring a transfer under the Mental Health Act should be transferred within the current transfer time guidelines.
- The range of psychosocial interventions should meet identified need and include the provision of medium- to high-intensity courses.
- Clinical substance misuse services should offer sufficient prescribing input to meet increased demand and complexity of need.
- Patient medication should be supplied in a timely fashion, to ensure that treatment is not interrupted.
- In-possession risk assessments should be reviewed in line with the local policy, to ensure that all risks are appropriately managed.
Good Practice: Health, Well-Being and Social Care:
- None identified/reported.
CQC Requirement Notices Issued:
- Regulation 12: Safe care and treatment. This was in relation to medicines being not always managed properly and safely.