This report presents the findings of the Independent Monitoring Board at HMP Holme House for the period 01 Jan 2018 to 31 Dec 2018. IMB evidence comes from observations made on rota visits, scrutiny of records and data, attendance at various meetings, informal contact with staff and prisoners, prisoners’ applications and monitoring of areas of concern.
In 2017 Holme House was chosen to pilot the concept of a Drug Recovery Prison (DRP) with an additional investment of £9 million provided by the Ministry of Justice (MOJ) and NHS England between 2017 and 2020. The objective is to test a whole prison approach to tackling both the supply and demand for drugs in prison, and to create an environment where opportunities for recovery can flourish.
The DRP Delivery Plan consists of four components: safety and security, care and well-being, community and environmental development, and continuity of care.
2018 saw significant and steady improvements in the stability and performance of the prison, characterised by a regular and consistent regime leading to a greater certainty for both men and officers alike.
Wing based community care is delivered by a dedicated healthcare team made up of DART nurses, recovery coordinators, mental health nurses, CRC and peer support.
The number of prisoners with a history of self-harm has been consistent throughout 2018 with approximately 250 prisoners in an average prison population of 1200. In 2018 there were 868 open ACCTs, a 6% increase over 2017, which remains an area of concern. The IMB has observed excellent examples of a caring and consistent approach to ACCT reviews.
There were 261 reported acts of violence in 2018, compared to 376 in 2017. Assaults on prisoners (including serious assaults) showed a downward trend in the second half of 2018. There were 98 reported prisoner-on-prisoner assaults in 2018 which is an ongoing cause for concern. Assaults on staff are an ongoing concern, with 16 reported incidents in the year. However, there is evidence of a downward trend in the last quarter of the year.
There were seven deaths in custody in 2018, five of which were due to natural causes. This compares to five deaths in 2017 when four were due to natural causes. Inquests into the other two deaths are currently ongoing.
Service Delivery Positives:
- Screening for bowel cancer, retinal screening, diabetic screening and healthy heart checks continue to be part of the routine.
- There have been some improvements in inpatient care, as a concerted effort has been made to remove prisoners with serious mental health problems to another provision, resulting in most of the beds being occupied by social or clinical need prisoners. A dedicated team of prison officers has also been established within the inpatient accommodation. A palliative care suite is available and there is close working with Teesside Hospice Care Foundation and Macmillan nurses.
- There has been a significant reduction in the percentage of men not turning up to appointments from last year (18% in 2017 down to 6% in 2018). This improvement can be attributed to the improvement in the delivery of the regime in the prison this year.
- The mental health team is fully staffed with nurses. psychiatrists, a speech and language therapist, a resettlement officer and counsellors from MIND. A range of group therapies are available to all men, including stress management, ’Hearing Voice’, team building and a well- being gym. Other therapies such as EMDR (eye movement desensitising reprocessing) are provided.
- A speech and language therapist (SLT) is employed as part of DRP, working within the mental health team to work with men who want to improve their communication skills or have swallowing difficulties due to mental health or medical problems. Part of the work is about making information easier to understand and making Holme House a more positive place for effective communication.
- The mental health team manager won the national Cavell Staff Nursing award during 2018, being the first mental health prison nurse ever to do so.
Service Improvement Opportunities:
- The IMB does not consider that the services provided to prisoners by Healthcare are equivalent to those that prisoners would receive in the community, and in some instances they are considerably worse, with unacceptably long waiting lists.
- Although this figure has improved, there are still unacceptable delays and at the end of the year men had to wait five to six weeks to have a GP appointment, with review appointments having an eight-week waiting list. There is some provision for urgent appointments with the GP.
- Dental appointments are worse, with the end of year figure of 280 men on the waiting list for an initial appointment, which will take 21 weeks, with an ongoing treatment waiting time of eight weeks and dental therapy nine weeks.
- A shortage of nurses has dominated the ability of Healthcare to deliver a fully effective service to the prison. There has been an average shortage of 10 nurses out of a total complement of 27.5. Bank and agency nurses cover the shortfall. This has impacted on attendance at GOOD and ACCT reviews as well as late delivery of medication and poor or late attendance in reception, causing disruption to the prison regime.
- Medication is supposed to be delivered by pharmacy technicians. However, due to shortages of staff, nurses are deployed to this work, which adds to the shortages in other areas. Medications on two house blocks are combined due to the low number of men requiring not in-possession medication.
- The IMB has observed problems with the health care complaint system, which is separate from the prison complaints system, is not well administered and does not appear to be monitored robustly, leading to long delays with responses. This is reflected in the high number of applications the IMB get relating to medical matters.
The IMB feels that Holme House has become a less volatile and dangerous place for both prisoners and staff in 2018. Staff training has been focused on violence and drug prevention, e.g. all safer custody staff are fully trained in engaging in Timewise, a violence reduction programme. A prison-wide focus on staff training on Five Minute Intervention [FMI] and key worker training under Offender Management in Custody [OMiC] have also contributed to this.
Holme House can present a very challenging and volatile environment. The IMB feels that due to the determination and effort of those who work there and with a more consistent application of assurance checking considerable progress has been made towards laying the foundations for improved performance indicators and a more safe and stable environment for all who live and work there.