This report was on an unannounced inspection of HMP/YOI Foston Hall between 04–15 February 2019, and was published 19 June 2019.
General Points of Note.
There had been two self-inflicted deaths since the previous inspection. Not all Prisons and Probation Ombudsman recommendations had been implemented in full.
Incidents of self-harm were very high and significantly higher than at similar prisons. A total of 900 self-harm incidents had occurred in the six months prior to the inspection, 52% of which were attributed to six individual prisoners with complex issues.
More than 300 assessment, care in custody and teamwork (ACCT) case management documents for prisoners at risk of suicide or self-harm were opened in the six months prior to the inspection, which was higher than at similar prisons. The ACCT documentation we examined showed some good practice and improvements, including regular case reviews and better attendance by health care staff. Care maps were limited – they were not updated regularly and were not always tailored to the prisoners’ individual needs, despite a PPO recommendation requiring these improvements.
A three-tier quality assurance process for ACCT documentation had been introduced. Although a positive initiative, it had not identified shortcomings in care maps or assessments of risk.
A new ACCT process was scheduled to be trialled for three months from mid-February 2019. The new process was more dynamic, prescriptive and holistic and included inviting family members to case reviews, which had been a previous PPO recommendation.
Healthy Prison Outcomes:
- Safety = 3 (3)*
- Respect = 3 (3)*
- Purposeful Activity = 3 (2)*
- Rehabilitation and Release Planning = 3 (3)*
Note: *(Previous inspection outcomes from June 2016 are stated in brackets)
- 4 = Outcomes for prisoners are good.
- 3 = Outcomes for prisoners are reasonably good.
- 2 = Outcomes for prisoners are not sufficiently good.
- 1 = Outcomes for prisoners are poor.
Key Points of Interest: Health, Well-Being and Social Care:
Not all clinical staff received clinical supervision, but some had received supervisor training and plans were in place to support the implementation of clinical supervision. Access to additional training was good and covered trafficking, sex working and domestic violence.
All prisoners had good access to health care services. Clinical space was limited, but the team used it effectively. All clinical areas were clean and well equipped, but there were no cleaning schedules.
Health care complaints were placed in boxes opened by PID workers, which meant they were not confidential. However, this practice stopped during the inspection. All concerns and complaints were dealt with face to face at a weekly clinic held by a senior manager. Issues that could not be addressed at this level were escalated. Responses to concerns and complaints were appropriate and timely. Analysis took place and trends were routinely discussed at regular governance meetings.
Health and well-being champions (peer workers) also saw prisoners in reception, asked health-related questions and made referrals to health and social care services. This breached prisoners’ confidentiality and the provider ended this practice during the inspection.
The introduction of telemedicine was a welcome development.
Medicines management had improved significantly since our previous inspection. Close links with the pharmacist at HMP Dovegate meant that advice and support was readily available in addition to the assistance provided by the medicine supplier.
The management of in-possession medication had improved. The senior pharmacy technician ran a weekly in-possession risk assessment clinic; 97% of prisoners had a completed risk assessment and 57% could keep their medication with them. At our previous inspection, the figure was less than 25%.
Prisoners requiring medication in the evening received a daily in-possession dose, or evening duty health care staff gave them their medication before they left the prison. A policy was now in place to ensure pain medication was available overnight if required.
In our survey, 74% of prisoners reported having a mental health problem and 54% of them said they had received help while at Foston Hall.
The integrated mental health team provided a service six days a week. The team was able to meet the needs of the population. With an average of 65 referrals a month, 37 patients were on the primary caseload, and 43 on the secondary caseload. This included 11 patients treated under the care programme approach (CPA).
Mental health practitioners held a daily meeting to discuss the allocation of all new referrals and consider any urgent patient issues.
Care UK provided the prison with a mental health worker to co-facilitate a mental health treatment programme Conquering Anxiety and Low Mood for prisoners with mental health needs.
The mental health team allocated a duty worker who attended all daily ACCT case management reviews for prisoners at risk of suicide or self-harm who were related to caseloads, or who were new in the prison, or in the segregation unit. All staff had clinical supervision and used multidisciplinary team meetings to discuss lessons learnt from ACCT reviews.
Care UK and Inclusion delivered the integrated substance use service. One third of the population was involved with Inclusion, which provided a good range of appropriate psychosocial interventions. Eighty-two prisoners were on opiate substitution treatment. Staff undertook 24-hour monitoring and regular observations.
Care UK and Inclusion provided specialist dual diagnosis treatment for prisoners with mental health issues, which was good. Prescribing was flexible, and there was a well-attended multidisciplinary approach towards clinical and psychological treatment, which demonstrated joint working.
The CQC found there were no breaches of the relevant regulations.
Recommendations: Health, Well-Being and Social Care:
- Cleaning schedules should be in place and monitored regularly to ensure the cleaning has been done and infection prevention standards are met.
- All clinical staff should receive regular clinical supervision.
- A prison-wide strategy should be established to support health and well-being, and it should include easy access to barrier protection.
- Health-related peer worker activities should not compromise patient confidentiality.
- The environment in which medication is administered should ensure patient confidentiality.
- In-possession medication should not be provided in transparent bags.
Good Practice: Health, Well-Being and Social Care:
- The weekly in-possession risk assessment clinic ensured risk assessments were completed promptly and enabled patients to discuss their medication with pharmacy staff.
- The safer prescribing meeting meant staff could focus on how they managed prisoners’ medication, which helped improve patient care.
CQC Requirement Notices Issued: