A Summary of Safety in Custody Statistics July 2019: Deaths in Custody, Self-Harm and Assaults.

Deaths In Custody – 12 months to 30 June 2019

Overall, the number of deaths continues to fall but self-inflected deaths continue to rise.

309 deaths in prison custody, a decrease from 311 deaths the previous year. Of these, 86 deaths were self-inflicted, up from 81 the previous year.

There were 165 deaths due to natural causes which is a decrease from the 176 deaths in the previous year. 55 deaths are recorded as other, as 50 of those are awaiting further information.

Self-Harm – 12 months to 31 March 2019

Self-harm incidents reached a record high.

57,968 incidents reported which is a 24% increase from the previous 12 months. This is a rate of 699 incidents per 1000 prisoners.

By gender, this rate equates to 596 incidents per 1000 in the male estate (up 24%) and 2,828 per 1000 in the female estate (up 22%).

The number of individuals self-harming increased 12,539, representing a 6% increase on the previous year.

The number of self-harm incidents requiring hospital attendance increased by 5% to 3,261 in the same period. Of these 3,026 were in male prisons and 235 were in female prisons.

Assaults – 12 months to 31 March 2019

Assaults reach new a record high.

34,425 assaults reported which is an 11% increase on the previous year. Of these, 32,908 were in male prisons (up 11%) and 1,517 assaults were in female prisons (up 21%).

3,949 of these assaults were recorded as serious. A serious assault is one which falls into one or more of the following categories:

  • a sexual assault
  • requires detention in outside hospital as an in-patient
  • requires medical treatment for concussion or internal injuries

…or incurs any of the following injuries:

  • a fracture,
  • a scald or burn,
  • a stabbing,
  • crushing,
  • extensive or multiple bruising,
  • a black eye,
  • a broken nose,
  • a lost or broken tooth,
  • cuts requiring suturing,
  • bites,
  • temporary or permanent blindness.

There were 10,311 assaults on staff (up 15%). There were 24,541 prisoner-on-prisoner assaults, some of which may then involve those assaults on staff.

Full Report Here

HMIP Annual Report 2018–19: Health Summary

General Points of Note.

Of the 35 inspections across the male estate, a total of 28 local and training prisons were inspected during the year. In 22 of them, inspectors judged safety to be poor or not sufficiently good.

It was also notable that self-harm had increased in two-thirds of the prisons inspected.

As of December 2018, 17% of the prison population was aged over 50. To date, there is neither a clear strategy nor indication of innovation in how this increasing cohort of prisoners will be catered for in the future. At the moment there are large and growing numbers of ageing and infirm prisoners who are held in expensive and unnecessary levels of security.

Overall, inspectors continued to find that outcomes for women held in prison were better than for men. Safety, respect and resettlement were good or reasonably good at all three of the women’s prisons that inspected during this reporting period. However, gradings for purposeful activity had deteriorated at two of the women’s prisons, and had declined to not sufficiently good at the third.

It remained the case that women were far more vulnerable to self-harm than men, and levels had increased significantly. The levels of victimisation suffered by many women before entering custody emphasised the need to continue and develop the vital trauma-informed work that has been implemented in recent years.

There had been 83 self-inflicted deaths in male prisons in England and Wales in 2018–19, an increase of 15% from 72 the previous year. There were 45,310 reported incidents of self harm in 2018, an increase of 25% from 36,347 incidents in 2017. A common theme across all prisons.

Self-harm had increased in two-thirds of the adult male prisons inspected during this reporting year. Main recommendations about serious deficiencies in suicide and self-harm prevention measures were noted at 14 establishments. The Prisons and Probation Ombudsman (PPO) investigates all deaths in custody and makes recommendations to improve care. Once again, inspectors found that PPO recommendations had not been adequately addressed at about a third of prisons.

At more than half of inspected adult male prisons, the quality of support for prisoners in crisis, delivered through assessment, care in custody and teamwork (ACCT) case management, was weak. In the surveys undertaken, only 47% of prisoners who had received this support had felt cared for. Too often, care planning did not target concerns or support was ended without the proper resolution of issues.

Key Points of Interest: Health, Well-Being and Social Care.

Male Prisons

This year, more prisons were found to be breaching CQC health regulations. This resulted in one warning notice and 16 requirement notices to 10 of the 35 adult male prisons inspected, with four prisons receiving more than one notice.

In 2018–19, most health services were reasonably good with 50 instances of good practice highlighted, including 11 for substance use services. However, there were problems with cleanliness – 10 prisons failed to meet minimum standards of infection control compliance and cleanliness – and seven prisons had poor resuscitation equipment, which was a concern given the increasing number of medical emergencies.

Generally, there was an improvement in health staffing levels, most staff felt supported and a majority participated in clinical and managerial supervision.

All prisons provided new arrivals with an initial health screening by a clinician but only two-thirds offered a second follow-up assessment to help identify key health issues.

HMIP inspectors found improving health services for older prisoners, with a growing awareness of dementia, and patients with long-term conditions received good planned care.

In over half the adult male prisons inspected, it was noted that the lack of assessment and treatment for prisoners with mental health, learning disabilities or emotional needs. Many prisoners were held in conditions that were in no way therapeutic, and which often clearly exacerbated their condition.

We remained concerned about the continuing plight of prisoners experiencing severe delays in transfer to secure mental health beds. In the vast majority of prisons, the 14-day target for transfer was not met.

An emerging theme this year was poor governance of medicines management, with many prisons lacking on-site pharmacists to provide oversight of medicines. Overall, there were 86 recommendations made to improve the quality and safety of medicines management across all 35 prisons inspected. Too often there was inconsistent supervision of medication queues to prevent trading and bullying, no lockable storage for in-possession medication, and risk assessments of prisoners for in-possession medication not being completed or reviewed.

In almost a quarter of adult male prisons there was poor monitoring of patients during drug and alcohol stabilisation.

Psychosocial support for patients with substance use needs remained variable; while a third of prisons did not deliver adequate interventions, the rest provided an excellent service. Positively, some prisons provided drug-free, recovery-focused wings.

Women’s Prisons

Levels of self-harm were very high and had increased throughout the women’s estate by 24% in 2018. However, a small number of prisoners often accounted for a large number of these incidents, with an estimated 8.3 incidents per individual, which reflected the complex needs of those in women’s prisons. Patterns of self-harm were well analysed in each prison, and the use of assessment, care in custody and teamwork (ACCT) case management for at-risk prisoners was good overall.

Staff–prisoner relationships were good in all three prisons and had a positive impact across all aspects of prison life.

Health provision and governance were reasonably good in all three prisons, and most prisoner needs were met. In the surveys, 67% of prisoners said they had mental health problems, and Inspectors found good support for them.

Healthy Prison Outcomes:

…..And this is what I find the most interesting. The average breakdown of outcomes across each of those prison types:

Local Prison Averages (across 14 sites):

  • Safety = 1.6
  • Respect = 2.3
  • Purposeful Activity = 1.7
  • Rehabilitation & Release Planning = 2.6

High Security Prison Averages (across 2 sites):

  • Safety = 3.0
  • Respect = 3.0
  • Purposeful Activity = 2.5
  • Rehabilitation & Release Planning = 3.0

Training Prison Averages (across 14 sites):

  • Safety = 2.2
  • Respect = 2.6
  • Purposeful Activity = 2.1
  • Rehabilitation & Release Planning = 2.4

Open Prison Averages (across 3 sites):

  • Safety = 4.0
  • Respect = 3.3
  • Purposeful Activity = 3.0
  • Rehabilitation & Release Planning = 3.0

Women’s Prison Averages (across 3 sites):

  • Safety = 3.7
  • Respect = 3.7
  • Purposeful Activity = 3.0
  • Rehabilitation & Release Planning = 3.7

Young Adult Prison Averages (1 site only):

  • Safety = 3.0
  • Respect = 3.0
  • Purposeful Activity = 2.0
  • Rehabilitation & Release Planning = 2.0

Therapeutic Community Averages (1 site only):

  • Safety = 4.0
  • Respect = 4.0
  • Purposeful Activity = 3.0
  • Rehabilitation & Release Planning = 3.0

Children’s Establishment Averages (across 5 sites):

  • Safety = 3.0
  • Respect = 3.6
  • Purposeful Activity = 3.0
  • Rehabilitation & Release Planning = 3.6

Extra Jurisdiction Averages (1 site only):

  • Safety = 2.0
  • Respect = 3.0
  • Purposeful Activity = 2.0
  • Rehabilitation & Release Planning = 4.0

Immigration Removal Centre Averages (across 5 sites):

  • Safety = 3.3
  • Respect = 3.3
  • Purposeful Activity = 3.8
  • Rehabilitation & Release Planning = 4.0

Conclusion.

The range of variance in the Outcomes against the Healthy Prisons test tells its own story. Contrast the average ratings in the local and training prisons against much of the rest of the prison estate.

The HMI Chief Inspector notes

“the continued displays of extraordinary dedication of those who work in our prisons. Their work is difficult, often dangerous, largely unseen by the public and, as a result, little understood. Many worked through a period in which reduced resources, both in terms of staff and investment, made it extremely difficult to run some of our jails.” – Peter Clarke

The healthy prison test averages give an overwhelmingly clear indication as to where the additional staff and investments need to be placed. If additional is not an option, then a reallocation of these resources is surely a must.


Links/Resources:

Full Report Here – HMIP Annual Report 2018–19

HMIP Report – Health Summary: HMP & YOI Askham Grange, Apr 2019

This report was on an unannounced inspection of HMP & YOI Askham Grange between 01–05 April 2019, and was published in July 2019.

General Points of Note.

At the last inspection in 2014, Askham Grange was awarded the highest grading of ‘good’ in all four of the healthy prison tests. This feat is repeated in 2019.

It is noted that Askham Grange has been under threat of closure for the past six years.

40% of the population were victims of domestic violence. More than half the population were prescribed anti-depressant medication.

Only 14 ACCT documents for prisoners at risk of suicide or self-harm were opened in the previous year and only two cases involved acts of self-harm. ACCT casework was good, however, it was found that health care staff did not always attend case reviews.

Healthy Prison Outcomes:

  • Safety = 4 (4)*
  • Respect = 4 (4)*
  • Purposeful Activity = 4 (4)*
  • Rehabilitation and Release Planning = 4 (4)*

Note: *Previous inspection outcomes from July/August 2014 are stated in brackets

Key:

  • 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:

Service delivery was good, but aspects of management oversight needed to be enhanced. For example, it was difficult to obtain staff supervision records and accurate information about waiting times during the inspection, and not all staff felt fully supported. A more regular management presence would have helped address the problem.

There had only been one Datix report (the electronic health care incident reporting system) in the previous 12 months and a risk register was established to monitor areas of concern. A confidential complaints process was in place. Inspectors were told that there had been a very small number in the previous 12 months and most were resolved face to face with the patient. However, inspectors were unable to verify this or see any complaints during the inspection to assess the standard of the replies.

The health care centre was welcoming and clinical rooms were clean and met infection control standards. Equipment was well maintained and regularly serviced.

The nursing team ran a daily drop-in triage session and two experienced GPs provided three clinics a week, supported by an advanced nurse practitioner who provided a weekly clinic. In the survey, 89% said it was easy to see a GP and 94% said it was easy to see a nurse. Prisoners were found to have ready access to the health team and were usually seen by the GP within two days for a routine appointment. An appropriate range of clinics, such as those offering podiatry, optician and physiotherapy services, was established and waiting times for all these services were short.

Access to external hospital appointments was well managed and there were up to four escorts available every day, but many patients could attend appointments while on ROTL. This is a generous provision of escorts – four per day is typically what prisons with populations between 800 to 1000 might expect to have available.

There was no clinical pharmacy support for patients and routine oversight of medicine management arrangements was limited. Nurses oversaw orders of medication from the pharmacy and prisoners’ repeat prescriptions.

There was a clear Mental Health referral pathway and prisoners’ initial needs were identified during reception screening. In 2018, assessments had not always been timely, but in the previous three months, performance had significantly improved.

A single mental health nurse operating as a community psychiatric nurse (CPN) undertook initial assessments and delivered appropriate support and interventions.

Approximately 10% of the population were on anti-psychotic medication and we saw evidence showing that patients’ physical health was routinely monitored.

The CQC issued no Requirement Notices against Regulation Standards.

Recommendations: Health, Well-Being and Social Care:

  • Staff from the health care department should attend all ACCT case reviews or make a written contribution if they are unable to.
  • There should be an agreed level of support and management presence on site to ensure that oversight is effective and that practitioners receive appropriate supervision in line with the provider’s policy.
  • Patients should have access to specialist support from a clinical psychologist.

Good Practice: Health, Well-Being and Social Care:

  • None identified/reported.

CQC Requirement Notices Issued:

  • None

Links/Resources:

Full Report Here – HMP & YOI Askham Grange

IMB Reports: Health Notes – June 2019

Published IMB reports during June 2019 were The Mount, Leyhill, Exeter, Lindholme, Grendon, Gartree, Northumberland, Lewes and Springhill.

Here are some of the more interesting points contained within those reports, pertaining to health:

IMB Report – HMP The Mount

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • A net gain of 83 officers in 12 months, going from 110 in Feb 2018 to 193 in Feb 2019. This increase has seen a positive reduction in prison cancellations of hospital appointments.
  • An operational Wellbeing wing is providing support to prisoners with both substance misuse and mental health needs. Prisoners with more serious mental health needs are often located in CSU in the interests of either Good Order or Discipline of Own Protection.
  • Peer supporters employed as Health and Wellbeing Champions (HAWCS) provide health and wellbeing advice, guidance, brief interventions and support to fellow prisoners.
  • Healthcare applications to the IMB decreased to 7 from 21 to 7 when compared to the previous reporting year.

Full IMB Report – The Mount


IMB Report – HMP Leyhill

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • As a Cat D prison, the Healthcare service is comparable to a well-run GP practice. Greater emphasis is placed on prisoners in accepting responsibility for improving their personal health, which is commendable.
  • Perhaps going to far in trying to replicate community equivalence, the GP Clinics have reduced by 1 day per week, leading to a waiting time of approx 3 weeks. The average waiting time for new dental referrals is reported as being 10 weeks.
  • Healthcare applications to the IMB increased to 5 from 2 when compared to the previous reporting year.

Full IMB Report – Leyhill


IMB Report – HMP Exeter

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • In May 2018, HMCIP invoked the Urgent Notification protocol, which provides its own challenging backdrop for the delivery of any healthcare services.
  • HMP Exeter boasts an 11-bed social care unit (F wing) which includes a palliative care suite and a constant supervision cell.
  • The telemedicine Video-link facility is proving to be effective in enabling prisoners to have specialist consultations without the need to attend hospital, although staff report delays in the receipt of those written reports.
  • Clinics receive the support of dedicated officers although attendances/DNA’s remain heavily reliant on motivated “runners” which is typical of many prisons. DNA rates fluctuate from less than 10 for the GP/Nurse clinics to as high as 60% for services such as the physio and the optician.
  • Healthcare applications to the IMB decreased to 25 from 39 when compared to the previous reporting year.

Full IMB Report – Exeter


IMB Report – HMP Lindholme

Reporting period – 01 Feb 2018 to 31 Jan 2019

  • The recruitment of extra prison staff is welcomed. However, the low age and limited life experience of a significant proportion of new recruits has been observed. The IMB pose the question to the Minister To consider raising the minimum age of application to the Prison Service to beyond the current 18 years.
  • The IMB ask the Prison Service to consider what measures are needed to ensure that the staffing levels of the Healthcare provider are maintained as per contract.
  • Incidents of self- harm decreased in comparison to the previous year, although the data still produced a worrying picture. The monthly average of incidents was 30.7 in this reporting year, with more or less consistency throughout the year. This compared to a monthly average of 44 incidents in the previous reporting year. The large majority of incidents were by cutting and were carried out on the wings in singular cell accommodation.
  • Cosistent with the above, the number of ACCTs opened in the reporting period saw a reduction with an average 15.5 per month compared to 36 per month in the previous year.
  • There were 7 Deaths in Custody during the reporting period.
  • Healthcare staffing levels revealed that at the end of the reporting year, 16 out of a total of 60 posts were either vacant, awaiting completion of the recruitment process or subject to a period of notice. Staffing recruitment problems have been identified on the risk register. Mental health has been the most affected, and Substance Misuse Services the least.
  • Waiting Times to see a GP varied significantly from month to month. At the end of the reporting year, this was 3 weeks 4 days. The vacant ANP post had an impact on this. Waiting times for physiotherapy were 41 weeks and podiatry 19 weeks.
  • The DNA rate for prison GP appointments has reduced towards the end of this reporting year to 7%.
  • A Telemedicine service has been provided but has proved to be not as useful as hoped. This was attributed to waiting times and the rejection of referrals, and therefore diverting referrals back into mainstream secondary care.
  • Cancellation of hospital appointments by the prison was high, and at the end of the reporting year it was 10.6%.
  • Work-fitness clinics: daily clinics (Monday to Friday) to assess prisoners who felt that they were not fit for work, in the context of a working prison, have been re-established with an 80% coverage of working days. This has been a welcome development.
  • Healthcare applications to the IMB decreased to 30 from 54 when compared to the previous reporting year.

Full IMB Report – Lindholme


IMB Report – HMP Grendon

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • Incidents of self-harm for the year were 26 compared with 43 for the previous year, which included two individuals who self-harmed on multiple occasions.
  • 52 ACCT’s were opened for the year compared with 62 in 2017. Reviews monitored by the Board, including some very challenged men, showed evidence of good care and support.
  • 8 assaults were recorded in 2018 compared with nine in 2017 and no use of force.
  • Grendon has been smoke free since 2017 and there is no current funding to support nicotine (cigarette) cessation, but some residents are now looking for support to come off vaping. Healthcare are exploring options.
  • Healthcare applications to the IMB increased to 7 from 4 when compared to the previous reporting year.

Full IMB Report – Grendon


IMB Report – HMP Gartree

Reporting period – 01 Dec 2017 to 30 Nov 2018.

  • The high number of men with complex mental health needs (i.e. those on ACCT documents, self- harming, on dirty protests in the SAPU puts considerable strain on staff, who despite doing everything they can in very difficult circumstances, may not be best placed to deal with some of these more complex prisoners.
  • The Board is aware of occasions throughout the year where men in the Segregation Unit have not received prescribed medication when it is due or needed.
  • For the majority of this reporting period, responsibility for provision of the integrated healthcare services at Gartree was provided through Mitie Care & Custody (Health) Limited. On 1 November 2018, Nottinghamshire Healthcare NHS Foundation Trust (NHFT) took over the responsibility for the delivery of healthcare at Gartree.
  • The IMB continued to hold the view, as expressed in their Annual Report 2016/17 that the prison regime and the health and wellbeing services at Gartree for this reporting period were not designed or resourced to improve health and wellbeing, or tackle health inequalities and the wider determinants of health.
  • The Board acknowledged that a change in provider was appropriate, and addressing the current inadequacies of the healthcare services is critical.
  • Healthcare applications to the IMB increased to 47 from 22 when compared to the previous reporting year. In many instances healthcare applications related to the lack of response to complaints by Healthcare.

Full IMB Report – Gartree


IMB Report – HMP Northumberland

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • 2018 saw one death in custody, compared with five in each of the two previous years.
  • The IMB have previously recorded their disappointment that the deterioration in routine waiting times for both GP and dental services has not been addressed more quickly. In this reporting year, the situation remains unchanged, with waiting times for both services continuing to fluctuate throughout 2018 despite the periodic provision of additional sessions.
  • Waiting times for the GP peaked at 36 days in July and August, and reduced at the end of the year. Waiting times for dental treatment stood at 29 weeks, with a hope that this would improve in 2019.
  • Healthcare applications to the IMB decreased to 38 from 46 when compared to the previous reporting year.

Full IMB Report – Northumberland


IMB Report – HMP Lewes

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • The Board is concerned about the safety of men in HMP Lewes. In the reporting year, recorded incidents of violence perpetrated by a prisoner on another prisoner rose from 165 to 278, an increase of 68%.
  • There have been five deaths in the reporting year. Over the last year 579 ACCT documents have been opened.
  • The Board has found that for much of the reporting year the delivery of healthcare services has suffered from staff shortages and poor process and communications which have significantly impacted on the care provided for prisoners.
  • The Board has found that waiting lists for routine GP and dentist appointments have been unacceptably long at various times: in the six months May-October the wait to see a GP was an average of 12 weeks, and in June and January, the waiting time for the dentist was 10–12 weeks. In addition, the integrated mental health team typically had in excess of 50 residents waiting for an assessment appointment, with some men waiting many months to be seen.
  • The Board considers that the complaint management process remains poor and provides little opportunity for an overarching view of healthcare delivery. Each service provider manages their own complaints, and the quality of responses and the integrity of the data is variable. There were typically 20–30 complaints a month to the two main providers and the consistent themes throughout the year were access and waiting times, and not getting the medication wanted.
  • The prison went smoke-free in April 2018, and a programme implemented by the pharmacy team supported by gym officers ensured that the transition went smoothly. The smoking cessation activity has continued, with 220–240 men supported each month. Feedback from participants of programmes run by Forward Trust (alcohol and substance misuse) was excellent.
  • Healthcare applications to the IMB increased to 72 from 50 when compared to the previous reporting year.

Full IMB Report – Lewes


IMB Report – HMP Springhill

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • HMP Springhill is jointly managed with HMP Grendon (located next door). A single Independent Monitoring Board monitors both prisons.
  • Opened ACCTs remain low at 5 for the year. It is a good indication that the prison has the confidence in care to be able to support men on ACCTs. There were no reported incidents of self harm for the entire reporting period.
  • Pregabalin appears to be the drug of choice over Spice/NPS (new psychoactive substances). Cannabis has also been more prevalent, which might account for the overall 46% increase in positive test results compared with 2017.
  • Healthcare staffing recruitment has proved challenging when striving for a full complement of staff during the year, and in particular to fill the post of pharmacy technician. Staff have been faxing scripts for validation to pharmacy staff at other prisons in the region, causing occasional delays in men getting their prescriptions at weekends.
  • There are currently no healthcare meetings with residents, but this is being addressed.
  • Dental services have made significant progress in ensuring that all new patients are seen within the prescribed time. Residents positively rate dental care.
  • Healthcare applications to the IMB decreased to 0 from 6 when compared to the previous reporting year.

Full IMB Report – Springhill


HMIP Report – Health Summary: HMP Berwyn, Mar 2019

This report was on an unannounced inspection of HMP Berwyn between 04–14 March 2019, and was published in July 2019.

General Points of Note.

This is the first inspection report for HMP Berwyn, having only opened in February 2017.

The full operational capacity of the prison will eventually be 2,106 prisoners. At the time of this inspection, the population was 1,273. The current operational capacity is 1300.

Predictably, 77% of officers had been in service for less than two years and about a third for less than a year.

All cells had a shower, telephone and laptop computer.

There had been no self-inflicted deaths since the prison opened.

Levels of self-harm were below those of other category C prisons. The strategic management of suicide and self-harm has been deemed to require improvement. Most of the at-risk prisoners on assessment, care in custody and teamwork (ACCT) case management did not feel sufficiently cared for. ACCT documents required improvement, and initial assessments and care plans were weak.

There had been 3,614 complaints in the previous six months, a much higher level than inspectors would usually see. Staff attributed this to the inexperience of many staff and ineffective operation of the applications process.

Healthy Prison Outcomes:

  • Safety = 2
  • Respect = 3
  • Purposeful Activity = 2
  • Rehabilitation and Release Planning = 2

Key:

  • 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:

There had been no recent infection control audits, but they were planned as part of the developing audit cycle with the health board. All clinical areas were clean and well maintained, but there were no cleaning schedules evident.

During the inspection, there was a two-week pilot project with the Welsh Ambulance Service Trust, with a paramedic deployed for 12 hours a day in the prison, with the aim of reducing the need for unnecessary ambulance attendance. Early findings were that during the inspection alone, 11 emergency calls had been managed without the need for further ambulance input, which was impressive. A substantial proportion of emergencies were related to psychoactive substances.

There was no overarching health promotion strategy or action plan, Health promotion literature was available in the health care centre and some other key areas, but was limited elsewhere.

Smoking cessation support, vaccinations, immunisations and health screening initiatives were provided, but there was no bowel screening.

An impressive radiology suite, staffed by a full-time radiographer, ensured good access to X-rays and ultrasound services.

There was good access to nursing staff, and a new daily wing- based nurse-led ‘see and treat’ clinic was considered to be a promising initiative.

The electronic appointments system was well managed. Prisoners could use their in-cell laptops to make appointments, and a peer-run health and well-being telephone service enabled prisoners to cancel and rearrange their appointments. However, non-attendance rates were very high, at 17.2%, but it was not clear why. Work was under way by the health and well-being peer mentors, facilitated by health staff, to reduce it.

The prison facilitated four external hospital appointments a day, in addition to any emergency escorts. Appointments were rarely cancelled due to lack of escorting staff. Health staff did not see all prisoners returning from an external hospital appointment, and so could miss ongoing treatment plans.

Health staff saw all prisoners being discharged from the prison. Prisoners were given a summary of their care, medication where relevant, information on how to register with community dental and GP services, health promotion leaflets and condoms.

In our survey, 46% of prisoners said they had a mental health problem, of who 34% said they were receiving help. Support for prisoners with mild to moderate mental health problems was good, with the provision of a wide variety of evidence-based therapies in group and one-to-one settings. A selection of self-help material for prisoners was also available.

At the time of inspection, 171 patients were receiving opiate substitutes, mostly on a maintenance basis, and all with a well-supervised controlled drug administration. Treatment was individual, regularly reviewed and well integrated. There was very good joint working with the wider health care team, and a dual-diagnosis nurse (substance use and mental health) supported patients.

The substance use service was embedded in the wider prison and worked closely with offender managers, resettlement and the security team, and was involved in ACCT reviews. Custody staff had received substance use training during induction and knew how to refer prisoners. The service had good links with local community services, and worked jointly to ensure treatment continuation for prisoners after their discharge. On release and where indicated, prisoners were given naloxone to treat opiate overdose.

Pharmacy provision was well developed and well managed. The in-house pharmacy ensured that patients received medicines promptly. Pharmacy technicians administered medicines alongside nurses on weekdays. Pharmacists clinically screened prescriptions and monitored prescribing, but did not hold medicines use reviews with patients. Patients could also make an application to speak to a pharmacist. Pharmacy policies were in place and followed, although some staff had not signed training records for the pharmacy’s standard operating procedures.

Around 80% of patients received their medicines in possession, but there was no facility for administering medicines after 7pm. As a result, night time medicines were always supplied in possession. All prisoners could store their medicines in lockable cupboards.

The quality of dental care was good but waiting times for routine care were excessive, at 42 weeks during the time of the inspection. This was partially attributed to the dental practice not being fit for use initially, as well as difficulty in recruiting dental staff. Urgent dental care was managed well, but with 440 prisoners (a third of the population) waiting for a routine appointment, and often affecting dental outcomes.

Recommendations: Health, Well-Being and Social Care:

  • There should be a prison-wide strategy to support health promotion.
  • Health staff should always see prisoners returning from external hospital appointments to
    establish any treatment and support needs.
  • The prison should ensure that suitable occupational therapy equipment and adaptations are provided and installed promptly.
  • The substance use services should have the necessary rooms to deliver therapeutic treatment.
  • There should be a formal and robust procedure to follow up patients who miss medicine doses.
  • Pharmacists should carry out medicines use reviews with patients.
  • Prisoners should have access to dental treatment within community-equivalent waiting times.

Good Practice: Health, Well-Being and Social Care:

  • The presence of a member of the pharmacy team in reception enabled prompt medicines reconciliation and easy access to medicines information for new arrivals.

Links/Resources:

Full Report Here – HMP Berwyn

HMIP Report: HMP Brixton, Mar 2019 – Health Summary

This report was on an unannounced inspection of HMP Brixton between 04–15 March 2019, and was published in July 2019.

General Points of Note

Inspectors were told that in the space of two years, staff sickness levels had dropped from 25% to 4.6%.

There have been no self inflicted deaths since the last inspection (January 2017).

The prison was fully staffed. Sixty-three per cent of staff were within their first 12 months in post.

Of those prisoners surveyed, they rated the overall quality of health services as either very good (16%) or quite good (42%). 17% had been on an ACCT during their time in Brixton.

Healthy Prison Outcomes:

  • Safety = 3 (1)*
  • Respect = 3 (2)*
  • Purposeful Activity = 2 (1)*
  • Rehabilitation and Release Planning = 3 (2)*

Note: *(Previous inspection outcomes from Jan 2017 are stated in brackets)

Key:

  • 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:

Feedback about patients’ experiences of services was actively encouraged. The Head of Healthcare organised wing-based forums where prisoners were able to challenge the way services were delivered.

Clinical and managerial leadership arrangements were robust and inspectors saw evidence of senior staff spending time on the wings to observe and interact with prisoners. Nurses worked from 7.30am to 6.30pm Monday to Friday and 8.30am to 6pm at the weekend. The health care department relied on agency cover, but outcomes for patients were deeded to have not been significantly affected. Many Of the vacant posts had now been filled.

Training, and professional development opportunities were generally good, and although staff reported that they received good support. Management and clinical supervision arrangements were not sufficiently embedded, particularly in the primary care team.

The health care centre and main waiting area needed redecorating and refurbishment. Wing treatment areas were also run-down and hard to keep clean; they did not comply with infection prevention standards.

Prisoners could make written applications for a health care appointment or directly approach staff with their health concerns. Wing-based nurses and pharmacy-led triage clinics provided patients with timely access to health care support.

Non-attendance rates were low and inspectors saw senior staff undertaking outreach to prisoners who failed to attend appointments. Prisoners were not systematically advised of appointment slots until the day of the appointment and they were sometimes unsure about why some follow-up appointments had been made. We observed clinically effective and positive interactions with prisoners when they attended the health care centre.

Access to routine external hospital appointments was good and there was little evidence of any curtailments due to prison demands. An excellent pre-release clinic ensured patients with ongoing needs received effective support, and all prisoners were offered a physical health check regardless of whether they had accessed health care during their stay.

Inspectors noted the high demand for MH services with over 130 referrals a month through an integrated and responsive approach to care.

The Mental Health provider had a caseload of about 125, and 34 prisoners experiencing enduring and severe mental health problems were managed under the care programme approach (CPA – mental health services for individuals diagnosed with a mental illness).

Relationships with the prison were noted as being positive and most prison staff had undertaken mental health awareness training.

The prison had developed a more strategic approach to reducing the drug supply and demand, but there was still a lack of joined-up working to support prisoners testing positive under mandatory drug testing or suspected of psychoactive drug use.

The Substance Misuse provider delivered psychosocial interventions to 277 clients (37% of the population). The service was well advertised on the wings, and a peer supporter offered induction input.

A substance misuse consultant psychiatrist also provided specialist input and held clinics for those with complex needs, including pain management issues.

Medicines requiring refrigeration were stored in medical fridges and monitored daily, although records showed maximum temperatures exceeded 8°C in several locations without prompting remedial action.

There were several helpful pharmacy-led clinics on the wings, including those for minor ailments, substance use support and smoking cessation. The waiting list for smoking cessation support was deemed as being too long, which is curious given a prisoners progression to Cat C status through a Smoke Free prison estate approximately 2 years post-Smoke Free implementation.

Medicines were administered twice a day, and night-time doses were provided in-possession during afternoon administration once the prisoner had been risk assessed.

Recommendations: Health, Well-Being and Social Care:

  • Treatment rooms should comply with infection prevention and control standards.
  • Support for prisoners should include timely access to sexual health advice and smoking cessation support.
  • Prisoners should have timely access to all primary care and screening services.
  • A memorandum of understanding between the prison and local authority should determine a pathway from assessment to the delivery of personal care.
  • Training on overdose management and access to naloxone on release should be provided.
  • Medication administration should be consistently and adequately supervised by prison staff, to ensure privacy and compliance, and reduce the risk of bullying and diversion. (repeated recommendation)
  • The essential repairs to the washer disinfector should be carried out expeditiously.

Good Practice: Health, Well-Being and Social Care:

  • The health and well-being model delivered an integrated and responsive approach to care, which provided effective support to over 130 prisoners a month.
  • Pharmacy clinics on the wings gave prisoners access to a flexible range of prompt and effective treatments.

CQC Requirement Notices Issued:

  • None.

Links/Resources:

Full Report Here – HMP Brixton

HMIP Report – Health Summary: HMP & YOI New Hall, Feb-Mar 2019

This report was on an unannounced inspection of HMP & YOI New Hall between 25 February to 08 March 2019, and was published in June 2019.

General Points of Note.

48% of prisoners were reported to have committed their offence to support the drug use of someone else.

Of those using the counselling service, 53% of prisoners said they had suffered domestic violence and 44% said they had been raped.

78% of prisoners disclosed they had a mental health problem, and 71% of the population were receiving services from the substance use psychosocial team.

There had been 3 self-inflicted deaths since the last inspection in June 2015.

There had been 359 incidents of self-harm in the six months prior to the inspection. This figure was higher than at the previous inspection but lower than in other women’s prisons. On average, the data identified four prisoners each month as prolific self- harmers, carrying out five or more incidents. In the six-month period before the inspection, prisoners who often self-harmed accounted for 46% of all self-harm incidents.

There had been 419 ACCTs opened in the six months before the inspection. This was higher than the time of the last inspection and comparable with other women’s prisons. A new ACCT case management system had been introduced and all those subject to the process now had a named case manager in their residential unit. The majority of care maps included targets and specific action, although too many daily entries were purely observational and lacked any detail of staff interactions.

Healthy Prison Outcomes:

  • Safety = 4 (4)*
  • Respect = 3 (4)*
  • Purposeful Activity = 3 (4)*
  • Rehabilitation and Release Planning = 4 (3)*

Note: *(Previous inspection outcomes from June 2015 are stated in brackets)
Key:

  • 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:

Many aspects of health care remained good, but significant staff vacancies in the mental health team had had a negative impact on the delivery of mental health services.

The confidential health complaints process was well promoted. Concerns were usually resolved in person, while complex complaints were escalated to managers for investigation. Responses we reviewed were generally prompt, although the outcome and action taken were not recorded consistently enough.

Monthly patient forums, together with an analysis of patient satisfaction surveys, had led to some service improvements. However, some issues had been raised repeatedly without being properly resolved.

Effective joint working was demonstrated through a range of meetings, including weekly complex case reviews and a daily handover attended by representatives from all teams identified any clinical concerns.

Clinical and managerial supervision was not provided or taken up consistently across the teams. Mandatory training was well managed and there were excellent professional development opportunities, particularly in the primary care team.

The waiting area in the health centre had been extended and it was now bright and welcoming. The lack of free-flow movement, meant that patients waited too long before and after appointments, which discouraged prisoners from attending.

Work was in progress to reduce the high non-attendance rate. Delays in prisoners receiving appointment slips had resulted in missed appointments, although a new initiative was being trialled – it involved the health care representative delivering appointment slips in sealed envelopes.

The waiting time for a routine GP appointment was over three weeks, which was too long. Urgent on-the-day appointments were prioritised by clinical need.

78% of prisoners reported having a mental health problem and 44% stated that they had received help for it while in the prison.

The MH service had deteriorated since the previous inspection, and was compounded by significant staffing shortages – five of nine clinical roles were vacant. It had also experienced a high staff turnover in recent months. The service used regular agency workers to cover some staffing gaps.

Prisoners with mild to moderate mental health issues did not have access to community equivalent, planned ongoing treatment or psychological interventions. Prisoners with more serious mental health problems received a better level of support – there was evidence of some helpful one-to-one work, informed by personal care plans and risk assessments.

In the 12 months prior to the inspection, more than 90% of prison officers had received trauma-informed training (to enable them to consider the trauma prisoners may have experienced in their lives).

The Drug & Alcohol Recovery Team (DART) was supporting 282 prisoners (about 71% of the population) during the inspection and about 170 (43% of the population) were receiving opiate substitution therapy,

The CQC issued one Requirement Notice against Regulation Standards.

Recommendations: Health, Well-Being and Social Care:

  • All health care staff should receive regular clinical and managerial supervision.
  • The non-attendance rates for all clinics should continue to be investigated and reduced,
    including a review of the applications process to see if this is hindering attendance.
  • Immunisations and vaccinations should be available to eligible prisoners in line with national programmes. They should be implemented promptly to promote prisoners’ health.
  • Routine waiting times to see the GP should be reduced and should not exceed two weeks.
  • The out of hours’ medicines cupboard and drug refrigerators should be robustly monitored to ensure medication is appropriately and safely stored.
  • The prison should ensure the process for transporting dental tools across the prison is safe.
  • Transfers under the Mental Health Act should occur within current Department of Health transfer time guidelines.

Good Practice: Health, Well-Being and Social Care:

  • None identified/reported.

CQC Requirement Notices Issued:

  • Regulation 9. Person-Centred care. Prisoners requiring mental health support did not always receive person centred care that was appropriate, met their needs and reflected their preferences.

Links/Resources:

Full Report Here – HMP & YOI New Hall