This report was on an unannounced inspection of HMP/YOI location between 18–28 February 2019, and was published 25 June 2019.
General Points of Note.
47 incidents of self-harm reported in the last six months involving 37 children, which was similar to the last inspection and to comparable prisons. No children had required hospital treatment following self-harm. During the same period, 73 ACCT documents had been opened, similar to the previous inspection.
Two children had been on constant supervision in the last six months. One of these children had been kept overnight in anti-ligature clothing without justification, which was deemed by inspectors as being not acceptable.
Although the prison was reported as being fully staffed, approx 40% of frontline staff had less than a year’s experience.
Healthy Prison Outcomes:
- Safety = 2 (3)*
- Care = 3 (4)*
- Purposeful Activity = 3 (3)*
- Rehabilitation and Release Planning = 3 (4)*
Note: *(Previous inspection outcomes from Jan 2018 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:
Working relationships between the commissioner, providers and establishment were good. Regular, reasonably well-attended joint governance and business meetings addressed essential areas, although there had been no recent minuted local delivery board meetings.
The processes for children to feed back on health concerns were effective. Since April 2018, there had been 40 compliments, 40 comments and only two complaints. The responses to written complaints were courteous and timely and provided an apology where necessary. There was evidence that concerns were acted on.
Clinicians, led by an experienced nurse, delivered responsive, child-focused care. Staffing levels were stable with few vacancies. Student nurses supplemented the team, and regular bank workers were used as required. The skills mix in the primary care team was appropriate to the patients’ needs, and staff training was noted as being very good.
Managerial supervision arrangements were in place and staff generally felt supported. Clinical group supervision had recently been implemented with the first session taking place in January 2019, and a plan for this to take place every six weeks. Annual appraisals were completed with all staff.
The small modern health care unit resembled a community practice. It was well maintained, meticulously clean, and complied with infection control standards. Wing health rooms were no longer used as surgeries, but mental health and substance misuse staff saw children in these rooms and other rooms on the wings. There was 24-hour nursing cover and emergency equipment was impeccably organised and maintained, with a clear checking process.
Access to the health centre and therapy sessions was seriously impeded by inefficient escort arrangements and only 41% said it was easy to see a doctor. Inspector witnessed a GP waiting 40 minutes for a patient to arrive, which was reported as a common occurrence. Inspectors also observed grossly inefficient medicine administration sessions where nurses waited for more than three hours to administer medicines to a list of a mere 17 patients, not all of whom arrived.
There was an appropriate range of primary care services and an effective appointments system. Waiting lists for routine GP appointments were short and appointments were triaged and prioritised appropriately. Daily nurse triage clinics were held for children to see a nurse.
About 70 patients were in treatment For Mental Health services at any time and benefited from individual psychological interventions, creative therapy and guided self-help materials. Treatment for harmful sexual behaviour was now available and some patients had been assessed and were moving to the treatment phase. Group therapies were temporarily unavailable because of staffing levels. Attendance for treatment was hampered by the use of keep-apart protocols to escort patients to their appointments
Only 14 operational staff had completed training modules on mental health awareness. We were not confident that officers knew when to refer a child to Inclusion.
Care UK had competent clinicians ready to deliver opiate substitution therapy and symptomatic relief, but none had been needed for several years. Inclusion drug recovery workers received regular training and supervision and provided age-appropriate psychosocial interventions to patients.
Some children had been abusing cannabis and alcohol in the community and about 50 at a time were in contact with Inclusion. Care plans and notes on SystmOne were of the highest standard.
There was no oversight by a professional pharmacist, but Care UK had consulted Lloyds and were reported to be considering developments. The lead GP and lead nurse undertook medicine reviews with nursing colleagues.
There was no medicines and therapeutics committee, but governance was assured through Care UK local operating policies and surveillance of prescribing trends by the lead nurse and GP via the regular quality assurance meetings.
There had been good initial uptake of Socrates (telephone application to aid medical care), but use in the community was disappointing. Care UK was considering how to make the system more attractive to patients.
There were no Requirement Notice against Regulation Standards issued by the CQC.
Recommendations: Health, Well-Being and Social Care:
- Patients should be enabled to receive their health care services at the appointed times and should not be held in transit for excessive periods.
- The prison should develop a memorandum of understanding with the local authority and social care provider to ensure that arrangements are in place should a child require social care while at HMYOI Werrington.
- The transfer of patients to community mental health services under the Mental Health Act should occur within the national guideline timescale.
Good Practice: Health, Well-Being and Social Care:
- The prompt enhancement of emergency equipment as a result of learning from experience led to a safer service.
CQC Requirement Notices Issued: