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)
- 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: