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
- 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.