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
- 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: