HMIP Health Notes: HMP Pentonville, Apr 2019

This report was on an unannounced inspection of HMP Pentonville between 01–12 April 2019, and was published in August 2019.

“Pentonville epitomises the challenges confronting ageing, inner-city prisons with transient populations, many with heightened levels of need and risk.”

General Points of Interest:

Use of force had been applied 419 times in the 6 month period prior to the inspection.

At the time of this inspection, 25% of the population were receiving psychosocial support for substance misuse needs.

During this same period, the positive MDT rate was 29% for those prisoners tested.

Since the last inspection in 2017, there had been 4 self-inflicted deaths, and another from natural causes.

There had been 316 incidents of self-harm in the previous 6 months, similar to comparator prisons. Constant supervision had been used 17 times.

Over the same period, 400 prisoners had been subject to ACCT processes. 30 of all ACCT documents were opened in reception.

Healthy Prison Outcomes:

2017 2019
Safety 1 1
Respect 2 2
Purposeful Activity 2 2
Rehabilitation & Release Planning 3 2

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

Healthcare managers provided strong leadership to a dedicated professional team who told inspectors that they felt well supported.

Staffing levels and retention had improved, with limited reliance on bank and agency staff. Staff received regular managerial and clinical supervision, and compliance with mandatory training was good. Staff were also supported in developing advanced clinical skills.

The introduction of a dedicated prison governor, custodial manager and prison officers into health care had improved communications and facilitated better access for patients. Patients no longer had to wait in health care for a long period after their appointments and waiting lists were shorter.

The DNA rate for the GP clinic had improved at 10% but remained too high for other clinics, for example dentist 31.8% and optician 35.8%. However, there were plans to deliver more treatment on wings from May 2019 to address this.

There was no overarching health promotion strategy or action plan. Health promotion literature was available in the health centre but limited elsewhere, which was a missed opportunity to encourage well-being.

Working relationships between prison and mental health staff were mature. The majority (97%) of recently appointed prison officers had received some training in mental health awareness, which was viewed by inspectors as being commendable.

There was an open MH referral system, daily well-being team meetings and prompt assessment via the Health and Wellbeing Model. Prisoners in the red zone were seen within one working day and those in the green within 5 days, which was efficient.

The impressive well-being centre continued to deliver an additional level of primary mental health care, supporting vulnerable prisoners through structured and consistent daytime therapies. All eligible prisoners could now use this service, from which 20 prisoners benefited each day.

Patients had complex emotional and mental health needs. About 220 (20%) patients at a time were on the caseload for primary mental health care and 60 (5%) for secondary mental health care. About one in nine prisoners (146) were on anti-psychotic medication which, although less than in 2017, was very high.

At the time of the inspection, 116 patients were receiving methadone or buprenorphine (opiate substitutes), with 54 appropriately on reducing doses. Prescribing was flexible and based on national clinical guidance.

At the time of the inspection, 31% of patients had their medicines in possession. Cells still lacked lockable facilities for storing medicines, but random checks of 10 cells a month had been introduced, which was a noted improvement on 2017.

As part of the survey, 30% of prisoners rated the overall quality of the health services as being either very good or quite good.

Recommendations: Health, Well-Being and Social Care:

  • The prison health care local delivery board should ensure that assertive action is taken to enable access to health care, safe storage of in-possession medicines, and a prison-wide strategy for health and well-being.
  • Governance procedures should be strengthened significantly to ensure safe and appropriate social care provision.
  • Patients requiring care in external mental health services should be transferred expeditiously.
  • Maximum and minimum temperatures should be recorded daily for refrigerators where medicines are stored and documented corrective action should be taken when temperatures fall outside the 2–8 degrees centigrade range.

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

  • The dedicated team of prison staff in health care had improved efficiency and the patient experience.
  • The well-being centre supported vulnerable prisoners with a structured therapeutic regime and enabled positive outcomes for those with both primary and secondary mental health needs.
  • The enhanced support service team offered valued guidance and support.

CQC Requirement Notices Issued:

  • None

Links/Resources:

Full Report Here – HMP Pentonville

World Suicide Prevention Day – Resources for Custodial Settings

On 10th September, the International Association for Suicide Prevention (IASP) collaborates with the World Health Organization (WHO) and the World Federation for Mental Health (WFMH) to host the World Suicide Prevention Day.

World Suicide Prevention Day (WSPD) is an awareness day observed on 10 September every year, in order to provide worldwide commitment and action to prevent suicides. Various activities have been taking place around the world since 2003.

The timing seems only appropriate that we consider the guidelines published in September 2018, when the National Institute for Health and Care Excellence (NICE) produced the guidance Preventing Suicide In Community and Custodial Settings.

Of the many organisations for which this guidance was intended, none are more relevant than those of us working in:

  • Prisons (both public and contracted out),
  • Children and young people’s secure estate,
  • Immigration Removal Centres (IRCs), and
  • Probation and Community Rehabilitation Services

High Suicide Risk

NICE determine that “High Suicide Risk” means that the rate of suicide in a group or setting is higher than the expected rate based on the general population (in England). Groups at high risk can include: young and middle-aged men, people who self-harm, people in care of mental health services, family and friends of those who have died by suicide, people who misuse drugs or alcohol, people with a physical illness, particularly older adults, people in the LGBT community, people with autism, people in contact with the criminal justice system, particularly those in prisons, people in detention settings, including immigration detention settings, and specific occupation groups.

Recommendations for Custodial and Detention Settings

There are 10 main recommendations, and listed below are those points within each of those recommendations that I view as being more specific to custodial environments:

Suicide Prevention Partnerships

Set up a multi-agency partnership for suicide prevention in residential custodial and detention settings. This could consist of a core group and a wider network of representatives. Ensure the partnership has:

  • clear leadership
  • clear terms of reference, based on a shared understanding that suicide can be prevented
  • clear governance and accountability structures

…and then include representatives from the following in the partnership’s core group:

  • governors or directors in residential custodial and detention settings
  • healthcare staff in residential custodial and detention settings
  • staff in residential custodial and detention settings
  • pastoral support services
  • voluntary and other third-sector organisations
  • escort custody services
  • liaison and diversion services
  • emergency services
  • offender management and resettlement services
  • people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicidal bereavement, to be selected according to local protocols

Suicide Prevention Strategies

Identify and manage risk factors and behaviours that make suicide more likely.

Consider collaborating with neighbouring residential custodial and detention organisations to deliver a single strategy.

Suicide Prevention Action Plans

Alongiside developing and implementing a plan for suicide prevention and for after a suspected suicide set out how to:

  • Work with the Prison and Probation Ombudsman and coroners to ensure recommendations from investigations and inquests are implemented
  • Implement recommendations from internal investigations of instances of self-harm
  • Assess suicide and self-harm prevention procedures (for example, HM Prison and Probation Service’s Assessment Care in Custody and Teamwork and Assessment care-planning system, and the Home Office’s Assessment Care in Detention and Teamwork case management systems)
  • Interpret and act on those findings
  • Ensure systems for identifying risk, information sharing and multidisciplinary working put the emphasis on ‘early days’ and transitions between estates or into the community
  • Monitor the impact of restricted regimes on suicide risk

Gathering and analysing suicide-related information

For residential custodial and detention settings, also collect data on:

  • sentencing or placement patterns
  • sentence type
  • offence
  • length of detention
  • transition periods (for example, ‘early days’ and transitions between estates or into the community)

Awareness raising by suicide prevention partnerships

For residential custodial and detention settings, also consider raising awareness of:

Reducing Access to Methods of Suicide

  • Provide safer cells
  • Reduce the opportunity by erecting physical barriers
  • providing information about how and where people can get help when they feel unable to cope
  • using CCTV or other surveillance to allow staff to monitor when someone may need help
  • increasing the number and visibility of staff, or times when staff are available

Training by Suicide Prevention Partnerships

Ensure training is available for:

  • those in contact with people or groups at high suicide risk
  • people working at locations where suicide is more likely
  • gatekeepers
  • people who provide peer support in residential custodial and detention settings
  • people leading suicide prevention partnerships
  • people supporting those bereaved by suicide

Supporting People Bereaved or Affected by a Suspected Suicide

Use rapid intelligence gathering and data from other sources, such as coroners to identify anyone who may be affected by a suspected suicide or may benefit from bereavement support. Those affected may include relatives, friends, classmates, colleagues, other prisoners or detainees, as well as first responders and other professionals who provided support.

Consider:

  • providing support from trained peers who have been bereaved or affected by a suicide or suspected suicide
  • whether any adjustments are needed to working patterns or the regime in residential custodial and detention settings

Preventing and Reponding to Suicide Clusters

After a suspected suicide in residential custodial and detention settings, undertake a serious incident review as soon as possible in partnership with the health providers. Identify how:

  • to improve the suicide prevention action plan
  • to help identify emerging clusters
  • others have responded to clusters

Develop a coordinated approach to reduce the risk of additional suicides.

Develop a standard procedure for reducing – or ‘stepping down’ – responses to any suspected suicide cluster.

Provide ongoing support for those involved, including people directly bereaved or affected and those who are responding to the situation.

Reducing the potential harmful effects of media reporting of a suspected suicide

For residential custodial and detention settings, where a suspected suicide would be reported via the Ministry of Justice, ensure Ministry of Justice press officers follow good practice in suicide reporting.

Baseline Assessment Tool

Alongside these recommendations, NICE also provide a baseline assessment tool that can be used to evaluate whether practice is in line with the recommendations. This assessment tools can then also be used to plan activity to meet those recommendations.

Alongside those recommendations listed above, the tool can then be used to determine:

  • whether or not the recommendation is relevelant
  • current activity (evidenced accordingly)
  • whether or not the recommendation is met
  • actions needed to implement the recommendation
  • whether there are any associated risks with not implementing the recommendation
  • whether or not there is a cost or a saving
  • the deadline
  • the lead or person responsible

Conclusion

Preventing suicides in custodial environments isn’t something to be done on an annual basis. It is an ongoing commitment that is undertaken day in, day out. However, with the up and coming World Suicide Prevention Day on September 10th, I would encourage all those working within custodial environments to take full advantage on the resources on offer here.

Links/Resources

Baseline Assessment Tool

Resource Impact Statement

NICE Guidelines – Preventing Suicide In Custodial Settings

Photo by Dan Meyers on Unsplash

HMIP Report Health Notes: HMP Elmley, Apr-May 2019

This report was on an unannounced inspection of HMP Elmley between 29 April to 03 May 2019, and was published in August 2019.

General Points of Interest:

There had been 2 self-inflicted deaths since the previous inspection in 2015.

In the previous six months, there had been 131 assaults, including 42 on staff and 55 fights. One in five assaults had resulted in hospital treatment.

In the 6 months to the end of March 2019, 22% of the Mandatory Drug Tests (MDT) were positive against a target of 14.2%. Almost half of these positive indications were for psychoactive substances.

Healthy Prison Outcomes:

2015 2019
Safety 3 2
Respect 2 2
Purposeful Activity 2 2
Rehabilitation & Release Planning 2 2

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

  • The change in classification of the painkillers pregabalin and gabapentin to controlled drugs from April 2019 had led to a reduction in prescribing. Staffing in the primary care service had been revised and additional qualified nurses were needed to facilitate supervised medication following the changes in drug classification.
  • Prisoners held very negative views about health care, particularly about access and the medication they were prescribed (see as above).
  • The previously high failure-to-attend appointments rate was reducing with the recent allocation of an officer to the outpatients’ department who followed up those who did not attend.
  • GP cover was good with attendance every day. A GP completed daily inpatient and segregation rounds as well as being present for reception screening. Waiting time for a routine GP appointment was around two weeks, and urgent on-the-day slots were available.
  • There was an active multi-disciplinary approach to the management of pain, which was positive. Provision included a GP who specialised in pain management and an increase in physiotherapy sessions. A senior nurse and a prescribing pharmacist reviewed patients on medication to treat neuropathic pain to actively reduce and support those who no longer needed it clinically, and provided appropriate pain relief and care.
  • There was a range of primary care services with mostly adequate waiting times, although the 3 week waiting time for nurse triage appointments was deemed as being too long.
  • The inpatient unit continued to be a calm, well-run environment with a flexible level of therapeutic support. Admission was based on clinical need and was used for patients with physical, mental health and substance use needs. Effective care plans were in place.
  • Too many external appointments were rescheduled due to various reasons but mostly prison operational issues, including lack of officer escorts. Patients with the most urgent needs were clinically prioritised, resulting in some patients with lower-level needs could have their assessments or treatment delayed by several months owing to multiple cancellations.
  • The Mental Health team received about 250 referrals a month. Urgent referrals and those that came through reception were seen within 24 hours, and more routine assessments were usually carried out within 7 days. The caseload at the time of the inspection was 130 patients.
  • Following patient feedback there was now a monthly mental health drop-in session on each house block; this was proving positive and had raised the visibility of the team.
  • There had been 10 transfers to secure mental health units under the Mental Health Act in the 6 months since November 2018. The 14-day transfer guideline was exceeded in 2 cases by a few weeks. However, despite active work by the transfer coordinator, one patient had been waiting for a bed for 19 weeks, which was excessive and due to a lack of beds in what would be his local area.
  • At the time of the inspection, 438 prisoners (40% of the population) currently engaged with the substance misuse service. 140 patients were prescribed opiate substitutes, mostly on a maintenance basis. New arrivals identified as having substance misuse needs were seen the following day.
  • Although most of the 170 spaces on house block 3 were designated as the drug support unit, one-third of prisoners were located there for other reasons, which undermined the ethos of the unit.
  • Psychoactive substance use remained an issue, with 31 medical call-outs recorded in the previous 6 months.
  • Prisoners could request to see a pharmacist, and this was becoming more frequent. The pharmacist on site was an independent prescriber and had been involved in supporting and managing the challenges brought about by the recent reclassification of pregabalin and gabapentin. Since the re-classification, 49 patients on pregabalin and 67 on gabapentin had been reviewed and an alternative had been sought.
  • Of those prescribed medication, around 60% were issued as in-possession.
  • As part of the survey, 29% of prisoners rated the overall quality of the health services as being either very good or quite good.

Recommendations: Health, Well-Being and Social Care:

  • Prisoners should be able to access internal and external health appointments promptly and within community-equivalent waiting times.
  • The transfer of patients to hospital under the Mental Health Act should take place within agreed Department of Health timescales.
  • The prison should work in partnership with substance misuse service providers and consult with service users to develop a more structured environment on the drug treatment unit that supports an ethos of recovery and well-being.
  • Prison officers should consistently monitor and manage medication administration queues to reduce the opportunities for bullying and diversion, and to maintain patient confidentiality at the hatch.

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

  • None identified/reported.

Links/Resources:

Full Report Here – HMP Elmley

Health Notes from IMB Reports – August 2019 (Pt.1)

The IMB reports published during the early part of August 2019 were from these establishments:

  • HMP Swaleside
  • HMP Maidstone
  • HMP Isle of Wight
  • HMP Send
  • HMP Nottingham
  • HMP Littlehey
  • HMP Lowdham Grange

IMB evidence comes from observations made on rota visits, scrutiny of records and data, attendance at various meetings, informal contact with staff and prisoners, prisoners’ applications and monitoring of areas of concern.

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

IMB Report – HMP Swaleside

Reporting period – 01 May 2018 to 30 Apr 2019.

  • There were 247 prisoner on prisoner assaults (220 in the previous year) and 182 assaults on staff (133 in the previous year). 14 Of these staff assaults were recorded as being serious. These rises are attributed to be as a result of better recording.
  • During the reporting year there have been 6 deaths in custody, 5 of which are thought to be from natural causes, and only one thought to be self-inflicted.
  • A more comprehensive system of recording ACCTs was introduced during the year, so the IMB have no comparative figures to set against last year. There is confidence that the system is now more robust and accurate and will allow interrogation on many different levels.
  • Waiting times for dental, optical and podiatry care are commensurate with those in the community, if not better. Healthcare has received no complaints in this regard for at least 6 months.
  • The installation of a brand new X-Ray machine is a welcome facility which should assist in cutting waiting time and also reducing the number of outside hospital appointments.
  • Cancelled NHS appointments due to lack of escort remains a concern. Of the 1872 appointments in total, 1026 were cancelled, and of these 576 appointments cancelled by the prison. Prison staffing profiles allow for 6 accompanied external visits per day, however the demand exceeds supply. Cancer patients are still prioritised but the consequences often mean other residents having to be put back on to a hospital waiting list.
  • The Life Limiting Illnesses Committee meets fortnightly since its inception in January 2018. The group identifies and plans how to manage life limiting illnesses and how to prepare for the death in custody of residents from natural causes. The purpose of this is so that due respect can be given to the dignity of residents in these circumstances.
  • Swaleside Outreach Service (SOS) started in August 2018 and is a partnership between HMPPS and Oxleas NHS. It is a multi-disciplinary team consisting of operational staff, psychologists and a mental health practitioner who work closely with men who are identified for the service. The aim is to help residents whose behaviour in prison is considered to be challenging, violent and disruptive, to better manage themselves and reduce their use of violence and disruptive behaviour. The caseload is currently 21. Needs of the individuals are assessed and individual management plans to help encourage them to develop their strengths and help them progress through their sentence. The team work closely with Violence Reduction and give regular and structured support to Wing staff to help manage these men who exhibit challenging behaviour. Although in its very early days the IMB consider that SOS has made a very positive contribution to helping Swaleside deal with its most difficult individuals. On this basis, the IMB strongly commend this initiative.
  • Healthcare applications to the IMB decreased to 111 from 130 when compared to the previous reporting year.

Full IMB Report – HMP Swaleside


IMB Report – HMP Maidstone

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • The routine waiting list for dentistry was 54 at the time the report was written. The pressures on the services remain, with significant dental needs as prisoners so often wish to address their dental problems before deportation or repatriation.
  • The waiting time to see a GP at 7 days at the time of writing.
  • The smoking ban has been successful, however, the nicotine replacement service has highlighted concerns that nicotine patches are being used as ‘currency’. Greater scrutiny around used and intact NRT is being applied and non-compliance results in the prisoner being withdrawn from the service and a warning issued.
  • Prisoners are now seen twice on arrival. The initial screen is performed in Reception by a senior healthcare nurse who will assess if the prisoner is considered ‘safe’ for the next 72 hours and will also include a prescription screen. The prisoner is then booked in for a secondary screen where more information is gathered and, anticipating that the do not attend (DNA) rate will reduce, appointments are entered onto the prison database.
  • Coinciding with national campaigns every month, facilitated by the discharge facility nurse, a new health topic will be covered: prostate cancer, bowel cancer, diabetes, mental health etc. Feedback from prisoners is positive. The media channel is also being used to promote health.
  • The healthcare complaints procedure was not being used and prisoner complaints were processed through the general complaints system and lacked confidentiality. The IMB was pleased to see that this is now being addressed and complaint forms are being placed with the healthcare application form so that the prisoners have access to them on each wing.
  • Healthcare applications to the IMB increased to 34 from 21 when compared to the previous reporting year.

Full IMB Report – HMP Maidstone


IMB Report – HMP Isle Of Wight (IOW)

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • Following the decommissioning of Albany in 2013, HMP IOW is a merger of both the remaining HMP’s Albany and Parkhurst.
  • The average age of the population is now over 50 years, which accounts for over 50% of the population (compared to 43% in 2017).
  • Assaults have increased to 189 for 2018, when compared to 2016 where there were 101 recorded.
  • Self-Harm has seen a similar upward trajectory in going from 286 in 2016 to 656 in 2018.
  • There were 9 Deaths In Custody (DIC’s) during 2018, of which 7 were of natural causes and 2 were suspected as being self-inflicted.
  • The prison Healthcare was described as “a well-run and well led organisation which provides a standard of care at least equal to that provided for the general public.” It also notes “The manager changed mid-year and the new incumbent has continued to maintain the same high standard, ensuring the staff remain positive and well-motivated.”
  • Patient satisfaction is high with survey responses usually about 94% for those who would recommend the service received.
  • Internal clinic appointments average out at 571.6 per week. External escorts average out at 31.8 appointments per week.
  • Taking October 2018 as a snapshot, there were 836 patients who were prescribed medication. Of these, 82% were prescribed as In-Possession.
  • The level of staffing continues to be a problem due to a national shortage of nurses – current service delivery requires bank staff and agency nurses. A situation that is all too common across the Health & Justice sector.
  • HMP IOW is the first prison to offer Choice Point acceptance and commitment therapy which is appropriate for people with personality disorders.
  • Healthcare applications to the IMB decreased to 33 from 42 when compared to the previous reporting year.

Full IMB Report – HMP Isle of Wight


IMB Report – HMP Send

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • HMP Send is a closed prison for adult women. It has an operational capacity of 282.
  • Reported self-harm incidents increased significantly to 452 during the reporting year from 268 in 2017, although only 8 of these required hospital treatment.
  • Dental provision is an area of going concern – the waiting list reached a high of 30 weeks in August. At the end of the reporting period it stood at 15 weeks for new patients and 33 weeks for treatment. Urgent cases are seen weekly.
  • The new easy-read applications and confidential complaints procedure was noted as working well.
  • Send is the first prison in the country to introduce the long overdue access to the NHS Spine.
  • Prisoners are training to become peer educators in Hepatitis C.
  • Overall, the Board acknowledged the continued focus on augmenting and improving on Send’s already excellent healthcare provision.
  • Healthcare applications to the IMB increased to 37 from 29 when compared to the previous reporting year.

Full IMB Report – HMP Send


IMB Report – HMP Nottingham

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • The normal Operational Capacity of HMP Nottingham is 1060 prisoners. The Certified Normal Accommodation (CNA) is 718. However, following the HMIP Urgent Notification efforts were made to reduce the roll. From November 2018 this was capped at 800.
  • Following the national launch of the Ten Prisons Project, HMP Nottingham was one of the designated prisons, with the aims included to reduce violence and drugs problems. As is always the case with any prison initiative, the IMB acknowledged it takes time to translate into evident change and it was not until near the end of the reporting period that more significant change began to impact on the establishment.
  • The number of recorded acts of self-harm reduced to 502 from 730 in the previous year, albeit with fewer prisoners in the establishment.
  • The number of ACCTs opened during the reporting year was 1499, an increase from 1452 the previous year; both prison and healthcare staff have struggled from time to time to meet the demand of managing this high number.
  • The number of assaults on staff was 244, an increase from 194 in the previous reporting year.
  • There were 5 deaths in custody during the reporting period. In one case, another prisoner is currently awaiting trial for murder.
  • The IMB welcomed the initiative to engage an academic member of staff from Nottingham Trent University to evaluate trends in acts of self-harm and related safety issues. Positive steps following the cluster of deaths in custody which occurred during the autumn of 2017.
  • For 2018, 906 external hospital appointments were booked but only 651 attended, with 250 cancelled; 103 were cancelled because there was no available escort, either because of prison staffing problems or because an emergency took priority.
  • A recent HMIP survey showed that 52% of prisoners said they had a mental health problem. Prisoners’ needs are identified and the IMB were advised that the threshold for being accepted onto the caseload is substantially lower than that applied in the community.
  • At the beginning of 2019 the healthcare service commissioned a Wellbeing Unit, based on the principles of the recovery model. This initiative promotes control and opportunity, with peer support workers playing a significant role in each other’s recovery journey.
  • Over the year there had been 14 transfers to hospital under the Mental Health Act 1983. There is still an over-long delay in some men waiting for transfers, with one case waiting for over eight weeks.
  • Healthcare applications to the IMB increased to 68 from 66 when compared to the previous reporting year.

Full IMB Report – HMP Nottingham


IMB Report – HMP Littlehey

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • The IMB were concerned to note that the number of ACCT documents opened during the reporting year has increased significantly (324 this reporting year compared to 256 the previous year). Incidents of self-harm had also increased to 557 incidents, when compared to 331 the previous year). It was also noted that a large number of those self-harm incidents were concentrated in the 26–30 year age group, and furthermore attributed to a small number of prisoners.
  • The age profile explains the higher than average number of deaths due to natural causes at Littlehey. There were 8 deaths in custody in the reporting year (9 last reporting year) with 7 due to natural causes and one that is still under investigation.
  • Maintenance issues continue to be a cause for concern, which then places the health of prisoners at risk. The HMPPS appointed contractor failed to clean to NHS standards as it was not written into the contract resulting in poor infection control.
  • The Prison and healthcare agreement allows for ‘only’ 4 prisoners in the morning and 4 prisoners in the afternoon to attend hospital appointments each day. If there are emergencies, then this limit can be increased. The IMB raised concerns around the limit imposed and the impact this has on provision of suitable healthcare to prisoners requiring treatment at external hospitals.
  • An average of 194 appointments (excluding emergency admissions) are booked each month, more or less at the limit of what is allowed by the staffing detail. Of these each month, an average of 10 will be cancelled due to staff shortages, and a further 15 will be cancelled to accommodate more urgent appointments. Essentially 25 appointments per month are cancelled due to the inability to provide enough staff for escort duties. Inevitably the health care team have to make judgements regarding relative urgency of needs for each prisoner in these circumstances, and they report that they cannot allocate any appointments to prisoners with non-urgent treatment needs.
  • There are 6,000–7,000 appointments for internal health care services each month. An average of 7.7% of these appointments are not attended.
  • The IMB were disappointed that some prisoners whose mental health issues cause trouble in normal accommodation are moved to CSU as the only place they can be safely managed whilst local treatment takes effect until they can be returned to normal accommodation.
  • Healthcare applications to the IMB remained unchanged at 23 when compared to the previous reporting year.

Full IMB Report – HMP Littlehey


IMB Report – HMP Lowdham Grange

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • The Prisoner Advice Line, operated by prisoners, provides a wide-ranging service to the prisoners in Lowdham Grange and is recognised for its support especially to newly arrived prisoners. During 2018 they handled 7,413 enquiries, and interestingly, over 50% of which were support for prisoners asking about the progress of their ‘Bag & Tag’ orders.
  • Prisoners are regularly segregated while on an ACCT and the recent HMIP report noted that ACCT segregation documentation does not indicate the exceptional reasons for this or the consideration of alternatives to accommodation in the RIU. HMIP also noted that during the first 6 months of the IMB reporting period 41 prisoners had been segregated while on an ACCT, at an average of 7 prisoners per month.
  • There were 4 deaths in custody at Lowdham Grange during this reporting period.
  • The IMB notes that the healthcare accommodation remains unfit for purpose as reported in the 2017–8 Annual Report when it was hoped funding for an extension would be found. No funds have been made available and the observation is that the improvements that have been made are only cosmetic.
  • This is an ongoing substance misuse issue in the prison, however the problem has been the subject of an innovative co-operation between NHS and Prison managers which has resulted in the creation of a ‘Drug Recovery Wing’ which opened in early 2019.
  • The IMB notes that the provision of escorts for external hospital appointments and bed watches remains a challenge for both Healthcare and Prison management. The IMB acknowledges the strain placed on the staffing detail of the prison and means that the decisions made by healthcare professionals to seek hospital investigations or treatment have to be prioritised more critically than in a community setting.
  • A recent one-off pilot of bringing scanning facilities into the prison on a sessional basis to facilitate diagnoses proved to be cost-effective and Commissioners have requested further work to be done to assess the feasibility of developing such services more routinely.
  • Healthcare applications to the IMB decreased to 24 from 35 when compared to the previous reporting year.

Full IMB Report – HMP Lowdham Grange


HMIP Report Health Notes: HMP Isle of Wight, Apr-May 2019

This report was on an unannounced inspection of HMP Isle of Wight between 15 April to 02 May 2019, and was published in August 2019.

General Points of Interest:

HMP Isle of Wight is spread across 2 separate sites, namely HMP Albany and HMP Parkhurst.

40% of the population were over 50 years old. 90% of the population are serving sentences of over 10 years.

The use of force had almost trebled from 40 incidents over a six-month period at the previous inspection to more than 110 at this inspection. This was higher than at other prisons holding prisoners convicted of sexual offences, although much of the force was low level.

Positive mandatory drug tests (MDT) had increased in the previous six months and stood at 5.2%. Whilst this figure is comparatively low by general standards, this was far higher than other designated prisons for sex offenders.

There had been 274 incidents of self-harm in the previous six months and 180 ACCT forms had been opened. There had been three self-inflicted deaths since the last inspection in 2015.

Healthy Prison Outcomes:

2015 2019
Safety 3 2
Respect 4 3
Purposeful Activity 3 3
Rehabilitation & Release Planning 2 2

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

As part of the survey, 63% of prisoners rated the overall quality of healthcare services as being very good or quite good.

Out-of-hours care was provided by clinical staff based in the inpatient unit on the Albany site and an on-call GP service.

Most services were delivered by the health centres in Albany and Parkhurst, and outreach to the wings was provided when appropriate. The centres were bright and welcoming and supervised by prison officers. However, fixtures and fittings in rooms on both sites were not fully compliant with infection control standards.

Clinical and managerial supervision was being delivered and recorded and annual appraisals were in date. Mandatory training compliance was excellent.

Health care complaints averaged 10 a month and were addressed and managed appropriately with good oversight of themes. Responses were timely and contained information on how to escalate the complaint.

Patients with long-term conditions were managed using the community GP Quality and Outcomes Framework (QOF) to ensure that their conditions were reviewed as necessary and that they had appropriate care plans.

More than 200 discipline staff (about 45%) had received mental health awareness training and appropriate referrals were made to the mental health team.

The mental health team received approx 80 referrals a month, and these are triaged within 24 hours and allocated appropriately using a stepped approach. This ensures timely assessments and case management and no waiting list.

At the time of the inspection, 174 patients were in treatment from mental health services and a quarter of these had serious and enduring illnesses. Twenty-one patients were subject to the care programme approach, with appropriate use of Section 117 and other care management reviews.

None of the nine patients transferred to hospital under the Mental Health Act in the six months to the end of March 2019 had been transferred within the guideline of 14 days, and some had waited several months. Whilst unacceptable, it is acknowledged that this was beyond the control of the prison and its health services.

Approx 150 patients were engaged in substance misuse therapies at any one time, of which up to a third had primary alcohol issues. Those receiving clinical or psychosocial treatment were seen in one-to-one or group sessions. At the time of the inspection, 31 patients were receiving opiate substitution therapy (OST) of whom 11 were reducing their intake.

Medicines were dispensed by the pharmacy based in the prison. The prescription documents were printed by the doctor, but many were not signed.

Medicines were administered by nurses each day from 7.45 to 8.15am, 11.45am to 12.15pm and 4.15 to 5pm with monitoring and control provided by officers. Night medication was generally issued as daily in possession. Approx 80% of patients received their medication in possession, with about 60% on a monthly supply.

The pharmacy was trialling a robot for the collection of medication which enabled prisoners accompanied by an officer to collect their in-possession medication using their fingerprint as identification. The objective was to allow flexibility in the times that medicine could be collected to reduce congestion at the administration hatches. A robust system was in place to identify when medicines were not collected.

Recommendations: Health, Well-Being and Social Care:

  • A memorandum of understanding should be formally agreed between the social care provider, the prison and the local authority, to ensure that social care needs are consistently met.
  • Patients requiring hospital admission under the Mental Health Act should be assessed and transferred expeditiously within the current transfer guidelines.
  • All clinical environments should comply with infection control standards.
  • There should be a whole-prison strategy to support health promotion.

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

  • The introduction of weekly mental health induction meetings and segregation ‘rounds’ provided an opportunity for prisoners and prison officers to talk to mental health professionals at times of heightened risk.
  • The pharmacy used a dispensing robot for prisoners who needed additional support in taking their medicines. This produced individually labelled and sealed pouches. Each pouch contained the required medication for a single dose. The robot had a high degree of accuracy and had released staff to focus on other tasks.
  • Joint working between the libraries and the mental health team in the prison was “unusually” effective. Clinical professionals had recommended to the library a range of relevant books, self-help guides, CDs and other resources, and prescribed these resources for patients.

CQC Requirement Notices Issued:

  • None.

Links/Resources:

Full Report Here – HMP Isle of Wight

Health Notes from IMB Reports – July 2019

The IMB reports that were published during July 2019 were Highpoint, Norwich, Lincoln, Berwyn and Hindley.

IMB evidence comes from observations made on rota visits, scrutiny of records and data, attendance at various meetings, informal contact with staff and prisoners, prisoners’ applications and monitoring of areas of concern.

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

IMB Report – HMP Highpoint

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • The late arrival of new receptions can often result in limited time to complete paperwork before lockdown. This leads to Healthcare not always being available to do the initial health assessment, resulting in prisoners going to induction without the proper checks being made.
  • The number of self-harm incidents has reduced from 343 in 2017 to 320 in 2018. ACCTS opened increased from 423 in 2017 to 462 in 2018 which includes 56 of those were prisoners transferring in from other establishments on open ACCTs.
  • The drug of choice during the reporting year was cannabis, both in herbal and resin form. Drugs recovered during the reporting year included: Cannabis Resin 839.6g (16.8g in 2017), herbal Cannabis 1648.7g (1674.3g in 2017), Heroin 3.1g (0.2g in 2017), and NPS 160.5g in 2018 (1433.9g in 2017).
  • The reduction in NPS is attributed to the increase in NPS impregnated paper making detection difficult. The main trafficking route is believed to be through mail sent to prisoners. The 160.5g as shown in the drug finds is for herbal NPS; in 2018 the herbal form of NPS decreased significantly.
  • For ‘hooch’ there was a 24% increase in the amount recovered compared to the previous year: Approx 717 litres in 2018, compared to Approx 580 litres in 2017.
  • Non-urgent appointments with the GP average 12 working days.
  • Dental services have been affected on the South site for the second consecutive year due to a non-functioning dental chair. Additional clinics have been provided but there is still an extended waiting list time of up to 22 weeks.
  • The well-being and suicide prevention service continues to engage with 70–75 residents each month.
  • Healthcare applications to the IMB increased to 66 from 56 when compared to the previous reporting year.

Full IMB Report – HMP Highpoint


IMB Report – HMP Norwich

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • A new ACCT process was introduced as a pilot scheme in February 2019. Insufficient staff training prior to the roll out has led to some concerns and confusion.
  • Healthcare recruitment and retention continues to be a concern, mirroring that of the community. In October 2018 there were 12 vacancies and over 500 hours lost due to sickness, and in February 2019 there were still 12 vacancies, although sickness hours had reduced to over 300 hours. 57% of posts are filled by permanent staff and long-term agency/bank staff fill the remaining positions.
  • Efficient and swift screening of new prisoners occurs when there are two nurses on duty during busy times in reception, although it is not always the case, leading to delays in processing new arrivals. Despite this, the quality of reception screening does appear to triage needs carefully and effectively.
  • A concern is that mandatory training for all healthcare staff remains incomplete. At the end of January 2019, percentages attained were: suicide and self- harm (SASH) trained 59% (although all permanent staff are trained); infection control 84%, basic life support 83%; immediate life support only 61%.
  • Clinic appointment DNA’s are a major and long-standing issue. In January 2019, there were over 80 DNA’s for GP clinics, over 50 DNA’s for hepatitis C appointments, over 35 DNA’s for mental health wellbeing appointments (IAPT), over 30 DNA’s for nurse clinics, over 25 DNA’s for dentistry and the same for nurse practitioner appointments.
  • Inpatient beds in the Healthcare Unit are also allocated to prisoners with mental health issues who cannot be housed for safety reasons on normal location. The unit is regularly staffed by nurses who have little mental health training and many of the other prison staff have also not received appropriate training for these complex patients. The austere cells in this unit are outdated and worn.
  • Mental health discharge summaries for community care information stood at 95% in Q3 and 96% in Q4; likewise learning disability discharge summaries were good at 100% in Q3, but declined to 83% in Q4.
  • Healthcare applications to the IMB increased to 82 from 68 when compared to the previous reporting year.

Full IMB Report – HMP Norwich


IMB Report – HMP Lincoln

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • The average number of prisoners over the reporting period was 538 which is 74% of the operational capacity. HMP Lincoln’s certified normal accommodation (CNA) was 408 and its operational capacity (Op Cap) was 729.
  • There were 620 incidents of self-harm reported (in 2017 this was 417), a Significant rise of 49%. It was noted that the latter half of the year showed the greater increase of acts of self-harm.
  • Not surprisingly, ACCT books being opened saw a rise of 13% on the previous year: 671 ACCT books were opened in the reporting period, up from 594 the previously.
  • The total number of violence reduction incidents reported during the reporting period on the local violence reduction database was 1087, up from 670.
  • There were three deaths in custody during 2018, which is the same figure for 2017.
  • The reception process has been further improved by the presence of both a member of healthcare working full time in Reception, who now assesses all prisoners before they are taken to the wing. There is now a seven day a week mental health nursing presence available to reception.
  • Healthcare holds a patient forum meeting every other week for prisoners to voice opinions, suggestions and concerns.
  • Prisoners are now given appointments directly using the wing telephones, which is reported to have almost eliminated any waiting lists.
  • The number of DNA’s, remains low with staff following up to find the reasons for missed appointments.
  • The establishment has a high number of prisoners with mental health problems who are well managed by the mental health team. A mental health team member is available from 8am to 8pm on weekdays and 8.30am to 5pm at weekends.
  • Healthcare applications to the IMB decreased to 37 from 44 when compared to the previous reporting year.

Full IMB Report – HMP Lincoln


IMB Report – HMP Berwyn

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • During the reporting year there were three deaths in custody. One was from natural causes, one was as a result of substance misuse, and the cause of the final death is still awaited.
  • There were 182 assaults on men and 233 assaults on staff between April 2018 and February 2019. The number of assaults continues to be a concern to the board.
  • The medication policy is becoming increasingly accepted by prisoners at HMP Berwyn. In part, this is attributed to the introduction of health and wellbeing peer mentors. This model has offered prisoners an opportunity to discuss with trained peer mentors the decisions that have been made in relation to their healthcare and the options available to them should they want to dispute any decisions that have been made.
  • The number of prisoners who DNA’d their healthcare appointments continues to be concerning. Between April 2018 and February 2019 the healthcare service provided 45,942 appointments. Of these appointments 7,525 (16.4%) were wasted appointments due to prisoners failing to attend. These wasted appointments cause frustration as it is well known that other prisoners are waiting for similar appointments.The peer mentor model is now being expanded to attempt to address this concern by working with prisoners who persistently DNA their healthcare appointments.
  • The health and wellbeing peer mentors have operated a healthcare helpline since November 2018. The helpline is available for prisoners to call if they are having healthcare related issues. The initiative has been well received so far with 1309 calls received between November 2018 and February 2019.
  • The lack of on-site healthcare staff after 1900 hours has been a concern to the board since the commissioned model was established. Following discussions with the senior leadership team, BCUHB has introduced overnight nursing cover with effect from April 2019.
  • Healthcare applications to the IMB increased to 43 from 42 when compared to the previous reporting year.

Full IMB Report – HMP Berwyn


IMB Report – HMPYOI Hindley

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • Appointment DNA’s were a notable concern from a relatively unremarkable report. Both in April and December 2018 the ‘Did Not Attend’ (DNA) rates were at 11% peaking at 14% in June and August 2018. The areas with the highest DNAs were for GP appointments (unusually), and vaccinations (predictably). If a man did not wish to attend an appointment, he was required to sign a written slip which improved an accountable trail but did not result in much improvement in attendance.
  • The provision of healthcare at HMPYOI Hindley has previously been of a very high standard. More recently, staff turnover and absence particularly within the nursing staff led to a reliance on ‘Bank Staff’ and managers to cover the shortfall.
  • Healthcare applications to the IMB increased to 17 from 12 when compared to the previous reporting year.

Full IMB Report – HMPYOI Hindley


HMIP Report – Health Summary: HMP Ashfield, Mar-Apr 2019

This report was on an unannounced inspection of HMP Ashfield between 25 March to 12 April 2019, and was published in July 2019.

General Points of Note.

Low levels of violence and bullying incidents, with just one fight and seven assaults recorded in the previous six months. There were six incidents of use of force for the same period.

In the previous six months, there had been only 25 self-harm incidents and 39 ACCT documents opened for prisoners at risk of suicide or self-harm. There have no self-inflicted deaths since the prison was re-roled in 2013.

95% officers had undertaken mental health awareness training.

At the time of the inspection, there were 338 Enhanced regime prisoners under the Incentives and Earned Privileges (IEP) Scheme. This represents approx 84% of the population. None were on Basic regime.

Healthy Prison Outcomes:

2015 2019
Safety 4 4
Respect 4 4
Purposeful Activity 2 4
Rehabilitation & Release Planning 3 2

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

In the survey, 84% of respondents said that the overall quality of health care was quite or very good. There was a well-established health care improvement group, which met every six weeks and enabled prisoner representatives to consult on services.

95% prison staff who had regular prisoner contact had been trained in first aid and the use of the automated external defibrillators (AED).

Nurses worked from 7.30am to 6pm every day, Monday to Sunday. Leadership of the team was strong and all staff were supported. Managerial and clinical supervision was established and systems to learn lessons were embedded.

Prisoners could request appointments using the touchscreen information kiosks on the wings.

The number of prisoners who failed to attend health care appointments was low. Patients requesting a routine GP appointment had to wait up to three weeks. Urgent appointments would be facilitated the same day.

A monthly social care drop-in centre was an excellent initiative, where caring, dedicated staff, including a social worker, occupational therapist and health care worker, listened to prisoners’ support needs and helped to ensure that they were fully met, so far as was possible.

In the previous six months, the Mental Health team had received 84 referrals. MH practitioners offered one-to-one interventions to 17 patients, and prisoners could also participate in groups focusing on low mood and anxiety, which was a positive development. In the same period, only six patients had presented with severe and enduring mental health problems. There had been no transfers under the Mental Health Act in the previous 12 months.

In the previous six months, 52 prisoners had been assessed for substance misuse support. The current caseload for structured one-to-one work (mainly relapse prevention), stood at 12. Only two prisoners had required opiate substitutes (OST) in the previous two years.

Substance Misuse and Mental Health practitioners were co-located, shared patient records and co-facilitated groups, which benefited patients.

Most prisoners were on in-possession medication, and for all of the records sampled by inspectors, there was an up-to-date in-possession risk assessment stored on SystmOne.

Recommendations: Health, Well-Being and Social Care:

  • There should be an up-to-date health and social care needs analysis.
  • Trained and supervised peer workers and health trainers should offer health information and support to prisoners.
  • All prisoners with long-term health conditions should have a care plan.
  • Trauma-informed psychological support should be available for prisoners.

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

  • The monthly social care drop-in service was an excellent initiative, allowing prisoners to discuss issues with a social worker, occupational therapist and health care worker.

CQC Requirement Notices Issued:

None.


Links/Resources:

Full Report Here – HMP Ashfield