This report was on an unannounced inspection of HMYOI Wetherby and Keppel between 11–21 March 2019, and was published in July 2019.
General Points of Note.
HMYOI Wetherby is able to house up to 326 boys aged between 15 and 18, of which 48 could be held on the Keppel unit. Keppel unit is a specialist national resource facility within the prison that is designed to hold and manage some of the most vulnerable and challenging children.
Children were issued with a free MP3 player with a comprehensive recording of the induction programme, enabling them to listen to information in their own time. This is particularly useful for those who struggled to retain everything they were told in the first few days of custody. An induction tour was being developed using virtual reality goggles which was an excellent and innovative use of technology.
During the previous six months, there had been 119 instances of self-harm at Wetherby which was comparable to similar establishments. For the same period, there had been 110 on the smaller Keppel unit reflecting the complex and vulnerable nature of the children held there.
Most ACCT documents were good, with contributions from child and adolescent mental health services (CAMHS) in every case. Only 54% of staff were trained in suicide and self-harm.
HMYOI Wetherby Unit Healthy Prison Outcomes:
- Safety = 3 (2)*
- Care = 3 (3)*
- Purposeful Activity = 3 (3)*
- Resettlement = 4 (4)*
Keppel Unit Healthy Prison Outcomes:
- Safety = 4 (4)*
- Care = 4 (4)*
- Purposeful Activity = 3 (3)*
- Resettlement = 4 (4)*
Note: *Previous inspection outcomes from March 2018 are stated in brackets
- 4 = Outcomes for children are good.
- 3 = Outcomes for children are reasonably good.
- 2 = Outcomes for children are not sufficiently good.
- 1 = Outcomes for children are poor.
Key Points of Interest: Health, Well-Being and Social Care:
Staff had access to a comprehensive set of policies and a range of helpful ‘one-minute’ guides outlining key information which they found useful.
Health staff received appropriate life support training and attended all emergencies. Emergency equipment, including automated external defibrillators (AEDs), were located in each treatment room. Staff signed daily check sheets, but it was found that some of the AED pads were out of date, compromising their effectiveness. The checking process was ineffective.
Since the last inspection, 16 concerns and no complaints had been raised.
Efforts to reduce the high rate of non-attendance at some clinics was a work in progress. Sometimes children had to wait too long in the waiting room before and after their appointments when there were not enough officers to escort them more promptly.
A ‘refusal form’ was being trialled to demonstrate that children had been offered the opportunity to be brought to health care. The range of primary care services was good and access was reasonable apart from the optician and dentist waiting times which were too long at eight weeks.
In the survey, 84% of children on Keppel and 29% of children at Wetherby said they had a mental health/emotional problem at the point of first reception. The mental health team were working with 119 children of whom 41 resided on Keppel.
Since the previous inspection, the mental health team are now delivering a range of therapeutic group work such as music and creative writing. Staff shortages were deemed to be preventing the delivery of low-level cognitive behaviour therapy group sessions for anxiety, mood management or emotional regulation.
In the survey, 52% of children on Keppel and 36% on Wetherby said they had a problem with drugs on arrival, significantly higher than the comparator in both cases. The Substance Misuse team were supporting 95 children of whom 14 resided on Keppel.
Again, staff shortages are preventing the delivery of group interventions. The team were developing specific harm minimisation groups, covering risks associated with being transferred to an adult establishment. At the time of inspection, this was delivered individually, which was positive.
All children were offered a pre-release appointment to complete the CHAT (comprehensive health assessment tool) discharge plan which was sent to relevant agencies. Children were given harm reduction advice and information before leaving. Children were also usually seen on the day of release or transfer to assess their health needs and were offered health promotion advice, including barrier protection. A week’s supply of medication or a prescription was provided for appropriate children.
Recommendations: Health, Well-Being and Social Care:
- An effective monitoring system should be in place to ensure that all emergency resuscitation equipment is in good order.
- There should be sufficient staff to ensure that all aspects of the service are delivered.
- There should be a whole-prison strategy to support health promotion, including healthy eating.
- Children should have timely access to the optician and dentist.
- Failure-to-attend rates for clinics should continue to be investigated and reduced.
Good Practice: Health, Well-Being and Social Care:
- Regular clinical supervision by the safeguarding lead and reflective practice sessions facilitated by a community psychologist provided excellent support to promote good standards of practice.
- The proactive approach to acquiring accurate immunisation history and the focus on achieving good uptake of vaccinations through innovative pop-up and regular clinics were commendable.
- Staff carried out comprehensive one-to-one harm-minimisation awareness sessions, which ensured that all children transferring to the adult estate were made aware of potential risks.
- The introduction of the transfer pack with life sustaining medication was a good initiative to ensure children going to court and in education had prompt access to emergency medication.