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