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:
|Rehabilitation & Release Planning||2||2|
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
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.