This report was on an unannounced inspection of HMP Eastwood Park between 03–17 May 2019, and was published in August 2019.
“On entering these units, I was immediately struck by the sight of rows of women’s faces pressed against the open observation hatches of their locked doors, peering out into the narrow, dark, cell block corridor. It was as if they were waiting for something or indeed anything to happen, however mundane, to relieve the monotony of their existence.”
– Peter Clarke, HM Chief Inspector of Prisons
General Points of Interest:
73% of prisoners told inspectors that they had mental health problems, and 48% had problems with illicit drug use. These issues were compounded by the fact that many women were serving short sentences of less than 6 months – clearly reducing the opportunity for effective interventions.
43% of prisoners were in custody for the first time, and 33% had served five sentences or more. 36% of prisoners had been at the prison for less than 3 months.
In the previous 6 months prior to the inspection, there had been 120 reported assaults and 578 incidents of self-harm.
Healthy Prison Outcomes:
|Rehabilitation & Release Planning||3||2|
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
Key Points of Interest: Health, Well-Being and Social Care:
The service was well led, supported by skilled clinical leads, and we observed conscientious staff who knew their patients well. Mandatory training was well managed, and professional development was identified and encouraged through regular managerial and clinical supervision and appraisals.
Effective patient engagement, with regular health improvement groups and surveys, had influenced service delivery improvements.
Prisoners had access to a secure separate health care complaints system. Sampled responses were respectful in tone and fully addressed the issues highlighted. However, response times and oversight were not managed well enough, as some fell outside of the recommended timescales. Compliments received were shared with staff.
Health promotion formed an integral part of the prison’s well-being strategy, and local and national well-being initiatives were well advertised.
Smoking cessation support was available for those who wished to stop nicotine vaping, but uptake was low.
New arrivals received a comprehensive initial health screen with a nurse, focusing on risks and immediate needs, including those relating to substance use withdrawal, pregnancy, mental health and self-harm. Secondary health screenings were booked promptly, to identify and address prisoners’ health needs immediately. Good liaison with community services helped to ensure continuity of care.
Waiting times were short, with a 3–4 day wait for a routine GP appointment, and urgent appointments facilitated on the same day.
A weekly multidisciplinary complex case meeting was effective at ensuring that concerns were identified and discussed, and solutions explored to maintain well-being.
During the inspection, only around 25% of prisoners prescribed medication received it in- possession, following an appropriate risk assessment. This relatively low level of in-possession medication led to particularly busy morning and evening administration sessions. This was partially due to a lack of secure in-cell storage, which the prison was addressing.
The recent change in the classification of pregabalin and gabapentin to controlled drugs from April 2019 had caused minimal disruption owing to the proactive approach to the management of pain. The service had introduced a pregabalin reduction programme, which offered support to help prisoners to reduce their dependency gradually, ensuring that they were on clinically appropriate medication.
Refrigerator temperatures were recorded well in most treatment rooms but there were some gaps. Inspectors also found another refrigerator for which the temperatures had not been recorded, which meant that the integrity of the medicines stored within it could not be assured. This issue was addressed during the inspection.
The teams were based in an open-plan office, which promoted effective communication and integrated work between the physical and mental health care teams.
The average number of referrals into the Mental Health service was approx. 135 per month and the team was currently supporting 152 patients (approximately 40% of the population) via individual and group sessions.
A crisis team, made up of registered and support staff, responded promptly to urgent referrals, including attendance at all initial assessment, care in custody and teamwork (ACCT) case management reviews, and worked from 8am to 8pm, seven days a week. The caseload was usually between 30 and 40 and was actively monitored and reviewed throughout the day. One or more sessions were offered, and referrals to other parts of the service were made, dependent on need.
The primary care mental health team consisted of two experienced registered mental health nurses, who were also non-medical prescribers and held regular clinics. Although the waiting time was at around 4 weeks, the crisis team offered support, and prioritised accordingly.
Prisoners attended a pre-discharge health clinic a few weeks before, and on the day of, release, to check their general health and welfare. A GP summary was provided; if the prisoner did not have a GP, they received information about the services available in the area they were being released to. Take-home medication was supplied.
Substance Misuse service provision was delivered by two separate providers – one for psychosocial support and the other for clinical services. Inspectors noted that although information sharing between substance use services had improved, teams were not yet fully integrated. Clinical and psychosocial substance use teams did not complete prescribing reviews jointly, and this was a missed opportunity to coordinate treatment and maximise support.
The substance use team contributed to the discharge board, and a continuity of care worker liaised with community prescribers and ensured treatment continuation on release. Naloxone training for relevant prisoners before release, to treat opiate overdose in the community, was well established but the provision of harm reduction information was not systematically recorded and evidenced. A designated through-the-gate worker maintained good links with community teams.
Dental appointments were appropriately prioritised according to clinical need, and sessions offered a range of treatment, equivalent to that in the community. Urgent referrals were seen promptly, but waiting times for routine appointments were too long, at around 11 weeks.
As part of the survey, 54% 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:
- Substance misuse services should be fully integrated, and a range of group work and mutual aid support should be available to prisoners, independent of location.
- Those with complex health needs should have recorded care plans that are reviewed regularly.
- Prisoners should have access to routine dental appointments within 6 weeks. (A repeated recommendation)
- The substance misuse team should systematically record and evidence the provision of pre-release harm reduction advice and information.
Good Practice: Health, Well-Being and Social Care:
- Prisoners with specific health issues were encouraged to participate in well-advertised fitness programmes which were tailored to meet individual needs.
- The introduction of the social prescriber role was a positive initiative, providing additional assistance for patients and links with other services promoting health and well-being
CQC Requirement Notices Issued: