IMB Health Notes – September 2019 (Pt. 2)

The IMB reports published during the latter part of Month 2019, of which there were only 4, were from these establishments:

  • HMYOI Wetherby
  • HMP Rye Hill
  • HMP Erlestoke
  • HMP Coldingley

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 – HMYOI Wetherby

Reporting period – 01 Jun 2018 to 31 May 2019.

  • From July 2018 to April 2019 there were 363 incidents of self-harm, and 258 ACCTs opened from June 2018 to April 2019.
  • In January 2019, although incidents were down by 50% on the main site, there was an increase of 144% on the Keppel unit. Those who had self-harmed twice or more was at 81.6%. In February, one YP self-harmed on 25 occasions. 78% of all self-harm was attributed to just 7 YP’s. Between March and April there was an increase of 247% on the main site and a decrease of 28% on Keppel. In April, 70% of those YP who self-harmed did it twice or more, with 8 YP’s accounting for 70% of all self-harm.
  • Keppel continues to be a very well-managed unit with staff meeting the challenges of the most complex YP. At the end of this year there were five YP with severe mental health needs awaiting transfer to a hospital placement and, as last year, there remains an unacceptable delay.
  • Between July 2018 and May 2019 there were 541 assaults between YP (compared to 667 last year), 20 of which were serious (compared to 8 last year), and 145 assaults on staff (129 last year), 6 of which were serious (8 last year).
  • The merger of the health care team, CAMHS and substance misuse services into one building, continues to build on its strength enabling a more effective and united work force.
  • The last 4 months have seen the employment of 2 new dedicated health centre officers. This has improved the number of YP attending appointments and facilitated follow-up of DNA’s, although DNA for optical and dental appointments are still high at 30% to 40% respectively. It was noted that the possibility of a designated health centre movements officer would further enhance this system.
  • The Beacon Suite, where YP are assessed by psychiatrists, also continues to have a high DNA rate, leading to delays of the diagnosis of conditions such ADHD and autism which can impact on behaviour through inadequate access to appropriate medication.
  • When YP with extreme mental health issues are sectioned under the Mental Health Act, there can be very long waits for adequate medical provision to be put in place. Sourcing an appropriate hospital setting can also be a lengthy process. Children’s secure hospitals will not take YP over 17.5 years so it is particularly challenging to find somewhere suitable for this group. Whilst appropriate accommodation is being sought, the YP may need to be placed under constant watch or similar arrangements which are extremely labour-intensive.
  • Difficulties Were noted around the recruitment and retention of healthcare staff. The primary care section of the health care department has lost several staff over recent months, compounded by a recruitment process that can take up to 6 months to replace those who have left, leaving a staffing deficit and imposing extra strain on the remaining members.
  • Healthcare applications to the IMB increased to 2 from 0 when compared to the previous reporting year.

Full IMB Report – HMYOI Wetherby

IMB Report – HMP Rye Hill

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • Notable average population demographics reveal 34.5% of the population as being registered disabled, 41.8% of the population are aged 50 or over, and 12.8% are aged 65 or over.
  • The need for the use of force has also increased over the past 12 months to an average of 22.8 events per month compared unfavourably to the 14 per month the previous year.
  • Incidents of self-harm through the 2018/19 reporting year averaged at 34.25 per month, compared with 18.9 per month in the last reporting year. Many of the prisoners who self-harm are long-term or multiple self-harmers with complex needs.
  • The number of open ACCT documents had reduced in the past year to around 13 prisoners per month.
  • There have been 5 deaths in custody during the year, 2 on units and 3 in hospices and all resulting from chronic illnesses or natural causes.
  • The number of booked hospital appointments remained high with an average of 177 per month, ranging between 80 to 141 each month.
  • For the 12 months from April 2017, clinic appointments averaged out at 77 cancellations per month out of 137 booked appointments (56%).
  • Measures to reduce the number of prisoners failing to attend healthcare appointments, including the issue of incentives and earned privileges (IEP) warnings, were very effective for a time but non-attendance without cancellation was noted as beginning to creep back up.
  • Healthcare applications to the IMB decreased to 31 from 52 when compared to the previous reporting year.

Full IMB Report – HMP Rye Hill

IMB Report – HMP Erlestoke

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • There were 248 ACCT documents were opened in the year – a reduction of 4%. Paperwork had improved although completion of care maps was deemed to be of variable quality. The number of ACCTs in the care and segregation unit (CSU) is a concern, although these cases are well managed. However, the mandatory requirement to have healthcare staff attend the first ACCT case review is rarely met. Representation at first review has only occurred in 15% of ACCTs opened (37 out of 248 first ACCT reviews) raising obvious concerns. In mitigation, healthcare is often not made aware of a review or the review takes place on a weekend when a healthcare representative is not available.
  • There were 326 self-harm incidents, reflecting an upward trend evident also in national statistics.
  • There were 91 prisoner-on-prisoner assaults and 58 assaults on staff. Assaults on staff were, in the main, not serious.
  • Drug and substance misuse continues to be a significant issue and is closely associated with debt, bullying and indiscipline. 40 prisoners are signed up to the integrated drug treatment system (IDTS). The dedicated well-being team offers a range of courses: Pillars of Recovery (a four-month programme), Alcohol Awareness (one day a week over six weeks), Inside Out (a programme to support recovery from addiction) and Spice Awareness (half a day highlighting the dangers of psychotic substances).
  • During the year, the practice of making daily healthcare visits to everyone on an ACCT was ended and restricted to those whose perceived need warranted a visit. As a result of the staff saving, a well-man clinic has now been established.
  • Waiting times for GP appointments has averaged 21 days but a reduction of weekly GP sessions from five to four is likely to extend waiting times. However, a “see and treat” system whereby applications for medical treatment are collected daily from sealed boxes on the wings by nurses has led to a swift disposal of minor ailments and a less frenetic atmosphere in the healthcare waiting room with appointments better co- ordinated.
  • Escorted visits for hospital outpatient appointments are limited to 10 a week (2 per day). Less urgent appointments are postponed when more pressing needs arise, leading sometimes to unacceptable delays for what may initially have been a non-urgent appointment. GPs are sometimes then put in a difficult position of prioritising cases among medical needs of similar weight.
  • The healthcare building is a single storey structure with an unprotected flat roof, and has provided disaffected prisoners with an easily accessed venue for roof-top protests. Such protests close healthcare and lead to delays and cancellation of medical appointments, a source of considerable inconvenience for prisoners.
  • Clinical concerns with regard to the perceived over-prescription of the potentially addictive and reclassified gabapentin and pregabalin drugs have led to a decision to confine these prescriptions to those for whom the drug is deemed appropriate. A number of prisoners no longer prescribed the drugs reacted angrily. Some applications from prisoners on the subject have been received. However, a programme of information and education has convinced others of the benefits of the policy.
  • 6 health trainers provide 1-to-1 sessions for those wishing to address negative lifestyle behaviours in a range of areas including eating, physical activity, alcohol and smoking.
  • A patient forum has been established, meeting every 2 months.
  • Healthcare applications to the IMB increased to 28 from 6 when compared to the previous reporting year.

Full IMB Report – HMP Erlestoke

IMB Report – HMP Coldingly

Reporting period – 01 Aug 2018 to 31 Jul 2019.

  • Recorded assaults in this reporting year were 42 for prisoner-on-prisoner (compared to 27 for 2017/18), 42 prisoner-on-staff assaults (compared to 18 for 2017–18). A further 31 prisoners had unexplained injuries 31 (compared to 20 in 2017–18).
  • On average, 10 ACCTs documents were opened each month, compared with 13 per month last year.
  • Improvements with the methods of mental health assessments has led to all patients being assessed within 5 to 7 days.
  • Prisoners not showing up for assessment or treatment is still an unnecessary drain on the resources available and more rigid rules are being followed to impress on prisoners the value of turning up when agreed. Hospital cancellations continue to be a problem due to the difficulty in allocating adequate escorts and overcrowding at the hospital.
  • A system for consulting with local hospitals via Telemedicine is being established for an anticipated start in 2019.
  • Substance misuse issues continue to be a major cause for concern and sadly led to a death in custody in August. A large variety of drugs and tobacco have been found during normal search operations in the prison and wing brewed alcohol was widely discovered during routine searches.
  • Over the year the number of drug-related incidents probably totalled 16 cases although another 120 incidents might also have been partially or wholly due to drug abuse and at least one required CPR by the healthcare staff. These incidents were managed by the prison staff. Prison records fail to differentiate between drug abuse call-outs and other health-related emergencies which consequently, raises concerns for the IMB.
  • Healthcare applications to the IMB increased to 7 from 5 when compared to the previous reporting year.

Full IMB Report – HMP Coldingly

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