IMB Health Notes – October 2019 (Pt. 2)

The IMB reports published during the middle part of October 2019 were from these establishments:

  • HMP & YOI Parc
  • HMP Wealstun
  • HMP Woodhill
  • HMP Styal
  • HMP Wandsworth

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 – HMP & YOI Parc

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • Operational staff and the healthcare administration team have been working closely together to address the high DNA rate that previously was running at 30% or more. A dedicated group of officers, employed as ‘runners’ had been introduced, who are responsible for bringing prisoners across to their appointments.
  • Healthcare champions on each wing are also responsible for encouraging men to attend their appointments and collating reasons when appointments are declined. This has had a significant positive impact on the number of wasted appointments.
  • Staff retention was a big concern, with a high number of nurses leaving. The Board was aware of a significant number of agency nurses being employed. Exit interviews conducted by Healthcare managers identified issues with a lack of support, long hours of work, and a lack of opportunity for clinical activity owing to long medication rounds. In response to this, nursing staff are being offered more flexibility with hours of work. Pharmacy Technicians have been recruited to complete the medication rounds. The Board has noticed the more regular pattern of nursing presence.
  • Subcontracted services, such as GP, dentist, optician and physiotherapists are well embedded and stable, with waiting lists very similar to community waiting times.
  • The mental health pathway for access to primary care services is now embedded and working well, with a dedicated RMN appointed to complete group work on a daily basis. The lack of secondary psychiatric care, particularly for elderly prisoners continues to be a major concern.
  • Formal complaints about healthcare services continue to be fairly low, largely due to the work completed by the patient advice and liaison officer (PALS). This officer is well known to Board members and helpful in addressing issues raised in applications which have certainly reduced this year. The PALS officer has a team of champions, who are prisoners employed on each wing, to assist in signposting men to the correct services and encouraging them to take responsibility for their own health. These champions have spoken to Board members expressing their pride in contributing to this role.
  • In the last quarter of 2018, HMP and YOI Parc was awarded autism accreditation from the National Autistic Society. HMP and YOI Parc is the joint first prison in the UK to receive this award.
  • Healthcare applications to the IMB decreased to 63 from 96 when compared to the previous reporting year.

Full IMB Report – HMP & YOI Parc

IMB Report – HMP Wealstun

Reporting period – 01 Jun 2018 to 31 May 2019.

  • The Board considers that this has been an extremely difficult year for the prison, which has been impacted by a significant level of violence and self-harm. It has been a year of three parts: June to August 2018 (ie prior to the 10 Prisons Project); August 2018 to March 2019 (with the introduction of the 10 Prisons Project but prior to any significant material support becoming available); and post-March 2019, when additional support eventually became available.
  • The number of open ACCTs has fluctuated but peaked at nearly 40. The number of self-harm incidents in April 2019 was the 2nd highest among the prisons in the 10 Prisons Project and the 5th highest among all category C prisons.
  • There were 2 deaths in custody during the reporting period and a further drug-related death in June 2019. There were also 2 apparently self-inflicted deaths in the community within 24 hours of release during the year.
  • Medicines are dispensed 3 times daily by Pharmacy Technicians and nursing staff. Between 70% and 75% of prisoners are on medication and 25% of those are on Opiate Substitution Therapy (OST).
  • Tele-health is working well, and additional contracts with more local hospitals being progressed. As this service has evolved, the need for more local contracts has become apparent where the prisoner requires more than just tele-health.
  • Dental waiting times were comparable with those in the community and prisoners are generally seen within 6 weeks unless it is urgent. However, since the regime changed in December 2018, dental waiting times have been affected by prisoners being unable to access the service due to there being insufficient officers to provide an escort. This has also been a problem for other healthcare appointments.
  • The time taken to issue medication continues to be a problem as prisoners are not always unlocked on time. 2 new treatment hatches have been installed (from 10 Prisons Project funding) which it is hoped will result in fewer problems when issuing medication.
  • The prison has been a no-smoking establishment since 2017. Prisoners are supported and given nicotine patches free of charge as part of the smoking cessation programme. Prisoners can purchase vapes through their normal canteen; however, this can be difficult for healthcare providers, who do not advocate their use where they have not been healthcare approved.
  • There are no longer any healthcare representatives however, in an effort to restore this function, the organisation A Better Life is coming into the prison to run some patient prisoner council groups.
  • Healthcare applications to the IMB decreased to 13 from 14 when compared to the previous reporting year.

Full IMB Report – HMP Wealstun

IMB Report – HMP Woodhill

Reporting period – 01 Jun 2018 to 31 May 2019.

  • The Board is saddened to report 8 deaths in custody and 7 ‘near misses’ in the reporting period. The deaths have been categorised as 2 by natural causes, 1 homicide, 1 accidental and 4 as being self-inflicted.
  • Management data recorded in Woodhill’s safety meetings identified that many ACCTs are associated with men repeatedly not getting answers to often quite straightforward complaints and then self-harming out of frustration.
  • Apart from some brief periods showing a reduction, the number of ACCT documents has remained high during the year. At one point in May 19 it rose to 54, nearly 10% of the population, which is an unsustainable and unmanageable number.
  • It is noted by the board that the change from 3 healthcare providers to one in April 2019, is allowing a new culture to develop with significant advantages, examples being with improvements such as evening medications being delivered at the optimum time for the prisoner; mental health attending 100% of ACCTs and improved cover for staff shortage.
  • Delays in security clearances result in suitable candidates for employment going elsewhere, although some improvement in clearance times is reported since the beginning of 2019.
  • A full range of clinics is available and waiting times are the same or better than in the community. Attendance at some clinics, especially dental clinics, is poor.
  • Prisoners have good daily access to wing-based nurses and can also self-refer for medical appointments.
  • Response times to healthcare-related complaints have deteriorated during the year.
  • The pharmacy continued to operate with a chronic shortage of staff which got even worse towards the end of the reporting year. Pressures on pharmacy staff were exacerbated from April 2019, when responsibilities extended to dispensing medication previously managed by another service provider.
  • There has been an increase in mental health staff this year with much-improved service to prisoners covering reception, care planning meetings, Rule 45 reviews and ACCT reviews as required, as well as clinics, facilitated self-help, in cell packs and individual care. All new prisoners are seen by the Mental Health team within 24–48 hours of their arrival. The team do a weekly ward round in the In-Patient unit and runs a group meeting every two weeks.
  • Healthcare applications to the IMB decreased to 17 from 43 when compared to the previous reporting year.

Full IMB Report – HMP Woodhill

IMB Report – HMP Styal

Reporting period – 01 May 2018 to 30 Apr 2019.

  • There were 3 reported deaths in custody during the reporting year, all on the First Night Centre.
  • There has been a dramatic reduction in the number of self-harm incidents from 282 in August 2018 to 149 in March 2019. The decrease was attributed to the release of several prolific self-harmers.
  • All women are seen by the mental health team on the day following a self-harm. Self-harm forums are held quarterly for prisoners to share their concerns with staff about suicide and self-harm.
  • 52.4% of operational staff and 7.5% of non-operational staff had received suicide and self-harm (SASH) training by March this year. The problem is that such training takes a whole day and no more than 12 staff can be trained at any one time. Additionally, the training has to be repeated every 2 years.
  • Prisoner-on-prisoner assaults have increased over the reporting year from 7 to 16. It would appear that disputes about debt involving vapes are a major cause.
  • The healthcare provider has a system for collecting women’s views on healthcare and results are prominently displayed in the health centre. 87% of women said they were listened to. 27% said that healthcare could do better.
  • Women on the first night centre (FNC) are assessed for physical health at the time of arrival, and for mental health usually within 24 hours, although this can be on Monday should women arrive on Saturday night. The IMB have been told that when fully staffed (currently there are 2 nurse vacancies) the MH team will offer a seven-day service, so all women will have a mental health assessment within 24 hours. In April 2019, 131 women had an initial mental health assessment.
  • The wait for optometrist and dental appointments is approximately 4 weeks. All women requesting a GP appointment are seen by a triage nurse either the same day or the next day, then there is a 5-week wait for a GP appointment. There are 2 emergency slots each day.
  • The IMB is concerned that no resolution has yet been found to the issue of the lack of appropriate accommodation for therapeutic group work; prior to August 2017 there was a dedicated building in which 5 groups, including a first custody group and a learning needs group were run weekly, but now only one anxiety group runs on alternate weeks in a room without a door in the Safer Custody area. The previous accommodation also acted as an ad-hoc drop-in facility where a woman’s concern could be quickly dealt with. The alternative provision offered by the prison has not been considered as being suitable by the mental health team. Prisoners and mental health staff feel that the lack of group work is detrimental to the overall wellbeing of the women.
  • On average 130 women, at any one time, are using the mental health provision (approx. 30% of the prison population). There are women with mental health problems who do not engage with the service and are not included in these figures.
  • Healthcare applications to the IMB decreased to 22 from 39 when compared to the previous reporting year.

Full IMB Report – HMP Styal

IMB Report – HMP Wandsworth

Reporting period – 01 Jun 2018 to 31 May 2019.

  • The Board was greatly encouraged by the increase in officer numbers and by the end of the reporting year the prison was fully staffed. As a result of the recruitment programme, the number of officers at 31 May 2019 had risen to 359 compared with 303 at 31 March 2018. While this is very good news, it is important to remember that it will take time for the new officers to develop “Jail craft”.
  • Each wing now had a regular ACCT review day and start time. However, too often the times were subject to last minute change without warning, which resulted in key agencies being unable to attend. There were many instances where the high number of reviews, on particular wings, prevented key personnel from attending the entire session owing to other duties.
  • There were 851 ACCTs opened during the year (compared to 814 in 2017/18). There is evidence that this increase was exacerbated by the influx of new staff who are over cautious when assessing risk for new prisoners. Around 30% of ACCTs were opened in reception and on E wing. Approximately 25% of ACCTs were closed at first review.
  • Between September and December, 125 staff took part in ACCT awareness training, and 37 new staff were trained to be ACCT assessors.
  • An analysis of the last 6 months of the reporting year showed that 50% of self-harm incidents were by men who self-harmed twice or more in a month. There were over 700 incidents. Cutting was the most common category, accounting for at least 75%, followed by ligatures and self-strangulation.
  • There were 244 prisoner on staff assaults (compared to 258 in 2017/18) and the most common reason was refusal to return to the cell. There were 294 prisoner on prisoner assaults (compared to 307 in 2017/18). The majority of assaults were perpetrated by young prisoners (i.e. 18–25 year olds). Fighting was the most common reason and around 30% occurred in cell.
  • There were 874 instances of use of force, a 30% increase on last year.
  • There were 6 deaths in custody (compared to 4 in 2017/18), although none were self-inflicted.
  • During the reporting year, the healthcare department was allocated a dedicated team of officers, including a senior officer and a custodial manager. This resulted in more officer availability to escort prisoners to hospital appointments; in the period from February to April there was only one cancelled hospital appointment. An average of only one clinic per week was cancelled due to officer unavailability and an average of 3 clinics per week were cancelled due to healthcare staff unavailability.
  • The percentage of prisoners failing to attend booked clinic appointments remains high and was 33% overall for the period February to April, similar to last year. Notable DNAs were: 14% for the dentist, 39% for the podiatrist, and 33% for the sexual health clinic (significant improvements on the 2017/18 figures of 20%, 60% and 60% respectively) – there were also 53% DNAs for the optician. DNAs are caused by a variety of factors including clashes with legal or social visits, education or work, and prison transfers – some prisoners simply refuse to attend.
  • The Board remains very concerned that the 12-bed inpatients unit is unfit for purpose. The unit has insufficient beds and cells are frequently awaiting repair.
  • Approximately 55% of inpatients unit prisoners were transferred to secure psychiatric accommodation, the majority within 2 months, and the longest wait being 3 months. Delays in transfers, reported by the Board each year since 2009, remains a national issue.
  • Officers and nurses continue to work together to facilitate the hearing voices group and a weekly community meeting, for prisoners to meet as a group.
  • The primary mental health team, as in previous years, receives multiple referrals each day, with the majority being seen within 48 hours. There has been a significant rise in the number of assessments, due to an increase in the number of prisoners who are seriously unwell, and those who, whilst not diagnosed as psychotic, present with worrying behaviour.
  • Healthcare applications to the IMB decreased to 76 from 123 when compared to the previous reporting year.

Full IMB Report – HMP Wandsworth

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