IMB Health Notes – October 2019 (Pt. 3)

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

  • HMP Oakwood
  • HMP Wymott
  • HMP Hatfield
  • HMP & YOI Kirklevington Grange
  • HMP Warren Hill

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 Oakwood

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • Over the reporting year, there has been an overall drop in the number of both prisoner-on-prisoner assaults and prisoner-on-staff assaults. In 2017/18 there were 185 prisoner-on-staff assaults and in 2018/19, there were 106. In 2017/18 there were 430 prisoner-on-prisoner assaults and in 2018/19 there were 378.
  • Over this reporting period, there were 6 deaths in custody, of which 5 occured within a 2 month time frame.
  • Nurses are no longer based in the CSU, which has led the service to prisoners not being as robust as previously. On occasion, the quality of input to the Good Order Reviews has been adversely affected as the welfare and related issues are not always known to the nurses in attendance.
  • A Pharmacy Technician now issues medication in the CSU.
  • End of life care continues to be provided in close liaison with the local hospice. The Board is of the view that the care provided is excellent.
  • Vacancies within healthcare have significantly reduced as a result of some proactive recruitment. The introduction of Pharmacy Technicians has seen an improvement in the management of medication, as is the continued use of Paramedics based at the prison – both initiatives praised by the IMB as good practice.
  • The HAS Line (Health Advisory Service Line) was established to improve healthcare delivery. A review of the scheme that HAS introduced to minimise missed appointments has been undertaken and prisoners are now either contacted by way of a reminder on the morning of the appointment, or by direct approach by a member of the HAS team, leading to a reduction in the number of missed appointments. On average only 7% of appointments have been missed since the introduction of the HAS team.
  • At any one time 12.5% of the prison population is known to the Substance Misuse Team, resulting in high caseloads.
  • Healthcare applications to the IMB decreased to 72 from 77 when compared to the previous reporting year.

Full IMB Report – HMP Oakwood

IMB Report – HMP Wymott

Reporting period – 01 Jun 2018 to 31 May 2019.

  • The number of ACCT documents opened each month remains stable (33 in May 2019 compared to 39 in May 2018).
  • There were 480 recorded incidents of self-harm, which is an increase up from 335 in the previous reporting year. Some of this increase is attributed to the small number of repeated self-harmers. Healthcare issues (such as medication and mental health), debt and bullying were also seen to be key drivers, as a number of prisoners have told staff that they used it as a coping mechanism.
  • There were 4 deaths in custody over the reporting period, of which 2 have been confirmed as natural causes, one was apparently natural causes, and the 4th was linked to PS use (these latter 2 both awaiting inquest).
  • Although there have been significant improvements in healthcare provision, the Board remains concerned that in some aspects, it continues to fall below the statutory duty to provide a service of equivalent standard to that in the community.
  • Staffing has improved in primary healthcare and the pharmacy, but there are still shortfalls, particularly in the area of mental health. A new Head of Healthcare was appointed in the middle of the year.
  • On a number of occasions nurse-led clinics have been late starting or cancelled with little or no notice, resulting in prisoners remaining in overcrowded waiting areas for long periods of time. Prisoners were often not escorted back to their wings or workplaces in a timely manner.
  • The frequency of GP visits to the CSU has again failed to comply with the PSO 1700 requirement (minimum of every 3 days). The Board remains concerned that ‘consultations’ often take place through observation panels. Prisoners have claimed to be unaware who they were speaking to.
  • Although the distribution of medication has improved, there have been several times when critical/time bound medications have not always been delivered in a timely manner.
  • Problems with the issue of appointment slips remain (as highlighted in the last report) – prisoners report that either they do not receive these or they arrive after the time of the appointment.
  • During most of the reporting year it has been unclear who was responsible for answering prisoners’ complaints about healthcare provision and thus there has been a lack of timely response and in some cases no response at all.
  • Staffing shortages in the Mental Health team for several months have meant that there has been a backlog in the initial Well Man assessments. Currently there are only 2 permanent Mental Health nurses out of a compliment of 6.
  • Inconsistency in the provision of carers has persisted. This has led to undue reliance on a buddy system whereby other prisoners provide assistance to the less able prisoners (excluding personal care) and on prison officers, resulting in care plans not being fully implemented.
  • The presence of significant numbers of high dependency elderly and/or disabled prisoners has put unreasonable pressure on officers, who are having to undertake caring activities beyond their role. Difficult cases can leave prisoners in situations that are neither dignified nor humane. The situation also presents staff with challenges and the Board commends the work of officers in this area.
  • Substance Misuse services are overstretched – relaint on only one nurse and one support worker, to attempt to provide a seven-day service.
  • The Board is further concerned that the healthcare forum, which continues to be a model of good practice, has been cancelled on several occasions by the prison authorities over the latter part of the reporting period with little or no notice to the participants.
  • Healthcare applications to the IMB increased to 81 from 42 when compared to the previous reporting year.

Full IMB Report – HMP Wymott

IMB Report – HMP Hatfield

Reporting period – 01 May 2018 to 30 Apr 2019.

  • During the reporting period 2 ACCTS were opened, and no deaths in custody.
  • MDT tests were carried out this year, with only 18 tests proved positive.
  • Healthcare provision operates across the two sites and in the opinion of the Board, the dedicated and integrated team continue to provide an excellent service.
  • The weekly case management meeting is attended by all clinical pathways to ensure those with complex needs are proactively managed. Prior to this meeting officers will also attend to outline any concerns. This is becoming more significant due to the ever ageing prison population.
  • Dental care is provided by HMP Moorland and prisoners are taken from both sites (Hatfield and Hatfield Lakes) for treatment on a weekly basis. Waiting times are commensurate with those in the community.
  • The Substance Misuse team delivers a comprehensive service, educating prisoners on the effects of drugs and focusing on recovery paths. One-to-one’s are available on induction and those not seen are sent a pack with information about the service, describing overdose risks and how to access Substance Misuse services. Posters are displayed on all units regarding drug usage. Narcotics Anonymous have started weekly meetings and cover all substances including alcohol. The Board recognises the excellent work being carried and the close working relationship with other areas of healthcare.
  • There were no healthcare applications to the IMB, which is unchanged from the previous reporting year.

Full IMB Report – HMP Hatfield

IMB Report – HMP Kirklevington Grange

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • There were 11 ACCT documents opened in 2018, with only 2 incidents of self-harm.
  • There was 1 reported incident for use of force for the year.
  • There were no reportable incidents in 2018. However, concerns were raised in late 2018 – seemingly around the lack of guidance from the Fire Guidance Group as to what the correct washing detergent should be, when used with the “new” bedding. (!?!)
  • Healthcare provision at Kirklevington Grange operates as a satellite of HMP Holme House, sharing services and staff. Joint healthcare meetings are held bi-monthly.
  • Kirklevington Grange’s healthcare requirements differ from most other prisons due to its open prison categorisation. The prison cannot accept some prisoners with severe physical disabilities or wheelchair users given the nature of the estate.
  • The expectation is that prisoners transferred from other prisons would have had investigations and treatment for any acute health issues at the sending prison. New arrivals still undergo reception screening within 24 hours of arrival. A Complex Case Register identified and recorded continuing and social care needs.
  • During Dec 2018, there was a cancellation of GP/Nurse Prescriber clinics at short notice (sometimes on Friday for the following week) which had a negative impact upon those prisoners, who had taken time off work to facilitate appointments. This in turn led to their loss of earnings and/or negative entries in prisoner notes.
  • During the year, there were 36 referrals for Smoking Cessation support.
  • Missed appointments (DNA’s) totaled 778 over the reporting period, which were attributed by staff to prisoners a simply forgetting or that the specific health issues were no longer a problem.
  • Mental health referrals can be made via the healthcare team or by self-referral to the mental health team based at HMP Holme House. Issues around sleep patterns/insomnia and anxiety featured highly.
  • Mental health referrals were low, with healthcare staff reporting some reluctance by prisoners to acknowledge mental health problems due to stigma and concerns and therefore the perceived potential to be returned to closed conditions if the condition could not be safely managed at HMP Kirklevington.
  • Within the healthcare department a former storage area has been redecorated and furnished to provide a base for mental health staff. This facility has not been taken up however, with staff citing it as too small for their needs.
  • At the end of the reporting period waiting times were 10 days for routine dental referrals, although urgent cases are always fast tracked. There was no wait for GP appointments. Urgent referrals were accommodated via a 20-minute emergency slot incorporated into each session.
  • The Drug and Alcohol Recovery Team (DART) assessed prisoners on arrival at Kirklevington Grange. The substance misuse programme was peer led with three peer mentors within the establishment and two working in the community, creating links and addressing student groups in schools and colleges.
  • Exit interview data indicated 67% of prisoners had general satisfaction with healthcare at Kirklevington Grange, with many prisoners commenting that healthcare within the prison mirrors or exceeds provision in their home communities.
  • Healthcare applications to the IMB decreased to 5 from 10 when compared to the previous reporting year.

Full IMB Report – HMP & YOI Kirklevington Grange

IMB Report – HMP Warren Hill

Reporting period – 01 Jun 2018 to 31 May 2019.

  • During the reporting year, Warren Hill was rated as the top-performing prison in the country, according to the Prison Service’s own monitoring measures.
  • The occasional use of psychoactive substances continues to be a concern, with small quantities getting into the prison on a frequent basis. The prison works closely with the drug support agency when residents are found to be under the influence. The specialist substance abuse team is actively working with 80 to 90 residents at any one time.
  • Typically, there are usually one or two residents at risk of self-harm being monitored under the ACCT process. The ACCT procedure is well managed, and the documentation examined by the Board showed good recording of meaningful conversations.
  • There was one death in custody during the reporting year.
  • Healthcare at Warren Hill is provided in a spacious, purpose-built accommodation completed seven years ago. Nursing staff are on-site from 7am to 7pm, Monday to Friday. Evenings and weekends are covered by 111 and 999 services.
  • Doctors attend daily during the week. Dentistry, Podiatry, Physiotherapy and Optical services are provided on an appointment basis, and there are regular phlebotomy, asthma, wellbeing and smoking cessation clinics. Residents sometimes fail to keep appointments, especially as they are expected to take responsibility for making and keeping these appointments themselves. Access to most aspects of healthcare in the prison compares positively with much of current provision in the community.
  • Residents complained that healthcare complaint forms were not available, and the Board failed to discover them either. This situation was duly rectified and complaint forms are now available both in the healthcare department and on the units.
  • The number of residents on medication is high, in part reflecting the older age profile of the prison’s population. As a consequence of Pregabalin and Gabapentin being reclassified as controlled medications, the number of residents who have to attend the healthcare department to receive ‘seen to take’ medication up to four times a day has risen to as many as 30. The requirement for nurses to now visit residents on the residential units to administer this medication also places additional pressure on healthcare staff and accommodation.
  • Healthcare applications to the IMB increased to 6 from 4 when compared to the previous reporting year.

Full IMB Report – HMP Warren Hill

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