This report was on an unannounced inspection of HMP Buckley Hall between 15–26 July 2019, and was published in November 2019.
“Work to reduce self-harm and support those in crisis was very good. The prison’s approach was multidisciplinary, based on evidence and good supervision but, most importantly, afforded men in need of support good quality of care.” – Peter Clarke
General Points of Interest:
Levels of violence had halved in the last 12 months, with only 52 incidents recorded for the first 6 months of 2019.
The number of adjudications had increased from 591 at the previous inspection to 791; this was similar to other category C prisons.
Substance use had increased since the previous inspection with the positive mandatory drug testing (MDT) rate now recorded as 15% for the previous six months. Some effective health promotion across the prison has been a contributory factor in deterring prisoners from taking psychoactive drugs, with only 1.6% of positive MDTs were for psychoactive substances.
There had been one self-inflicted death since the last inspection.
Healthy Prison Outcomes:
|Rehabilitation & Release Planning||3||4|
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
Key Points of Interest: Health, Well-Being and Social Care:
A range of strategic clinical governance meetings covered essential areas and commissioners held regular contract reviews. During the inspection, however, gaps were identified in some local clinical governance; a few areas were addressed immediately but others needed further attention.
The service risk register did not sufficiently reflect local concerns. Only 6 clinical incidents had been reported in the last 6 months and inspectors found some issues that should have been reported but were not.
There was a well-established patient engagement group, chaired by a community advisor (peer mentor), using wing representatives to seek prisoners’ views about health services and implemented suggestions. The peer worker also worked in the healthcare centre to inform staff when patients arrived for their appointments and followed up those who did not attend. The role was organised by the prison but did not receive formal healthcare oversight or support.
The health centre had been redecorated and now resembled a community health centre with a bright and inviting reception and waiting room. The centre was clean and well maintained, and there had been a recent infection prevention and control check. However, inspectors found that sharps bins were not managed effectively, which the recent check had not identified.
Emergency equipment was in place but the emergency bag in the segregation unit had been stored on the floor in the staff toilet and was very dusty. Some equipment checks had not been signed off, and the date on one emergency medicine had not been amended for storage at room temperature. Monthly management checks had not identified these concerns.
Primary care staff were available from 8am to 7pm every day. The small and well-established team received suitable training, but managerial and clinical supervision were insufficiently prioritised and recorded.
The patient records that were reviewed were clear and demonstrated the patient’s involvement in their care, and consent was recorded for treatment and information sharing. However, there was no service-wide review of entries or record keeping audit.
There had been 12 health complaints in the last year through the trust’s complaints system. The Head of Healthcare saw most complainants as part of this process. Response letters were courteous and prompt but did not include information on a formal route for prisoners to follow if they were not satisfied with the response.
The prison-wide approach to promoting health and well-being with a wealth of activity was impressive. An engagement and well-being calendar was followed to mark events such as mental health awareness week, where joint activities and events enabled open discussion on mental health.
The equality and well-being clinic was particularly noteworthy as good practice. All prisoners were invited to attend an appointment with the health and well-being coordinator and the equality officer between six and eight weeks after arrival to ensure the prison had recorded all relevant information. This had resulted in effective information sharing, referrals and resolution of some issues.
Nurses worked effectively with local specialists to improve screening and treatment for blood-borne viruses and national screening programmes. A recent Saturday screening event had included testing 230 prisoners with appropriate follow up in place.
Relevant health promotion literature was displayed in the healthcare waiting area and on the wings. Good smoking cessation support was available, including for those who wanted to stop vaping.
Healthcare Assistants, trained and supervised by registered nurses, screened new arrivals in reception to identify immediate health needs. The room in reception used for screening was not clean enough; with out-of-date hand gel and a flammable air-freshener spray. This was rectified during the inspection.
Patient attendance at healthcare appointments was generally good, and had improved with a recent change in the daily regime. Patients with long-term conditions were overseen by individual nurses and GPs. There were some good care plans in patient records, but clinical information and coding of long-term health conditions were not always recorded accurately and used to inform patient care. As a result, the health conditions for a few patients had not been promptly identified and reviewed.
Referrals to secondary care services were well managed. Fewer than 10% of external appointments were cancelled due to lack of officer escorts, and these were rescheduled promptly.
Healthcare staff contributed to the weekly prison safety meeting to ensure that prisoners with complex needs were identified and relevant information shared.
The Mental Health (MH) service offered a very good quality of support for prisoners with mild-to-moderate to more complex needs. The service was currently available from Monday to Friday from 7.45am to 4.15pm. Additional posts had been funded to cover weekends and run some groups.
Guided self-help material was available, and mindfulness and relaxation techniques were encouraged. The MH team had produced 100 relaxation discs for loan, in liaison with the safer custody team, which was a positive initiative.
The MH team attended ACCT case management reviews for prisoners at risk of suicide or self-harm and the weekly segregation unit meeting.
There were around MH 20 referrals a month with an open referral system.
Most custody staff had received mental health awareness training in the last 3 years, including new officers who had completed it in their initial training.
The Substance Misuse Team (SMT) had staff that were competent, well supervised and had good access to relevant training.
The SMS team saw all new arrivals (up to 35 a month) during induction, and offered support and harm minimisation advice.
Around 119 patients were currently engaged in psychosocial therapy at the time of the inspection, with relaxation therapy and acupuncture proving popular. An extensive range of one-to-one and group sessions and programmes were available and could be assembled into individual packages of treatment. Joint work was available to prisoners with complex substance use and mental health needs.
Prescribing and clinical management were consistent with national guidance and included joint 13-week reviews.
3 prisoner recovery champions were employed along with up to 18 voluntary recovery champions throughout the prison. All were suitably trained and supervised. The recovery champions recognised as being inspiring, and some were being trained to pursue a career in recovery work after release.
Around 75% of prisoners prescribed medication had it in-possession following appropriate risk assessment at reception, and reviewed when there was a change of circumstance.
Over-the-counter remedies to treat minor ailments were available, and paracetamol was on the prison shop list. A weekly list of paracetamol purchases was sent to the healthcare manager to ensure safe governance of this.
Inspectors observed unsupervised medication queues in the health centre, which increased the potential for diversion of medicines, and officers failed to challenge prisoners vaping in the waiting room.
Medicines were delivered and stored securely with stock checks. Arrangements to ensure safe temperature storage were not sufficiently effective. High temperatures had been recorded on room and refrigerator monitoring sheets and not reported so that remedial action could be taken.
There was a range of patient group directions (PGDs), which allowed nurses to administer specified medicines without a prescription, mainly for immunisations. However, there was no record of the signature required by nurses who used PGDs or the authorising manager.
There were bimonthly medicine management meetings and a prescribing formulary, and drug alerts were managed well. There was good oversight of tradable medicines, and an active approach to the management of pain with appropriate prescribing based on clinical assessment. A full range of standard operating procedures (SOPs) and policies were accessible to staff electronically, but there was no documentation to show that they had been read by staff, which needed to be addressed.
As part of the survey, 58% of prisoners rated the overall quality of the health services as being either very good or quite good.
The CQC issued 2 Requirement Notices against Regulation Standards.
Recommendations: Health, Well-Being and Social Care:
- Governance arrangements should ensure that all aspects of the health service are monitored and delivered in line with required guidance.
- Prisoners who make a health care complaint should receive information about how to raise any concerns to external agencies if they are dissatisfied with the initial response.
- All patients with long-term conditions should be promptly identified, assessed and receive reviews of their conditions.
- There should be effective officer supervision of medication administration queues in the health care centre to reduce the risk of diversion and manage prisoner behaviour.
Good Practice: Health, Well-Being and Social Care:
- The active approach taken by the whole prison to promoting health and well-being was impressive; it helped to improve the general well-being of prisoners and generated a positive atmosphere in the prison.
- The equality and well-being clinic was a positive initiative demonstrating effective joint working to help identify prisoners with specific needs, enhance information sharing and promote the well-being of all prisoners.
- The annual health and well-being review for prisoners over 50 was a good opportunity to explore any health or mental health issues and act on them, promoting well-being.
- The service provided by Survivors Manchester was an excellent resource, offering prisoners who had experienced sexual abuse or trauma a safe and therapeutic environment to make positive life changes.
CQC Requirement Notices Issued:
Regulation 17(1) Good Governance
How the regulation was not being met:
- The registered person had systems or processes in place that operated ineffectively in that they failed to enable the registered person to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk. In particular in relation to: infection control, medicines management, equipment and risk management.
- Systems to identify and address the risks associated with infection prevention and control were not effective.
- Infection prevention and control audits had not identified risks arising from local processes.
- Three sharps disposal containers and one medicine disposal container were not signed or dated. Two sharps disposal containers had been in use for over three months.
- The reception healthcare screening room was dirty and dusty.
- There were out of date hand gels in an unlocked drawer in the reception healthcare screening room, which had no hand washing facilities.
- Systems to identify and address the risks associated with medicines storage and use were not effective.
- Records showed that the temperature of one medicine fridge had been out of range for 4 consecutive days in July 2019 but not reported and no remedial action was taken.
- Records showed that the pharmacy room temperature where medicines were stored had been out of range for 2 days in July 2019 but was not reported and no remedial action was taken.
- The expiry date for glucagon had not been amended for storage at room temperature.
- Patient group directions had not been signed by staff and authorised by managers in line with legal requirements.
- Systems to identify and address the risks associated with healthcare equipment use were not effective.
- Monthly management checks had not identified occasions when daily equipment checks had not been carried out by staff.
- There were missing signatures on 6 occasions for the medicinal gas checks during May and June 2019.
- There were missing signatures on 6 occasions for the suction and automated electronic defibrillator checks between March and July 2019.
- Systems to identify, manage and learn from risks were not effective.
- Not all incidents we identified had been reported through the incident reporting system. This meant that opportunities for shared learning and service improvement were missed.
- The risk register did not reflect management concerns about the service at HMP Buckley Hall and was predominantly focused on the service at HMP Manchester.
Regulation 18 (2) Staffing
How the regulation was not being met:
The service provider had failed to ensure that persons employed in the provision of a regulated activity received such appropriate supervision as was necessary to enable them to carry out the duties they were employed to perform:
- Management and clinical supervision were not taking place regularly in line with the trust policy.