This report was on an unannounced inspection of HMP & YOI Bronzefield between 26 Nov to 06 Dec 2018, and was published in April 2019.
“Bronzefield was an overwhelmingly safe prison…. There was, however, evidence to suggest that the population of prisoners held had become more challenging in recent years, with many experiencing significant mental health problems.” – Peter Clarke
General Points of Interest:
The catchment area had increased and now included 95 courts, up from 71 at the time of the last inspection.
The proportion of remand prisoners had increased since the previous inspection and was now almost one third of the total population, including a large number from London.
The number of prisoners moving through the prison was large, with 71% of sentenced prisoners had been in the prison for less than 6 months. In the previous 6 months, 1057 prisoners had been released.
There had been a 50% increase in the number of prisoners accessing substance misuse support services wen compared to the previous inspection in 2015. The use of segregation had also doubled during this time.
Incidents of self-harm remained high – 925 incidents took place in the previous 6 months.
Healthy Prison Outcomes:
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
Key Points of Interest: Health, Well-Being and Social Care:
There were 12 nurse vacancies during the inspection, but regular agency staff were used to manage them. Permanent staff were being recruited on an ongoing basis. All health care staff received clinical supervision.
Electronic record keeping was good and some positive interactions between staff and prisoners were observed. Interpretation was used appropriately for prisoners who did not speak English.
The service had identified issues with infection prevention and control across all clinical areas. Work was in progress to address those concerns.
Emergency equipment was located appropriately across the prison and trained health care staff provided a 24-hour response. Officers were aware of medical emergency codes and ambulances were called promptly.
Prisoners accessed health care services by applying for them through the electronic kiosks. Administrative staff only dealt with applications on week days. A process for reviewing applications at the weekend was introduced following feedback during this inspection.
The health care service had received 93 complaints in the 3 months prior to the inspection. A confidential process was now in place and responses were polite and timely and addressed the issues raised.
Health promotion material was displayed throughout the prison. Health service information was available in reception, but it was only in English. Smoking cessation support was provided through a daily clinic and involved peer workers and custodial and health care staff.
Prisoners arriving late in the evening were still seen by a nurse and a GP was on site until 9pm. An out of hours’ GP service was available. A comprehensive second screening followed within 72 hours.
GPs in reception initiated opiate substitution therapy, but clinical resources for ongoing treatment were stretched. The number of prisoners receiving methadone or buprenorphine had risen by almost 50% to 172 since the previous inspection, but the number of substance use prescribing clinics had not increased, which meant that reviews and changes to treatment regimes could be delayed. Limited resources also affected managerial oversight and service development.
Access to health care was reasonable. Triage drop-in sessions were available on each house block, and nursing staff held other clinics, including those covering sexual health, phlebotomy and long-term conditions.
The nurse-led inpatient unit had 18 beds for prisoners requiring physical care or mental health support. An admissions policy was in place, and patients were appropriately located there. Officers, nurses and mental health staff provided compassionate, caring support for patients in the unit. Regular handovers ensured staff were aware of patients’ care needs and plans. Management oversight was appropriate and patients were regularly risk assessed. A weekly multidisciplinary meeting enabled staff to receive updates on inpatients and to discuss those of concern across the prison, which was good.
External hospital appointments were well managed. 4 escorts were available every day. The reasons for any rescheduling were recorded, but few appointments were cancelled because of a lack of officer escorts.
Medicines were mostly obtained promptly, but prisoners complained about delays. The pharmacist robustly oversaw prescribing, which included a clinical assessment of all medicines. A pharmacist-led clinic was held once a week.
Medicines were administered from the health care centre and 4 house blocks, 4 times a day. Officers supervised medicine administration, but their ability to control prisoners and ensure confidentiality between administration areas was varied.
Fridge temperatures were routinely monitored and were within acceptable ranges. The supply and administration of medicines were recorded on SystmOne. Staff explained the process for following up prisoners who missed doses.
The in-possession policy ensured the person and the medicine were assessed. Prisoners ordered their own in-possession medicines; nurses ordered it when necessary.
There was a procedure for accessing medication out of hours, but no written policy, which was addressed during our inspection.
Audits of controlled drugs (CD) registers took place regularly and CD keys were managed robustly. Apart from the CD cupboard in the health care department and one of the house blocks, CD cupboards did not comply with legal requirements. In the morning nurses dispensed CDs from the original pack into bottles, which they labelled with the name of the prisoner and the medicine. Two nurses witnessed this process and signed the register. Nurses took the bottles to the house blocks and administered the drugs without a witness. This unacceptable practice ended during the inspection following feedback.
A well-attended drug and therapeutics committee met regularly. Prescribing data on potentially tradable and high cost medicines were reviewed.
In our survey, 69% of prisoners reported having a mental health problem and 41% of them said they had received help for their problem while in the prison. Prisoners could refer themselves to mental health services via the electronic kiosk, but information about mental health services was confusing because 2 providers were offering mental health support. Police, court, prison and health care staff could also refer prisoners.
A daily referral meeting took place during which mental health practitioners discussed all new referrals and allocated prisoners appropriately. Of the 205 prisoners referred to the service in the 2 months prior to inspection, 64 had been accepted by the team for a mental health assessment. Others were referred to other services or further information was requested. Of the 123 prisoners on the caseload at the time of the inspection, 12 were being treated under the care programme approach (CPA).
Mental health staff were well integrated into the rest of the prison and provided good support to those in the segregation and inpatient units. Practitioners attended assessment, care in custody and teamwork (ACCT) case management reviews for prisoners at risk of suicide or self-harm related to their caseload. However, more work was ongoing to improve their involvement in the process.
In the 6 months prior to the inspection, 9 prisoners were transferred to external mental health units under the Mental Health Act. Only one had been transferred within 2 weeks of their assessment.
A community worker was part of the mental health in-reach team and provided good support to prisoners, both prior to release and for up to 6 months post release.
A weekly multidisciplinary meeting to discuss prisoners with complex health issues was well attended by a wide range of staff, including representatives from the offender management unit and local authority social services departments. As a result, well-informed decisions could be made regarding their release and transfer.
The integrated substance misuse service had developed good links with community providers to enable treatment to continue on release, and local agencies conducted pre-release assessments at the prison to plan ongoing support. Prisoners consistently received harm reduction information, and overdose prevention now included naloxone training to treat an opiate overdose.
As part of the survey, 36% 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:
- Clinical substance use services should be sufficient to meet demand and have effective managerial oversight.
- All clinical areas should comply with national standards for infection prevention and control.
- Barrier protection should be well advertised and widely available.
- Stock medicines should be stored appropriately and audited regularly so that supplied stock can be reconciled against prescriptions issued.
- Prisoners referred to primary mental health care services should be assessed within two weeks.
- Patients requiring a transfer under the Mental Health Act should be transferred within the current transfer time guidelines (a repeated recommendation).
Good Practice: Health, Well-Being and Social Care:
- The daily smoking cessation clinic provided prisoners who smoked with easily accessible support to help them give up.
- The gym offered a wide range of healthy lifestyle programmes that were specifically tailored to individual prisoners’ needs.
- Dentists provided prisoners with a range of treatment options, recorded prisoners’ consent and offered a clear rationale to inform prisoners’ choice of procedure. This meant prisoners had an influence on their care and knew what options were available.
CQC Requirement Notices Issued: