This report was on an unannounced inspection of HMYOI Cookham Wood between 10–20 December 2018, and was published in April 2019.
General Points of Interest:
50% of officers were in their first year.
Two-thirds of children said they had been physically restrained while at Cookham Wood.
Levels of self-harm and open ACCT documents remained low compared to similar establishments. The quality of ACCT documentation had improved since the last inspection. However, there was a lack of input from healthcare in too many of the cases inspectors reviewed, particularly at the time of closure.
The use of constant watch procedures was excessive and operational managers did not always complete defensible decision logs before segregating children on an ACCT.
Time out of cell had improved slightly since the previous inspection but was still insufficient to meet the needs of children. We found an average of 25% of children locked up during the core day. Children spent an average of 6 hours out of their cell each weekday and only 12 hours in education each week.
Healthy Prison Outcomes:
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
Key Points of Interest: Health, Well-Being and Social Care:
In our survey, 82% of respondents said they had been helped with a health problem at the prison. Children spoke of being very satisfied with the quality of health care provision.
Health care professionals were available from 7am to 9pm each day with slightly shorter hours at weekends. There had been a striking improvement in staffing since the last inspection, now with only 0.5 vacancies in primary care. Staff were competent and motivated and felt well supported. Each provider’s staff were in receipt of clinical and managerial supervision, and all appraisals were up to date. All mandatory training had been completed except for one individual.
Access to all health services continued to be hindered because of delays in movements and frequent lockdowns, wasting valuable clinical resources, with one member of staff quoted as saying ‘we have the same row every Wednesday’ (because patients had not arrived for their clinics). On Wednesday it was observed that only 3 patients arrive for a therapy group for 10 patients, and a patient arrived 20 minutes late for an appointment with a consultant clinician, which curtailed therapy. The overall DNA rates were too high, for example 9.4% for the GP and 33.9% for the optician, which was unacceptable.
Service user feedback for all providers was positive in exit surveys, patient experience reports, the prison youth council and health council. There had only been 4 complaints in 2018.
Treatment rooms were clinically appropriate and cleaned each day. Infection Control had improved: a recent audit had scored 91% (85% in 2017).
Smoking cessation support lasted up to 6 weeks and included nicotine replacement patches. Children seemed to respond well to treatment.
The dedicated health care room in reception remained separated from the main reception area. Nurses said that custody staff stood outside the room on a risk-assessed basis, but potential safety issues remained because of the location of the room.
Children could request health services on the wings via the ATMs or through pictorial applications, which were collected daily by the Health Care Assistants.
External hospital appointments were well managed. Only 5% of 253 appointments in 2018 to date had been cancelled and rebooked.
There were 89 patients in one-to-one therapy, with a range of mild to moderate and complex mental health conditions. Cases continued to be triaged using the Comprehensive Health Assessment Tool (CHAT), and prioritised through an effective weekly multidisciplinary referral meeting. Urgent cases were responded to promptly through the team’s duty rota. The clinical records that we examined demonstrated individual formulations and treatment pathways.
There was a wide range of focused group sessions, including art therapy, managing emotions and resilience groups, with a lifer group about to start. Up to 30 patients could attend groups at any time. However, difficulties remained in getting patients to one-to-one and group sessions, largely because of the lack of escort officers. Between July to September 2018 only 3% of groups had had full attendance because of regime constraints, which represented a waste of expensive NHS resources.
The sexual behaviour service continued to provide a valuable assessment and intervention service for up to 15 patients at a time.
The MH team worked effectively with other departments, including case workers, and 49% of officers had been trained in emotional and mental wellbeing.
Children had mainly used cannabis and alcohol in the community. About half the patients (80 plus) were in impressive individual or group therapies at any time. The personal social and health education programme included substance awareness groups and bespoke sessions and, in our survey, 60% of respondents said they had been helped with a drug or alcohol problem. However, attendance for therapy was hampered by the restricted regime and too many appointments had to be rescheduled.
Medicine management was efficient. Medicines were supplied by the pharmacy at HMP Rochester on a named patient basis via a secure supply chain. Medicines storage was efficient, with clear differentiation of supervised and stock medicines. Nurses undertook stock checks and there was good oversight by the pharmacist who visited each week.
Prescribing was age appropriate and most medicines were administered twice a day in a confidential, safe and supervised manner. The use of in-possession medicines was uncommon because of the risk profile of the population, although patients could keep medicines, such as inhalers and ointments, in their cells.
Children experiencing pain at night could request paracetamol from wing staff which was carefully logged by officers and monitored by nurses. Medicines such as insulin pens (for diabetes) and EpiPens (to counteract allergic reactions) were kept by nursing or custody staff and given to children as necessary on a risk-assessed basis.
Recommendations: Health, Well-Being and Social Care:
- Patients’ access to health care should not be curtailed by prison issues and they should arrive promptly for consultations and therapy.
- All automated external defibrillators should be in good working order with a clear audit trail to ensure they are regularly checked and maintained.
Good Practice: Health, Well-Being and Social Care:
- The CHAT neuro-disability assessment ensured that all children with functional impairments were identified for further testing.
- The post-restraint health assessment checks ensured that a child who had been restrained was seen by an independent person who was concerned for his welfare.
- Medical alert wristbands and the information given to custody staff on potentially life-threatening health conditions continued to ensure the support and safety of patients.
- The service user development programme remained an excellent initiative to help remove the stigma of emotional and mental health needs and promote self-esteem.
- The regular medicine use reviews for patients with unusual medicines and/or controlled drugs ensured that prescribing was assured and appropriate.
CQC Requirement Notices Issued: