IMB Health Notes – w/c 16 Dec 2019

The IMB reports published during the week commencing 16 December 2019 were from these 7 establishments:

  • HMP Stafford
  • HMP Lancaster Farms
  • HMP Ranby
  • HMP & YOI Bedford
  • HMP Buckley Hall
  • HMP Birmingham
  • HMP & YOI Thorn Cross

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 Stafford

Reporting period – 01 May 2018 to 30 Apr 2019.

  • Self-harm incidents increased by over 50% during the reporting year, but at 134 remained relatively low compared with similar prisons and against the national average. Almost 85% of these incidents involved cutting, mainly by a small number of prisoners who repeated their actions, e.g. 2 prisoners were responsible for 59 events, which is 44%.
  • During the year, 177 ACCT documents were opened, some for the same prisoner more than once. A slight decrease when compared to the 139 in 2017–2018.
  • There were 3 deaths in custody during the reporting year, and like the 6 deaths the previous year, all were thought to have been a result of natural causes.
  • Improved freeflow saw the opening of more gates and a trusting approach to prisoners who move freely to medical and other appointments during the day.
  • Physiotherapy continues to be a problem, although not unexpected with the ageing population. Waiting time figures have substantially increased at the end of the reporting period, with plans are in place to reduce these significantly by the end of the first month of the next reporting period.
  • 5 nurses and other healthcare staff are trained to deal with podiatry which, together with extra sessions, during the last quarter of the reporting period, has seen the waiting time of 6 weeks reduced to nil.
  • During the last quarter, the waiting list for the optician was extremely long and extra sessions were booked to cope with the large numbers.
  • X-ray and other scans are carried out in the prison as needed by bringing in mobile resources.
  • By the end of the reporting period a mental health on-call service was made available for weekends.
  • The Board recognises the positive progress made by the head of healthcare and their team in the management of waiting lists. If a list becomes too long, extra sessions are brought in.
  • During the reporting period, 24/7 cover was introduced and, whilst there were some initial teething problems, this service has proved to be beneficial, especially to those prisoners requiring the provision of night time medication. Prisoners received clinical advice and support throughout the night, which lessened the need hospital escorts during the night.
  • Healthcare champions have been appointed from the prisoner population and are located in the healthcare department and on the wings to monitor the use of the facilities and to obtain feedback from those prisoners using healthcare services. They receive training on taking and reporting on blood pressure. The champions were also actively involved in a highly successful and well supported prisoner healthcare promotion event held in the gym in January 2019.
  • The Board is concerned that the supervision of medication issue continues to be a problem. The governor explained to the Board that his expectation was that queues are to be monitored by an officer who had ‘line of sight’. Rota visits by the Board show that this is not always the case, and the risk of older and vulnerable prisoners being bullied for medication remains.
  • The Board has watched with interest the plans for a designated wing to become a regional social care facility, equipped for prisoners with demanding social care needs. This facility would allow prisoners to receive the correct type of support in an appropriate facility. The plans appear very close to being finalised; however, progress appears to have stalled, despite discussions being under way for two years.
  • Healthcare applications to the IMB increased to 33 from 18 when compared to the previous reporting year.

Full IMB Report – HMP Stafford

IMB Report – HMP Lancaster Farms

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • Incidents of self-harm by prisoners have increased during the year whilst the number of ACCTs has diminished.
  • Staff report a modest decline in substance misuse during the year, largely due to strategies to reduce supply of illicit substances. The Board welcomes the detailed monitoring of Code Blue alarms, attributable to substance misuse, commenced towards the end of the reporting period.
  • Working relationships between those involved in the management and delivery of healthcare services continue to be good as reflected in the CQC/HMIP reports in 2018, although new genito-urinary medicine clinics have been introduced, as well as a new paramedic role, and extra dental sessions in response to the findings of that report.
  • Friction exists when medications are withdrawn, leading to healthcare and IMB applications. Drug misuse is identified as the major health issue. Whilst the drug recovery team work well with the GP services, the incidence of psycho-active substance use has led to increased demands.
  • Overall, healthcare services work well at reception. However, some prisoners have been disadvantaged at the time of transfer from another prison (eg medication not received on transfer; loss of contact with previous prison health care services). Both health and prison staff are aware of these issues; some prisons have now changed their procedures re transfer of prisoners/medication/records. The position was worse on Fridays, however extra GP clinics are now available for first-night prisoners on Fridays.
  • Waiting times for GP appointments are at 14 days (7 days last year). However, urgent slots are available each day. Sickness reporting by prisoners is relatively high; putting pressure on services. Primary care nurses and healthcare staff support the health centre (10–12 hours per day)
  • The dental service is still under pressure. The waiting list time is now between 6 and 8 weeks. There was a change in the delivery of dental services in late 2017; snagging problems included the loss of dental records (also two dental nurses resigned). By the end of 2018 a more stable dental service was established with new dental nurses and a dental hygienist. Attention has been given to increasing the number of consultation periods per week.
  • The issue concerning the secure storage of medication has now been resolved. However, the pharmacy contract is commissioned through Lloyds Pharmacy in Preston. Whilst the system/medical records work well, there are delays before medications arrive at the prison (especially at weekends). In addition, more focus is required on prescribing reviews (especially re long-term conditions) and funding is now available to employ a 0.8 full-time equivalent pharmacist.
  • Healthcare applications to the IMB increased to 30 from 20 when compared to the previous reporting year.

Full IMB Report – HMP Lancaster Farms

IMB Report – HMP Ranby

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • ACCT quality improved during the year with further focus on the single case manager model to provide consistency of care to men subject to an ACCT procedure. Additional training has been provided to ACCT case management to improve skills in identifying risks and triggers and building effective care maps around the issues highlighted. A duty worker is available daily from the mental health team to provide attendance and input to all ACCT documentation.
  • An IMB member attends the safeguarding meetings and a member will attend ACCT reviews if informed when they are taking place. Difficulty arises with ACCT reviews as the time on the review day is not set and healthcare will arrive at the houseblock at a time that suits them and without necessarily giving adequate notice to IMB.
  • There was one death in custody in December 2018 which was described as a ‘natural causes death that is drug related’.
  • As of April 2018, a 24-hour nursing service is now provided.
  • Mental awareness peer support (MAPS) navigators are also available as peer supporters who are trained by the mental health team to provide 24-hour practical support to prisoners struggling with their mental health.
  • In addition to the normal GP clinic service, healthcare also provides dentistry, optometry, podiatry, physiotherapy and pharmacy services. Waiting times are closely monitored to ensure compliance with key performance indicator (KPIs) which are reviewed at contract review meetings. Pharmacy services have separate KPIs and all prescriptions are ordered via an external pharmacy including both urgent and routine. Review data is shared with HMP Ranby’s performance team and are seen as being equivalent to or better than comparable external services.
  • Long waiting times in excess of 28 days are still being experienced for required transfers to secure units. During this reporting year 6 prisoners were sectioned.
  • Physical and mental health of prisoners is addressed through a monthly ‘Time for You’ session which is an educational forum that has a specific theme. Patients are invited to attend and feedback is requested from attendees. The mental awareness peer support (MAPS) programme continues with navigators who work closely with the mental health team and two dedicated healthcare representatives (prisoners) who provide feedback from patients on the houseblocks. A healthcare forum meets once a month where dedicated prisoner representatives bring issues from the houseblocks for discussion. An IMB member regularly attends and considers this to be extremely worthwhile meeting where problems are actively addressed and where all members of the group are provided with an overview of prison health issues.
  • Missed appointments run on average at 20% over the year and efforts to improve communication between the prisoner, prison staff and healthcare should be considered to reduce this high figure although these figures are already reported daily at the morning meetings.
  • The Board commends the healthcare staff for their continuing hard work and commitment to prisoners’ wellbeing.
  • Healthcare applications to the IMB increased to 55 from 42 when compared to the previous reporting year.

Full IMB Report – HMP Ranby

IMB Report – HMP & YOI Bedford

Reporting period – 01 Jul 2018 to 30 Jun 2019.

  • The number of self-harm incidents shown an upward trend for the reporting year. The figure for June 2019 is over 3x that for July 2018.
  • There were no deaths in custody during the 12 months covered by this report.
  • Waiting times have mostly been better than in the previous reporting year and compare favourably with what might be expected in the community. Whilst the waiting time for mental health assessment at 8 days does not meet the target of 5 days, it has improved from the 10-day wait in May 2019.
  • Missed appointments for the doctor are on average 14% from September 2018 to June 2019 and, for the dentist, 15%. The most common reason for missed appointments is that the resident declined – 21% in the case of medical and 14% in the case of dental appointments.
  • Residents with substance misuse issues should be located on the wing adjacent to the healthcare unit on their first night. This wing provides the specialist services required by residents with substance misuse issues. Access to these services and supervision by staff trained to deal with their particular needs is crucial from the first night. However, in the past year, success in achieving this has not improved. In 4 of the 6 months between January and June 2019, only 40% to 44% were appropriately located.
  • Since the classification of gabapentin and pregabalin as controlled drugs in April 2019, a considerable amount of planning has been involved in setting up the assisted withdrawal programme to get residents off these drugs. Staff and residents have been fully involved in the setting up of the programme.
  • An excellent information postcard has been produced, involving the education department with graphics by residents. There are also posters in various locations with further information. Letters have been sent to the doctors of residents on these drugs requesting that they do not issue repeat prescriptions to relatives (there had been occasions where they were sold to other residents). On release, letters are sent to the doctor informing them of a reduction or withdrawal.
  • The frequency of MH attendance at segregation reviews has doubled from last year, although at less than 50% it is still deemed as being inadequate. The reasons for this is a combination of a shortage of resources and a reluctance to prioritise attendance over other activities, although the Board believe that this is mistaken and urge the mental health team to discuss with the governor where they might most profitably concentrate their time.
  • The MH team has a good record of attendance at ACCT reviews (more than 90%) and its contribution has been commended by the regional review team. Staff also now attend the safer custody meetings on a regular basis.
  • The lack of group-based activities for mental health support in the prison was noted in the last IMB report. This year the team has been running a regular ‘emotion management’ group, set up specifically to address the needs of residents at HMP and YOI Bedford. It is short (6 weeks) and looks at ways to manage anxiety, low mood and frustration (anger). It also includes advice on activity scheduling, managing self-harm, and finding positive ways of coping on the wings. The team has also been running a group with the drug rehabilitation support team on mental health and substance misuse. These are very welcome developments and we believe that groups of a similar nature should be a permanent feature of the mental health service in the future.
  • There is also now a systematic process for monitoring outcomes, which did not exist before. The target time from referral to being seen is 5 days, but the data indicate this is seldom achieved (usually around 8 to 12 days).
  • A contributing factor may well be the volume of referrals coming from reception, often between 100 and 150 in a week. Each referral takes over an hour to process but usually less than 20% are accepted by the mental health team. Given the pressures on staff time, it seems that streamlining the process would deliver a number of benefits.
  • There is still little direct training of officers on mental health issues by the team. Sessions have been offered but take-up has been poor. This is a lost opportunity and contributes to the relatively low profile of the mental health team and the lack of integration within the establishment.
  • There have been no deaths in custody this year, which is welcome. The mental health team feels that it has made a contribution to this outcome. On the other hand, the overall number of self-harm incidents has increased and remains stubbornly high.
  • Healthcare applications to the IMB increased to 34 from 11 when compared to the previous reporting year.

Full IMB Report – HMP & YOI Bedford

IMB Report – HMP Buckley Hall

Reporting period – 01 Aug 2018 to 31 Jul 2019.

  • The safer custody department remains one of Buckley Hall’s strengths. It is well led and staffed by experienced and committed uniformed and non-uniformed staff.
  • The ACCT process is well organised and quality assured. In terms of ACCT documentation, it is the judgement of the Board that in the ACCT documents, the records of observations are often more thoroughly recorded than those of the conversations with the man concerned.
  • In 2018, an external healthcare audit reported that there was a relatively high level of patient satisfaction at Buckley Hall, with 32% of the men surveyed saying that it was either ‘good’ or ‘excellent’ – which compared to a figure of 20% for two comparator prisons.
  • Board members have attended some of the patient forums and have reported that these are more effective when a representative from the senior management team is present. The department is judged to work collaboratively with other prison departments, such as safer custody, the gym and the kitchens.
  • The Board welcomes the decisions to increase the staffing for mental health services and provide a 24/7 service. The team is judged to provide an effective and integrated service within the prison, and their diagnoses and advice are respected and valued by prison staff and managers.
  • The medicines dispensary section for the nurses is cramped. There is a relatively high volume of prescribing in-possession medication, and while the queue for collecting medication is generally orderly, it is often self-policing as the officer detailed to the healthcare department takes the register outside the building, at the external gate to the department compound.
  • A new drugs strategy has been published, and the Board commends the governor for being prepared to consider innovative and less punitive ways of managing those with substance abuse problems, which support their recovery better. The protocol for psychoactive substances (PS) appears to be satisfactorily embedded into the prison regime, and men thought to have been under the influence of PS are monitored, interviewed and offered harm-reduction advice. There are multidisciplinary meetings to address the issues of prolific drug users. The men queuing for methadone in the morning are usually, although not always, supervised by an officer.
  • The drug and alcohol recovery service (DARS) attracts appropriate men, is well received by them and has good treatment outcomes. It is proactive and has introduced a number of new initiatives, such as acupuncture, a therapy room, motivational speakers and family days for men engaging in the programmes. The new drug recovery pathway is very promising – with its structured programme, for which the men taking part are paid. When the Board interviewed one of the mentors, he spoke highly of DARS and said that it was the best service he had experienced while in prison.
  • Following an inquest this year, as a result of a death in custody, changes were made to the night pegging system and new first night procedures were introduced. In terms of the 2 deaths from natural causes, it is hard to fault Buckley Hall’s care of these terminally ill men – in both cases, the handcuffing procedures were queried by the coroner and, on both occasions, they were satisfied with the appropriateness of the prison’s response and its humane care of the prisoner and his family and friends.
  • Healthcare applications to the IMB decreased to 27 from 31 when compared to the previous reporting year.

Full IMB Report – HMP Buckley Hall

IMB Report – HMP Birmingham

Reporting period – 01 Jul 2018 to 30 Jun 2019.

  • The Board recognizes that the prison has made progress since the HMIP inspection report. Following the Urgent Notification to improve, a new governor was appointed, there was significant capital investment and staffing levels were raised with experienced prison officers deployed from other prisons. At the same time the number of prisoners (operational capacity) was reduced from 1340 to 977.
  • A joint approach to managing nicotine replacement therapy (NRT) between healthcare and operations ran a weekly session with a compact. This ran successfully for the first few months but later proved difficult to staff. NRT clinics continue to be challenging, although when supervised well they function well.
  • There has been a reduction in DNAs, largely attributable to an improvement in allocating runners. Also, prisoners can now cancel appointments using the kiosk on the wings, and this too has reduced the number of DNAs.
  • There have been several positive new interventions including vulnerable prisoners piloting “Breaking Free Online” on the virtual campus. This was introduced by the Inspire group where an individual in recovery comes in to speak to service users.
  • Following the HMIP inspection, waiting lists and assessment processes were reviewed, and subsequently simplified for service users who are in prison for less than one month. There is now a commitment to respond to all referrals within one working day.
  • There has been a focus on suicide and self-harm (SASH) staff training in order to gain a more in-depth understanding of these issues.
  • From January onwards, 7-day working across the mental health team has enabled duty workers to provide a RMN to respond to urgent referrals and support ACCT processes at all times.
  • Healthcare applications to the IMB increased to 37 from 30 when compared to the previous reporting year.

Full IMB Report – HMP Birmingham

IMB Report – HMP & YOI Thorn Cross

Reporting period – 01 May 2018 to 30 Apr 2019.

  • The number of ACCT documents opened is extremely low but when opened they are managed appropriately and reviewed by the correctly designated staff. The establishment has trained and maintained adequate numbers of ACCT assessors during the year. The changing age groups have seen the use of ACCTs improve and any open ACCTs are reviewed at the monthly integrated risk management team (IRMT) meetings. The ACCT assessors on duty are displayed on a daily basis at the main gate.
  • Healthcare staffing has been maintained. They still share specialist staff across other establishments, mainly HMP Risley and HMP Hindley. The staff still experience some attitude and disrespect issues, but these are manageable and seen as part of the job, as with other frontline NHS staff.
  • Staff continue to work closely with the discipline staff on the health and wellbeing unit to ensure disabilities and special needs are catered for and have been instrumental in alternative therapies such as yoga, mindfulness and weight management. They are closely involved in assessing prisoners for cell sharing as well as fit for work notices when a prisoner feels health reasons prevent him from working. They are also involved in assessing for specialist mattresses and work footwear.
  • All routine specialist clinics, health promotion and screening programmes continue and vaccinations programmes have seen a continued increase in uptake.
  • The Change Grow Live (CGL) service ensures the rehabilitation of those with substance and alcohol misuse problems and works with the service in the community to ensure continuity of care on release. The mentors in the service attend the induction programme for new prisoners and offer a drop-in service for individuals who may be experiencing difficulties. Some of the mentors have worked in the service’s community setting.
  • There were no healthcare applications to the IMB. There were 8 in the previous reporting year.

Full IMB Report – HMP & YOI Thorn Cross

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