There were 5 IMB reports published last week:
- HMP Hull
- HMP & YOI Downview
- HMP & YOI Stoke Heath
- HMP Preston
- HMP Whatton
Here are some of the more interesting points that I found contained within those reports, pertaining to health and wellbeing:
IMB Report – HMP Hull
Reporting period – 01 Mar 2018 to 28 Feb 2019.
- Prison data recorded an average of 50 self-harm incidents per month throughout the year. The Board notes that self-harm can increase after the seizure of psychoactive substances.
- There were 8 deaths in custody during the reporting year, although 6 of which were from natural causes. The 2 apparently self-inflicted deaths were the first of this type since 2015.
- A total of 792 ACCT documents were opened in the reporting year, compared with 752 in the previous year. The Board found the documents and checks to be up-to date and accurate, and the way that ACCT reviews are managed indicates that procedures are used effectively.
- An overview of healthcare staffing, services and resources cannot be commented on as, despite contact and requests for information from the management of Hull’s healthcare unit, no information was forthcoming. The Governor was taking steps to ensure that Healthcare information is passed to the Board.
- The wellbeing unit is located on the second floor of the healthcare unit and has 14 individual cells, including a palliative care suite and 2 constant observation cells. Duty rota reports note that this unit has a positive atmosphere, with experienced officers who are knowledgeable about the prisoners in their care. The unit is clean and well presented. It has been observed that the officers communicate well with prisoners and visitors alike.
- There were 36 healthcare applications to the IMB. There was no IMB report or data recorded for the previous year.
IMB Report – HMP & YOI Downview
Reporting period – 30 Apr 2018 to 01 May 2019.
- In February 2019, E wing was redesignated at short notice as a unit for high-risk transgender women. At the end of the reporting year, and 2 months after the unit opened, there was still no regular purposeful activity for those residents. Furthermore, Mental health services were noted as being severely stretched by the additional demands placed on them by E wing. The reallocation of E wing’s purpose means that the planned-for health and wellbeing centre has been delayed.
- There were 684 incidents of self-harm during the reporting period, involving 64 residents. Of these incidents, 60 required treatment at hospital. There was one death in custody.
- There were concerns around the number of women arriving at Downview on open ACCTs, and also the number of women arriving at Downview who have had ACCTs closed only a few days before transfer.
- The standard of health service provision and care is noted as having been consistently very good overall throughout the reporting period. The comparator standard is the service provided in the community, which, in the view of healthcare staff, Downview meets and often exceeds.
- There are relatively few complaints to, or about, healthcare, and these relate mainly to the ‘non-prescribing of drugs’ by GPs and to ‘attitudes’ of healthcare staff. The Board does not share these concerns.
- Waiting times vary by service. GP appointments usually take place within 24 hours during the week. The waiting time for the optician has improved to around 4 weeks. Physiotherapist waiting time is within one week, and the podiatry service has a waiting time of about 12 weeks. Similarly, waiting times for an initial non-emergency dental appointment is within 3–8 weeks since the problems with the dental chair and related equipment were resolved. A nurse triage system has been running, to ensure that urgent cases receive priority appointments. This is not always popular with the women because they see a nurse rather than a doctor in the first instance.
- Mental health staffing levels are now good. Women are able to self-refer to mental health services, and the referral system means that there are multiple routes for accessing mental health support. Healthcare champions encourage the take-up of mental health support and provide feedback to healthcare professionals. Access to one-to-one therapy is good; women have to wait longer to access group support, although this is partly because groups run over a number of weeks.
- Over 2 separate 3-month periods during the reporting year, 62 external hospital appointments were made, of which 7 were cancelled for patient refusal to attend, 22 were cancelled as a result of healthcare staff having to prioritise other cases, 20 were cancelled by the hospital and 5 were cancelled due to the unavailability of escort staff. Eight appointments were missed because they were no longer at Downview (attributed to transfers or releases).
- The Board remains concerned that the prison has little specialist accommodation/provision for physically disabled prisoners, as highlighted in the previous annual report. With an ageing population, it is likely that such provision will be increasingly required, suggesting that planning might need to take place now.
- Some of the accommodation used for clinical and mental health appointments, at present comprises former cells, in poor condition and unsuitable for healthcare purposes.
- After a difficult previous year, Substance Misuse Services have been fully staffed for the last 6 months and are recruiting promptly as vacancies arise. There is an added emphasis on wellbeing, and there are now 5 wellbeing and recovery practitioners, working alongside 3 substance misuse nurses, a clinical prescriber and a clinical manager. They have introduced a volunteer working one day a week, and apprenticeships; there are also 6 peer support workers. With a full complement of staff, shortage of workspace is a confining factor, although there are plans to improve this.
- At the end of the reporting year, there were 54 residents being treated for opioid dependence, and in excess of 50% of the population is registered for support services. Joint mental health and substance misuse workshops have been run, and a mental health and drug use group meets regularly. The Bridge programme has been run at quarterly intervals, as scheduled, and attracted 40 residents to attend, although a number did not complete the course due to relapse/dropping out. An alcohol awareness session was run, attracting 48 residents. The Stepping Stones programme has also been delivered, with 11 of the 12 participants completing the course.
- Healthcare applications to the IMB decreased to 12 from 26 when compared to the previous reporting year.
IMB Report – HMP & YOI Stoke Heath
Reporting period – 01 May 2018 to 30 Apr 2019.
- There were 427 ACCT documents opened during the reporting period. There is a good quality assurance system in place to make sure levels of self-harm are not as a result of poor case management. 99% of operational staff have now been trained in the new ACCT processes, as have 94% of non-operational employees (which includes healthcare staff).
- A new integrated healthcare contract became active on 1 April 2019 and, whereas previously services were provided under three single contractors, the prime provider model means that all services will be delivered by one provider or through a sub-contracted/partnership arrangement, accountable to the prime provider.
- Health and well-being champions (HAWCs – prisoners recruited and trained by Healthcare) are progressing exceptionally well with their integration into many elements of both prison and healthcare services. Currently, there are 11 active HAWCs and a patient/service user forum has commenced with the HAWCs co-ordinator and primary care nurse leading it.
- Weekly multidisciplinary meetings are held every Thursday and HAWCs are allocated time within the meeting to discuss patients/concerns with the team. The team is made up of primary and secondary mental health staff, including a consultant psychiatrist, psychological and clinical substance misuse workers (services being provided for 100 patients), a learning disabilities nurse and the HAWC co-ordinator. Feedback from all parties is very positive.
- A dedicated green/amber/red care plan function has been activated, together with dry blood spot testing and vaccination at first contact.
- Escort services and bed watches continue to create a cost pressure – in an attempt to alleviate this, telemedicine services are being explored.
- Complaints are resolved well with no noticeable themes, other than complaints regarding the pain management pathway and tradeable medications.
- Difficulties are still being experienced with the recruitment of band 5 nurses in primary care, but the healthcare department is actively engaging with the nurse associate training programme and offering 2 existing healthcare assistants the 2-year training programme.
- Healthcare applications to the IMB increased to 64 from 58 when compared to the previous reporting year.
IMB Report – HMP Preston
Reporting period – 01 Apr 2018 to 31 Mar 2019.
- In total, 3,413 new prisoners entered Preston prison the reporting period, with a total of 11,924 movements through reception, which include those for court visits, police interviews and hospital visits.
- Healthcare provision was identified as a continuing source of concern at the time of the previous report, despite having significantly improved since the current provider assumed responsibility in April 2017. There had been a 23% increase in applications to the Board about healthcare over the previous year. The provider has taken steps to address this over 2018 – 2019, resulting in a 25% reduction in applications (i.e., to slightly below the pre-2017 level). It is anticipated that the improvements made will show reductions in complaints in future years.
- HMP Preston operates a regional hospital facility, which includes a general medical ward with 12 beds as well as a mental health ward with 18 beds. It takes prisoners from other prisons in the North West who have serious conditions or who are recovering from operations. It also has a palliative care role.
- The prison operates 2 first night centres, one general and one offering support to those prisoners who use addictive substances – a 28-bed recovery wing for those with addiction problems.
- There have been 3 deaths in custody this year. Of these, 2 were from other prisons who had been transferred to the regional hospital, and one was an HMP Preston prisoner. All 3 deaths were initially classed natural causes albeit with final PPO reports pending.
- Staffing levels continue to improve, building on what was achieved last year with optimised frontline service provision through changes to its rota system. Other additions include 2 paramedic posts, with the aim of providing more treatment in-house, reducing the need for resource-intensive escorts to secondary care. There was also an increased use of advanced nurse practitioners (ANP’s) running clinics, reducing waiting times. Agency nurses continue to be used to maintain staffing numbers, but this is in most cases using agency staff who are familiar with both the provider and prison itself.
- BBV screening for prisoners has seen a 30% increase on uptake.
- The waiting time to see a GP is no more than 6 days, and waiting times for both dental and ophthalmic subcontracted services are generally no longer than 4–6 weeks.
- Communication with prisoners has improved this year, with well-run monthly meetings with prisoner representatives from each wing to discuss any suggested changes or address any concerns they raise.
- Work is continuing to establish wing-based triage clinics within the prison, with that aim of reducing the logistical cost of moving prisoners around the prison. As yet, no such clinics are taking place. Suitable locations on each wing have been identified, and work is progressing on arranging access to patients’ computer-based records from these locations. This initiative began in 2017 – 2018 and is taking some time, which is largely attributed to the cost and complexity of arranging secure IT communications within what is the Victorian structure of the buildings.
- Healthcare applications to the IMB decreased to 61 from 83 when compared to the previous reporting year.
IMB Report – HMP Whatton
Reporting period – 01 Jun 2018 to 31 May 2019.
- There has been a total of 284 self-harm incidents reported during the current reporting period. This is an increase from 223 in the previous reporting year. The number of ACCT documents opened in the current reporting year was 287. This is an increase on the previous reporting year, where 243 documents were opened.
- There have been 6 deaths in custody during the reporting period, and 4 inquests have been held. The cause of death in all of these has been recorded as ‘natural causes’. Two inquests are still waiting to be held.
- The Board has seen a discernible improvement in the healthcare services and an improvement in staffing levels during this reporting period. Referrals are now submitted in a timely manner, and specialist appointments, including dental, podiatrist, optician and physiotherapy appointments, are arranged more quickly than might be expected in the local communities. Healthcare staff have worked hard to deliver a high-quality service.
- The healthcare unit is adequately equipped and includes an end-of-life suite and dementia care suite. However, the unit is too small for the number of prisoners who need to use it, and the Board continues to be disappointed that business plans submitted by the governor for the replacement or improvement of the healthcare facilities have not been progressed. The standard of the accommodation in the healthcare centre remains a concern. The Board also commented that the CQC recently visited the prison and concurred with their observations that the facility is not fit for purpose.
- Mental health and intellectual and developmental disability (IDD) services are fully staffed, and Care Programme Approach targets are being met. An IDD psychologist has been employed. There are no waiting lists for case management.
- The reclassification of the medications gabapentin and pregabalin to class C controlled substances in April 2019 has resulted in a requirement for additional nurses and prison officers. Furthermore, the NHS mandatory requirements for dispensing these drugs to 16 or more people means that morning telephone triage has had to be moved to midday because the new mandatory requirements mean that more staff are needed. Nursing staff are currently working overtime in the evenings and at weekends to dispense these drugs. These controls have had a significant financial impact, and at the time of writing this report, neither the NHS nor the Prison Service was prepared to compensate for the additional costs. Additional funding for nursing staff has now recently been agreed by NHS England and the recruitment process is underway.
- The ageing population within HMP Whatton continues to be a challenge. In May 2019, 14% of the prison’s population were aged over 65. Over 10% of the prisoners have been diagnosed with diabetes, 12% with asthma, 7% with chronic obstructive pulmonary disease, 2% with cancer, 2% have epilepsy and 34% are obese. 6 prisoners have been diagnosed with dementia and up to 20 prisoners could have cognitive impairment.
- There were 1,402 hospital escorts in the reporting year, and there were 89 bed watches. Given Whatton’s ageing population, it can only be anticipated that these numbers for escorts and bed watches will increase.
- Healthcare applications to the IMB increased to 30 from 10 when compared to the previous reporting year.
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.