IMB Annual Reports – Health Notes 06 Jan 2020

The IMB reports published last week were from these 6 establishments:

  • HMP & YOI Chelmsford,
  • HMP Bure,
  • HMP & YOI Wormwood Scrubs,
  • HMP & YOI Askham Grange,
  • HMP Brixton,
  • HMP Onley

Here are some of the more interesting points contained within those reports, pertaining to health and wellbeing:

IMB Report – HMP & YOI Chelmsford

Reporting period – 01 Sep 2018 to 31 Aug 2019.

  • There have been fewer serious incidents than in the previous reporting year. However, the number of deaths in custody totalled 6, compared to 5 the previous year. Of the 6, 3 were the result of natural causes, whereas all 5 deaths in custody in the previous year were self-inflicted.
  • The change in healthcare provider is noted as being more positive in relation to having a much stronger presence on the wings and closer collaboration with prison managers.
  • Negative outcomes from mandatory drug tests have improved, going from a high of 50% to 22.4% at the end of the reporting year.
  • The incoming healthcare provider encountered initial problems when many of the outgoing provider’s staff did not transfer to them. Despite this, the report states that there are early signs that healthcare provision has improved, although 3 prison psychiatrists had been reduced to one at the time this report was published.
  • The efficiency and effectiveness of the already overstretched medical services are being adversely affected by the number of prisoners who miss appointments. The reasons cited include poor liaison between the wings and the healthcare department, as well as prisoner refusals.
  • Complaints received directly by the healthcare department had been dealt with more promptly than in the previous year.
  • Weekly drop-in sessions on all wings have now been introduced, where nurses are on hand to help prisoners with their health issues. There has been some reduction in the number of those who do not attend clinics.
  • The smoking cessation programme is now targeted at individual prisoners who enrol on an 8-week smoking cessation programme, which is an improvement on the previous, open-ended programme.
  • IAPT operate within the healthcare department, offering support to prisoners in the form of talking therapies, and now include prisoners on ACCTs, who were excluded previously.
  • A new GP contract commenced on 1 May 2019, and had strengthened the integrity of medication prescription provision.
  • Healthcare applications to the IMB decreased to 47 from 61 when compared to the previous reporting year.

Full IMB Report – HMP & YOI Chelmsford

IMB Report – HMP Bure

Reporting period – 01 Aug 2018 to 31 Jul 2019.

  • There has been a change of provider for healthcare. The new provider, has made significant changes with increased numbers of staff and an experienced manager in place. 47.8% of residents are over 50 years of age. Healthcare works closely with the safer custody team and relatives of those who are terminally ill, receiving palliative or end of life care. HMP Bure continues to rely at times on beds being available at HMP Norwich hospital wing and it is evident that HMP Bure needs better facilities in order to be able to provide this care on site to avoid the distress and concern of residents and their families.
  • HMP Bure has a healthcare centre open on 7 days a week, Monday to Friday 8:00am to 19.00pm, and Saturday and Sunday 08.00am to 17.30pm. Out of hours service is provided through the NHS 111 service. The GP visits on 2-days a week; however, a telephone service to a GP is now available to residents supported by healthcare staff. This is comparable to expectation in the community.
  • The healthcare department has supported the training of prison officers to enable them to have better understanding of residents in the early stages of dementia.
  • There has been a marked improvement in staffing levels since the last report. There are issues around recruitment to HMP Bure due to the isolated site and potential candidates not wishing to work with the resident group. However, the manager has been creative in offering training to current healthcare assistants and pharmacy technicians to enable them to progress to more responsible roles. The newly appointed team, including a paramedic and occupational therapist, has made good progress with minimal use of bank/agency staff.
  • Prescriptions are now issued to each wing on an allocated day and set time for collection which seems to be avoiding the long queues in the open air. Following applications, acknowledgements are issued to residents with an appointment date and time. Improved arrangements have been made between prison and healthcare staff enabling residents to leave their normal place of work to collect delayed medication. However, this does disrupt lessons in education and activities in the workshop. The Board state that they will continue to monitor.
  • Complaints regarding healthcare are managed directly by staff and/or the healthcare manager and if they are not able to resolve them, residents are advised to write to NHS England and/or the Prisons and Probation Ombudsman. Resident healthcare representatives meet with a member of the healthcare team bi-monthly and up-skilling of staff reduces the need for residents to attend outside hospitals.
  • Opportunities are being explored with Norfolk and Norwich University Hospital with the aim of offering placements to students studying general nursing and occupational therapy.
  • Healthcare applications to the IMB increased to 42 from 37 when compared to the previous reporting year.

Full IMB Report – HMP Bure

IMB Report – HMP & YOI Wormwood Scrubs

Reporting period – 01 Jun 2018 to 31 May 2019.

  • At any one time, around 40 prisoners are subject to ACCT procedures. The Board is pleased to note that self-harm has become less frequent in recent months.
  • At the end of the reporting year, the prison introduced a new practice whereby ACCT reviews would be held on a set day in each wing. Although this practice has only just started to take effect, the early signs are that it has encouraged participation in ACCT reviews by a wider range of staff. It is hoped that this will make the ACCT process more effective for those prisoners who are at risk of self-harm.
  • There were 6 deaths in custody during the year, of which 3 are believed to be self-inflicted and 3 are believed to be from natural causes.
  • The prison benefits from 55-place detoxification unit and a residential Healthcare Centre (H3) with 17 beds.
  • There has been a steady increase in the number of GP appointments available, and the rates of non-attendance have improved compared to the previous year with waiting times for routine GP appointments continuing to remain low.
  • The Board repeats its observation that hospital appointments remain a problems. In October, 25 external appointments were postponed, 11 of these because staff were not available to escort a prisoner. Although the number of cancelled escorts fluctuates, it has not significantly decreased, with 28 cancellations in May also noted.
  • There have been several occasions in previous years when investigations into deaths have criticised confusion over emergency codes. Although the management team has already taken steps to address this, the Board is pleased to note that the correct emergency codes are now printed on notices near to every cell door in H3.
  • Healthcare complaints are handled by a separate system from other prison complaints and the complaints procedures do not appear to be well understood. In September, the Board could not find any healthcare complaint forms in H3 and staff gave incorrect information about how to make a complaint. The Board repeated this exercise again in April, with the same results.
  • As in previous years, the Board notes that the X-ray machine is still not operational; the provider stating that this is the responsibility of the NHSE commissioners. In addition, there was a prolonged power outage which prevented any use of the dental X-ray machine for over a month.
  • Healthcare applications to the IMB increased to 66 from 49 when compared to the previous reporting year.

Full IMB Report – HMP Wormwood Scrubs

IMB Report – HMP & YOI Askham Grange

Reporting period – 01 Jul 2018 to 30 Jun 2019.

  • The baseline certified normal accommodation (CNA) is 128, and an operational capacity of 128.
  • 14 ACCTs were opened from June 2018 to June 2019. Open ACCTs are monitored closely with support given to the resident and are reportedly closed within a few days.
  • A recent HMIP report stated that the provision of healthcare was good. Despite a recent relatively settled period with a full complement of nursing staff, recent resignations have led to reliance on bank/agency staff or staff from HMP New Hall being used to backfill the current vacancies.
  • All new arrivals are seen for an initial health screening within 24 hours of arrival at Askham Grange and a further follow up appointment is offered within 7 days. In the reporting year 130 of the 131 reception screenings were seen within the above timescales.
  • In addition to the nursing staff, a GP attends the prison three days per week and appointments are generally readily available. Waiting times for the various clinics are short and services which cannot be accessed at the prison (e.g. dentistry, X-ray and hospital appointments) are available in the community. Many of these ‘external’ appointments are managed via the release on temporary licence (ROTL) process and do not require prison staff to escort the residents, although escorts are available should they be required.
  • There is a significant percentage of the population at Askham Grange who identify as having mental health issues, with over 50% of the women being prescribed anti-depressants. There is one mental health nurse for the establishment, with additional psychological support. Incidents of self-harm are low and those most at risk are managed well. The prison has had very few residents on ACCTs during the reporting period and reviews are held regularly, although healthcare staff do not always attend these. HMIP has recommended that they do attend or submit a written contribution if they are unable to attend.
  • Overall the healthcare provision at Askham Grange is good and recent patient feedback has indicated that most are satisfied with the services provided. The very few complaints or concerns which have been raised have all been resolved by face to face contact between healthcare staff and residents.
  • There were no healthcare applications to the IMB, which remains unchanged from the previous reporting year.

Full IMB Report – HMP & YOI Askham Grange

IMB Report – HMP Brixton

Reporting period – 01 Sep 2018 to 31 Aug 2019.

  • ACCTs have been opened more frequently this year (with a monthly average of 22 compared with 19 last year). More ACCT reviews are multidisciplinary, and there have been improvements in the quality of reviewing, and the prioritising of risk assessment. The quality of ACCT documentation is still imperfect. Care maps tend to be aspirational rather than specific, and in several cases a lack of detail and appropriate follow-up rendered them almost useless. This chronic failing is recognised by the prison as requiring constant oversight. Since March 2019, ACCT files have had care plans and assessments placed together, to encourage linkage. Self-harm statistics have been higher than in the previous year, with an average of 23 per month.
  • The residence governor has daily briefings with senior wing staff to consider security intelligence and drive up performance against expectations – for example, about the time taken to answer cell call bells; a year ago, more than 100 cell bells a day were routinely not answered within 5 minutes, but in August 2019 the figure had fallen to fewer than 10.
  • Primary care staffing continues to be a challenge, and the long vetting process adds to the frustrations. Agency staff ensure continuity of service. Prisoner surveys following medical consultations are generally positive.
  • The reinstatement of local delivery board meetings half-way through the year has improved communication between the prison and healthcare staff, but the lack of attendance by healthcare staff at Rule 45 segregation reviews and ACCT reviews remains an issue. Healthcare staff are not always notified of planned shut-downs, so routine appointments are wasted. The number of hospital appointments cancelled by the prison has fallen steadily.
  • Heavily subscribed services like smoking cessation and sexual health clinics have long waiting lists, and are reported to cause anxiety for men.
  • Officer supervision of medication rounds on the wings is uneven and often non-existent, creating opportunities for the diversion of medication.
  • The recording and tracking of healthcare complaints changed in January 2019, and since then complaints have been hard to monitor. The number of psychoactive substance-related incidents to which nurses were called has also been unavailable all year as a result of misrecording; the Board has been told that this is being resolved.
  • For Mental Health services, the awareness centre (TAC) provides a welcome expansion of counselling services. With a caseload of 30 to 35, TAC staff consistently see men within 5 days of referral. Communication between the prison and TAC has yet to be properly established. This has frequently resulted in TAC staff not being able to attend their clients’ ACCT reviews, where they could often make a valuable contribution.
  • Substance Misuse services typically carrries a caseload of between 270 and 280 men – about a third of the prison roll – through the year, and received about 40 referrals per month.
  • The rest of the drug recovery wing population require health and wellbeing (H&WB) support, and engage in group work and therapies such as meditation, acupuncture, yoga and family workshops. D wing is a mixed drug recovery and wellbeing unit; Men are referred to the service through daily meetings between all healthcare service pathways.
  • All men have a meeting with a primary healthcare nurse 2 weeks before release, ensuring that they have a registered GP and continuing access to mental health services. Contributions from other health-related agencies are uneven. Appointments with community drug and alcohol teams are also offered, housing or rehabilitation placements for anyone needing one are supported. Lambeth Council has taken responsibility for the continuity of social care, whether to another prison or outside, coordinating with the social services of the local authority where a man has ended up living. In August 2019, it was discovered that some men were being discharged without their prescription medication; the prison is investigating this.
  • Healthcare applications to the IMB decreased to 34 from 35 when compared to the previous reporting year.

Full IMB Report – HMP Brixton

IMB Report – HMP Onley

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • There were 2 deaths in custody during the year, and both believed to be attributed to natural causes.
  • The Segregation Unit is well supported by the mental health team, which visits the CSU daily (Monday to Friday) to dispense medication and speak to every prisoner. The mental health team continues to be present at every review held in the CSU and creates a mental health care plan within 24 hours if a prisoner is on an ACCT.
  • The year started with severe health staff shortages, though with the help of agency staff, backlogs were kept to a minimum. Roll call problems persisted throughout the summer, exacerbated by continuing staff shortages. Despite this, the workload has been judged to have been managed well.
  • To reduce missed appointments, prisoners are on the roll board and they should also receive an appointment slip, which is now collected by an orderly. Lockdowns prevent this smooth delivery process. Staff shortages continue to adversely affect hospital escorts, which is continuation of the previous year.
  • The high number of referrals for substance misuse appear to have been reduced in this reporting year. There continue to be many Code Blues (an emergency code used by the prison to indicate breathing difficulties) over the last year, presumably referring the misuse of psychoactive substances.
  • There have been no major concerns raised about the smoking ban that was implemented in this reporting year. However, there are concerns about the level of support that prisoners have received when they arrive from other establishments (as Onley no longer provides nicotine patches).
  • Healthcare applications to the IMB increased to 13 from 7 when compared to the previous reporting year.

Full IMB Report – HMP Onley

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.

Thanks to Luis Melendez for making this photo available freely on Unsplash