This report was on an unannounced inspection of HMP & YOI Hatfield between 05–16 August 2019, and was published in January 2020.
“…the prison had benefited from consistent leadership for a number of years, which was also reflected in what appeared to be a settled, mature and very competent staff group.” – Peter Clarke
General Points of Interest:
The prison was spread over 2 sites, and 4 miles apart.
There had been no self-inflicted deaths since the previous inspection, and levels of self-harm were exceptionally low, with no such incidents in the previous year. On the rare occasions that a prisoner needed support for self-harm, staff were aware of the ACCT case management procedures to follow.
Incidents requiring the use of force were rare, with only 2 incidents during the previous 6 months.
Healthy Prison Outcomes:
|Rehabilitation & Release Planning||4||4|
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
Key Points of Interest: Health, Well-being and Social Care:
There was now a fully staffed, stable and experienced health services team. Compliance with mandatory training was good and staff had excellent access to additional training to support their lead roles. There was regular supervision and all staff had up-to-date appraisals. Staff stated that there was a clear management presence and that they felt supported. Services were available for 12 hours each weekday, and with shorter hours at the weekend.
Regular consultation with patients informed service delivery and the service was found to be highly responsive to patients’ expressed needs. In the survey, most prisoners indicated satisfaction with their health care.
Only 5 health care complaints had been submitted in 2019 to date and most complaints were quickly resolved face to face. No quality assurance audit had been carried out to ensure that responses were appropriate. There was limited information for patients on how to complain, little access to complaint forms and no confidential complaints box, although action was taken to install a box during the inspection.
The health centre on both sites had improved since the previous inspection, particularly the pharmacy rooms. Clinical rooms met infection control standards and were clean. The clinical room on The Lakes site did not offer patients full privacy, as prisoners in the corridor knocked on the door, or attempted entry to the room, during consultations. The health centre waiting room on the main site was too small, which meant that the corridor outside, where medication was administered, was congested.
There was a rolling programme of clinical audits, including some peer audits, along side corresponding action plans to drive improvements.
There was a strategic approach to health promotion, with a lead member of staff following the NHS calendar of events and leading additional focused drop-in sessions. Relevant health information leaflets and posters were available throughout the prison. The recruitment of peer workers to act as health champions had been completed, but they had not started these promising roles at the time of the inspection.
Barrier protection was available but not advertised. Smoking cessation was available as clinically indicated.
New prisoners received a timely health screen on arrival and were offered a further detailed secondary assessment, with relevant onward referrals made.
Prisoners had access to a wide range of primary care services, and waiting times were short. The appointment system was effective, although the application form had insufficient space to record periods of home leave, which meant that patients were sometimes assigned appointment dates that they were unable to attend; despite this, overall did-not-attend rates were very low. The were some evening clinics.
There was only one GP clinic a week at each site, but other prescribers were available daily, so patients’ medication needs were met in a timely manner. The waiting time to see a GP was 2 weeks, which was similar to that in the community, and recent gaps in GP cover has been addressed.
There was effective monitoring of patients with long-term conditions and those with complex care needs, such as pain management, with care plans in place where necessary. However, inspectors did not see an audit of care plans, despite staff reassuring them that this been completed There was evidence of a few patients without care plans although this was rectified during the inspection.
All prisoners were offered an appointment for a health check before their release and were supplied with take-home medications and GP letters as necessary.
The prison was imaginative in making reasonable adjustments to aid prisoners’ mobility and self-care, but environmental constraints limited options – for example, none of the rooms on the residential units could accommodate a hospital bed.
Mental health services were deemed to have improved since the last inspection. Record keeping was of a high standard and showed evidence of patients’ involvement in their own care.
Reception screening identified the need for a mental health referral, and direct referrals could be accepted from prisoners, health professionals and prison staff. All prison staff had undertaken mental health awareness training in the last three years – a substantial improvement since the previous inspection – so that their referrals were appropriate. About 25 routine referrals were received each month and were seen within a week. Urgent cases were seen within 24 working hours. The senior nurse effectively contributed to ACCT case management procedures, safer custody processes and subsequent case reviews, as necessary.
The MH nurse and the lone substance use practitioner met regularly and reviewed all patients in their joint care to determine ongoing treatment needs, which ensured coordinated care. There were 14 patients receiving ongoing mental health care at the time of the inspection.
Substance Misuse Services were well advertised on the residential units, and peer recovery workers ensured a high profile for the help available. New referrals were usually seen on the same day. During the inspection, 34 patients were receiving psychosocial treatment. There was evidence of high quality individual casework; pop-up groups on harm minimisation responded to emerging needs of patients and were well advertised. Patients were highly appreciative of the services of the drug recovery worker.
The drug recovery worker coordinated the clinical management of patients with the lead GP. During the inspection, 14 patients were receiving opiate substitute treatment, with flexible prescribing and multidisciplinary reviews every 13 weeks.
Information sharing between substance misuse and resettlement services was very good. Pre-release planning consistently included the provision of harm reduction information and naloxone training, to enable prisoners to treat opiate overdose after release. Effective joint working with community services ensured treatment continuation ‘through the gate’.
Medicines were supplied efficiently by several companies on the same or next day. They were delivered directly to the respective health centres, with the exception of controlled drugs; these had to be collected by the pharmacy technicians from the respective main gates and transported by trolley to the health centres, introducing needless vulnerability into the secure supply chain.
A regional pharmacist was responsible for the service, and pharmacy technicians ran the 2 pharmacy services from day to day. The technicians had regular managerial and clinical supervision, and stated that they felt supported. The pharmacist visited monthly, to undertake quality checks and provide advice to prisoners as needed.
The comprehensive in-possession medicines policy was followed by careful attention to periodic reviews of patients’ individual risks. At the time of the inspection, 93% of patients had medicines in-possession, with few on medications which needed to be administered under supervision, including controlled drugs, which was appropriate. No patients reported problems with in-cell storage of medicines. Medicines were administered at both health centres without officer supervision and without incident, although the location of the medicine hatches afforded little privacy for patients.
As part of the survey, 70% of prisoners rated the overall quality of the health services as being either very good or quite good.
The CQC issued no Requirement Notices against Regulation Standards.
Recommendations: Health, Well-being and Social Care:
- The confidential health care complaints system should be effectively managed and fully accessible.
- The supply chain for medicine supplies coming into the prison should be free of foreseeable risks.
Good Practice: Health, Well-being and Social Care:
- Health care professionals had direct telephone access to hospital consultants, who gave immediate and specialist advice, enabling more accurate and efficient care.
CQC Requirement Notices Issued: