Health Notes 20 Jan 2020 – IMB, PPO & IRP Reports

Last weeks reporting from the IMB and the PPO produced one report published from each organisation. Whereas I would normally write a post for each organisation; typically an overview of all PPO reports on a Monday, and then the IMB reports on a Wednesday, this week I’ve opted to combine both reports for this weeks post and have also included the recently published Independent Review of Progress (IRP) at HMP Lewes.

The only IMB report published last week was from HMP & YOI New Hall. The report produced little pertaining to health and wellbeing, and what there was, was centred around concerns and complaints. The sole death in custody report (less is more) from the PPO was attributed to natural causes at HMP Wymott, and produced no recommendations.

IMB Report – HMP & YOI New Hall

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • Previous concerns regarding bullying in the Health Care Centre seem to have reduced to almost none since the refurbishment work took place, and the allocation of an officer to supervise the area.
  • There were no deaths in custody during the reporting period.
  • The main concerns expressed by residents to the IMB are the length of time it takes to get an appointment; medication issues; cancellations of outside hospital appointments (often due to insufficient escort staff), and complaints not being answered in a timely fashion.
  • The healthcare provider has a complaints/concerns procedure, whereby residents place their written complaints/concerns in a box on the wings which are collected daily by the nurses on duty. They are then recorded by the Healthcare Complaints Clerk and passed back to nursing staff to deal with. It is the expectation of staff that most matters will be dealt with by way of face-to-face contact with only a limited number of issues being escalated to the status of a complaint.
  • The most common themes for those healthcare concerns/complaints during this reporting period are Pharmacy (112), GP (53), Nursing (49), and Mental Health (27).
  • Healthcare applications to the IMB decreased to 30 from 51 when compared to the previous reporting year.

Full IMB Report – HMP & YOI New Hall

PPO Deaths In Custody Report: 29 Jan 2016 – HMP Wymott. Natural Causes Death.

No recommendations.

Full Report 29 Jan 2016 – HMP Wymott. Natural Causes Death.

IRP Health Notes: HMP Lewes, Dec 2019

This report was on an independent review of progress HMP Lewes between 02–04 December 2019, and was published in January 2020.

At this IRP visit, HMIP inspectors followed up 12 of the 53 recommendations made at their most recent inspection and made judgements about the degree of progress achieved to date. Of these 12, there were 4 related to health, wellbeing and social care:

Recommendations: Health, Well-being and Social Care:

  • Health governance structures should be robust enough to identify and effectively address key risks and concerns and should ensure that prisoners have prompt access to all health services.
  • All health care staff should receive regular clinical and managerial supervision, and be up to date with mandatory training.
  • Prisoners with long-term health conditions should receive regular reviews by trained staff, informed by an evidence-based care plan.
  • Prisoners referred to the service should be reviewed and assessed promptly, and offered a suitable range of mental health interventions within agreed timescales.

Here is a summary of progress found to have been made for each of those recommendations.

Health Governance Structures

  • There was now an agreed robust governance structure for health services. Partnership and local delivery board meetings were in place and the terms of reference had been reviewed and ratified.
  • A weekly local team meeting had been implemented, which monitored progress on required improvements. Applications were now managed more promptly and there were regular audits to monitor the 24-hour response target.
  • Senior oversight of identified service risks on the risk register was not robust. The action and mitigation had not been effective, and some risks remained unresolved for more than a year. Some of the long-term unresolved risks included: prisoners not getting to their health appointments; too few rooms to deliver clinics; and the lack of 2-way radios to keep health staff safe.
  • Waiting times had improved but were exacerbated by the large number of prisoners who DNA’d their appointments. The figure for those not attending their appointments was reported to delivery and partnership board meetings, but no progress had been made on this issue. Inspectors witnesses 2 clinics with zero attendance because prisoners were attending other activities. There were also wing restrictions or prison officers failed to bring prisoners to the health care department.
  • Inspectors considered that the prison had made reasonable progress against this recommendation.

Supervision & Training

  • Training plans for all health care staff were now in place and monitored every week. Any action arising from weekly monitoring was allocated to clinical lead staff to progress.
  • Managerial supervision and reflective practice for all staff were now embedded and monitored weekly. Most staff felt supported and were participating in reflective practice opportunities (which encourages staff to identify areas for continuous learning and development).
  • All clinical staff had undertaken basic or immediate life support (ILS) courses and plans were in place to upgrade all clinical staff to ILS training.
  • Inspectors considered that the prison had made good progress against this recommendation.

Long Term Conditions Management

  • A new long-term conditions process and patient pathway had been implemented. All those identified were now on a patient register. The registers were monitored every week and all those on the register who had not had a comprehensive review had a scheduled appointment. Prisoners who were classed as non-attenders, either because they chose not to attend or, more frequently, because officers were unable to transfer prisoners to the health care department from the wing or activities, were rebooked several times. There were plans to visit patients on the wings after they had failed to attend several appointments to check their potential engagement in the next appointment.
  • A long-term conditions nurse attended the prison to support the assessment and care planning of those on the register and to offer the nursing team additional supervision. Those who had been seen and assessed now had meaningful care and treatment plans.
  • Appointments were booked promptly, but the lack of access to health care created longer waiting times and a significant loss of clinical resources. Some prisoners remained unmonitored, lacked care plans and did not have regular reviews due to the lack of access. Inspectors observed 2 long-term conditions clinics with zero attendance and 15 missed appointments in 2 days. In November 2019, 10 long-term conditions clinics were booked with a total of 219 appointments. Of these, 125 appointments were missed.
  • Inspectors considered that the prison had made insufficient progress against this recommendation.

Mental Health Interventions

  • The mental health service had improved and effective clinical oversight had been introduced. Staffing levels had also improved. An additional specialist registrar was in place to support the consultant psychiatrist and waiting times for a medical consultation were shorter and were now 4-6 weeks.
  • There was now a clear referral pathway for mental health services. Those who were at a potentially higher risk to themselves or others due to their presentation were managed as a priority.
  • Referrals were dealt with every day by a member of the clinical mental health team and allocated to appropriate individual staff at a weekly meeting for ongoing care, and care plans were in place for those on the caseload. More mental health interventions were available than at the inspection.
  • Inspectors considered that the prison had made good progress against this recommendation.

Full Report Here – HMP Lewes

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