“There is still work to be done around violence, drugs and resettlement, but with the solid foundations that are in place in terms of the incredibly strong positive ethos that permeates the prison, there is no reason why the necessary improvements cannot be achieved.” – Peter Clarke
This report was on an unannounced inspection of HMP Highpoint between 12–23 August 2019, and was published in January 2020.
General Points of Interest:
This former Royal Air Force base and refugee camp opened as a prison in 1977. Originally, there were two prisons, one holding women and the other holding men. In 2005, the women’s prison became a men’s prison and in 2011, the 2 prisons merged to form HMP Highpoint, with a North and South site.
There had been 2 self-inflicted deaths and one drug-related death since the previous inspection.
Over the past 2 years prior to inspection, the number of self-harm incidents averaged just under 40 each month. There had been an increase over the most recent 6-month period to 56 incidents a month.
The number of ACCT documents opened was also high – 322 in the 6 months leading up to this inspection in 2019. A significant increase on the 60 ACCT’s opened in the 6 months leading up to the previous inspection in 2015.
More than 170 custody staff (41%) had received mental health awareness training.
Healthy Prison Outcomes:
|Rehabilitation & Release Planning||2||2|
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
Key Points of Interest: Health, Well-being and Social Care:
The current health provider had been in place since 2011. There were strong and effective working relationships between the prison and commissioners, and regular partnership board meetings covered key issues.
Patient forums were organised, and results from monthly questionnaires completed by patients following appointments were analysed. Inspectors noted several positive changes to practice following patient feedback.
Regular clinical audits were used to monitor and review the service, although there was a lack of oversight of clinical appointment bookings for patients who moved from one site to the other.
The service was delivered 7-days a week between 7.45am and 6.15pm on week days and 8am to 6pm at weekends. NHS 111 services were used out of hours if required.
Overall, staffing levels and the skills mix met most needs and any shortfalls in staffing levels were offset by using regular bank and agency staff. Oversight of staff rotas on the North site was deemed to be not effective enough.
Professional development and training were good and staff spoke of feeling supported. Clinical and managerial supervision took place regularly, however, clinical supervision for primary care staff was not effectively recorded, and plans were in place to improve this.
Healthcare facilities on the North and South sites generally met infection prevention and control standards. However, on the South site, the waiting area was austere and the dental suite flooring needed to be repaired.
A well-being approach had been introduced that underpinned all health activities. Prisoners received comprehensive health care information on reception and health promotion material was displayed throughout the prison, despite the lack of a prison-wide health promotion strategy.
A health care nurse saw new patients on arrival and carried out an assessment for any immediate or ongoing health or substance use needs. When prisoners arrived late in the evening, staff ensured they were seen the next day. There were plans for staff to provide a more in-depth screening, involving taking samples and undertaking physical examinations in one clinic, with the anticipation that this would capture patients’ needs more effectively.
Prisoners had good access to health checks and screenings, and oversight was effective. The ‘One-stop shop’ well-being clinics were being introduced on the wings and were due to start imminently. There were no peer workers to provide health information and support.
There was a range of qualified and experienced staff and a good selection of primary care services. However, waiting times for GP and dental appointments were not the same as in the community. GPs could be seen on the same or on the next day if their issue was urgent. However, it was a 4-week wait for routine appointments on the South site and a 6-week wait on the North site.
The management of patients with long-term conditions had improved and patients’ needs were met although not all patients had a specific care plan in place.
Scheduled daily escorts were available for hospital appointments. All appointments were overseen by a clinician and patients were re-booked if appointments were cancelled.
Prisoners were screened for mental health problems on arrival and could refer themselves using the prison application process. Referrals were clinically triaged and discussed in the weekly referral meeting and allocated appropriately using a stepped model approach. Prisoners with urgent cases could be seen on the same or following day. The team was well integrated in the prison and attended ACCT reviews, complex case meetings and the governor’s briefing.
The MH team had a rich skills mix, was highly competent and had been enhanced by the appointment of a learning disabilities nurse. All staff spoke of feeling supported and clinical and managerial supervision was robust. Working relationships between prison and mental health staff were effective, and joint working with substance misuse services was good.
A high intensity cognitive behavioural therapist had also been appointed, which was promising. During the inspection, the caseload for psychological interventions was 40 and there was an 8-week waiting list. The lack of IT provision for the team was affecting the number of prisoners they were able to see.
In the previous 12 months, 3 prisoners had been transferred to hospital under the Mental Health Act. None had been transferred within the 14-day guideline, and the longest waiting was 87 days.
Substance Misuse clinical services and psychosocial interventions were delivered by separate providers (subcontracted to the primary provider) and both worked closely together, holding regular meetings and undertaking joint treatment reviews that included the specialist GP who ensured patients were involved in their own care. The psychosocial services provider did not have access to patient records on SystmOne. Despite this, those individual case records sampled were good and were audited regularly.
Psychosocial services had experienced staffing issues over the previous 6 months, although they had since been resolved. Caseloads were about 25–30 per staff member, which was considered reasonable. Services were accessible and the team delivered good support to 235 prisoners across both sites through structured one-to-one sessions and group sessions, which delivered harm reduction, relapse prevention and recovery focused activities and 4 peer mentors provided advice during induction, and organised groups and offered drop-in sessions on all wings.
Clinical treatment was flexible and patient-centred. During the inspection, 53 patients were prescribed opiate substitution therapy, with 18 of those being stabilised or maintained and 35 were on reduction regimes, which was appropriate. Controlled drug administration took place in the recovery unit and it was supervised appropriately.
Medicines management had improved since the previous inspection. Medicines were dispensed by the in-house pharmacy in the prison and were individually labelled and stored in the cupboards in the administration dispensary until issued to the patient. In-possession medicines were supplied from rooms on the wings that were basic and in varying states of decoration and repair.
Pharmacy technicians and nurses administered medication every day between 8am and 10am and between 3.30pm and 5pm. Night-time medication was generally issued in-possession, but some patients were receiving their night-time medication in the afternoon. This had led to some prisoners appearing intoxicated on the wings and others declining their anti-depressant medication because of its sedating effects. Where a prisoner’s in-possession status changed, staff administered the medication at a time that was not in accordance with the prescription.
Supervised medicines were administered in a private area. A lack of communication when prisoners were transferred between the North and South sites meant there was sometimes a delay in transferring their medication to the appropriate site.
The prison had an in-possession policy and risk assessments took the drug and the patient into account. Spot checks of in-possession medication were completed where appropriate. About 90% of patients received their medication in-possession and about 30% received a monthly supply.
There was an out-of-hours cupboard and supplies were recorded. However, managers did not check stock against the records. This was rectified during the inspection.
Access for urgent dental care was reasonable and patients could either attend the next clinic or receive an appointment within three days. However, on average, there was a 14-week wait for routine appointments.
As part of the survey, 40% of prisoners rated the overall quality of the health services as being either very good or quite good.
The CQC issued one Requirement Notice against Regulation Standards.
Recommendations: Health, Well-being and Social Care:
- Managers should ensure there is effective oversight of clinical appointments.
- The dental suite flooring on the South site must meet infection prevention control standards.
- Suitably trained and supervised peer workers should be available to provide health and well-being support and information.
- All patients with long-term conditions should have a person-centred care plan.
- Patients requiring hospital admission under the Mental Health Act should be assessed and transferred expeditiously within current transfer guidelines.
- When appropriate, prisoners should have access to naloxone on release.
- Sedating medication should be administered at a clinically appropriate time.
- Dental waiting times should be equivalent to those in the community.
Good Practice: Health, Well-being and Social Care:
- None identified.
CQC Requirement Notices Issued:
Regulation 17 (1) – Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
How the regulation was not being met:
There were insufficient systems or processes that enabled the registered person to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk. In particular:
- The dental waiting list arrangements did not ensure continuity of treatment for patients who moved between Highpoint locations. This resulted in one patient who required urgent dental care and treatment waiting over 75 days before being assessed.
- The processes for responding to chemical incidents and checking the dental tools and equipment on one site were not adequate.
- Staff were not checking the stock of out of hours medications against the log book to ensure that stock levels were sufficient to meet patient need.
There were inadequate systems or processes that ensured the registered person had maintained securely such records as are necessary to be kept in relation to persons employed in the carrying on of the regulated activity or activities. In particular:
- There was no accurate record or log of staff’s clinical supervision.