“Health services were reasonably good, but we received many credible complaints about disrespectful healthcare staff. The service was further undermined by poor opening times.” – Peter Clarke
This report was on an unannounced inspection of HMP & YOI Standford Hill between 19–20 August to 02–05 September 2019, and was published in February 2020.
General Points of Interest:
All prisoners were employed.
About 80% of the population had access to release on temporary licence (ROTL), amounting to 28,300 incidences of ROTL in the 6 months before the inspection.
55% of prisoners had a job to go to on release, and 96% of prisoners were released to suitable permanent accommodation.
There had been 3 deaths since the previous inspection, all from natural causes. Self-harm levels were very low and there had only been one incident in the previous 6 months. Over that same period, 2 men had received support through the ACCT process.
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:
Overall, the health provision was reasonably good. The services were integrated, and most quality assurance and governance arrangements had improved and were now good, although access to most services for approximately half the population, who worked outside during core hours, was limited. Governance meetings included partnership meetings, as well as those on quality assurance, safeguarding, contracts and medicines management. However, very few risks and incidents were reported and monitored, when they should have been.
Serious incidents were thoroughly investigated and action was implemented. There was now a confidential health complaints system, which was well advertised. There was an inflexible approach to complaints – only those submitted on the correct forms could be accepted, which was not patient centred. Responses to health complaints were apt and prompt, and apologetic when required.
Patient user forums had been inconsistent across providers since the User Voice contract had ceased. Prior to March, there was evidence that consultation had led to changes to services. Prisoners’ perceptions of primary care services were negative, and some said that staff were rude and disrespectful. Only 41% in our survey said the overall quality of services was good, which was significantly lower than in similar prisons surveyed since 2017, where the figure was 67%.
The health teams were fully staffed, well trained and received both managerial and clinical supervision. All except those working in the psychosocial substance use department had full access to the shared clinical information system and all clinical and psychosocial records were of a good standard.
The health and well-being team, which worked across the 3 Sheppey prisons, offered individual appointments for prisoners seeking advice on diet, sleep and smoking cessation, but support groups were not established owing to prisoners’ limited availability during the day.
On arrival, prisoners received a prompt assessment of their health and social care needs and any immediate associated risks. Onward referrals for health services and secondary health screening appointments were timely. All prisoners were booked to attend a secondary assessment to identify their needs in more detail.
Applications for healthcare services were dealt with promptly. Prisoners had the option to attend morning nurse triage sessions if they needed an urgent consultation. Prisoners who did not work off site were required to see a nurse before being allocated a GP appointment. The waiting time for routine GP appointments was about 3 weeks, but prisoners with an urgent need would be seen on the same day or during the following GP surgery. Custody staff had access to weekend and out-of-hours’ advice from the healthcare team at HMP Elmley.
Nurse-led clinics were held for prisoners with diabetes and respiratory issues, overseen by a senior nurse who covered the 3 Sheppey prisons and provided training support to the onsite nursing team. The management of other long-term conditions was overseen by GPs.
Prisoners were referred to external hospital appointments promptly and appropriately and could choose the hospital they attended. Monthly optician and sexual health clinics were held on site. Physiotherapy and podiatry appointments were arranged in the community, and a healthcare assistant ran a weekly footcare clinic at the prison. Prisoners on ROTL could travel to hospital on their own, which meant there was a limited need for officer escorts. However, prisoners cancelled a significant number of external appointments owing to work commitments. This had been the case in 13 out of the 27 appointments cancelled between April and June 2019.
The prison identified prisoners with social care needs well and provided them with an impressive level of support. Informal peer supporters helped residents to stay safe and independent within the prison and in the wider community.
Mental health services included a weekly session run by a mental health clinician and a psychiatric clinic when required. The clinicians’ caseloads were low. No complex clinical interventions were available for those who required them. The service contract was due to change with an additional session becoming available from late September 2019.
In our survey, 11% of prisoners said they had a mental health problem, of whom 50% said they were receiving help. The service had very short waiting lists, however only 16% of prisoners in the survey said it was easy to see someone from the mental health team compared with 28% in similar prisons surveyed since 2017, owing to half the population working outside the prison during core hours, making access only viable if they took a day off work.
The mental health team supported prisoners before release through effective liaison with external health professionals to ensure continuity of care. There had been no mental health transfers under the Mental Health Act in the previous year.
The integrated clinical and psychosocial substance use service, were noted as being patient centred. The team was fully staffed, had the required competencies and was well managed. Up-to-date policies and procedures were available electronically. Governance and oversight were integrated into wider health governance processes, which was good.
Psychosocial support was good. Prisoners were seen promptly and there was no waiting list. Some work had been done to test alternative access methods, such as phone consultations from work. The substance misuse service delivered a good range of individual and group psychosocial interventions and patient-centred clinical treatments, which were reviewed regularly. Caseloads were manageable, with 47 prisoners in structured treatment and 142 in unstructured treatment. An active and well-managed peer support scheme enhanced the service.
During the inspection only 2 patients were receiving opiate substitution therapy, both on maintenance doses. The service had good links with local community services and worked jointly to ensure treatment continued after prisoners were discharged. On release and when the criteria were met, prisoners received the drug naloxone to treat an opiate overdose.
The pharmacy provision was very well organised. However, there were daily delays in the delivery of medicines from the offsite pharmacy and staff supervision was limited. Missed doses were not reported on the clinical incident database.
Trained healthcare assistants administered the in-possession medicines. Pharmacists clinically screened all prescriptions and monitored prescribing remotely, which was good, but they did not hold medicines use reviews with patients.
Most patients received their medicines in-possession. Medication could be collected up to 3 times a day and there were special arrangements for those requiring supervised medicines outside these times. Prisoners who worked outside and who could not collect their medicines had them delivered to their rooms while they were out. The head of healthcare reviewed the delivery process during our inspection, after some risks were identified.
Very few prisoners were prescribed tradeable medicines. All new arrivals on prescribed medicines had a review to see if their prescription was clinically appropriate.
Healthcare staff recorded the medicine supply twice, both electronically and on paper. There was no policy on prisoners who did not collect their medicines and were not on the delivery list. Systems were put in place once inspectors had identified the problem.
Medicines were stored and transported securely, and temperature-sensitive medicines were kept in suitable fridges that were monitored, as were room temperatures. Healthcare assistants monitored stock levels efficiently, and vigilantly followed up medicines that had not arrived or were due imminently. Controlled drugs were well managed.
A dentist, supported by 2 dental nurses, provided 2 sessions a week. Waiting times for routine dental appointments remained too high, at 8–9 weeks. Weekly sessions were held on Friday mornings and afternoons, which limited prisoners’ access, but those on ROTL could access community services if they preferred. Prisoners with an urgent need were prioritised for the following session, and those with a dental emergency were supported through access to community dentists.
As part of the survey, 42% of prisoners rated the overall quality of the health services as being either very good or quite good.
Recommendations: Health, Well-being and Social Care:
- Out-of-hours’ access to primary and mental health services, including nurse and GP clinics, should be increased to support the significant number of prisoners who work off site.
- The head of healthcare should ensure that all incidents and risks are identified and managed through agreed governance processes.
- The head of healthcare should ensure that all staff communicate with prisoners with respect and should monitor the issue through governance processes.
- The pharmacist or a pharmacy technician should attend the prison regularly to offer face-to-face appointments with prisoners and to support dispensary staff.
- All missed doses of medicine should be monitored, reported as clinical incidents and treated as a service risk until rectified.
- Prisoners should have access to routine dental appointments within six weeks.
Good Practice: Health, Well-being and Social Care:
- The prison used a community pharmacist to dispense opiate substitution therapy, which enabled prisoners receiving the treatment to work in the community.
CQC Requirement Notices Issued:
[Full HMIP Report – HMP & YOI Standford Hill