Author Archives for PrisonHealthMatters

9 Steps To Prevent Drug Relapse And Deaths in Custody-Community Transition

In June 2019, the Advisory Council on the Misuse of Drugs (ACDM) published their report Custody-Community Transitions which contains details of the emerging evidence on the increasing drug-related harms in prisons and related to transitions through the criminal justice system. In particular, the increased risk of death, including by overdose, in the weeks immediately following release to the community.

This report from the Advisory Council on the Misuse of Drugs (ACMD) provides advice on how to reduce drug-related harms that occur when people move between custody and the community. It seeks to answer three questions.

  1. What are the drug-related harms and benefits associated with transitions between custody and the community?
  2. What are the most important existing recommendations in this area, and to what extent have they been implemented?
  3. Is there a need for new or adapted recommendations?

The report identifies substantial harms associated with transitions between custody and the community, especially for people who have problems with drugs, including the following:
• Homelessness. In 2017/18, 34.5% of adult prisoners under supervision from the National Probation Service (NPS) or Community Rehabilitation Companies were discharged to unsettled or unknown accommodation on their first night of release.
• Reoffending. Adults serving sentences of less than 12 months in England and Wales had a reoffending rate of 64.4% between April and June 2017, with rates likely to be even higher among those with a drug problem.
• Transmission of blood-borne viruses. Prison is a risk environment for the transmission of HIV and Hepatitis C, so entry to prison can be a risk for infection, and release may spread that risk to the community.
• Increased risk of death, including by overdose. Death rates among prisoners and, especially, those on post-release supervision are many times higher than in the general population. The few weeks immediately after release is a particularly high risk period for drug-related death.

There is a particular problem for people released from custody who use opioids (e.g. heroin). Restricted access to heroin while in custody can reduce physical tolerance to these substances. If these people then relapse to drug use on release, they face a heightened risk of dying by overdose. Such relapses and deaths are particularly likely when people are released without access to housing or drug treatment.

In the last ten years, a new challenge has emerged in the form of synthetic cannabinoid receptor agonists, which are often referred to as Novel Psychoactive Substances (also known by the acronym NPS but not to be confused with the National Probation Service), ‘Spice’ or ‘legal high’s’. These have exacerbated problems in prisons around safety, security and health. Prisoners reported that the main reasons for taking synthetic cannabinoids in prison were ease of access, avoidance of drug testing for other substances, and boredom. Action is already being taken by the Ministry of Justice in the 10 prisons project.

Issues around synthetic cannabinoids that are particularly related to custody-community transitions include the following.
• The frequent movement of people on short sentences or prison recall from the community into custody facilitates the supply of synthetic cannabinoids in prison.
• It is reported that many people begin or deepen a problem with the misuse of synthetic cannabinoids after entering prison, and may continue these problems on release.
• The additional problems caused by the use of synthetic cannabinoids in prison can inhibit effective rehabilitation and resettlement planning. This is because resources are often drawn away from rehabilitation-focused activities to deal with cannabinoid-related emergencies. It is also because the use of synthetic cannabinoids can inhibit individual prisoners’ engagement in pre-release planning.

Key Themes From Previous Recommendations

The biggest challenge, and the greatest missed opportunity for reducing reoffending and improving health, is the absence of continuity of care for people who enter and leave custody with complex needs.

  • That healthcare provided to people in the criminal justice system should be at least equivalent to that provided in the community.
  • Co-morbidity between mental health problems and drug misuse (‘dual diagnosis’) in prisons is prevalent. There needs to be more clearly defined mechanisms for managing patients with dual diagnosis, formal links between mental health and drug treatment provision, and greater awareness among staff.
  • The need for a cohesive, inter-departmental strategy on drug misuse in prison is often raised. Fragmentation between different services and conflict between different organisations’ targets was identified as a problem that leads to inconsistency in care and inefficiencies.
  • Services should be more integrated. The criminal justice system should coordinate with healthcare providers, mental health services, and community supports to ensure that people are given continuity of care in the vulnerable weeks following release. It is often noted that individuals should be involved in pre-release planning and should be put in contact with support and treatment options in the community quickly after leaving prisons.
  • Treatments that help people with drug problems to accrue recovery capital – which includes social relationships, health, skills and aspirations, as well as employment and housing – are identified as valuable to sustained recovery. It is often recommended that local housing and employment organisations are also integrated into the resettlement process.
  • The benefits of mutual aid to recovery are often highlighted. Support groups are linked to improved treatment outcomes, and it is suggested that actively guiding people towards these groups improved engagement.
  • Ensuring access to services and support is consistent across the country, as adapted to local needs. The difficulty of securing continuity of care for people who are imprisoned far from their homes is frequently mentioned.
  • Data collection should be developed, and different organisations should share information where possible to reduce inefficiency, identify areas for improvement and highlight gaps in service provision.
  • There should be a national framework for continual improvement of services by setting clear performance outcomes and analysing local needs and evidence of what works.

Despite the difficulty in assessing implementation of these previous recommendations, some concerning trends are visible in the data that are available.

  • Continuity of care. The Patel Report stated that the key issue to address was the continuity of care between prison and the community. However, the latest data from PHE (2017/18) suggest that only 32.1% of people who are assessed as needing treatment when they leave prison enter treatment in the community within 21 days.
  • Equivalence of care. The Bradley Review endorsed the principle of equivalence of health between custody and the community. The current guidelines on clinical management of people with substance misuse problems states that previously heroin-dependent prisoners should be provided with a supply of naloxone on release from prison and that commissioners should support the provision of naloxone and overdose training in the community. However, only 12% of prisoners who were previously heroin- dependent left English prison with naloxone in 2017/18. In Scotland, this figure is better at 35% but much more work is still to be done.
  • Reoffending. The aim of the Transforming Rehabilitation White Paper was to reduce reoffending rates. This was partly to be achieved by providing more support to prisoners released from sentences of less than 12 months, and an expansion of ‘through the gate’ services. However, the performance of CRCs in providing these services has been widely criticised, more recently by Her Majesty’s Inspectorate of Probation who commented on serious shortcomings in supervision of short-term prisoners on release, with no evidence that expanding post-release supervision to this group reduced their reoffending.

In English and Welsh prisons, the provision of screening and treatment was improved through the Counselling, Assessment, Referral, Advice and Throughcare (CARAT) teams and, in England, the Integrated Drug Treatment System (IDTS), which expanded the provision of opioid substitution therapy (OST) in prisons. Although CARAT teams and the IDTS are no longer centrally supported, the legacy of multi-agency working continues. NHS England’s service specifications from 2018 explicitly call for a joint, multi-disciplinary approach to the screening, assessment and provision of services for substance misuse, using a range of services that are equivalent to those used in the community. The provision of ‘opt-out’ testing for blood-borne viruses (BBVs) has increased uptake and the possibility to provide effective treatment in prison.

Systemic Recommendations

  1. That the Drug Strategy Board nominates one Minister who will have over-arching responsibility and accountability for the improvement of custody-community transitions for prisoners with complex health needs, including problems with drugs.
  2. That this Minister be given the following mandate: To assess and improve performance in delivering officially accepted recommendations on transitions between custody and community for people with substance misuse, mental health and homelessness problems. The indicators of progress in this area should include the following.
    a. Reducing the rate of reoffending (within six months and after two years) of people who leave prison and who have an assessed need for drug treatment.
    b. Reducing the numbers of people who die within four weeks of leaving custody (separated by police and prison custody) and while under the supervision of the probation services. These data should be collated separately for suicides and drug- related deaths, following the definitions that the Office for National Statistics uses for the general population.
    c. Reducing the proportion of people who leave prison with unsettled or unknown accommodation on the first night of release.
    d. Increasing the proportion of people who have an assessed need for drug treatment on release who enter treatment in the community within four weeks of release.
    e. Increasing the proportion of prisoners who are assessed as having a problem with opioids who leave prison with naloxone.
  3. That the Minister of Justice (England and Wales), the Cabinet Secretary for Justice (Scotland) and their counterpart in Northern Ireland take further steps to reduce the number of transitions into and out of prisons, especially as multiple short sentences are associated with increased risk of death. This should involve:
    a. reform sentencing to minimise the use of sentences of less than 12 months, with the aim of eliminating the use in sentencing of periods of less than 3 months in prison; and,
    b. reforms to the system of supervision on licence, so as to reduce the number of people who are recalled to prison.

When prisoners are released under licence to the supervision of the NPS or CRCs, they can be recalled to prison for breaching conditions of their licence. In the year 2017/18, there were 22,183 licence recalls to prisons in England and Wales. This is an increase of 27% since 2013/14. These recalls increase the number of transitions between custody and community. As noted above, these transitions increase the risk of health problems and often break continuity of care. They also create an opportunity to smuggle substances, including synthetic cannabinoids, into prison.

Practical Recommendations

In support of the systemic recommendations made above, this report makes the following practical recommendations.

  1. That the prison services of the UK take steps to minimise the release of prisoners with complex needs (including substance misuse) on Friday afternoons. As prisoners with release dates on Saturdays, Sundays or a bank holiday Monday are released on Fridays, more than a third of prisoners are released on Fridays. Friday releases makes it difficult to access stable housing, drug treatment, and connections with probations services and job centres. People often have to attend several appointments on their first day of release. If these appointments are missed on a Friday, then the person may be left for the weekend with no housing, no money and no drug treatment. These are circumstances in which relapse to drug use and offending are highly likely to occur.
  2. That the Department for Work and Pensions (DWP) should:
    a. accelerate the introduction of the measures listed in the 2018 Rough Sleeping
    Strategy (MHCLG, 2018) to enable prisoners to access employment or Universal Credit immediately on release;
    The Rough Sleeping Strategy committed the DWP to the following measures:
  • increasing the level of prisoner engagement with Prison Work Coaches;
  • supporting prisoners to begin the Universal Credit claim in prison;
  • continuing work to support prisoners to open bank accounts in prison; and,
  • supporting prisoners to verify their identity for Universal Credit purposes.
    b. work in partnership with Her Majesty’s Courts and Tribunal Services (HMCTS) and the NPS to ensure that people who are imprisoned are not overpaid the housing element of Universal Credit; and,
    c. Following the completion of the evaluation of the pilots, implement the effective elements identified through evaluation.
  1. That the prison and probation services of the UK should develop and extend services that provide face-to-face, individualised support to prisoners who have drug problems in the run up to release and through the transition to the community.
  2. That the Drug Strategy Board should make a clear statement that it is the responsibility of the national NHS bodies to ensure that all people who have an assessed problem with opioid use should be given the opportunity to take home naloxone when they leave prison or police custody. The Board should ensure that resources are made available to the national NHS bodies to support this responsibility.
  3. That relevant agencies (e.g. PHE) establish custody-community pathways into identified treatment for prisoners who have an assessed problem with alcohol, cannabis, cocaine, or other non-opioid drugs – as well as for users of opioids. Additionally, that a pathway should be developed that offers sufficient support to enable prisoners leaving abstinence-focused interventions to maintain such change following release.
    The experience of the drug recovery wing pilots suggests that existing services in England do not provide sufficient responses to the needs of people who have problems with substances other than opioids. It also suggests that the benefits of abstinence-focused interventions in prisons are often lost when people are released. The ACMD recommends that post-release pathways for people with non-opioid problems and for people who have achieved abstinence in prison be strengthened.
  4. That the Home Office should commission research specifically to identify and ameliorate problems and opportunities related to transitions into and out of police custody by people who have problems with drugs. This should include gathering information, across the UK, on:
    a. the levels of overdose and drug-related deaths in police custody and immediately afterwards; and,
    b. the coverage and effectiveness of Liaison and Diversion schemes in meeting the needs of arrestees with drug and alcohol misuse problems.

Conclusion

Transitions between custody and community are inherently risky. People with drug problems are particularly likely to experience such transitions, as they are frequently given short prison sentences for repeated acquisitive offences and are often recalled to prison from probation supervision in the community due to breaches of conditions. These transitions damage continuity of care, and so increase the potential for reoffending and relapse to problematic drug use. Short prison sentences are less effective than community penalties in reducing reoffending.

It is paramount that the government makes sure more is done to help prevent vulnerable people from relapsing after their release from prison.

Full Report Here

GOV.UK News Story

More ACDM Here

Photo by Jonathan Gonzalez on Unsplash

IMB Report: HMP Holme House 2018 – Health Summary

This report presents the findings of the Independent Monitoring Board at HMP Holme House for the period 01 Jan 2018 to 31 Dec 2018. 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.

General Points:

In 2017 Holme House was chosen to pilot the concept of a Drug Recovery Prison (DRP) with an additional investment of £9 million provided by the Ministry of Justice (MOJ) and NHS England between 2017 and 2020. The objective is to test a whole prison approach to tackling both the supply and demand for drugs in prison, and to create an environment where opportunities for recovery can flourish.

The DRP Delivery Plan consists of four components: safety and security, care and well-being, community and environmental development, and continuity of care.

2018 saw significant and steady improvements in the stability and performance of the prison, characterised by a regular and consistent regime leading to a greater certainty for both men and officers alike.

Wing based community care is delivered by a dedicated healthcare team made up of DART nurses, recovery coordinators, mental health nurses, CRC and peer support.

The number of prisoners with a history of self-harm has been consistent throughout 2018 with approximately 250 prisoners in an average prison population of 1200. In 2018 there were 868 open ACCTs, a 6% increase over 2017, which remains an area of concern. The IMB has observed excellent examples of a caring and consistent approach to ACCT reviews.

There were 261 reported acts of violence in 2018, compared to 376 in 2017. Assaults on prisoners (including serious assaults) showed a downward trend in the second half of 2018. There were 98 reported prisoner-on-prisoner assaults in 2018 which is an ongoing cause for concern. Assaults on staff are an ongoing concern, with 16 reported incidents in the year. However, there is evidence of a downward trend in the last quarter of the year.

There were seven deaths in custody in 2018, five of which were due to natural causes. This compares to five deaths in 2017 when four were due to natural causes. Inquests into the other two deaths are currently ongoing.

Healthcare

Service Delivery Positives:

  • Screening for bowel cancer, retinal screening, diabetic screening and healthy heart checks continue to be part of the routine.
  • There have been some improvements in inpatient care, as a concerted effort has been made to remove prisoners with serious mental health problems to another provision, resulting in most of the beds being occupied by social or clinical need prisoners. A dedicated team of prison officers has also been established within the inpatient accommodation. A palliative care suite is available and there is close working with Teesside Hospice Care Foundation and Macmillan nurses.
  • There has been a significant reduction in the percentage of men not turning up to appointments from last year (18% in 2017 down to 6% in 2018). This improvement can be attributed to the improvement in the delivery of the regime in the prison this year.
  • The mental health team is fully staffed with nurses. psychiatrists, a speech and language therapist, a resettlement officer and counsellors from MIND. A range of group therapies are available to all men, including stress management, ’Hearing Voice’, team building and a well- being gym. Other therapies such as EMDR (eye movement desensitising reprocessing) are provided.
  • A speech and language therapist (SLT) is employed as part of DRP, working within the mental health team to work with men who want to improve their communication skills or have swallowing difficulties due to mental health or medical problems. Part of the work is about making information easier to understand and making Holme House a more positive place for effective communication.
  • The mental health team manager won the national Cavell Staff Nursing award during 2018, being the first mental health prison nurse ever to do so.

Service Improvement Opportunities:

  • The IMB does not consider that the services provided to prisoners by Healthcare are equivalent to those that prisoners would receive in the community, and in some instances they are considerably worse, with unacceptably long waiting lists.
  • Although this figure has improved, there are still unacceptable delays and at the end of the year men had to wait five to six weeks to have a GP appointment, with review appointments having an eight-week waiting list. There is some provision for urgent appointments with the GP.
  • Dental appointments are worse, with the end of year figure of 280 men on the waiting list for an initial appointment, which will take 21 weeks, with an ongoing treatment waiting time of eight weeks and dental therapy nine weeks.
  • A shortage of nurses has dominated the ability of Healthcare to deliver a fully effective service to the prison. There has been an average shortage of 10 nurses out of a total complement of 27.5. Bank and agency nurses cover the shortfall. This has impacted on attendance at GOOD and ACCT reviews as well as late delivery of medication and poor or late attendance in reception, causing disruption to the prison regime.
  • Medication is supposed to be delivered by pharmacy technicians. However, due to shortages of staff, nurses are deployed to this work, which adds to the shortages in other areas. Medications on two house blocks are combined due to the low number of men requiring not in-possession medication.
  • The IMB has observed problems with the health care complaint system, which is separate from the prison complaints system, is not well administered and does not appear to be monitored robustly, leading to long delays with responses. This is reflected in the high number of applications the IMB get relating to medical matters.

Conclusion

The IMB feels that Holme House has become a less volatile and dangerous place for both prisoners and staff in 2018. Staff training has been focused on violence and drug prevention, e.g. all safer custody staff are fully trained in engaging in Timewise, a violence reduction programme. A prison-wide focus on staff training on Five Minute Intervention [FMI] and key worker training under Offender Management in Custody [OMiC] have also contributed to this.

Holme House can present a very challenging and volatile environment. The IMB feels that due to the determination and effort of those who work there and with a more consistent application of assurance checking considerable progress has been made towards laying the foundations for improved performance indicators and a more safe and stable environment for all who live and work there.


Holme House IMB Report 2018

Strep A – Guidance on Management and Prevention in Prisons

On 12th June 2019, Public Health England issued further guidance around the management and prevention of bacterial wound infections in Prisons and Immigration Removal Centres.

This latest publication offers guidance for both healthcare and custodial staff along with those within the responding health protection services in managing and preventing the spread of skin and soft tissue infections. Within prisons and secure settings the most prevalent of those infections is group A streptococcal (GAS).

An increase in cases of bacterial infections caused by Group A streptococci (GAS) among people in prisons has been reported across England in early 2019. Clusters of infection, primarily wound infections, were initially reported in prisons in Yorkshire and Humber, the North West, the East and West Midlands and the South West. Affected prisons has been associated with infections in people who inject drugs (PWID) and homeless people in recent community clusters and there are links between prison cases and these risk groups.

The following provides some of the more selected aspects that I found interesting:

Controlling the spread of infection in prisons will be contingent on the coordinated efforts of both health and custodial staff working with PHE Health Protection Teams (HPT’s) in these more specific areas:

  • Healthcare teams to ensure that swabs are taken from all patients with skin and soft tissue infections.
  • Custodial/detention staff should work together with prison healthcare teams to enable the identification of new cases and their subsequent isolation, clinical assessment and treatment.
  • Any cell/room sharers of identified cases should be encouraged to contact healthcare in the event they develop signs of infection for assessment and swabbing (nose and throat swabs if no skin lesions but any wounds should be swabbed on finding).
  • Prison management and healthcare staff should work alongside regional HPTs and PHE’s national Health and Justice team to implement the infection control recommendations described herein while balancing public health risk against any operational pressures on those establishments and the wider secure and detained estate in England.

Reception Screening – Health and Custodial Staff

All reception custodial staff should be alert to the enhanced risk of wound infections in people who inject drugs (PWID) or those using other illicit drugs, people with mental health issues at risk of self-harming, homeless people admitted from the community and transfers from other establishments with declared clusters of GAS infection.

Persons presenting to reception staff with signs of wound infection must be referred to Healthcare immediately for appropriate follow up at the next clinical opportunity; all information relating to prisoners’/detainees’ health is confidential and must be dealt with in the strictest confidence.

Persons should be assessed for any signs of wound infection on first entry to the establishment and before allocation to a cell/room.

At first reception screening, undertake assessment for any wounds, skin lesions or sore throat and swab accordingly as described above before allocation to a cell/room. Where possible, patients presenting with wounds should be allocated to single cell/room accommodation if available and if first night isolation poses no risk to their mental wellbeing.

Plan a follow-up healthcare review at a suitable time based on clinical judgement, taking into account the length of sentence.

Movement Restrictions – Health and Custodial Staff

The advice is that cases are not transferred to other prison establishments until 48 hours of compliance with antibiotic treatment. Medical holds are discouraged and will require individual risk assessment and agreement from both the establishment Governor/Director and population management unit (PMU) before they can be enacted.

No regime restrictions normally necessary for individuals post 48 hours antibiotic treatment with appropriately dressed wounds.

It may be advisable to restrict social mixing of prisoners/detainees between wings with high and low numbers of cases so as to limit cross-transmission of infection. This could entail limiting association activities for example, education, training and exercise; but practicability of implementation is dependent on both operational and security risk assessments.

Given the high risk for the cross-transmission of infection, patients should not participate in gym activities or sports where there is prolonged skin-to skin contact unless their wounds are covered adequately (seek advice from Healthcare if in doubt).

Inter-Prison Transfers

Prisons admitting persons without infection from other establishments with declared outbreaks should be notified to this effect. Healthcare in the receiving establishment should be made aware of these individuals to enable appropriate assessment of any wounds if needed.

Infection Control Measures – Health and Custodial Staff

All healthcare staff should be familiar with proper hand hygiene protocol as described in national guidance for prisons and make use of available liquid soap dispensers, paper towels and foot-operated pedal bins.

Any cuts should be kept clean and covered and healthcare staff should be mindful that patients may require support with wound management particularly for very deep lesions. Advice around personal hygiene and wound care will be a priority for infected patients and security staff should be made aware of the importance of regular access to shower blocks.

Consideration should be given to the need for dressing wounds and administering medications in the prison healthcare facility. Where the infected prisoner needs to attend the healthcare facility to do this, they should be seen as ‘last on the list’ and appropriate cleaning of the treatment room should be undertaken straight after.

All custodial staff should be familiar with proper hand hygiene protocol as described in national guidance for Prisons. All people (including staff, prisoners/detainees, visitors, etc.) should be encouraged to wash hands often and every time they use the toilet and before eating.

Wall-mounted liquid soap dispensers, paper towels and foot-operated pedal bins should be made available and accessible in key areas such as toilets, showers, the gym, the canteen and any other ‘high traffic’ communal areas to facilitate regular hand hygiene. Staff should assess whether these fixtures don’t pose a self-harm risk to residents prior to their installation.

Simple gym ‘instructions for use’ should be in place and visible to all gym users advising:

  • not to use the gym with open wounds/sores unless covered with a water-proof dressing
  • to wash hands with warm water and liquid soap and dry with paper towels before entering the gym or using any gym equipment
  • wearing of clean cotton clothes for gym/sports workouts
  • not to share gym clothes, towels and personal items including t-shirts, socks, etc.
  • to wipe surfaces of shared equipment before and after use with detergent wipes or detergent spray (wall-mounted dispensers in gyms are recommended) and disposable paper; focus should be on surfaces which are in contact with skin for example, handles, benches, seating pads, etc
  • to shower and wash with liquid soap and water after training
  • to wash personal items such as towels, underwear and sports clothing after every session at the highest possible temperature (refer to ‘Laundry’ section above) Laundry or food handing orderlies with proven infections should be transferred to other duties until their wounds have healed.

Staff are advised that the risk of infection to themselves from contact with cases is very low, as is the risk of carrying the bacteria from prison to home, as long as general hygiene precautions are in place. This includes:

  • regular hand hygiene with soap and water or alcohol hand-rub.
  • keeping any cuts clean and covered.
  • seeking advice from occupational health services on proper wound management if they have any doubts.

Should a staff member come into contact with someone who has an infected wound, for example by touching an infected site or being exposed to any exudate (ooze) that it produces, they should wash their hands thoroughly using warm water and soap or alcohol hand gel if soap and water is not available. Gloves can transfer infection from one person to another and if custodial staff are wearing gloves for prisoner/detainee movement/handling, gloves should be changed between case contacts.

Any staff presenting with signs or symptoms of wound infection, or throat infection, should seek medical attention immediately and be excluded from work until no longer infectious. They should advise their general practitioner (GP) of occupational risk and appropriate swabs should be carried out to determine if GAS is the cause of the symptoms.

Isolation/Cohorting of Symptomatic Persons – Health and Custodial Staff

All cases are to isolated in single cell accommodation until 48 hours of compliance with antibiotic treatment. The complexity of symptoms and treatment will inform duration of isolation and an individual risk assessment should be undertaken with input from custodial/detention staff to account for safeguarding and security considerations.

Ideally, isolation of cases in single accommodation is advised given the high likelihood of cross-transmission of infection to asymptomatic cellmates. If such accommodation is not available cases should be held alone in higher occupancy accommodation, or, if this is not possible, cohorted with other cases with wound infections (cases with GAS infection can be cohorted in the same cells/rooms even if they don’t have the same emm type).

Asymptomatic cell/room sharers of cases should be assessed and monitored for any signs of infection and isolated/cohorted if necessary. Cell/room sharers should be swabbed at the earliest clinical opportunity; nose and throat swabs should be taken if no evidence of superficial wounds.

Isolated cases should take all their meals in their cell/room and not in communal dining areas during the isolation period (48 hours for most cases as per directions received from Healthcare). Healthcare workers or prison/centre staff should enter the room to administer treatment, bring food and beverages, change linen etc.

Regular access to shower facilities by isolated cases will be important to manage infection. Where the isolation cell/room does not have adjacent bathing facilities, the case should use the nearest facilities separately before or after the block/wing prisoners or detainees have showered. If the isolation room does not have adjacent toilet facilities, a toilet should be designated for sole use by the case, wherever possible. Contact with other prisoners/detainees en route to the toilet should be avoided.

Isolated prisoners/detainees with infections will need to receive regular changes of their bed linen and towels.

Recommendations For Healthcare Staff

All staff should be alert to the enhanced risk of wound infections in groups including people who inject drugs (PWID) or those using other illicit drugs, people with mental health issues at risk of self-harm, homeless people admitted from the community and transfers from other prisons with declared clusters of GAS infection.

Cases may be identified by notifications received from custodial/detention staff, other prisoners/detainees, self-referral, at reception screening or through other means.

Any prisoners/detainees manifesting signs or symptoms consistent with invasive infection (iGAS) should be urgently reviewed by a doctor and/or arrangements made for referral to A&E for assessment if signs of sepsis present.

Treatment

Cases with infected wounds should be isolated in a single cell/room until 48 hours of compliance with antibiotic treatment plus/minus topical treatment as advised by local microbiology department.

More complex presentation (for example, Staphylococcus coinfection) may necessitate extended isolation/treatment periods as per individualised treatment plan advised by Healthcare.

Recommendations For Custodial Staff

Environmental Cleaning and Laundry

Staff and other persons, particularly those with cleaning/washing duties, should familiarise themselves with the general environmental cleaning protocols as outlined in national infection prevention and control guidance for custodial envirnments.

Thorough and regular (at least twice daily) cleaning of surfaces in communal areas must be undertaken with hot water, detergent and chlorine-based disinfectant agents; this will include ‘high-touch’ surfaces such as handrails, cell door handles, communal chairs and tables etc., and should extend to any communal bathrooms and showers.

“Titan-Chlor®” tablets are the only chlorine-based disinfectant product authorised for use in the prison estate in England and guidelines on its use can be found in existing health protection guidance issued by PHE’s Health and Justice team.

A ‘deep clean’ of cells occupied by any occupant diagnosed as having a wound infection once they have moved from the cell or after the decolonisation period is over, is necessary. This should be undertaken by specially trained prisoners or cleaning staff and is defined as follows:

  • cleaning of surfaces using hot water and detergent.
  • disinfection of these surfaces using a chlorine-based disinfectants.
  • allowing surfaces to dry before use.
  • checking that mattress and pillow covers are intact and, if not, ensuring that the damaged items are replaced.

Ideally, orderlies cleaning affected areas should not visit other parts of the establishment so as to avoid cross-contamination. If this is not possible, cleaning orderlies must ensure the appropriate use of personal protective equipment (PPE) and be aware of the importance of washing their hands with warm water and liquid soap after removal of PPE and before returning to their own cells/rooms.

All laundry staff should be familiar with washing protocols as outlined in national infection prevention and control guidance for prisons.

To limit the possibility of re-infection in prisoners/detainees with infected skin lesions, it is recommended that linen (for example, bedsheets and towels) is changed daily during the infectious period. Used linen must be placed into a soluble bag and then into a linen bag and tied promptly, half full bags should never be left lying about. The linen bag must be highlighted as ‘infected’. The linen that is contained in the soluble bag can be placed straight into an industrial washing machine. All linen should be washed and dried at the highest temperature setting possible.

Infected prisoners/detainees should be encouraged to send their clothing to laundry services for regular washing and made aware of the potential risks of doing their own laundry. Advice on the appropriate use of on-wing washing facilities (where applicable), including the importance of using high heat wash/dry cycles, should be given. Establishments should ensure appropriate maintenance of all on-wing laundry facilities is being undertaken to meet manufacturers’ guidance.

Where on-wing washing is necessary, laundry from infected prisoners/detainees should be done at the end of the day (N.B. consider risks to laundry orderly, wounds/cuts must be covered at all times), with high-temperature wash of empty machine after potentially infected laundry is processed. Articles of clothing should be placed in a soluble bag and tied in cell for transportation to the laundry facility by the prisoner/detainee or for collection by the laundry orderly, as appropriate. The entire laundry bag should be placed in the washing machine and washed at the highest temperature possible for the clothing; advisable that temperature settings above 60°C are used but lower temperatures may be suitable if the washed clothing is appropriately dried. After placing laundry in the washing machine, it is important that the handler (for example, prisoner/detainee, laundry orderly, etc.) wash their hands with soap and water and dry them at the first opportunity to prevent potential cross-transmission of infection.

Restrictions on visits

Consistent with patient welfare, visitor access to symptomatic prisoners/detainees should be kept to a minimum and any visitors should be provided with hygiene advice whilst ensuring patient confidentiality is maintained. Symptomatic visitors should avoid visiting the establishment.

If practicable, non-urgent visits should be rescheduled until 48 hours after patient compliance with antibiotic treatment and following an individual risk assessment by Healthcare.

Legal visits may be a requirement if preparing for court and alternatives to face-to-face meetings (e.g video-link) should be explored wherever possible.

Prisoners with effectively dressed wounds but no signs of infection can continue to receive visitors.

Full Guidance Here


Photo by Claudio Schwarz on Unsplash

HMIP Report: HMP & YOI Moorland, Feb 2019 – Health Summary

This report was on an announced inspection of HMP/YOI Moorland between 11–21 February 2019, and was published 11 June 2019.

General Points of Note.

Levels of violence had not only stabilised, but had actually decreased, which was noted as bucking the national trend over that period. However, despite this overall reduction, assaults against staff had doubled and were higher than at similar prisons.

Use of force by staff had increased since the last inspection, consistent with the levels at other category C prisons. There had been 202 uses in the six months leading up to the inspection, compared with 110 uses in the same period before the previous inspection.

Levels of NPS use had decreased since the last inspection. drug testing positive rate was 15%, including the positive rate for NPS, which on its own was 11%.

Self-harm was described as being “very high” and these levels were reported as being 50% higher than the average for category C prisons. In the previous six months, there had been 423 incidents of self-harm, involving 195 prisoners.

The quality of assessment, care in custody and teamwork (ACCT) case management for prisoners at risk of suicide or self-harm was considered to be mostly good, and staff training and quality assurance were driving improvement in care. Assessments were consistently good, and mental health workers regularly attended case reviews.

The most serious concern for inspectors was the lack of effective public protection measures. Over half the population, 530 men, were assessed as presenting a high risk and about a third were convicted sex offenders.

Healthy Prison Outcomes:

  • Safety = 3(2)*
  • Respect = 3(2)*
  • Purposeful Activity = 3(3)*
  • Rehabilitation and Release Planning = 2(2)*

Note: *(Previous inspection outcomes from February 2016 are stated in brackets)

Key:

  1. = Outcomes for prisoners are poor.
  2. = Outcomes for prisoners are not sufficiently good.
  3. = Outcomes for prisoners are reasonably good.
  4. = Outcomes for prisoners are good.

Key Points of Interest: Health, Well-Being and Social Care:

Leadership and accountability arrangements were considered as being robust. A culture of reporting serious untoward incidents and of learning from them was established, including learning from Prisons and Probation Ombudsman recommendations. Prisoner health representatives were now in place on most house blocks, and inspectors saw evidence of consultation about service delivery.

The training available to staff was impressive, with good access to clinical supervision and opportunities for professional development.

Clinical records captured the care provided and were subject to audit. We found equity of access to services for all prisoners. Infection prevention audits had been undertaken and clinical rooms were generally suitable and clean.

The management of health complaints had improved. We saw evidence of effective face-to- face resolution, and the quality of responses to concerns and complaints was generally good. However, complaint forms were not freely available and often had to be requested directly from health services staff, which potentially limited their use and submission.

A strategic approach to health promotion had been developed and bespoke events took place throughout the year. Patients who arrived at the establishment needing smoking cessation support were supported effectively.

Some secondary care was available onsite, including ultrasound scans and telemedicine. Out-of-hours support was delivered through the NHS 111 telephone line.

A complex case meeting took place fortnightly and was attended by a range of health care professionals. Patients’ care needs were discussed, and planned interventions were monitored and reviewed during the meeting. The management of long-term conditions was good and patient care was appropriately reviewed. Care plans were detailed and informed ongoing care provision.

Urgent mental health support was good. A duty worker was available seven days a week for prisoners experiencing acute distress, and they operated an initial gate-keeping assessment, which was impressive. This support included input into the segregation unit, and the team routinely contributed to all initial ACCT processes and subsequent case reviews, where appropriate.

All routine MH referrals were generally seen and assessed within a week.

Most custody staff had undertaken mental health awareness training, which was a positive development, particularly given the importance attached to the new key worker role.

The integrated substance misuse team provided well-led and coordinated clinical management, seven days a week. Currently, 115 patients were receiving opiate substitute treatment, compared with 66 at the time of the previous inspection, but prescribing input had not increased with this rising demand. The team appropriately prioritised 13-week reviews, and met weekly to discuss the care of the large number of patients with complex needs. A dual diagnosis nurse, who was part of the primary mental health team, provided support to patients with substance- as well as mental health-related problems.

There was a comprehensive in-possession (IP) policy, but inspectors found that not all IP risk assessments were reviewed in line with it. The use of IP medication had increased from 30% at the time of the previous last inspection to 65% in January 2019, which was positive. About a third of the population (330 patients) was prescribed supervised or controlled medication, which included a number of tradable medicines. Officers were now consistently available to supervise the process, which had improved safety and reduced the likelihood of diversion.

The CQC issued 1 Requirement Notice against Regulation Standards.

Recommendations: Health, Well-Being and Social Care:

  • Automated electronic defibrillators should be easily accessible to prison staff, particularly when nurses are not on site.
  • Patient information should be readily accessible in a range of formats and languages.
  • Prisoners with identified mental health needs should be able to access a full range of individual and group psychological interventions.
  • Patients requiring a transfer under the Mental Health Act should be transferred within the current transfer time guidelines.
  • The range of psychosocial interventions should meet identified need and include the provision of medium- to high-intensity courses.
  • Clinical substance misuse services should offer sufficient prescribing input to meet increased demand and complexity of need.
  • Patient medication should be supplied in a timely fashion, to ensure that treatment is not interrupted.
  • In-possession risk assessments should be reviewed in line with the local policy, to ensure that all risks are appropriately managed.

Good Practice: Health, Well-Being and Social Care:

  • None identified/reported.

CQC Requirement Notices Issued:

  • Regulation 12: Safe care and treatment. This was in relation to medicines being not always managed properly and safely.

Links/Resources:

News Release – HMP/YOI Moorland
Full Report – HMP/YOI Moorland

National IMB 2017/18 Report – Prisons in ‘fragile recovery’

On the 5th June 2019, the Independant Monitoring Board (IMB) published their National Annual Report for the late 2017 to 2018 period.

The IMB findings reported on 10 key aspects of prison life:

  • Staffing
  • Drugs
  • Safety
  • Segregation
  • Accommodation
  • Property
  • Equality and Diversity
  • Health and Social Care
  • Education, work and Purposeful Activity
  • Preparation for Release

As part of the introduction to this report Dame Anne Owers sets the scene:

“…the visible decline in (prison) safety, control and the expectations of both prisoners and staff since I last visited them, as Chief Inspector of Prisons, in 2010. It is therefore welcome that additional resources have now been put into prisons, with an influx of staff, but it will take time before prisons can not only stabilise, but progress.”

Here are some of the more noteworthy takeaways from the report that impact on the general health and wellbeing of prisons and prisoners:

Staffing.

Staffing issues dominated annual reports in this period. The main theme from across the estate is the ongoing influx of new, and therefore inexperienced staff. This is further compounded by the churn as prisons struggle to retain those officers. This affects every kind of prison and every aspect of prison life: from security and safety to healthcare, activities and rehabilitation. A recognition from the IMB that cannot be understated.

Drugs.

Drugs in prison not only have a direct impact on health and on prisoners’ erratic and sometimes violent behaviour; they also undermine safety and stability by producing an alternative power structure, based on debt, bullying and intimidation of prisoners, their families and sometimes prison staff. This also impacts on already stretched healthcare services.

Safety.

In general, incidents of violence and self-harm increased, often significantly, throughout 2018. Boards attributed this to a combination of the availability of drugs (and the associated debt and bullying), the inexperience or shortage of staff, and frustration due to inactivity.

Most boards reported an increase in the number of Assessment, Care in Custody and Teamwork (ACCT) documents opened for those at risk of suicide or self-harm during the period. It is recognised within the report that this may be in part a consequence of increased vigilance, following the steep rise in suicides in preceding years.

One board reported that they were concerned that an “overly risk-averse approach” had resulted in too many ACCTs being opened, making it more difficult properly to identify and support those at serious risk of harm. Whilst this may be very true, prisons could equally be criticised for doing the opposite. Such a practice of not opening too many ACCT’s could and is often recognised at Coroners Inquests as a failing in a duty of care. This feels very much like a case of damned if you do, damned if you don’t.

Another board noted that self-harm tended to coincide with canteen day and when the prison was in patrol state (i.e. prisoners being locked in their cells). Another, recognising the same phenomenon, had produced information and distraction programmes on in-cell television, with input from mental health. Commendable indeed.

Many boards welcomed the increased staff training in suicide and self-harm, and some reported improvements as a result. However, some also pointed to continuing concerns about the quality and consistency of ACCT documentation, observations and support, and in some cases the lack of involvement by healthcare staff in ACCT reviews, especially given the strong connection between mental health issues and self-harm.

Health and Social Care.

Boards reported the pressure on prison healthcare, reflecting the level of both physical and mental health need, as well as staff shortages and the impact on prisons of shortfalls in provision outside criminal justice.

It is well known that overall prisoners’ health, both physical and mental, is worse than among the general population. Physical health outcomes are affected by lifestyles, drug and alcohol misuse and disengagement with community healthcare, as well as the complex needs of an ageing prison population.

Prisons, like the rest of the criminal justice system, disproportionately contain individuals with mental health problems, which imprisonment can exacerbate – particularly as prisons, unlike mental hospitals, cannot compulsorily treat patients except in extreme circumstances.

Many boards reported the effects of staffing shortages, both of uniformed and healthcare staff. Sometimes there were not enough uniformed staff to escort prisoners to appointments, either within the prison or to external hospitals. Staff shortages also impacted on the supervision of medication queues.

Shortages of nursing staff, particularly mental health nurses, led to long waiting times, over-high caseloads and reliance on expensive agency staff with no continuity of care.

Shortages of uniformed prison staff and poor communication also affected the high number of prisoners not attending appointments made for them (DNA’s).

The IMB report states that the underlying problem was a disconnect between the level of need and the level of provision. The demand for healthcare services, especially mental health, was extremely high in many prisons, and many boards reported that need was increasing beyond current resource.

What the report doesn’t recognise, but is equally worth noting is the demands placed on staffing resources that are compounded further – for those in need of mental health services, our prisons are recognised by the courts as being places of safety. (Feel free to pause to reflect on this for a moment.)

Conclusion.

The report provides a benchmark for the future, and it is with a sense of both hope and optimism that the array of promising intiatives already underway as part of the prison reform programme begin to reap results. Those initiatives include:

  • the roll-out of offender management in custody (OMiC)
  • the prison estate transformation programme
  • lessons learnt from the then Prisons Minister’s ten priority prisons project, and responses to the Inspectorate of Prisons’ urgent notification process
  • revised processes for supporting prisoners at risk of suicide and self-harm
  • the new drug strategy
  • embedding the CSIP (challenge, support and intervention) process for violence reduction
  • new processes and contracts for dealing with prisoners’ property.

From now on, we can also look forward to a quarterly digest of published IMB Annual Reports, as the IMB undergoes further work with Boards to identify emerging themes and issues and to record progress against the hopes and expectations of the prison reform programme.

The prison night is very much at its darkest right before the dawn.

Read the full report here

Guidance: Suicide & Self-Harm Prevention In Prison

On 15th May 2019, the Government published guidance relating to the issues of suicide and self harm in prison.

The guidance acknowledges that the transition of going to prison affects people in different ways as they vary in their abilities to adapt and adjust in what may be a new environment. What should also be recognised is that fact that it also affects people in different ways when they are returning to what can may be considered be a familiar environment, which again can be viewed in either a positive or negative sense.

Either way, what is clear is that the risk factors for suicide are found more frequently among the prison population. Prisoners are a high risk population for suicide and self-harming behaviours. Those high risk times include:

  • early days and weeks (in local/remand prisons)
  • post transfer
  • post recall (in local/remand prisons)
  • post sentencing (in local/remand prisons)

Note the common theme above in the concentration of risk factors faced in local/remand prisons.

The guidance recognises that someone in crisis is likely to be:

  • actively engaged in self-harm or suicide attempts (although some may not be)
  • visibly agitated (although some may not be)
  • expressing current ideas and thoughts of suicide (although some may not be)

Identifying someone in crisis and reacting is different from identifying someone in need of support and intervening proactively. Many prisoners who complete suicide don’t present as ‘in crisis’. Sometimes they have limited risk factors beyond being male and incarcerated.

Theories of suicide suggest risk is heightened when people feel:

  • a lack of connectedness
  • burdensomeness
  • hopeless that things won’t change

Not everyone who self-harms intends on taking their own lives. Many incidents of self-harm are unrelated to suicidal ideation or intent, but there is a link. Over half of people who die by suicide have a history of self-harm.

Self-harm may occur at any stage of custody, when prisoners are trying to deal with difficult and complex emotions. This could be to punish themselves, express their distress or relieve unbearable tension or aggression. Sometimes the reason is a mixture of these. Self-harm can also be a cry for help, and should never be ignored or trivialised.

Steps To Take For Those Who Need Support.

Taking in account the probability of risk factors and the degree to which they may apply in the general sense, it could be suggested that each person be supported according to his or her own individual needs. Those step outlined within the guidance include:

  • Using the Assessment, Care in Custody and Teamwork (ACCT) case management system. ACCT is a prisoner-centred, multi-disciplinary process used for risk identification, care planning and support. Prison Service Instruction PSI 64/2011 requires that any prisoner identified as at risk of suicide or self-harm must be managed using ACCT – but for how long? When does a period of crisis end?
  • Forming positive relationships and fostering sense of connection to others. Prisoners at risk of suicide or self-harm can be supported through positive relationships. This can be staff/prisoner and prisoner/prisoner. This includes through peer mentoring schemes such as Listeners. Sustaining and improving prisoners’ relationships with their families and friends outside is important. It can help identify when someone is distressed and help them overcome it.
  • Supporting prisoners where appropriate through physical and mental health interventions, counselling or other support services.
  • Reducing a sense of burdensomeness. Helping prisoners engage in meaningful activities where they feel they are contributing, and enhancing hope for the future.
  • Information sharing and proactive multidisciplinary working. Communication between prison staff and partner agencies inside prison (like healthcare) and outside prison (like court and probation) must be robust. Including the prisoner themselves in all decisions and communications is important. Prisons should also ensure it is easy for prisoners’ family members to contact the prison to report concerns.
  • Training and support for staff. Staff should be empowered to make decisions based on the individual’s unique needs, and knowledge about best practice in addressing vulnerabilities and providing appropriate care. Ongoing training, up skilling and supervision will benefit staff and the individuals they support.
  • Staff showing that they care. Effective prison officers demonstrate good listening skills, recognise people’s humanity, and pass on hope and optimism.

Conclusion.

Suicide prevention initiatives are more effective when establishments adopt a whole prison approach. Taking steps to reduce suicide and self-harm reduction is everyone’s responsibility. Management visibility and leadership around suicide and self-harm prevention is extremely important.

Whilst the guidance is undoubtably helpful, identifying probable risk factors alone offers no reassurance for the prison officers and healthcare staff in keeping those within their charge, safe. If only it was that easy.

Read the full guidance here.

Photo by Ye Jinghan on Unsplash.


HMIP Report: HMP Stocken, Jan-Feb 2019 – Health Summary

This report was on the announced inspection of HMP Stocken (22 January 2019 – 8 February), and was published 29 May 2019.

Points To Note.

The use of illicit drugs, particularly new psychoactive substances (NPS), remained a serious problem. In the survey, nearly half of prisoners said that it was easy to get drugs at the prison. The mandatory drug testing (MDT) positive rate was high, at around 26% over the previous six months, and almost exclusively for NPS.

There had been two self-inflicted deaths since the previous inspection (in July 2015). Prisons and Probation Ombudsman (PPO) recommendations were not always implemented or embedded. Levels of self-harm had increased substantially since the previous inspection and were now comparable with those at similar prisons. Over half of the 184 incidents in the previous six months had concerned just eight prisoners, which is a telling statistic.

For the same six month period, there were a total of 115 Assessment, Care in Custody and Teamwork (ACCT) case management documents had been opened, which represented an increase since the previous inspection. This was noted as being below the number HMIP inspectors usually find at similar prisons.

Several aspects of health provision had deteriorated since the previous inspection and, overall, the service required improvement. There was a lack of robust governance for several areas of health care. The management of medicines had deteriorated, in terms of poor oversight of medicines management, poor stock control and unsafe storage that needed immediate attention. Some patients requiring nursing care did not always receive the treatment they needed, which left patients at risk of their health deteriorating. Care plans were not always followed or regularly reviewed, and primary care staff did not receive regular managerial or clinical supervision. Waiting times for most primary care services were acceptable, apart from long waits to see the physiotherapist and for a routine GP appointment.

Long-term health conditions were managed effectively. However, a lack of oversight of some patients with complex nursing care needs led to poor outcomes. A social care pathway was in place but the recording of planned care was poor. Staff shortages had had an impact on the delivery of some mental health services, including delays in routine assessments, but urgent referrals were seen promptly.

The drug recovery unit provided a positive environment, with a wide range of psychosocial support available. Not all patients on opiate substitution therapy received regular and timely clinical reviews.

Healthy Prison Outcomes:

  • Safety = 3 (2)*
  • Respect = 3 (3)*
  • Purposeful Activity = 2 (4)*
  • Rehabilitation and Release Planning = 2 (3)*

Note: *Previous inspection outcomes in brackets (from July 2015)

Summary: Health, Well-Being and Social Care:

No patient consultation forums had been established and there was no embedded system to gather patient feedback for primary care services.

Mandatory training was well managed, with some opportunities for professional development. Managerial and clinical supervision was in place for mental health and psychosocial staff but there were gaps in primary care managerial supervision, and clinical supervision was not offered.

The health centre was clean and treatment rooms generally met clinical requirements, including regularly checked and calibrated equipment. However, some of the wing-based medication administration rooms did not meet Infection Prevention and Control (IPC) standards. Daily cleaning checks for clinical rooms were not consistently completed. An IPC audit completed in September 2018 had identified some deficits.

Smoking cessation support was available for those who wished to stop nicotine vaping. Two peer health orderlies had been involved in this with health services staff, but these posts had recently become vacant.

Health care applications were triaged by non-clinical staff, so inspectors could not be sure that patients needing an urgent appointment would be identified, posing a potential clinical risk. Waiting times were adequate for most primary care services, but too long for physiotherapy, dental and routine GP appointments. There were urgent appointment slots available in each GP clinic.

There was an effective system to manage the booking of external hospital appointments. There were sufficient prison officer escorts, which meant that few hospital appointments were cancelled for operational reasons.

Health care release and transfer planning arrangements were effective, when health services staff were given sufficient notice. However, there had been occasions when the transfer of a patient’s care had been arranged only after the patient had left the prison, and when prisoners on release had received only a limited supply of medicines.

45% of prisoners reported to inspectors that they had mental health problems, and 58% of these said that they had been helped with these at the prison. During the inspection, the MH team had 60 patients on their caseload, including six with severe and enduring mental health needs.

The MH team received approximately 50 referrals per month from reception, self-referral, and health services and custody staff.

The waiting time for a routine Mental Health assessment was six weeks, which was too long. The manager triaged referrals each morning, prioritising them on clinical need. The team responded to urgent referrals promptly. There was an effective weekly team meeting and good interaction with prison staff.

There was only one psychiatry session per week, which meant that some patients waited too long for a routine appointment and medication reviews.

23% of prisoners reported an alcohol problem, and 33% a drug problem, on arrival; of these, 61% and 63%, respectively, advised inspectors that they had been helped with this while at the prison.

The Inclusion team, although stretched because of staff absence, was actively engaged with 279 prisoners (33% of the population). Eighty-one prisoners (10% of the population) were prescribed methadone, which was the only opiate substitution therapy available at the time of the inspection and limited patient treatment options. A third were on reducing doses. The prison did not receive any prisoners on buprenorphine (a heroin substitute), which needed to be reviewed.

The CQC issued 3 Requirement Notices against Regulation Standards.

Recommendations: Health, Well-Being and Social Care:

  • Effective and robust (clinical) governance structures should be in place, to ensure that all aspects of health delivery meet the needs of prisoners and are safe, including effective oversight of patient care and the immediate implementation of robust and secure medicines management arrangements.
  • Local partnership board meetings should occur more frequently, to provide strategic oversight and effective governance of the service.
  • Screening, immunisation and vaccinations should be offered and implemented in a timely fashion.
  • Specialist sexual health services should be available within the prison, to ensure privacy and dignity.
  • There should be clinical oversight of the appointment system, to ensure that patients are appropriately booked into clinics.
  • Waiting times for some primary care services, including physiotherapy, the GP and dental services, should not exceed clinically acceptable waiting times in the community.
  • Prisoners should have timely access to mental health services, including routine mental health assessments.
  • Prisoners needing treatment for their condition in hospital under the Mental Health Act should be transferred within the timescales established by the Department of Health.
  • Wider options for clinical treatment should be available, in line with national clinical guidance.
  • Joint clinical and psychosocial reviews should be timely, to support effective management and care of prisoners on opiate substitution therapy.
  • Medicines should be prescribed and administered at clinically appropriate times, to ensure optimal treatment.
  • Medication administration should be supervised effectively by prison staff, to ensure confidentiality and compliance, and reduce the risk of bullying and diversion.
  • The medicines management quorate should ensure that medicines storage and oversight are in line with legal and professional standards, and deficits should be immediately resolved.

Good Practice: Health, Well-Being and Social Care:

None identified.

CQC Requirement Notices Issued:

  • Regulation 9 – Person-centred care
  • Regulation 12 – Safe care & treatment
  • Regulation 17 – Good governance

Links/Resources:

Press Release

Full Report

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