HMIP Health Notes: HMP Bullingdon, Jul 2019

This report was on an unannounced inspection of HMP Bullingdon between 01–12 July 2019, and was published in October 2019.

“Even though there were indications that illicit drugs were becoming harder to obtain, the fact remained that more than half of the prisoners believed it was easy to get hold of them, and around one in five said that they had acquired a drug habit since coming into Bullingdon.” – Peter Clarke

General Points of Interest:

Staffing levels had increased substantially since the previous inspection, leading to 67% of prison officers having less than 2 years experience.

75% of the population had been in the prison for 6 months or less.

Self-harm levels were similar to that at the time of the previous inspection, and still much lower than at other local prisons. There were 25 prisoners subject to assessment, care in custody and teamwork (ACCT) case management procedures during the inspection.

Since the previous inspection, there had been 5 self-inflicted deaths.

Constant supervision was used often but there was only one suitable cell in which this high level of support could be delivered effectively. Too often, prisoners were locked in a normal residential cell, with an officer seated outside checking them through the observation panel, which was unsafe.

Prisoners had submitted 3,621 complaints in the previous six months, which was more than at other local prisons and in the same period at the time of the previous inspection.

Healthy Prison Outcomes:

2017 2019
Safety 2 3
Respect 2 3
Purposeful Activity 2 2
Rehabilitation & Release Planning 2 2

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

Learning from incidents, audits, complaints and patient surveys informed service delivery, and lessons learnt were now shared with staff. Considerable progress had been made on Prisons and Probation Ombudsman recommendations from death in custody reports relating to health care practice, leading to improved initial health screening and more regular mental health staff attendance at ACCT case reviews.

Healthcare appointment slips were sometimes given out to prisoners after the appointment time had passed. This problem had been repeatedly raised by prisoners through the monthly consultation meetings, and staff were seeking to address it.

The chronic staffing shortages found at the time of the previous inspection had been mitigated by recruitment to key positions and use of regular agency staff, who now felt part of the team. Raising the skills and competency levels of staff and ensuring a cohesive team had been a priority.

Health services staff had received life support training, and responded to medical emergencies 24 hours a day. They had good access to suitable and well-checked emergency equipment. The introduction of a paramedic had been a useful addition to the team.

Staff handover meetings and a weekly multi-disciplinary complex case meeting demonstrated effective joint working to promote good standards of care. Health services staff were aware of their safeguarding responsibilities and had received relevant training.

The management of health care complaints had improved. Patients could complain about their treatment in confidence, and forms were available on the residential units. The responses sampled had been timely and included details of how managers had investigated them.

There was no prison-wide health promotion strategy, but the service was involved in joint initiatives with the prison. Health promotion material was now displayed in the waiting area and across the prison, following the national calendar of health topics.

Immunisation and blood-borne virus screening were discussed at the second reception health screen. There was good smoking cessation support and access to community screening programmes, including retinal and abdominal aortic aneurysm screening.

The inpatient unit had improved and admission was based on clinical need. It was used for patients with physical, mental health and social care needs. Managers had reviewed the admission and discharge criteria, ensuring appropriate use of clinical beds. There was a regular team of nursing staff and discipline staff on the unit, who knew the patients well and delivered a good standard of care.

On release, there was also a choice for patients to receive their information via a mobile phone app. This enabled community GP services to continue their care in a timely way.

There was a comprehensive memorandum of understanding between the prison and the local authority to ensure the delivery of social care to those who met the threshold. Local authority arrangements for the assessment and provision of social care were good. Prisoners were able to self-refer.

A stepped model of care was provided by two mental health teams, who worked well together to provide high-quality support for individuals with mild-to-moderate to more complex needs. However, more resources were needed, particularly to enhance the range of primary mental health services available.

The primary mental health team (PMHT), comprised 3 mental health nurses, an assistant practitioner and a team leader. The team was available 7-days a week and responded to urgent need promptly, and routine referrals within 5 days. Prisoners could self-refer, and other referrals came from health services and prison staff. The PMHT undertook approximately 65 assessments per month and were the gatekeepers to the secondary mental health service. Servces offered included self-help material, psychoeducation sessions and computerised cognitive behavioural therapy sessions on an individual basis. However, they did not run any groups. The assistant practitioner completed well-being assessments, which promoted self-awareness and goal setting.

A process had been introduced to increase attendance at ACCT case reviews. The mental health teams met at least twice a week to discuss referrals.

At the time of the inspection, there were 41 patients on the in-reach team’s caseload, with 29 being managed effectively under the Care Programme Approach (CPA). Access to psychiatry was good, with six sessions per week.

Physical health checks, including regular blood tests, were completed for patients on mental health medication. The clinical records sampled were good, with thorough risk assessments, comprehensive progress notes and care plans demonstrating patient involvement.

The Substance Misuse team saw all new prisoners during induction, offering support and harm minimisation advice. Prescribing to meet clinical needs was available on the first night. About 240 patients were engaged in psychosocial therapy, representing an increase since the time of the previous inspection. A reasonably wide range of one-to-one and group sessions was available although some therapeutic options were not running.

Joint dual diagnosis work, for those with co-existing mental health and substance use problems, was available.

Substance Misuse clinical management was consistent and included joint 5-day, 28-day and 13-week reviews with psychosocial practitioners, an improvement since the previous inspection.

During the inspection, 198 patients were receiving opiate substitution therapy (OST), including methadone and buprenorphine. Few were on reducing doses, which was appropriate.

Community drug services no longer accepted referrals from the provider, which introduces a potential risk of relapse on release. Those in receipt of OST were linked with community services and were released with a prescription to last them until they attended their first community appointments. Take-home naloxone had been introduced as part of the discharge process, which helped to minimise harm.

Medicines were supplied by the in-house pharmacy. There was now a dedicated medicines management team, mainly consisting of pharmacy technicians, who were based on the residential units. The management of stock and the ordering of prescriptions had improved as a result, and provided consistency to patients. Supervised medicines were administered safely and efficiently from the residential units twice a day, with additional provision for night-time administration by nurses, although this was rarely used.

A weekly review of patients’ non-attendance for medication ensured that staff were adhering to the policy and ascertaining the reasons for non-attendance.

There was an in-possession policy, and risk assessments were carried out, although the reasons for decisions were not always recorded. These assessments were regularly reviewed. Around 50% of medicines were given to patients in-possession.

All prescriptions were clinically screened by the pharmacists, and some joint medication reviews had been carried out between pharmacist and the independent pharmacy prescriber. There were monthly risk meetings, which included a good focus on the management of medicines.

As part of the survey, 38% 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:

  • Health promotion material should be available throughout the prison, in a variety of languages and formats, to meet the needs of the prison population.
  • A comprehensive primary mental health service should be provided, offering a full range of support for prisoners with mild and moderate mental health problems.
  • The substance use psychosocial therapy needs of prisoners should be met in a timely manner.
  • Patients risk-assessed as not being able to have their medicines in-possession should not be given their medicines in this way.

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

  • The dietician provided an innovative approach to reviewing the nutritional value of prison food and helping individuals to make informed choices to improve their health.

CQC Requirement Notices Issued:

  • None.

Links/Resources:

Full Report Here – HMP Bullingdon

HMIP Health Notes: HMP Hewell, Jun 2019

This report was on an unannounced inspection of HMP Hewell between 03–14 June 2019, and was published in September 2019.

“The award of our lowest grade of ‘poor’ for safety was not a consequence so much of the actual level of violence, but more of a reflection of a range of failures to provide an environment in which prisoners could feel safe, where victims of violence would be supported, where perpetrators would be challenged and poor behaviour would lead to consistent and effective sanctions.” – Peter Clarke

General Points of Interest:

Adjudications had risen significantly from 1,584 in the 6 months before the previous inspection to 2,222 for the same period at this inspection. At the time of the inspection there were 382 adjudications that had been adjourned for up to 6 months. In addition, a further 526 were dismissed or not proceeded with in the previous 6 months.

Use of force on the closed site has increased from 178 incidents at the previous inspection to 497 in the previous 6 months. Governance of use of force incidents was weak and there was too much missing paperwork, and at the time of the inspection there were 350 missing use of force documents.

Self-harm incidents at the closed site had increased from 209 in the 6 months before the previous inspection to 350 in the same period this time. The number of ACCT documents opened had also increased from 517 in the 6 months before the previous inspection to 533 in the same period before the current one. The number of open ACCTs during the inspection was high with over 60 prisoners, 7% of the population, receiving at least hourly observational checks by staff.

Since the last inspection in August 2016 there had been 4 drug-related deaths, 2 self-inflicted deaths and 1 manslaughter on the closed site. There had been no deaths in custody on the open site.

Healthy Prison Outcomes (HMP Hewell Closed Site):

2016 2019
Safety 1 1
Respect 2 2
Purposeful Activity 3 1
Rehabilitation & Release Planning 3 2

Healthy Prison Outcomes (HMP Hewell Open Site):

2016 2019
Safety 4 4
Respect 3 2
Purposeful Activity 3 1
Rehabilitation & Release Planning 3 1

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

Prisoner council meetings had restarted one week before the inspection, the patient forum had recently recommenced, and patient feedback was gathered and analysed following health appointments.

Staff supervision was not provided in line with the health providers policies. There was no clinical supervision for staff.

Health complaints were managed well with the recent introduction of quality assurance, but face-to-face resolution was limited.

The health care department was a learning environment for nursing students and trainee paramedics from Worcester and Staffordshire universities.

Infection prevention and control had improved since the last visit. Most clinical rooms had cleaning schedules, but these were not always consistent in high-use rooms and some lacked prison contract cleaning. Although there were clinical audits continuous improvements remained outstanding.

Health and well-being information was available throughout the prison, and monthly national health campaigns were widely advertised and followed. There were robust systems and policies to prevent and manage communicable diseases.

9 prisoner health care ‘champions’ were supporting health care staff in the delivery of well-being advice and management. Those inspectors spoke to felt valued and well supported in their role, and received appropriate training.

The well-led and skilled primary care team offered an improved service since the last inspection, with shorter waiting times for appointments with nurses and GPs. There was good practice in the management of the very high levels of blood-borne viruses.

All new arrivals received a comprehensive initial health screening by a registered nurse, who reviewed risks and made onward referrals. A GP or nurse prescriber was available during the evening for complex cases, although late arrivals often missed out on this provision, causing prescribing delays. An additional nurse had been deployed to help screen new arrivals, but only 24% of newly arrived prisoners received secondary health screening. Secondary screenings were being cancelled due to lack of rooms.

External hospital appointments were managed well. Although some appointments had been cancelled to facilitate the large number of emergency admissions, the number that had breached the NHS 18-week rule for non-urgent consultant treatment had been minimal in recent months.

Clinical information flows for patients had improved when attending the local hospital emergency unit for urgent care. An alternative pathway had been developed for patients with long-term conditions, although work was ongoing to ensure that all these patients were receiving care in line with National Institute for Health and Care Excellence (NICE) guidance.

The 18-bed inpatient facility delivered positive outcomes for patients, despite the lack of permanent staff and living conditions that continued to be extremely poor. There were squalid cells with filthy drainage guttering outside each cell, leaking toilets and poor ventilation, resulting in the unit smelling strongly of urine. There was now a positive regime with most inpatients unlocked for a proportion of the morning and afternoon, although they still had to eat inside their squalid cells. Prison officers were not always available for the unit, leaving nursing staff to monitor at-risk inpatients with no cell keys.

5 prisoners were currently awaiting referrals to social care, of which 2 had waited over 2 months. There was no formal peer support or buddy scheme, which meant that support for prisoners with low-level social care needs was informal and not supervised or monitored.

Mental health provision had improved through investment in the service, recruitment and introducing a stepped care model for mental health support.

The integrated mental health service used group rooms, but vulnerable prisoners had limited access to group sessions. There were insufficient interview rooms for meaningful therapeutic interventions.

The recent introduction of a duty professional role had improved the initial assessment and allocation of prisoners to the appropriate level of support. There were 150 prisoners on the caseload during the inspection, 44 of whom were on the Care Programme Approach (CPA). Staff were allocated to attend ACCT case management reviews for prisoners at risk of suicide or self-harm, although late notice of the reviews affected attendance.

A range of self-help material was given to prisoners with low to moderate needs. There were health checks for prisoners prescribed mental health medicines.

Not all mental health team staff had completed their mandatory training in basic life support, safeguarding, infection prevention, fire safety etc. Caseload supervision ensured mental health care met individual prisoners’ needs.

The MH service had identified and assessed 18 prisoners for transfer to secure mental health hospitals in the last 6 months. The average wait for transfer was 80 days. While some of these prisoners were accommodated in the inpatient unit, others were held in the segregation unit due to behavioural problems; this was not an appropriate environment for prisoners with severe mental health problems.

Drug strategy meetings focused on reporting individual actions rather than taking a strategic approach to demand and supply reduction. However, the mental health and clinical substance use needs assessment had led to recent significant increases in the psychosocial provision. This was not yet matched by clinical substance use staffing, despite ongoing recruitment.

There were currently 199 prisoners on opiate substitution treatment (OST) and 333 on the psychosocial caseload.

A GP or non-medical prescriber saw new arrivals if they had a substance use problem. However, if prisoners arrived late on a Saturday and needed detoxification or stabilisation they might not be prescribed medicines until Monday, which was unacceptable.

There were no arrangements for overnight observations of any prisoner prescribed alcohol detoxification, which created significant risk. Monitoring of patients prescribed substitute and stabilisation medicines often did not take place due to insufficient clinical staff.

Inspectors observed supportive interactions with prisoners but administration of medicines was not confidential. Methadone and buprenorphine were prescribed appropriately. Prescribing reviews took place throughout the week, with one GP session and 6 non-medical prescriber sessions for substance use prescribing. There were no audits or reviews of prescribing.

Prisoners received most medicines via prescriptions. Health services staff could also administer and/or supply an appropriate range of medicines without a prescription through an authorised process. However, there were no records of staff trained and authorised to administer medicines without a prescription.

Custody Officer supervision of medicines queues had improved, although medication administration in the segregation unit was unsafe – this was rectified during the inspection.

Nurses, paramedics and pharmacy technicians administered medicines. Staff told inspectors that they followed up missed doses after the 3rd missed dose, and more quickly for critical medicines.

The medicines reconciliation rate was 20% within 72 hours and 40% in total, meaning that 60% of prisoners had not had their medicines reconciled during their detention. Staff also told us there were no specific processes to identify or prioritise prisoners with high-risk medical conditions or medicines.

At the time of the inspection, 63% of prescribed medicines were supplied in possession. Highly tradable medicines were administered only as supervised doses. Most prisoners had signed a compact agreement at reception and had an in-possession risk assessment. The monitoring of in-possession medicines was reactive and intelligence-driven, and they were not reviewed regularly.

Dental treatment and oral hygiene advice was available 5-days a week and was sufficient to meet prisoner needs. Waiting times during the inspection were around 2 weeks. Same or next day appointments were available for prisoners requiring urgent treatment, following clinical triage. 4 dental nurses and 2 dentists were in post, and there was good clinical oversight of the waiting list. The dental surgery was clean, well ordered and well maintained, and met infection prevention control requirements. Clinical governance of the dental service was robust, and staff received appropriate training and support. The surgery had access to interpreting services for non-English speaking patients.

As part of the survey, 29% of prisoners rated the overall quality of the health services as being either very good or quite good.

The CQC issued 3 Requirement Notice against Regulation Standards.

Recommendations: Health, Well-Being and Social Care:

  • There should be a joint local operating procedure to optimise emergency response, including automated external defibrillation accessible for each house block and working area.
  • Clinical supervision should be provided and recorded for all clinical staff, and mandatory training requirements should be fulfilled.
  • Social care arrangements should meet the needs of all prisoners and the requirements of the Health and Social Care Act 2014.
  • Transfers under the Mental Health Act should occur expeditiously and within the current Department of Health transfer time guidelines.
  • Prisoners with substance use needs should receive substitution treatment in line with national guidance, and monitoring should ensure that their care is safe.
  • New arrivals should receive their prescribed medicines promptly.
  • The governance of medicines optimisation should ensure the competency of staff, and the monitoring and auditing of the effectiveness of the use of medicines.

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

  • The management of the high numbers of patients with blood-borne viruses was commendable, given the high turnover of prisoners. The system for ensuring effective patient information flow to and from the local emergency unit was improving continuity of care and patient outcomes.

CQC Requirement Notices Issued:

  • Regulation 12: Safe Care and Treatment.
    How the regulation was not being met:
    The provider had not ensured that all risks to patients were assessed and appropriate action taken to reduce these risks.
    The registered person did not have arrangements in place to fully assess and monitor the risks of patients requiring alcohol detoxification.
  1. Patients receiving alcohol detoxification treatment were not monitored by health care staff overnight for withdrawal symptoms or seizures.
  2. In April and May 2019, 62 patients were prescribed medicine for alcohol detoxification and withdrawal support. No overnight monitoring of these patients took place.
  3. The 62 patients who were prescribed alcohol detoxification medicine during April and May did not receive regular or consistent monitoring by suitably trained staff.
  • Regulation 17: Good Governance
    How the regulation was not being met:
    The registered person did not establish and operate effective systems and processes to assess and monitor the quality and safety of the service. The provider’s systems and oversight of the service had not identified all risks to patients:
  1. The provider had not identified the risks associated with the absence of appropriate monitoring of patients with substance misuse needs who were prescribed medicines for stabilisation and withdrawal.
  2. At the time of the inspection, monitoring of the contents of the emergency bags did not ensure that the expiry date of glucagon was amended when removed from refrigerated storage.
  3. Records were not maintained of staff trained and authorised to administer medicines without prescriptions.
  • Regulation 18 Staffing
    How the regulation was not being met:
    Staff had not been supported by regular supervision in line with the provider’s own policy.
  1. Out of 48 staff, 16 had not received any supervision in 2019.
  2. One member of staff who was employed for three months in 2019 had left having not received supervision.
  3. A new member of staff had not received their first supervision for four months.
  4. Mental health and psychosocial staff who worked at HMP Hewell had not had access to the electronic staff record system to complete their mandatory training.
  5. The overall mandatory training compliance on 14 June 2019 was 54.74%.

Links/Resources:

Full Report Here – HMP Hewell

IMB Health Notes – September 2019 (Pt. 2)

The IMB reports published during the latter part of Month 2019, of which there were only 4, were from these establishments:

  • HMYOI Wetherby
  • HMP Rye Hill
  • HMP Erlestoke
  • HMP Coldingly

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.

Here are some of the more interesting points contained within those reports, pertaining to health and wellbeing:

IMB Report – HMYOI Wetherby

Reporting period – 01 Jun 2018 to 31 May 2019.

  • From July 2018 to April 2019 there were 363 incidents of self-harm, and 258 ACCTs opened from June 2018 to April 2019.
  • In January 2019, although incidents were down by 50% on the main site, there was an increase of 144% on the Keppel unit. Those who had self-harmed twice or more was at 81.6%. In February, one YP self-harmed on 25 occasions. 78% of all self-harm was attributed to just 7 YP’s. Between March and April there was an increase of 247% on the main site and a decrease of 28% on Keppel. In April, 70% of those YP who self-harmed did it twice or more, with 8 YP’s accounting for 70% of all self-harm.
  • Keppel continues to be a very well-managed unit with staff meeting the challenges of the most complex YP. At the end of this year there were five YP with severe mental health needs awaiting transfer to a hospital placement and, as last year, there remains an unacceptable delay.
  • Between July 2018 and May 2019 there were 541 assaults between YP (compared to 667 last year), 20 of which were serious (compared to 8 last year), and 145 assaults on staff (129 last year), 6 of which were serious (8 last year).
  • The merger of the health care team, CAMHS and substance misuse services into one building, continues to build on its strength enabling a more effective and united work force.
  • The last 4 months have seen the employment of 2 new dedicated health centre officers. This has improved the number of YP attending appointments and facilitated follow-up of DNA’s, although DNA for optical and dental appointments are still high at 30% to 40% respectively. It was noted that the possibility of a designated health centre movements officer would further enhance this system.
  • The Beacon Suite, where YP are assessed by psychiatrists, also continues to have a high DNA rate, leading to delays of the diagnosis of conditions such ADHD and autism which can impact on behaviour through inadequate access to appropriate medication.
  • When YP with extreme mental health issues are sectioned under the Mental Health Act, there can be very long waits for adequate medical provision to be put in place. Sourcing an appropriate hospital setting can also be a lengthy process. Children’s secure hospitals will not take YP over 17.5 years so it is particularly challenging to find somewhere suitable for this group. Whilst appropriate accommodation is being sought, the YP may need to be placed under constant watch or similar arrangements which are extremely labour-intensive.
  • Difficulties Were noted around the recruitment and retention of healthcare staff. The primary care section of the health care department has lost several staff over recent months, compounded by a recruitment process that can take up to 6 months to replace those who have left, leaving a staffing deficit and imposing extra strain on the remaining members.
  • Healthcare applications to the IMB increased to 2 from 0 when compared to the previous reporting year.

Full IMB Report – HMYOI Wetherby

IMB Report – HMP Rye Hill

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • Notable average population demographics reveal 34.5% of the population as being registered disabled, 41.8% of the population are aged 50 or over, and 12.8% are aged 65 or over.
  • The need for the use of force has also increased over the past 12 months to an average of 22.8 events per month compared unfavourably to the 14 per month the previous year.
  • Incidents of self-harm through the 2018/19 reporting year averaged at 34.25 per month, compared with 18.9 per month in the last reporting year. Many of the prisoners who self-harm are long-term or multiple self-harmers with complex needs.
  • The number of open ACCT documents had reduced in the past year to around 13 prisoners per month.
  • There have been 5 deaths in custody during the year, 2 on units and 3 in hospices and all resulting from chronic illnesses or natural causes.
  • The number of booked hospital appointments remained high with an average of 177 per month, ranging between 80 to 141 each month.
  • For the 12 months from April 2017, clinic appointments averaged out at 77 cancellations per month out of 137 booked appointments (56%).
  • Measures to reduce the number of prisoners failing to attend healthcare appointments, including the issue of incentives and earned privileges (IEP) warnings, were very effective for a time but non-attendance without cancellation was noted as beginning to creep back up.
  • Healthcare applications to the IMB decreased to 31 from 52 when compared to the previous reporting year.

Full IMB Report – HMP Rye Hill


IMB Report – HMP Erlestoke

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • There were 248 ACCT documents were opened in the year – a reduction of 4%. Paperwork had improved although completion of care maps was deemed to be of variable quality. The number of ACCTs in the care and segregation unit (CSU) is a concern, although these cases are well managed. However, the mandatory requirement to have healthcare staff attend the first ACCT case review is rarely met. Representation at first review has only occurred in 15% of ACCTs opened (37 out of 248 first ACCT reviews) raising obvious concerns. In mitigation, healthcare is often not made aware of a review or the review takes place on a weekend when a healthcare representative is not available.
  • There were 326 self-harm incidents, reflecting an upward trend evident also in national statistics.
  • There were 91 prisoner-on-prisoner assaults and 58 assaults on staff. Assaults on staff were, in the main, not serious.
  • Drug and substance misuse continues to be a significant issue and is closely associated with debt, bullying and indiscipline. 40 prisoners are signed up to the integrated drug treatment system (IDTS). The dedicated well-being team offers a range of courses: Pillars of Recovery (a four-month programme), Alcohol Awareness (one day a week over six weeks), Inside Out (a programme to support recovery from addiction) and Spice Awareness (half a day highlighting the dangers of psychotic substances).
  • During the year, the practice of making daily healthcare visits to everyone on an ACCT was ended and restricted to those whose perceived need warranted a visit. As a result of the staff saving, a well-man clinic has now been established.
  • Waiting times for GP appointments has averaged 21 days but a reduction of weekly GP sessions from five to four is likely to extend waiting times. However, a “see and treat” system whereby applications for medical treatment are collected daily from sealed boxes on the wings by nurses has led to a swift disposal of minor ailments and a less frenetic atmosphere in the healthcare waiting room with appointments better co- ordinated.
  • Escorted visits for hospital outpatient appointments are limited to 10 a week (2 per day). Less urgent appointments are postponed when more pressing needs arise, leading sometimes to unacceptable delays for what may initially have been a non-urgent appointment. GPs are sometimes then put in a difficult position of prioritising cases among medical needs of similar weight.
  • The healthcare building is a single storey structure with an unprotected flat roof, and has provided disaffected prisoners with an easily accessed venue for roof-top protests. Such protests close healthcare and lead to delays and cancellation of medical appointments, a source of considerable inconvenience for prisoners.
  • Clinical concerns with regard to the perceived over-prescription of the potentially addictive and reclassified gabapentin and pregabalin drugs have led to a decision to confine these prescriptions to those for whom the drug is deemed appropriate. A number of prisoners no longer prescribed the drugs reacted angrily. Some applications from prisoners on the subject have been received. However, a programme of information and education has convinced others of the benefits of the policy.
  • 6 health trainers provide 1-to-1 sessions for those wishing to address negative lifestyle behaviours in a range of areas including eating, physical activity, alcohol and smoking.
  • A patient forum has been established, meeting every 2 months.
  • Healthcare applications to the IMB increased to 28 from 6 when compared to the previous reporting year.

Full IMB Report – HMP Erlestoke


IMB Report – HMP Coldingly

Reporting period – 01 Aug 2018 to 31 Jul 2019.

  • Recorded assaults in this reporting year were 42 for prisoner-on-prisoner (compared to 27 for 2017/18), 42 prisoner-on-staff assaults (compared to 18 for 2017–18). A further 31 prisoners had unexplained injuries 31 (compared to 20 in 2017–18).
  • On average, 10 ACCTs documents were opened each month, compared with 13 per month last year.
  • Improvements with the methods of mental health assessments has led to all patients being assessed within 5 to 7 days.
  • Prisoners not showing up for assessment or treatment is still an unnecessary drain on the resources available and more rigid rules are being followed to impress on prisoners the value of turning up when agreed. Hospital cancellations continue to be a problem due to the difficulty in allocating adequate escorts and overcrowding at the hospital.
  • A system for consulting with local hospitals via Telemedicine is being established for an anticipated start in 2019.
  • Substance misuse issues continue to be a major cause for concern and sadly led to a death in custody in August. A large variety of drugs and tobacco have been found during normal search operations in the prison and wing brewed alcohol was widely discovered during routine searches.
  • Over the year the number of drug-related incidents probably totalled 16 cases although another 120 incidents might also have been partially or wholly due to drug abuse and at least one required CPR by the healthcare staff. These incidents were managed by the prison staff. Prison records fail to differentiate between drug abuse call-outs and other health-related emergencies which consequently, raises concerns for the IMB.
  • Healthcare applications to the IMB increased to 7 from 5 when compared to the previous reporting year.

Full IMB Report – HMP Coldingly


HMIP Health Notes: Brook House IRC, Sep 2019

This report was on an unannounced inspection of Brook House IRC between 20 May to 7 June 2019, and was published in September 2019.

“In terms of safety, levels of violence were low. However, there was a need to understand why instances of self-harm had significantly increased and respond to our survey finding that 40% of detainees said they had felt suicidal at some point while in the centre.” – Peter Clarke

General Points of Interest:

During the period from October 2018 to March 2019, 54% of detainees leaving Brook House were released into the community.

The number of self-harm incidents had risen significantly since the last inspection. During the previous six months, there had been 79 recorded incidents of self-harm compared to 46 at the previous inspection when the population was also markedly higher.

Over the same period, 167 Assessment, Care in Detention and Teamwork (ACDT) forms had been opened, which was proportionately more than at our the inspection. Injuries resulting from self-harm were usually superficial.

There had been 95 constant supervision cases in the previous six months.

The quality of ACDT documentation was deemed to be not good enough. Assessments and reviews were timely but care maps frequently lacked detail, case reviews were not sufficiently multidisciplinary and some post-closure reviews were not completed.

The number of detainees refusing food was high and there had been 388 cases in the previous six months. Since the previous inspection, detainees refusing food or fluids were no longer routinely monitored through the ACDT process.

The level of detainee-on-detainee violence was low and no serious assaults had been recorded in the previous six months. The level of assaults on staff was much higher than in other immigration removal centres, however these were generally minor and none were reported as serious.

Healthy Prison Outcomes:

2016 2019
Safety 3 3
Respect 3 3
Activities 3 3
Preparation for Removal & Release 3 3

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

Most detainees were positive about health care, but a significant minority complained about their treatment and especially about the attitude of health care staff, often citing dismissive behaviour.

During the six months from October 2018 to March 2019, Brook House doctors had submitted 93 Rule 35 reports, 91 of which related to torture and two to the impact of detention on health, leading to 14% of those 91 reports to be released.

The latest annual infection control audit showed 97% compliance and areas of concern about governance were found to have been addressed.

Feedback from detainees was gathered through patient surveys in several languages and analysed at clinical governance meetings. Health staff also received feedback from detainees at the regular safer community meetings.

Detainees could complain about health services through several channels including a dedicated confidential complaints box in the health care waiting area, although this was not well promoted. Most complaints were received through the Home Office complaints system and then passed to health care, which potentially compromised medical confidentiality.

Difficulties with staff recruitment persisted, particularly RGN’s and HCA’s. On a positive note, Paramedics had now been added to the team.

The provision of recorded managerial and clinical supervision for health staff was inconsistent, and not in line with the policy. Both the quality and consistency of staff supervision records that were reviewed varied. Clinical supervision was being developed, including recent group sessions. Compliance with mandatory training requirements was good across the staff group and staff told the inspectors that they were well supported in using development opportunities.

All health staff had received intermediate life support training. Emergency equipment and medication were well maintained and checked regularly. Inspectors were informed that although custody staff were aware of code blue and red emergency protocols, they were rarely used, with other radio calls used to summon health care in an emergency.

The provider had developed and was starting to implement a health promotion strategy based on NHS national events. A health champion helped to promote health services to other detainees which was positive.

Access to primary care services was very good. Detainees waited no longer than 3 days for a routine GP appointment, with emergency appointments available each day. Nurses conducted daily walk-in triage clinics in the health care centre, and HCAs had recently started running regular well man clinics across the centre to improve engagement with detainees and offer health promotion advice.

DNA rates for primary care clinics were monitored. These were reducing and in April 2019 the rate stood at 14% for nurse-led clinics and 18% for GP clinics.

Two escorts a day were available for detainees requiring treatment at hospital. Cancellation rates were low at the time of the inspection.

All operational staff had received mental health awareness training as part of their initial training. Mental health first aid training had recently been introduced with the intention of rolling it out to all staff, which was positive. More than a third of staff had already received this.

An emotional health group was run by a clinical psychologist which included anxiety and depression. However, the group was for English speakers only.

A senior mental health nurse worked every weekday and there was a duty mental health nurse seven days a week. All urgent referrals were seen within 24 hours and routine referrals within 3–4 days, which was reasonable.

The recent implementation of the well-man clinic on the wings had identified mental health concerns which were referred to the mental health nurses and dealt with very promptly.

There was an average of 50 referrals a month and, at the time of the inspection, the team was supporting 32 detainees with varying levels of need. The DNA rate for individual sessions was high but these were actively followed up and further appointments offered. There was a symptomatic approach to post-traumatic stress disorder, which was appropriate given the unpredictable and short stay of detainees.

In the previous 12 months, 4 detainees had been transferred under the Mental Health Act – 3 within the agreed timescales of within 14 days, and 1 had exceeded this by 12 days.

Detainees with substance misuse problems were referred for an assessment promptly on reception. The demand for clinical prescribing for drug and alcohol dependence was low and detainees were given appropriate support. Prescribing for opiate dependence focused on reduction, although prescribing was flexible and patients were involved in treatment decisions with regular reviews. At the time of the inspection, only 1 detainee was receiving opiate substitution therapy and was on methadone. A further 2 detainees were detoxing from alcohol and had received good care with regular checks throughout the first 5 days of treatment.

A team leader and two psychosocial workers screened all new arrivals and offered individual and group work. At the time of the inspection, the team were supporting 20 detainees. Access to psychosocial interventions was good, with effective use of 2 peer supporters who ran drop-in sessions on each wing to promote the service. They also participated in weekly workshops which covered a range of topics including alcohol, cannabis awareness and psychoactive substances.

There was evidence of a small amount of illicit drug use in the centre, mainly cannabis and psychoactive substances (NPS). Health care kept a log of suspected use of NPS. During 2019, there had been 5 episodes in both March and May whereby detainees needed observation.

The substance misuse team delivered monthly training and awareness sessions for custody staff on substance misuse, including the effects of NPS. All custody staff had received this training, which was commendable.

A pharmacy technician worked every weekday and managed the pharmacy efficiently. Since October 2018, a pharmacist had been visiting for 4 hours each week to give professional oversight of the service.

About 60 to 70% of detainees on medication received it in-possession following an appropriate risk assessment.

A Dental Officer from East Surrey Hospital attended the centre fortnightly to assess patients and provide oral health advice. Detainees requiring urgent treatment were referred to hospital dental clinics at weekends. Detainees waited approx 3 weeks for a routine assessment and could access emergency care daily at Crawley Hospital.

There were no on-site dental facilities and the provider was considering engaging a mobile dental service to improve access to dental treatment.

As part of the survey, 38% 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:

  • Health care complaints system should be well advertised and ensure that medical confidentiality is maintained.
  • All health staff should receive regular, recorded managerial and clinical supervision.
  • The centre should promote the emergency protocols to ensure that all custody staff are familiar with them and are confident to use them when needed to prevent confusion and potential risk.
  • A wide range of translated health information, including self-help guidance, should be easily accessible and clearly promoted.
  • Formal monitoring should be introduced to ensure that all detainees leave the centre with their prescribed medication.

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

  • The introduction of well-man sessions across the centre was a positive initiative to improve engagement with the service and offer health promotion advice.
  • There was effective use of substance misuse peer supporters who ran drop-in sessions on each wing to promote the substance misuse service. They participated in weekly workshops which covered a range of topics including alcohol, cannabis awareness and psychoactive substances. A detainee ‘health champion’ also helped to promote health services.

CQC Requirement Notices Issued:

  • None.

Links/Resources:

Full Report Here – Brook House IRC

NICE Guidance For Suicide Prevention in 2019

In September 2019, the National Institute for Health and Care Excellence (NICE) published new guidance for Suicide Prevention (Quality Standard 189).

This quality standard covers ways to reduce suicide and help people bereaved or affected by suicide. It describes high-quality care in priority areas for improvement by the outlining of 5 quality statements:

Statement 1 Multi-agency suicide prevention partnerships have a strategic suicide prevention group and clear governance and accountability structures.

Such a structure could be in the form of Safer Custody Teams made comprising all disciplines within each establishment that simply goes beyond representation from residential functions and mental health teams.

Quality measures would be evidenced through clear terms of reference and accurate minutes from meetings with the specific focus on planned actions and accountability.

Expected outcomes would be reductions in the rates of incidents of suicide and self-harm.

Statement 2 Multi-agency suicide prevention partnerships reduce access to methods of suicide based on local information.

Considerations:

  • Identify emerging trends in suicide methods and locations
  • Understand local characteristics that may influence the methods used
  • Determine when to take action to reduce access to the methods of suicide.

Reducing access to common methods of suicide and to places where suicide may be more likely to occur can be an effective way of preventing suicide, along with consideration of any measures that can be used to interrupt prisoner’s plans, enough to give them time to stop and think, or making it more difficult for them to put themselves in danger.

It’s not inconceivable that one of the positives of allowing smoking in prisons in England and Wales was the act of rolling a cigarette, that then allowed such an opportunity to stop and think. In the Smoke Free estate, it is doubtful that any e-cigarette or vape can fill the void of such a process. This isn’t the only example, but certainly one of the more obvious that springs to mind.

Statement 3 Multi-agency suicide prevention partnerships have a local media plan that identifies how they will encourage journalists and editors to follow best practice when reporting on suicide and suicidal behaviour.

Best practice when reporting on suicide and suicidal behaviour includes:

  • Using sensitive language that is not stigmatising or in any other way distressing to people who have been affected
  • Reducing speculative reporting (that often serves no other purpose than to attract more online “clicks” perhaps?)
  • Avoiding presenting detail on methods providing stories of hope and recovery including signposting to support.

Statement 4 Adults presenting with suicidal thoughts or plans discuss whether they would like their family, carers or friends to be involved in their care and are made aware of the limits of confidentiality.

The judgement may be that it is right to share critical information, which is what the Assessment, Care in Custody and Teamwork (ACCT) process permits. After all, families and friends would prefer to be involved, and be a part fo the support process rather than after the event when being informed that their loved one has completed suicide.

Statement 5 People bereaved or affected by a suspected suicide are given information and offered tailored support.

Support that is focused on the person’s individual needs. As well as professional support, it could include:

Improving Outcomes

The quality standard is expected to contribute to improvements in the following outcomes:

  • Quality of life for people bereaved or affected by suicide
  • Rate of self-harm
  • Hospital attendances and admissions for self-harm
  • Suicide rate.

Further Links/Resources

NICE – Suicide Prevention PDF

Support after a suicide: a guide to providing local services

National Suicide Prevention Alliance’s Support after a suicide: developing and delivering local bereavement support services.

Support After Suicide – Help Is At Hand

Photo by Jon Tyson on Unsplash

HMIP Health Notes: HMP Bristol, May-Jun 2019

This report was on an unannounced inspection of HMP Bristol between 20–21 May and 3–7 June 2019, and was published in August 2019.

“Bristol may not have reached the extreme lack of order and crisis seen in some other prisons and this report acknowledges some developments and some improvements, but many initiatives were poorly coordinated, applied inconsistently or not well embedded.” – Peter Clarke

General Points of Interest:

More than 10% of the population were subject to Assessment, Care in Custody and Teamwork (ACCT) case management procedures which is partly attributed to health services staff being instructed to open an ACCT document routinely whenever a prisoner had a history of self-harm, without applying their clinical judgement first.

62% of prison officers were within their first two years of service.

19% of prisoners said that they had developed a drug problem at the prison.

The safer custody hotline was not checked by staff. During the inspection, staff retrieved 21 voicemail messages dating back over two weeks. Three of the prisoners concerned had already been released from the establishment.

Healthy Prison Outcomes:

2017 2019
Safety 1 1
Respect 2 2
Purposeful Activity 1 1
Rehabilitation & Release Planning 2 2

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

Patient engagement was newly established via prison-led forums.

The incident reporting system was good, had clinical oversight and demonstrated that learning was occurring.

Training was good and staff received monthly management supervision and quarterly clinical supervision. Clinical records appropriately captured patient contacts and clinical decisions, and were audited to ensure compliance with professional standards.

An effective governor-led, prison-wide approach to health promotion was established, with well-being materials displayed throughout the prison.

There was no access to prescribed smoking cessation, leading to too much reliance on prisoners buying their own nicotine substitutes.

Initial health screening was undertaken promptly by a registered nurse in reception, with appropriate onward referral to other clinicians. Secondary screening was routinely offered but take-up was variable. Health practitioners were advised always to open an ACCT if a prisoner mentioned any historical risk of self- harm, irrespective of when this had occurred and without regard for its severity and context, which was deemed by inspectors as being disproportionate.

Prisoners made appointments by approaching health care professionals on the wings, which triggered an initial triage appointment with a nurse. The absence of a written confidential request system could have inhibited prisoners from seeking help, although nurse-led triage on wing hubs worked well.

Besides the poor access for patients with mobility issues, escorting and regime issues also sometimes delayed general access to the health centre. The excellent ground-floor urgent care facility was rarely used owing to a shortage of prison staff.

Inspectors observed positive engagement with prisoners, and some very proactive outreach by senior clinicians to ensure that patients who were unable to attend appointments were seen on the wings.

The Integrated Mental Health Service included a crisis team, therapies team, neurodevelopmental nurse, social prescriber, non-medical prescriber, clinical psychologist and psychiatry input. The care programme approach (CPA) was used to manage secondary mental health needs.

The therapies team saw all new arrivals, to inform them of services and provide a range of literature, including in-cell distraction packs. Overall, a dedicated and passionate team offered a wide range of treatments, including psycho-education, facilitated self-help, psychological therapies in both a one-to-one and group setting, crisis support and specialist secondary care.

The crisis team operated seven days a week, from 7am to 8pm, and the therapies team operated Monday to Friday, from 9am to 5pm. Demand for mental health services was high, with 67% of prisoners in the survey saying that they had a mental health problem. There was an open referral system, and triage assessments were completed in a timely manner.

New MH referrals and assessments were reviewed during a weekly multidisciplinary team meeting, and daily handovers took place to share concern and risk information.

The crisis team saw all 24-hour ACCT reviews and contributed to the multidisciplinary support offered to prisoners who self-harmed. Working relationships with the prison were positive and staff supported the work of the segregation unit.

Integrated Substance Misuse Services had improved and were impressive. In the survey, 33% of respondents said that they had had an alcohol or drug problem on arrival at the prison, and at the time of inspection 163 (33%) were engaged with recovery-focused work.

All new prisoners were screened for alcohol and drug issues and, if necessary, saw a clinical prescriber and were referred for assessment. New referrals were usually assessed within two days.

First-rate partnership working was underpinned by a good drug strategy and relevant action plan. A governor was dedicated to health and substance misuse care, and oversaw implementation of the action plan.

Substance misuse services staff were competent and compliant with mandatory training requirements, and clinical and managerial supervision was well embedded. Staff spoke of feeling valued and supported.

Naloxone was provided to prisoners being released, as indicated. ʻThrough-the-gateʼ work with community drugs services, housing and homelessness charities.

An in-house pharmacy supplied medicines. Not in-possession (NIP) medicine was administered safely and efficiently from the wings, three times a day, by pharmacy technicians, with night-time administration facilitated by nurses. A dedicated wing-based medicine management team provided consistent support to patients. NIP medication was mostly administered from stock, which limited the additional checks that individually labelled use would have provided. Officer supervision of medicines queues was inconsistent, which meant that there were opportunities for diversion, and privacy was difficult to achieve.

In-possession (IP) medicine arrangements were effective; risk assessments were undertaken and regularly reviewed. Cell checks were conducted but the lack of lockable cupboards in shared cells was a factor determining that only around 13% of patients received their medicines IP.

The transport of medicines was secure and incorporated the use of padlocked bags. There was insufficient storage space on some wing treatment rooms.

There was a full range of standard operating policies in place. A comprehensive range of medicines was available without prescription via patient group directions (PGD’s), and a minor ailments policy.

There was the potential for more pharmacy-led clinics, including smoking cessation. All prescriptions were clinically screened by the pharmacy, and some joint medication reviews were carried out between the pharmacist and the prescriber.

Espranor (a freeze-dried wafer which contains buprenorphine) was supplied to prisoners prescribed buprenorphine. The benefits being that this dissolves directly on the tongue, reducing the time spent in administration and the risk of diversion.

There were monthly clinical governance meetings, and good input from the pharmacy team into drugs and therapeutics committee meetings.

As part of the survey, 29% 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:

  • All clinical rooms should meet required infection control standards, with adequate storage and space to provide effective and accessible health services. (Repeated recommendation)
  • A rolling programme of mental health awareness training should be provided for all custody staff. (Repeated recommendation)
  • All medicine queues should be supervised adequately, to protect patient confidentiality and prevent bullying and diversion.

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

  • Through-the-gate work with community drugs services, housing and homelessness charities, and Bristol Council services provided prisoners with an unusually wide range of supported living options.
  • A dedicated wing-based medicine management team carried out most medicine administration, improving the management of stock, the ordering of prescriptions and the provision of consistent support to patients.
  • Espranor was supplied to prisoners prescribed buprenorphine; this dissolves on the tongue, reducing the time spent in administration and the risk of diversion.

CQC Requirement Notices Issued:

  • None.

Links/Resources:

Full Report Here – HMP Bristol

Health Notes from IMB Reports – September 2019 (Pt. 1)

The IMB reports published during the first half part of September 2019 were from these establishments:

  • HMP Peterborough Men
  • HMP Peterborough Women
  • HMP/YOI Swinfen Hall
  • HMP/YOI Aylesbury
  • HMP/YOI Hollesley Bay

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.

Here are some of the more interesting points contained within those reports, pertaining to health and wellbeing:

IMB Report – HMP Peterborough Men

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • Self-harm incidents have reduced. There were 674 incidents in 2018/19, compared to 790 in 2017/18.
  • Assaults are increasing. In 2018/19 there were 90 serious prisoner-on-prisoner assaults, compared to 59 in 2017/18 and 60 in 2016/17. In 2018/19 there were 22 serious prisoner-on-staff assaults compared to 15 in 2017–8, and 16 in 2016–7.
  • Improvements to the governance and delivery of healthcare have been put in place following the issuing of a CQC warning notice issued in August 2018.
  • Staffing levels remain a concern and there continues to be a reliance on agency nurses and locum doctors.
  • Compliance with the completion of secondary screening of all new receptions within 5 days improved to almost 100%.
  • The health promotion action group, responsible for promoting health and activities linked to local and national campaigns, was reviewed and reformed in the second half of the year. There is a healthwatch-trained representative who liaises with residents. The Board has, however, seen little evidence of systematic health promotion activity.
  • The use of electronic kioks means appointments can be booked and also cancelled where patients no longer require it. There is no waiting list for GP appointments. Waiting times for podiatry, dentistry and ophthalmology clinics are under three weeks. There is still no physiotherapy provision in the prison.
  • Non-attendance (DNAs) across all clinics remains high (27%). Residents who are trained healthcare champions chase up non-attendance and give information to new arrivals about the healthcare provision. A team of officers challenges non-attendance.
  • Occupancy of the healthcare unit remains high. The unit is manned by officers with no healthcare expertise, but clinicians visit the unit daily. There remain concerns about the lack of therapeutic activities in the unit. The healthcare waiting room has been extended and improved.
  • The mental health provision is good and waiting times compare well with those in the community. DNAs remain high, but there has been a general decrease as a result of efforts to chase up non-attendees. There were 18 referrals to transfer residents to secure hospitals of which only 2 were completed within the 2 week stipulated timescale.
  • Mental health clinicians visit the healthcare unit daily, and deliver regular awareness raising sessions for staff. They attend ACCT and segregation reviews when relevant.
  • Healthcare applications to the IMB increased to 84 from 82 when compared to the previous reporting year.

Full IMB Report – HMP Peterborough (Men)


IMB Report – HMP Peterborough Women

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • Overall prisoner on prisoner violence has been almost unaltered since last year (116 incidents versus 117 in 2017–8), although serious assaults were down from 8 to 5. Serious assaults on staff however increased from 4 in 2017–8 to 10. This is partly attributable to a small number of difficult to manage residents.
  • Self-harm incidents have reduced but re still high, falling from 1053 in 2017–8 to 937, but the monthly incidence varies significantly from under 60 to nearly 120, which is largely attributed to a small number of very complex cases. There is a continuing management emphasis on improvement and refresher training for the assessment, care in custody and teamwork (ACCT) process. There are six Listeners and plans to train four more.
  • Use of force has increased markedly in the last six months to almost 60 incidents per month, again attributed to multiple occurrences for a small number of residents. Security measures are intelligence led and full searching must now be justified and authorised through a revised and more robust procedure.
  • Substance misuse and availability remains a significant issue, although the result for mandatory drug testing (MDTs) (6.3%) only just exceeds the 6% target. During the year a scanner was installed to screen incoming mail for illicit substances.
  • Improvements to the governance and delivery of healthcare have been put in place following the issuing of a CQC warning notice issued in August 2018.
  • Staffing levels remain a concern and there continues to be a reliance on agency nurses and locum doctors.
  • Consultation with residents improved towards the end of the year when the newly formed health and wellbeing board started its monthly meetings with wing representatives. A Healthwatch-trained resident works as a ‘healthcare champion’. She liaises with the healthcare team to raise awareness, support residents and follow up non-attendance. Non-attendance (DNAs) across all clinics is approximately 18%.
  • The weekly nurse-led well-woman clinic is praised by residents. Services include cervical cancer screening and sexual health advice. An outreach programme for mammogram screening has been introduced.
  • Occupancy of the 12-bed healthcare unit remains high. Most residents are referred by the mental health team. The unit is manned by officers with no healthcare expertise, but clinicians visit the unit daily. Concerned exist around the number of residents with complex needs held in the unit (with limited regime), and the lack of therapeutic activities in the unit.
  • The mental health provision is good and waiting times compare well with those in the community. DNAs remain high, but there has been a general decrease as a result of efforts to chase up non-attendees. There were 44 referrals to transfer residents to secure hospitals of which only 2 were completed within the 2 week stipulated timescale.
  • Mental health clinicians visit the in-patient unit daily, and deliver regular awareness raising sessions for staff. They attend ACCT and segregation reviews when relevant.
  • Healthcare applications to the IMB increased to 61 from 44 when compared to the previous reporting year.

Full IMB Report – HMP Peterborough Women


IMB Report – HMP/YOI Swinfen Hall

Reporting period – 01 May 2018 to 30 Apr 2019.

  • Self-harm has increased. Data provided notes 803 incidents of self-harm, 415 ACCT’s documents opened, and 349 incidents of violence. For the previous reporting year those figures were 478, 351 and 348 respectively.
  • Of the 803 incidents of self-harm, 25% required outside hospital treatment, and 87% of which were attributed to YOI’s.
  • Mental Health provision now extends to a full 7-day service.
  • The serious concerns have been raised at the absence of a member of the healthcare team at reviews of some ACCTs continues. This is possibly attributed to the late notice given and the limited information provided by wings, despite healthcare staff working more closely with safer custody.
  • Feedback from patients about treatment and services continues to be low, notwithstanding the healthcare provider introducing ‘health champions’: prisoners who are trained and work both in healthcare and on residential wings and who provide feedback from other prisoners.
  • Non-attendance of prisoners for appointments continues to be of significant concern, as it was in 2018. On average across the various clinics, 33% of prisoners did not attend in the present reporting year, compared with 36% the year earlier. Reasons given by staff and prisoners include: (a) prisoners not going to healthcare because of feeling unsafe due to bullying; (b) wing staff not notifying prisoners that they have appointments; and (c) prisoners unsure what their appointments are for, and therefore not attending. Staff follow up each non-attendance, but the situation remains very unsatisfactory.
  • Healthcare applications to the IMB increased to 16 from 4 when compared to the previous reporting year.

Full IMB Report – HMP/YOI Swinfen Hall


IMB Report – HMP/YOI Aylesbury
Reporting period – 01 Jul 2018 to 18 Mar 2019.

  • The Ministry of Justice announced in February 2019 that HM YOI Aylesbury was being placed in Special Measures for performance reasons. In parallel with that decision, a strategy was devised to reduce the roll by approximately 50%. This downsizing is understood to last twelve months or so and a rapid decant of prisoners was completed in March and April 2019.
  • Self-harm and violence has increased. Data provided notes 258 incidents of self-harm, 214 ACCT’s documents opened, and 481 incidents of violence. For the previous reporting year those figures were 170, 145 and 244 respectively.
  • The IMB is firmly of the opinion that this increase of violence is a direct result of the poor staffing situation at Aylesbury. The average experience for basic grade officers is just over five months, and more than half of them have in post for less than two years.
  • Healthcare is possibly the only area of the prison where recruitment of new staff is not an issue, although they do suffer the common problem of long delays in the vetting of new personnel; 6 months for clearance to work in the prison is still not unusual.
  • Healthcare services are provided from a custom-built block, housing surgeries and dental facilities. Prisoners who have applied to receive healthcare are let into the waiting room at the start of each session, but need to be escorted back to their wings by staff from the healthcare unit. Sometimes, such staff are not available, so prisoners can routinely spend a whole morning or afternoon in the healthcare waiting room. This may be the reason why there are a number of prisoners who, having applied for an appointment, change their mind and decline to visit healthcare.
  • Healthcare applications to the IMB in/decreased to 4 from 2 when compared to the previous reporting year.

Full IMB Report – HMP/YOI Aylesbury


IMB Report – HMP/YOI Hollesley Bay
Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • Data provided notes incidents of self-harm, 19 ACCT’s documents opened, and 7 incidents of violence. For the previous reporting year those figures were, 14 and respectively. The average time each ACCT was open was 4.1 days.
  • Healthcare services within the prison operate 7-days a week, but not on a 24 hour basis. Out of hours care is provided by ringing NHS 111 services.
  • Healthcare has good contacts with a local GP practice that provides four GPs on a rota basis. Dentistry, ophthalmic and podiatry care is met with no issues raised.
  • Routine and emergency appointments together with a weekly drop in clinic are readily available.
  • An average of 2500 appointments are made a month, with very low figures for non-attendances.
  • There are a number of healthcare awareness programmes. These include bowel cancer, diabetes and prostate cancer. Prisoners can ask for guest speakers on a particular subject to appear at one of the monthly healthcare forum meetings.
  • Monthly healthcare forums are held for healthcare representatives from each wing. This is usually well supported and the IMB are invited and occasionally attend.
  • Mental health services are provided for prisoners with on-going or newly diagnosed problems. The mental health team actively participate in healthcare forums, attend regular meetings with the drug strategy team and are present at the veterans (ex-servicemen) forum meetings.
  • Approximately 20% of the prison population have some form of mental health need and prisoners may be referred to a psychiatrist who visits the prison on a monthly basis. Towards the end of a prisoner’s sentence the mental health team will contact local authority social workers to establish a relationship with the prisoner prior to leaving the prison.
  • Healthcare applications to the IMB in/decreased to 8 from 6 when compared to the previous reporting year.

Full IMB Report – HMP/YOI Hollesley Bay