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

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

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

HMIP Health Notes: HMP Forest Bank, May 2019

This report was on an unannounced inspection of HMP Forest Bank between 13,14,20–24 May 2019, and was published in September 2019.

General Points of Interest:

The levels of self-harm had increased significantly since the previous inspection and were concerning. There had been 734 incidents of self-harm by 177 prisoners during the previous six months.

As part of the survey, 63% of prisoners said that they had mental health issues.

51% of prison officers had less than 2 years’ experience, 37% had under 12 months.

In the survey, 61% of prisoners said it was easy to get illicit drugs at the prison and 26% said that they had developed a drug problem while at Forest Bank against the comparator of 16%.

Healthy Prison Outcomes:

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

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:

The complaints system was now confidential with work in progress to differentiate complaints more clearly from applications and concerns. Most patients expressed dissatisfaction with medication issues. Written responses to complaints were courteous, timely and apologetic where necessary. Patients could influence health services development through regular user surveys and the monthly consultative meeting.

Clinical leadership (other than in in-patients) was good with experienced staff providing primary care, along with 24-hour nursing cover. Health staff mandatory and further training was very good, and now included safeguarding of adults.

Annual appraisal and managerial supervision arrangements were in place and staff generally felt supported. Clinical supervision was voluntary and not all primary care staff took advantage of it.

Most clinics were held in the health centre where the range of clinical activities had outgrown the space available. The waiting area was well supervised and contained relevant health promotion materials. Patients spent less time there than in 2016. The temporary waiting room facilities for vulnerable prisoners were sparse and unwelcoming.

SystmOne records that we sampled were informative and subject to clinical audit. Audits demonstrated good compliance with information governance standards along with an active programme of other clinical audits ensured compliance with expected standards.

There was a prison-wide approach to health promotion and the multidisciplinary action board met every two months to promote wellbeing across the prison. National health campaigns were promoted by identified staff. Health-related materials were displayed throughout the wings, health care and the gym. Supportive self-help materials were available in the library.

At time of inspection, there were no health champion peer workers, although there were advanced plans to start recruitment.

Opt-out screening and treatment of blood-borne viruses were very effective, supported by good links with a local specialist service. There was good access to age-appropriate immunisations and vaccinations, national screening campaigns, such as abdominal aortic aneurysm and bowel cancer, and smoking cessation.

Initial health screening was undertaken promptly by a registered nurse. Attendance rates at secondary health assessments had improved significantly, ensuring good support during prisoners’ early days. Staff made appropriate referrals to other clinicians from these initial assessments.

The appointments system was effective, although appointment slips were handed to officers without a sealed envelope, which compromised confidentiality.

At the time of the inspection, 355 patients had long-term conditions such as asthma, diabetes or epilepsy and were regularly reviewed by competent staff, with care plans and evidence-based practices.

GP services were available each weekday and Saturdays, and out-of-hours cover had been introduced but was rarely used. Patients had good access to urgent same-day GP appointments and non-urgent appointments within 10 days, which was reasonable.

The did-not-attend (DNA) rate was 16% for the GP, which was an improvement. While DNA rates for some other clinics remained high, innovative ways to engage patients and reduce DNAs had been introduced, such as a clinic in the gym. The range of specialist clinics was good and included physiotherapy, ophthalmics and podiatry, with short waiting lists.

External health care appointments were well managed by an administrator, with clinical input where required. Few were cancelled for security reasons. Telemedicine equipment was installed during the inspection to enable specialist consultations without leaving the prison.

All patients were reviewed before release by a nurse and given any ordered medication to take home, along with advice on accessing community health services and a care summary record. While most released and transferred prisoners left with their required medication, recording of this was inaccurate and ineffective, despite recent measures implemented to monitor and improve compliance.

The inpatient unit remained a poor environment with 19 beds in single and double cells, and one four-bed bay. The unit was stark and sometimes excessively noisy. Bed occupancy ran at about 63%. One bay was in use as a temporary waiting room for vulnerable prisoners attending out-patients, which was not ideal. Prison and health staff were not familiar with the admission criteria, though these were updated and re-issued at the time of the inspection. Between the well-attended weekly multidisciplinary care team meetings, admissions were made to the unit for non-clinical reasons, which was not appropriate.

In the survey, 63% of prisoners said that they had mental health problems. While only 32% said they received help with these problems, inspectors found that mental health provision had improved since the last inspection, despite high demand for support.

The integrated mental health team was well staffed and provided daily support to prisoners, including attendance at ACCT reviews. Three of the registered mental health nurses regularly covered general primary care duties, which affected their capacity to deliver mental health care.

New MH referrals and complex cases were reviewed at an effective weekly team meeting and single point referral meeting with multidisciplinary input.

The waiting list for initial triage appointments had halved since our last inspection. Prisoners could wait up to three weeks for an initial triage appointment, which was too long. Attendance at mental health appointments was good, and staff appropriately followed up those who did not attend.

The in-reach team provided good support to 58 men with more severe mental health conditions using the care programme approach. There was prompt access to the service and prisoners were reviewed regularly, including physical health checks and psychiatric consultations. Clinical records that we sampled contained evidence of responsive and personal care planning and regular risk assessment.

60% of prison officers had received mental health awareness training, which was an improvement since 2016. The psychological wellbeing practitioner had recently started delivering a more detailed training programme for prison staff.

In the survey, 49% of respondents said they had a drug problem on arrival at the prison against the comparator of 34%. At the time of inspection, 402 prisoners were engaged with the Integrated Substance Misuse Services (ISMS) work focused on recovery.

New ISMS referrals were seen within five days and there were robust systems for urgent referrals to be seen promptly. All prisoners arriving in reception were seen by an ISMS worker for assessment. They could see a clinical prescriber if necessary and were given harm reduction advice and materials as appropriate.

Effective multi-agency working between the ISMS, health care and the prison was evident with recorded monthly meetings to share information and intelligence. There was a drug strategy but no action plan (see paragraph 1.53). The prison programme manager was co- located with ISMS team managers which facilitated effective communications.

The governance of the ISMS was very good, compliance with staff mandatory training was excellent, and clinical and managerial supervision was well embedded. Staff we spoke to valued weekly group supervision sessions and felt supported in their roles. A recent prisoner consultation (February 2019) had informed service delivery.

At time of inspection, 192 prisoners were in receipt of methadone opiate substitution therapy (OST) and four were receiving rapid release buprenorphine. The majority (85%) were receiving maintenance doses, which was clinically appropriate. Prescribing was flexible and medicines were administered from G/H wing. We observed a noisy and poorly controlled medication queue, but the risks were addressed immediately when we raised concerns.

About 87% of patients had medicines in possession (50% in 2016). The policy was applied and risk assessments were completed and repeated as necessary. Patients received in-possession medications in health care. There was still no lockable storage for patients to store medicines in their cells safely.

The small number of tradeable medications being prescribed was impressive, reducing the risks of bullying. However, many prisoners complained that they were not receiving medicines that their GPs prescribed in the community.

Nurses administered medicines up to three times a day at appropriate times. The medicines queue at the administration room on the A-F hub was congested but well supervised. Patients sometimes experienced delays in receiving their medicines, causing gaps in their treatment, but many did not request repeat prescriptions despite reminders to do so.

As part of the survey, 30% 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:

  • Appointment slips for health appointments should be distributed in a way that preserves the patient’s confidential medical status.
  • All prisoners should be released or transferred with their required medication, and this process should be recorded accurately and regularly monitored.
  • Patients requiring mental health inpatient care should be transferred within the national guidance timeframe.

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

  • The novel introduction of a nurse-led clinic in the gym enabled patients who preferred to attend the gym to access health care. Long-term condition monitoring was improved by arranging health checks in the gym.
  • Integrated substance misuse services (ISMS) workers were aligned with identified community services which created a ‘virtual’ through-the-gate team ensuring seamless, collaborative release planning and aftercare.

CQC Requirement Notices Issued:

  • None

Links/Resources:

Full Report Here – HMP Forest Bank

HMIP Report Health Notes: HMP Eastwood Park, May 2019

This report was on an unannounced inspection of HMP Eastwood Park between 03–17 May 2019, and was published in August 2019.

“On entering these units, I was immediately struck by the sight of rows of women’s faces pressed against the open observation hatches of their locked doors, peering out into the narrow, dark, cell block corridor. It was as if they were waiting for something or indeed anything to happen, however mundane, to relieve the monotony of their existence.”
– Peter Clarke, HM Chief Inspector of Prisons

General Points of Interest:

73% of prisoners told inspectors that they had mental health problems, and 48% had problems with illicit drug use. These issues were compounded by the fact that many women were serving short sentences of less than 6 months – clearly reducing the opportunity for effective interventions.

43% of prisoners were in custody for the first time, and 33% had served five sentences or more. 36% of prisoners had been at the prison for less than 3 months.

In the previous 6 months prior to the inspection, there had been 120 reported assaults and 578 incidents of self-harm.

Healthy Prison Outcomes:

2016 2019
Safety 3 3
Respect 3 3
Purposeful Activity 3 3
Rehabilitation & Release Planning 3 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:

The service was well led, supported by skilled clinical leads, and we observed conscientious staff who knew their patients well. Mandatory training was well managed, and professional development was identified and encouraged through regular managerial and clinical supervision and appraisals.

Effective patient engagement, with regular health improvement groups and surveys, had influenced service delivery improvements.

Prisoners had access to a secure separate health care complaints system. Sampled responses were respectful in tone and fully addressed the issues highlighted. However, response times and oversight were not managed well enough, as some fell outside of the recommended timescales. Compliments received were shared with staff.

Health promotion formed an integral part of the prison’s well-being strategy, and local and national well-being initiatives were well advertised.

Smoking cessation support was available for those who wished to stop nicotine vaping, but uptake was low.

New arrivals received a comprehensive initial health screen with a nurse, focusing on risks and immediate needs, including those relating to substance use withdrawal, pregnancy, mental health and self-harm. Secondary health screenings were booked promptly, to identify and address prisoners’ health needs immediately. Good liaison with community services helped to ensure continuity of care.

Waiting times were short, with a 3–4 day wait for a routine GP appointment, and urgent appointments facilitated on the same day.

A weekly multidisciplinary complex case meeting was effective at ensuring that concerns were identified and discussed, and solutions explored to maintain well-being.

During the inspection, only around 25% of prisoners prescribed medication received it in- possession, following an appropriate risk assessment. This relatively low level of in-possession medication led to particularly busy morning and evening administration sessions. This was partially due to a lack of secure in-cell storage, which the prison was addressing.

The recent change in the classification of pregabalin and gabapentin to controlled drugs from April 2019 had caused minimal disruption owing to the proactive approach to the management of pain. The service had introduced a pregabalin reduction programme, which offered support to help prisoners to reduce their dependency gradually, ensuring that they were on clinically appropriate medication.

Refrigerator temperatures were recorded well in most treatment rooms but there were some gaps. Inspectors also found another refrigerator for which the temperatures had not been recorded, which meant that the integrity of the medicines stored within it could not be assured. This issue was addressed during the inspection.

The teams were based in an open-plan office, which promoted effective communication and integrated work between the physical and mental health care teams.

The average number of referrals into the Mental Health service was approx. 135 per month and the team was currently supporting 152 patients (approximately 40% of the population) via individual and group sessions.

A crisis team, made up of registered and support staff, responded promptly to urgent referrals, including attendance at all initial assessment, care in custody and teamwork (ACCT) case management reviews, and worked from 8am to 8pm, seven days a week. The caseload was usually between 30 and 40 and was actively monitored and reviewed throughout the day. One or more sessions were offered, and referrals to other parts of the service were made, dependent on need.

The primary care mental health team consisted of two experienced registered mental health nurses, who were also non-medical prescribers and held regular clinics. Although the waiting time was at around 4 weeks, the crisis team offered support, and prioritised accordingly.

Prisoners attended a pre-discharge health clinic a few weeks before, and on the day of, release, to check their general health and welfare. A GP summary was provided; if the prisoner did not have a GP, they received information about the services available in the area they were being released to. Take-home medication was supplied.

Substance Misuse service provision was delivered by two separate providers – one for psychosocial support and the other for clinical services. Inspectors noted that although information sharing between substance use services had improved, teams were not yet fully integrated. Clinical and psychosocial substance use teams did not complete prescribing reviews jointly, and this was a missed opportunity to coordinate treatment and maximise support.

The substance use team contributed to the discharge board, and a continuity of care worker liaised with community prescribers and ensured treatment continuation on release. Naloxone training for relevant prisoners before release, to treat opiate overdose in the community, was well established but the provision of harm reduction information was not systematically recorded and evidenced. A designated through-the-gate worker maintained good links with community teams.

Dental appointments were appropriately prioritised according to clinical need, and sessions offered a range of treatment, equivalent to that in the community. Urgent referrals were seen promptly, but waiting times for routine appointments were too long, at around 11 weeks.

As part of the survey, 54% 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:

  • Substance misuse services should be fully integrated, and a range of group work and mutual aid support should be available to prisoners, independent of location.
  • Those with complex health needs should have recorded care plans that are reviewed regularly.
  • Prisoners should have access to routine dental appointments within 6 weeks. (A repeated recommendation)
  • The substance misuse team should systematically record and evidence the provision of pre-release harm reduction advice and information.

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

  • Prisoners with specific health issues were encouraged to participate in well-advertised fitness programmes which were tailored to meet individual needs.
  • The introduction of the social prescriber role was a positive initiative, providing additional assistance for patients and links with other services promoting health and well-being

CQC Requirement Notices Issued:

  • None.

Links/Resources:

Full Report Here – HMP Eastwood Park

HMIP Health Notes: HMP Pentonville, Apr 2019

This report was on an unannounced inspection of HMP Pentonville between 01–12 April 2019, and was published in August 2019.

“Pentonville epitomises the challenges confronting ageing, inner-city prisons with transient populations, many with heightened levels of need and risk.”

General Points of Interest:

Use of force had been applied 419 times in the 6 month period prior to the inspection.

At the time of this inspection, 25% of the population were receiving psychosocial support for substance misuse needs.

During this same period, the positive MDT rate was 29% for those prisoners tested.

Since the last inspection in 2017, there had been 4 self-inflicted deaths, and another from natural causes.

There had been 316 incidents of self-harm in the previous 6 months, similar to comparator prisons. Constant supervision had been used 17 times.

Over the same period, 400 prisoners had been subject to ACCT processes. 30 of all ACCT documents were opened in reception.

Healthy Prison Outcomes:

2017 2019
Safety 1 1
Respect 2 2
Purposeful Activity 2 2
Rehabilitation & Release Planning 3 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:

Healthcare managers provided strong leadership to a dedicated professional team who told inspectors that they felt well supported.

Staffing levels and retention had improved, with limited reliance on bank and agency staff. Staff received regular managerial and clinical supervision, and compliance with mandatory training was good. Staff were also supported in developing advanced clinical skills.

The introduction of a dedicated prison governor, custodial manager and prison officers into health care had improved communications and facilitated better access for patients. Patients no longer had to wait in health care for a long period after their appointments and waiting lists were shorter.

The DNA rate for the GP clinic had improved at 10% but remained too high for other clinics, for example dentist 31.8% and optician 35.8%. However, there were plans to deliver more treatment on wings from May 2019 to address this.

There was no overarching health promotion strategy or action plan. Health promotion literature was available in the health centre but limited elsewhere, which was a missed opportunity to encourage well-being.

Working relationships between prison and mental health staff were mature. The majority (97%) of recently appointed prison officers had received some training in mental health awareness, which was viewed by inspectors as being commendable.

There was an open MH referral system, daily well-being team meetings and prompt assessment via the Health and Wellbeing Model. Prisoners in the red zone were seen within one working day and those in the green within 5 days, which was efficient.

The impressive well-being centre continued to deliver an additional level of primary mental health care, supporting vulnerable prisoners through structured and consistent daytime therapies. All eligible prisoners could now use this service, from which 20 prisoners benefited each day.

Patients had complex emotional and mental health needs. About 220 (20%) patients at a time were on the caseload for primary mental health care and 60 (5%) for secondary mental health care. About one in nine prisoners (146) were on anti-psychotic medication which, although less than in 2017, was very high.

At the time of the inspection, 116 patients were receiving methadone or buprenorphine (opiate substitutes), with 54 appropriately on reducing doses. Prescribing was flexible and based on national clinical guidance.

At the time of the inspection, 31% of patients had their medicines in possession. Cells still lacked lockable facilities for storing medicines, but random checks of 10 cells a month had been introduced, which was a noted improvement on 2017.

As part of the survey, 30% 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:

  • The prison health care local delivery board should ensure that assertive action is taken to enable access to health care, safe storage of in-possession medicines, and a prison-wide strategy for health and well-being.
  • Governance procedures should be strengthened significantly to ensure safe and appropriate social care provision.
  • Patients requiring care in external mental health services should be transferred expeditiously.
  • Maximum and minimum temperatures should be recorded daily for refrigerators where medicines are stored and documented corrective action should be taken when temperatures fall outside the 2–8 degrees centigrade range.

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

  • The dedicated team of prison staff in health care had improved efficiency and the patient experience.
  • The well-being centre supported vulnerable prisoners with a structured therapeutic regime and enabled positive outcomes for those with both primary and secondary mental health needs.
  • The enhanced support service team offered valued guidance and support.

CQC Requirement Notices Issued:

  • None

Links/Resources:

Full Report Here – HMP Pentonville