Health Notes from IMB Reports – July 2019

The IMB reports that were published during July 2019 were Highpoint, Norwich, Lincoln, Berwyn and Hindley.

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 Highpoint

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • The late arrival of new receptions can often result in limited time to complete paperwork before lockdown. This leads to Healthcare not always being available to do the initial health assessment, resulting in prisoners going to induction without the proper checks being made.
  • The number of self-harm incidents has reduced from 343 in 2017 to 320 in 2018. ACCTS opened increased from 423 in 2017 to 462 in 2018 which includes 56 of those were prisoners transferring in from other establishments on open ACCTs.
  • The drug of choice during the reporting year was cannabis, both in herbal and resin form. Drugs recovered during the reporting year included: Cannabis Resin 839.6g (16.8g in 2017), herbal Cannabis 1648.7g (1674.3g in 2017), Heroin 3.1g (0.2g in 2017), and NPS 160.5g in 2018 (1433.9g in 2017).
  • The reduction in NPS is attributed to the increase in NPS impregnated paper making detection difficult. The main trafficking route is believed to be through mail sent to prisoners. The 160.5g as shown in the drug finds is for herbal NPS; in 2018 the herbal form of NPS decreased significantly.
  • For ‘hooch’ there was a 24% increase in the amount recovered compared to the previous year: Approx 717 litres in 2018, compared to Approx 580 litres in 2017.
  • Non-urgent appointments with the GP average 12 working days.
  • Dental services have been affected on the South site for the second consecutive year due to a non-functioning dental chair. Additional clinics have been provided but there is still an extended waiting list time of up to 22 weeks.
  • The well-being and suicide prevention service continues to engage with 70–75 residents each month.
  • Healthcare applications to the IMB increased to 66 from 56 when compared to the previous reporting year.

Full IMB Report – HMP Highpoint

IMB Report – HMP Norwich

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • A new ACCT process was introduced as a pilot scheme in February 2019. Insufficient staff training prior to the roll out has led to some concerns and confusion.
  • Healthcare recruitment and retention continues to be a concern, mirroring that of the community. In October 2018 there were 12 vacancies and over 500 hours lost due to sickness, and in February 2019 there were still 12 vacancies, although sickness hours had reduced to over 300 hours. 57% of posts are filled by permanent staff and long-term agency/bank staff fill the remaining positions.
  • Efficient and swift screening of new prisoners occurs when there are two nurses on duty during busy times in reception, although it is not always the case, leading to delays in processing new arrivals. Despite this, the quality of reception screening does appear to triage needs carefully and effectively.
  • A concern is that mandatory training for all healthcare staff remains incomplete. At the end of January 2019, percentages attained were: suicide and self- harm (SASH) trained 59% (although all permanent staff are trained); infection control 84%, basic life support 83%; immediate life support only 61%.
  • Clinic appointment DNA’s are a major and long-standing issue. In January 2019, there were over 80 DNA’s for GP clinics, over 50 DNA’s for hepatitis C appointments, over 35 DNA’s for mental health wellbeing appointments (IAPT), over 30 DNA’s for nurse clinics, over 25 DNA’s for dentistry and the same for nurse practitioner appointments.
  • Inpatient beds in the Healthcare Unit are also allocated to prisoners with mental health issues who cannot be housed for safety reasons on normal location. The unit is regularly staffed by nurses who have little mental health training and many of the other prison staff have also not received appropriate training for these complex patients. The austere cells in this unit are outdated and worn.
  • Mental health discharge summaries for community care information stood at 95% in Q3 and 96% in Q4; likewise learning disability discharge summaries were good at 100% in Q3, but declined to 83% in Q4.
  • Healthcare applications to the IMB increased to 82 from 68 when compared to the previous reporting year.

Full IMB Report – HMP Norwich

IMB Report – HMP Lincoln

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • The average number of prisoners over the reporting period was 538 which is 74% of the operational capacity. HMP Lincoln’s certified normal accommodation (CNA) was 408 and its operational capacity (Op Cap) was 729.
  • There were 620 incidents of self-harm reported (in 2017 this was 417), a Significant rise of 49%. It was noted that the latter half of the year showed the greater increase of acts of self-harm.
  • Not surprisingly, ACCT books being opened saw a rise of 13% on the previous year: 671 ACCT books were opened in the reporting period, up from 594 the previously.
  • The total number of violence reduction incidents reported during the reporting period on the local violence reduction database was 1087, up from 670.
  • There were three deaths in custody during 2018, which is the same figure for 2017.
  • The reception process has been further improved by the presence of both a member of healthcare working full time in Reception, who now assesses all prisoners before they are taken to the wing. There is now a seven day a week mental health nursing presence available to reception.
  • Healthcare holds a patient forum meeting every other week for prisoners to voice opinions, suggestions and concerns.
  • Prisoners are now given appointments directly using the wing telephones, which is reported to have almost eliminated any waiting lists.
  • The number of DNA’s, remains low with staff following up to find the reasons for missed appointments.
  • The establishment has a high number of prisoners with mental health problems who are well managed by the mental health team. A mental health team member is available from 8am to 8pm on weekdays and 8.30am to 5pm at weekends.
  • Healthcare applications to the IMB decreased to 37 from 44 when compared to the previous reporting year.

Full IMB Report – HMP Lincoln

IMB Report – HMP Berwyn

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • During the reporting year there were three deaths in custody. One was from natural causes, one was as a result of substance misuse, and the cause of the final death is still awaited.
  • There were 182 assaults on men and 233 assaults on staff between April 2018 and February 2019. The number of assaults continues to be a concern to the board.
  • The medication policy is becoming increasingly accepted by prisoners at HMP Berwyn. In part, this is attributed to the introduction of health and wellbeing peer mentors. This model has offered prisoners an opportunity to discuss with trained peer mentors the decisions that have been made in relation to their healthcare and the options available to them should they want to dispute any decisions that have been made.
  • The number of prisoners who DNA’d their healthcare appointments continues to be concerning. Between April 2018 and February 2019 the healthcare service provided 45,942 appointments. Of these appointments 7,525 (16.4%) were wasted appointments due to prisoners failing to attend. These wasted appointments cause frustration as it is well known that other prisoners are waiting for similar appointments.The peer mentor model is now being expanded to attempt to address this concern by working with prisoners who persistently DNA their healthcare appointments.
  • The health and wellbeing peer mentors have operated a healthcare helpline since November 2018. The helpline is available for prisoners to call if they are having healthcare related issues. The initiative has been well received so far with 1309 calls received between November 2018 and February 2019.
  • The lack of on-site healthcare staff after 1900 hours has been a concern to the board since the commissioned model was established. Following discussions with the senior leadership team, BCUHB has introduced overnight nursing cover with effect from April 2019.
  • Healthcare applications to the IMB increased to 43 from 42 when compared to the previous reporting year.

Full IMB Report – HMP Berwyn

IMB Report – HMPYOI Hindley

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • Appointment DNA’s were a notable concern from a relatively unremarkable report. Both in April and December 2018 the ‘Did Not Attend’ (DNA) rates were at 11% peaking at 14% in June and August 2018. The areas with the highest DNAs were for GP appointments (unusually), and vaccinations (predictably). If a man did not wish to attend an appointment, he was required to sign a written slip which improved an accountable trail but did not result in much improvement in attendance.
  • The provision of healthcare at HMPYOI Hindley has previously been of a very high standard. More recently, staff turnover and absence particularly within the nursing staff led to a reliance on ‘Bank Staff’ and managers to cover the shortfall.
  • Healthcare applications to the IMB increased to 17 from 12 when compared to the previous reporting year.

Full IMB Report – HMPYOI Hindley

HMIP Report – Health Summary: HMP Berwyn, Mar 2019

This report was on an unannounced inspection of HMP Berwyn between 04–14 March 2019, and was published in July 2019.

General Points of Note.

This is the first inspection report for HMP Berwyn, having only opened in February 2017.

The full operational capacity of the prison will eventually be 2,106 prisoners. At the time of this inspection, the population was 1,273. The current operational capacity is 1300.

Predictably, 77% of officers had been in service for less than two years and about a third for less than a year.

All cells had a shower, telephone and laptop computer.

There had been no self-inflicted deaths since the prison opened.

Levels of self-harm were below those of other category C prisons. The strategic management of suicide and self-harm has been deemed to require improvement. Most of the at-risk prisoners on assessment, care in custody and teamwork (ACCT) case management did not feel sufficiently cared for. ACCT documents required improvement, and initial assessments and care plans were weak.

There had been 3,614 complaints in the previous six months, a much higher level than inspectors would usually see. Staff attributed this to the inexperience of many staff and ineffective operation of the applications process.

Healthy Prison Outcomes:

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


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

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

There had been no recent infection control audits, but they were planned as part of the developing audit cycle with the health board. All clinical areas were clean and well maintained, but there were no cleaning schedules evident.

During the inspection, there was a two-week pilot project with the Welsh Ambulance Service Trust, with a paramedic deployed for 12 hours a day in the prison, with the aim of reducing the need for unnecessary ambulance attendance. Early findings were that during the inspection alone, 11 emergency calls had been managed without the need for further ambulance input, which was impressive. A substantial proportion of emergencies were related to psychoactive substances.

There was no overarching health promotion strategy or action plan, Health promotion literature was available in the health care centre and some other key areas, but was limited elsewhere.

Smoking cessation support, vaccinations, immunisations and health screening initiatives were provided, but there was no bowel screening.

An impressive radiology suite, staffed by a full-time radiographer, ensured good access to X-rays and ultrasound services.

There was good access to nursing staff, and a new daily wing- based nurse-led ‘see and treat’ clinic was considered to be a promising initiative.

The electronic appointments system was well managed. Prisoners could use their in-cell laptops to make appointments, and a peer-run health and well-being telephone service enabled prisoners to cancel and rearrange their appointments. However, non-attendance rates were very high, at 17.2%, but it was not clear why. Work was under way by the health and well-being peer mentors, facilitated by health staff, to reduce it.

The prison facilitated four external hospital appointments a day, in addition to any emergency escorts. Appointments were rarely cancelled due to lack of escorting staff. Health staff did not see all prisoners returning from an external hospital appointment, and so could miss ongoing treatment plans.

Health staff saw all prisoners being discharged from the prison. Prisoners were given a summary of their care, medication where relevant, information on how to register with community dental and GP services, health promotion leaflets and condoms.

In our survey, 46% of prisoners said they had a mental health problem, of who 34% said they were receiving help. Support for prisoners with mild to moderate mental health problems was good, with the provision of a wide variety of evidence-based therapies in group and one-to-one settings. A selection of self-help material for prisoners was also available.

At the time of inspection, 171 patients were receiving opiate substitutes, mostly on a maintenance basis, and all with a well-supervised controlled drug administration. Treatment was individual, regularly reviewed and well integrated. There was very good joint working with the wider health care team, and a dual-diagnosis nurse (substance use and mental health) supported patients.

The substance use service was embedded in the wider prison and worked closely with offender managers, resettlement and the security team, and was involved in ACCT reviews. Custody staff had received substance use training during induction and knew how to refer prisoners. The service had good links with local community services, and worked jointly to ensure treatment continuation for prisoners after their discharge. On release and where indicated, prisoners were given naloxone to treat opiate overdose.

Pharmacy provision was well developed and well managed. The in-house pharmacy ensured that patients received medicines promptly. Pharmacy technicians administered medicines alongside nurses on weekdays. Pharmacists clinically screened prescriptions and monitored prescribing, but did not hold medicines use reviews with patients. Patients could also make an application to speak to a pharmacist. Pharmacy policies were in place and followed, although some staff had not signed training records for the pharmacy’s standard operating procedures.

Around 80% of patients received their medicines in possession, but there was no facility for administering medicines after 7pm. As a result, night time medicines were always supplied in possession. All prisoners could store their medicines in lockable cupboards.

The quality of dental care was good but waiting times for routine care were excessive, at 42 weeks during the time of the inspection. This was partially attributed to the dental practice not being fit for use initially, as well as difficulty in recruiting dental staff. Urgent dental care was managed well, but with 440 prisoners (a third of the population) waiting for a routine appointment, and often affecting dental outcomes.

Recommendations: Health, Well-Being and Social Care:

  • There should be a prison-wide strategy to support health promotion.
  • Health staff should always see prisoners returning from external hospital appointments to
    establish any treatment and support needs.
  • The prison should ensure that suitable occupational therapy equipment and adaptations are provided and installed promptly.
  • The substance use services should have the necessary rooms to deliver therapeutic treatment.
  • There should be a formal and robust procedure to follow up patients who miss medicine doses.
  • Pharmacists should carry out medicines use reviews with patients.
  • Prisoners should have access to dental treatment within community-equivalent waiting times.

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

  • The presence of a member of the pharmacy team in reception enabled prompt medicines reconciliation and easy access to medicines information for new arrivals.


Full Report Here – HMP Berwyn