Tag Archives: CQC

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

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

General Points of Note.

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

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

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

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

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

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

Healthy Prison Outcomes:

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

The CQC issued 1 Requirement Notice against Regulation Standards.

Recommendations: Health, Well-Being and Social Care:

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

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

  • None identified/reported.

CQC Requirement Notices Issued:

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


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

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

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

Points To Note.

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

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

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

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

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

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

Healthy Prison Outcomes:

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

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

Summary: Health, Well-Being and Social Care:

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

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

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

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

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

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

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

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

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

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

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

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

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

The CQC issued 3 Requirement Notices against Regulation Standards.

Recommendations: Health, Well-Being and Social Care:

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

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

None identified.

CQC Requirement Notices Issued:

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


Press Release

Full Report

HMIP Inspection Report Health Summary – HMP Lewes, Jan 2019

Date of publication: 14 May 2019
Report type: Prison and YOI inspections
Location: Lewes

Background and Context.

HMP Lewes is a medium sized Cat B male Local/resettlement prison. The last inspection was in January 2016. Since then there have been 5 self inflicted deaths and reported incidents of self harm have increased 300%.
On the positive side, 78% of prisoners told the HMIP Inspectors that staff treated them with respect. This finding in itself attracted the notable remark of this statistic being an “unusually high figure for this type of prison.”
A recognition surely of the challenges faced within the local/resettlement prisons across the estate?

Healthy Prison Outcomes:

  • Safety = 2 (2)*
  • Respect = 2 (3)*
  • Purposeful Activity = 1 (2)*
  • Rehabilitation & Release Planning = 2 (3)*
Note: *(Previous inspection outcomes in brackets)

Summary – Health, well-being and social care:

Many prisoners were very negative about the health services, with two-thirds of prisoners in the survey responding that the overall quality was quite or very bad. Services had deteriorated since the previous inspection, most notably mental health services and the provision of nurse-led primary care.

Over half of prisoners said they had mental health problems. Waiting lists were lengthy and the under-resourced integrated mental health team could not meet the level of need.

The range of primary care services was limited and the oversight of prisoners with long-term conditions was poor. The application process for health appointments was very poorly managed. Inspectors found 143 outstanding applications, presenting significant risks to prisoner care.

Managers did not have accurate data on waiting times.

The inpatient unit continued to provide good quality care for some of the most seriously ill patients. However, it still lacked a therapeutic regime and some of the cells were in poor condition. There were five prisoners receiving funded social care packages, and they received good quality care.

In relation to Substance Misuse services, The Forward Trust provided good clinical and psychosocial services for prisoners requiring substance use treatment.
Prison officers did not always manage medication queues effectively, which continued to compromise confidentiality and increased the opportunity for medication diversion.

Dental care was good but some aspects of governance needed immediate attention, particularly the maintenance of fixed equipment.

The CQC issued 3 Requirement Notices against Regulation Standards.

Recommendations – Health, well-being and social care:

  • Health governance structures should be robust enough to identify and effectively address key risks and concerns, and should ensure that prisoners have prompt access to all health services.
  • All health care staff should receive regular clinical and managerial supervision, and be up to date with mandatory training.
  • All health care should be delivered in a clinically appropriate setting that meets infection control standards.
  • There should be a prison-wide strategy and approach to support health promotion and well-being activities.
  • Waiting times for patients should be regularly monitored to ensure prompt access to care.
  • Applications for health care appointments should be reviewed and actioned without delay.
  • The reasons for prisoner non-attendance at health care appointments should always be recorded and reviewed.
  • Prisoners with long-term health conditions should receive regular reviews by trained staff, informed by an evidence-based care plan.
  • External hospital appointments should not be cancelled. (Repeated recommendation)
  • The prison should work with key stakeholders to produce an updated memorandum of understanding and information-sharing agreement for social care provision.
  • Prisoners referred to the service should be reviewed and assessed promptly, and offered a suitable range of mental health interventions within agreed timescales.
  • There should be a regular substance use strategic meeting to support the implementation and development of the strategy.
  • In-possession medication should be prescribed, reviewed and administered by health care professionals adhering to an up-to-date policy and risk assessment that reflects the range of medications prescribed, up-to-date prescribing guidelines, robust risk assessment of patient and medication, and appropriate storage of such medicines/doses. (Repeated recommendation)
  • Custody officers should manage queues during medication collection times to maintain confidentiality and minimise potential bullying and diversion of supplies (Repeated recommendation)
  • Prisoners should have access to routine dental appointments within six weeks.
  • All dental equipment, including the x-ray machine, should be regularly serviced and certified.
  • The provider should maintain an up-to-date file to document local arrangements for radiation protection.

Good Practice – Health, well-being and social care:

None Identified.

CQC Requirement Notices Issued:

  • Regulation 9 – Person-centred care
  • Regulation 17 – Good governance
  • Regulation 18 – Staffing


Press Release

Full Report

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