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

HMIP Report – Health Summary: HMP Ashfield, Mar-Apr 2019

This report was on an unannounced inspection of HMP Ashfield between 25 March to 12 April 2019, and was published in July 2019.

General Points of Note.

Low levels of violence and bullying incidents, with just one fight and seven assaults recorded in the previous six months. There were six incidents of use of force for the same period.

In the previous six months, there had been only 25 self-harm incidents and 39 ACCT documents opened for prisoners at risk of suicide or self-harm. There have no self-inflicted deaths since the prison was re-roled in 2013.

95% officers had undertaken mental health awareness training.

At the time of the inspection, there were 338 Enhanced regime prisoners under the Incentives and Earned Privileges (IEP) Scheme. This represents approx 84% of the population. None were on Basic regime.

Healthy Prison Outcomes:

2015 2019
Safety 4 4
Respect 4 4
Purposeful Activity 2 4
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:

In the survey, 84% of respondents said that the overall quality of health care was quite or very good. There was a well-established health care improvement group, which met every six weeks and enabled prisoner representatives to consult on services.

95% prison staff who had regular prisoner contact had been trained in first aid and the use of the automated external defibrillators (AED).

Nurses worked from 7.30am to 6pm every day, Monday to Sunday. Leadership of the team was strong and all staff were supported. Managerial and clinical supervision was established and systems to learn lessons were embedded.

Prisoners could request appointments using the touchscreen information kiosks on the wings.

The number of prisoners who failed to attend health care appointments was low. Patients requesting a routine GP appointment had to wait up to three weeks. Urgent appointments would be facilitated the same day.

A monthly social care drop-in centre was an excellent initiative, where caring, dedicated staff, including a social worker, occupational therapist and health care worker, listened to prisoners’ support needs and helped to ensure that they were fully met, so far as was possible.

In the previous six months, the Mental Health team had received 84 referrals. MH practitioners offered one-to-one interventions to 17 patients, and prisoners could also participate in groups focusing on low mood and anxiety, which was a positive development. In the same period, only six patients had presented with severe and enduring mental health problems. There had been no transfers under the Mental Health Act in the previous 12 months.

In the previous six months, 52 prisoners had been assessed for substance misuse support. The current caseload for structured one-to-one work (mainly relapse prevention), stood at 12. Only two prisoners had required opiate substitutes (OST) in the previous two years.

Substance Misuse and Mental Health practitioners were co-located, shared patient records and co-facilitated groups, which benefited patients.

Most prisoners were on in-possession medication, and for all of the records sampled by inspectors, there was an up-to-date in-possession risk assessment stored on SystmOne.

Recommendations: Health, Well-Being and Social Care:

  • There should be an up-to-date health and social care needs analysis.
  • Trained and supervised peer workers and health trainers should offer health information and support to prisoners.
  • All prisoners with long-term health conditions should have a care plan.
  • Trauma-informed psychological support should be available for prisoners.

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

  • The monthly social care drop-in service was an excellent initiative, allowing prisoners to discuss issues with a social worker, occupational therapist and health care worker.

CQC Requirement Notices Issued:

None.


Links/Resources:

Full Report Here – HMP Ashfield

HMIP Report – Health Summary: HMYOI Wetherby and Keppel, Mar 2019

This report was on an unannounced inspection of HMYOI Wetherby and Keppel between 11–21 March 2019, and was published in July 2019.

General Points of Note.

HMYOI Wetherby is able to house up to 326 boys aged between 15 and 18, of which 48 could be held on the Keppel unit. Keppel unit is a specialist national resource facility within the prison that is designed to hold and manage some of the most vulnerable and challenging children.

Children were issued with a free MP3 player with a comprehensive recording of the induction programme, enabling them to listen to information in their own time. This is particularly useful for those who struggled to retain everything they were told in the first few days of custody. An induction tour was being developed using virtual reality goggles which was an excellent and innovative use of technology.

During the previous six months, there had been 119 instances of self-harm at Wetherby which was comparable to similar establishments. For the same period, there had been 110 on the smaller Keppel unit reflecting the complex and vulnerable nature of the children held there.

Most ACCT documents were good, with contributions from child and adolescent mental health services (CAMHS) in every case. Only 54% of staff were trained in suicide and self-harm.

HMYOI Wetherby Unit Healthy Prison Outcomes:

  • Safety = 3 (2)*
  • Care = 3 (3)*
  • Purposeful Activity = 3 (3)*
  • Resettlement = 4 (4)*

Keppel Unit Healthy Prison Outcomes:

  • Safety = 4 (4)*
  • Care = 4 (4)*
  • Purposeful Activity = 3 (3)*
  • Resettlement = 4 (4)*

Note: *Previous inspection outcomes from March 2018 are stated in brackets

Key:

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

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

Staff had access to a comprehensive set of policies and a range of helpful ‘one-minute’ guides outlining key information which they found useful.

Health staff received appropriate life support training and attended all emergencies. Emergency equipment, including automated external defibrillators (AEDs), were located in each treatment room. Staff signed daily check sheets, but it was found that some of the AED pads were out of date, compromising their effectiveness. The checking process was ineffective.

Since the last inspection, 16 concerns and no complaints had been raised.

Efforts to reduce the high rate of non-attendance at some clinics was a work in progress. Sometimes children had to wait too long in the waiting room before and after their appointments when there were not enough officers to escort them more promptly.

A ‘refusal form’ was being trialled to demonstrate that children had been offered the opportunity to be brought to health care. The range of primary care services was good and access was reasonable apart from the optician and dentist waiting times which were too long at eight weeks.

In the survey, 84% of children on Keppel and 29% of children at Wetherby said they had a mental health/emotional problem at the point of first reception. The mental health team were working with 119 children of whom 41 resided on Keppel.

Since the previous inspection, the mental health team are now delivering a range of therapeutic group work such as music and creative writing. Staff shortages were deemed to be preventing the delivery of low-level cognitive behaviour therapy group sessions for anxiety, mood management or emotional regulation.

In the survey, 52% of children on Keppel and 36% on Wetherby said they had a problem with drugs on arrival, significantly higher than the comparator in both cases. The Substance Misuse team were supporting 95 children of whom 14 resided on Keppel.

Again, staff shortages are preventing the delivery of group interventions. The team were developing specific harm minimisation groups, covering risks associated with being transferred to an adult establishment. At the time of inspection, this was delivered individually, which was positive.

All children were offered a pre-release appointment to complete the CHAT (comprehensive health assessment tool) discharge plan which was sent to relevant agencies. Children were given harm reduction advice and information before leaving. Children were also usually seen on the day of release or transfer to assess their health needs and were offered health promotion advice, including barrier protection. A week’s supply of medication or a prescription was provided for appropriate children.

Recommendations: Health, Well-Being and Social Care:

  • An effective monitoring system should be in place to ensure that all emergency resuscitation equipment is in good order.
  • There should be sufficient staff to ensure that all aspects of the service are delivered.
  • There should be a whole-prison strategy to support health promotion, including healthy eating.
  • Children should have timely access to the optician and dentist.
  • Failure-to-attend rates for clinics should continue to be investigated and reduced.

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

  • Regular clinical supervision by the safeguarding lead and reflective practice sessions facilitated by a community psychologist provided excellent support to promote good standards of practice.
  • The proactive approach to acquiring accurate immunisation history and the focus on achieving good uptake of vaccinations through innovative pop-up and regular clinics were commendable.
  • Staff carried out comprehensive one-to-one harm-minimisation awareness sessions, which ensured that all children transferring to the adult estate were made aware of potential risks.
  • The introduction of the transfer pack with life sustaining medication was a good initiative to ensure children going to court and in education had prompt access to emergency medication.

Links/Resources:

Full Report Here – HMYOI Wetherby and Keppel

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

Key:

  • 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.

Links/Resources:

Full Report Here – HMP Berwyn

HMIP Report: HMP Brixton, Mar 2019 – Health Summary

This report was on an unannounced inspection of HMP Brixton between 04–15 March 2019, and was published in July 2019.

General Points of Note

Inspectors were told that in the space of two years, staff sickness levels had dropped from 25% to 4.6%.

There have been no self inflicted deaths since the last inspection (January 2017).

The prison was fully staffed. Sixty-three per cent of staff were within their first 12 months in post.

Of those prisoners surveyed, they rated the overall quality of health services as either very good (16%) or quite good (42%). 17% had been on an ACCT during their time in Brixton.

Healthy Prison Outcomes:

  • Safety = 3 (1)*
  • Respect = 3 (2)*
  • Purposeful Activity = 2 (1)*
  • Rehabilitation and Release Planning = 3 (2)*

Note: *(Previous inspection outcomes from Jan 2017 are stated in brackets)

Key:

  • 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:

Feedback about patients’ experiences of services was actively encouraged. The Head of Healthcare organised wing-based forums where prisoners were able to challenge the way services were delivered.

Clinical and managerial leadership arrangements were robust and inspectors saw evidence of senior staff spending time on the wings to observe and interact with prisoners. Nurses worked from 7.30am to 6.30pm Monday to Friday and 8.30am to 6pm at the weekend. The health care department relied on agency cover, but outcomes for patients were deeded to have not been significantly affected. Many Of the vacant posts had now been filled.

Training, and professional development opportunities were generally good, and although staff reported that they received good support. Management and clinical supervision arrangements were not sufficiently embedded, particularly in the primary care team.

The health care centre and main waiting area needed redecorating and refurbishment. Wing treatment areas were also run-down and hard to keep clean; they did not comply with infection prevention standards.

Prisoners could make written applications for a health care appointment or directly approach staff with their health concerns. Wing-based nurses and pharmacy-led triage clinics provided patients with timely access to health care support.

Non-attendance rates were low and inspectors saw senior staff undertaking outreach to prisoners who failed to attend appointments. Prisoners were not systematically advised of appointment slots until the day of the appointment and they were sometimes unsure about why some follow-up appointments had been made. We observed clinically effective and positive interactions with prisoners when they attended the health care centre.

Access to routine external hospital appointments was good and there was little evidence of any curtailments due to prison demands. An excellent pre-release clinic ensured patients with ongoing needs received effective support, and all prisoners were offered a physical health check regardless of whether they had accessed health care during their stay.

Inspectors noted the high demand for MH services with over 130 referrals a month through an integrated and responsive approach to care.

The Mental Health provider had a caseload of about 125, and 34 prisoners experiencing enduring and severe mental health problems were managed under the care programme approach (CPA – mental health services for individuals diagnosed with a mental illness).

Relationships with the prison were noted as being positive and most prison staff had undertaken mental health awareness training.

The prison had developed a more strategic approach to reducing the drug supply and demand, but there was still a lack of joined-up working to support prisoners testing positive under mandatory drug testing or suspected of psychoactive drug use.

The Substance Misuse provider delivered psychosocial interventions to 277 clients (37% of the population). The service was well advertised on the wings, and a peer supporter offered induction input.

A substance misuse consultant psychiatrist also provided specialist input and held clinics for those with complex needs, including pain management issues.

Medicines requiring refrigeration were stored in medical fridges and monitored daily, although records showed maximum temperatures exceeded 8°C in several locations without prompting remedial action.

There were several helpful pharmacy-led clinics on the wings, including those for minor ailments, substance use support and smoking cessation. The waiting list for smoking cessation support was deemed as being too long, which is curious given a prisoners progression to Cat C status through a Smoke Free prison estate approximately 2 years post-Smoke Free implementation.

Medicines were administered twice a day, and night-time doses were provided in-possession during afternoon administration once the prisoner had been risk assessed.

Recommendations: Health, Well-Being and Social Care:

  • Treatment rooms should comply with infection prevention and control standards.
  • Support for prisoners should include timely access to sexual health advice and smoking cessation support.
  • Prisoners should have timely access to all primary care and screening services.
  • A memorandum of understanding between the prison and local authority should determine a pathway from assessment to the delivery of personal care.
  • Training on overdose management and access to naloxone on release should be provided.
  • Medication administration should be consistently and adequately supervised by prison staff, to ensure privacy and compliance, and reduce the risk of bullying and diversion. (repeated recommendation)
  • The essential repairs to the washer disinfector should be carried out expeditiously.

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

  • The health and well-being model delivered an integrated and responsive approach to care, which provided effective support to over 130 prisoners a month.
  • Pharmacy clinics on the wings gave prisoners access to a flexible range of prompt and effective treatments.

CQC Requirement Notices Issued:

  • None.

Links/Resources:

Full Report Here – HMP Brixton