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

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

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

IMB evidence comes from observations made on rota visits, scrutiny of records and data, attendance at various meetings, informal contact with staff and prisoners, prisoners’ applications and monitoring of areas of concern.

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

IMB Report – HMP Peterborough Men

Reporting period – 01 Apr 2018 to 31 Mar 2019.

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

Full IMB Report – HMP Peterborough (Men)


IMB Report – HMP Peterborough Women

Reporting period – 01 Apr 2018 to 31 Mar 2019.

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

Full IMB Report – HMP Peterborough Women


IMB Report – HMP/YOI Swinfen Hall

Reporting period – 01 May 2018 to 30 Apr 2019.

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

Full IMB Report – HMP/YOI Swinfen Hall


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

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

Full IMB Report – HMP/YOI Aylesbury


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

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

Full IMB Report – HMP/YOI Hollesley Bay