Health Notes from IMB Reports – August 2019 (Pt.2)

The IMB reports published during the latter part of August 2019 were from these establishments:

  • HMP/YOI Rochester
  • HMP Frankland
  • HMP Moorland
  • HMP North Sea Camp
  • HMP Pentonville
  • Dungavel House IRC
  • HMP/YOI Portland
  • Morton Hall IRC

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 Rochester

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • Staff shortages noted within the healthcare team, but remains a team of dedicated nurses at the prison, often working additional hours and exceeding what is expected of them.
  • Strained relations between the healthcare provider and the prison, although recent improvements were noted. Prison officers are now in attendance at all clinic sessions, but there are still occasions when wing officers fail to deliver appointment slips to prisoners until it is too late to attend.
  • There is the ongoing of medication being concealing by prisoners, presumably for trading. When identified, such prisoners are referred to the GP for review; as too are those who fail to collect medication regularly or are found to be non-compliant as a result of wing-based medication checks.
  • Delays in outpatient appointments remain, due to a lack of officers being available for escort duty, although it is noted to have improved during the year. As the availability of NPS remains significant in the prison, its effects are the cause of a significant proportion of the emergency A & E call-outs.
  • There were 176 complaints to Healthcare – primarily about medication and external hospital appointments, which is the same position as last year. Complaints to the IMB usually relate to perceived delays in appointments to see GPs or a hospital visit and are generally resolved.
  • An Optician visits the prison every fortnight, and there is a long waiting list. The growing profile of elderly prisoners with deteriorating eye sight adding to this pressure.
  • At time of writing this report, the IMB noted that substance misuse services are supporting 179 prisoners in structured treatment, a further 40 are given unstructured treatment, and 85 are on Opiate Substitution Therapy (OST).
  • Mental health services have a caseload of 77 patients with a 43 referrals in process. The IMB is noting that with the focus on opening up about mental health issues, the team at Rochester are spending more time and energy is helping with prisoners with their mental health issues.
  • Healthcare applications to the IMB increased to 42 from 40 when compared to the previous reporting year.

Full IMB Report – HMP/YOI Rochester

IMB Report – HMP Frankland

Reporting period – 01 Dec 2017 to 30 Nov 2018.

  • Reported self-harming incidents rose to 560 carried out by 83 prisoners compared with 403 carried out in the previous year. At the time of writing HMP Frankland has adopted a new SASH (Suicide and Self-Harm) policy which aims to reduce incidents of self-harm and deaths in custody.
  • The Governor is introducing a specialist into the Segregation Unit to monitor Mental Health issues and has deployed a Nurse Station in the Unit full time.
  • Recruitment of nursing staff continue to cause issues which reflects the national problem.
  • The focus of clinical and professional improvement noted by the CQC was the unmonitored fridge temperatures where drugs are stored, clinical supervision and staff training. Training is now evidenced and continually updated through a combination of face-to-face courses and on-line updates.
  • Although the Healthcare team have been through a particularly difficult year, the staff have engaged well and a tracking system of audits shows discernable improvement indicating a well-led service.
  • There continues to be considerable challenges in Healthcare, in caring for patients who have mental health conditions or non-medical issues who are lodged in Healthcare (in-patients) and could be returned to the wings were they not considered to be too disruptive.
  • An emerging dimension of healthcare for the long term high secure estate (LTHSE) is dealing with long term conditions such as dementia and a range of chronic diseases. Future development of services requires easy access to secondary care expertise to support both patients and staff. This certainly will need innovation and resource to meet this growing challenge. Training for prison staff needs consideration as part of this service development.
  • Overall, waiting times have improved across the range of services offered. Part of the solution is to challenge prisoners to use the telephone lines to cancel appointments and reduce ‘did not attend’, so appointment lists can be managed effectively. If prisoners use the telephone lines correctly, they can seek advice on healthcare issues without necessarily needing a GP appointment. There appears to be a confidence in prisoners using this service and improvements continue.
  • The Patient Consultative Committee (PCC) for Healthcare has been regenerated by the Clinical Lead and has become a focussed meeting actively seeking prisoner engagement. Following the CQC visit, the prisoners have been asked to contribute to the service review so healthcare services are ‘fit for purpose’. After initial hesitancy and some negativity, the meeting is going from strength to strength with a far more ‘can do’ attitude and honest dialogue.
  • A long term problem within Healthcare is the unacceptable waiting times prisoners experience when attending out-patient appointments. At the time of writing the report, the Governor has approved two posts who are effectively ‘Move Officers’ who can move prisoners back to their wings in order to tackle this problem. Priority transfer will be given to prisoners who are going to education or work so they do not miss out on morning or afternoon activity.
  • Healthcare applications to the IMB remained unchanged with 15 when compared to the previous reporting year.

Full IMB Report – HMP Frankland

IMB Report – HMP Moorland

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • HMP Moorland has benefited financially this year by being nominated as one of the prisons in the 10 prison project (10PP). The focus of this programme is on improving decency, leadership and the reduction of violence and drug-use within the prison.
  • Notable statistics for this reporting year include: 578 ACCT documents opened, 755 incidents of self-harm, 45 constant supervisions, 198 prisoner-on-prisoner assaults and 119 assaults on staff.
  • Mental health staffing has been increased so that care is now available 7 days per week, and prisoners put on an ACCT can be seen within 24 hours.
  • The overall cancellation rate for hospital escorts reduced to 8.1%, which equated to 62 cancellations from the 769 that were planned.
  • The number of psychoactive substance (PS) incidents have significantly decreased over the year, most likely as a result of the 10PP investment and additional resources. This reduction means that the 1–1 interventions with the Substance Misuse team are now more effective.
  • Overall the IMB is satisfied that healthcare services including mental health, substance misuse, and the arrangements for social care are of a standard equivalent to those available to the general population.
  • Healthcare applications to the IMB increased to 52 from 29 when compared to the previous reporting year.

Full IMB Report – HMP Moorland

IMB Report – HMP North Sea Camp

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • HMP North Sea Camp has adopted a rehabilitative culture and now refers to the prisoners as residents.
  • The Board is satisfied that healthcare provision at the prison is generally of the equivalent standard to that provided outside prison and, in some cases, exceeds it.
  • Typical waiting times for residents seeking medical attention are generally seen the same day by a triage nurse, and within a modern healthcare facility. GP appointments are facilitated within about a week. Optometry waiting time is within 4 weeks. Residents requiring urgent access to mental health services are seen within the same day. Residents are referred for screening programmes such as abdominal aortic aneurysm (AAA) screening and diabetic retinopathy screening within the same timescales as in the community.
  • The Board is pleased to note that the health provider continues to provide the finance to employ 4 extra prison officers to escort residents to hospitals and for bed watches when required. This has made a considerable difference to residents’ treatment in that appointments rarely have to be cancelled and rearranged. Escort duties no longer negatively impact on the prison regime which was the case in the past.
  • There are plans for the extension of the Healthcare centre during the 2019/20 financial year with funding from NHS England.
  • At periods throughout the year, and particularly for the compilation of this report, Board members have sought the opinions of the residents as to the standard of healthcare they receive. Whilst there are on occasion some complaints, and 12 healthcare-related applications to the IMB, in the main their opinion is favourable. One resident said recently of his treatment, leading to a surgical operation, that he was “impressed and delighted” with the service he had received, particularly by the staff at the Healthcare centre.
  • The percentage of residents over 50 years of age has increased and continues to do so. The health needs of an older population are well documented. Long term chronic age related issues include COPD, diabetes, cancers, mobility problems, arthritis, anxiety and increased comorbidity (2 or more long-term conditions). There is also an increase in those registered as “disabled”.The Board considers that the prison currently meets the healthcare needs of the population. However, going forward, it is likely that there will need to be more healthcare staff to service the increasing healthcare needs of an ageing prison population.
  • A small but very efficient unit of two mental health nurses provides an excellent service. There is an open-door policy and “nobody is ever turned away” from seeking help at the door. The team are part of the Quality Network for Prison Mental Health Services (QNPMHS) – the national peer review quality network. At the annual reviews for the last two years they were rated as the best MH team in the country, when rated against other participating prisons.
  • However, this small team have a heavy personal caseload and a lack of support. Between the two of them they currently have a combined personal caseload of over 50 patients. During the year to end of February 2019, the team dealt with a combined caseload of 224 patients. In addition, they run mental health awareness days, and give ongoing support to other patients in conducting “wellbeing interviews” There is currently no patient waiting list to see a mental health professional.
  • At the time of reporting, 22% of the residents at this prison are classed as “disabled” in some way and 30 residents have a personal emergency evacuation plan (PEEP) in place to assist them to leave their rooms safely in the event of an emergency. The prison has recently formed a team of five “residential support workers” – residents who are employed to support 20 disabled residents who are on PEEP plans.
  • In previous reports, the IMB have raised concerns about certain aspects of healthcare. The provision of dentistry has been addressed by the introduction of a mobile dental van (since Nov 2018). Residents get to see a dentist quite quickly now (within 4 weeks typically) for an initial assessment; however, there is typically a 10 week wait for treatment unless the resident is in severe pain or has a deep infection. Credit is given to the clinical lead at HMP North Sea Camp who has fought hard to get this service provided.
  • Healthcare applications to the IMB decreased to 12 from 15 when compared to the previous reporting year.

Full IMB Report – HMP North Sea Camp

IMB Report – HMP Pentonville

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • One recorded self-inflicted death this year compared with 3 and 6 deaths respectively for the last two years, bucking the national trend.
  • ACCT numbers have risen from 709 to 742 reflecting a trend seen across the prison estate since the introduction of Key Workers – a scheme carving out regular dedicated time for officers to support prisoners and pick up on issues – and the influx of newly trained officers. Many ACCTs are able to be closed within a day once immediate concerns are addressed.
  • Reported incidents of self-harm have increased this year to 598 from 500 in the previous year.
  • Mental health staff cannot always attend initial ACCT case reviews. Although a nurse is allocated Monday – Friday for this duty, the reviews are not well coordinated by the prison.
  • All health referrals are considered at a daily meeting of the Wellbeing team (Primary Care, In Reach Mental Health, the Wellbeing Centre, and Building Futures). This ensures co-ordination of provision and prevents time wastage by misdirected referrals.
  • The outstanding Wellbeing Centre has strong leadership and a motivated team. Largely refurbished, the services now include activities such as cooking and baking. Users are very enthusiastic about the activities and the staff.
  • National policy to return prisoners from secure psychiatric units to the nearest prison means that Pentonville receives a disproportionate number of such prisoners, putting pressure on the prison’s mental health services.
  • Wellbeing Centre staff continue to report that ACCT documents are not always sent across with prisoners.
  • No dedicated rooms on the wings for mental health staff to use for assessments means interviews take place in difficult conditions with little privacy.
  • A substance misuse through-the-gate worker may accompany an offender to key appointments on release and keeps in touch for up to three months.
  • Last year, the Board said it should be a prison priority to ensure that misusers go to the designated wing where extra medical support is available. The risk to life of alcoholics in first days of detox is acute. However, some men are still scattered across the prison endangering life.
  • Healthcare applications to the IMB decreased to 73 from 114 when compared to the previous reporting year.

Full IMB Report – HMP Pentonville

IMB Report – Dungavel House IRC

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • The numbers detained at Dungavel dropped significantly during the reporting year. This was in line with other establishments throughout the Immigration Estate.
  • The capacity of the Centre is 249. This is made up of 235 male beds, 14 female including the 3 disabled beds.
  • There were 21 detainee-on-detainee assaults, and 3 detainee-on-staff assaults and during the reporting period.
  • There is no medical recording IT system in the Health Centre. This results in an increased amount of clinical time being spent dealing with paper files. The Scottish Prison Service do not always pass on medical notes for Time Served Foreign National Offenders (TSFNOs).
  • Detainees are seen by a nurse within two hours of admission and offered an appointment with a doctor within 24 hrs. The health centre has open access but all further requests for an appointment are triaged by a nurse and detainees can then see a doctor within 24 hours. Medication is dispensed three times a day with an officer in attendance.
  • The mental health team help with anxiety, relaxation and anger management where detainees are having difficulty coping with situations in detention. They also run a horticultural group.

Full IMB Report – Dungavel House IRC

IMB Report – HMP/YOI Portland

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • The Board’s concerns regarding healthcare provision in general have changed little over a number of years. They involve issues about the way the prison facilitates the delivery of healthcare services as well as aspects of service provision delivered by the health provider. Whilst the senior management team and the healthcare lead are alert to the issues, there has been improved collaboration between the two services, but the IMB view is that access to the services provided in Portland are still not on a par with services in the community.
  • A service user forum has been established for the first time this year.
  • A seemingly intractable problem impacting on the smooth and safe delivery of healthcare services, is the timely, efficient and effective dispensing of medicines. Until recently facilitating the dispensing of medication was not a profiled duty for operational staff on the wings. The result was that, despite the fact that 25% of the population are in receipt of daily medication and between 50–60 prisoners, at any one time, are on a methadone script, no officer was allocated the responsibility of escorting prisoners to and from the dispensary in the healthcare building.
  • Deficiencies in the deployment of operational staff to provide support for the delivery of health and social care services are being addressed, but there is little evidence that the time taken to dispense medicines has improved. The knock-on effect is that subsequent clinics run late, have to be curtailed or are cancelled so prisoners face significant delays in accessing appointments with specialist service providers.
  • The Board continues to have concerns about the profile of the healthcare team. A shortfall in mental health staff and difficulties appointing and retaining staff means that the limited resource has to be focused on mental health assessments. As a consequence, treatment is based on drug therapy rather than psychosocial support as a treatment for mentally disordered prisoners.
  • At the time of writing of the report, there was no psychiatrist in post on the mental health team, although one had been appointed. The nursing complement does not appear to be adequate for the requirements of the prison. It is currently taking 5 weeks to access a mental health appointment. Although this year has seen an improvement, staffing shortages mean that segregation and ACCT reviews take place without a mental health or other health representative, or are attended by a staff member who has minimal knowledge of the prisoner.
  • Mental health data for July and August 2018 evidenced that in the respective months only 190 out of 313 (61%) and 157 out of 252 (62%) were brought for their appointment. Prisoners and wing staff are alerted to appointments by healthcare the day before via an appointment slip. In December a wodge of these undelivered appointment slips was found in waste management.
  • More recently changes to the funding of substance misuse services from the Prison Service to NHS public health teams have seen some downgrading of its priority. This will have a significant impact on the service, which holds an average caseload of 200 prisoners at any one time.
  • Healthcare applications to the IMB increased to 27 from 23 when compared to the previous reporting year.

Full IMB Report – HMP/YOI Portland

IMB Report – Morton Hall IRC

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • The operational capacity of Morton Hall is 391 detainees. For much of 2017 the centre operated nearly at full capacity. However, in keeping with other IRCs, the roll fell significantly during 2018; the average figure for the year was 293.
  • The average length of time detainees spent at Morton Hall during 2018 was between 2 and 4 weeks.
  • Healthcare provision at Morton Hall continues to build on the former HMIP/CQC Inspection reports with respect to strong clinical leadership, an effective team approach, an integrated service, sound governance and a good partnership with the centre’s management team.
  • Mental health provision has continued to improve. There has been an increase in the staff component from 3 to 6, now consisting of 2 clinical matrons, 3 senior mental health nurses and 1 mental health nurse.
  • The contribution of the Substance Misuse Practitioners is applauded by the IMB; their service is well used by detainees who often commend its quality and availability.
  • For the second year running the Mental Health Team has been recognised in the Quality Network for Prison Mental Health Services (QNPMHS) Peer Review (2018) as offering a high- quality service, coming second with a score of 91% of standards fully met. The site that placed first (North Sea Camp) has the same healthcare provider.
  • While healthcare is an agenda item on the monthly Residents’ Representative Group’s meetings, detainees feel they have limited involvement in the governance and development of the service. This is possibly a matter for future consideration.
  • Wellbeing Days are held monthly. They continue to be supported by all pathways; primary care; mental health and substance misuse.
  • The healthcare team continues to be proactive with respect to the management of complex cases. Complex case meetings are held every week and attended by everyone on shift, including primary care, mental health, substance misuse and pharmacy.
  • Healthcare applications to the IMB decreased to 11 from 19 when compared to the previous reporting year.

Full IMB Report – Morton Hall IRC

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

The IMB reports published during the early part of August 2019 were from these establishments:

  • HMP Swaleside
  • HMP Maidstone
  • HMP Isle of Wight
  • HMP Send
  • HMP Nottingham
  • HMP Littlehey
  • HMP Lowdham Grange

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 Swaleside

Reporting period – 01 May 2018 to 30 Apr 2019.

  • There were 247 prisoner on prisoner assaults (220 in the previous year) and 182 assaults on staff (133 in the previous year). 14 Of these staff assaults were recorded as being serious. These rises are attributed to be as a result of better recording.
  • During the reporting year there have been 6 deaths in custody, 5 of which are thought to be from natural causes, and only one thought to be self-inflicted.
  • A more comprehensive system of recording ACCTs was introduced during the year, so the IMB have no comparative figures to set against last year. There is confidence that the system is now more robust and accurate and will allow interrogation on many different levels.
  • Waiting times for dental, optical and podiatry care are commensurate with those in the community, if not better. Healthcare has received no complaints in this regard for at least 6 months.
  • The installation of a brand new X-Ray machine is a welcome facility which should assist in cutting waiting time and also reducing the number of outside hospital appointments.
  • Cancelled NHS appointments due to lack of escort remains a concern. Of the 1872 appointments in total, 1026 were cancelled, and of these 576 appointments cancelled by the prison. Prison staffing profiles allow for 6 accompanied external visits per day, however the demand exceeds supply. Cancer patients are still prioritised but the consequences often mean other residents having to be put back on to a hospital waiting list.
  • The Life Limiting Illnesses Committee meets fortnightly since its inception in January 2018. The group identifies and plans how to manage life limiting illnesses and how to prepare for the death in custody of residents from natural causes. The purpose of this is so that due respect can be given to the dignity of residents in these circumstances.
  • Swaleside Outreach Service (SOS) started in August 2018 and is a partnership between HMPPS and Oxleas NHS. It is a multi-disciplinary team consisting of operational staff, psychologists and a mental health practitioner who work closely with men who are identified for the service. The aim is to help residents whose behaviour in prison is considered to be challenging, violent and disruptive, to better manage themselves and reduce their use of violence and disruptive behaviour. The caseload is currently 21. Needs of the individuals are assessed and individual management plans to help encourage them to develop their strengths and help them progress through their sentence. The team work closely with Violence Reduction and give regular and structured support to Wing staff to help manage these men who exhibit challenging behaviour. Although in its very early days the IMB consider that SOS has made a very positive contribution to helping Swaleside deal with its most difficult individuals. On this basis, the IMB strongly commend this initiative.
  • Healthcare applications to the IMB decreased to 111 from 130 when compared to the previous reporting year.

Full IMB Report – HMP Swaleside

IMB Report – HMP Maidstone

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • The routine waiting list for dentistry was 54 at the time the report was written. The pressures on the services remain, with significant dental needs as prisoners so often wish to address their dental problems before deportation or repatriation.
  • The waiting time to see a GP at 7 days at the time of writing.
  • The smoking ban has been successful, however, the nicotine replacement service has highlighted concerns that nicotine patches are being used as ‘currency’. Greater scrutiny around used and intact NRT is being applied and non-compliance results in the prisoner being withdrawn from the service and a warning issued.
  • Prisoners are now seen twice on arrival. The initial screen is performed in Reception by a senior healthcare nurse who will assess if the prisoner is considered ‘safe’ for the next 72 hours and will also include a prescription screen. The prisoner is then booked in for a secondary screen where more information is gathered and, anticipating that the do not attend (DNA) rate will reduce, appointments are entered onto the prison database.
  • Coinciding with national campaigns every month, facilitated by the discharge facility nurse, a new health topic will be covered: prostate cancer, bowel cancer, diabetes, mental health etc. Feedback from prisoners is positive. The media channel is also being used to promote health.
  • The healthcare complaints procedure was not being used and prisoner complaints were processed through the general complaints system and lacked confidentiality. The IMB was pleased to see that this is now being addressed and complaint forms are being placed with the healthcare application form so that the prisoners have access to them on each wing.
  • Healthcare applications to the IMB increased to 34 from 21 when compared to the previous reporting year.

Full IMB Report – HMP Maidstone

IMB Report – HMP Isle Of Wight (IOW)

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • Following the decommissioning of Albany in 2013, HMP IOW is a merger of both the remaining HMP’s Albany and Parkhurst.
  • The average age of the population is now over 50 years, which accounts for over 50% of the population (compared to 43% in 2017).
  • Assaults have increased to 189 for 2018, when compared to 2016 where there were 101 recorded.
  • Self-Harm has seen a similar upward trajectory in going from 286 in 2016 to 656 in 2018.
  • There were 9 Deaths In Custody (DIC’s) during 2018, of which 7 were of natural causes and 2 were suspected as being self-inflicted.
  • The prison Healthcare was described as “a well-run and well led organisation which provides a standard of care at least equal to that provided for the general public.” It also notes “The manager changed mid-year and the new incumbent has continued to maintain the same high standard, ensuring the staff remain positive and well-motivated.”
  • Patient satisfaction is high with survey responses usually about 94% for those who would recommend the service received.
  • Internal clinic appointments average out at 571.6 per week. External escorts average out at 31.8 appointments per week.
  • Taking October 2018 as a snapshot, there were 836 patients who were prescribed medication. Of these, 82% were prescribed as In-Possession.
  • The level of staffing continues to be a problem due to a national shortage of nurses – current service delivery requires bank staff and agency nurses. A situation that is all too common across the Health & Justice sector.
  • HMP IOW is the first prison to offer Choice Point acceptance and commitment therapy which is appropriate for people with personality disorders.
  • Healthcare applications to the IMB decreased to 33 from 42 when compared to the previous reporting year.

Full IMB Report – HMP Isle of Wight

IMB Report – HMP Send

Reporting period – 01 Apr 2018 to 31 Mar 2019.

  • HMP Send is a closed prison for adult women. It has an operational capacity of 282.
  • Reported self-harm incidents increased significantly to 452 during the reporting year from 268 in 2017, although only 8 of these required hospital treatment.
  • Dental provision is an area of going concern – the waiting list reached a high of 30 weeks in August. At the end of the reporting period it stood at 15 weeks for new patients and 33 weeks for treatment. Urgent cases are seen weekly.
  • The new easy-read applications and confidential complaints procedure was noted as working well.
  • Send is the first prison in the country to introduce the long overdue access to the NHS Spine.
  • Prisoners are training to become peer educators in Hepatitis C.
  • Overall, the Board acknowledged the continued focus on augmenting and improving on Send’s already excellent healthcare provision.
  • Healthcare applications to the IMB increased to 37 from 29 when compared to the previous reporting year.

Full IMB Report – HMP Send

IMB Report – HMP Nottingham

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • The normal Operational Capacity of HMP Nottingham is 1060 prisoners. The Certified Normal Accommodation (CNA) is 718. However, following the HMIP Urgent Notification efforts were made to reduce the roll. From November 2018 this was capped at 800.
  • Following the national launch of the Ten Prisons Project, HMP Nottingham was one of the designated prisons, with the aims included to reduce violence and drugs problems. As is always the case with any prison initiative, the IMB acknowledged it takes time to translate into evident change and it was not until near the end of the reporting period that more significant change began to impact on the establishment.
  • The number of recorded acts of self-harm reduced to 502 from 730 in the previous year, albeit with fewer prisoners in the establishment.
  • The number of ACCTs opened during the reporting year was 1499, an increase from 1452 the previous year; both prison and healthcare staff have struggled from time to time to meet the demand of managing this high number.
  • The number of assaults on staff was 244, an increase from 194 in the previous reporting year.
  • There were 5 deaths in custody during the reporting period. In one case, another prisoner is currently awaiting trial for murder.
  • The IMB welcomed the initiative to engage an academic member of staff from Nottingham Trent University to evaluate trends in acts of self-harm and related safety issues. Positive steps following the cluster of deaths in custody which occurred during the autumn of 2017.
  • For 2018, 906 external hospital appointments were booked but only 651 attended, with 250 cancelled; 103 were cancelled because there was no available escort, either because of prison staffing problems or because an emergency took priority.
  • A recent HMIP survey showed that 52% of prisoners said they had a mental health problem. Prisoners’ needs are identified and the IMB were advised that the threshold for being accepted onto the caseload is substantially lower than that applied in the community.
  • At the beginning of 2019 the healthcare service commissioned a Wellbeing Unit, based on the principles of the recovery model. This initiative promotes control and opportunity, with peer support workers playing a significant role in each other’s recovery journey.
  • Over the year there had been 14 transfers to hospital under the Mental Health Act 1983. There is still an over-long delay in some men waiting for transfers, with one case waiting for over eight weeks.
  • Healthcare applications to the IMB increased to 68 from 66 when compared to the previous reporting year.

Full IMB Report – HMP Nottingham

IMB Report – HMP Littlehey

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • The IMB were concerned to note that the number of ACCT documents opened during the reporting year has increased significantly (324 this reporting year compared to 256 the previous year). Incidents of self-harm had also increased to 557 incidents, when compared to 331 the previous year). It was also noted that a large number of those self-harm incidents were concentrated in the 26–30 year age group, and furthermore attributed to a small number of prisoners.
  • The age profile explains the higher than average number of deaths due to natural causes at Littlehey. There were 8 deaths in custody in the reporting year (9 last reporting year) with 7 due to natural causes and one that is still under investigation.
  • Maintenance issues continue to be a cause for concern, which then places the health of prisoners at risk. The HMPPS appointed contractor failed to clean to NHS standards as it was not written into the contract resulting in poor infection control.
  • The Prison and healthcare agreement allows for ‘only’ 4 prisoners in the morning and 4 prisoners in the afternoon to attend hospital appointments each day. If there are emergencies, then this limit can be increased. The IMB raised concerns around the limit imposed and the impact this has on provision of suitable healthcare to prisoners requiring treatment at external hospitals.
  • An average of 194 appointments (excluding emergency admissions) are booked each month, more or less at the limit of what is allowed by the staffing detail. Of these each month, an average of 10 will be cancelled due to staff shortages, and a further 15 will be cancelled to accommodate more urgent appointments. Essentially 25 appointments per month are cancelled due to the inability to provide enough staff for escort duties. Inevitably the health care team have to make judgements regarding relative urgency of needs for each prisoner in these circumstances, and they report that they cannot allocate any appointments to prisoners with non-urgent treatment needs.
  • There are 6,000–7,000 appointments for internal health care services each month. An average of 7.7% of these appointments are not attended.
  • The IMB were disappointed that some prisoners whose mental health issues cause trouble in normal accommodation are moved to CSU as the only place they can be safely managed whilst local treatment takes effect until they can be returned to normal accommodation.
  • Healthcare applications to the IMB remained unchanged at 23 when compared to the previous reporting year.

Full IMB Report – HMP Littlehey

IMB Report – HMP Lowdham Grange

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • The Prisoner Advice Line, operated by prisoners, provides a wide-ranging service to the prisoners in Lowdham Grange and is recognised for its support especially to newly arrived prisoners. During 2018 they handled 7,413 enquiries, and interestingly, over 50% of which were support for prisoners asking about the progress of their ‘Bag & Tag’ orders.
  • Prisoners are regularly segregated while on an ACCT and the recent HMIP report noted that ACCT segregation documentation does not indicate the exceptional reasons for this or the consideration of alternatives to accommodation in the RIU. HMIP also noted that during the first 6 months of the IMB reporting period 41 prisoners had been segregated while on an ACCT, at an average of 7 prisoners per month.
  • There were 4 deaths in custody at Lowdham Grange during this reporting period.
  • The IMB notes that the healthcare accommodation remains unfit for purpose as reported in the 2017–8 Annual Report when it was hoped funding for an extension would be found. No funds have been made available and the observation is that the improvements that have been made are only cosmetic.
  • This is an ongoing substance misuse issue in the prison, however the problem has been the subject of an innovative co-operation between NHS and Prison managers which has resulted in the creation of a ‘Drug Recovery Wing’ which opened in early 2019.
  • The IMB notes that the provision of escorts for external hospital appointments and bed watches remains a challenge for both Healthcare and Prison management. The IMB acknowledges the strain placed on the staffing detail of the prison and means that the decisions made by healthcare professionals to seek hospital investigations or treatment have to be prioritised more critically than in a community setting.
  • A recent one-off pilot of bringing scanning facilities into the prison on a sessional basis to facilitate diagnoses proved to be cost-effective and Commissioners have requested further work to be done to assess the feasibility of developing such services more routinely.
  • Healthcare applications to the IMB decreased to 24 from 35 when compared to the previous reporting year.

Full IMB Report – HMP Lowdham Grange

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

IMB Reports: Health Notes – June 2019

Published IMB reports during June 2019 were The Mount, Leyhill, Exeter, Lindholme, Grendon, Gartree, Northumberland, Lewes and Springhill.

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

IMB Report – HMP The Mount

Reporting period – 01 Mar 2018 to 28 Feb 2019.

  • A net gain of 83 officers in 12 months, going from 110 in Feb 2018 to 193 in Feb 2019. This increase has seen a positive reduction in prison cancellations of hospital appointments.
  • An operational Wellbeing wing is providing support to prisoners with both substance misuse and mental health needs. Prisoners with more serious mental health needs are often located in CSU in the interests of either Good Order or Discipline of Own Protection.
  • Peer supporters employed as Health and Wellbeing Champions (HAWCS) provide health and wellbeing advice, guidance, brief interventions and support to fellow prisoners.
  • Healthcare applications to the IMB decreased to 7 from 21 to 7 when compared to the previous reporting year.

Full IMB Report – The Mount

IMB Report – HMP Leyhill

Reporting period – 01 Feb 2018 to 31 Jan 2019.

  • As a Cat D prison, the Healthcare service is comparable to a well-run GP practice. Greater emphasis is placed on prisoners in accepting responsibility for improving their personal health, which is commendable.
  • Perhaps going to far in trying to replicate community equivalence, the GP Clinics have reduced by 1 day per week, leading to a waiting time of approx 3 weeks. The average waiting time for new dental referrals is reported as being 10 weeks.
  • Healthcare applications to the IMB increased to 5 from 2 when compared to the previous reporting year.

Full IMB Report – Leyhill

IMB Report – HMP Exeter

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • In May 2018, HMCIP invoked the Urgent Notification protocol, which provides its own challenging backdrop for the delivery of any healthcare services.
  • HMP Exeter boasts an 11-bed social care unit (F wing) which includes a palliative care suite and a constant supervision cell.
  • The telemedicine Video-link facility is proving to be effective in enabling prisoners to have specialist consultations without the need to attend hospital, although staff report delays in the receipt of those written reports.
  • Clinics receive the support of dedicated officers although attendances/DNA’s remain heavily reliant on motivated “runners” which is typical of many prisons. DNA rates fluctuate from less than 10 for the GP/Nurse clinics to as high as 60% for services such as the physio and the optician.
  • Healthcare applications to the IMB decreased to 25 from 39 when compared to the previous reporting year.

Full IMB Report – Exeter

IMB Report – HMP Lindholme

Reporting period – 01 Feb 2018 to 31 Jan 2019

  • The recruitment of extra prison staff is welcomed. However, the low age and limited life experience of a significant proportion of new recruits has been observed. The IMB pose the question to the Minister To consider raising the minimum age of application to the Prison Service to beyond the current 18 years.
  • The IMB ask the Prison Service to consider what measures are needed to ensure that the staffing levels of the Healthcare provider are maintained as per contract.
  • Incidents of self- harm decreased in comparison to the previous year, although the data still produced a worrying picture. The monthly average of incidents was 30.7 in this reporting year, with more or less consistency throughout the year. This compared to a monthly average of 44 incidents in the previous reporting year. The large majority of incidents were by cutting and were carried out on the wings in singular cell accommodation.
  • Cosistent with the above, the number of ACCTs opened in the reporting period saw a reduction with an average 15.5 per month compared to 36 per month in the previous year.
  • There were 7 Deaths in Custody during the reporting period.
  • Healthcare staffing levels revealed that at the end of the reporting year, 16 out of a total of 60 posts were either vacant, awaiting completion of the recruitment process or subject to a period of notice. Staffing recruitment problems have been identified on the risk register. Mental health has been the most affected, and Substance Misuse Services the least.
  • Waiting Times to see a GP varied significantly from month to month. At the end of the reporting year, this was 3 weeks 4 days. The vacant ANP post had an impact on this. Waiting times for physiotherapy were 41 weeks and podiatry 19 weeks.
  • The DNA rate for prison GP appointments has reduced towards the end of this reporting year to 7%.
  • A Telemedicine service has been provided but has proved to be not as useful as hoped. This was attributed to waiting times and the rejection of referrals, and therefore diverting referrals back into mainstream secondary care.
  • Cancellation of hospital appointments by the prison was high, and at the end of the reporting year it was 10.6%.
  • Work-fitness clinics: daily clinics (Monday to Friday) to assess prisoners who felt that they were not fit for work, in the context of a working prison, have been re-established with an 80% coverage of working days. This has been a welcome development.
  • Healthcare applications to the IMB decreased to 30 from 54 when compared to the previous reporting year.

Full IMB Report – Lindholme

IMB Report – HMP Grendon

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • Incidents of self-harm for the year were 26 compared with 43 for the previous year, which included two individuals who self-harmed on multiple occasions.
  • 52 ACCT’s were opened for the year compared with 62 in 2017. Reviews monitored by the Board, including some very challenged men, showed evidence of good care and support.
  • 8 assaults were recorded in 2018 compared with nine in 2017 and no use of force.
  • Grendon has been smoke free since 2017 and there is no current funding to support nicotine (cigarette) cessation, but some residents are now looking for support to come off vaping. Healthcare are exploring options.
  • Healthcare applications to the IMB increased to 7 from 4 when compared to the previous reporting year.

Full IMB Report – Grendon

IMB Report – HMP Gartree

Reporting period – 01 Dec 2017 to 30 Nov 2018.

  • The high number of men with complex mental health needs (i.e. those on ACCT documents, self- harming, on dirty protests in the SAPU puts considerable strain on staff, who despite doing everything they can in very difficult circumstances, may not be best placed to deal with some of these more complex prisoners.
  • The Board is aware of occasions throughout the year where men in the Segregation Unit have not received prescribed medication when it is due or needed.
  • For the majority of this reporting period, responsibility for provision of the integrated healthcare services at Gartree was provided through Mitie Care & Custody (Health) Limited. On 1 November 2018, Nottinghamshire Healthcare NHS Foundation Trust (NHFT) took over the responsibility for the delivery of healthcare at Gartree.
  • The IMB continued to hold the view, as expressed in their Annual Report 2016/17 that the prison regime and the health and wellbeing services at Gartree for this reporting period were not designed or resourced to improve health and wellbeing, or tackle health inequalities and the wider determinants of health.
  • The Board acknowledged that a change in provider was appropriate, and addressing the current inadequacies of the healthcare services is critical.
  • Healthcare applications to the IMB increased to 47 from 22 when compared to the previous reporting year. In many instances healthcare applications related to the lack of response to complaints by Healthcare.

Full IMB Report – Gartree

IMB Report – HMP Northumberland

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • 2018 saw one death in custody, compared with five in each of the two previous years.
  • The IMB have previously recorded their disappointment that the deterioration in routine waiting times for both GP and dental services has not been addressed more quickly. In this reporting year, the situation remains unchanged, with waiting times for both services continuing to fluctuate throughout 2018 despite the periodic provision of additional sessions.
  • Waiting times for the GP peaked at 36 days in July and August, and reduced at the end of the year. Waiting times for dental treatment stood at 29 weeks, with a hope that this would improve in 2019.
  • Healthcare applications to the IMB decreased to 38 from 46 when compared to the previous reporting year.

Full IMB Report – Northumberland

IMB Report – HMP Lewes

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • The Board is concerned about the safety of men in HMP Lewes. In the reporting year, recorded incidents of violence perpetrated by a prisoner on another prisoner rose from 165 to 278, an increase of 68%.
  • There have been five deaths in the reporting year. Over the last year 579 ACCT documents have been opened.
  • The Board has found that for much of the reporting year the delivery of healthcare services has suffered from staff shortages and poor process and communications which have significantly impacted on the care provided for prisoners.
  • The Board has found that waiting lists for routine GP and dentist appointments have been unacceptably long at various times: in the six months May-October the wait to see a GP was an average of 12 weeks, and in June and January, the waiting time for the dentist was 10–12 weeks. In addition, the integrated mental health team typically had in excess of 50 residents waiting for an assessment appointment, with some men waiting many months to be seen.
  • The Board considers that the complaint management process remains poor and provides little opportunity for an overarching view of healthcare delivery. Each service provider manages their own complaints, and the quality of responses and the integrity of the data is variable. There were typically 20–30 complaints a month to the two main providers and the consistent themes throughout the year were access and waiting times, and not getting the medication wanted.
  • The prison went smoke-free in April 2018, and a programme implemented by the pharmacy team supported by gym officers ensured that the transition went smoothly. The smoking cessation activity has continued, with 220–240 men supported each month. Feedback from participants of programmes run by Forward Trust (alcohol and substance misuse) was excellent.
  • Healthcare applications to the IMB increased to 72 from 50 when compared to the previous reporting year.

Full IMB Report – Lewes

IMB Report – HMP Springhill

Reporting period – 01 Jan 2018 to 31 Dec 2018.

  • HMP Springhill is jointly managed with HMP Grendon (located next door). A single Independent Monitoring Board monitors both prisons.
  • Opened ACCTs remain low at 5 for the year. It is a good indication that the prison has the confidence in care to be able to support men on ACCTs. There were no reported incidents of self harm for the entire reporting period.
  • Pregabalin appears to be the drug of choice over Spice/NPS (new psychoactive substances). Cannabis has also been more prevalent, which might account for the overall 46% increase in positive test results compared with 2017.
  • Healthcare staffing recruitment has proved challenging when striving for a full complement of staff during the year, and in particular to fill the post of pharmacy technician. Staff have been faxing scripts for validation to pharmacy staff at other prisons in the region, causing occasional delays in men getting their prescriptions at weekends.
  • There are currently no healthcare meetings with residents, but this is being addressed.
  • Dental services have made significant progress in ensuring that all new patients are seen within the prescribed time. Residents positively rate dental care.
  • Healthcare applications to the IMB decreased to 0 from 6 when compared to the previous reporting year.

Full IMB Report – Springhill

IMB Report: HMP Holme House 2018 – Health Summary

This report presents the findings of the Independent Monitoring Board at HMP Holme House for the period 01 Jan 2018 to 31 Dec 2018. 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.

General Points:

In 2017 Holme House was chosen to pilot the concept of a Drug Recovery Prison (DRP) with an additional investment of £9 million provided by the Ministry of Justice (MOJ) and NHS England between 2017 and 2020. The objective is to test a whole prison approach to tackling both the supply and demand for drugs in prison, and to create an environment where opportunities for recovery can flourish.

The DRP Delivery Plan consists of four components: safety and security, care and well-being, community and environmental development, and continuity of care.

2018 saw significant and steady improvements in the stability and performance of the prison, characterised by a regular and consistent regime leading to a greater certainty for both men and officers alike.

Wing based community care is delivered by a dedicated healthcare team made up of DART nurses, recovery coordinators, mental health nurses, CRC and peer support.

The number of prisoners with a history of self-harm has been consistent throughout 2018 with approximately 250 prisoners in an average prison population of 1200. In 2018 there were 868 open ACCTs, a 6% increase over 2017, which remains an area of concern. The IMB has observed excellent examples of a caring and consistent approach to ACCT reviews.

There were 261 reported acts of violence in 2018, compared to 376 in 2017. Assaults on prisoners (including serious assaults) showed a downward trend in the second half of 2018. There were 98 reported prisoner-on-prisoner assaults in 2018 which is an ongoing cause for concern. Assaults on staff are an ongoing concern, with 16 reported incidents in the year. However, there is evidence of a downward trend in the last quarter of the year.

There were seven deaths in custody in 2018, five of which were due to natural causes. This compares to five deaths in 2017 when four were due to natural causes. Inquests into the other two deaths are currently ongoing.


Service Delivery Positives:

  • Screening for bowel cancer, retinal screening, diabetic screening and healthy heart checks continue to be part of the routine.
  • There have been some improvements in inpatient care, as a concerted effort has been made to remove prisoners with serious mental health problems to another provision, resulting in most of the beds being occupied by social or clinical need prisoners. A dedicated team of prison officers has also been established within the inpatient accommodation. A palliative care suite is available and there is close working with Teesside Hospice Care Foundation and Macmillan nurses.
  • There has been a significant reduction in the percentage of men not turning up to appointments from last year (18% in 2017 down to 6% in 2018). This improvement can be attributed to the improvement in the delivery of the regime in the prison this year.
  • The mental health team is fully staffed with nurses. psychiatrists, a speech and language therapist, a resettlement officer and counsellors from MIND. A range of group therapies are available to all men, including stress management, ’Hearing Voice’, team building and a well- being gym. Other therapies such as EMDR (eye movement desensitising reprocessing) are provided.
  • A speech and language therapist (SLT) is employed as part of DRP, working within the mental health team to work with men who want to improve their communication skills or have swallowing difficulties due to mental health or medical problems. Part of the work is about making information easier to understand and making Holme House a more positive place for effective communication.
  • The mental health team manager won the national Cavell Staff Nursing award during 2018, being the first mental health prison nurse ever to do so.

Service Improvement Opportunities:

  • The IMB does not consider that the services provided to prisoners by Healthcare are equivalent to those that prisoners would receive in the community, and in some instances they are considerably worse, with unacceptably long waiting lists.
  • Although this figure has improved, there are still unacceptable delays and at the end of the year men had to wait five to six weeks to have a GP appointment, with review appointments having an eight-week waiting list. There is some provision for urgent appointments with the GP.
  • Dental appointments are worse, with the end of year figure of 280 men on the waiting list for an initial appointment, which will take 21 weeks, with an ongoing treatment waiting time of eight weeks and dental therapy nine weeks.
  • A shortage of nurses has dominated the ability of Healthcare to deliver a fully effective service to the prison. There has been an average shortage of 10 nurses out of a total complement of 27.5. Bank and agency nurses cover the shortfall. This has impacted on attendance at GOOD and ACCT reviews as well as late delivery of medication and poor or late attendance in reception, causing disruption to the prison regime.
  • Medication is supposed to be delivered by pharmacy technicians. However, due to shortages of staff, nurses are deployed to this work, which adds to the shortages in other areas. Medications on two house blocks are combined due to the low number of men requiring not in-possession medication.
  • The IMB has observed problems with the health care complaint system, which is separate from the prison complaints system, is not well administered and does not appear to be monitored robustly, leading to long delays with responses. This is reflected in the high number of applications the IMB get relating to medical matters.


The IMB feels that Holme House has become a less volatile and dangerous place for both prisoners and staff in 2018. Staff training has been focused on violence and drug prevention, e.g. all safer custody staff are fully trained in engaging in Timewise, a violence reduction programme. A prison-wide focus on staff training on Five Minute Intervention [FMI] and key worker training under Offender Management in Custody [OMiC] have also contributed to this.

Holme House can present a very challenging and volatile environment. The IMB feels that due to the determination and effort of those who work there and with a more consistent application of assurance checking considerable progress has been made towards laying the foundations for improved performance indicators and a more safe and stable environment for all who live and work there.

Holme House IMB Report 2018

National IMB 2017/18 Report – Prisons in ‘fragile recovery’

On the 5th June 2019, the Independant Monitoring Board (IMB) published their National Annual Report for the late 2017 to 2018 period.

The IMB findings reported on 10 key aspects of prison life:

  • Staffing
  • Drugs
  • Safety
  • Segregation
  • Accommodation
  • Property
  • Equality and Diversity
  • Health and Social Care
  • Education, work and Purposeful Activity
  • Preparation for Release

As part of the introduction to this report Dame Anne Owers sets the scene:

“…the visible decline in (prison) safety, control and the expectations of both prisoners and staff since I last visited them, as Chief Inspector of Prisons, in 2010. It is therefore welcome that additional resources have now been put into prisons, with an influx of staff, but it will take time before prisons can not only stabilise, but progress.”

Here are some of the more noteworthy takeaways from the report that impact on the general health and wellbeing of prisons and prisoners:


Staffing issues dominated annual reports in this period. The main theme from across the estate is the ongoing influx of new, and therefore inexperienced staff. This is further compounded by the churn as prisons struggle to retain those officers. This affects every kind of prison and every aspect of prison life: from security and safety to healthcare, activities and rehabilitation. A recognition from the IMB that cannot be understated.


Drugs in prison not only have a direct impact on health and on prisoners’ erratic and sometimes violent behaviour; they also undermine safety and stability by producing an alternative power structure, based on debt, bullying and intimidation of prisoners, their families and sometimes prison staff. This also impacts on already stretched healthcare services.


In general, incidents of violence and self-harm increased, often significantly, throughout 2018. Boards attributed this to a combination of the availability of drugs (and the associated debt and bullying), the inexperience or shortage of staff, and frustration due to inactivity.

Most boards reported an increase in the number of Assessment, Care in Custody and Teamwork (ACCT) documents opened for those at risk of suicide or self-harm during the period. It is recognised within the report that this may be in part a consequence of increased vigilance, following the steep rise in suicides in preceding years.

One board reported that they were concerned that an “overly risk-averse approach” had resulted in too many ACCTs being opened, making it more difficult properly to identify and support those at serious risk of harm. Whilst this may be very true, prisons could equally be criticised for doing the opposite. Such a practice of not opening too many ACCT’s could and is often recognised at Coroners Inquests as a failing in a duty of care. This feels very much like a case of damned if you do, damned if you don’t.

Another board noted that self-harm tended to coincide with canteen day and when the prison was in patrol state (i.e. prisoners being locked in their cells). Another, recognising the same phenomenon, had produced information and distraction programmes on in-cell television, with input from mental health. Commendable indeed.

Many boards welcomed the increased staff training in suicide and self-harm, and some reported improvements as a result. However, some also pointed to continuing concerns about the quality and consistency of ACCT documentation, observations and support, and in some cases the lack of involvement by healthcare staff in ACCT reviews, especially given the strong connection between mental health issues and self-harm.

Health and Social Care.

Boards reported the pressure on prison healthcare, reflecting the level of both physical and mental health need, as well as staff shortages and the impact on prisons of shortfalls in provision outside criminal justice.

It is well known that overall prisoners’ health, both physical and mental, is worse than among the general population. Physical health outcomes are affected by lifestyles, drug and alcohol misuse and disengagement with community healthcare, as well as the complex needs of an ageing prison population.

Prisons, like the rest of the criminal justice system, disproportionately contain individuals with mental health problems, which imprisonment can exacerbate – particularly as prisons, unlike mental hospitals, cannot compulsorily treat patients except in extreme circumstances.

Many boards reported the effects of staffing shortages, both of uniformed and healthcare staff. Sometimes there were not enough uniformed staff to escort prisoners to appointments, either within the prison or to external hospitals. Staff shortages also impacted on the supervision of medication queues.

Shortages of nursing staff, particularly mental health nurses, led to long waiting times, over-high caseloads and reliance on expensive agency staff with no continuity of care.

Shortages of uniformed prison staff and poor communication also affected the high number of prisoners not attending appointments made for them (DNA’s).

The IMB report states that the underlying problem was a disconnect between the level of need and the level of provision. The demand for healthcare services, especially mental health, was extremely high in many prisons, and many boards reported that need was increasing beyond current resource.

What the report doesn’t recognise, but is equally worth noting is the demands placed on staffing resources that are compounded further – for those in need of mental health services, our prisons are recognised by the courts as being places of safety. (Feel free to pause to reflect on this for a moment.)


The report provides a benchmark for the future, and it is with a sense of both hope and optimism that the array of promising intiatives already underway as part of the prison reform programme begin to reap results. Those initiatives include:

  • the roll-out of offender management in custody (OMiC)
  • the prison estate transformation programme
  • lessons learnt from the then Prisons Minister’s ten priority prisons project, and responses to the Inspectorate of Prisons’ urgent notification process
  • revised processes for supporting prisoners at risk of suicide and self-harm
  • the new drug strategy
  • embedding the CSIP (challenge, support and intervention) process for violence reduction
  • new processes and contracts for dealing with prisoners’ property.

From now on, we can also look forward to a quarterly digest of published IMB Annual Reports, as the IMB undergoes further work with Boards to identify emerging themes and issues and to record progress against the hopes and expectations of the prison reform programme.

The prison night is very much at its darkest right before the dawn.

Read the full report here