Tag Archives: IMB

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.

Healthcare

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.

Conclusion

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.

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.

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.

Safety.

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.)

Conclusion.

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

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