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


HMIP Report Health Notes: HMP Isle of Wight, Apr-May 2019

This report was on an unannounced inspection of HMP Isle of Wight between 15 April to 02 May 2019, and was published in August 2019.

General Points of Interest:

HMP Isle of Wight is spread across 2 separate sites, namely HMP Albany and HMP Parkhurst.

40% of the population were over 50 years old. 90% of the population are serving sentences of over 10 years.

The use of force had almost trebled from 40 incidents over a six-month period at the previous inspection to more than 110 at this inspection. This was higher than at other prisons holding prisoners convicted of sexual offences, although much of the force was low level.

Positive mandatory drug tests (MDT) had increased in the previous six months and stood at 5.2%. Whilst this figure is comparatively low by general standards, this was far higher than other designated prisons for sex offenders.

There had been 274 incidents of self-harm in the previous six months and 180 ACCT forms had been opened. There had been three self-inflicted deaths since the last inspection in 2015.

Healthy Prison Outcomes:

2015 2019
Safety 3 2
Respect 4 3
Purposeful Activity 3 3
Rehabilitation & Release Planning 2 2

Outcome Ratings:

Rating Outcomes for Prisoners
4 Good
3 Reasonably Good
2 Not Sufficiently Good
1 Poor

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

As part of the survey, 63% of prisoners rated the overall quality of healthcare services as being very good or quite good.

Out-of-hours care was provided by clinical staff based in the inpatient unit on the Albany site and an on-call GP service.

Most services were delivered by the health centres in Albany and Parkhurst, and outreach to the wings was provided when appropriate. The centres were bright and welcoming and supervised by prison officers. However, fixtures and fittings in rooms on both sites were not fully compliant with infection control standards.

Clinical and managerial supervision was being delivered and recorded and annual appraisals were in date. Mandatory training compliance was excellent.

Health care complaints averaged 10 a month and were addressed and managed appropriately with good oversight of themes. Responses were timely and contained information on how to escalate the complaint.

Patients with long-term conditions were managed using the community GP Quality and Outcomes Framework (QOF) to ensure that their conditions were reviewed as necessary and that they had appropriate care plans.

More than 200 discipline staff (about 45%) had received mental health awareness training and appropriate referrals were made to the mental health team.

The mental health team received approx 80 referrals a month, and these are triaged within 24 hours and allocated appropriately using a stepped approach. This ensures timely assessments and case management and no waiting list.

At the time of the inspection, 174 patients were in treatment from mental health services and a quarter of these had serious and enduring illnesses. Twenty-one patients were subject to the care programme approach, with appropriate use of Section 117 and other care management reviews.

None of the nine patients transferred to hospital under the Mental Health Act in the six months to the end of March 2019 had been transferred within the guideline of 14 days, and some had waited several months. Whilst unacceptable, it is acknowledged that this was beyond the control of the prison and its health services.

Approx 150 patients were engaged in substance misuse therapies at any one time, of which up to a third had primary alcohol issues. Those receiving clinical or psychosocial treatment were seen in one-to-one or group sessions. At the time of the inspection, 31 patients were receiving opiate substitution therapy (OST) of whom 11 were reducing their intake.

Medicines were dispensed by the pharmacy based in the prison. The prescription documents were printed by the doctor, but many were not signed.

Medicines were administered by nurses each day from 7.45 to 8.15am, 11.45am to 12.15pm and 4.15 to 5pm with monitoring and control provided by officers. Night medication was generally issued as daily in possession. Approx 80% of patients received their medication in possession, with about 60% on a monthly supply.

The pharmacy was trialling a robot for the collection of medication which enabled prisoners accompanied by an officer to collect their in-possession medication using their fingerprint as identification. The objective was to allow flexibility in the times that medicine could be collected to reduce congestion at the administration hatches. A robust system was in place to identify when medicines were not collected.

Recommendations: Health, Well-Being and Social Care:

  • A memorandum of understanding should be formally agreed between the social care provider, the prison and the local authority, to ensure that social care needs are consistently met.
  • Patients requiring hospital admission under the Mental Health Act should be assessed and transferred expeditiously within the current transfer guidelines.
  • All clinical environments should comply with infection control standards.
  • There should be a whole-prison strategy to support health promotion.

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

  • The introduction of weekly mental health induction meetings and segregation ‘rounds’ provided an opportunity for prisoners and prison officers to talk to mental health professionals at times of heightened risk.
  • The pharmacy used a dispensing robot for prisoners who needed additional support in taking their medicines. This produced individually labelled and sealed pouches. Each pouch contained the required medication for a single dose. The robot had a high degree of accuracy and had released staff to focus on other tasks.
  • Joint working between the libraries and the mental health team in the prison was “unusually” effective. Clinical professionals had recommended to the library a range of relevant books, self-help guides, CDs and other resources, and prescribed these resources for patients.

CQC Requirement Notices Issued:

  • None.

Links/Resources:

Full Report Here – HMP Isle of Wight