HMIP Report – Health Summary: HMP & YOI New Hall, Feb-Mar 2019

This report was on an unannounced inspection of HMP & YOI New Hall between 25 February to 08 March 2019, and was published in June 2019.

General Points of Note.

48% of prisoners were reported to have committed their offence to support the drug use of someone else.

Of those using the counselling service, 53% of prisoners said they had suffered domestic violence and 44% said they had been raped.

78% of prisoners disclosed they had a mental health problem, and 71% of the population were receiving services from the substance use psychosocial team.

There had been 3 self-inflicted deaths since the last inspection in June 2015.

There had been 359 incidents of self-harm in the six months prior to the inspection. This figure was higher than at the previous inspection but lower than in other women’s prisons. On average, the data identified four prisoners each month as prolific self- harmers, carrying out five or more incidents. In the six-month period before the inspection, prisoners who often self-harmed accounted for 46% of all self-harm incidents.

There had been 419 ACCTs opened in the six months before the inspection. This was higher than the time of the last inspection and comparable with other women’s prisons. A new ACCT case management system had been introduced and all those subject to the process now had a named case manager in their residential unit. The majority of care maps included targets and specific action, although too many daily entries were purely observational and lacked any detail of staff interactions.

Healthy Prison Outcomes:

  • Safety = 4 (4)*
  • Respect = 3 (4)*
  • Purposeful Activity = 3 (4)*
  • Rehabilitation and Release Planning = 4 (3)*

Note: *(Previous inspection outcomes from June 2015 are stated in brackets)
Key:

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

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

Many aspects of health care remained good, but significant staff vacancies in the mental health team had had a negative impact on the delivery of mental health services.

The confidential health complaints process was well promoted. Concerns were usually resolved in person, while complex complaints were escalated to managers for investigation. Responses we reviewed were generally prompt, although the outcome and action taken were not recorded consistently enough.

Monthly patient forums, together with an analysis of patient satisfaction surveys, had led to some service improvements. However, some issues had been raised repeatedly without being properly resolved.

Effective joint working was demonstrated through a range of meetings, including weekly complex case reviews and a daily handover attended by representatives from all teams identified any clinical concerns.

Clinical and managerial supervision was not provided or taken up consistently across the teams. Mandatory training was well managed and there were excellent professional development opportunities, particularly in the primary care team.

The waiting area in the health centre had been extended and it was now bright and welcoming. The lack of free-flow movement, meant that patients waited too long before and after appointments, which discouraged prisoners from attending.

Work was in progress to reduce the high non-attendance rate. Delays in prisoners receiving appointment slips had resulted in missed appointments, although a new initiative was being trialled – it involved the health care representative delivering appointment slips in sealed envelopes.

The waiting time for a routine GP appointment was over three weeks, which was too long. Urgent on-the-day appointments were prioritised by clinical need.

78% of prisoners reported having a mental health problem and 44% stated that they had received help for it while in the prison.

The MH service had deteriorated since the previous inspection, and was compounded by significant staffing shortages – five of nine clinical roles were vacant. It had also experienced a high staff turnover in recent months. The service used regular agency workers to cover some staffing gaps.

Prisoners with mild to moderate mental health issues did not have access to community equivalent, planned ongoing treatment or psychological interventions. Prisoners with more serious mental health problems received a better level of support – there was evidence of some helpful one-to-one work, informed by personal care plans and risk assessments.

In the 12 months prior to the inspection, more than 90% of prison officers had received trauma-informed training (to enable them to consider the trauma prisoners may have experienced in their lives).

The Drug & Alcohol Recovery Team (DART) was supporting 282 prisoners (about 71% of the population) during the inspection and about 170 (43% of the population) were receiving opiate substitution therapy,

The CQC issued one Requirement Notice against Regulation Standards.

Recommendations: Health, Well-Being and Social Care:

  • All health care staff should receive regular clinical and managerial supervision.
  • The non-attendance rates for all clinics should continue to be investigated and reduced,
    including a review of the applications process to see if this is hindering attendance.
  • Immunisations and vaccinations should be available to eligible prisoners in line with national programmes. They should be implemented promptly to promote prisoners’ health.
  • Routine waiting times to see the GP should be reduced and should not exceed two weeks.
  • The out of hours’ medicines cupboard and drug refrigerators should be robustly monitored to ensure medication is appropriately and safely stored.
  • The prison should ensure the process for transporting dental tools across the prison is safe.
  • Transfers under the Mental Health Act should occur within current Department of Health transfer time guidelines.

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

  • None identified/reported.

CQC Requirement Notices Issued:

  • Regulation 9. Person-Centred care. Prisoners requiring mental health support did not always receive person centred care that was appropriate, met their needs and reflected their preferences.

Links/Resources:

Full Report Here – HMP & YOI New Hall