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