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


HMIP Health Notes: HMP Pentonville, Apr 2019

This report was on an unannounced inspection of HMP Pentonville between 01–12 April 2019, and was published in August 2019.

“Pentonville epitomises the challenges confronting ageing, inner-city prisons with transient populations, many with heightened levels of need and risk.”

General Points of Interest:

Use of force had been applied 419 times in the 6 month period prior to the inspection.

At the time of this inspection, 25% of the population were receiving psychosocial support for substance misuse needs.

During this same period, the positive MDT rate was 29% for those prisoners tested.

Since the last inspection in 2017, there had been 4 self-inflicted deaths, and another from natural causes.

There had been 316 incidents of self-harm in the previous 6 months, similar to comparator prisons. Constant supervision had been used 17 times.

Over the same period, 400 prisoners had been subject to ACCT processes. 30 of all ACCT documents were opened in reception.

Healthy Prison Outcomes:

2017 2019
Safety 1 1
Respect 2 2
Purposeful Activity 2 2
Rehabilitation & Release Planning 3 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:

Healthcare managers provided strong leadership to a dedicated professional team who told inspectors that they felt well supported.

Staffing levels and retention had improved, with limited reliance on bank and agency staff. Staff received regular managerial and clinical supervision, and compliance with mandatory training was good. Staff were also supported in developing advanced clinical skills.

The introduction of a dedicated prison governor, custodial manager and prison officers into health care had improved communications and facilitated better access for patients. Patients no longer had to wait in health care for a long period after their appointments and waiting lists were shorter.

The DNA rate for the GP clinic had improved at 10% but remained too high for other clinics, for example dentist 31.8% and optician 35.8%. However, there were plans to deliver more treatment on wings from May 2019 to address this.

There was no overarching health promotion strategy or action plan. Health promotion literature was available in the health centre but limited elsewhere, which was a missed opportunity to encourage well-being.

Working relationships between prison and mental health staff were mature. The majority (97%) of recently appointed prison officers had received some training in mental health awareness, which was viewed by inspectors as being commendable.

There was an open MH referral system, daily well-being team meetings and prompt assessment via the Health and Wellbeing Model. Prisoners in the red zone were seen within one working day and those in the green within 5 days, which was efficient.

The impressive well-being centre continued to deliver an additional level of primary mental health care, supporting vulnerable prisoners through structured and consistent daytime therapies. All eligible prisoners could now use this service, from which 20 prisoners benefited each day.

Patients had complex emotional and mental health needs. About 220 (20%) patients at a time were on the caseload for primary mental health care and 60 (5%) for secondary mental health care. About one in nine prisoners (146) were on anti-psychotic medication which, although less than in 2017, was very high.

At the time of the inspection, 116 patients were receiving methadone or buprenorphine (opiate substitutes), with 54 appropriately on reducing doses. Prescribing was flexible and based on national clinical guidance.

At the time of the inspection, 31% of patients had their medicines in possession. Cells still lacked lockable facilities for storing medicines, but random checks of 10 cells a month had been introduced, which was a noted improvement on 2017.

As part of the survey, 30% of prisoners rated the overall quality of the health services as being either very good or quite good.

Recommendations: Health, Well-Being and Social Care:

  • The prison health care local delivery board should ensure that assertive action is taken to enable access to health care, safe storage of in-possession medicines, and a prison-wide strategy for health and well-being.
  • Governance procedures should be strengthened significantly to ensure safe and appropriate social care provision.
  • Patients requiring care in external mental health services should be transferred expeditiously.
  • Maximum and minimum temperatures should be recorded daily for refrigerators where medicines are stored and documented corrective action should be taken when temperatures fall outside the 2–8 degrees centigrade range.

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

  • The dedicated team of prison staff in health care had improved efficiency and the patient experience.
  • The well-being centre supported vulnerable prisoners with a structured therapeutic regime and enabled positive outcomes for those with both primary and secondary mental health needs.
  • The enhanced support service team offered valued guidance and support.

CQC Requirement Notices Issued:

  • None

Links/Resources:

Full Report Here – HMP Pentonville