Report on HMP Addiewell 6-17 August 2018

Standard 9 – Health and Wellbeing

The prison takes all reasonable steps to ensure the health and wellbeing of all prisoners.

All prisoners receive care and treatment which takes account of all relevant NHS standards, guidelines and evidence‑based treatments. Healthcare professionals play an effective role in preventing harm associated with prison life and in promoting the health and wellbeing of all prisoners.

Satisfactory performance

Inspection Findings
Overall Rating: Satisfactory performance

The healthcare team at HMP Addiewell was a well‑motivated and caring workforce. Staff reported feeling generally safe. However, there were particular instances where they described being poorly supported by Sodexo staff to deliver healthcare in the prison. This included Sodexo staff not intervening when patients were being verbally aggressive to nursing staff during medication rounds. Inspectors observed that there were ongoing problems with bringing patients to appointments in the health centre or on the halls. These issues affected staff morale and the overall provision of healthcare to patients and waiting times for all services.

Inspectors saw a number of examples of innovative practice by the healthcare team. There was an emphasis on ensuring that prisoners were directly involved in their own healthcare, and that they understood the risks and benefits of proposed treatments. The prisoners spoken with were positive about the healthcare they received.

Leadership and management

Inspectors were concerned that Sodexo and NHS staff did not work together to solve problems which negatively impacted on the delivery of healthcare within the prison. Patients were not brought to appointments at the appropriate times resulting in some clinic start times being delayed by 1.5 hours, which had an effect on the ongoing waiting times for patients to be seen. Even though this was reported to Sodexo senior managers, inspectors did not see evidence of any change. In addition, there was no evidence to indicate that the health centre manager kept a record of the numbers of missed appointments from non‑attendance. Furthermore, although reports of verbal abuse were documented in the adverse event reporting system and reported to Sodexo senior managers, again there was no evidence of any change.

The senior charge nurse for primary care was unable to work to her banding due to the staff shortages in the primary care team.

Primary care

The primary care team provided a comprehensive range of clinics within the prison, including admission clinics and chronic disease management clinics. The primary care team was made up of GPs, advanced nurse practitioners and primary care nurses. There were significant delays in bringing patients to the health centre or triage clinics on the halls. This resulted in the waiting times for chronic disease management, dental, triage clinics and other services being extended and wasting the resources for these services. For example, dental waiting times were 14 weeks; which was over the Scottish Government guidelines of no more than 10‑week waits.

Systems and processes were in place from the reception assessments onward to identify patients with chronic conditions such as asthma or diabetes. Patients with chronic conditions were seen by the trainee Advanced Nurse Practitioners where they were assessed, treated and encouraged to be actively involved in their own management. A sexual health clinic was not running at the time of the inspection.

There was a comprehensive pharmacy service within the prison which included a pharmacist from Lloyd’s pharmacy and one from NHS Lothian. The service would be enhanced if Lloyd’s pharmacist had access to the electronic patient records on Vision. In‑possession medication was not always safely stored by all prisoners because some privacy locks were broken, or the keys were not available for the prisoner to use.

Infection prevention and control was seen to be practised well. All equipment inspected was found to be clean and ready for use. The clinical environments were also clean.

Staff were aware of health inequalities and provided inequalities‑sensitive practice in order to reduce the barriers to accessing healthcare. Staff demonstrated an awareness of safety and their procedural responsibilities in the provision of healthcare, and had a good knowledge of how to raise any concerns to senior management and Sodexo.

Mental health

The Mental Health Team was made up of a wide range of professionals, including psychologists and mental health nurses. Systems and processes were in place to ensure that where necessary, patients needing urgent access to the Mental Health Team were being seen quickly. However, staff used the patient’s self‑referral form to assess whether there was an urgent need to see the patient. This was a risk as the patient may not be able to express the severity of their symptoms on the self‑referral form. As stated above, a number of appointment slots were regularly missed as patients were not brought to be seen. Waiting times for routine mental health appointments were four weeks.

Although patients were assessed using a standardised tool this was not supported by a recognised risk assessment tool. Patient care plans were personalised but review dates were not documented on all the plans inspectors looked at.

The TTM strategy is adhered to within the prison with the exception of assessing patients when they return to the prison from court with a change in circumstances.

Substance misuse

A comprehensive service was offered to those with substance misuse problems. This included having a personalised care plan being put in place. There were a variety of programmes available to prisoners, such as narcotics anonymous and SMART recovery, but there was limited input about NPS and their risks. Some patients reported that they wanted to be prescribed Buprenorphine rather than Methadone for opiate replacement; both are identified as suitable for this in the ‘Drug misuse and dependence UK guidelines on clinical management’.

Health improvement

An opt‑out blood‑borne virus screening service was in place. Hepatitis B vaccination was available to patients. However, no posters or information was displayed anywhere within the prison about how to obtain condoms.

As previously mentioned, the sexual health clinic was not running at the time of our inspection.

We saw that prisoners had access to smoking cessation services and information was displayed/available in the halls and health centre about the health benefits of stopping smoking and how to access services to help with this. Naloxone training took place before liberation and a good number of Naloxone kits were taken by prisoners as they were liberated.