Report on HMP Kilmarnock Follow-up Inspection, 14-19 July 2014

1. Progress on Recommendations

1.1 High Risk Assessment and Teamwork (HRAT) should be reviewed and the sharing of best practice should be further developed to ensure that prisoners transferring from public to private prisons, or vice versa, experience no difference in terms of standards of care or treatment (paragraph 2.19).

Achieved. HMP Kilmarnock has ceased to employ the HRAT system to manage those prisoners at risk of self-harm or suicide and has replaced it with the SPS system 'ACT 2 Care'.

1.2 The number of prisoners attending production workshops and vocational training programmes should be increased (paragraph 4.19).

Achieved. The repositioning of vocational activities within learning and skills has created effective collaboration between staff responsible for education and vocational areas. This collaboration has resulted in an increase in opportunities for prisoners to participate in production workshops and vocational training programmes. Vocational training programmes in bricklaying, painting and decorating, and horticulture have been introduced and prisoners are offered an opportunity to complete training in all three areas to enhance their employment prospects. Bricklaying and horticulture instructors have undertaken assessor awards to enable them to deliver vocational qualifications and plans are in place to extend this across other vocational areas. The prison has successfully obtained six commercial contracts which have led to an increase in prisoner places in production workshops. Approximately 240 prisoners a week attend production workshops and improved arrangements for allocating places and responding to non-attendance have contributed to increased levels of prisoner participation.

1.3 The number of prisoners attending education should be increased (paragraph 4.25).

Achieved. Since the full inspection, the prison revised its education provision to align the range of programmes more closely with prisoner needs and interests. The current range of education programmes takes good account of the skill levels of prisoners and provides increased opportunities for prisoners to develop core skills within a vocational or thematic context. Classes in the Learning Centre are well attended. Art, Information Communication and Technology and Catalyst programmes have waiting lists for places. Delivery of core skills within vocational areas has increased opportunities for prisoners to develop their numeracy and communication skills. Literacy and numeracy outreach sessions delivered in the residential Wings are being successful in encouraging and supporting hard-to-reach prisoners to take the first steps towards developing these skills. This is an area of good practice. These arrangements have resulted in a significant increase in the number of prisoners attending education programmes and around 40% of the prison population engaging in educational activities.

1.4 A review of accommodation and associated facilities for programme delivery should be undertaken (paragraph 4.28).

Achieved. A review of accommodation and associated facilities for programme delivery took place which resulted in a reconfiguration and in some instances relocation of the offices and classroom facilities used by psychologists and programme deliverers.

All programme delivery has been relocated to the Multi-Faith Centre (MFC) from the area adjacent to the gymnasium. The centre has suitable facilities within it including attractive, well lit classroom space, toilets, a tea preparation area and sufficient and comfortable seating. The quiet atmosphere in the MFC is conducive to the type of activity delivered and its location ensures that prisoners can access it easily from the main route. Discipline cover is provided as required.

1.5 Management should consider the introduction of a multi‑disciplinary system for the management of prisoners deemed to be at risk of self‑harm (paragraph 4.29).

Achieved. The management of prisoners deemed to be at risk of self-harm is now delivered through the application of the ACT 2 Care strategy. The decision to move from HRAT to ACT 2 Care is welcomed by HMIPS and ensures that prisoners in HMP Kilmarnock are provided with the same standards of care and treatment as those held in every other establishment, public and private, across Scotland. This successful transition from the use of HRAT is reflected in the evident multi-disciplinary approach now adopted. There is a locally established multi-disciplinary ACT 2 Care Group who currently meet on a monthly basis and minutes from these meetings are published on the prison's intranet.

In the main, there is a good sense of knowledge of the principles and application of ACT 2 Care. Training is being delivered to all staff on an on-going, rolling programme basis. During inspection, ACT 2 Care case conferences observed were attended by a range of relevant disciplines, with an empathetic approach and conducted in a professional manner. Documentation reviewed was found to be completed to a high standard. This is positive.

Every ACT 2 Care document is reviewed and audited by senior management and any deficits or omissions are identified and addressed as a priority. This is an area of good practice.

At the time of the inspection three prisoners were being cared for under the ACT 2 Care Strategy. This figure may be reflective of a positive environment and staff group which contribute to reduce risk factors and, as a consequence produce low instances of those at risk of potential self-harm being observed. However, caution is advocated as low use of ACT 2 Care may also reflect a lack of vigilance and recognition of early indicators of those at risk.

Recommendation 1: HMP Kilmarnock should undertake further analysis of the number of prisoners identified as being at risk to provide assurance of safe practice.

1.6 Clinical treatment should stop immediately in the medical room in house block 1 (paragraph 4.52).

Partially Achieved. All of the treatment rooms located in the house blocks have been refurbished however they remain cramped and do not fully comply with the NHS QIS Healthcare Associated Infection (HAI) Standards (2008).

Recommendation 2: NHS Ayrshire and Arran should ensure that all treatment rooms are fit for purpose and comply with all relevant standards and legislation.

1.7 A system should be introduced immediately to ensure all prisoners on Methadone are tested regularly (paragraph 4.70).

Achieved. All prisoners are routinely screened for substance misuse by the assessing nurse on admission as part of the reception health assessment process. This includes the testing of a urine sample.

On referral for addictions support, a urine drug test is conducted as part of the initial assessment. All prisoners who commence or continue on substitute prescribing are further tested; initially on a three monthly basis, reducing to six monthly if providing two consecutive negative tests at the three monthly intervals. There is a process in place to address those who fail to attend for the purpose of their pre-arranged screening. All arrangements for drug screening are described in the NHS Addictions Services, HMP Kilmarnock, Standard Operating Procedure (SOP); Drug Screening.

1.8 A community based provider should confirm that a prisoner is on Methadone before it is commenced in the prison, and a support package should be in place before commencing a prisoner on Methadone (paragraph 4.71).

Achieved. There is now an SOP in place for confirming any prisoner's community-based prescribing including those prescribed Methadone. Confirmation methods include accessing healthcare records (paper based and Electronic Patient Record ), reviewing Emergency Care Summaries from the community and action taken by the Pharmacy Assistant who contacts the community-based prescriber to confirm current medication regime.

There is also an SOP for the liberation process for addiction related medication. This process includes pre-liberation review and the offer of pre-release harm reduction training. If a prisoner is released to an address within the NHS Ayrshire and Arran area and registered to a GP, medication instruction is forwarded by e-mail. If the prisoner is released to any other NHS Board region, prescription and health-related information is conveyed by telephone contact where appropriate and a letter. NHS Ayrshire and Arran use a standardised Pre-release Medication Referral Form. This is an area of good practice.

1.9 The SPS video and information package aimed at prisoners progressing to the Open Estate should be made available to HMP Kilmarnock (paragraph 4.92).

This recommendation is no longer applicable. The SPS video is out of date and no longer in use throughout prisons in Scotland. HMP Kilmarnock have however access to information leaflets for prisoners produced by HMP Open Estate as well as information relating to Risk Management Team guidance, National Top-End (NTE) facilities, handbooks and induction packs and community access advice. Much of this information is available for staff to access on HMP Kilmarnock's intranet and copies are displayed on notice boards throughout the prison.

Staff including those with specific responsibility for Integrated Case Management (ICM) and Induction have visited the Open Estate and both NTE at HMPs Greenock and Barlinnie in order to familiarise themselves with these facilities so that they can pass on this information to those prisoners seeking to progress to less secure conditions.

1.10 Additional training in report writing should be considered for personal officers, and thereafter a quality assurance system put in place to ensure improved standards are maintained (paragraph 4.103).

Partially Achieved. In direct response to this recommendation, a report writing protocol was produced in 2011 which provided training literature and guidance for all aspects of the prisoner narrative procedure highlighting examples of best practice and suggested templates for report content. This protocol also covered the purpose and frequency of report writing expected of Prison Custody Officers (PCO) together with an overview of the ICM process and the role and responsibilities of the Personal Officer. While this training is seen as a positive response to the recommendation, once it had been disseminated to all line managers to deliver to their teams, there is little evidence to confirm that the training was evaluated or that this training is still on-going.

Report writing training continues to be delivered as part of the initial training recruits (referred to as the syndicate) schedule but feedback from the latest syndicate participants noted that they would find it helpful if more report-writing training was available to them.

Recommendation 3: HMP Kilmarnock should consider delivering the report writing protocol to relevant staff and monitor its impact on the quality of reports produced thereafter.