HMP & YOI Styal

Updated 15 July 2024

HMP & YOI Styal is operated by HM Prison Service. It is a women’s prison located in Cheshire and holds up to 450 women. It is a busy prison with a high turnover of prisoners and a short average length of stay. The prison population includes those on remand, sentenced prisoners, recalled prisoners, and pregnant women. The prison experiences regular transfers in and out.

Most prisoners live in house blocks. The site also has a vulnerable adults unit and a wing (Waite) that holds the Care and Separation Unit. Health care services are based in the healthcare building and a nearby portacabin.

NHS England Health has commissioned Spectrum Community Health C.I.C. (Spectrum) to provide primary healthcare, substance misuse services and social care. These services have interdependencies with other health care services provided at the prison by other providers including mental health care, perinatal care and dentistry. This inspection looked at the services provided by Spectrum.

Spectrum is registered with CQC to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder, or injury and family planning services.

Updated 15 July 2024

We carried out an unannounced comprehensive inspection of healthcare services provided by Spectrum Community Health C.I.C. (Spectrum) at HMP & YOI Styal. We visited the services between 30 April and 2 May 2024, and continued to inspect remotely until 10 May 2024.

The purpose of this comprehensive inspection was to determine if the health care services provided by Spectrum were meeting the legal requirements and regulations under Section 60 of the Health and Social Care Act 2008 and that patients were receiving safe care and treatment.

We do not currently rate services provided in prisons. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

At this inspection, we found:

• Medicines management was not safe and effective enough with the issues we found ranging from the availability of medicines, poor record-keeping, delays to administration, and medicines errors due to insufficient storage space.

• Infection prevention and control was inadequate with poor standards of cleanliness in clinical environments.

• The health care service lacked stable and consistent leadership, which had a significant impact on primary healthcare.

• There was insufficient or ineffective scrutiny and oversight of the safety and quality of the service.

• Primary healthcare lacked sufficient numbers of suitably qualified and experienced staff to provide a safe service.

• Primary healthcare staff did not receive the appropriate training and supervision to support them in their roles.

• Primary healthcare staff worked under pressure in challenging circumstances and worried about keeping patients safe.

• Patients did not always receive their planned social care support in a timely manner, especially in the evening and during the night.

However, we also found:

• Staff showed a strong commitment to their colleagues and patients and worked hard to provide a full service in challenging circumstances.

• Staff completed timely assessments of patients’ needs and risks and planned appropriate care and treatment.

• Staff from other teams saw the pressure that primary healthcare was under and offered to help whenever they could.

• The integrated substance misuse service provided a safe and responsive service in line with the relevant clinical guidelines.

• The service had an experienced and dedicated social care lead who oversaw all social care matters and ensured patients received the personal care, aids and adaptations they needed in a timely manner.

We found breaches in relation to Regulation 12 Safe care and treatment, Regulation 17 Good governance, and Regulation 18 Staffing. We took enforcement action, and we will keep the service under review.

The provider must:

• Ensure that critical and emergency medicines are available and managed in line with the provider’s procedures.

• Ensure patients receive critical medicines at the times they are prescribed.

• Ensure prescription stationery is managed securely.

• Ensure the correct monitoring of ambient temperatures and act where needed to ensure that medicines remain suitable for use.

• Ensure there is always legal authorisation to administer medicines.

• Ensure audits related to medicines management are taking place, including the monitoring of omitted doses.

• Ensure sufficient numbers of suitably qualified and experienced staff to provide a safe service.

• Ensure sufficient staffing capacity especially during late and night shifts to meet patients’ social care needs in a timely manner.

• Maintain adequate infection prevention and control standards.

• Ensure emergency equipment is available, in date, and regularly checked.

• Ensure that governance systems and processes are fit for purpose and utilised appropriately to effectively monitor the safety and quality of services.

In addition to the breaches, the provider should:

• Ensure the robust management of ‘in possession’ (IP) medicines and that records are completed in a timely manner.

• Ensure ‘medicines in possession risk assessments’ (MIPRAs) are completed and accurately reflect the status of the patient.

• Ensure all staff can access current copies of Patient Group Directions (PGDs) when they are administering medicines.

• Ensure patients comply with the requirements attached to their IP status, for example, secure storage.

• Improve the storage of medicines at medicines administration points (MAPs) so that it is clear if they are available for administration.

• Cleanse data and keep records such as waiting lists, tasks and reviews updated.

• Improve the quality of care records and record-keeping practices.

• Submit statutory notifications to CQC and other agencies where required.

• Ensure that patients’ complaints are handled in a timely manner.