Archived: Bridgewater CHCFT HMP Wymott

The five questions we ask and what we found

Are services safe?

• Information provided by the trust showed that not all primary health care staff had completed safeguarding training appropriate to their role. Neither had a sufficient number of staff completed either basic life support training or intermediate life support training commensurate with their role.
• The availability of chaperones during examinations and intimate examinations was not advertised or promoted in healthcare literature or on information boards located within the healthcare centre.
• Treatment rooms on wings and those located in the healthcare centre did not meet infection prevention standards. Whilst the trust is not directly responsible for the cleaning of treatment areas as these are the responsibility of the prison, nurses told us that they did what they could to ensure areas were as clinically clean as possible by wiping down areas in which they treated prisoners and/or administered medicines.
• The risks to patients were not adequately identified, managed or monitored, for example, primary health care managers did not keep accurate records of clinics cancelled, which impacted on their ability to adequately monitor and review service delivery. An exception to this was in respect of dental services, where we found that health and safety policies and risk assessments were up to date and reviewed regularly to help manage potential risks.
• Emergency medical equipment was available but staff did not regularly complete daily checks of emergency bags and records of such checks were not maintained in accordance with local policy. This meant that the safety of patients requiring an emergency response and/or treatment could be compromised.
• The arrangements for managing medicines did not keep patients safe.
• There was a system in place for recording and acting on significant events. However, we were not assured that all significant incidents, with the exception of those reported by dental staff, were reported and appropriate action was taken to ensure patient safety.
• There was no evidence of learning from adverse events and the subsequent dissemination of information to improve safety across primary health care services.
• Dental decontamination procedures were appropriate and all necessary equipment used in the process was available to clinical staff.

Are services effective?

• Not all prisoners received a secondary health assessment within the first seven days of their reception into HMP Wymott, which compromised their safety and wellbeing. Healthcare assessments within the first few days in prison are crucial in identifying prisoners’ healthcare needs, providing treatment and keeping people safe.
• Healthcare staff did not always ensure that prisoners received a continuous supply of prescribed medicines. Reviews of prescribed medicines did not happen with sufficient regularity.
• The dentist confirmed they referred prisoners to specialists in primary and secondary care when treatment was needed and monitored urgent referrals with colleagues from primary health care services to make sure they were dealt with promptly.
• Care and treatment for prisoners with long term conditions (LTC) was effective and supported by a dedicated LTC nurse.
• Prisoners’ attendance at healthcare appointments was monitored monthly and analysed for trends. Prisoners who did not attend healthcare appointments were followed up by nurses.
• The supervision and management of social care provision at the prison was unclear. Care planning for prisoners in receipt of a social care package was not consistent and care plan reviews did not take place regularly.
• Supervision arrangements for all members of the staff team were insufficient.

Are services caring?

• Primary healthcare staff including dental staff spoke to prisoners in a respectful and caring manner.
• Clinic room doors remained open during nurse-led consultations and conversations could be heard by other staff including prison staff and other prisoners passing through the health care reception area. This practice compromised patient confidentiality.
• Prisoners told us their requests to meet privately with a nurse to discuss their health concerns were not met.

Are services responsive to people’s needs?

• The healthcare centre was small with insufficient treatment rooms to meet the needs of the prison population; however this was not the direct responsibility of the trust.
• Prisoners were not always able to access primary health care and treatment within acceptable timescales, Clinics were cancelled and/or oversubscribed.
• Prisoners sometimes received their medicines late.
• Prisoners were supported to attend external hospital appointments.
• Information on how to complain was publicised on most wings and in the healthcare centre.

Are services well-led?

• Senior managers within the trust were not sufficiently focused on staff development and/or service development and because of this lack of focus, improvements were not sustained. There were inadequate processes in place for providing all staff with the development they need, including supervision, training and support.
• Some healthcare staff told us that healthcare managers were not always visible and they did not effectively work with front line staff. Despite the varying views of staff, most were optimistic about achieving change and improvements, though not enough staff had been consulted and involved in plans for the future.
• Systems and processes to support good governance and management of the service were limited at local level and this impacted on overall effectiveness of the service. The exception being dental services which were managed effectively by the trusts dental network.
• Health care managers did not routinely share learning from incidents with primary healthcare staff in order to make improvements.
• Governance checks were not undertaken to ensure that equipment in emergency bags was monitored and fit for purpose.
• Measures to monitor primary health care services, including checks of fridge temperatures and the clinical environment, were poorly implemented.
• Quality assurance processes for dental services including audits of care records, radiographs and infection prevention and control were effective.
• Induction for permanent and agency primary health care staff was not a priority and many staff had not had a formal induction, missing a crucial opportunity to help all staff understand the trust’s vision and values
• Staff we spoke with told us they were able to raise concerns and were encouraged to do so. However, many were less confident that action would be taken in response to their concerns.

Key Findings

The areas where the provider must make improvements are:

• The provider must ensure that staff receive the support, training, professional development, and supervision that are necessary for them to carry out their role and responsibilities.
• The provider must ensure that people who use the service receive safe care and treatment and prevent avoidable harm or risk of harm by making sure equipment used is safe, medicines are available and supplied in sufficient quantities.
• The provider must ensure that people using the service receive appropriate person-centred care and treatment that is based on an assessment of their needs and preferences.
• The provider must ensure that they employ effective governance arrangements, including assurance and auditing systems or processes to support, assess, monitor and drive improvement in the quality and safety of the services. Systems and processes must assess, monitor and mitigate any risks relating to the health, safety and welfare of people using the service.
• The provider must maintain accurate, complete and detailed records in respect of each person using the service and records relating the employment of staff and the overall management of the regulated activity.

The areas where the provider should make improvements are:

• The provider should provide information about the availability of chaperones to people using the service.
• The provider should ensure that all clinical areas, in which primary healthcare nursing staff provide treatments and medicines, meet infection prevention standards and do not compromise patient safety.
• The provider should establish arrangements to effectively support multi-disciplinary review of people with complex needs who use the service.
• The provider should ensure that people who use the service have information on how to escalate their concerns if they are dissatisfied with how their complaint had been managed.