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HM Inspectorate of Prisons: Report on HMP Greenock - February 2006

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4. ADDICTIONS

Management and Policy

4.1 Addiction services are well co-ordinated within the prison. They are the responsibility of the Interventions Manager who is also the Drug Strategy Co-ordinator. This responsibility is exercised alongside a range of other functions including prisoner induction, management of the Links Centre, community placements and social work and learning centre liaison. As well as fulfilling the contract monitoring function between the Phoenix House service and the prison, the Interventions Manager manages the Mandatory Drug Testing Team and four Interventions Officers who have been trained in addictions. The Health Care Manager manages the two Addictions Nurses.

4.2 The Interventions Manager/Drug Strategy Co-ordinator reports on addictions issues to the Local Risk Management Group which is chaired by the Deputy Governor. The Phoenix House service manager attends this group. This group also provides links to the Multi-Disciplinary Mental Health Group. The Interventions Manager/Drug Strategy Co-ordinator sits on the Addictions Co-ordinators Forum, which is a national SPS group.

4.3 Individual cases are discussed at weekly multi-disciplinary Treatment and Care Meetings. These are attended by the Addictions Nurses, the Phoenix House service manager and caseworkers, the Drugs Strategy Co-ordinator and the Health Centre Manager.

4.4 There are also good links that ensure some continuity of care between the Addictions Nurses and their community equivalents in NHS Argyll and Clyde.

Addiction Treatment Process

4.5 Arrangements in Greenock reflect the national situation. The structure is going through a period of transition, from services previously provided by Cranstoun to a new contract provided by Phoenix House. There has been some continuity in that staff previously employed by Cranstoun are now working for Phoenix House. The new contract has been implemented incrementally since August 2005 and is scheduled to be fully operational by February 2006.

4.6 The addictions process begins with the Reception Risk Assessment and Nursing Assessment. Where appropriate a Drug Withdrawal Assessment Chart is completed. The assessment culminates in a score, and depending on this score, a range of responses can be provided including symptomatic relief and automatic referrals to the Phoenix House. Prisoners will also provide a 'dip test' for toxicity, which gives a result within 15 minutes.

4.7 Any prisoner who requires to see the doctor can usually do so within one day of admission, Sunday to Thursday. The doctor has the final say regarding prescribing. Some prisoners said that the prescribing policy for methadone is inflexible and does not sufficiently acknowledge individual circumstances.

4.8 On reception, the majority of prisoners go to Ailsa Hall and are allocated a cell in the Assessment Unit. The Core Screen Assessment includes a section on substance misuse which is completed by a member of the Interventions staff within 72 hours. This process is well supported by the Reception. Prisoners arrive and are seen on a one-to-one basis by a receiving officer and then a nurse. The health centre is immediately adjacent to the reception area.

4.9 There have been management issues regarding the reliable completion of the Core Screen Assessment for all prisoners in Ailsa. These were previously the responsibility of hall officers but they were unable always to prioritise this task alongside a range of other duties. Responsibility now lies with the Interventions Officers who scrutinise admissions on a daily basis and ensure that all prisoners are assessed.

4.10 Some prisoners spoken to were critical of the methadone dispensing process in Ailsa. At the time of inspection there were 47 prisoners prescribed methadone in Ailsa. Prisoners are responsible for getting their own breakfast when they are unlocked in the morning. They have a limited amount of time to get their roll before they are escorted to their work place elsewhere in the prison. Those being prescribed methadone also have to queue at the dispensary in the hall in order to collect their medication. The prisoners spoken to maintain that there is often not enough time to attend the dispensary and get breakfast before they are taken to work. This is causing friction between staff and prisoners in the hall.

4.11 There are far fewer prisoners being prescribed methadone in Darroch and Chrisswell (ten and eight respectively at the time of inspection). They are taken to the health centre to receive their medication and there does not appear to be any issue in relation to these arrangements.

Phoenix House

4.12 The full Phoenix House service is available only to those serving over 31 days. This includes remand prisoners. For those serving less than 31 days there is access to a harm reduction session and a harm reduction pack with referral information and practical advice.

4.13 Prisoners referred to Phoenix House contribute to the completion of a Common Addictions Assessment Recording Tool ( CAART) and the development of a Personal Care Plan. There are a range of services available including detoxification, methadone reduction, methadone maintenance, motivational interviewing, harm reduction and smoking cessation. There is also access to Narcotics Anonymous. Drug testing is available from the Mandatory Drug Testing team.

4.14 Phoenix House are well on the way to meeting their contractual obligations by the agreed date in February 2006. The service has established very positive working relationships with the Interventions Manager and his staff, the Addictions Nurses and with a range of other agencies working within the prison and externally. They provide a wide range of services on a contractual basis and there are monitoring arrangements in place to measure performance against targets. The service manager was very positive about the progress made since the transition and did not report any difficulties with issues such as the service timetable or access to prisoners.

Mandatory Drug Testing

4.15 There is a lack of clarity regarding the future of this service. This is a national issue however and since the announcement of the Addiction Prevalence Testing policy, the MDT Team has had little further information. Random drug testing is being carried out but only to generate statistical information. Suspicion, risk assessment, frequent, reception, liberation and voluntary testing are still taking place.

4.16 The service is provided by two officers who also have other responsibilities. The staff feel they link well to other addictions services. The service offers Frequent Drug Testing as a means to support prisoners who want to abstain from drugs while in custody. Phoenix confirmed that this can be a valuable component in an individual's care plan while they are in custody.

Alcohol

4.17 Phoenix has recently recruited a member of staff with a background in working with people with alcohol problems in a prison context. The service offers alcohol counselling and alcohol awareness. There is also access to Alcoholics Anonymous.

Community Links

4.18 The Inclusion Manager is a member of the local Alcohol and Drug Action Team ( ADAT) and the manager of Phoenix is also a member of two ADAT sub groups. The chair of the ADAT is a member of the local visiting committee. Good working links with external drug and alcohol services have also been established.

4.19 Phoenix has contractual links to the expanded Throughcare Addictions service provided on a partnership basis by six local authorities: Inverclyde, East Dunbartonshire, West Dunbartonshire, Argyll and Bute, East Renfrewshire and Renfrewshire. There are also a range of other agencies who have representatives present on a daily basis at the Links Centre, including housing, benefits and employment services.