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

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6. HEALTHCARE

Physical Environment

6.1 The Health Centre at Greenock is clean and the décor relatively fresh. The layout is cramped with one corridor partially blocked by medical case notes. This could constitute a fire hazard. The case notes are not current records and should be archived elsewhere. The Health Centre has adequate equipment to meet healthcare needs.

Access to Healthcare

6.2 Prisoners are brought to the Health Centre for most treatments rather than delivering healthcare in the halls. There is one officer dedicated as a 'runner'. This officer starts at 0900 in time for the doctor's surgery. This was generally felt to be adequate.

6.3 As is common throughout SPS, prisoners complete a form requesting a medical appointment. They are then triaged, in the residential areas, by nursing staff.

6.4 Medications (which are mostly drug detoxification and maintenance programmes) are dispensed in 'A' hall four times per day. Prisoners from Darroch and Chrisswell go to the Health Centre between 0800 and 0830. An emergency trolley is kept at the Health Centre, however there is no emergency care provision in the Halls. This should be addressed.

Nursing Services

6.5 The nursing complement of twelve is filled at present, although one practitioner nurse was on maternity leave and another was due to leave in December. The introduction of the two new addiction nurses provides an opportunity to build good communication links between healthcare staff and Phoenix House. This is already having a positive impact on the overall service to prisoners. However there is only one mental health nurse in post.

6.6 Nurses normally stayed in the room during prisoner consultations with the doctor, although they will leave at the prisoner's request. This should be the exception rather than the rule and only for good clinical or safety reasons. Prisoners should not have to request that nurses leave.

6.7 The nursing staff spoken to were all committed but it was apparent that the current working arrangements were not motivating. Dealing with medication and general administration generates the highest volume of work for nurses. They are therefore involved in a great deal of non-clinical work. There has been no development in nurse led clinics and the nurses have not had any specific training, for example, in asthma or diabetes. There is little evidence of any audit/quality assurance being carried out. These issues should be addressed to ensure that administrative duties are minimised and that nurses are given the opportunity to develop their clinical and auditing/quality assurance skills. Although staff felt supported and were given opportunities to do some in-house training on SPS issues, there was little evidence of formal clinical supervision and professional development. A Royal College of Nursing learning representative is available and should be utilised more fully.

6.8 The prison has achieved the Scottish Health At Work ( SHAW) silver award. There are links with the community health centre and staff from there occasionally come to the prison. Smoking cessation sessions are available for prisoners and staff. The Mental Health nurse has established good links with Napier University regarding health promotion.

Medical Services

6.9 General medical care is arranged through the central SPS Medacs contract. Two doctors provide cover although one doctor is contracted to provide the majority of care, including on call. The actual medical input is variable. There was uncertainty about the number of hours which the doctor was spending in the prison. It is also of concern that Medacs have occasionally failed to provide medical cover to the prison despite having advance notice that the doctors will be on annual leave. Staff have written several letters of complaint to Medacs but the results have been unsatisfactory. These issues should be resolved.

6.10 On call cover is provided seven nights per week. When the doctor is called out of hours, the prisoner is normally sent direct to hospital, without clinical examination. This should be reviewed. Three-monthly reviews of medication prescriptions are not carried out by medical staff. In one instance a patient was prescribed a strong analgesic for over three years and in another situation a prisoner had difficulty getting medication for pain relief. These issues should be reviewed. Chronic illness management is not established in a formalised way. Consequently, there are no medical led clinics and, as stated above, no nurse led clinics. Chronic illness management should be formalised.

Mental Health Services

6.11 A Multidisciplinary Mental Health Team ( MDMHT), chaired by the Deputy Governor meets every fortnight and oversees the mental health provision for the prison. To date the Consultant Psychiatrist has not attended the meeting but can see the benefit and is willing to do so in future.

6.12 NHS Argyll & Clyde provide psychiatric input through two consultant forensic psychiatrists. Liaison between the forensic psychiatrists, the forensic community psychiatric nurses at NHS Argyll & Clyde and the mental health nurse at the prison is very good. This liaison extends to the courts and to social work departments. The mental health nurse has a good awareness of all prisoners with a severe and enduring mental health problem. Such prisoners are referred to the forensic psychiatrists. However, it was highlighted, that due to only one mental health nurse being in post, this good liaison is compromised when the nurse is on leave.

6.13 Two psychiatrists are contracted for four hours per week. They are very well supported by the Mental Health Nurse.

6.14 Prisoners presented with a range of mental health problems and the psychiatrist spoken to felt that mental health issues were dealt with reasonably well within the available resources.

Suicide Prevention

6.15 In the last year there have been no suicides at the prison. An ACT meeting is held bi-monthly, and this includes the Deputy Governor, the mental health nurse, the ACT co-ordinator and two Listeners. This Group proactively manages the ACT strategy. Eighty eight per cent of staff are trained in the new ACT2 CARE process with mechanisms in place to address the other 12%.

6.16 The management of prisoners who are assessed and placed on ACT is very good. The ACT co-ordinator has overall responsibility for ACT implementation and for the 18 Listeners. Case conferences for prisoners placed on ACT are normally carried out within 24 hours and prisoners are moved to the observation cell in Ailsa hall. This ensures that the correct levels of observation are carried out. The Listener Scheme is very well run and there is good liaison between the prison and the Samaritans. Listeners are provided with certificates when appropriately trained.

Psychology Services

6.17 Two psychologists provide a total of three days input per week. A local Rehabilitation and Care Group, chaired by the deputy governor oversees the psychology input including the supervision of the work of the programme officers.

6.18 Referral systems to psychology are now established and the average waiting time to be seen is one week. This includes referrals for risk assessment and Cognitive Behavioural Therapy.

Dental Services

6.19 The dental equipment in the Health Centre is equivalent to that in a community based dental practice. The dentist attends on a Friday evening. Prisoners are seen within four to six weeks.

Pharmacy

6.20 The Pharmacy is organised through the contract with 'Alliance'. The pharmacist visits the prison once a week to provide advice on the storage, administration and handling of drugs; to maintain the emergency equipment; and to review the pharmacy financial reports.

Optician

6.21 The optician holds a clinic every two to three months. Although this service appears to be based on the availability of the optician, it is comparable with NHS provision.

Podiatry

6.22 Podiatry services are supplied by the NHS once every three months, and again this is comparable with NHS provision.

Physiotherapy

6.23 Physiotherapy services are provided by the NHS, and prisoners are escorted to local services in the community.

Summary

6.24 Concerns about the provision of healthcare were raised during the inspection. In particular, there was uncertainty about the number of hours which the doctor was spending in the prison; the current working arrangements were not motivating; there were issues about the prescribing of medications; and nurses normally stayed in the room during patient-doctor consultations. It is recommended that healthcare arrangements are reviewed.