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HM Inspectorate of Prisons: Report on HMP Peterhead

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6. Healthcare

Physical Environment

6.1 The heath centre in Peterhead is located next to "C" hall and is within easy walking distance of all residential halls.

6.2 There are two consulting rooms, a large room for group work/ meetings, a dental surgery, and a clinical treatment room. The health centre does not meet modern design standards, however it is spacious and clean. There is a disabled access shower facility within the centre, and a bath in the Induction Unit: there are no aids for disabled prisoners in the bath.

Access to Healthcare

6.3 Prisoners wishing to see the doctor complete a form requesting an appointment. They are then triaged by nursing staff who go to the residential areas each morning for this purpose.

6.4 On average, there are fifteen self referral forms submitted each day. Six of these referrals are usually for a visiting specialist, six for medication requests and three to see a nurse. The prisoner is normally seen by the nurse within 48 hours. There are no consulting rooms in the residential areas. Prisoners are brought to the Health centre for consultations.

6.5 There are currently 166 prisoners receiving a monthly prescription; nine prisoners receiving a weekly prescription and seven prisoners receiving their medication on a supervised basis.

Medical Services

6.6 Most prisoners see the doctor for urgent referrals at the next available date. Medical cover is provided three days a week from a local GP practice. On average the doctor sees ten to fifteen prisoners per clinic. The GP out of hours service for Grampian has been utilised 20 times in the last six months. This has included telephone support and twelve visits to the prison or transfers to hospital.

Nursing Services

6.7 There should be five full time equivalent nursing staff, with a health centre manager, and a full time administrator in post. However the centre has not been running with a full staffing complement for a significant period of time.

6.8 Due to the absence of the health centre manager, day-to-day management and monitoring of the health centre has been lacking. This means that the quality of clinical provision is wholly dependent on each individual being professional in their clinical practice. Long-term staffing issues (over the past 18 months), have had a severe impact on the working relationships amongst nursing staff. Relationships were reported as being poor with staff grievances being actioned. Agency staff and staff from other prisons have been drafted in due to the staff shortages. Arrangements have also been put in place for nursing staff to have telephone access to Inverness and Aberdeen prisons for advice when required.

6.9 At present staff can only provide core nursing duties on an 08.00-17.00 hrs cover. They are not able to provide backshift cover and halls do not always have prison officer cover with a first aid certificate. No nurse led clinics were being run at the time of inspection. 'Well men' clinics are run twice a year and are popular with the prisoners.

6.10 It is recommended that the staffing issues within the health centre are resolved as a matter of urgency.

Mental Health Services

6.11 Medical provision for mental health services is provided by three forensic psychiatrists based at Royal Cornhill Hospital ( RCH) in Aberdeen. Contractual issues last year led to the withdrawal of the service from RCH. It was agreed to cut the sessions from five to three per week. This led to a complete withdrawal of medical mental health input from April to September 2005. At that time mental health was covered by the GP and the mental health nurse.

6.12 There was no mental health nurse in post at the time of the inspection, although this was being addressed. A psychologist provides input to the mental health service, focusing on cognitive behavioural therapy and a counselling model (see paragraphs 8.22 and 8.24).

6.13 Referrals to the mental health service would normally be screened by the mental health nurse in the first instance and taken to the fortnightly multidisciplinary meeting. This is not happening and the psychologist is currently screening referrals in the first instance. The way in which referrals to the mental health service are screened should be reviewed.

6.14 Efforts to establish a day care type facility to encourage individuals with mental health problems to increase their social interaction have not been successful, despite a need being identified. Ways of providing a day care type facility for prisoners with mental health issues should be examined.

Suicide Prevention

6.15 In the year prior to the inspection there had been no suicides at the prison. Incidences of self-harm are low. At the time of inspection one prisoner was subject to ACT procedures. A full description of self harm statistics is provided at paragraphs 3.2 and 3.3

6.16 The ACT to care model is well established in the prison with a proactive ACT co-ordinator in place. ACT is high on senior management's agenda and all staff in the prison attend a session on ACT once a year. Training on ACT is well monitored. Hall Managers take responsibility for ensuring that ACT case conferences take place.

Dental Services

6.17 The dentist is currently employed one day per week. He sees approximately twelve prisoners each week. The waiting time for this clinic is approximately three months for a check up. If a prisoner is suffering from toothache he is seen at the next clinic. An out of hours service is available. The dental equipment is adequate.

Pharmacy

6.18 The Pharmacy is organised through the contract with Alliance. Alliance visits the prison once a week to provide advice on the storage, administration and handling of drugs; maintain the emergency equipment; and review the pharmacy financial reports. The arrangements appear to work very well.

Optician

6.19 A local optician visits the health centre for one clinic per month. He sees approximately fourteen prisoners in each clinic. The waiting time for an appointment is approximately one month.

Podiatry

6.20 A podiatrist attends the prison three times per month and sees approximately eight prisoners in each clinic. The waiting time for the podiatrist is approximately three weeks.

Physiotherapy

6.21 The physiotherapist attends the prison twice per month, and sees five prisoners on average. Waiting time for this clinic is approximately seven weeks.

Aids and Adaptations

6.22 The prison did not have sufficient aids and adaptations to cope with the more elderly prisoner population. For example, there was only one wheelchair in each hall, and one prisoner said that he hadn't been able to go outside the previous day because 'someone else had the wheelchair'. Other prisoners spoken to did not seem aware whether mobile hoists or other simple aids to help in dressing were available. The prison should ensure that it has sufficient aids and adaptations to meet the needs of the prisoner population.