Healthcare is provided to the same standard as in the community outside prison, available in response to need, with a full range of preventive services, promoting continuity with health services outside prison.
8.1 Healthcare facilities are excellent and very well used. Prisoners in Perth have access to the same level of care as people in community. Addictions clinical support and throughcare is provided to a very high standard. Management provide direction and support to a fairly new but motivated professional team. However, the number of prisoners testing positive for illegal substances on liberation seems high.
8.2 The healthcare team have moved to a new purpose built facility since the last full inspection. The facilities, décor, equipment and prisoner record storage are all excellent. It is a stand-alone facility and comprises a range of offices and treatment areas over two floors. There is ample health promotion literature situated throughout the treatment areas.
8.3 The practice of employing cleaners rather than "pass men" ensures that the facilities are consistently cleaned to a high standard. Nurse dispensing is undertaken in "nurse stations" in the halls. These are clean and tidy. Temperature control monitoring and equipment checks are very good.
8.4 The facilities in Friarton hall for healthcare delivery are adequate, clean and tidy.
8.5 The healthcare team comprises 12 primary care nurses; two addictions nurses; three mental health nurses; a healthcare assistant; three administrators; three pharmacy assistants; two clinical nurse managers; and a full time doctor, a part-time doctor and a specialist addictions doctor (part-time). This team also delivers healthcare to Friarton hall.
8.6 The Healthcare Manager is a member of the senior management team and is also responsible for healthcare delivery in the Open Estate for which there is a separate group of staff.
8.7 The administrative support for the team ensures that the nurses are well supported and freed up to deliver healthcare rather than focus on paper driven tasks. Medical clinics are provided every day except Sundays.
8.8 Nursing staff deliver a range of nurse led clinics. These include immunisation clinics; a blood borne virus clinic (including specialist hepatitis C service); a sexual health service; and smoking cessation. Chronic disease management clinics are delivered by an external provider, although new staff have started to train in specialist areas.
8.9 Self referral and complaints forms are readily available in all halls. Prisoners are seen by all services within appropriate timescales. Analysis of healthcare statistical information is of a very high standard, and this has led to complaints dropping by 50%.
8.10 The pharmacy assistants are well integrated with the healthcare team. A robust process is in place for 'in possession' medication spot checks in the halls.
8.11 The internal daily team communication system ensures adequate support to all team members (including the medical team) and the electronic healthcare night report is an area of good practice. The establishment of a local health care staff training group ensures a balance between ongoing professional development and meeting the needs of prisoners.
8.12 A dentist and dental nurse attend the prison two days per week. The dental facilities are very good. A dental decontamination room allows this service to be delivered on site. An optician, chiropodist and dermatology service are also delivered on site. A visiting pharmacist attends the prison one day per week.
8.13 Excellent links have been established with Tayside NHS Trust for the delivery of a blood borne virus and sexual health service. A nurse within the establishment takes the lead with this service. The level of one-to-one support that prisoners receiving clinical treatment is of a very high standard. Specialist nurse knowledge and experience within the prison is excellent. Both of these clinics are areas of good practice.
8.14 Liaison with external hospitals for appointments is very good.
Mental Health Services
8.15 Consultant psychiatrists deliver three sessions per week. They work closely with the three mental health nurses. A nurse assesses individual prisoners and makes referrals to the Multi-disciplinary Mental Health Team and psychiatrist. Nurses hold individual caseloads of between 12 - 24 prisoners. One-to-one support for individuals is of a good standard with the team utilising a number of the "Books on Prescriptions Scheme: Self Help for Primary Care Mental Health" for prisoners in their care. This team takes the lead for ACT2Care case conferences within the establishment.
8.16 Fortnightly Multi-disciplinary Mental Health Team meetings take place, and the level of joint working is excellent. Consideration should be given to inviting uniformed staff to this meeting.
Management of Medicines
8.17 Medication is stored in line with current legislation, and controlled drugs are dispensed safely. The process where there is only one nurse signatory for methadone at the weekend should be reviewed.
8.18 Although there is no designated Addictions Co-ordinator, addictions services are working well. However, there is a lack of visibility at a local level in terms of substance misuse testing particularly for the YOs in Friarton hall. The testing focus is on suspicion and risk assessment. Clinical prescribing on the day a prisoner enters the prison relies on the result of an unobserved urine sample. This should be reviewed.
8.19 One of the doctors is the lead specialist for prescribing substance misuse clinical support. He works two five hour sessions each week, split between the Open Estate and Perth. Having one individual take the lead and support other doctors and nursing staff ensures continuity of care.
8.20 To ensure throughcare arrangements are in place the doctor and addictions nurse see all prisoners receiving methadone prior to liberation. This is an area of good practice.
8.21 In response to a gap in provision for short-term prisoners, the addictions nurses have recently piloted a process where they see all new prisoners with a substance misuse history on the day of admission. This enables them to liaise, support (where appropriate) and signpost prisoners back into the community at this early stage. This is an area of good practice.
8.22 The Enhanced Addictions Casework Team comprises a team leader, a senior practitioner, four case workers and an administrator. Facilities for the team are satisfactory and the team sees prisoners in the Links Centre. The team is well integrated within the prison and has established excellent links with the addictions team. The team provides a session during induction, delivers one-to-one substance misuse support; and provides group work sessions.
8.23 External links are excellent at all levels. The Senior Management Team are proactive in dealings with the national Thoughcare Addictions Service, Alcohol and Drug Partnerships, local drug death groups, Tayside Throughcare Network, the Community Justice Authority and Tayside Drug Strategy Group.
8.24 Admission statistics show that 89% of prisoners tested positive for illegal substances on admission to the establishment. On liberation this is 28%. Although this is a very big reduction from the figure on admission, 28% of prisoners testing positive on liberation seems high. It is recommended that the reasons for so many prisoners testing positive for illegal substances on liberation are explored.
8.25 A fortnightly Addictions Team Meeting is held to discuss individual prisoner needs. This is a multi-disciplinary group with input from the doctor.
8.26 On the first day of inspection 167 prisoners in the establishment were in receipt of a methadone prescription, of which 28 were on reducing doses. A small number of prisoners were being prescribed suboxone.