8. HEALTHCARE
Health Services
Overview
8.1 Healthcare services at Polmont are among the most extensive, the best run and the best managed in the SPS. The unique nature of the prisoner population in a YOI - i.e. the relatively low incidence of long-term conditions and the low number of prisoners coming into prison with an established drug-injecting habit - arguably make the challenges less complex than in adult prisons. However this does not lessen the impression that in Polmont, healthcare staff are providing an excellent service to the prisoners in their care.
Accommodation
8.2 The health centre is adequately sized and well maintained. It is very quiet in comparison to some in other establishments, because the majority of health interventions are conducted in the residential areas. Staff feel that this is appropriate as it makes them more accessible and allows them to spend more time with prisoners in 'social' type situations. The logistics and challenges of moving prisoners to and from the health centre are also avoided.
Staffing
8.3 The health centre has a full staffing complement and a low turnover of nursing staff. Staff are organised by competence and qualification into discrete teams - primary care staff; mental health and learning disabilities; and addictions. Only primary care staff are involved in the triage of prisoner self-referrals and that, along with the very low number of methadone prescriptions to be dispensed on a daily basis, means mental health and addictions staff are freed up to work more intensively with prisoners.
Access to Care
8.4 In common with other SPS establishments, Polmont operates a triage system to see the doctor. Prisoners complete a self-referral form and nursing staff based in the residential areas decide if they need to see a GP or can be seen instead by a nurse, dentist, or other allied health professional. Prisoners who need to see a GP are normally seen on the same day as they make their request.
GP Services
8.5 GP appointments are available six mornings each week and also on a Friday afternoon. Working relationships between GPs and nursing staff are good and prisoners made no complaints about access to GP services.
Dental Services
8.6 The dentist is available two afternoons each week and prisoners are seen and assessed within one week of being referred. Thereafter they may wait up to three months for routine treatment. The dentist noted that the majority of prisoners have not seen a dentist since primary school and have little idea of dental hygiene. A recent development has been the investment from Forth Valley Health Board in supplying an oral health educator for one day a week to run dental hygiene sessions.
Mental Health Services
8.7 Mental health nursing staff are able to provide a very responsive service. They are based in the residential areas and are in daily contact with prisoners. They are clearly identified as mental health nurses and feel that far from being unapproachable because of this, it makes it easier for prisoners to speak to them. Prisoners are normally seen on the same day as they self-refer or are referred.
8.8 One team member is also trained in Cognitive Behavioural Therapy and is able to offer this service to prisoners.
8.9 Psychiatrists provide two afternoon sessions each week. Psychiatrists and nurses work well together and there is frequent cross-referral: for example psychiatrists refer prisoners with anxiety, sleep problems and other neuroses to nursing staff. Waiting time to see a psychiatrist is around one week.
8.10 ACT2Care notification is relatively low in Polmont and staff feel that this may be due to a combination of good relationships between prison officers and prisoners and the visibility and accessibility of mental health nurses.
Learning Disability
8.11 The health centre has a member of staff with a qualification in learning disability who supports prisoners identified as having a difficulty.
Nurse-led clinics and links to local services
8.12 Every member of the nursing team is a specialist in a particular area of healthcare, and is responsible for leading clinics in that area. This allows the healthcare team to offer a wide range of clinics including smoking cessation and social skills for prisoners with learning difficulties.
8.13 Prisoners can also be referred to Blood Borne Virus and Diabetes clinics at Stirling Royal Infirmary. The prison has good relationships with the health promotion departments at Forth Valley and Greater Glasgow and Clyde Health Boards and with the Sandyford (sexual health) Initiative.
8.14 On admission, prisoners are offered both Hepatitis B and Meningitis C vaccinations; uptake of both is good.
Sexual Health
8.15 The approach to sexual health education is impressive. Sessions are delivered to all prisoners during the induction programme. A range of issues are covered in this session, with the focus being placed on the prevention of Sexually Transmitted Infections.
Addictions
Overview
8.16 All prisoners are assessed for drug and/or alcohol dependence on admission. Prisoners who are dependent are seen within 24 hours. All prisoners also undergo the national harm reduction programme within five days of admission unless they sign a disclaimer, at which point they will be visited by a manager to discuss any issues. If the issue of drugs and alcohol are highlighted at the Core Screen Assessment as a contributing factor to the offence, a referral is made to Phoenix Futures.
8.17 Polmont is different from other establishments in that there does not appear to be a significant heroin problem, and methadone prescribing is minimal. There has only been one needle found in the past three years. The approach to methadone prescribing is to encourage a reduction. This strategy appears to be successful with only ten prisoners at the time of inspection requiring methadone.
Phoenix Futures
8.18 Phoenix Futures are currently in the third year of their contract with SPS. At the time of inspection they were dealing with 195 active cases. Most referrals come through core screening and the Links Centre. Phoenix currently provide one alcohol programme a week, a drugs programme in Munro and a smoking cessation programme four times a year. They also provide one-to-one support for prisoners.
8.19 Prisoners said that Phoenix staff were visible in the halls and felt that they could obtain help and intervention as required.
Partnership Working
8.20 Health centre staff also provide a service to prisoners with addiction problems. This service is based on the differing needs of prisoners. However there is duplication in some areas such as smoking cessation with referrals being made to both nursing staff and to Phoenix. Any overlap should be avoided.
Throughcare Addictions Service
8.21 Phoenix Futures is responsible for the Throughcare Addictions Service in the prison and state they are receiving referrals and have established links with many local authorities. This appears to have been helped by the establishment of the Links Centre where Phoenix is located.
Addictions Support and Prevention Unit
8.22 The Addictions Support and Prevention Unit has been located in Munro Hall since the closure of Nevis. The unit is a very positive initiative and all staff and prisoners reinforced this. However, staff and prisoners also agreed that since the move to Munro many of the benefits of the unit had been lost as a result of the increase in size and the inability to have a clear focus on what had been achieved previously. This situation was being reviewed.