8. HEALTHCARE
Health Services
8.1 Healthcare provision has improved since the last inspection.
8.2 Staff numbers and the skills mix within the healthcare team are good and the inclusion of two healthcare assistants means that Registered Nurse time is used appropriately. Access for prisoners to all healthcare professionals - Nurses, Doctor, Dentist, Psychiatrist, and Allied Health Professionals (Physiotherapist, Podiatrist & Optician) - is at least as good as in the community.
8.3 One particularly innovative measure is the three times weekly visit of a physiotherapist to the prison. This has been introduced as a precursor to reducing the prescribing of routine pain medication. This is an area of good practice.
8.4 The layout of the current health centre is not ideal. Space is cramped in the consulting areas while the 'in-patient' facility takes up space that could be much better used. The possibility of converting the in-patient area into a learning zone for activities such as life-skills, health promotion and harm reduction was raised during the inspection.
8.5 In common with most prisons, Kilmarnock operates a triage system for determining who a prisoner sees in relation to his healthcare needs, and when. Nurses are based in the residential areas, see prisoners on a daily basis and can refer prisoners direct to colleagues working in addictions, mental health and with blood borne virus issues. Nurses can also dispense 'over the counter' medicines at triage.
8.6 The healthcare team's Mental Health staff are used well, rarely being involved in general care. The RMNs see all prisoners at reception and screen them for mental health problems. Prisoners are then seen by medical staff within 24 hours. All prisoners go to the First Night in Custody Centre and the staff there are also able to pick up on and alert healthcare staff to any issues they notice. There are plans to introduce Cognitive Behavioural Therapy sessions and also pilot Neuroelectric therapy for addictions should SPS agree.
8.7 The provision of 'specialist' clinics in Kilmarnock is good, with well-man clinics run three to four times a year. There are more frequent clinics for chronic disease management, blood borne virus, cardiac (as necessary), diabetes, wound care, addictions (weekly) and the RMNs running several sessions each week.
8.8 Prisoners with a Learning Difficulty are seen on a one-to-one basis by a member of the education staff who liaises closely with the healthcare team over any relevant issues.
8.9 At any one time, approximately one third of the prisoner population in Kilmarnock will be on a methadone maintenance programme: this is similar to most other Scottish prisons. Around 10% of that number will subsequently start on a reduction programme and come off methadone whilst in Kilmarnock. Issues raised about healthcare at the weekly prisoner focus groups are almost all related to access to subutex (prisoners can not presently be started on this at Kilmarnock), lack of detoxification opportunities and a lack of aftercare and maintenance for those who have come off drugs.
Addictions
8.10 The substance misuse team consists of a senior case worker and three case workers for drugs and two for alcohol, the latter funded through the Action Team. There were some difficulties with staffing last year when two case workers left to take up promoted posts. Workers commit to undertaking counselling qualifications.
8.11 The healthcare team also have an addictions nurse who works very closely with the addictions team, and the good working relationships were evident.
8.12 Prisoners can be referred to the addictions team or can self-refer. The self-referral form has a tear-off slip at the bottom, which is returned to the prisoner within 48 hours to acknowledge its receipt. The team works to a deadline of ten days between referral and initial assessment. There have been waiting lists for drug awareness intervention in the past, but not at the moment.
8.13 The addictions team do not tend to jointly work cases with prison social workers and social workers are not involved in developing or delivering group work programmes. These are both missed opportunities in terms of the holistic perspective that social work can bring to the underlying and ongoing factors in substance misuse, and also because of the 'Hidden Harm' obligations. It is important that everyone's awareness is raised, including prisoners, regarding the impact and procedural implications of parental substance misuse. There also appeared to be difficulties for local prisoners obtaining a throughcare service from or through social work in the community.
8.14 The team attend senior management or working groups along with social work as part of a larger group but do not have any regular scheduled meetings to discuss interface or development issues.