8. HEALTHCARE
Outcome
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 is good, particularly in the context of the complex prisoner mix and high levels of overcrowding. However, the provision of dentistry and mental health support is inadequate, and the addiction service is struggling to meet the demands caused by overcrowding and a lack of staff.
Health Services
Primary Healthcare
8.2 The healthcare nursing team consists of one clinical manager and eight nursing staff. The full complement is five practitioner nurses and three addictions nurses. There is no dedicated full-time mental health nurse. To overcome this, three of the team are also mental health trained, although there is very little time for them to deliver a mental health service. Despite being funded for three addictions nurses the majority of addictions nurse time, with the exception of the addictions nurse/coordinator role, is taken up delivering primary nursing care and ensuring the smooth running of the health centre. Due to the concentration on primary nursing care, only crisis mental health and basic addictions needs are being met. The team is supported by a pharmacy administrator who works 30 hours per week. An administrator has recently been recruited.
8.3 The nursing service is available Monday to Friday from 07.00hrs to 21.30hrs and at weekends until 17.30hrs, but this is barely meeting demand.
8.4 Medical cover is provided by Medacs. The doctor attends the prison for 20 hours per week and also provides an out of hours on call service. The doctor sees prisoners on his own, although if a prisoner wishes a nurse to be in attendance he is able to request this.
8.5 The health centre has three separate areas with the main access corridor to the residential areas running through the middle. It is always busy and noisy. Facilities comprise a dental suite, doctor's consultation room, addictions nurse office, nurse resource area, clinical managers office, and treatment area/storage/drugs dispensing facility. The pharmacy administrator works out of a large 'cupboard' and the healthcare administrator's desk sits in the middle of the thoroughfare area. The waiting room doubles as an interview room and prisoners often hover outside the doctor's room waiting to be seen because every area including the waiting room is being used. There is very little health promotion literature in the waiting area and some of the furniture is damaged. It is recommended that the health centre is made fit for purpose.
Referral Process
8.6 Prisoners receive a healthcare screening on admission and are seen by the doctor within 24 hours. Routine admission urinalyses is undertaken in the healthcare reception area. The door has to be kept open during the nurse assessment as there is no glass partition. Thereafter all referrals are self referrals, and prisoners are seen timeously and within the standards set by SPS.
Secondary Healthcare
8.7 A dentist and dental nurse attend the prison every two weeks from 09.00hrs to 15.00hrs. Emergency dental advice is available outwith these times. In an emergency the prison can also refer to an Emergency Dental Service. The dentist aims to see 16 prisoners on each visit. The dental room is basic but adequately equipped. It is also used by the visiting optician.
8.8 A lack of administrative support in organising sessions has exacerbated an already large waiting list. The dentist spoke of a crisis management service. Prisoners have to wait a very significant length of time to see the dentist.
8.9 It is recommended that steps are taken to reduce the waiting times to see a dentist.
8.10 An optician attends the prison on a regular basis, and the waiting list is minimal.
Nurse Led Services
8.11 Nursing staff deliver a bloodborne virus and harm reduction service. Prisoners are able to access harm minimisation packs: this is an area of good practice. Nursing staff also deliver a weekly sexual health clinic in partnership with NHS Genito-Urinary Medicine Clinic. However no proactive nurse led services are available for prisoners with conditions such as asthma, epilepsy or diabetes.
Mental Health Services
8.12 Three Consultant Psychiatrists from NHS Grampian attend the prison on a rota basis to cover fortnightly psychiatric sessions. They spoke very positively about the mental health support given to prisoners by the doctor who would only refer to them when it was absolutely necessary.
8.13 A psychiatrist attends the multidisciplinary mental health team meeting which takes place every two weeks to give ongoing supervision and support. The waiting list for assessment at the time of the inspection was ten with the longest wait being three weeks.
8.14 The psychologist has been removed from mental health work to oversee delivery of the Substance Related Offending Behaviour programme.
8.15 There is no dedicated full-time mental health nurse.
Secondary Care
8.16 Appointments for secondary care are arranged by the healthcare administrator. Since January 2008, 95 appointments have been arranged for prisoners in the community. The prisoner is informed of his appointment immediately before he has to leave the prison. This gives him no time to prepare or to freshen up.
Management of Medicines
8.17 Medications are stored as required by current legislation. Prisoners also receive medication to keep in their possession. The Pharmacy Assistant carries out "on the spot" assurance checks on medication in prisoners' possession on a weekly basis. Prisoners who are not engaging with the medication compact are placed in the next available clinical slot for reassessment.
8.18 The Pharmacy Assistant assists the team and any visiting specialists by organising and taking prisoners' blood samples.
Clinical Prescribing
8.19 The doctor prescribes using a harm reduction approach. The full range of clinical interventions is available in line with Healthcare Standard 10 with the exception of first night in custody medication. However, should prisoners be showing signs of severe drug or alcohol withdrawal on admission, advice will always be sought. Weekend evening supervised medication is dispersed to the prisoner, unsupervised, at 16.00hrs. This should stop.
Addictions
Strategy and Co-ordination
8.20 An Addictions Strategy Group, chaired by the Head of Prisoner Management, meets monthly. Statistical data is gathered and shared with the local Joint Alcohol and Drug Action Team ( JADAT): for example on prisoners who arrive in prison on a methadone script, those starting methadone or liberated on methadone. This sharing of information is an area of good practice.
8.21 At the time of the last full inspection (2004) 27 prisoners (on average) were in receipt of a methadone prescription. This has increased substantially: the number receiving methadone in the prison during this inspection was 76.
8.22 The prison is very well represented in the local community at local drug meetings and forums. The Governor attends the Aberdeen JADAT and the Alcohol and Drugs Action Team ( ADAT) meetings. She also chairs the Aberdeen City Criminal Justice Sub Committee. A member of Senior Management Team attends the Aberdeenshire ADAT. The prison also has an input to the local Drug Related Death Group. As a result of the evidence base that the prison has established they have recently been asked to send a representative to attend the local Substance Misuse Service Clinical Managers Meeting.
8.23 The addictions team is multidisciplinary and comprises staff from healthcare ( SPS and NHS), Phoenix Futures, social work, intelligence and chaplaincy. There is no input from residential or operations staff. This should be addressed.
Prevalence Testing
8.24 Eighty five percent of prisoners in Aberdeen prison are in custody for offences related to their addiction. In 2007-08, 79% of prisoners who were randomly tested on admission to the prison tested positive for drugs. When tested randomly on liberation this reduced to 67%. This 12% reduction from reception to liberation is the lowest reduction noted in any prison in Scotland. The availability of drugs in the prison is a major issue for both prisoners and staff.
Enhanced Addictions Casework Team
8.25 The Phoenix Futures Team consists of a Team Leader, two Caseworkers, and one Administrator. At the time of inspection the team were not at full complement and had not been for a significant period of time.
8.26 Most one-to-one work is carried out in the Links Centre although there is a lack of organised discipline officer cover to ensure prisoners always arrive for appointments.
8.27 The team delivers drugs and alcohol interventions in line with the SPS/ EACS Contract. However, they have not yet started to deliver the pre-release harm reduction awareness session to prisoners on remand.