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 The health centre is not fit for purpose, but care delivery itself is satisfactory. A proactive clinical mental health service is being delivered and there are good links with Act2Care. Prisoners do not receive their daily medications, including methadone, prior to going to court.
Physical Environment
8.2 The health centre is not fit for purpose. It comprises two offices; a pharmacy area; a medical notes cupboard; a dental room; a doctor's room with a consultation room attached (which is also used for nurse triaging and storing medical records); and a prisoner waiting area. It is very cramped, and a lack of appropriate facilities has meant that some visiting specialists have to see prisoners in the hall (when a room is available) or the agents visits area. Nurse led clinics have also been cancelled due to lack of an available space.
8.3 Although the health centre is clean and tidy, there are problems in terms of noise, interruptions to consultations, privacy, confidentiality and infection control. Conversations should not be heard in the consultation rooms. Medical records should not be stored in the consultation room. The dentist room should not be used for other clinical interventions.
8.4 Satellite clinical areas have recently been developed in Ailsa Hall and Darroch Hall. These are clean and have recently been decorated. At the time of inspection the nurses were using these areas for the dispensing of medication only. Nurse triage was being undertaken in the health centre.
8.5 Although there is a lot of health promotion literature available, it needs to be refreshed as a number of posters were torn or had been written on.
8.6 All emergency equipment is stored in the health centre. No temperature control monitoring is undertaken of the drugs fridge.
8.7 It is recommended that the health centre is made fit for purpose.
Primary Healthcare
8.8 The primary care team comprises 6.3 whole time equivalent primary care nurses; two addictions nurses; a mental health nurse; an administrator; a clinical nurse manager; and a part-time doctor. There is no pharmacy assistant.
8.9 Primary care nurses work 12 hour shifts, with mental health and addictions nurses working an eight hour shift pattern. Weekday shifts are 07.45hrs to 21.15 hrs. Weekends are 08.30hrs to 18.30hrs. Medical clinics are provided every day with the exception of Sundays.
8.10 The team is not at full complement and has been significantly depleted over the last few months, with overtime and agency nurse support regularly required. Delivering a consistent service in these circumstances is very difficult.
8.11 Since the last inspection nursing staff have been trained to deliver nurse led interventions. If time permits these are delivered on an ad hoc or one-to-one basis. Waiting lists for nurse led services are not maintained as referral forms are given directly to nursing staff.
8.12 Prisoners with chronic disease conditions are seen only if they present with ill health or if they self refer. Prisoners are able to keep diabetic equipment in their cells. This is an area of good practice. However safe storage, operating and disposal practices for this equipment should be developed and monitored.
8.13 Female prisoners have specific healthcare needs and should be made aware that they can see a female doctor in the prison if they ask for this.
Secondary Healthcare
8.14 A dentist attends the prison three sessions each month. The dental suite has recently been upgraded and facilities developed to improve dental decontamination. The current waiting time for non-urgent pre-planned dental work is 10 weeks, although urgent cases have access to immediate pain relief from the doctor. Due to the lack of space the dental surgery is also used for other clinical interventions. In terms of infection control this should stop.
8.15 An optician and chiropodist visit the establishment when enough prisoners need to be seen. A visiting pharmacist attends the prison one morning each week. She is supported in this role by prison nursing staff who complete the administrative work. This administrative work could be undertaken by a pharmacy administrator which would free the nurses to work with prisoners.
8.16 A blood borne virus service is now being delivered monthly within the establishment with specialist nurse input from Inverclyde and Paisley Hospital. This is an improvement on the level of care previously delivered.
Mental Health Services
8.17 A Consultant Psychiatrist attends the prison for one session each week. This is flexible to meet the needs of the prison. The mental health nurse works Monday to Friday. The nurse assesses individual prisoners and makes referrals to the Multidisciplinary Mental Health Team and psychiatrist.
8.18 The Multidisciplinary Mental Health Team, chaired by the Deputy Governor, meets weekly to discuss individual cases. Minutes are available and circulated widely. This team is well represented by all disciplines and the level of joint working is good.
8.19 Prisoners with mental health problems can attend a supported session with PTI's.
Referral Process
8.20 A range of self referral forms are readily available in all halls. Nurse triage and doctors appointments are given priority: prisoners are seen within 72 hours. However, there is no formal process for recording referrals, and prisoners are not given set appointments or any feedback on waiting times. The referral system should be more robust.
Management of Medicines
8.21 Medication is stored in line with current legislation. Prisoners are encouraged to keep medication in their own possession where appropriate. However, none of the cells have individual locking cabinets for safe storage. Medication administration times have changed recently to support the separation of controlled drugs and this appears to be working well in terms of clinical administration. Evening medication at weekends is dispensed from 16.00hrs. Supervised medication at weekends is provided by the pharmacist.
8.22 Nurse administration of controlled drugs is always undertaken by two qualified nurses. Officer support for this process is very good.
8.23 Just before the inspection a decision was taken to stop giving medication to prisoners before going to court. Methadone is also no longer administered before going to court or on the day of liberation. It is recommended that the decision to stop giving prisoners going to court their medication should be reviewed.
Addictions
8.24 Admission statistics for January 2009 show that 83% of prisoners tested positive for illegal substances on admission to the establishment. On liberation this was 33%.
8.25 Substance misuse testing is undertaken by officers. Female healthcare staff support this process for female prisoners. Testing for compliance for those on a methadone script is undertaken monthly.
8.26 The Enhanced Addictions Casework Team comprises a team leader, two case workers and a part-time administrator. Facilities for the team are satisfactory and the team is very flexible about where they will see individual prisoners. The team is well integrated within the prison and has established close links with the healthcare team, particularly in relation to smoking cessation delivery and individual addictions care planning. Weekly management and practitioner meetings ensure that individual needs of prisoners are shared and prioritised between the two teams. The team provides a session in the induction programme; delivers one-to-one substance misuse support; and provides group work sessions.
8.27 Fifty five prisoners in the establishment are on a methadone prescription, of whom nine are on reducing doses.
8.28 The Interventions Manager oversees the implementation of the addictions policy within the establishment. Monthly minutes evidence discussion on local issues and national developments. Representatives of the team attend the Glasgow Drug Related Death Group and local Throughcare Addictions Strategy Meeting. However no one from the senior management team attends the Greater Glasgow and Clyde Alcohol and Drug Action Team.