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6. HEALTHCARE
Physical Environment
6.1 The Health Centre is among the best in the SPS. It is purpose-built, bright, spacious and adequately provided with equipment to meet the healthcare needs of prisoners. The location of the Health Centre, in the Hub, also allows for more immediate communication over areas of shared concern for staff.
6.2 However, the Health Centre is very under-used and it has already 'lost' one designated health care room to the chaplaincy centre. Most interaction between nursing/medical staff and prisoners still seems to take place in the residential areas. Prisoners go to the Centre for dental and psychiatrist appointments. Indeed, the ground floor of the building feels more like an office suite than a working Health Centre.
6.3 It is recommended that the opportunity to make full use of a custom-built health centre should not be missed.
Access to Healthcare
6.4 In line with practice throughout the SPS, prisoners must complete a form requesting a medical appointment. They are then triaged by nursing staff in the residential areas each morning.
6.5 The residential areas have a consulting room where medical staff see prisoners. As happens elsewhere in the SPS, nurses tend to stay in the room during consultations, but will leave at the prisoner's request. Nurses staying with medical staff during prisoner consultations should be the exception rather than the rule and even then for good clinical reasons only, prisoners should not have to request that they leave.
6.6 Afternoon medications, mostly related to drug detoxification and maintenance programmes, are also dispensed in the residential areas from a designated pharmacy area. The physical arrangements for this are unsatisfactory. Prisoners are called from the cell areas four to six at a time. They then queue outside the room to sit on a chair, still outside the room, facing the barred door, through which the medicine is passed. While the security concerns around the whole process are appreciated, it should still be possible to improve this situation.
6.7 Waiting times to see a doctor are four to five days, sometimes rising to seven depending on circumstances.
Nursing Services
6.8 The nursing service is not up to full complement, (17 full-time equivalent), although new staff have been and are being recruited. The Health Centre has its fourth Manager in four years.
6.9 While the nursing staff were committed to providing a good service they felt that they were constantly in 'fire-fighting' mode as a result of shortages of staff.
6.10 Due to the current shortage of nursing staff, health promotion efforts are not what they could be and not what they have been in the past. Nursing staff do however participate in the living skills programmes.
6.11 All of the healthcare staff said that they felt safe in the prison.
Medical Services
6.12 Medical staff feel that the health centre is under-used. They also commented that to deliver a consistent service across the prison, they need another two sessions of medical staff time. For example, there is no medical session on a Monday morning and so Tuesdays are exceptionally busy. Bringing prisoners to the Health Centre and developing nurse-led clinics would also free up medical staff time to do more health promotion, more addictions work and more chronic disease management.
6.13 The introduction of the G.Pass system across SPS will allow better access to prisoners health records.
Mental Health Services
6.14 A Multidisciplinary Mental Health Team ( MDMHT), chaired by the Deputy Governor meets twice per month and oversees the mental health provision in the prison. The establishment of this group provides an excellent opportunity for close liaison both within and outwith the prison. Consideration should be given to providing the MDMHT with input from a psychiatrist.
6.15 However, there is only one dedicated nurse working in mental health. As outlined above the healthcare team are generally in 'fire fighting' mode due to staff shortages. More concerning is the fact that when the primary care team are struggling to meet the demands of physical health care delivery, the mental health resource is called upon to help out. There is a feeling amongst health care staff that mental health is not given the priority it requires, for example, the mental health nurse has been called away from an ACT case conference to cover a medication run in one of the residential areas. Mental health provision can only respond to crisis situations.
6.16 Liaison with NHS Lothian's Orchard Clinic is very good. The relationship which has been built up over a period of time, ensures a quick response from this service. Given the good relationship there is both an opportunity and a willingness to develop a more proactive mental health service.
6.17 Overall, despite motivated mental health professionals, staff are unable to provide prisoners with mental health problems an adequate level of care and treatment. It is recommended that support for prisoners with mental health problems is improved.
Suicide Prevention
6.18 In the year prior to the inspection there have been no suicides at the prison. Incidences of self-harm have reduced this year, with the Listener Service being cited as a contributory factor.
6.19 An ACT policy group is in place and meets bi-monthly. It is in the process of preparing for the introduction of new ACT paperwork. The MDMHT discusses specific cases on ACT and this is a good forum for raising concerns about prisoners mental health care. At the time of the visit one prisoner was on ACT high risk and 12 prisoners were on ACT low risk.
6.20 It is the responsibility of Hall Managers to call ACT case conferences but on many occasions this is left to the mental health nurse to arrange. This issue needs to be addressed but in general the ACT procedures appear to work well in the prison.
Dental Services
6.21 The equipment in the new healthcare facility is excellent. However, the dentist is currently employed one day per week which does not fully meet the needs of prisoners: the current waiting time is around nine weeks.
6.22 The logistics of prisoner movement means that the effective use of the dentist's time is not maximised. The dentist is mainly attempting to get prisoners 'dentally fit' but in many cases this is not achieved due to the fact that some prisoners are in the prison for relatively short periods of time. There is no system in place for long-term prisoners to have routine dental treatment or check ups.
Pharmacy
6.23 Pharmacy is organised through the SPS Contract with Moss Pharmacy and the pharmacist visits prison once a week to provide advice on the storage, administration and handling of drugs, maintain the emergency equipment and review the pharmacy financial reports. The input from Moss appears to work very well.
6.24 However, the storage of medications in the residential areas is inadequate. For example eye ointments are left by window ledges as they have no fridges to store them in. This should be addressed.
6.25 Self-medicating prisoners have personalised pre-packed medications which are double checked and sealed prior to them being dispensed by a qualified nurse. Whether or not this is the best use of qualified nursing time needs to be considered. Despite concerns expressed by officers the move towards fortnightly and monthly prescriptions seemed to be working well.
Optician
6.26 An optician is contracted for one session per month. The waiting time for the optician had at one point reached nine months due to a period of no cover. This has been resolved and waiting time has reduced to three months.
Podiatry
6.27 A podiatrist is contracted for one session every six weeks. The waiting time is approximately five weeks.
Physiotherapy
6.28 A physiotherapist is contracted from the NHS to provide 81 sessions per year: which averages six hours per week. The resource was considered adequate and there was a six week waiting list. Many complaints are neck and back pain and the physiotherapist has highlighted that bad pillows and hard mattresses may contribute to this. The physiotherapist makes links with the Physical Education Instructor and refers many of these cases on for Yoga or other interventions.
Counselling
6.29 'Cruse' provide a counselling service for prisoners when they experience a bereavement. This service can be accessed on request and is well used.
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