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6. HEALTHCARE
Physical Environment
6.1 The health centre is located in an old building, although the new build will address this. The décor in the current centre is relatively fresh and the environment is clean and tidy. The current layout is cramped with the majority of care being provided on the ground floor. Many of the rooms on the first floor were under utilised or not used at all. Better use should be made of the current space available in the health centre.
6.2 The four bedded ward in the health centre has been closed as part of SPS policy. Staff generally felt that patients were now accessing more appropriate NHS facilities when in-patient care was required.
Access to Healthcare
6.3 The practice of bringing prisoners to the health centre for the majority of treatment rather than delivering it in the halls is welcomed. Having three dedicated officers as 'runners' is also a very positive initiative and ensures that the best use is made of healthcare staff time.
6.4 At the same time, it is recognised that the dispensing of methadone and general medication is logistically easier and safer in the halls. However, due to ongoing work in the halls methadone was being dispensed in the health centre (apart from in 'E' Hall) as a temporary measure. This is currently manageable due to the reduced number of prisoners. Although there is no need to have a treatment room in the halls, it is necessary to have secure facilities for the storage of medications, including methadone. This secure environment should also be used to house emergency equipment. It was noted that in an emergency staff must carry emergency equipment from the health centre to the halls. This should be addressed.
6.5 The practice of bringing prisoners to the health centre is very much in line with the ethos of health care delivery in the community. It has also led to a significant drop in the number of prisoners reporting unfit for work. That said, prisoners were unhappy with the healthcare provided. The SPS Prisoner Survey showed that 81% of prisoners felt that their healthcare needs were better met in the community. During the inspection a prisoner group said that health care staff were dismissive and did not communicate with them effectively, often "keeping us in the dark". Prisoners complained that they had to go to the health centre rather than staff coming to them. Health care staff and officers should work together to raise awareness of the benefits of this approach.
Nursing Services
6.6 The nursing team has a complement of one health centre manager, 25 nursing staff and 1.5 health care assistants. Only 19 nursing staff were in place at the time of inspection. The vacancies consist of two clinical nurse managers and a new resource of four addiction nurses. Within the current complement there are three mental health nurses and one addictions nurse, the rest being dedicated primary care nurses. The current skills mix within the health centre should be reviewed.
6.7 The team is keen to progress the development of specialist clinics. Primary care nurse led clinics have been established in sexual health, Blood Borne Viruses ( BBV) and smoking cessation, with the opportunity to progress some of the doctor led clinics to nurse led. These clinics work well and nurses are given the opportunity to gain skills and training in these specialist areas. Well established links with Ninewells Hospital ensures referral for treatment. A nurse has been appointed as the 'lifelong learning' representative: a Royal College of Nursing initiative to ensure the personal development of all nursing staff.
6.8 When operating at full complement, the team is well resourced and they have the opportunity, with a reduced prison population, to embed a community health centre culture.
Medical Services
6.9 General medical care is arranged through the central SPS Medacs contract. There are two doctors providing cover, who have worked at the prison for 15 years and for four years. The doctors apply the same principles of general practice to the prison health centre which is apparent in, for example, the appointment system and the encouragement of prisoners to take responsibility for their repeat prescriptions.
6.10 On call cover is provided seven nights per week by one of the doctors. The doctors expressed concern that the nurse triage system had been withdrawn, and although calls are at a minimum, officers contact the doctor direct. When the doctor is on leave, cover is usually provided by a doctor located in the Central Belt. Should this cover be required, the travelling time to the prison would seem to be excessive.
6.11 There are four doctor led clinics: asthma, chronic obstructive airways disease, diabetes and cardiovascular. Steps are underway to progress some of these clinics to nurse led. Once this is established the doctors will move to a supervisory role.
Mental Health Services
6.12 Psychiatry input is provided by the Murray Royal Hospital in Perth with two consultant psychiatrists providing five sessions per week. The psychiatrists involve their junior doctors and specialist registrars (SpRs), as the prison is considered to be a good training environment. The prison benefits from research projects carried out by the SpRs in conjunction with the mental health team. A multidisciplinary team is in place with representation from all the appropriate staff and agencies. The Royal College of Psychiatry, when reviewing the prison for training purposes of SpRs, commented on the comprehensive input to the multidisciplinary mental health team.
6.13 Mental health staff do not work at weekends, therefore occasions arise where general nurses need to assess prisoners' mental health in the first instance. This is not ideal and should be addressed. That said, access to mental health expertise during the week is very good.
6.14 Referral to the mental health team is straightforward. As well as routine referral procedures, prisoners can self refer, and Listeners and other prisoners who are concerned about a fellow prisoner can also refer.
6.15 The mental health team have recently set up co-ordinated group work. For example, they target vulnerable individuals on remand who lack confidence or self esteem. Although in its early stages, this type of work has been well received. Patient information leaflets about accessing mental health services are available and the team are keen to advertise this on the internal TV loop for those prisoners who cannot read or write.
6.16 Members of the mental health team expressed concern about the lack of communication and information sharing relating to prisoners with mental health problems when they are transferred to the Open Estate from other prisons around Scotland. This is an SPS issue. It is recommended that better systems of communication relating to prisoners with mental health problems are put in place across the SPS.
6.17 In general, provision for prisoners in Perth with mental health problems is good.
Dental Services
6.18 The dental equipment in the health centre was described as being equivalent to that in the dentist's own practice. The dentist is currently employed two days per week (four sessions). All prisoners are seen within three weeks of referral with an average waiting time of two weeks.
6.19 Having dedicated Officers as 'runners' maximises the use of the dentist's time and the four sessions meet demand. The dentist deals mainly with gross negligence and attempting to get prisoners 'dentally fit'. In many cases this is not achieved due to the high turnover of prisoners.
Pharmacy
6.20 Pharmacy is organised through the contract with Alliance (formerly Moss Pharmacy). The pharmacist visits the prison once a week to provide advice on the storage, administration and handling of drugs; and to maintain the emergency equipment and review the pharmacy financial reports.
6.21 Medications are dispensed on a weekly basis. Although this is appropriate for remand and short-term prisoners it might be less time consuming to move long-term prisoners to fortnightly or monthly prescriptions.
6.22 Concern was expressed about supervised administration of medications. Nurses pre dispense medication into a plastic sleeve which holds the medication kardex for the individual prisoner. It is then transported to the hall and administered to the prisoners. This is an unacceptable practice and should be improved. Having suitable storage for medications in the halls would resolve this issue.
6.23 Although it is good that prisoners are encouraged to initiate routine repeat prescriptions, this can lead to prisoners stockpiling medications they are not using. There are potential safety issues here and steps should be taken to stop it happening.
6.24 Prisoners' medication prescriptions should be reviewed by the doctor every three months. This was established at the set up of the first contract with Moss Pharmacy in 1998-99. However, audits carried out by the pharmacist show that on average there is 60% non compliance with this. Prisoners taking methadone often have two separate prescription kardex's which increases the risk of an error being made. These issues should be addressed.
Optician
6.25 The optician provides one session per month with the facility to provide extra sessions if required. The waiting time is approximately six weeks.
Podiatry
6.26 The podiatrist provides one session per month with the facility to provide extra sessions if required. The waiting time is approximately five weeks
Physiotherapy
6.27 There is no physiotherapy provision within the prison. Should a prisoner require this, he is escorted to Perth Royal Infirmary for an out patient appointment. The prison has been unable to recruit a physiotherapist.
Counselling
6.28 There is no general counselling service provided by health care. Input from the Prisoner Listener Scheme is available, and the opportunity to telephone the Samaritans when requested are in place. The open referral system to mental health nurses ensures that anyone requiring counselling receives it.
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