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6. HEALTHCARE
Physical Environment
6.1 The Health Centre is clean and well organised. However, it is dated and no longer fit for purpose. Healthcare is moving to new, purpose-built premises early in 2007. The healthcare manager has been involved in the planning of the new premises and consideration has gone into requirements around space and functionality.
6.2 The Health Centre 'holding area' is a potential danger. Prisoners claim they can be kept there for 'hours' at a time awaiting escort. There is no access to water and although this is in part because prisoners have destroyed facilities in the past, it is still not acceptable and should be addressed. While there have been no incidents to date the situation should be kept under constant review.
Staffing
6.3 The Health Centre is adequately and appropriately staffed, and staff turnover and absence rates are low. Nursing staff run several clinics with a focus on the management of long-term conditions, including diabetes, asthma and epilepsy. Prisoners are informed of these in a booklet issued on admission. Prisoners with a Blood Borne Virus are seen at hospital-run clinics and there are plans to begin a pain management clinic.
Access to Health Services
6.4 As is common across healthcare in the SPS, nursing staff operate a triage system for written requests by prisoners to see the GP and other staff. If prisoners become acutely ill overnight, a call is made to the duty doctor or an ambulance called. If not acutely ill, they are seen at the triage clinic run by nursing staff at 08.30 the following day.
6.5 Prisoners can request direct access to the GP if they have a confidential issue to discuss. Prisoners did complain that there is always a member of nursing staff present at GP consultations and the healthcare manager confirmed that a healthcare assistant is present at most consultations, albeit to help the GP with forms, requests etc. However, this is not good practice and should be discontinued.
6.6 It is not good practice that prisoners' names are shouted from a central area when their medication is being dispensed. If prisoners do not hear their name they miss their medication. This should be stopped.
6.7 A Healthcare Forum is in place. Prisoners meet with staff at this and raise issues and make suggestions about good practice. The degree of buy in from prisoners was noticeable. This forum is an area of good practice. Health Promotion activities are the subject of particular focus twice a year and there are plans to hold an additional week-long health promotion event annually.
6.8 The Practice Nurse is also a sexual health specialist and runs a clinic that prisoners can self-refer to. Condoms are made available to prisoners at this clinic.
Medical Services
6.9 General medical input is provided by a GP through the MEDACS contract with the SPS. The GP holds surgeries five mornings per week and most prisoners are seen within 24-48 hours of requesting an appointment. Occasionally this is exceeded, for example over a weekend. A GP colleague who also works in other SPS establishments provides holiday and absence cover.
Mental Health
6.10 Psychiatric input is provided by two visiting psychiatrists, offering four sessions per week. There is no waiting list to see a psychiatrist. Psychiatrists are concerned at the lack of general counselling services available to prisoners and feel that if there were more mental health nurses a better and more consistent service with facilities like anger management and life skills could be made available. Follow-up and throughcare after liberation can be difficult. Where possible, Social Services are made aware of prisoners being liberated who have been receiving support with mental health issues, but this is not always possible.
6.11 The prison chaplains are included on the mental health team and have provided useful input and support to prisoners around particular issues, for example, bereavement. The organisation 'Open Secret' - an independent community-based group offering free, confidential support to adult survivors of childhood sexual abuse - is active in the prison. This is an excellent service. Awareness of the service is raised through the use of posters, by word of mouth and by staff already working with prisoners who have mental health problems.
6.12 The nurse in charge of the clinical team is herself a mental health nurse and she co-ordinates information sharing between staff dealing with mental health issues, addictions and blood borne viruses.
6.13 There appears to be some difficulty in accessing some levels of 'in-patient' type psychiatric care for prisoners. There is no local secure facility available in the NHS, and so the choice is between the prison or the State Hospital at Carstairs. In some cases neither of these will be appropriate.
Pharmacy Services
6.14 Pharmacy services are provided through the SPS contract with Alliance. The Pharmacist checks all prescriptions and raises any issues with medical and nursing staff. All repeat prescriptions are reviewed by the GP on a three-monthly basis. All medications are appropriately and safely stored.
Dentistry
6.15 Dental services are available two days per week. Waiting times have come down. Prisoners might attend a dentist in prison, having not been to a dentist in the community for ten or maybe twenty years. Some prisoners have not used a toothbrush for many years and have little idea about what constitutes good dental hygiene or dental health. Male prisoners have three times more tooth decay than the general public. For these reasons, the dentist feels that any waiting time for dentistry should be set in context. Demands on the service are so high that there is little time to do preventative dentistry. The service is mostly reactive.
6.16 Overall, the dentist was very committed and enthusiastic, and was keen to see dentistry develop across the SPS.
Allied Health Professional Access
6.17 Access to other services is good, with most prisoners travelling out of the prison to hospital-based clinics. This currently includes podiatry appointments, although there will be a dedicated podiatry suite in the new Health Centre. All prisoners aged 45 and over are referred to an optician on admission to the prison. Prisoners wait around four weeks for an appointment.
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