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8. HEALTHCARE
Health Services
Physical Accommodation
8.1 The Health Centre is clean and bright and has adequate capacity for all the relevant activities. There is no healthcare activity in the residential areas apart from methadone dispensing, The areas from which methadone is dispensed are drab and cluttered. The facilities in Kerr House are particularly poor with the nurses working in a corridor that is otherwise unused. These facilities should be improved.
Staffing
8.2 At the time of inspection the staffing complement in the Health Centre was two lower than the agreed level and this was having an impact on the services being offered. There was only one nurse dedicated to mental health issues which does not compare favourably to other SPS establishments. There is money available for a second Mental Health Nurse in 2007-08.
8.3 The staff group has changed almost completely over the last 18 months, with several of the new members of staff also new to prison healthcare. Although the atmosphere and relationships were good, there may still be a settling in process occurring, reflected in the plans to introduce more nurse-led clinics.
Access to Health Services
8.4 A triage system is in operation, in common with other SPS establishments. Prisoners complete a form in the morning and this is considered by nursing staff who decide if the prisoner needs to see a doctor. Prisoners are informed in the evening about what is to happen and if they need to see a doctor. This will usually happen the following day. Any prisoner who needs to see a GP urgently can be accommodated on the day they make their original request.
8.5 The triage system was the most complained about aspect of healthcare during the inspection. At present, prisoners who do not go to work because they are 'sick' are put on report. This is reversed only if it turns out that they need to see a doctor. Prisoners feel that this discourages people who may be genuinely ill from reporting sick in case the report will affect their progression through the prison system. The healthcare manager is aware that both staff and prisoners regard the current system as unacceptable and has taken steps to engage prisoners in coming up with a better approach. It is recommended that the triage system is improved. Consideration should also be given to reintroducing the Healthcare Forum which used to be in place.
8.6 Nurses run clinics for Asthma, Epilepsy (when needed), Diabetes, Coronary Heart Disease, Dermatology and Sexual Health. Prisoners can access condoms at the sexual health clinic. However, all of these clinics are ad hoc and should be run on a regular and planned basis. Smoking cessation courses are held and groupwork is available for Anxiety and Insomnia. The appointment of a Blood Borne Virus nurse, funded jointly with Lanarkshire Health Board, has been a positive development for the prison and means that the capacity for close liaison with local NHS services is good for staff and patients alike.
Medical Services
8.7 The doctor works in the prison six mornings per week and in addition does an addictions clinic on two afternoons.
8.8 The doctor feels that relationships across the healthcare team are good and this was reflected in discussions with a number of staff. Nurses or Healthcare Assistants are present at all doctor/patient consultations. The need for this should be established.
Mental Health
8.9 Meetings of the Multi-Disciplinary Mental Health Team include nurses, social work, psychiatry and chaplaincy, with occasional psychology input.
8.10 Psychiatry services are provided by NHS Lanarkshire and the State Hospital. Waiting times to see a psychiatrist are currently comparable to those across SPS health services. The Mental Health Nurse has a caseload of around 100 prisoners and the plans to recruit a second Mental Health Nurse are to be welcomed.
8.11 Urgent referrals to a psychiatrist can be seen on the same day if necessary, while non-urgent referrals might wait for several weeks.
Learning Difficulties
8.12 There is no particular nursing support for prisoners with learning difficulties.
Pharmacy Services
8.13 Pharmacy services are provided by Alliance. A pharmacist comes in to the prison weekly to check prescriptions and the controlled drugs. A pharmacy assistant works with the pharmacist and healthcare staff on a day-to-day basis, ensuring sufficient stocks are maintained.
Dentistry
8.14 The dentist who has been providing services for almost ten years was due to leave shortly after this inspection. Recent provision had been variable and waiting times for an appointment had risen. The prison has devoted significant effort to resolving the situation. Waiting times and appointments were reviewed in September 2006 and a database created which showed where individuals were in relation to their treatment. Contact was made with a Dental Agency later in 2006 to obtain additional cover to tackle the waiting list. Efforts have also been made to recruit a permanent dentist but with no success to date. Prisoners themselves did not raise any issues. The prison continues to monitor the system to find a permanent solution.
Allied Health Professionals
8.15 Access to the services of Allied Health Professionals - podiatrists, opticians, and physiotherapists - is adequate.
Addictions
8.16 The addictions service is moving towards a healthcare model. Staffing levels have been increasing gradually and are now sufficient. The addictions team comprises a general practitioner, an addictions strategy co-ordinator, three addictions nurses, three Phoenix caseworkers and officers from the Drug Testing Unit. There is also a Blood-Borne Virus Nurse.
8.17 Active steps are being taken to prevent the introduction of drugs into prison but the prison is not drug free. Policies and protocols for delivering services are driven by the SPS drugs strategy and healthcare standard 10.
8.18 The range of services offered is wide and includes advice on harm reduction, one-to- one counselling, alcohol awareness groups and Alcoholics Anonymous, HIV/Hepatitis C awareness, smoking cessation and relapse prevention. There are protocols covering the use of methadone, subutex and lofexidine, removals from prescriptions, and arrangements for linking with community treatment services.
8.19 Addictions staff are working well together. Decisions about treatment are taken at the Addictions Intervention Group ( AIG) which has wide representation.
8.20 The main clinical intervention is the methadone programme. Prisoners either arrive at the prison already prescribed methadone or are placed on it following an assessment. At the time of the inspection almost 150 prisoners were receiving methadone. If prisoners are still receiving methadone when they leave the prison arrangements are made with community services or within the SPS to ensure that this will be continued.
8.21 There is no waiting list for methadone as such. However, the assessment period of 4-6 weeks can lead to backlogs. Addictions staff said that the main reason for offering the methadone programme is that the treatment 'has credibility with prisoners'. They also felt that treatment is 'needs led'. Prisoners participating in the programme are seen by the addictions nurses or Phoenix staff at least monthly and more frequently on request. The main objective of the programme is to stabilise prisoners so that they can participate constructively in activities. The likelihood is that maintenance would be long term 'because this is a long term jail'. The service operates a warning system and methadone may be withdrawn after two infringements of the code of conduct agreed with the prisoner at the outset. Prisoners confirmed that the onus was on them to initiate steps to reduce their prescription and stop taking methadone.
8.22 Managers reported that prisoners had responded well to the voluntary testing programme (an 89% response - which is higher than in other prisons). There was also some 'suspicion testing' taking place as well as testing which was required to progress to open conditions.
8.23 Phoenix staff undertake all initial addiction assessments. They have had more requests for assessments since the introduction of the ICM procedures. Phoenix work together with addictions nurses as 'key workers' as well as providing counselling. They contribute to the SPS alcohol education group and provide some one-to-one help with alcohol problems. They also offer smoking cessation advice and counselling. With the exception of this latter service, the counselling undertaken by Phoenix staff counts towards progression in the same way as a formal programme.
8.24 The written assessments from Phoenix are linked to the PR2 system. It would be helpful if the team could have another computer terminal.
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