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4. 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.
4.1 Partly met. The range of healthcare services is very good at both sites. However, the times at which prisoners can access these services is more restricted at Noranside than at Castle Huntly.
4.2 Although methadone throughcare is excellent on both sites the administration of this at Noranside falls outside recommended standards.
Health Services
Primary Care Team
4.3 The primary care team delivering services to both sites consists of one Clinical Manager, one Mental Health Nurse, two Addictions Nurses, three Practitioner Nurses and a Health Care Assistant. There is no administrator. Bloodborne virus and sexual health input is delivered by a nurse from HMP Perth. Chronic disease management is delivered by a pharmacist from Alliance Pharmacy. The main healthcare base is Castle Huntly.
4.4 A doctor covers both sites. His clinic is held every afternoon at Castle Huntly and three mornings each week at Noranside. Prisoners can see the doctor without a nurse in attendance; this happens regularly at Castle Huntly but not at Noranside.
4.5 Addictions specialist input is delivered by a doctor and consists of one session each week. This may be on either site depending on need. Considering the number of prisoners receiving methadone (40), the input required to addictions case management and ongoing supervision of the addictions clinical team, this one session a week should be reviewed.
4.6 A psychiatrist provides support from Perth when required.
Secondary Services
4.7 Prisoners access the local community dental service. Ophthalmology and podiatry are delivered on site. Waiting times for these services are similar to waiting times in the community.
Healthcare Facilities
4.8 The healthcare facilities at Castle Huntly are good.
4.9 The facilities at Noranside consist of one clinical room and a waiting room in a state of disrepair. A Chaplains room can also be accessed and this was being used during the inspection for a Chronic Disease Management Clinic. The clinical room is used as sluice, a doctor's surgery, a file storage area, an emergency room, a pharmacy storage area, a computer access for the team, and a tea/coffee preparation area. It is recommended that the healthcare facilities at Noranside are improved.
4.10 Medication is also dispensed from this area from a wooden hatch in the door. Controlled drugs keys are kept with the main health centre keys which are held in the central area of the prison when the nurse is not on duty. This does not meet the Standard for Safe Operating Procedure for Controlled Drugs (2008). It is recommended that the Standard for Safe Operating Procedure for Controlled Drugs (2008) is met at Noranside.
4.11 Milk and coffee were being stored in the medication fridge: this should stop. There is also a lack of health promotion literature for prisoners at Noranside.
Healthcare Addictions Service
4.12 Forty prisoners were receiving methadone, with over half of those on reducing doses. Prisoners can also receive detoxification, stabilisation and maintenance prescribing. No prisoners have started methadone in the last year - all prisoners taking methadone have been continued on transfer from a closed prison. Input from the Addictions Nurses particularly in relation to pre-and post home leave, and one-to-one throughcare support for those on methadone is excellent. Close links have been established with community pharmacy services. The team works closely with Phoenix Futures to deliver smoking cessation support.
Bloodborne Virus and Sexual Health Service
4.13 This is delivered by a nurse from Perth prison who visits both sites. Extensive links have been made with hospitals in Tayside, Glasgow, Edinburgh and Stirling to ensure continuity of care and ongoing support for prisoners who require secondary care and ongoing treatment. A nurse from Tayside regularly visits to see BBV prisoners on both sites. The BBV Nurse represents SPS on the Scottish Viral Hepatitis Group and attends the SPS Hepatitis C Forum.
4.14 Since January 2008, 100 referrals have been seen at the Sexual Health Clinic. Support, training and supervision are ongoing from Tayside Sexual Health Services. This is an area of good practice.
Mental Health Service
4.15 Prisoners who are acutely mentally ill do not stay at the Open Estate but are transferred back to closed conditions or to a Psychiatric Hospital. Prior to transfer to the Open Estate any prisoner identified as having chronic mental illness is visited and assessed by the Mental Health Nurse, and a member of the local Case Management Board to ensure that he has an awareness of what to expect on transfer and also that the estate can meet the prisoner's health care needs. Home visits and telephone support can also be part of an individual's care plan particularly prior to and during home leave. Over the last year this process resulted in fewer prisoners being returned to closed prisons. This is an area of good practice.
4.16 The Mental Health Nurse has a case load of approximately 35 prisoners over both sites. She is a member of the local Case Management Board. Risk assessment is also undertaken and shared with relevant professionals. Supervision and support is received from the Consultant at HMP Perth.
Management of Medicines
4.17 All prisoners in the Open Estate keep their medication in their possession. Methadone is dispensed on a daily basis on both sites. Standards for Medicines Management (Nursing & Midwifery Council) recommend that for the administration of controlled drugs a secondary signatory is required "within secondary care and similar health care settings". This standard is not always applied in Castle Huntly and is never met at Noranside. It is recommended that a secondary signatory is always available when controlled drugs are being administered.
4.18 No officers are trained as 'Competent Witnesses'. An officer is in attendance on both sites during methadone administration from a security perspective only. At Castle Huntly the officer stands in the healthcare area outside the pharmacy and is able to observe what is happening. However, at Noranside the officer is in the nurse station with the nurse and sight levels are poor. This should be addressed.
4.19 Differing standards of practice are also carried out in relation to urinalyses for Health Care Standard 10. Castle Huntly undertakes urinalyses according to the standard, Noranside does not. This should be addressed.
Chronic Disease Management
4.20 Prisoners diagnosed with a chronic disease (respiratory, cardiac, diabetes) are referred to the pharmacist who looks at the prisoner's full medical history. The prisoner is then seen on a regular basis depending on need. Investigations, treatment and ongoing support are then organised. This information is written into the patient's notes. Although a database is held by the pharmacist regarding ongoing care and treatment, this is not shared with the healthcare team and it is not put into GPASS.
Addictions
4.21 The 2005 inspection report noted that: "staff and prisoners stated that there was a high level of drug misuse" in the Open Estate. At that time, on average, 28% of prisoners tested positive for drugs. This inspection is very different. Prisoners and staff spoke of drugs being available "if you really wanted them". However this appeared to be significantly less of a problem than in the past.
4.22 Prevalence statistics from April to August 2008 showed that 8% of the population tested positive for illegal drugs. The SPS Prisoner Survey supports these findings: in 2007 9% of prisoners in Castle Huntly and 7% of prisoners in Noranside admitted to using drugs in the prison in the month prior to the survey taking place. This is very different from the 2005 statistics which show that 29% of prisoners in Castle Huntly and 17% of prisoners in Noranside had used drugs during the previous month. The reduction in positive tests may be due to lower numbers of prisoners in the Open Estate, but it could also be due to the smaller number of short-term prisoners, and more likely, due to the more stringent requirements for admission to the Open Estate.
4.23 There has been an increase in the amount of drug testing that is undertaken in open conditions: on average 400 tests per month are now taken between both sites. This increase in testing was introduced in 2006, as a consequence of the introduction of the Extended Home Leave scheme.
4.24 The prison also tests prisoners for alcohol misuse on a random basis when they return from placement or home leave. Results show that 2% of prisoners who were tested were positive during the period April to August 2008.
4.25 Another change in strategy is that prisoners in the Open Estate now have access to the same range of clinical interventions that are available in closed prisons.
4.26 Smoking intervention and support is also now available. Both Phoenix Futures and the Addictions Nurse deliver smoking cessation groupwork sessions and one-to-one support. However, throughout the inspection it was evident that prisoners were smoking outwith their cells. This should be addressed.
Addictions Strategy and Co-ordination
4.27 An Open Estate Addictions Strategy was produced in 2006. It has not been updated since then despite progress in a number of areas. The Addictions Strategy Co-ordinator retired earlier this year and as yet this post remains vacant. It is being overseen, but no one has attended any SPS Addictions Co-ordinator Meetings or Drug Action Team Meetings this year. The Enhanced Addictions Casework Services ( EACS) Team Leader represents the prison at Dundee Substance Misuse Forum.
4.28 An Addictions Management Meeting is held every two months. Minutes from the last few meetings show that the Governor, Head of Inclusion, Representative from Enhanced Addictions Casework Team, Programmes and Interventions Officer and Healthcare regularly attend.
4.29 An Addictions Case Management Meeting takes place every two weeks. Any prisoner receiving care from the Addictions Nurse or EACS team can be discussed. The Addictions Specialist Medical Officer, EACS Team and Addictions Nurses attend. The minutes of the meeting are widely circulated and give the reasons for referral, outcome of the referral, first and second reviews, intervention commencement date and further reviews.
Enhanced Addictions Casework Team
4.30 The Phoenix Futures Team comprises a Team Leader, Senior Practitioner, three Caseworkers and an Administrator. They are based in the Links Centres on both sites. Office space and access to SPIN is satisfactory. Castle Huntly has cover five days each week and Noranside three days each week. Although the majority of their workload is office hour based, evening sessions have been arranged to try and engage with prisoners families or to do one-to-one work with families if this has been requested.
4.31 The team delivers support in the form of drugs, alcohol and smoking interventions. A change from the previous inspection is that this service is now available to sex offenders. Other interventions include the national harm reduction awareness session (on admission); addictions ICM assessment; one-to-one work; care plan reviews; pre release home leave group work sessions; alcohol counselling and groupwork; and smoking cessation sessions.
4.32 Prisoners can self refer to the EACT service, although the referral forms are only available in the Links Centres. Self referral forms and addictions literature should be available in the residential areas as well as in the Links Centres.
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