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HM INSPECTORATE OF PRISONS FOR SCOTLAND

REPORT ON HM PRISON : CASTLE HUNTLY 2002

CHAPTER EIGHT : HEALTHCARE

Introduction

8.1 Castle Huntly is an open prison and largely does not require the services of a large healthcare team – for example, the nurse is based in nearby HMP Perth. Nevertheless, though small, the healthcare team adopts a commendably holistic approach to the care of prisoners, which was reflected during our inspection.

Accommodation

8.2 The Health Centre consists of a small L-shaped medical room with an adjoining dental surgery door. The medical surgery contains storage shelves for medical records, a locked cabinet for prescribed medication, a separate locked cabinet for controlled drugs, a stock cabinet, and cupboards for dressings and medical equipment. There is also an examination couch, desk and chairs, together with two dressings trolleys and an examination lamp. In addition a fax machine for requesting prescribed drugs from the contracted chemist is also available. There is, however no waiting area for patients, though we were told that plans were in hand for one.

8.3 The accommodation is adequate but cramped and this does not make it easy to carry out examinations when patients are required to be recumbent.

Medical Services

8.4 The medical officer is a partner in a local general practice, and at the time of the inspection was providing 24 hour cover for the prison (his partners were not involved in these duties but he was hopeful that this situation would change in the near future when the commitments of one of his partners would permit him to become available for locum cover for the prison).

8.5 In keeping with current SPS policy the medical officer was under contract to MEDACS. He attends the prison on three days each week for the purpose of examining prisoners as part of statutory requirements and also sees those prisoners referred to him by the nursing staff.

8.6 On average the doctor saw 30 prisoners a week. He referred between one and two prisoners per month for inpatient treatment. Figures for referrals for outpatient treatment were not available. He was also able to use the services of a chiropodist and an optician who were available on a sessional basis.

Comment

8.7 The medical officer said he received excellent support from the nursing staff and prison management, and was generally content with medical arrangements, though he said he found the surgery facilities were cramped. He was also concerned about the soundproofing of the surgery.

8.8 He had considerable concern, however about the ongoing problem of illicit drug use which presented the healthcare team with a dilemma as to how the problem should be handled from a medical perspective. This issue was of particular concern when prisoners volunteered information to healthcare workers and requested help and possible detoxification. Resources for detoxification were not available to make this a standard procedure.

8.9 The MO also said that a weekly physiotherapy session would greatly enhance the service and reduce pressure to prescribe medication. He also thought that an alarm should be installed in the surgery (which is now common practice in the community).

Pharmacy - Comment

8.10 The establishment does not have a separate pharmacy, but uses customised cabinets in the surgery accommodation to store all medications. There were three such cabinets, all of which were secure and had been approved by an inspecting pharmacist.

8.11 Prisoners are normally given a week or monthly course of treatment and have responsibility for their own medication (as would occur in the community).

8.12 The pharmacy receives its supplies through the SPS pharmacy contract which also ensures that stocks and treatment courses are regularly checked and the pharmacy arrangements inspected. As routine the prescriptions were faxed to the central pharmacy and delivered the same day. (In the event of a drug or treatment being required urgently outside the routine delivery schedule it could be obtained from a local pharmacy.)

8.13 Appropriate up to date documentation was being maintained by the health care team and a proper record kept for each patient.

Medical Records and Documentation - Comment

8.14 The A4 size medical records were stored in shelving in the surgery and from a random sample appeared to be well maintained. They included a comprehensive admission summary as well as information obtained at the recently introduced Well Person Clinic, though they did not contain dental information (nor did the dentist write in the records).

8.15 There was also a comprehensive record of hepatitis B immunisations which showed an extremely high uptake with both the initiation and completion of courses of treatment.

8.16 Nevertheless, we believe that information should be more readily available on the activities of healthcare within the prison; for example the number of patients referred for outpatient treatment etc.

Psychiatric Services

8.17 Specialist psychiatric advice is provided through the mental health team at HMP Perth.

ACT - Comment

8.18 There had been no prisoners on ACT since 1998/99, and arrangements for ACT within the prison were under the supervision of an ACT co-ordinator and a Suicide Risk Management Group. The ACT co-ordinator also supervised the Listener Scheme within the prison, in addition to the support which was given by the local branch of Samaritans. The Suicide Risk Management Group met quarterly with prisoner representatives also attending these meetings.

8.19 ACT documentation was readily available and we found that most staff had received training (with two trainers at the prison to provide ongoing training for staff). We were very pleased to note that the establishment had produced a support criteria "for Life Sentence Prisoners Awaiting the Designated Punishment Part of their sentence" as part of an ongoing review and assessment of potential risk. This we consider to be an example of Best Practice.

8.20 The Listener Group (3 at the time of inspection) also held monthly meetings with the Samaritans and plans were in hand to increase the profile of the Scheme within the establishment. (For example, we were shown posters and photos of listeners which were to be put on display to increase awareness. Listeners also contributed to the induction programme.)

Dentist

8.21 The dentist held weekly sessions in the prison, and provided her own dental nurse for these. The dental surgery was adjacent to the medical surgery and was provided with a standard range of equipment, including x-ray facilities.

Comment

8.22 Facilities for sterilisation were satisfactory, and the surgery had been inspected within the last 2 years by representatives from the Health Board (though we noted that cleaning up of the surgery was not always being carried out on a weekly basis).

8.23 Though equipment was in good condition, it was old, whilst the dentist had also identified a need for a new amalgamator (with sealed capsules and some additional hand pieces) which we fully support.

8.24 The dentist and her nursing colleague also expressed some anxiety about personal safety. (Not based on specific incidents per se, but rather on the fact that they worked alone in an area which was fairly isolated). We believe, therefore, that it would be appropriate to install an alarm system in the surgery, and also to offer some security training to the dental nurse.

Nursing Staff

8.25 The health service is staffed from 0730 to 1530 hours; Monday to Friday, by one registered nurse. There is no nurse on site at weekends. Any health problem arising after 1530 hours on a weekday, and at a weekend, are directed by the duty prison officer to the health centre at HM Prison Perth.

8.26 The nurse working at Castle Huntly is part of the nursing team at Perth. Registered nurses are rotated to cover a 3-6 month period of duty at Castle Huntly.

8.27 The current nurse is a registered mental health nurse; she is enthusiastic and demonstrated a good rapport with the patients; she also demonstrated sensitivity to the needs of patients. A second nurse (a registered general nurse) covers any absence and annual leave. The deployment of mental health skills has enabled the nurse to detect a range of needs amongst those prisoners who are close to release. These needs include life support skills, coping skills, relationships, health promotion and dealing with anxiety.

8.28 The duty nurse, although working apart from the main nursing team at Perth, did not feel isolated and was well supported by the visiting medical officer and other visiting health professionals. She is involved in teams that address sentence planning, pre and post home visit reviews and discharge planning; she is well supported by the prison management team and relationships with the prison officers are good.

Nursing Practice

8.29 All prisoners who are transferred to Castle Huntly are given a health assessment by the nurse prior to an assessment by the medical officer.

8.30 As a single practitioner the nurse provides the full range of clinical services to prisoners. These include emergency treatment in the event of accident or sudden illness; chronic disease management; daily triage for primary care; prevention of illness through a prescribed immunisation programme; administration of medicines; mental health assessment and the monitoring of substance abuse; also health promotion. The nurse has developed good networks with external agencies that can offer clinical support.

8.31 The nature of this post requires the nurse to undertake all the administration needed to support the health centre. We understand that clinical supervision and nursing standards are undertaken by Perth Health Care Management. We were disappointed to note however that an audit of SPS nursing standards had not been carried out for some time.

Comment

8.32 The size of the prison population and the nature of the prison regime enables the nurse to deploy her mental health skill in the field of one to one consultations, which provides adequate support for prisoners.

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