Report on HM Prison Noranside

HM Inspectorate of Prisons for Scotland 1998

8. HEALTH CARE

Introduction

8.1 Medical and nursing arrangements were based on part-time working by the nurse practitioner and the MO. Although we were satisfied with the quality of health care, we came to the conclusion that extra nursing cover was required in order to meet the SPS Standards for the Health Care of Prisoners which were introduced in 1998. The range of medical conditions which were now being seen in the establishment added further weight to this need.

Accommodation

8.2 The Health Clinic was situated within the Administration building. It consisted of one large multi-purpose room which served as a consulting room, examination room, treatment room and general office. There was also a small but adequate separate waiting room.

8.3 The medical room also acted as a pharmacy insofar as it was provided with two metal lockable cupboards in which drugs and topical treatments were stored. There was also a fridge (which did not have a lock) in addition to which there were washing facilities and a sink, a range of medical equipment for examinations and treatments, a set of weighing scales and some basic resuscitation equipment. There was also a number of built in cupboards and next to the desk was a fax machine. This room was also used to store the medical records, which were all filed in A4 folders in metal shelving. Part of the room was separated off by a heavy screen behind which was an examination couch and lamp.

Comment

8.4 In general, the facilities were adequate for the size of establishment. The room was clean and the equipment was set out neatly. The drug cupboards were well organised and the stock had clearly been kept to a minimum, compatible with the day to day needs of the prisoners who required treatment.

8.5 We believe, however, that there are certain changes that could be made to improve the existing facilities. Firstly, the area for carrying out examinations was separated by a good quality screen but we suggest that it would be better if a separate room could be provided for this purpose. This would not only ensure confidentiality and a suitable degree of privacy but it would also allow a more efficient arrangement when the nurse practitioner and the MO were working together. Secondly, we have written to the Governor suggesting that a number of new items of equipment should be purchased.

Medical Officer

8.6 The MO was a partner in a local practice. He worked two sessions weekly in the prison on Tuesday and Friday mornings, seeing between 10 and 12 patients at each session. In the event of him being unavailable, one of his partners carried out the necessary duties. For the rest of the week the MO was available for advice, with out of hours cover being provided by a rota of doctors which had been set up by the local practices which served the area that took in Noranside. The MO encouraged ‘open access’ and in the event of a prisoner requiring to be seen outwith his normal consulting times, either he or one of his partners was available in his surgery, with transport being provided by the prison. Prisoners could also be referred to the Accident and Emergency Department of Strathcathro Hospital, which also provided out-patient as well as in-patient services for the prisoners. On average, there were about four referrals each week. In addition to this provision, the MO had access to general practitioner beds in the hospital at Forfar, which he could use to provide in-patient treatment for prisoners when appropriate.

8.7 The MO, together with the nurse practitioner, normally saw admissions on Tuesday mornings after their arrival the day before. Routine consultations were also included in this session.

8.8 There was no routine psychology cover available to the establishment though if this was required, then it would be provided either through the psychologist attached to the MO’s practice or if it was for parole purposes, through HMP Perth. In the rare event of a psychiatrist opinion being required, the local psychiatric hospital specialist staff would be consulted.

8.9 Other specialist services supporting general health care were those of a dental surgeon who provided one session weekly in his own surgery, an optician who provided consultations for prisoners as required and a chiropodist who attended the prison bi-monthly.

8.10 In addition to his clinical work, the MO was a member of the establishment’s ACT Strategy Group. He was also a member of the Healthcare Strategy Group, the other members of which were the Deputy Governor (who chaired the Group), the nurse practitioner, the drugs co-ordinator and a Residential Officer who had the role of alcohol programme co-ordinator. Whilst we were pleased to learn that this Group had been established, we were disappointed to note that at the time of the inspection, it had not actually held any meetings. We were assured, however, that a date for a meeting would be set once the new Deputy Governor took up post.

Comment

8.11 We were impressed by the service provided by the MO and by the good working relationship which he appeared to have both with the nurse practitioner and with other prison staff. The ready access to a medical opinion outwith his prison sessions and the additional availability of his services through the use of his general practitioner beds were, in our view, to be commended.

8.12 The MO was content with his working arrangements but he was concerned that the current nursing hours were insufficient to maintain the level of medical care now demanded of the prison service. In his opinion, this was preventing the development of health promotion and chronic disease management programmes. He was also of the view that in addition to extra nursing hours, there was a need to link with other local penal establishments if health promotion was to be introduced on a cost-effective basis. These are views with which we concur.

Nursing Services

8.13 Nursing provision within the establishment was provided by a part-time nurse practitioner who worked 19 hours a week. Within this time he was required to triage the 10-12 prisoners on average who reported sick between Monday and Friday. He was also expected to prepare and administer prescribed medication, carry out treatments, see all admissions and prisoners about to be discharged and contribute to the ACT strategy. In addition, he was required to carry out all administrative work in relation to health care as well as the monitoring and ordering of pharmacy stock from Strathcathro Hospital. He also assisted the MO in his twice weekly clinics.

8.14 On a daily basis, the nurse practitioner dispensed prescribed medication in the medical centre and then administered the appropriate doses in the residential Wings. Certain long term medication, involving about 40 prisoners, was made up by the nurse on a weekly basis.

Comment

8.15 The nurse practitioner had previously worked abroad for 14 years and had a great deal of experience of working unsupervised and this was an undoubted advantage in this particular post. However, it was clear to us that the nursing hours required to be increased if the SPS’s Standards for the Health Care of Prisoners were to be met. These Standards require that health promotion forms part of good medical care and whilst we accept the argument that one nurse practitioner might not be able to carry out all this work, we believe that he should have time to contribute to at least part of it. In addition to general medical care, two other areas of work within the establishment made demands on nursing time which could not easily be met within the current working arrangements. One was work connected with the implementation of the ACT strategy, the second was in connection with MDT, when appropriate information regarding any medication being prescribed for prisoners being tested was required by Discipline staff.

8.16 A nurse working longer hours would also be more available to talk to prisoners with a variety of problems and to give psychological support where necessary. At present, the lack of time prevents this type of work and we recommend, therefore, that there should be an increase in the number of nursing hours.

8.17 The secondary dispensing work being carried out by the nurse should cease. It is not legally defensible, particularly because of the considerable risks involved due to the fact that the person concerned is working alone. Efforts should be made to resolve this problem locally prior to the introduction of a national policy on this issue. The solution should also include the monitoring and controlling of the pharmacy stock.

8.18 It is important also that the nurse practitioner receives any necessary training to enhance the work that he is already undertaking. We see it as important that his attendance at appropriate courses is facilitated.