8. HEALTHCARE

Introduction

8.1 Management and strategic planning of healthcare within the Institution was by monthly meetings of the Health Care Management Group (HCMG) which was chaired by the Governor and whose membership comprised the Deputy Governor, the Senior Social Worker, the Clinical Supervisor and the MO; reporting to the HCMG were two sub-groups which dealt with HIV/Aids and Addiction.

Medical Unit

8.2 The health centre was situated in the ground floor of ‘D’ Hall, with accommodation consisting of a pharmacy store, MO’s consulting room, dental suite, nurses’ office and Clinical Supervisor’s office. In addition, there was a store room, a treatment room, a waiting area and toilets. The treatment room was adequately equipped and there was comprehensive resuscitation equipment which was checked monthly by one of the nursing team.

Comment

8.3 Accommodation was about adequate; however, it did not have in-patient or day care facilities, which would greatly facilitate the work of the medical team by providing a much more relaxed environment for the management and care of ‘at risk’ remands. The area also needs redecoration and the flooring should be refurbished.

Medical Officer

8.4 The MO had been in post for ten years and was contracted to work 12 hours per week for consultation purposes. He also had on call responsibilities but now shared the out of hours rota with the MOs from HMPs Shotts and Low Moss, an arrangement which we were told considerably improved the level of service on offer. He usually attended every weekday morning including Saturday, or made arrangements for locum cover, and saw all admissions from the previous day, as well as anyone who required a medical consultation following triage by the nursing staff. All referrals for specialist opinion, including psychiatry, were also normally referred through him. In addition to his membership of the HCMG, he had an input to the SRMG - see paragraph 5.18.

8.5 Sick parades took place every morning except Sunday and were carried out in the health centre. On average, the daily parade numbered seven in addition to which, seven admissions were normally seen each day. The MO saw those whom the nursing team assessed as requiring his opinion, whilst the remainder were treated by the nursing team according to clearly defined protocols which were supported by a comprehensive nursing formulary. Consultation statistics for the year prior to our inspection showed that the main medical problems requiring treatment were those associated with the respiratory tract, skin, musculo-skeletal system, digestive system and drug addiction problems. Those statistics also showed that 8% of cases involved self inflicted injury or suicide risk. Over that same period, there had been 12 hospital admissions, one of which had been to the State Hospital at Carstairs. Three admissions had been associated with attempted suicide.

Comment

8.6 We concluded from our inspection that the MO was committed to the work he carried out in Longriggend and his working relationship with the nursing team seemed to be satisfactory and mutually supportive in dealing with a very vulnerable age group. We did form the impression, however, that his other work outside the Institution could at times make his hours of attendance and availability unpredictable. We also gained an impression that whilst the MO sometimes became involved in dealing with drug dependent remands, this work was often left to the drug addictions worker - see also paragraph 5.10. It was not clear to us that there was a consistency of approach in this respect and we suggest that much clearer protocols are required for the management of remands who have identified drug dependency problems.

Nursing Services

8.7 The nursing team consisted of a Clinical Supervisor and three nurse practitioners. Nursing cover was provided from 0600 to 2130 hours Monday to Friday and from 0730 to 1730 hours at the weekend but in order to meet this arrangement, the Clinical Supervisor was regularly required to cover nurse practitioner shifts.

8.8 Members of the nursing team saw all admissions in the reception area where they worked from a large but spartanly furnished room. At the time of our inspection, new arrivals were being processed using the SPS’s new A4 medical records. All admissions were normally seen by the MO the day following their arrival, unless there was an urgent medical problem which required his opinion.

8.9 Each nurse practitioner had been allocated responsibility for monitoring and maintaining contact with those remands who had been identified as possible suicide risks. The names of those individuals, along with the name of the responsible nurse, were identified on a board in the nurses’ office. Whenever staffing and discipline cover made it possible, group sessions for vulnerable or at risk remands were run in the Health Centre in addition to the work done by the Social Work Unit with this group. Prior to attending those group sessions, each potential member was assessed using a structured interview to establish the topics which would be suitable for discussion within the groups. If appropriate, one-to-one sessions were arranged.

Comment

8.10 We were impressed by the work of the nursing team and thought that the Clinical Supervisor was more than adequately performing his duties as team leader. He was keen further to develop the services provided, particularly with regard to group work. It was also pleasing to note that there had been a high level of training provided for the nursing team, which had greatly facilitated the design of a variety of patient care protocols. A lack of night cover did not appear to have caused any serious difficulty, but is a situation which should be kept under review.

8.11 There were two problem areas relating to the working of the nursing team which if resolved, would undoubtedly lead to an improvement in the quality of care for the remands. Firstly, the shortfall in nurse practitioners for covering the rota - and the use of the Clinical Supervisor to make up that deficiency - reflected on the effectiveness of the nursing team. In particular, that lack of proper staff cover had an impact on group work and the implementation of other intervention strategies. One additional member of the nursing team would make a marked difference to the development of pro-active nursing and we therefore so recommend. The second problem related to the availability of Discipline staff for escort duties, as it further limited the amount of activities which could take place in the health centre. We suggest, therefore, that there should be a review of the existing arrangements to ensure consistency of cover.

Medical Records

8.12 New A4 records were being used by medical and nursing staff and were being filed in the health centre. Entries on those records were being made by all members of the health care team, including the visiting psychiatrist. At the time of inspection, the transfer of old records to the new system was almost complete and some special filing cabinets which were on order should resolve any security problems.

Comment

8.13 Initially, the new record-keeping system had produced extra work for the nursing team, who at the time of inspection were still becoming familiar with the new protocols involved. However, the team is to be complimented for its introduction of that new system which, given its requirement for more detailed entries about admissions, represents a considerable improvement over the previous system.

8.14 We were pleased to note that all the medical records appeared to be well maintained and comprehensive, with appropriate information on medication being included. We were also reassured to note that the visiting psychiatrist made notes in the records to ensure that there was clear communication with medical and nursing staff.

Pharmacy

8.15 The pharmacy store contained all the appropriate drugs and topical treatments and plans were in hand to introduce an emergency drug pack prepared by the pharmacist at Monklands Hospital, from where routine drug supplies were obtained on a regular basis. If a drug was required urgently, it could be collected from the hospital on the same day. The pharmacist from Monklands visited the pharmacy twice yearly and the Clinical Supervisor carried out monthly audits; spot checks were also carried out by the Governor.

8.16 The stock which was held in the health centre was based on the drug formulary which had been devised by the MOs working in Scottish penal establishments and which was used for the majority of prescriptions. A day’s medication was normally supplied in the Halls by the nurses but where someone required a drug which had the potential for abuse or where the consequences of omitting to take medication could be serious, the drug would be administered in individual doses.

Comment

8.17 We were impressed by the efficient way in which the pharmacy was run and there appeared to be good control over the stock which was held there. The use of a drug formulary was also helping to keep drug costs within budget. Our only criticism was that some means should be found to avoid secondary dispensing by nursing staff.

Psychiatrist

8.18 At the time of inspection the consultant psychiatrist, who was based at the Douglas Inch Clinic in Glasgow, was unavailable for interview though we did speak to the Senior Registrar. The psychiatrist normally visited the Institution every Wednesday for a 2-3 hour session in addition to which she was involved with the SRMG - see paragraph 5.18. There were about 10 cases per week and full reports on each were sent to the MO. In general, there was very little direct mental illness, though there were occasional referrals to the State Hospital at Carstairs.

Comment

8.19 The psychiatrist was of the opinion that many individuals were vulnerable, especially in their first few days of custody. Increased telephone contact with families and the establishment of day care facilities were thought to be of particular priority.

Dental Surgeon

8.20 The dentist, who came from a local practice, normally attended on Thursday afternoons and dealt mainly with acute problems. He said that he had very little, if any, contact with management and no recent direction on what he should be doing. The main difficulty appeared to be some waste of his limited time, as a lack of Discipline cover often meant that patients could not be brought to his surgery in the required timely manner; quite often, in fact, he was left doing nothing. We have, therefore, written to the Governor about these issues.

8.21 The surgery was well equipped with modern equipment and an X-ray machine. We were also pleased to note that a staff alarm had been installed.

Medical Summary

8.22 In general, we were impressed by the quality of health care being provided and by the way in which it was all documented. However, the potential for further development was being hampered by staffing problems which could be overcome by the addition of one more nursing post. The management of ‘at risk’ remands would also be enhanced by the provision of a facility within the health centre.