Introduction

8.1 Healthcare within the establishment was overseen by the Healthcare Policy Group which was chaired by the Deputy Governor. In the past it had met infrequently but since October 1997 there had been regular monthly meetings. The membership consisted of representatives from the Healthcare Team, the Social Work Department and Discipline staff as well as the Suicide Risk Management Co-ordinator and the Training and Development Manager. Included in the Group’s remit was responsibility for Suicide Risk Management.

Accommodation

8.2 The Health Centre was situated in a converted hut and consisted of a store room, WC, office, doctor’s surgery/treatment room, a small pharmacy (which was not much bigger than a large cupboard) and a dental suite. There were movable benches down one side of the corridor within the building for prisoners waiting for medical and dental treatment. In overall terms, the accommodation was equipped to a satisfactory standard with adequate resuscitation and emergency equipment readily available.

8.3 Connected to the Health Centre was a 7-bed dormitory which contained a toilet/shower area. This area had a drab appearance and was generally cramped with no nursing station for observing those located there. Supervision could only be achieved, therefore, by a nurse walking from the office and along the Health Centre corridor.

Comment

8.4 We concluded that the Health Centre accommodation was satisfactory for the work that was currently being undertaken, though there are two issues which need to be addressed. Firstly, there was a shortage of storage space and we suggest that it would be possible to make a storeroom available if the dead files currently being stored were removed and transferred to HMP Barlinnie.

8.5 The second issue relates to the dormitory which would benefit from re-decoration and a generally brightening of its appearance. As far as its function is concerned, this would depend on any decisions on the future use of the dormitory which is attached to Alba House. Currently, the medical dormitory is not adequate for locating those who are unwell due to drug withdrawal problems alongside those who are unwell for other reasons. It would, therefore, make good sense to use the ward attached to Alba House for those prisoners with withdrawal problems with the existing Health Centre dormitory then becoming a more truly medical facility. Such a change would of course depend on any future plans to increase the throughput of Alba House.

Medical Records

8.6 At the time of our inspection, medical records were in the process of being transferred from a Kardex system to the new A4 SPS Healthcare Record Folder and were stored in a special shelving system in the office. The old system held clinical records, correspondence and investigations in three different places whereas the new system would incorporate all those data in each prisoner’s individual record. This should be a much more efficient method of medical record keeping and should make information retrieval easier though, as a result of the timing of our visit, it was not possible to make a proper assessment of the system

8.7 Routine statistics of healthcare activity within the establishment were not routinely kept in a way which made them readily available, an issue which requires to be addressed as a matter of urgency. We were provided with data of activity over the seven months prior to our inspection but these did not allow us to carry out any detailed analysis. They did, however, show that on average, one prisoner per week was being returned to HMP Barlinnie due to the lack of suitable ward facilities and the necessary nursing support. The figures also showed that fewer prisoners - i.e. between none and three per month - were being sent to hospital for treatment as in-patients, with only one of those being the result of assault. The number of patients attending out patient clinics ranged on average between two and six per month, whereas the number of patients treated in the Health Centre due to accidents or as the result of assaults, averaged 22 per month. There was, however, no evidence to indicate that this number was increasing.

Medical Officer

8.8 At the time of our inspection, the MO had been in post for about three months having previously worked as a family doctor in the centre of Glasgow. She worked at the prison on five mornings each week from 0900 until 1200 hours but was on call until 1800 hours. Out-of-hours cover was contracted to agency doctors through Medicare.

8.9 Patients were seen in the surgery every weekday morning following an assessment of those reporting sick by a member of the nursing team. The numbers seen by the MO each day ranged from six to ten. Following the sick parade, the MO went to the admission dormitory to examine the new arrivals, all of whom would have been seen by a nurse practitioner the previous day. Any prisoner who caused concern at the initial examination by the nurse was seen by the MO the same day. The doctor also supervised the care of any patients in the 7-bedded dormitory attached to the Health Centre. However, as there was no continuous nursing cover for that area, it limited the type of patient who could be admitted.

Comment

8.10 We formed the impression that the establishment was fortunate in having an MO who was keen to provide good quality care to the patients. She seemed to work well with her colleagues and relationships appeared good. She was new to prison work and we felt it was important for her to establish early on the role which she wished to play in the establishment as this would allow her to develop her ideas for the expansion of medical care in consultation with the nursing team.

8.11 As regards her working procedures, in our view it was neither convenient nor appropriate for the medical examination of new arrivals to be carried out in the admission dormitory and arrangements should, therefore, be made for these to take place in the Health Centre. Should the early implementation of such an arrangement not be possible then, as a temporary measure, the examinations could take place in the area within the Reception which had been customised to facilitate private medical examinations.

8.12 The out-of-hours cover appeared to be adequate but there was some indication that there had been problems with that in the recent past. We suggest, therefore, that in the absence of any overnight nursing cover, this is an area that requires careful monitoring.

Nursing Team

8.13 The nursing complement consisted of a Supervisor and three Nurse Practitioners though for some months prior to our inspection, only two nurses had been in post. Fortunately, that staffing deficit had been filled by the arrival of a newly appointed nurse two weeks prior to the start of our inspection.

8.14 Nursing cover was provided from the Health Centre from 0630 hours to 2130 hours every day. The heaviest demand on nursing time was on weekday mornings when the daily sick parades and the admission of new prisoners took place. The numbers reporting sick ranged between 20 and 30 with six prisoners on average being seen by the MO. A nurse was normally responsible for the initial screening of newly arrived prisoners in the reception area, for which purpose a small room had been allocated - see paragraph 6.4. The MO sometimes took part in that process but more usually, she examined the admissions the next day in their dormitory. Nurses were also responsible, along with the MO, for the supervision of prisoners admitted to the medical dormitory. Blood tests were taken by the nursing staff who also had to make arrangements for specimens to be transported to the hospital laboratory.

8.15 There was a limited amount of preventive medical work and this was carried out by the nurses. It consisted of an asthma clinic and a hypertension screening clinic for prisoners over the age of 30 years. In addition, prisoners were offered HIV and Hepatitis C screening. This was supported by a nurse practitioner who was undergoing training for counselling work.

Comment

8.16 Unfortunately, we were unable to interview the Nursing Supervisor who was not available at the time of inspection. Nevertheless, we formed the impression that the nursing staff were a committed team.

8.17 It was clear that the recent shortage of staff had put the team under considerable pressure and had resulted in extra hours having to be worked. This had a serious impact on the provision of preventive medical work and in particular, it had meant that although screening for HIV and Hepatitis C continued, the time available for appropriate counselling was reduced. That situation will recur in the near future during the maternity leave of one of the nurses. We suggest, therefore, that locum cover should be provided during that period in order to alleviate the problem and reduce the strain on the other members of the nursing team. In our view, it is important that if screening for HIV and Hepatitis C is to continue during that time, the importance of counselling prisoners taking those tests should be recognised with skilled nursing time being made available for that work. Unless time is made available for counselling, it raises serious ethical issues as to whether such testing should be allowed to continue.

8.18 The lack of a Discipline Officer attached to the Health Centre was, in our view, greatly reducing the effectiveness of the nursing team and the potential for carrying out preventive medical work and health promotion was being hindered by the problem of providing escorts. If such Discipline cover could be provided, it would also ensure that the dental surgeon’s patients arrived on time and that prisoners in the medical dormitory would have readier access to the telephone. It would also allow the MO to examine newly admitted prisoners in the Health Centre, which is good practice (see paragraph 8.11).

8.19 We considered that there was an imbalance of duties during the nurses’ working day in that the sick parade and admissions occurred in the morning. A trial of evening sick parades had recently been introduced and under that procedure, nurses saw prisoners reporting sick in the evening and gave appropriate advice/treatment or arranged for them to see the MO the following morning. The system had, however, been abandoned for administrative reasons, a decision which the nursing team regretted because it appeared to have been working well. Holding an evening sick parade would free time during the day which could be spent on activities such as health promotion and counselling. We suggest, therefore, that further consideration should be given to holding evening surgeries as a means of improving the efficiency and effectiveness of the Health Care Team.

Dental Surgeon

8.20 The dentist had worked in the prison for four years having previously worked in HMYOI Dumfries. On his appointment, the dental suite had been completely refurbished with modern equipment being installed, including sterilising equipment, though where possible, disposal equipment was used to reduce the risks of cross-infection. The dentist had two sessions weekly on Monday and Thursday mornings and brought his own dental nurse.

8.21 Most of the patients seen were in need of pain relieving procedures and dental hygiene. There was little opportunity to undertake prophylactic dental work given the demand on the dentist’s time and the length of time prisoners spent in the establishment. The waiting list was normally about two weeks.

8.22 The dentist said he was happy with the arrangements for dental care in the prison, his only criticism being the delay which sometimes occurred in prisoners arriving for his list. He also highlighted the fact that the rise in dental fees in the NHS could impact on the budget allocated for dentistry and this needed to be recognised.

Comment

8.23 In overall terms, the arrangements for dental care at the prison appeared to be very satisfactory.

Pharmacy

8.24 The pharmacy was situated in a small cupboard-like room which was entered from the dental suite. It contained a limited range of therapies based on the protocol suggested by the Glasgow Drug Formulary, with supplies being obtained from Glasgow Royal Infirmary. Drugs which were likely to give a positive result in the event of a prisoner having a mandatory drug test were not stocked. The facilities were cramped but adequate and the stock was regularly checked by prison management.

8.25 The arrangements for dispensing drugs involved the MO handing out the medication to each patient. Usually this involved a week’s course of treatment but if therapy was required on a repeat basis, this was done by a member of the nursing team.

8.26 At the time of our visit, discussions were taking place with the staff of the pharmacy at the Infirmary with a view to changing those arrangements, the aim being to have the Hospital pharmacy dispense the appropriate course of treatments. That would then avoid the need for the MO or the members of the nursing team to act as dispensers.

Comment

8.27 The pharmacy arrangements were not completely satisfactory though clearly the arrangements in operation at the time of our visit were a temporary measure to overcome the secondary dispensing duties carried out by nursing staff. However, as some secondary dispensing by nurses was being undertaken, it is essential that a system for the longer term is introduced through the use of a Hospital or community pharmacy.

Other Medical Services

8.28 The establishment relied on HMP Barlinnie for the provision of certain specialist medical and nursing services such as psychiatry, psychology and ward nursing where continuous supervision of patients was essential. We were satisfied that the provision of those services was available when requested and the arrangements did not therefore give rise to serious difficulties.

Healthcare Summary

8.29 On the whole, we were content with the current standard of medical care being provided for prisoners in the establishment. Additionally we were impressed by the work which was being done in Alba House to help prisoners with addiction problems (see paragraphs 5.10-5.11).

8.30 We also considered that the lack of routine Discipline staff as part of the Health Centre restricted both the range of activities and the efficiency of the health team and we suggest, therefore, that consideration should be given to the provision of such routine cover.

8.31 Finally, we suggest that there should be an upgrading of the medical dormitory and its possible extension in tandem with improved nursing cover. In our view, this would improve the range of care available within the establishment and make it less dependent on HMP Barlinnie.