| Report
on HM Prison Shotts
HM Inspectorate of
Prisons for Scotland 1998
8. HEALTH CARE
Introduction
8.1 In general we found that the health care team was
approaching its task in a most positive manner, an example being its willingness to carry
out user surveys and to act on their findings. It had also produced a report on the
operation of the health centre, assisted in an evaluation of the local drug detoxification
programme and been involved in the development of health care activities at national
level. A wide range of consultants clinics had also been introduced, as had an excellent
proactive approach to blood borne diseases.
Accommodation
8.2 The Health Centre was based in the main
management/administration block. It comprised a small general office and an office shared
by the centre Manager and Clinical Supervisors, together with a large treatment room,
waiting room, pharmacy, dental suite and a four bedded ward. All the rooms were off a main
corridor at the end of which was a separate area which contained three cells, two of which
formed the drug detoxification unit.
8.3 The treatment room was well equipped for a variety of
treatments including minor surgery and was also used by visiting hospital specialists. It
contained a range of resuscitation equipment and there was ample fitted cupboard space for
the storage of equipment and dressings.
8.4 In addition, each Residential Hall had a room in which
nurses and the MO were able to see prisoners; these contained basic furnishings such as a
desk, chair and examination couch.
Comment
8.5 We had commented on the poor accommodation in our 1994
report. However, on this latest occasion it was obvious that the facilities were now well
below what was needed on a sustained basis to meet the new SPS health care standards.
Staff were managing to maintain a good standard of care but there was no separate
consulting room and the doctor’s room was located some distance away. The general
office was extremely cramped and conditions militated against patient privacy and were not
conducive to the promotion of health. Additionally, the centre was some considerable
distance from the Residential Halls, the NIC and Shotts Unit, which greatly added to the
escort burden. The full range of equipment was not available to staff who saw prisoners in
the Halls, nor was there access to medical records for the nurses carrying out morning
triage. The potential for unnecessary delay in attending to emergencies also has to be
considered, whilst the presence of the health centre in the main administration block can
present a number of security risks. We therefore recommend that the health centre
is re-sited in a more central area. Its facilities should also be matched much more
closely with current clinical needs.
Medical Officer
8.6 The number of prisoners reporting sick was averaging
just over 40 a day, three quarters of whom were dealt with initially by the nurse
practitioner. The remainder were then seen later by the MO, who attended the prison for 26
hours per week. He also saw all newly admitted prisoners.
8.7 Additional arrangements had been made with local
Hospital Trusts for specialist consultants to hold clinics in the Health Centre (assisted
by members of the prison nursing team). Referrals were normally made by the MO and where
appropriate, prisoners were admitted for inpatient investigations and treatment, with
follow up appointments normally taking place in the prison. (If an urgent appointment was
required, a specific visit would be arranged, though each specialist tended to wait until
a suitable number of patients had accumulated before coming to the prison.)
Comment
8.8 The MO was becoming more involved with Monklands
Hospital in preventive work, particularly in the field of blood borne diseases. Within the
prison, a Clinical Supervisor who had received specialist training in this field organised
the basic work which involved a programme to identify prisoners who were positive for
Hepatitis C and included pre and post-test counselling, which was carried out by trained
counsellors from either the Social Work or Addiction Units. Blood tests were available to
those prisoners who requested them and all those found to be Hepatitis C positive were
later tested again in order to establish the progress of their infection. Individuals
could also be referred to the specialist for advice on treatment and management. (At the
time of inspection 45 prisoners had been so identified, a level which initially we thought
was high, though given the fact that similar problems are encountered in the community,
this is perhaps not quite so surprising.)
8.9 We noted that a member of the Discipline staff was
present during medical consultations and given the history of assaults on MOs at Shotts
this presence was understandable. Equally, whilst a private consultation was possible if
requested, medical confidentiality was not routinely being maintained, a practice which is
unacceptable. We strongly encourage the search for an alternative solution.
8.10 We thought that the special arrangements which had
been made for consultant clinics were excellent. Apart from the obvious security
advantages of avoiding the need for transport and escorts, it also meant that there was
easy communication between members of the health care team and hospital specialists on
patient management; it also helped to avoid misunderstanding about prescribed drugs, which
might conflict with the prison formulary and prescribing policy. The hospital consultants
said that they found these arrangements did not conflict with their policy for outpatient
consultations - indeed they said that the system worked far better than the alternative of
prisoners having to attend their hospital clinics.
Nursing Services
8.11 The nursing team provided a 24 hour service with staff
rotating between day and night shifts. It comprised two Clinical Supervisors, nine
Practitioner Nurses and one Health Care Assistant. Approval had also been given for two
additional nursing posts and at the time of inspection, starting dates for new post
holders had been agreed.
Comment
8.12 The health centre Manager and one of the Clinical
Supervisors were leaving to take up work at HMP Kilmarnock. We noted that the practitioner
team appeared to be strong in its support for each other and had established good
multi-disciplinary working relationships with other health care professionals, the
Addictions Unit and Discipline staff. However, morale seemed to be mixed; whilst
individuals were positive about their own peer group support, there was a sense of unease
about relationships with management, with nurses describing a lack of involvement in major
decision making. That said, sick absence levels were relatively low compared to other
establishments, though a relatively high level of TOIL had been accumulated. Recent
changes in staff also highlighted the need for improved succession planning and staff
retention practices.
8.13 The health centre adopted a primary care approach to
service delivery and in the main, the work of the nurses was largely focused on reactive
care and treatment arising from day-to-day health problems. There was also an ongoing
health surveillance element arising from MDT and the testing for Hepatitis and AIDS,
whilst considerable nursing time was being expended in the area of pharmacy and the
administration of medicines. Much of the reactive care work was being driven by the
traditional sick parade but it might be possible to release more nursing time were an
alternative system similar to that at HMYOI Polmont to be introduced.
8.14 The nursing role in the field of chronic disease
management was changing, nurses having previously taken the lead in disease specific
clinics. However, Clinical Supervisors were now undertaking this role but whilst the
excellent clinical skills of the Supervisors had made this practice possible, it should be
recognised that recruiting to such a level of knowledge and clinical skill might be
difficult in future.
8.15 We were pleased to see that there was evidence of a
keen commitment to health care user surveys and the use of audit and morbidity data as a
means of improving and shaping nursing services. A nurse led dermatology clinic was also
now in place.
Psychiatric Services
8.16 These were provided by specialists from Hartwood
Hospital. Two psychiatrists attended the prison for a total of three sessions each week
and we were told that there were about 200 referrals a year, the majority of which came
from the MO.
Comment
8.17 Hartwood Hospital has no secure beds which means that
prisoners with treatable psychiatric illnesses must be cared for within the prison unless
admission to the State Hospital is appropriate. (Considerable strain can thus be placed on
prison staff when they have to cope with disturbed prisoners, a situation which can only
be properly remedied in the long term by the separate provision of more secure psychiatric
beds at a national level, a matter which is beyond our remit.)
8.18 The projected appointment of a full-time mental health
trained nurse should go some way to providing the visiting psychiatrists with more first
hand information about prisoner referrals. This will also allow for more comprehensive
monitoring of treatments and progress and should further improve communication between the
psychiatrists and the rest of health care team. The use of therapeutic groups which would
further meet the needs of the psychiatrists is a development which might also be
considered for this post. In addition, consideration ought to be given to the opening of a
day care unit.
8.19 The psychiatrists to whom we spoke said they were
satisfied with the way the service operated; it also appeared that they were well
supported in their work by the health care team and management.
Pharmacy
8.20 Supplies were obtained under contract from Kirklands
Hospital with drugs being stored on open shelving in a small pharmacy room. A computer
system had also been installed to maintain a medication record for each patient and to
produce a dispensing label in keeping with statutory requirements. Prescriptions were
maintained on a manual Kardex.
8.21 Prescribed drugs were prepared by a nurse on night
duty and medication was given out to prisoners in the medical room in the Halls. In
addition, in agreement with the MO, nurses were allowed to give out medication within a
limited range for symptomatic treatments (though we were concerned to learn that medicines
could be left with Discipline staff if the patient was not readily located in the Hall).
Currently there were 170 prisoners on repeat medication, this number having trebled over
the last three years, possibly due to the introduction of a more proactive health care
policy.
Comment
8.22 The pharmacy was poorly situated, as it was next to
the prisoners’ waiting room and an area in which prisoners were undergoing
detoxification. This posed a security risk, but if the health centre were to be relocated
(see paragraph 8.5) this problem would be resolved. The use of a local formulary for
prescribing ensured that pharmacy stocks were being kept to a reasonably low level and the
arrangement of the stock on the shelving was well organised and allowed for easy
stocktaking. We were also advised that discussions were underway to try and resolve the
issue of secondary dispensing by nursing staff.
Medical Records
8.23 The medical records, which were kept on shelving in
the General Office, were neatly filed and a random selection indicated they were being
relatively well maintained. Whilst all members of the Health Care Team made appropriate
entries, these were not available when triage was carried out in the Halls, during which
nurses worked from a day book. Visiting hospital consultants brought their own hospital
medical records for their clinics.
Dental Surgeon
8.24 A dental surgeon attended the prison three times a
week with an assistant and it appeared that a full range of treatments was being
delivered. However, much of the dental equipment was obsolescent, with lighting, x-ray and
aspirating equipments, the compressor, chair and bracket table all in need of replacement.
Ancillary Services
8.25 Support for the treatment of musculo-skeletal
disorders was available via fortnightly visits from a physiotherapist who also provided
acupuncture treatment. A chiropodist and optician also attended fortnightly. |
