HMP Altcourse

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked at 2 quality statements in this key question. Clinical activities took place as planned with little or no delay, which meant patients benefited from timely assessments, care and treatment.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

At our last inspection, we found several areas where there were delays to assessing the needs of patients, including nurse triage, routine clinics, health screening and care planning. This time we found there had been many improvements, the most notable in the primary and secondary screening assessments of new arrivals to the prison.

Last time, the provider used a brief screening assessment (exceptional safety assessment (ESA)) to see new arrivals because they did not have sufficient resource to complete full screenings for everyone. At this inspection, we found that the ESA had only been used on one day in the last 3 months due to the additional staffing resources in place. This meant patients received a comprehensive assessment on their first night in custody. This was despite the high number of new arrivals and reduced access to the reception area, which was undergoing refurbishment.

At our last inspection, we found a backlog of 333 patients who had not received a secondary reception screening. At this inspection, we found that this had been addressed and increased staff resource and daily reporting meant that secondary screenings were now well managed, and no patients waited longer than the recommended 7 days. The reduction in the use of ESAs also helped ensure timely secondary screenings as now staff rarely had to complete outstanding initial reception screenings from the previous day. These improvements meant that managers had time to oversee clinical activities and make the most efficient use of clinical time.

Since our last inspection the process to manage patient applications via the electronic prison system had been streamlined. A senior paramedic now oversaw all applications and had provided training to nurses to upskill them in the triage of applications. All staff now had access to the electronic system to support triage. Managers allocated a clinician daily to triage applications from the previous day, and GPs also reviewed the system daily to identify patients to add to their waiting list. The number of patient applications remained high, however, this was reviewed daily at the staff handover to identify any actions required.

Routine health clinics were now running consistently in primary care with 3 days of long-term condition clinics followed by 2 days of vaccination clinics. Clinics were overseen by the primary care lead who now had the capacity to manage the team and their activity carrying out audits of care plans and maintaining data for activity such as BBV testing and vaccinations. Data captured during our inspection showed that 93% of patients with a known long-term condition had a care plan recorded in their clinical notes.

At the time of our inspection, patients could access a daily triage service with a nurse or paramedic. Previously, we had found 41 patients awaiting triage with a nurse, however, this time, only 9 patients were waiting to be seen and had waited no more than 2 days.

During this inspection, we reviewed patients’ records and found they were of a good standard. However, staff told us they often found it difficult to find an available computer in healthcare to complete patients’ records in a timely manner, including those that were urgent. We informed the managers of this concern, who advised they would try to increase the number of computers in healthcare.

At the last inspection, we found patients were unable to access flexible prescribing options for opiate substitution therapy. At this inspection, we found additional clinics were now available, which meant that patients could continue or consider other treatment options.

At our last inspection, we found that a single nurse allocated to night shifts had to undertake observations for high numbers of patients undergoing substance or alcohol detoxification alongside an already heavy workload that included emergency responses, which was unsafe. For example, we found one night where there were 9 urgent care calls and 16 patients requiring 2 sets of observations.

At this inspection, we found the provider had improved the process for observations at night, including developing a new standard operating procedure for the management of patients requiring observations during their first 5 days in custody. The procedure set out clear expectations for nurses undertaking observations and provided guidelines on ceasing overnight checks for patients whose observations indicated they were no longer at risk. This helped to reduce the number of patients requiring overnight checks and the workload for night staff.

The provider had introduced regular audits of night observations, which were completed by the substance misuse lead. Initially, managers used the audits to ensure checks were completed as required, and when they were assured, the focus moved to checking the quality of the observations. The audits had proved very useful in highlighting some discrepancies in practice and had allowed managers to address these with staff. This meant patients now received an improved quality of monitoring during their early days in custody when withdrawing from drugs or alcohol.

At our previous inspection, the provider had failed to ensure patients received vaccinations in a timely manner. For example, the vaccine offer rate for Measles Mumps and Rubella (MMR) was 50%, and uptake was at 3%. We found 488 patients were waiting to start or complete their course of the MMR vaccination, which was concerning due to an outbreak of measles in the Liverpool area.

At this inspection, we found the primary care team had worked extremely hard to increase their vaccination offers and uptake with a targeted approach including promotional material at all medicines administration points and on the electronic kiosk system; and leaflets drops in prisoners’ cells. The team had also conducted a survey to understand patients’ reluctance to take up vaccinations, and how this might be addressed. The team had increased the MMR offer rate to 94% and while uptake remained low, it had increased to 5%. Nearly all patients eligible to receive the flu jab had received it, and only 5 patients were waiting for their COVID-19 vaccine.

The judgement for How staff, teams and services work together is based on the latest evidence we assessed for the Effective key question.

The judgement for Supporting people to live healthier lives is based on the latest evidence we assessed for the Effective key question.

The judgement for Monitoring and improving outcomes is based on the latest evidence we assessed for the Effective key question.

The judgement for Consent to care and treatment is based on the latest evidence we assessed for the Effective key question.