HMP Altcourse

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked at 2 quality statements in this key question.

Effective local leadership and improved governance systems had led to better oversight of the service, which had helped improve practice. However, more time was needed to embed the changes and ensure sustainability.

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

The judgement for Shared direction and culture is based on the latest evidence we assessed for the Well-led key question.

At our previous inspection, we found a good local team of staff and managers but an absence of support from the provider, which hampered their ability to address known risks and issues. This resulted in an under resourced and unsupported team and service. At this inspection, we saw that the provider had invested much time and resource to assist the local team to deliver a safer and more effective service.

The provider had invited the local manager and team to identify their needs and provided the appropriate support, which had worked well. Regional and national managers regularly attended the prison to provide support to the local team. The interim lead GP attended the site 4 days a week to help drive improvements to clinical services.

Staff we spoke with gave us positive feedback about their local managers and their inclusive and supportive manner in dealing with a wide range of challenges. Staff spoke highly of onsite leaders and were also impressed with the clinical leadership and invaluable support provided by the lead GP.

We received feedback from partners including other health care services, prison leaders and commissioners. They gave positive feedback about the primary care leaders and current service. They described the service as more stable and efficient with more opportunity to communicate with each other, consult and work together, for example, at daily multidisciplinary handovers.

The judgement for Freedom to speak up is based on the latest evidence we assessed for the Well-led key question.

The judgement for Workforce equality, diversity and inclusion is based on the latest evidence we assessed for the Well-led key question.

At our previous inspection, the governance arrangements in place failed to assure us there was adequate oversight of the service. At this inspection, we found a more strategic approach being applied to the service and its challenges, and a range of new or improved measures that effectively supported service delivery and improvement. These included increased leadership and operational resources and support, re-invigorated medicines management meetings, improved partnership working, a range of quality assurance mechanisms, and an effective risk management approach.

At our previous inspection, we found that risks listed on the risk register were not always monitored or addressed. At this inspection, we found that the risk register was a live working document that accurately reflected local risks and showed mitigating actions and outcomes. Managers reviewed items on the register regularly. A clear process was in place to escalate risks and identify actions, which, at the time of our inspection, included weekly summit meetings.

The provider’s quality assurance mechanisms included an audit programme and quality assurance meetings. We found that audits developed by clinical leads and managers had helped improve practice by identifying issues leading to remedial action. However, while we found improvements were evident, more time was needed to ensure these were embedded and sustained. Managers we spoke with agreed, and they also recognised that some quality assurance processes needed refining further.

We found improved partnership working across stakeholders. We could see that the provider and prison leaders had collaborated to make positive changes aided by each party inviting the other to key meetings, where appropriate. Prison and healthcare leaders told us that the local delivery boards were more effective with greater information sharing and a solution-focused approach. Staff told us that supervision at medicines hatches had improved with a direct impact on their time and efficiency. There was a joint agreement relating to admission to the IPU. The rollout of electronic dispensing for methadone in wing treatment hatches meant that patients did not have to be escorted to the healthcare unit. Newly installed cabinets in treatment room helped improve storage of medicines. Prison leaders told us they were working well with healthcare staff and had restarted discussions about installing lockers for issuing ‘in-possession’ medicines.

The provider had liaised with the mental health provider to clarify interdependencies and improve joint working arrangements. These included changes to primary mental health care referral processes to GPs, and access to regular support for mentally unwell patients on the IPU.

The provider had good oversight of staffing and recruitment. The HR team supported local managers with their ongoing recruitment programme and helped minimise delays, wherever possible. For example, local managers could advertise potential vacancies in advance. With HR’s support, local managers intended to consider new ideas and different approaches for improving recruitment and retention in early Spring and organise a big recruitment drive.

The provider had submitted a business case to commissioners for additional funding to reflect the increased activity and demand at the prison. The provider had discussed the IPU specification with commissioners to agree the purpose and criteria of the unit, resulting in an agreed interim position.

Overall, while the service had improved significantly in a short period of time and was now safe, it remained fragile. Much change had taken place, and more time was needed to embed it and ensure it was sustainable. Some staff and managers we spoke with also expressed concern about sustainability. The provider acknowledged this and expressed commitment to continue the progress evident in the long-term improvement plan developed to follow the shorter-term remedial plan. Furthermore, the service would soon be benefiting from 11 new staff and potentially some additional resources from commissioners.

The judgement for Partnerships and communities is based on the latest evidence we assessed for the Well-led key question.

The judgement for Learning, improvement and innovation is based on the latest evidence we assessed for the Well-led key question.