HMP Chelmsford

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed 1 quality statement for this key question. We were not assured that patients always had access to the care, support and treatment they need when they need it.

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

The judgement for Person-centred Care is based on the latest evidence we assessed for the Responsive key question.

The judgement for Care provision, Integration and continuity is based on the latest evidence we assessed for the Responsive key question.

The judgement for Providing Information is based on the latest evidence we assessed for the Responsive key question.

The judgement for Listening to and involving people is based on the latest evidence we assessed for the Responsive key question.

Prior to our inspection, we received concerns that patients could not get an appointment when they needed one, causing delay to care and treatment.

Patients requested appointments using paper applications, which were collected from each wing and triaged by a duty nurse.

We could not determine how long people were actually waiting for appointments because applications were not recorded on the clinical system. This meant there was no record of when requests were submitted, what decisions were made during triage, or whether updates were communicated back to the patient.

At the time of our inspection, staff told us that patients waited about 2-3 weeks for a routine GP appointment, with urgent appointment slots available in the morning and afternoon.
An advanced nurse practitioner was also available with similar wait times (ANPs are experienced healthcare professionals working at an advanced level, including diagnosis and prescribing).
Patients could also be seen by nurses and healthcare assistants for routine care needs such as wound care, blood tests and ECGs, NHS health checks, screening for blood-borne viruses and national screening programmes including bowel cancer.
However, GP and nurse waiting lists were not managed effectively. This meant we could not be assured that patients were seen promptly or in line with clinical need.

Patients who were high risk and needed urgent mental health support were placed on a ledger and seen quickly. We were told that mental health nurses carried their own caseload and that this was manageable. We were also told that patients could be seen by the mental health team within 1 day for an urgent assessment and within 5 days for a non-urgent assessment. However, the evidence we found during our visit did not align with these timescales. Waiting lists for assessments were not being managed effectively because patients were allocated appointments based on the length of time they had been waiting rather than their level of risk. Staff also told us that the care navigation process was not working well, as referrals into the team were not always appropriate.

However, we were informed that recent changes had been made to address these issues, including a daily referral meeting at 1:30pm to review people waiting, and the service lead had taken control of work allocation so that patients were prioritised appropriately.

We spoke with 5 patients who told us they waited a long time for appointments and did not know whether their applications were even received. Some told us they felt rushed in appointments and felt they were not being treated with care and concern.

Although we saw some tasks between teams that resulted in timely appointments, the information recorded on these tasks was inconsistent. Important details such as the urgency of the request or the reason for the appointment were often missing. We saw examples where this lack of detail led to delays in care, such as a patient waiting 26 days for a GP appointment when they needed to be seen urgently.

Staff explained that the DNA (Did Not Attend) rate was high, at around 25–30%. Work was beginning to address this, including a project to improve applications, support cell‑based triage, and strengthen communication with the activities, education, and gym departments to help patients attend scheduled appointments. DNAs were being recorded and brought into meetings for review and follow‑up.

Additionally, there was no evening association, meaning that after 4pm men were locked in their cells. As a result, patients were required to make choices about accessing services between 9am and 4pm. This limited flexibility and impacted on the healthcare teams' abilityto see patients.

Prior to our inspection, we were made aware of concerns about delays in transporting patients to hospital. Although processes for managing hospital escorts had recently improved, and risk assessments were now completed for people waiting to attend hospital appointments, further work was needed. We observed a multi‑disciplinary meeting with the prison where upcoming escorts were discussed, showing that staff were working together to organise them. However, oversight of hospital escorts remained under‑developed, and recording was inconsistent.
Hospital escorts were affected by the regime and the high turnover of the population. Only 2 routine escorts were available each day, and staff reported frequent cancellations or delays. This impacted scheduling activities and continuity of care. The provider told us they were working with the prison to improve communication and reduce disruption to patient care.

The judgement for Equity in experiences and outcomes is based on the latest evidence we assessed for the Responsive key question.

The judgement for Planning for the future is based on the latest evidence we assessed for the Responsive key question.