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 found:

• Patients could generally access care, treatment and support when they needed it. Feedback from patients and staff about appointment availability was more positive.
• External hospital appointments were well coordinated, with patients prioritised according to clinical need.
• New processes had been introduced to improve the management of healthcare applications, but theywere not yet fully embedded. Records did not consistently demonstrate that applications had been received, assessed and processed.
• Appointment attendance remained a challenge, and barriers to accessing healthcare were not always accurately recorded or monitored.

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.

At our last inspection, we could not determine whether patients always had access to thecare, support and treatment they needed, when they needed it, because applications and triage decisions were not recorded. Additionally, 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.

At this inspection, we found the provider had taken steps to improve oversight of waiting lists and access to primary care. Staff told us, and records confirmed, that urgent appointments were generally available on the same day and routine GP or nursing appointments were typically offered within 2 weeks. Feedback from patients and staff about appointment access was also more positive than at the previous inspection.

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.

Staff described a new process for managing healthcare applications, which had been introduced shortly before the inspection. Applications were discussed at daily multidisciplinary huddles to identify urgent needs and agree appropriate actions. Clinical staff carried out triage and prioritised urgent concerns, while administrative staff booked appointments and communicated these to patients through a digital system. The process had only been in place for around 2 weeks and was not yet fully embedded, but staff told us it had improved communication and oversight of patient requests for care.

The provider had also introduced a new template on the clinical recording system to improve oversight of how healthcare applications were recorded and managed. However, this remained inconsistent. Records did not consistently demonstrate that applications had been received, assessed and processed. We reviewed a sample of 5 records and found that only 1 included a completed application processing template. As a result, the provider could not always demonstrate the timeliness of its response, the rationale for triage decisions or that requests for care were being managed consistently.

We found there was some confusion among both staff and patients about how healthcare applications should be submitted and processed. Patients and staff gave mixed accounts of whether applications were submitted through a digital platform, paper forms, or a combination of both methods. Although the provider had recently produced a process flowchart and communicated changes through posters and other communications, these arrangements were not yet fully understood or embedded. This indicated that further patient engagement and staff communication were needed to ensure the process was clear and accessible.

The service continued to experience challenges with patients not attending appointments. Data showed the did not attend (DNA) rate remained high, at around 20% to 30% for GP and ANP appointments. Staff were working with prison departments, including activities, education and the gym, to help patients attend scheduled appointments. However, there was no evening association, meaning patients were locked in their cells after 4pm. This limited flexibility and required patients to choose between attending healthcare appointments and other activities during the day, which affected the healthcare team's ability to see patients. Despite this, data showed 0% of appointments were recorded as no access visits (NAVs), where patients are unable to attend due to factors such as the prison regime or lack of officer availability. This was not consistent with staff feedback or other evidence reviewed during the inspection, including cancelled escort appointments. This meant that barriers to accessing healthcare were not being accurately recorded, monitored or analysed to develop targeted actions to improve access.

At our last inspection, the administrative processes for managing hospital escorts were being improved.

At this inspection, we found hospital appointments were generally well coordinated despite ongoing pressures on escort availability. The high turnover of the prison population and limited availability of routine escorts continued to present challenges, with 2 routine escorts available each day. Healthcare and prison staff worked together to manage this effectively. Patients awaiting hospital appointments were individually risk assessed, and regular discussions took place to prioritise patients based on clinical need. Staff gave examples of advocating for patients and escalating to senior prison governors where necessary. These arrangements helped ensure patients with the greatest need were seen promptly.

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.