HMP Chelmsford

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 5 quality statements for this key question. We found:

• The reporting and management of incidents, complaints, patient feedback and clinical information had improved. Staff described a more positive reporting culture, backlogs had reduced significantly, and patients gave more positive feedback about healthcare staff.
• Assurance processes remained inconsistent. Actions following complaints were not always thoroughly recorded, referral oversight arrangements required strengthening and leaders could not always demonstrate that learning and improvement actions had been implemented.
• Emergency response arrangements and staffing levels had improved. Emergency equipment was appropriately maintained, and most staff felt staffing was safe. However, the quality of clinical documentation relating to emergencies was variable, and training compliance was low in some key areas, including immediate life support and safeguarding.
• Medicines management had improved. Medicines were administered safely, records were complete, fridge temperature monitoring had improved, and records showed patients received their medicines as intended.

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 that whilst there were processes to identify, record and act on incidents, they were not consistently followed. Incidents, emergencies and staffing shortages were not always recorded or reviewed. Complaints records lacked key information. Although themes from incidents, complaints and feedback were discussed at senior meetings, incomplete data reduced oversight, and learning was not always shared. Improvements to strengthen complaints handling, patient feedback and organisational learning were not yet embedded.

At this inspection, we found the reporting and management of incidents, complaints and patient feedback had improved. Staff across all teams described a more positive reporting culture and gave examples of reporting a range of incidents. Incidents were discussed at clinical governance meetings and fed into a provider-wide system to identify themes and trends. However, oversight arrangements were not fully effective. Several incidents remained open and overdue, some dating back several months. We did not see evidence to demonstrate all investigations had been completed, lessons had been learned, or improvements had been made promptly. Oversight of serious incidents and deaths was also inconsistent. Some recommendations were not yet fully implemented, and action plans were not being monitored closely enough to make sure improvements were completed.

The management of complaints had improved. We saw examples of personalised, caring and solution-focused engagement between the complaints lead and patients. However, the provider’s complaints policy directed staff to manage most complaints informally. This meant complaints were not routinely managed through a formal complaints process. In the 6 months before the inspection, 71 informal complaints and only 1 formal complaint was recorded. Records we reviewed did not consistently demonstrate that complaints had been acknowledged, investigated or responded to appropriately. Patients were not always informed of escalation routes if they remained dissatisfied. As a result, we were not assured that complaints were being managed consistently or that all opportunities for learning and service improvement were being effectively captured. The complaints process was also heavily reliant on a single member of staff, which limited resilience and increased the risk of delays if that individual was unavailable.

Patient feedback was more positive than at the previous inspection, with patients describing healthcare staff as friendly, kind and supportive. There was a patient engagement lead and health promotion leads who described some activities to gather patient feedback and promote health initiatives. However, patient engagement could improve further as it was not well coordinated and opportunities for patients to share their views remained limited. There were no healthcare peer mentors, and patient forums were only available for mental health services. This contributed to confusion among patients about how to access healthcare appointments through a new booking process. During the inspection, the provider responded promptly to improve communication with both staff and patients about the new arrangements.

At our last inspection, we found staff shortages affected the management of information. There were backlogs of outstanding tasks, incomplete referral tracking, and delays in processing discharge information and correspondence.

At this inspection, we found improvements in the management of clinical information. Staff described working collaboratively to manage referrals, correspondence, test results and other clinical information to support safe patient care. We found that outstanding tasks had reduced significantly, from 1,961 at the previous inspection to around 260 at the time of this assessment. Correspondence was processed promptly, and test results we reviewed had been reviewed without delay. Test results were reviewed by a wider group of prescribers, improving both timeliness and resilience.

Clinicians were now responsible for completing their own referrals, supporting greater ownership of patient care. The administration team tracked referrals to check whether patients had been offered appointments, whether they attended, and whether any follow-up was needed. However, referral management needed to improve further. Although referrals were actioned by clinicians, the monitoring systems relied on clinicians tasking the administration team to notify of a referral to trigger the monitoring process. There were no formal safety-netting arrangements to provide assurance that all referrals had been sent, tracked, reviewed and followed up appropriately.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

At our last inspection, we had concerns about the service’s capacity and capability to respond to emergencies. Staff reported staffing levels were not always sufficient, and some staff were not up to date with mandatory emergency response training. While emergency bags were regularly checked, we found some items that were out of date or stored incorrectly.

At this inspection, we found the provider had strengthened the arrangements for responding to medical emergencies and had reviewed emergency response processes following our previous inspection. Staff feedback was generally positive, and staff told us they had access to the equipment they needed and that staffing levels were monitored.

There were processes to regularly check emergency equipment, which had management oversight. During the inspection, we reviewed 3 emergency response bags and found they contained appropriately stored medicines and equipment, all of which were in date.

However, training compliance required further improvement. At the time of inspection, 18% of staff were compliant with immediate life support (ILS) training and 79% compliant with basic life support training. The provider recognised this risk and had arranged additional ILS training and planned to recruit a dedicated trainer. All agency staff were ILS trained, which provided some mitigation while compliance levels improved. Contingency arrangements also included support from trained staff at another prison operated by the provider. Leaders told us they considered staff competencies when preparing rotas to help ensure an effective emergency response.

During our inspection we reviewed records to determine whether patients consistently received care and treatment that met their needs following emergency and unplanned presentations. While clinical templates were generally completed, the quality of documentation was variable and records did not always demonstrate that patients had received a comprehensive assessment. In some cases, important observations, clinical assessments, follow-up arrangements and clinical rationale were not recorded. This reduced assurance that patients presenting with urgent physical health needs were consistently assessed, monitored and managed appropriately.

The judgement for Safe environments is based on the latest evidence we assessed for the Safe key question.

At our last inspection, we had concerns about staffing levels, recruitment, training compliance and staff support. Staff reported workload pressures, workforce instability and inconsistent supervision arrangements. We also found staff vaccination records and a required recruitment check had not been fully completed prior to employment.

At this inspection, we found staffing levels had improved. Leaders monitored staffing pressures closely and had regular meetings to identify gaps and respond to emerging demands. We saw that rotas were being managed effectively and any staffing shortages or incidents were accurately recorded.

Recruiting and retaining permanent pharmacy and primary care staff remained challenging, particularly due to delays that were outside the provider’s control, such as vetting processes. However, the mental health team was now fully staffed, additional staff were joining the service, agency staff were used appropriately, and staff supported from another prison operated by the provider when required. Leaders were also developing a wing-based nursing model to improve patient access to care and support more proactive healthcare delivery.

Using staff questionnaires and interviews, we received feedback from a range of staff across all teams. We also spoke with prison staff during our visit. The majority told us that staffing levels had improved and were safe. Staff were confident that leaders were recruiting permanent staff to bring stability and were using bank or agency staff where necessary. However, the demand for the mental health services remained very high, which placed the team under constant pressure.

Training compliance was low in some key areas, with the average completion rate of 70% across all topics. For example, we saw that only 52% of staff had completed safeguarding adults level 3 training. The intercollegiate guidance for adult safeguarding sets out the recommended competency levels for staff. This includes an expectation that all GPs, nurses and other clinical staff achieve level 3 safeguarding training. Additionally, some staff we spoke with were unable to clearly explain how to make a safeguarding referral, indicating a need to strengthen awareness and understanding.

There was also a skills gap in compression bandaging, with no substantive staff trained to provide this treatment despite ongoing patient need. Although agency staff were available to deliver care and plans were in place to develop skills within the permanent workforce, a sustainable solution had not yet been implemented.

Staff told us they were encouraged to complete their training but sometimes struggled to find available dates. Formal supervision, including clinical supervision, was not taking place consistently. Supervision records showed low levels of compliance, and staff told us they did not routinely receive supervision.

Staff described induction processes positively and told us they received good day-to-day support from local and regional leaders, who were visible, approachable and responsive to concerns.

Staff had access to support including on-site wellbeing support, reflective practice sessions, remote professional nurse advocacy, and senior leadership support. Staff also had access to occupational health and the employee assistance programme.

At this inspection, we saw evidence that the service had improved its recruitment processes, including immunisation records. Occupational health records showed that vaccination information had been obtained for new staff. We also saw that applicants were now required to provide reasons for leaving previous jobs as part of the recruitment process. This information is reviewed before employment checks are completed, helping the service make sure staff are suitable for their roles.

The judgement for Infection prevention and control is based on the latest evidence we assessed for the Safe key question.

At our last inspection, we found concerns relating to the monitoring of refrigerator temperatures, and incomplete records to demonstrate whether patients had received their medicines, including those that were critical.

At this inspection, we found medicines management had improved. Medicines were supplied through an on-site pharmacy and administered from 7 medicines administration points. The pharmacy team worked closely with the wider healthcare service and provided prescribing support, including during periods of limited psychiatrist availability. Although there were vacancies within the pharmacy technician team, these were mitigated using regular agency staff.

We observed medicines administration being carried out in a caring and organised manner. Staff treated patients with dignity and respect and were able to facilitate confidential discussions when required. Records relating to medicines, including controlled drugs, were complete and up to date. Electronic records that we reviewed showed that patients, including those prescribed critical medicines, received their treatment as intended.

Medicines reconciliation was completed for all patients on arrival, helping to ensure continuity of treatment and safe prescribing. In line with the provider’s plans, more patients were being assessed as suitable to keep their medicines in possession, with this increasing from 28% at our last inspection to 34% at this inspection. We saw evidence that patients signed medicines agreements where appropriate. There were arrangements in place to provide access to critical medicines out of hours, and patients could obtain treatment for minor ailments through a canteen-based medicines scheme.

Access to prescription stationery was appropriately controlled and medicines-related documentation was stored securely.

Monitoring of medicines stored in refrigerators had improved. We found previous concerns relating to fridge temperature monitoring had been addressed, with no gaps identified in the recording. The provider also had data loggers to strengthen oversight of medicines storage. We found that the temperature in the emergency medicines room occasionally exceeded the recommended range, but staff were monitoring this. They had put arrangements in place to manage the risk while plans to install air conditioning were progressed.

The pharmacy lead produced monthly reports for medicines management meetings, where incidents, learning and actions were reviewed. Medicines safety huddles enabled staff to discuss immediate concerns and pharmacists appropriately challenged prescribing decisions when issues were identified. Medication reviews were being undertaken for complex patients, although leaders recognised the number completed remained low. Regular in-cell medicines checks were also completed, and we saw prompt action taken where concerns were identified.

There were opportunities to further strengthen medicines oversight. The pharmacy team carried out prescribing and medicines management audits and responded to changes in prescribing activity when identified. However, there was scope to make greater use of data to support a more routine and proactive approach to identifying trends, emerging risks and opportunities for improvement.

There were arrangements to support continuity of medicines on transfer or release from prison. Local data showed that 94% of patients left prison with a supply of their medicines and 96% had medicines available when transferred to another establishment.