HMP Chelmsford

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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 assessed 2 quality statements for this key question. We found:

• Governance, leadership and partnership working had improved. New leaders had brought greater direction and support, governance systems were in place, and there were plans to improve patient outcomes and access to care.
• Some governance arrangements were not yet fully effective. Oversight of incidents, serious incidents, deaths, audits, complaints and some risks did not always provide assurance that improvements were implemented and sustained.
• Staff feedback was significantly more positive than at the previous inspection. Most staff felt more comfortable raising concerns and described leaders as visible and approachable, although further work was needed to rebuild trust across all teams and support staff wellbeing.

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.

The judgement for Capable, compassionate and inclusive leaders is based on the latest evidence we assessed for the Well-led key question.

At our last inspection, we found indications of a closed culture, with some staff feeling unable to speak up due to intimidation and fear of being treated unfairly. Concerns raised were not always responded to or addressed, and incidents were not always recorded.

At this inspection, leaders told us they had focused on rebuilding staff confidence and creating a more open and supportive culture. Improvements in team working were supported by the recruitment of new staff, greater leadership visibility and regular communication. New leaders described a period when staff were reluctant to speak openly and raised concerns about previous management arrangements. In response, leaders had adopted an open-door approach and increased their presence within teams.

Staff feedback was significantly more positive than at the previous inspection, although experiences varied between teams. Staff recognised the improvements being made and were positive about action being taken. Most staff told us communication had improved, especially following management changes, and that they felt more comfortable raising concerns. Staff told us they were proud of the healthcare team and commented that staff are exceptionally caring towards their patients.

Feedback about the pharmacy team, including from staff working within the team, remained positive. Staff described their service leader as inspiring, supportive, approachable and open. They told us they felt confident speaking up and were confident that their views and concerns would be listened to.

There were several opportunities for staff to raise concerns and provide feedback. Monthly staff meetings were held, and a staff feedback process had been introduced to enable leaders to identify and respond to concerns. The provider had confidential routes for raising concerns, including a Freedom to Speak Up Guardian and staff surveys.

The provider had also introduced initiatives to support staff wellbeing and engagement, including access to counselling services, management training and staff recognition schemes.

However, further work was needed to rebuild trust across all teams. Some staff told us that the previous culture of bullying and historic divisions within teams had affected working relationships. Some staff told us they still felt unable to raise concerns or believed nothing would be done if they did. Staff in the mental health team continued to report significant workload pressures, which affected their wellbeing. Despite this, staff and leaders described the culture as improving and felt the service was moving in a positive direction.

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

At our last inspection, we found the provider did not have effective governance systems in place to identify, assess and address the full range of risks.

Following our last inspection, the service demonstrated they had taken our concerns seriously and were focused on making improvements. They sent us their action plan to describe the actions they had completed immediately and their next steps to address all of the concerns we had highlighted. Leaders and staff described positive support from the provider, prison colleagues, regional teams and the commissioners of healthcare, NHS England.

We found governance had improved, and leaders were open and transparent about their progress. They were fully engaged and committed to completing improvement actions, although there were some areas which were in the process of being developed or embedded. Healthcare leadership had been through a period of instability, but the appointment of new leaders had brought greater direction and support. Service leads understood the performance, challenges and risks within their own areas.

Partnership working had also improved. The reintroduction of the local delivery board provided a regular forum for healthcare, prison and social care partners to discuss risks, performance and service improvements. Leaders spoke positively about the support they received through local and regional governance meetings.

Leaders had developed plans to improve patient outcomes and access to care. This included a proposed wing-based model of care, which they expected would allow more proactive healthcare delivery and better use of clinical time. The provider had submitted a business case to support this approach and was awaiting a decision. Leaders had also increased administrative support to improve clinic management and make better use of appointment capacity. Other improvements included developing the use of a digital platform to communicate with patients, strengthening health promotion activity, and revising secondary screening processes to improve the identification of patients' health needs.

Most governance systems were in place, and leaders had identified many of the key risks facing the service. However, there were opportunities to strengthen oversight and ensure that improvement actions were progressed consistently. Some risks had remained on the risk register for extended periods. Recruitment also remained challenging in several areas, particularly pharmacy, and the service continued to rely on agency staff.

Oversight of quality and safety was developing. Staff generally felt able to report incidents, but several investigations remained overdue and learning was not always identified, shared or acted upon promptly. Serious incidents and deaths were not always monitored, to ensure recommendations were fully implemented. Limited audit and quality improvement activity was taking place across the service. However, leaders could not always demonstrate that these processes provided reliable assurance about the effectiveness, safety and quality of healthcare services. We found some audits lacked sufficient scope, independence or accuracy, limiting their ability to identify risks and support service improvement.

Progress had been made in some areas of the healthcare environment, although further improvements were needed. The condition of the clinical rooms, particularly the enhanced care unit clinical room and C wing dispensary, warranted review to determine whether they remained suitable for clinical use, as damaged fixtures, fittings and surfaces could not be effectively cleaned and maintained in line with infection prevention and control requirements. Although beyond the provider’s control, staff facilities were in poor condition and staff told us it contributed to low morale and affected their wellbeing. There was a lack of evidence to demonstrate these concerns had been reviewed, escalated and progressed effectively through partnership arrangements.

Other governance processes showed signs of improvement but remained variable. The quality of clinical record keeping had improved but was not consistent, and we found some examples of incomplete or missing documentation about patient care. Staff training and supervision varied across services, including for emergency response and safeguarding. Arrangements for managing complaints had improved, and patients received positive support from the patient engagement lead. However, complaints were not always formally recorded, responses were not always provided in writing, and patients were not consistently told how to escalate concerns if they remained dissatisfied.

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.