HMP Fosse Way

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed 3 quality statements for this key question. We found that patients did not always receive care and treatment that was assessed and regularly reviewed to ensure it met their health and well-being needs. There was no structure to the management of long term conditions.

We found that patients could access a nurse or GP quickly. We had no concern with substance misuse services. However, patients requiring mental health support were not always seen within the provider’s target of 5 days, and the treatment options available to them were limited.

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

Patients requested an appointment with healthcare using the prison’s electronic kiosk system. Healthcare staff were allocated daily to respond to queries and managers carried out daily checks to ensure outstanding applications were dealt with. Health staff used the in cell telephones to contact patients if more information was required and this was recorded on the patients’ clinical record.

Nursing staff ran triage clinics 5 days per week, and patients could see a nurse the following day. Wound care and dressing clinics also ran 5 days per week to manage patient needs and bloods clinics had been increased to 5 days per week to address a backlog.

GP waiting times were reasonable at around 4 weeks for a routine appointment and the same or next day for an urgent appointment. The GP was allocated time to visit the prison segregation unit 3 times per week in line with prison policy. However, we saw examples of routine appointments being booked in embargoed urgent slots, which was a concern.

Managers were in the process of developing an ‘unscheduled care hub’ on one of the prison houseblocks which would be staffed by a member of the substance misuse, pharmacy and mental health team. Nurses and paramedics would also be based in the hub to triage urgent needs and allocate these to the most appropriate person. The aim of the hub was to provide a single point of contact for the prison to use and improve communication reducing the number of emergency codes being called.

Staff we spoke with reported a reduction in the number of emergency codes in recent months but still fed back that a high volume of emergency calls they received were inappropriate or unnecessary. Managers were working with the prison to support officer education around identifying when an emergency code should be used and the process to follow if it was not an emergency but required healthcare intervention. We saw good examples of record keeping when health staff responded to emergencies detailing who had attended and what interventions were carried out.

Patients arriving at the prison with substance misuse issues were seen immediately to address any urgent needs and received a full assessment from the team within 5 working days. Recovery workers saw all prisoners reported to be under the influence of illegal substances to offer support, harm reduction advice, and encourage them to access support from the service.

The mental health team received between 200 and 280 referrals per month which was very high. Despite additional agency staff deployed to reduce a backlog of patients awaiting a triage, the waiting time was still too long at around 9 days during the inspection, breaching the provider’s policy of 5 days for a routine triage. Positively, those requiring an urgent triage were seen within 48 hours. However, staff told us they had not received training in the provider’s triage process, which differed significantly from the previous model they worked to where full assessments were carried out instead of triage. Managers told us guidance had been provided but could not evidence this, and the expectation for staff to carry out 6 triages per day appeared unrealistic. As a result, staff did not feel clear in the triage and assessment of patients requiring mental health support, and patients waited too long to be seen.

Staff could access Language Line for patients who did not speak or understand English and could also book interpreters if required.

Patients with long term conditions were overseen by one nurse at the time of our inspection but a second was due to start imminently. Patients with a long term condition were identified through reception health screenings or routine appointments. Managers were in the process of formalising pathways for common conditions so that staff were clear on how to manage patients’ conditions.

Annual reviews for patients with a long term condition were completed alongside care plans and we saw good examples of detailed records for these reviews. Healthcare assistants carried out monitoring tasks such as taking bloods when tasked by a nurse.

However, systems to ensure patients received ongoing monitoring in line with their condition were not fully established. There was no clear, reliable process to ensure patients were routinely recalled or monitored, and oversight of deterioration was inconsistent. Processes lacked management oversight, and we were not assured that systems were sufficiently robust or in line with national guidance.

Clinical reports showed only 291 patients out of 611 with a long term condition had a care plan. This contradicted staff feedback that there were no care plans outstanding. Following our inspection the provider told us they were 71% compliant with long term conditions care planning and now had 3 long term condition nurses in post. Staff had not received sufficient training in care plan documentation, including how and where to record patient care plans. This had resulted in some care plans being inaccurately recorded. The service relied heavily upon agency staff and there was a high risk that staff might not be able to locate the patients care plan and therefore patients might not receive the appropriate care and treatment in line with their care plan.

The substance misuse team offered a wide range of evidence based care for patients on their caseload. Treatment options included mutual aid support through Alcoholics Anonymous and Narcotics Anonymous, and all substance misuse staff were training to deliver SMART recovery, a mutual aid support group for patients. Psychosocial recovery workers delivered one to one interventions with patients in areas such as harm reduction, coping with cravings and release planning, and groups had recently commenced within a dedicated area of one houseblock which was in the early stages of becoming an incentivised substance free living unit.

Patients could access evidence based clinical interventions in opiate substitution therapy including Buvidal, a slow release drug used to treat opiate addiction. Patients receiving clinical treatment were reviewed in line with national guidance to monitor their treatment. Due to low staffing levels of recovery workers, the treatment reviews had not been carried out jointly with the prescriber and recovery worker, but since staffing levels had recently increased this was due to start soon.

The interventions available for patients requiring support for their mental health were too limited. There were long standing issues with psychology staff recruitment however a psychologist was now in the process of coming on board and was expected to join the team in summer 2026. There had been no psychological interventions for patients since the provider commenced the contract at the prison in July 2025, and no alternative treatment options had been offered during this time. This increased the pressure on nursing staff who held caseloads of around 30 patients each and were unable to refer them for psychology support.

Nursing staff delivered one to one sessions with their patients and records we reviewed were of a very high quality with clear details of the patient’s presentation, discussions and action required. However, staff told us that they had previously been advised by managers to pause their case management and care planning with patients on their caseload so that they could prioritise the high number of new referrals. Following a change in leadership, managers told us they had tried to support the mental health team by providing clear ways of working and additional training, however there was no evidence available to support this and no clear local mental health pathway. This meant that staff did not have clear guidance to deliver treatment, and patients did not have access to a full range of timely interventions to support their mental health.

Despite the pressure the mental health team were under, nurses continued to work closely with segregation staff and patients. Prison staff spoke highly of the mental health nurses and valued their input on the unit.

The judgement for How staff, teams and services work together is based on the latest evidence we assessed for the Effective key question.

A newly recruited patient engagement lead had recently joined the team and had developed an action plan to drive patient engagement. This included a patient survey to create ‘you said, we did’ feedback, as well as a health promotion events calendar and board to display in health care.

There had not been any staff trained to deliver vaccinations until recently, which meant the team were behind in offering and delivering routine vaccinations to patients. Clinics were scheduled in the coming weeks to address this now that all primary care staff had received the appropriate training.

There were 171 patients requiring an NHS health check outstanding at the time of the inspection, but 3 newly recruited healthcare assistants were due to start booking these patients in for their checks.

Patients were offered blood borne virus screening on arrival to the prison and referred for onward treatment if required.

The judgement for Monitoring and improving outcomes is based on the latest evidence we assessed for the Effective key question.

The judgement for Consent to care and treatment is based on the latest evidence we assessed for the Effective key question.