Archived: City Health Care Partnership CIC - HMP Hull

We carried out an announced focused follow up inspection of healthcare services provided by City Health Care Partnership CIC (CHCP) at HMP Hull to check that the provider had made the necessary improvements. Following our last inspection in July 2021 we found that safe care and treatment; personalised care; and governance systems operated by CHCP at this location required improvement. We issued a Requirement Notice in relation to Regulation 17, Good Governance; Regulation 9, Personalised Care; and Regulation 12, Safe Care and Treatment. We also imposed five conditions on CHCPs registration as a service provider in respect of the regulated activities: Treatment of disease, disorder or injury and Diagnostic and screening procedures.

The purpose of the inspection was to determine if the healthcare services provided by CHCP were meeting the legal requirements and regulations under Section 60 of the Health and Social Care Act 2008 and that prisoners were receiving safe care and treatment. This inspection was carried out alongside Her Majesty’s Inspectorate of Prisons (HMIP) during an Independent Review of Progress to monitor how the prison was progressing against the key concerns and recommendations identified at the previous inspection in July 2021.

CQC undertook some of the inspection processes remotely to minimise infection risks due to the coronavirus pandemic.

We do not currently rate services provided in prisons. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

At this inspection we found:

• Patients with long-term conditions were not always being cared for safely in line with national guidance, including the management of their medicines.
• There was effective triage of patients’ applications for a healthcare appointment and urgent need was identified and acted upon.
• There was improvement in the management of patients requiring wound care and social care support, however, some patients did not receive this in line with their care plan.
• There were significant backlogs of patients requiring a mental health assessment or awaiting allocation to a staff member’s caseload.
• Not all patients who required a care plan had one in place and not all care plans relating to long-term conditions and mental health were personalised in consultation with patients.
• Staffing pressures continued due to the impact of the Covid-19 and recruitment difficulties. The provider had recruited to some roles and continued to employ many recruitment initiatives, however several vacancies remained, and many registered nurse and health care assistant shifts remained unfilled.
• While staff felt supported and had access to peer support, there was little formal management or clinical supervision taking place and such meetings were not always recorded.
• Compliance with Intermediate Life Support (ILS) and National Early Warning Signs (News2) mandatory training was poor.
• Not all actions had been implemented or embedded in practice following recommendations made in Prison and Probation Ombudsmen reports about deaths in custody. For example, in the completion of a monthly audit of the NEWS2 document to review compliance in their completeness and accuracy.
• Not all staff had the required skills to undertake their roles; for example, in the undertaking of specific wound dressings.
• Governance systems and processes had been developed further since our previous inspection but remained insufficiently embedded to assess, monitor and improve the quality and safety of patient care.
• The areas where the provider must make improvements as they are in breach of regulations are:
• Consult with patients to determine the care and treatment provided is suitable and reflects their specific needs and preferences and document this in the patient’s personalised care record, in relation to long-term conditions and mental health needs.
• Ensure that waiting times for service users requiring a mental health assessment and ongoing mental health care and treatment are reviewed to ensure appropriate access and provision to meet patient need.
• Ensure governance systems are effective in providing oversight of risks to the safety of service users and ensure that action is taken to mitigate such risks. This must include an effective audit programme which identifies areas of risk and identifies measurable actions which are fully implemented and reviewed.
• Ensure that staff receive supervision in line with the provider’s own supervision policy and that such supervision meetings are recorded, and any actions are implemented.
• Ensure that staff are compliant with mandatory training, specifically NEWS2 and ILS training.
• Patients requiring ongoing wound care and treatment should receive this in line with their care plan.
• The areas where the provider should make improvements are:
• Continue with their recruitment drive to fill remaining vacant positions.
• Continue to engage with community specialist teams in order to improve the care of patients with long-term conditions.
• Ensure staff receive an annual appraisal.
• Ensure staff have the suitable skills and competencies for their roles.