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Inspection Summary


Overall summary & rating

Updated 11 April 2018

We carried out a focused inspection on 7 February 2018, under section 60 of the Health and Social Care Act 2008. This inspection was carried out to follow up on concerns raised during a joint inspection with Her Majesty’s Inspectorate of Prisons in March 2017. We found evidence that essential standards were not being met and issued Requirement Notices to the previous provider of health services.

This report can be found at:

https://www.justiceinspectorates.gov.uk/hmiprisons/inspections/hmp-preston/.

We do not currently rate services provided in prisons.

NHS England commission health services at HMP Preston. The contract for the provision of healthcare services at HMP Preston transferred to Spectrum Community Health C.I.C in April 2017. CQC appraised Spectrum of the concerns identified during the joint inspection in March 2017 so that they could address these within the new service provision.

This focused inspection was carried out to confirm that the new provider had made improvements in the areas, which were identified in March 2017 as concerning. This report covers those areas and also additional improvements made since our last inspection.

Our Key findings were as follows:

  • Long-term condition management, monitoring and outcomes for patients had improved.

  • Patients with dementia had care plans in place and were being offered appropriate support.

  • Staff treated patients with dignity and respect; appointment slips were confidential and placed in sealed envelopes.

  • The provider’s training matrix showed 92% of staff had been trained in dementia. Overall staff compliance with mandatory training was 95%.

  • All informal complaints and incidents were logged and discussed at local and corporate level. We saw where lessons learnt had been shared between the provider, prison and other locations.

  • Managers regularly reviewed the full risk register and effective actions had been taken to reduce the risks identified.

There remained areas of practice where improvements had not yet been fully embedded which the provider should continue to address.

  • The provider should ensure care planning supports individual patients to manage their own conditions.

  • The provider should complete the planned improvements to ensure all prisoners have timely and equitable access to a GP and managers monitor this.

  • The provider should continue to develop medicine optimisation auditing procedures and recording to monitor and improve patients care and treatment.

Inspection areas

Safe

Updated 11 April 2018

We did not inspect the safe key question at this inspection.

Effective

Updated 11 April 2018

We did not inspect the effective key question in full at this inspection. We inspected only those aspects identified as requiring improvement during the joint inspection March 2017. We found that the areas of concern identified in March 2017 had been significantly addressed.

  • The overall management of long-term conditions had improved. Nurse practitioners were holding respiratory and diabetes clinics regularly, which meant patients with long-term conditions were being monitored and received appropriate treatment.

  • Spectrum had recruited a range of suitably qualified staff. There were sufficient registered nurses in post to meet patients’ needs with recruitment ongoing.

  • The provider’s training matrix showed 92% of staff had been trained in dementia.

  • Overall staff compliance with mandatory training was at 95%.

  • Prisoners could request and receive common medications to treat minor ailments.

  • Spectrum staff ensured that prisoners had timely access to the mental health team who provided a range of psychological therapies including groups. A new mental health referral pathway between teams had reduced waiting times.

We found some areas needing improvement

  • Some long term condition care plans had insufficient detail to support patients to self manage their conditions.

Caring

Updated 11 April 2018

We did not inspect the caring key question in full at this inspection. We inspected only those aspects identified as requiring improvement in the joint inspection March 2017. We found that the areas of concern identified in March 2017 had been addressed.

  • Spectrum had a healthcare complaint/application box on each wing so prisoners could place a confidential complaint or application easily and confidentially.

  • Healthcare appointments were placed in sealed envelopes to ensure confidentiality.

Responsive

Updated 11 April 2018

We did not inspect the responsive key question at this inspection.

Well-led

Updated 11 April 2018

We did not inspect the well-led key question in full at this inspection. We inspected only those aspects identified as requiring improvement in the joint inspection March 2017. We found that the areas of concern identified in March 2017 had been significantly addressed.

  • Spectrum had introduced a new integrated team governance meeting, which all healthcare staff attended. This enabled staff to share learning across the teams.

  • Staff supervision and personal development reviews took place. All staff, had an up to date appraisal and supervision record.

  • Patients could influence how the service was delivered through written feedback, which was used by managers to make service improvements.

  • All informal complaints were logged and discussed at local and corporate level. Managers reviewed complaints and completed a monthly learning log to help improve the service.

  • Suitable rooms had been identified on each residential wing and were being furnished to provide wing-based clinics.

  • Managers regularly updated the service risk register to ensure that risks were monitored and reduced.

We found some areas needing improvement.

  • Access to GPs remained limited for prisoners on one wing, with some patients waiting up to five weeks but plans to address this were progressing.

  • The pharmacist was embedding medicine optimisation and auditing procedures. Some further work was needed around monitoring medications.