HMP Stafford

We carried out an announced focused inspection of healthcare services provided by Practice Plus Group Health & Rehabilitation Services Limited (PPG) at HMP Stafford in response to information of concern we received about medicines management and staffing levels. Following our last joint inspection with Her Majesty’s Inspectorate of Prisons (HMIP) in January 2020, we found the quality of healthcare provided by PPG at this location required improvement. We issued a Requirement Notice in relation to Regulation 12, Safe care and treatment relating to medicines management.

The purpose of this focused inspection was to determine if the healthcare services provided by PPG were meeting the legal requirements of the Requirement Notice that we issued in May 2020, and to determine if the provider was 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.

At this inspection we found not all required improvements had been made and the provider was not meeting the regulations in relation to medicines management. We also found additional concerns in relation to staffing and governance.

We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering how we carried out this inspection. We therefore undertook some of the inspection processes remotely and spent less time on site. The provider consented to our remote activity to reduce inspection activity carried out on site and 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 did not always receive their medicines in a timely way which, in some cases, had a clinical impact on their health.
• There were not always sufficient staff to safely administer medicines which caused delays and meant there were occasions when patients could not have pain relief.
• Improvements had been made to the storage and security of medicines.
• Pharmacy technicians had been allocated to designated wings which resulted in some initial improvements to medicines management, although this had not been sustained.
• The provider had experienced staffing challenges due to the coronavirus pandemic which meant they could not always allocate all shifts on the rota.
• Staff did not always receive supervision, and some felt unsupported.
• Governance systems were not always effective in assessing, monitoring and improving the quality and safety of patient care.
• Records relating to patient care and treatment were not always completed as required.

During our feedback at the end of this inspection the provider agreed to produce an action plan to address the issues covered in this report. We were assured by the evidence received that the provider had identified and begun to address the issues sufficiently and further improvements would be made in a timely manner.

The areas where the provider must make improvements as they are in breach of regulations are:

• Patients must receive their medicines as prescribed without delays or gaps in treatment.
• Governance systems must be re-established and used to detect and act upon risks to patient care.
• Supervision and support for staff must be provided on a regular basis.

The areas where the provider should make improvements are:

• The provider should complete their planned recruitment to vacant positions and seek to further expand the staff team so that there is sufficient cover available to provide a service that meets patients’ needs.
• Local and standard operating procedures should be reviewed at appropriate intervals and staff should be aware of how these apply to their roles.