HMP Long Lartin

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• 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 looked at 1 quality statement in this key question. We found that there had been significant improvement to the management of long term conditions and patients received comprehensive care planning.

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

At the last inspection, new patients arriving at the prison did not always receive a full health screening despite there being an opportunity to complete this on the day of arrival. At this inspection, we reviewed the records of 7 patients who had arrived at the prison recently and found that all had received a comprehensive health screen on their day of arrival, as well as a secondary health screen within their first 7 days at the prison. We saw that referrals were made to appropriate services such as mental health or substance misuse in a timely manner, and there were no outstanding actions for these patients.

The early days in custody process included initial and secondary reception screening that was overseen by a dedicated team leader. This provided oversight to ensure patients’ needs were met promptly in their early days. A nurse was allocated to work in reception every day, and since the last inspection, the provider had not experienced any days of not being able to provide cover for this. On one occasion since our last visit there had been 3 prisoners arriving at around midnight who were all taken straight to segregation. On this occasion, nursing staff completed the exceptional screening assessment upon arrival to identify any urgent needs, with a full health screen completed within the first 24 hours.

At the last inspection we found patients did not receive the appropriate care to safely manage their wounds, and care plans were not in place to guide staff when caring for them. During this visit we reviewed the records for 3 patients who were receiving active wound care; All 3 patients had comprehensive notes for all interactions with healthcare, and it was clear that the patients were receiving the care they needed in line with their care plans. Care plans had been completed in detail and were personalised to the individual patient. It was also documented that the patients were offered a copy of their care plan, and on one occasion (with consent) health staff shared the care plan with prison wing staff to aid their understanding of the patients’ needs.

At the last inspection, patients with diagnosed long term conditions did not always have a care plan in place and some patients experienced a delay in the treatment of their condition. In addition, some patients with historical conditions were not adequately reviewed to ascertain if further treatment was required. The provider had worked hard to address this concern and there was now evidence of excellent care planning and oversight of these patients. We reviewed 10 patients receiving care for a long term condition and found all had excellent quality care plans which gave comprehensive accounts of the patient, their needs and how their conditionshould be managed. All the patients had received a review of their long term condition in the last 12 months, and their care plans had been updated to reflect any changes from this.

Managers had implemented several changes to maintain oversight of long term condition management. This included adding recall codes to the electronic patient records to ensure care plans were reviewed regularly. There was also a spreadsheet to monitor patients conditions’ including the dates their next reviews and care plans were due. Finally, a care plan audit had been introduced which was carried out every month to identify any patients with a long term condition who did not have a care plan recorded. The latest audit had shown a figure of 98% compliance which was excellent.

The provider was now taking steps to improve the quality of care planning. A recent audit had highlighted that some care plan goals were not always SMART. To address this, two managers had run a clinical supervision session focusing on this. The team had also sought additional training opportunities to improve the quality of care for example in stoma care and catheter training.

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

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

The judgement for Supporting people to live healthier lives is based on the latest evidence we assessed for the Effective key question.

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.