HMP Full Sutton

We carried out a desk-based review of healthcare services provided by Redbridge Associated Limited at HMP Full Sutton in September 2020. Following a joint inspection of HMP Full Sutton with Her Majesty’s Inspectorate of Prisons (HMIP) in March 2020, we found that the quality of dental care services provided at this location did not meet regulations. We issued a Requirement Notice in relation to Regulation 17: Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The purpose of this review was to determine if dental care services provided by Redbridge Associates Limited were now meeting the legal requirements and regulations under Section 60 of the Health and Social Care Act 2008. We found that improvements had been made and the provider was no longer in breach of the regulations. We do not currently rate services provided prisons.

Background to HMP Full Sutton

HMP Full Sutton is a high security prison for men, holding category A and B prisoners. It is situated near York. The prisoner population is complex, including prisoners convicted of a wide range of very serious offences. Dental services at the prison are currently commissioned by NHS England (NHSE). The contract for the provision of dental care services is held by Redbridge Associates Limited, who is registered with CQC to provide the regulated activities of diagnostic and screening procedures, and treatment of disease, disorder or injury. Our last joint inspection with HMIP was in March 2020.

The joint inspection report can be found at: https://www.justiceinspectorates.gov.uk/hmiprisons/inspections/hmp-full-sutton-2/

This report covers our finding in relation to those aspects detailed in the Requirement Notices issued to Redbridge Associates Limited in June 2020.

How we carried out this review.

This desk-based review was carried out by a CQC health and justice inspector in discussion with a second health and justice inspector colleague and the manager for the health and justice team. We did not visit the prison to carry out this inspection because we were able to gain sufficient assurance through the documentary evidence provided and through two video conference calls with the Registered Manager for the service. As part of the desk-based review we reviewed an action plan submitted by the provider and we requested a range of information to analyse and evaluate as part of this review. Evidence included:

• An audit of radiography undertaken 23 March 2020
• Information pertaining to staff recruitment and training records
• Patient feedback
• A complaint investigation template letter, including information of what a patient could do if they remained dissatisfied with the response.
• A copy of the complaints policy for the service.
• A clinical complaints investigation template letter
• A Patients Guide to Our Practice Complaint Procedure

Additionally, two meeting were held remotely with the registered manager for the service on the 1 September and 24 September 2020 to discuss action taken and improvements made. We spoke with the head of healthcare at HMP Full Sutton and we spoke with a senior commissioning manager at NHSE.

At this desk-based review we found that:

At the time of this desk-based review the provider had submitted all requested information and evidence to demonstrate that the regulatory breach had been met.

• Patients were now advised of how to escalate a complaint if they remained dissatisfied with the response from the provider.
• Patients had access to a ‘patient’s complaint leaflet’, that explained how they could make a complaint.
• The complaints process had been reviewed and all complaints were now reviewed by both the dental provider and the head of healthcare prior to being sent out to the complainant and all responses were sent on appropriate headed paper.
• Staff records relating to recruitment and training were monitored.
• Clinical audits are now completed and arrangements in place for this to continue a quarterly basis.
• Patient feedback is gathered and reviewed.

There were areas where the provider could make improvements. They should:

• Ensure that information requested as part of future inspections and where concerns have been raised or identified are submitted in a timely way to the Care Quality Commission.
• Staff should complete training in the Mental Capacity Act 2005 to enable them to support patients with treatment decisions.