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Inspection carried out on 02 Sep to 06 Sep 2019

During an inspection looking at part of the service

We carried out an announced focused inspection of healthcare services provided by Spectrum Community Health C.I.C (Spectrum) at HMP Liverpool between 2 – 6 September 2019, alongside a comprehensive joint inspection of health and social care services at the prison with Her Majesty’s Inspectorate of Prisons (HMIP).

During a comprehensive inspection by CQC in October 2018, we found that the quality of healthcare provided by Spectrum at this location did not meet the fundamental standards. 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 focused inspection was to determine if the healthcare services provided by Spectrum were now meeting the legal requirements of the above regulation, under Section 60 of the Health and Social Care Act 2008.

We do not currently rate services provided in prisons.

At this inspection we found:

  • Improved arrangements to monitor patients withdrawing from alcohol or other substances, including the development of a clearer care pathway and evidence of more consistent observations to ensure patients’ safety.
  • Staff able to access to a good range of training and regular supervision which was usually completed promptly and accurately recorded.
  • Evidence of detailed care plans which were personalised and reflected patients’ individual needs and preferences, particularly for patients with long-term health conditions.

The areas where the provider should make improvements are:

  • Governance processes recently developed to support and monitor the safe care and treatment of substance misuse patients should be fully embedded.
  • All health staff should receive regular individual supervision in line with the provider’s policy.

Inspection carried out on 09 October to 12 October

During a routine inspection

This inspection was an announced comprehensive inspection of health care services at HMP Liverpool between 9 and 12 October 2018.

Spectrum Community Health C.I.C. (Spectrum) had commenced providing health and social care services at HMP Liverpool on 1 April 2018, after the previous provider withdrew from the prison health contract. We found that Spectrum had made good progress during their first six months in improving health services for prisoners in several key areas. CQC do not currently rate services provided in prisons.

We announced this inspection on the 14 September 2018, to follow up the previous areas of concern we identified in September 2017 and to determine how Spectrum had taken action to address the risks they had inherited.

Spectrum had subcontracted several aspects of health service provision to meet the needs of prisoners. However, the service was branded one health service: “Better Health Liverpool”, which was the joint name of health services at HMP Liverpool. Spectrum had worked with its key health partners to introduce a comprehensive governance framework for the service. We found a service where health providers worked together with the prison to deliver improved health services.

At this inspection we found:

  • The registered provider had implemented a robust governance process, which was clear about the risks and pressures within the service but there remained areas where ongoing improvement was required.
  • Spectrum had focused on recruiting, supporting and developing staff and managers with a range of organisational and professional development initiatives to improve the focus on safe and effective patient care.
  • There was work ongoing in developing staff records and local training systems.
  • There had been significant staffing challenges in April 2018, as the provider had inherited shortfalls in staffing across the service. Progress had been made in most areas, with some regular agency staff covering vacancies in the primary health care services.
  • The final primary care structure and recruitment was due to be completed by the end of October 2018. This was crucial to developing the effectiveness of the primary health team and patient experience. Supporting patients with long-term conditions remained an area for improvement.
  • Arrangements to support prisoners arriving at the prison, including initial and secondary screening and oversight of substance misuse prescribing had been improved since April 2018, however further improvements were required to ensure patients experiencing alcohol withdrawal on arrival were safe.

There remained areas where the provider needs to take further action to improve services:

The provider must:

  • Ensure overnight observations for patients undergoing alcohol detoxification are undertaken, recorded and monitored.
  • Ensure that patient records are accurate, fit for purpose and person centred.
  • Ensure that staff records include all relevant information including training and supervision.

There were also areas where the provider should make further improvements, these are:

  • Ensure effective prioritisation and monitoring of patients with long term conditions awaiting reviews and ensure that vulnerable and older patients receive care that meets their needs.
  • Complete the introduction of new structures and staffing arrangements to deliver effective primary care services.
  • Ensure all appropriate managers are involved in investigating incidents and complaints and have access to relevant information to develop learning and service improvement.
  • Develop the audit programme to include clinical, patient outcome, therapeutic medicines audits and monitoring of missed doses.
  • Ensure that all aspects of medicines are monitored through regular medicines management meetings, including the tracking system for hand written prescriptions.
  • Ensure that complaints are accurately recorded and that robust quality assurance informs service improvement.
  • Ensure the availability of more comprehensive information and engagement with prisoners to improve their understanding of the health care services offered at HMP Liverpool.