HMP Durham

On this page

• 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. Patients on the EPCU had regular access to a multidisciplinary team and care records were up to date, including admission processes and daily clinical entries. However, the quality of some care plans and records of discharge from the EPCU required some improvement.

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

At the previous inspection, we identified that managers did not have effective oversight of the EPCU. In addition, systems and processes were not sufficiently robust to ensure the safe management and monitoring of patient care.

At this inspection, we found that the provider had taken action to address these concerns and had improved the admissions process for the EPCU. Comprehensive guidance had been developed, providing a clear and structured pathway for admission to and discharge from the unit. This guidance set out admission criteria across four defined care pathways: physical and social health, mental health, substance misuse, and end-of-life care. Additional guidance was in place to support staff managing admissions for prison operational reasons. Following a pilot project, the guidance has now been rolled out across the North East cluster of prisons to standardise practice.

The EPCU admission template was detailed and supported a holistic assessment of patients’ needs. This included clinical assessment, communication needs, mobility, and personal hygiene. Expectations were clearly defined in relation to the timely completion of documentation, including admission assessments, baseline physical observations, and the EPCU admissions and discharge register.

Roles and responsibilities for the oversight of admissions and ongoing care were clearly outlined within the guidance. This included the responsibilities of the nurse in charge, senior nurses, and the head of healthcare.

We reviewed 8 patient clinical records during the inspection. Most records included the new EPCU admission template, which had been completed to a good standard and demonstrated a comprehensive assessment of patients’ needs and required care. Although 3 records did not include the new template, the clinical entries provided sufficient detail to demonstrate that patients’ needs had been appropriately assessed.

All records included care plans relevant to the reason for admission. However, we identified some variability in the quality of care plans, particularly in relation to personalisation and level of detail. For example, one patients’ record indicated a need for support with aspects of washing and dressing; however, this was not reflected in the social care plan. In another case, a wound care plan did not specify the location of a pressure ulcer, although this was documented elsewhere in the wound care assessment. While relevant information was recorded within the clinical records, a more consistent approach is required to ensure that assessed needs and interventions are clearly and consistently documented within the appropriate care plans.

Daily clinical entries were present in all records and demonstrated how patients’ needs were being met. Relevant information was recorded to inform handovers. Weekly multidisciplinary ward rounds were established within the EPCU, providing patients with access to a range of professionals, including nursing staff, a pharmacist, and a GP. During this inspection we observed one interaction where a patient participated in the ward round; staff were engaging and actively listened to the patient when he was discussing his concerns regarding his upcoming release from prison.

We reviewed one case where a patient had self-discharged from the EPCU. In this instance, staff had followed the appropriate procedures. However, the reasons for some discharges were not consistently or clearly recorded within clinical records. In addition, the admissions and discharge guidance did not clearly set out the process to be followed when a patient is clinically fit to return to the wing.

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.