HMP Erlestoke

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 2 quality statements for this section. We found they were now compliant with relevant regulation.

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

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

During the June 2024 inspection we had concerns around GP waiting times, gaps in the health screening of patients and missed opportunities to ensure adequate patient discharge planning. Long term conditions were poorly managed without a focused strategy to ensure all patients received a regular health check. There was no health and wellness strategy promotion to enable or educate patients on common health issues.

At this inspection we found.

GP waiting times had reduced from 6 weeks to 4 weeks and in some months into a 3 week wait for routine appointments. Better coordination between Oxleas and Dr PA meant that clinics ran with a predictable routine which allowed for better clinic utilisation.

An improved picture for reception screening was apparent with more patients having access to a timely reception screen as well as BBV and NHS health checks. Challenges remained with late arrivals due to conditions outside of the provider’s control. However better data and collaborative working with the prison ensured that more patients were seen promptly.

Secondary health screening uptake still had its issues but also showed improvement. Despite the introduction of booking patients in for second screen during the reception process, patients were choosing to decline this appointment. Work was undertaken to understand why the men were choosing to decline this important intervention. The provider was looking at additional ways to support and educate those choosing to decline and support them to attend.

Discharge planning continued to impact patients leaving the prison without being registered with a GP. However, the provider was working hard to address the issue. For example, running daily checks from the prison system, sending appointment reminders to patients and escalation to the prison. Despite this, patients continued to either decline this support or were released sooner than all the information provided indicated. Ongoing work continues to manage this issue.

The provider had embedded a more coherent system to manage long term medical conditions. This now meant patients had timely reviews and interventions to help them manage their conditions. Better use of the appointment recall process further helped safety net patients and ensured good oversight and responsiveness. Regular reports were now run as well as better use of health performance data. Following the June 2024 inspection the provider had cleared the backlog of 99 of patients. Challenges remained, such as the churn of patients moving through the prison, however the better use of data and reception screening was reducing the risk to these patients.

The provider had developed a health and wellbeing strategy. Collaboration with the prison helped ensure it targeted the appropriate health needs of the patients and how to fit within the prison regime. The strategy now aligned with the provider’s health calendar and promoted specific events through the year to increase patient engagement.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe environments is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe and effective staffing is based on the latest evidence we assessed for the Safe key question.

The judgement for Infection prevention and control is based on the latest evidence we assessed for the Safe key question.

At the previous inspection we found the governance and oversight of medicines were not robust, and inadequate support and reviews of opioid substitution therapy were putting prisoners at unnecessary risk of significant harm. There were gaps in patients’ risk assessments and room and refrigerator temperature recording, missed doses of medicines were not always investigated and incidents were not reviewed in a timely manner.

At this inspection we found the following:

The management of patients on opiate substitution therapy had improved with safe prescribing and good support offered from both the clinical and psychosocial substance misuse teams. Patients had access to an onsite prescriber and regular reviews were held to ensure joined-up patient centred care.

Concerted efforts had been made to improve the follow-up of patients not attending to collect their medicines. A written policy had been established and staff received additional training on the importance of medication adherence. The in-possession medicines policy was in date. All new arrivals continued to receive an in-possession medicines risk assessment and processes were now in place to review these at regular intervals including when circumstances changed, in line with expected practice.

Medicine reconciliations were completed within 72 hours. The out of hours cupboard and stock medicines were in good order and weekly audits were embedded. Quarterly audits for the management of controlled drugs were happening but some of the monthly medicine management audits over the last six months had not been completed, which staff had been reminded about.

NHS England were keen for pharmacy led clinics to occur and these were due to commence following our inspection, to be held every 2 weeks. The management of medicine related incidents had improved, and lessons learnt were shared with staff.

Refrigerator and room temperatures where medicines were stored were checked daily, but there were still a few gaps in the recording sheets we reviewed.