Archived: HMP Ranby

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• 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 reviewed 1 quality statement under the safe key question. We found improvements had been made to staffing with many vacancies now recruited to. Services were no longer significantly impacted by low staffing levels and managers held increased accountability for their teams.

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.

The judgement for Safe systems, pathways and transitions is based on the latest evidence we assessed for the Safe key question.

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.

At the time of our last inspection there was a 27% vacancy rate within the prison healthcare team. This, alongside a complex population in the prison, and a high turnover of prisoners, had resulted in the provider delivering limited services to patients. Managers were frequently required to cover clinical roles which resulted in staff feeling under pressure and carrying a high level of risk. We found clinical supervision uptake was low at 69% in January 2025, and staff mandatory training completion was below the provider’s expected compliance rate of 85%. For example, only 61% of staff requiring intermediate life support training were up to date, and only 71% of staff were up to date with their adult safeguarding training.

Since the last inspection the provider had recruited to many vacancies with multiple applicants in the pipeline at various stages of the recruitment process awaiting start dates. Central HR support was now available to support the team with recruitment, and a weekly report and monitoring meeting were now in place. This ensured all steps were taken to fill vacancies as quickly as possible and escalate any concerns. Agency and bank staff continued to provide short term cover for some posts.

During this inspection staff told us they felt safer in their roles and could see improvements in staffing levels. Mandatory training completion had improved with 81% of staff now up to date with adult safeguarding and life support training. Some work was still required to ensure all clinical supervision was documented to ensure data reflected improvements, but staff told us they did receive support and supervision. In the staff well-being room, managers displayed information such as the service development plan, and a notice board for ‘what we’ve learnt and changed’ to improve transparency. Managers had also worked with the prison to allocate additional radios to the healthcare team to support staff safety.

Only 2 of 4.8 posts in the administration team were filled at our last inspection. This meant administrative staff had insufficient time to effectively manage and oversee external hospital appointments, and clinical summaries from hospitals were often not uploaded to the electronic patient record system for all healthcare staff to see, which created risk. We found that since the last inspection all vacancies in this team had been recruited to with new staff at various stages of vetting and recruitment checks prior to confirming start dates. Although newly recruited staff were not yet on site, the concerns regarding the impact on secondary care appointments had been escalated to senior managers and the team now received remote support and some additional cover from other sites. This meant there was now improved oversight of the secondary care appointments and the data we reviewed during the inspection was up to date and well managed. Some work was still needed to ensure all clinical summaries received from hospitals were uploaded to patient records, but it was anticipated this would further improve as new staff came onboard.

There was insufficient primary care staff in place at the last inspection which impacted weekend cover, emergency response management and delays to secondary health screenings for newly arrived prisoners. The shortages had also resulted in some delays to daily checks such as the monitoring of fridge and room temperatures. Staff from mental health and substance misuse teams were routinely pulled away from their teams to support medicines administration because of gaps in the primary care nursing team. This time we found a more positive picture with all vacancies now fully recruited to and no backlog of secondary screenings. The team spoke positively about improvements with safer staffing levels each day including weekends, and adequate time to complete daily checks. Fridge temperatures we reviewed had been checked consistently and where too high this was escalated appropriately and medicines expiry dates amended accordingly. Members from other teams were now only called upon occasionally to cover medicines administration as a last resort if there were last minute gaps due to sickness for example.

At the last inspection there was insufficient GP provision to meet demand with 129 patients waiting up to 8 weeks for a routine GP appointment. This time, we found an improved picture; 41 patients were awaiting a GP appointment, of whom 24 had booked appointments and 7 were awaiting a triage from the advanced care practitioner. The next available GP appointment was in 6 days which was a significant improvement and meant patients could now see a GP in a timely manner. A weekly report was produced by the head of healthcare for senior managers to monitor the GP waiting times and ensure this did not become a risk again.

Staffing vacancies in the substance misuse team had impacted the delivery of substance misuse interventions at our last inspection, and clinical substance misuse prescribing was reliant on one individual with no cover for absence. Too few staff were available to offer a full range of 1:1 and group work programmes with 109 patients waiting for group interventions, and the provider was also unable to offer any tier 3 or 4 interventions in line with their tiered model of interventions.

The substance misuse team continued to experience challenges with a high turnover of staff. Recruitment was ongoing but rotas were now completed 3 months in advance to improve planning with agency or bank staff to cover shortfalls. The team had worked hard to continue offering tier 1 and 2 interventions to patients including 1:1 work and some group sessions. The clinical and psychosocial team now carried out joint reviews of treatment plans which was positive, and cross site cover was in place for non-medical prescribing provision. The clinical lead tried to ensure staff had 1 protected day per week for case management, but further work was required to ensure the substance misuse provision ran consistently with a stable team.

The substance misuse team supported approximately 330 patients and managed a very high rate of referrals and appointment requests. Additional agency staff had been utilised to increase the number of assessments carried out at weekends, and at the time of inspection there was a total of 20 patients awaiting assessment from the team. The longest patient on the list had waited for 28 days but the average waiting time for an assessment was now 5 days which was an improvement from the last inspection. A weekly management meeting monitored waiting times to ensure additional resources were put in place when waiting times escalated.

At the last inspection we found staffing shortages had impacted the delivery of mental health and psychological therapy (PT) interventions, and the provider could not offer treatment in line with their stepped care model; 29 patients had been waiting up to 29 weeks for tier 2 mental health interventions. Since the last inspection an additional 2 full time band 6 mental health nurses had been recruited as well as a full-time counsellor. Staff we spoke with told us they felt they were able to manage their caseload safely and used a RAG rating to prioritise patients with urgent needs. More work was needed to reduce the number of patients receiving psychological therapies; 36 patients had waited up to 7 weeks for an assessment for PT at the time of this inspection, however these patients had been assessed by mental health prior to the referral to the PT team and continued to see a nurse whilst awaiting assessment where a risk was identified.

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

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