HMP Lowdham Grange

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• 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 assessed three quality statements for this key question. We found that patient needs were assessed promptly for those requiring primary care and mental health support, however waiting times for a substance misuse assessment were too long.

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

Patients requested an appointment with healthcare using the prison’s electronic kiosk system. Healthcare staff were allocated daily to respond to queries and managers carried out daily checks to ensure outstanding applications were dealt with. Applications were clinically triaged and directed to the appropriate pathway.

Nursing staff ran triage clinics 5 days per week, and patients could see a nurse within 3 days. Daily nurse clinics were scheduled to facilitate wound care, bloods and triage. Primary care services were supported by a sub-contracted GP service. Managers spoke positively of working arrangements with the sub-contractor and access to GP services was good with a waiting time of approximately 5 working days. Patients with urgent needs could be seen by a GP on the same day in embargoed slots.

All patients arriving at the prison were screened to identify any current or historic substance misuse issues. Patients could also request a referral to the team for support either on arrival or at any other time using the prison application system on wings. Whilst the waiting time for a routine assessment with the substance misuse team had recently reduced from 17 weeks to 3 weeks, this was still too long and in breach of the providers policy to see all new referrals for assessment within 5 working days. Managers had oversight of the waiting list to ensure risk and needs were identified and prioritised, but the waiting time meant that some patients waited too long for an assessment.

The substance misuse team worked closely with the prison to address the needs of patients taking illicit substances and appearing under the influence (UTI) in the prison, which was positive, however the high number of UTI referrals (approximately 300 during April 2026) meant this significantly impacted the team’s ability to carry out their daily roles. The provider had also introduced a policy for the substance misuse team to see all patients who are being discharged from the segregation unit back to main residential units as a result of learning from a death in custody. This was a good initiative but also increased the workload of an already stretched team.

Patients requiring an assessment with the mental health team were seen within the target of 5 working days and those with urgent needs identified were seen within 48 hours in line with the providers policy. All new referrals were discussed during a weekly multi-disciplinary team meeting to ensure allocation to the appropriate clinician for treatment.

Care for patients with long term conditions was led by the primary care nursing team. Training was in progress for nurses to lead on specialist areas including asthma, epilepsy and diabetes. Nursing staff carried out routine annual reviews and completed care plans for patients with a complex need or long term condition to inform their care. Nurses were able to seek advice or escalate any concerns regarding long term condition management to the GP service or the advanced nurse practitioner for further advice and support.

The mental health team provided a 7 day service to patients delivering a range of groups, one to one case management and brief interventions. Psychology provision included one to one support and a range of groups; waiting times were reasonable at around 8 weeks. Patients had access to a psychiatrist who engaged in the multidisciplinary team meeting weekly and there was effective monitoring of patients’ physical health needs for those prescribed anti-psychotic medicines.

The health provider had commissioned Maverick Sounds, who used music to foster creativity and promote self-esteem, to work with a group of patients on the mental health caseload. This had led to positive outcomes for improved wellbeing and both staff and prisoners spoke very highly of the support they had received from the group.

A robust neurodiversity (ND) pathway was well-embedded, and an additional learning disability nurse had been recruited to meet the demands of the service. Patients spoke highly of the support they received for neurodiversity and care plans for patients were detailed and evidenced patient involvement.

48 patients were receiving clinical substance misuse interventions at the time of the inspection. A substance misuse prescriber currently attended the prison weekly or ran remote clinics to monitor patients’ treatment. All patients prescribed opiate substitution received a review of their treatment to evaluate the effectiveness of the medicines, monitor any side effects, and to review the care plan for their treatment. The lack of face to face reviews meant that it was not always easy for recovery workers to attend. The provider acknowledged it was not best practice for patients to receive remote reviews rather than in person, and training for a newly recruited GP was planned to enable them to contribute to the clinical oversight of these patients.

All patients receiving clinical treatment were required to engage with psychosocial recovery workers to enhance their treatment. Staff felt that the interventions available to patients were more suited to a remand site rather than long term prisoners, but groups were facilitated and included harm minimisation and relapse prevention support. Alcoholics Anonymous attended the prison to facilitate mutual aid support.

A project was underway between the prison and substance misuse team to set up an incentivised substance free living wing. Regular meetings were well attended by relevant staff to progress actions and enhance support available to prisoners.

The judgement for How staff, teams and services work together is based on the latest evidence we assessed for the Effective key question.

Systems were in place to ensure patients had access to health screening programmes in line with the community, including bowel screening and screening for abdominal aortic aneurisms for those eligible.

The provider had identified a gap in the delivery of routine immunisations and vaccinations to patients. A staff vacancy resulted in a lack of trained staff to deliver these programmes and whilst a new staff member had been identified for training, this meant that patients had experienced a delay in receiving eligible vaccinations. This was recorded on the provider’s risk register and was due to be resolved with the training taking place imminently so that work could begin.

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.