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Archived: HMP Liverpool

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Inspection Summary


Overall summary & rating

Updated 15 December 2017

Summary Letter

We carried out an announced focused inspection of HMP Liverpool between 11 and 14 September 2017, alongside a comprehensive joint inspection with Her Majesty’s Inspectorate of Prisons (HMIP) under our memorandum of understanding. The focused inspection was in response to previous breaches of our regulations, and to concerns raised by whistle blowers about patients’ experience at HMP Liverpool. Some of these related to prison issues outside the remit and control of Lancashire Care NHS Foundation Trust (LCFT). HMIP will publish the joint report separately at:

https://www.justiceinspectorates.gov.uk/hmiprisons/inspections

CQC do not currently rate services provided in prisons.

The background to inspection activity for HMP Liverpool is:

  • In May 2015 we carried out a joint comprehensive HMIP and CQC inspection. Breaches of regulations led to CQC issuing four Requirement Notices to improve care against: Regulation 9, - Person centred care; Regulation 10 - Dignity and respect; Regulation 12 - Safe care and treatment, and Regulation 16 - Receiving and acting on complaints.

  • In July 2016 we undertook a CQC-led focused inspection. We found the trust had made some improvements. However, further breaches in some areas led to CQC issuing two further Requirement Notices against Regulation 9, - Person centred care and Regulation 12, - Safe care and treatment.

  • CQC decided to follow up these breaches by carrying out a focused follow up inspection alongside the planned joint comprehensive inspection with HMIP in September 2017.

During this inspection, we found that issues identified in the inspection in 2016 had mostly been addressed, and there were improvements in some aspects of care. However, we also found a number of other areas where Lancashire Care NHS Foundation Trust must make improvements. 

Importantly, the trust must ensure that:

  • Complaints are investigated effectively and in a timely way with appropriate action to address patients’ concerns.
  • Complainants are kept informed of the status of their complaint and its investigation.
  • Complaint monitoring actively informs service improvement and learning is shared with staff to improve patient care.
  • Appropriate monitoring and recording of prescribing errors is embedded to improve prescribing safety and patient care.
  • Patient engagement informs the delivery of services and service improvement.
  • Governance arrangements for the dental service are robust; including monitoring the quality of x-rays and sharing learning from audits to improve patient care.
  • Clear and accurate records are kept in relation to staffing rotas that support effective monitoring.
  • Clinical staff receive appropriate managerial and clinical supervision in line with trust policy.
  • Clear and accurate up to date records are kept in relation to staff supervision.
  • Staff receive regular appraisal of their performance.
  • Staff conducting detoxification reviews are appropriately supported by clinicians.

Additionally the trust should:

  • Ensure systems to monitor the safe storage of medicines are effective.
  • Routinely update emergency medicine expiry dates where they are stored out of refrigerators, in line with guidance.
  • Implement comprehensive reporting and escalation systems in relation to regime activity on the inpatient unit.
  • Ensure that patients on detoxification regimes are monitored appropriately in line with guidance.
  • Implement an action plan to build on the cultural values assessment carried out in August 2017 to support staff and patient care.
  • Ensure there is sufficient management oversight and staffing during the remainder of the service contract.

Inspection areas

Safe

Updated 15 December 2017

We found that while Lancashire Care NHS Foundation Trust was providing reasonably safe care in accordance with the relevant regulations, there remained a range of concerns about the environment, governance, and staffing levels which posed a risk to patients.

  • Most incidents were being reported by staff and investigated by managers.

  • Governance arrangements were not sufficiently robust around recording prescribing errors, refrigerator temperature monitoring and accuracy of emergency medicine expiry dates.

Healthcare staff were unable to monitor patients on detoxification regimes overnight and there was no clinical involvement in the five-day reviews in line with guidance.  

Effective

Updated 15 December 2017

We found that although the trust had made a number of improvements since our previous inspection, LCFT was not providing effective care in accordance with the relevant regulations.

  • Improvements made since our previous inspection included community equivalent NHS screening and long-term condition management.

  • The trust had taken appropriate and sustained action to recruit to fill staffing vacancies, and recruitment issues were routinely discussed with NHS England at partnership meetings, however, vacancies continued to impact on the team’s ability to deliver effective care; in particular the monitoring of patients who were experiencing mental health problems.

  • Whilst the trust carried out a range of audits and complaints monitoring, these were not embedded within the prison healthcare team to improve patient care.

  • Many staff did not receive regular supervision or timely performance reviews.

  • The psychiatrist provision did not meet the needs of patients.

  • The Talking Therapies team delivered a range of interventions to support prisoners with low-level mental health conditions.
  • Whilst patients did not have access to discuss their medicines with a pharmacist, GPs and pharmacy technicians did support patients with their medicines.

Caring

Updated 15 December 2017

We found that LCFT was providing caring services in accordance with the relevant regulations.

  • We observed a range of caring interactions between patients and staff.

  • Staff delivered personalised care despite the complex working environment.

  • Care planning had been effectively introduced for patients with long-term conditions.

Responsive

Updated 15 December 2017

We found that LCFT was not always providing responsive care:

  • Patients experienced waits for up to four months for written responses to complaints.

  • There was a regular forum for up to 26 patients residing in the inpatient unit, but no engagement with the remainder of the 1,155 patients through survey or forum groups.

  • Prisoner perceptions were poor, especially around referrals to secondary care and escorts to external hospital appointments.

  • Some improvements had been introduced by the trust in order to meet the needs of the patient population, for example reintroducing community and screening pathways, appointing a permanent long-term condition nurse and integrating the mental health and substance misuse services.

  • Most routine GP appointments took place within two weeks.

  • Urgent GP appointments were available daily, along with nurse led triage and long-term condition management.

Well-led

Updated 15 December 2017

We found LCFT was not providing well-led care.

  • There was evidence of continual improvement and improvements to patient care.

  • The trust had ensured recruitment remained an ongoing priority and this was discussed with commissioners and prison management regularly.

  • Wider trust governance systems were not all effectively embedded into HMP Liverpool.

  • Staff told us they felt supported by local management but not by the wider trust.

  • Patient engagement was good for inpatients but did not take place for prisoners living on the main residential units.

  • The trust had carried out a staff cultural values assessment (CVA) as part of engagement and team building in August 2017, however, no action plan to take this forward was in place at the time of the inspection.

  • The trust’s decision to give notice to withdraw from the contract to provide services at HMP Liverpool coincided with the CVA report publication and contributed to staff feeling devalued by the trust.

  • There remained a number of areas where healthcare treatment was not sufficiently prioritised by partnership working with prison staff and managers. Whilst healthcare staff reported some incidents through the trust reporting system, they did not always escalate to prison management when it would be appropriate to do so, and monitoring arrangements were insufficient to evidence escalation and reporting.