HMP Garth

We carried out an announced comprehensive inspection of healthcare services provided by Greater Manchester Mental Health (GMMH) NHS Foundation Trust between 6 and 8 September 2023.

The purpose of this comprehensive inspection was to determine if the healthcare services provided by GMMH were meeting the legal requirements and regulations under Section 60 of the Health and Social Care Act 2008 and that patients were receiving safe care and treatment. This inspection included follow up of the Requirement Notice we issued after our inspection in November 2022. This related to issues we found with medicines management practices. Details can be found at https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2023/03/Garth-web-2022.pdf

We do not currently rate services provided in prisons. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

At this inspection, we found:

• Healthcare staff worked diligently and flexibly to provide safe and effective care in challenging circumstances associated with the prison regime and culture.
• The provider had made significant improvements to medicines management practices.
• The provider had a wide range of skilled staff across all services who were suitably qualified and experienced for their roles. Staff reported good team working and mutual support.
• Staff treated patients with dignity and respect. Staff completed timely assessments of patients’ needs and risks and planned appropriate care and treatment.
• Examples of good practice included the neurodevelopmental pathway, the range of groups offered by the drug and alcohol recovery service, the social care pathway and tracker, the flexible, timely access to the substance misuse prescriber, and the lessons learned bulletin.

However, we also found:

• Some issues with medicines management had not been fully resolved, and we also identified new concerns.
• There were staffing shortages across healthcare with the primary care team being the most stretched.
• There were delays in collecting and responding to complaints, and the quality of responses varied. The spreadsheet for managing external appointments was not up to date.
• There was a lack of accurate data on daily staffing deficits and cancelled clinics, which made it difficult to assess the extent of the issues faced by the service. Audits did not always identify issues or result in effective improvements.

We found two breaches of regulations. The provider must:

• Ensure the proper and safe management of medicines (Regulation 12 (1))
• Ensure good governance through effective systems and processes (Regulation 17 (1)).

In addition to the breaches, the provider should:

• Improve staffing levels, especially in primary care.
• Address the back logs for activities such as 13-week reviews and routine drugs testing for people on opioid substitution treatment, and annual health checks for people on the Care Programme Approach.
• Offer specialist training in substance misuse to all staff involved in any substance misuse care.
• Cleanse data and keep records such as waiting lists, tasks and reviews updated.
• Review and personalise care plans for patients with long-term conditions.
• Review policies that are overdue for review or out of date.
• Continue to work with the prison to address the inequitable access to healthcare for patients on E, F and G wings.
• Continue to work with the prison to improve medicines administration, especially at the points for A and B, and C and D wings.