Bridgewater CHCFT HMP Wymott Inspection report Wymott Prison Ulnes Walton Lane Leyland Lancashire PR26 8LW Tel: 01772 442000 Date of inspection visit: 17/07/2018 to 20/07/2018 www.bridgewater.nhs.uk Date of publication: 31/12/2018 This report describes our judgement of the quality of care at this service. It is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information given to us from the provider, patients, the public and other organisations. Ratings 1 Bridgewater CHCFT HMP Wymott Inspection report 31/12/2018 Overall summary The five questions we ask and what we found • Dental decontamination procedures were appropriate and all necessary equipment used in the process was Are services safe? available to clinical staff. • Information provided by the trust showed that not all Are services effective? primary health care staff had completed safeguarding training appropriate to their role. Neither had a • Not all prisoners received a secondary health sufficient number of staff completed either basic life assessment within the first seven days of their reception support training or intermediate life support training into HMP Wymott, which compromised their safety and commensurate with their role. wellbeing. Healthcare assessments within the first few • The availability of chaperones during examinations and days in prison are crucial in identifying prisoners’ intimate examinations was not advertised or promoted healthcare needs, providing treatment and keeping in healthcare literature or on information boards located people safe. within the healthcare centre. • Healthcare staff did not always ensure that prisoners • Treatment rooms on wings and those located in the received a continuous supply of prescribed medicines. healthcare centre did not meet infection prevention Reviews of prescribed medicines did not happen with standards. Whilst the trust is not directly responsible for sufficient regularity. the cleaning of treatment areas as these are the • The dentist confirmed they referred prisoners to responsibility of the prison, nurses told us that they did specialists in primary and secondary care when what they could to ensure areas were as clinically clean treatment was needed and monitored urgent referrals as possible by wiping down areas in which they treated with colleagues from primary health care services to prisoners and/or administered medicines. make sure they were dealt with promptly. • The risks to patients were not adequately identified, • Care and treatment for prisoners with long term managed or monitored, for example, primary health conditions (LTC) was effective and supported by a care managers did not keep accurate records of clinics dedicated LTC nurse. cancelled, which impacted on their ability to adequately • Prisoners’ attendance at healthcare appointments was monitor and review service delivery. An exception to this monitored monthly and analysed for trends. Prisoners was in respect of dental services, where we found that who did not attend healthcare appointments were health and safety policies and risk assessments were up followed up by nurses. to date and reviewed regularly to help manage potential • The supervision and management of social care risks. provision at the prison was unclear. Care planning for • Emergency medical equipment was available but staff prisoners in receipt of a social care package was not did not regularly complete daily checks of emergency consistent and care plan reviews did not take place bags and records of such checks were not maintained in regularly. accordance with local policy. This meant that the safety • Supervision arrangements for all members of the staff of patients requiring an emergency response and/or team were insufficient. treatment could be compromised. Are services caring? • The arrangements for managing medicines did not keep patients safe. • Primary healthcare staff including dental staff spoke to • There was a system in place for recording and acting on prisoners in a respectful and caring manner. significant events. However, we were not assured that all • Clinic room doors remained open during nurse-led significant incidents, with the exception of those consultations and conversations could be heard by reported by dental staff, were reported and appropriate other staff including prison staff and other prisoners action was taken to ensure patient safety. passing through the health care reception area. This • There was no evidence of learning from adverse events practice compromised patient confidentiality. and the subsequent dissemination of information to • Prisoners told us their requests to meet privately with a improve safety across primary health care services. nurse to discuss their health concerns were not met. Are services responsive to people’s needs? 2 Bridgewater CHCFT HMP Wymott Inspection report 31/12/2018 Overall summary • The healthcare centre was small with insufficient • Staff we spoke with told us they were able to raise treatment rooms to meet the needs of the prison concerns and were encouraged to do so. However, population; however this was not the direct many were less confident that action would be taken in responsibility of the trust. response to their concerns. • Prisoners were not always able to access primary health Key Findings care and treatment within acceptable timescales, Clinics were cancelled and/or oversubscribed. The areas where the provider must make improvements • Prisoners sometimes received their medicines late. are: • Prisoners were supported to attend external hospital • The provider must ensure that staff receive the support, appointments. training, professional development, and supervision • Information on how to complain was publicised on that are necessary for them to carry out their role and most wings and in the healthcare centre. responsibilities. Are services well-led? • The provider must ensure that people who use the service receive safe care and treatment and prevent • Senior managers within the trust were not sufficiently avoidable harm or risk of harm by making sure focused on staff development and/or service equipment used is safe, medicines are available and development and because of this lack of focus, supplied in sufficient quantities. improvements were not sustained. There were • The provider must ensure that people using the service inadequate processes in place for providing all staff with receive appropriate person-centred care and treatment the development they need, including supervision, that is based on an assessment of their needs and training and support. preferences. • Some healthcare staff told us that healthcare managers • The provider must ensure that they employ effective were not always visible and they did not effectively work governance arrangements, including assurance and with front line staff. Despite the varying views of staff, auditing systems or processes to support, assess, most were optimistic about achieving change and monitor and drive improvement in the quality and improvements, though not enough staff had been safety of the services. Systems and processes must consulted and involved in plans for the future. assess, monitor and mitigate any risks relating to the • Systems and processes to support good governance health, safety and welfare of people using the service. and management of the service were limited at local • The provider must maintain accurate, complete and level and this impacted on overall effectiveness of the detailed records in respect of each person using the service. The exception being dental services which were service and records relating the employment of staff managed effectively by the trusts dental network. and the overall management of the regulated activity. • Health care managers did not routinely share learning from incidents with primary healthcare staff in order to The areas where the provider should make improvements make improvements. are: • Governance checks were not undertaken to ensure that • The provider should provide information about the equipment in emergency bags was monitored and fit for availability of chaperones to people using the service. purpose. • The provider should ensure that all clinical areas, in • Measures to monitor primary health care services, which primary healthcare nursing staff provide including checks of fridge temperatures and the clinical treatments and medicines, meet infection prevention environment, were poorly implemented. standards and do not compromise patient safety. • Quality assurance processes for dental services • The provider should establish arrangements to including audits of care records, radiographs and effectively support multi-disciplinary review of people infection prevention and control were effective. with complex needs who use the service. • Induction for permanent and agency primary health care staff was not a priority and many staff had not had a formal induction, missing a crucial opportunity to help all staff understand the trust’s vision and values 3 Bridgewater CHCFT HMP Wymott Inspection report 31/12/2018 Overall summary • The provider should ensure that people who use the service have information on how to escalate their concerns if they are dissatisfied with how their complaint had been managed. 4 Bridgewater CHCFT HMP Wymott Inspection report 31/12/2018 Overall summary Our inspection team Our inspection team was led by a CQC health and justice We do not currently rate services provided in prisons.