- Prison healthcare
HMP & YOI Styal
All Inspections
30 April to 2 May 2024; 3 May to 10 May 2024 (remote)
During a routine inspection
We carried out an unannounced comprehensive inspection of healthcare services provided by Spectrum Community Health C.I.C. (Spectrum) at HMP & YOI Styal. We visited the services between 30 April and 2 May 2024, and continued to inspect remotely until 10 May 2024.
The purpose of this comprehensive inspection was to determine if the health care services provided by Spectrum 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.
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:
- Medicines management was not safe and effective enough with the issues we found ranging from the availability of medicines, poor record-keeping, delays to administration, and medicines errors due to insufficient storage space.
- Infection prevention and control was inadequate with poor standards of cleanliness in clinical environments.
- The health care service lacked stable and consistent leadership, which had a significant impact on primary healthcare.
- There was insufficient or ineffective scrutiny and oversight of the safety and quality of the service.
- Primary healthcare lacked sufficient numbers of suitably qualified and experienced staff to provide a safe service.
- Primary healthcare staff did not receive the appropriate training and supervision to support them in their roles.
- Primary healthcare staff worked under pressure in challenging circumstances and worried about keeping patients safe.
- Patients did not always receive their planned social care support in a timely manner, especially in the evening and during the night.
However, we also found:
- Staff showed a strong commitment to their colleagues and patients and worked hard to provide a full service in challenging circumstances.
- Staff completed timely assessments of patients’ needs and risks and planned appropriate care and treatment.
- Staff from other teams saw the pressure that primary healthcare was under and offered to help whenever they could.
- The integrated substance misuse service provided a safe and responsive service in line with the relevant clinical guidelines.
- The service had an experienced and dedicated social care lead who oversaw all social care matters and ensured patients received the personal care, aids and adaptations they needed in a timely manner.
We found breaches in relation to Regulation 12 Safe care and treatment, Regulation 17 Good governance, and Regulation 18 Staffing. We took enforcement action, and we will keep the service under review.
The provider must:
- Ensure that critical and emergency medicines are available and managed in line with the provider’s procedures.
- Ensure patients receive critical medicines at the times they are prescribed.
- Ensure prescription stationery is managed securely.
- Ensure the correct monitoring of ambient temperatures and act where needed to ensure that medicines remain suitable for use.
- Ensure there is always legal authorisation to administer medicines.
- Ensure audits related to medicines management are taking place, including the monitoring of omitted doses.
- Ensure sufficient numbers of suitably qualified and experienced staff to provide a safe service.
- Ensure sufficient staffing capacity especially during late and night shifts to meet patients’ social care needs in a timely manner.
- Maintain adequate infection prevention and control standards.
- Ensure emergency equipment is available, in date, and regularly checked.
- Ensure that governance systems and processes are fit for purpose and utilised appropriately to effectively monitor the safety and quality of services.
In addition to the breaches, the provider should:
- Ensure the robust management of ‘in possession’ (IP) medicines and that records are completed in a timely manner.
- Ensure ‘medicines in possession risk assessments’ (MIPRAs) are completed and accurately reflect the status of the patient.
- Ensure all staff can access current copies of Patient Group Directions (PGDs) when they are administering medicines.
- Ensure patients comply with the requirements attached to their IP status, for example, secure storage.
- Improve the storage of medicines at medicines administration points (MAPs) so that it is clear if they are available for administration.
- Cleanse data and keep records such as waiting lists, tasks and reviews updated.
- Improve the quality of care records and record-keeping practices.
- Submit statutory notifications to CQC and other agencies where required.
- Ensure that patients’ complaints are handled in a timely manner.
04 October 2022
During an inspection looking at part of the service
We carried out an announced focused inspection of healthcare services provided by Spectrum Community Health C.I.C. at HMP and YOI Styal to follow up on the requirement notice issued after our last inspection in October 2021. At the last inspection, we found the quality of healthcare provided by Spectrum at this location required improvement. We issued a requirement notice in relation to Regulation 12, Safe Care and Treatment.
The purpose of this focused inspection was to determine if the healthcare services provided by Spectrum were meeting the legal requirements of the requirement notice; regulations under Section 60 of the Health and Social Care Act 2008 and that patients were receiving safe care and treatment.
At this inspection we found the required improvements had been made and the provider was meeting the requirements for Regulation 12, Safe Care and Treatment.
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:
- Staff managed medicines safely
However;
- Managers had not fully implemented quality assurance processes to ensure changes in service delivery are embedded and effective.
The areas where the provider SHOULD make improvements:
- The provider should ensure systems and processes that enable the registered person to assess, monitor and improve the quality and safety of the services continue to be embedded.
5 February 2020
During an inspection looking at part of the service
We carried out an announced focused inspection of healthcare services provided by Spectrum Community Health C.I.C. at HMP & YOI Styal on 5 February 2020.
Following our last joint inspection with Her Majesty’s Inspectorate of Prisons (HMIP) in April and May 2018, we found that the quality of healthcare provided by Spectrum Community Health C.I.C. at this location required improvement. We issued a Requirement Notice in relation to Regulation, 12, Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We carried out a focused inspection in April 2019 and we found that improvements were still required. We issued Requirement Notices in relation to Regulations, 12, Safe care and treatment, and 17, Good Governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The purpose of this focused inspection was to determine if the healthcare services provided by Spectrum Community Health C.I.C were meeting the legal requirements of the Requirement Notices that we issued in April 2019. We checked to see if patients were receiving safe care and treatment and that governance systems had improved. At this inspection we found that improvements had been made and the provider was meeting the regulations.
We do not currently rate services provided in prisons.
At this inspection we found:
- Checks of medicines fridge and room temperatures were carried out.
- Stock of homely remedies was appropriately managed.
- Emergency equipment and medicines were regularly checked.
- Patients’ medicines in-possession risk assessments were carried out when they arrived at the prison.
- There was a system to follow up patients not attending for their medicines, which was mostly effective.
- Governance systems had improved and there was regular assurance of staff practice relating to medicines management.
The areas where the provider should make improvements are:
- Follow up all patients who don’t attend for their medicines for three consecutive days.
- Amend the expiry date of certain medicines when required.
- Complete medicines administration records accurately to reflect the reasons why medicines were not administered to patients.
18 April 2019
During an inspection looking at part of the service
We carried out an announced focused inspection of healthcare services provided by Spectrum Community Health C.I.C. on Thursday 18 April 2019.
Following our last joint inspection with Her Majesty’s Inspectorate of Prisons (HMIP) in May 2018, we found that the quality of healthcare provided by Spectrum Community Health C.I.C. at HMP YOI Styal required improvement. We issued a Requirement Notice in relation to Regulation 12, Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The purpose of this inspection was to determine if the healthcare services provided by Spectrum Community Healthcare C.I.C were meeting the legal requirements of the Requirement Notice and that patients were receiving safe care and treatment. At this inspection we found that some improvements had been made but further improvements were required. We also found new areas of concern.
We do not currently rate services provided in prisons.
At this inspection we found:
- Patients accessed prescribed medicines in a timely way.
- All medicines trolleys were securely fixed to a wall in various treatment rooms located across the prison.
- Medicines were transported around the prison in secure bags and cases.
- Medicine key cabinet logs were still not consistently recorded.
- Maximum and minimum fridge temperatures were still not consistently recorded and when temperatures were not within the accepted range insufficient action was taken to resolve this.
- Out of hours medicines were not sufficiently monitored, dates were not recorded when an out of hours medicine was given and neither was a running total record of the number of remaining medicines.
- We found that records of room temperatures where medicines were stored were not consistently maintained.
We found some new areas of concern
- Checks of medicines and equipment in emergency bags were not consistently completed.
- Medication Administration Records (MAR) were not completed consistently and gaps in MAR records were not monitored.
- Patients sometimes did not collect prescribed medicines for several days; no actions was taken and the reasons for non-attendance were not recorded.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure that emergency equipment is safe to use
- Ensure that medicines are managed safely, administered appropriately and patients’ individual records are complete.
- Ensure that effective governance arrangements, assess, monitor the safety and quality of the service, including assurance and auditing systems or processes.
The areas where the provider should make improvements are
- In possession risk assessments should be completed promptly to support patients assessed as suitable to manage their own medicines.
10, 11 November 2014
During a themed inspection looking at Offender Healthcare
We spoke with NHS England who commissioned the service provided by Spectrum Community Health CIC. They told us they did not have any concerns about the services provided at HMP & YOI Styal at the time of our inspection.
Spectrum Community Health CIC provided primary health care services at the prison.
We observed a good range of health promotion literature available in the healthcare centre and on wings that informed patients of what health services were available in the prison.
Formal care planning for some prisoners with complex health needed further development.
There were systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.