Archived: HMP Wymott

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked at 3 quality statements in this key question. The provider had safe systems and processes for ensuring continuity of care for patients entering and leaving prison. However, there were occasions where people did not receive their medicines (including critical medicines) as prescribed and records were not completed accurately. The provider now had a permanent head of healthcare and we found an improved staffing picture in psychological therapies.

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

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

The provider had safe systems and processes for ensuring continuity of care for patients entering and leaving prison. There were effective pathways for patients who needed access to secondary care services outside of prison.

New prisoners received an initial health screening assessment on reception, and a secondary screening assessment in the following days. The initial screening process helped identify prisoners’ health and social care needs and any immediate actions needed, for example, critical medicines, urgent prescriptions or treatment. Staff made sure patients who needed ongoing health care for diseases such as diabetes, epilepsy, heart and chest conditions were booked into the long-term conditions (LTC) clinics. Staff made timely referrals to substance misuse, mental health or social care services, where needed. GPs referred patients to local hospitals where indicated.

The service supported very high numbers of patients who had conditions and diseases that required hospital-based treatment. The prison worked closely with healthcare to manage the external appointments, offering 6 escorted trips per day. However, these were not sufficient for the demand at the prison, which often exceeded the number of escorts available. Healthcare had a triage process in place to assess risks and prioritise needs, when necessary. In addition, they had weekly meetings with the local hospital, which helped to clinically triage patients and manage waiting times.

Where feasible, healthcare and the prison tried to meet patients’ needs on site, which benefited not only patients but also healthcare and the prison. With advice and support from the local authority, the prison had developed a 59-bedded wing (the Haven Unit) that accommodated “prisoners with complex health, social care and emotional needs” of any age, though most residents were older and frail. The unit included 6 ground floor cells with wide doors that could accommodate wheelchairs and space for larger specialist beds. One cell had a hoist. Pendants and sensors were available. The unit was staffed 24 hours a day by specially trained prison officers and a small team of dedicated healthcare support workers from 8am to 8pm.

The prison had links to a local hospice they could transfer patients to if safe and appropriate. However, the Haven Unit also supported patients with palliative care and end of life care with the support of visiting specialists such as Macmillan nurses.

Healthcare and the prison had good arrangements for the release and transfer of patients. Patients were seen by healthcare before they left and had at least 7 days’ supply of their medicines, or a prescription or an appointment in the community. However, the provider’s data did not accurately reflect this due to data quality issues.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe environments is based on the latest evidence we assessed for the Safe key question.

At our previous inspection, there had been no on-site head of healthcare for several months, which had affected clinical leads’ abilities to fulfil their roles and maintain effective oversight of the department. The provider had since recruited a new experienced head of healthcare who was determined to transform the service, with visible improvements evident in their first few months.

At our previous inspection, we found patients had poor access to psychological therapies due to only 1 person being in post, a reduced service offer and long waiting lists. At this inspection, we found the provider had improved patients’ access to psychological therapies.

The integrated mental health service included a small psychological therapies team of 3.3 full-time posts, which equated to 5 staff. At this inspection, we found the team had 4 staff in post and only 1 vacancy. Patients received timely assessments and interventions in line with the stepped model of care for mental health. Following an initial assessment, patients were discussed at the team’s single point of access (SPOA) meeting to determine the most appropriate treatment/intervention. Urgent needs were prioritised. Patients on waiting lists were monitored by the wider team and received welfare checks if needed.

We reviewed caseloads and found a much-increased number of patients who were receiving 1-1 psychological therapies. We reviewed waiting lists and found the number of patients and the length of wait time had reduced. For example, the longest waiting time for initial assessment was 6 weeks. The longest waiting time for step 2 interventions was 8 weeks, and 3 weeks for step 3-4 interventions. At the time of our inspection, there were no groups running due to the remaining vacant role for a health and wellbeing practitioner.

At our previous inspection, we found the overall compliance rate for mandatory training was low. At this inspection, we found an overall increase in the training compliance levels for clinical staff. In particular, there had been an increase in the number of primary care staff who had completed immediate life support training. The new head of healthcare monitored training data weekly and encouraged staff to complete the mandatory and essential training for their roles.

At our previous inspection, we found staff did not receive regular clinical and managerial supervision. At this inspection, we found the frequency and quality of supervision had improved significantly since the arrival of the new HoHC. For example, data showed that clinical and line management supervision levels had increased from 56% in July 2024 to 100% in November 2024 for all services with the exception of pharmacy (88%). Appraisal levels had increased from around 63% in July 2024 to 100% in November 2024.

Overall, the staffing picture was positive with most staff in place and good access to a reliable group of temporary staff. However, the service experienced challenges in managing the high and increasing levels of need in the prison population within their overall staff capacity. For example, data showed that 699 patients had long-term conditions (LTCs), of which 570 had multiple conditions. The service had employed a nurse (community matron) on a temporary basis to provide a much-needed focus on long-term conditions but this was not sufficient resource to manage the level of need. Staff worked diligently and flexibly to manage the high demands.

The judgement for Infection prevention and control is based on the latest evidence we assessed for the Safe key question.

The provider had systems and processes in place for managing medicines but we found areas that needed further attention. We found errors and omissions that presented a potential risk of harm in a very busy service with a prison population that included very high numbers of patients requiring 1 or more prescribed medicines.

The provider had safe procedures for storing and administering medicines. Medicines were dispensed from a registered on-site pharmacy and administered from the medicine administration points (MAPs) on wings twice a day at 8am and 4pm. MAPs were clean and organised. Staff undertook daily checks of all areas where medicines were stored, including room temperatures.

During our inspection, we observed the administration of medicines at MAPs and found a well-managed system with good joint working between healthcare and prison staff. Staff followed good practice, for example, checking each patient’s ID. Prison officers supervised the administration queues effectively, which reduced the overall administration time.

The provider used an electronic care records system (SystmOne) to manage medicines administration. We found legal authorisations or prescriptions in place for all medicines administered to patients. Staff used ‘placeholders’ to alert them to check for any medicines supplied to patients during hospital appointments. The service had patient group directives (PGDs) allowing them to administer medicines to treat minor ailments.

Staff completed medicines reconciliation for new patients efficiently, for example, in July 2024, 97% were completed within 72 hours. Staff repeated these checks for patients returning from hospital appointments. However, we found a new patient had been allowed to keep the medicines he brought into the prison but his notes did not detail these medicines. He had a prescription dispensed the following day, which meant he could have received duplicate medicines. One of the medicines was classed as a tradeable medicine.

The prison had very high numbers of patients who needed prescribed medicines, the majority of whom received their medicines in-possession (IP). For example, 693 patients received 28 days of medicines for self-administration and 270 patients received 7 days of medicines in-possession. The service had systems and processes for managing IP medicines but these were not always effective for monitoring potential risks. For example, there was no clear system for following up patients who were prescribed critical medicines but had not collected them. This meant patients were at risk of deterioration to their health. In another example, a patient’s pain medicine had ended in August 2024, yet the prescription had continued to be generated and dispensed and the patient continued to collect it. This was classed as a tradeable medicine.

IP medicines were available for collection at designated times. However, for various reasons, patients were not always available to collect their IP medicines at the allocated time. When they tried to collect them at other times, the medicines could not always be located. This presented the risk of delays to patients’ treatments, for example, while new prescriptions were issued.

Staff returned any IP medicines that were not collected to the pharmacy. However, we found staff did not always complete the relevant form to log the movement of the medicines to ensure an accurate audit trail. Staff completed spot checks regularly to monitor patients’ compliance with IP medicines and took action if they identified any concerns.

We found several examples where patients’ medicines were not available to them even though they had been prescribed. A patient who required supplements (cholecalciferol and folic acid) had not received them for 18 days, and he was due a follow-up blood test to monitor the effectiveness of these after 1 month. A patient with a long-term respiratory condition did not have his preventative inhaler prescribed or supplied for the month of October 2024. Some medicines were not supplied that were needed to support wound care. One of the possible causes of these issues was the pharmacy’s printers failing to print prescriptions, which meant that pharmacy staff could not dispense them.

There was no monitoring of missed medicines and escalation was not always completed in line with the provider’s policy when patients did not receive their medicines. Staff could issue medicines from emergency stocks if needed urgently, but this was not always noted in the patient’s care record.

The pharmacy had a process for recording the use of prescription stationery, but records had not been completed accurately and the process had not been audited.

Medicines management meetings took place every 2 months although they were not always consistent and quorate. The meetings included discussions about medicines-related incidents but not complaints, even though the pharmacy team were involved in their investigation.

The service completed medicines audits and used their findings to improve care and treatment, for example, reducing the usage of dihydrocodeine in the prison. At the time of our inspection, the service was completing an audit to check that patients were provided oral nutritional supplements in line with national guidance (Advisory Committee on Borderline Substances (ACBS)).