HMP Manchester

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked at 3 quality statements in this key question. The provider had made sufficient progress to address the regulatory breaches found at our previous inspection and was no longer in breach.

We found improvements in the identification and initial management of patients with a long-term health condition. However, managers should ensure staff are trained and competent to deliver care and treatment in line with national best practice guidance.

Staff scrutinised data effectively and this had improved the quality and accuracy of the data produced. This enabled managers to have better oversight of attendance at healthcare appointments and the management of long-term health conditions. Audits relating to care plans, complaints and appointments demonstrated progress and some service improvements.

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

At the previous inspection we identified significant concerns in relation to the management of long- term health conditions (LTC), such as asthma, diabetes and hypertension. During this inspection we found staff had made several improvements to ensure patients received safe care and treatment for their health condition.

Managers allocated a temporary additional staffing resource to support the required developmental work relating to LTC. Staff completed a data cleanse on the clinical recording system; this included checking data for outstanding health monitoring, establishing accurate registers and discontinuing old care plans. This meant managers had accurate information. To ensure data remained up to date, staff introduced a daily check of all new patients received into the prison; to ensure those with a LTC were identified and appropriately registered.

Managers prioritised work in relation to asthma, diabetes, hypertension and epilepsy. We reviewed 11 care records and it was evident staff were successfully using the recall and caseload management function for each condition. Patients had care plans, annual reviews were scheduled, and each patient was allocated to the caseload of the lead clinician for each condition. For those patients who had their annual review completed, their care plan was updated, and the required physical health observations were recorded. Additional annual assessments, such as retinal eye screening and foot examinations were also completed or scheduled.

Between 1 November 2024 and 31 January 2025, 44 long-term condition clinics had been delivered and 181 patients offered an appointment. However, staff had yet to establish a schedule of regular clinics, largely due to staff availability. Managers told us they were aware that a co-ordinated approach to regular clinics was necessary, and consideration was also needed for those patients with more than one condition.

Lead nurses for asthma, epilepsy and hypertension had received training; however other key staff members were not appropriately trained. Although all staff received support and supervision and had participated in some self-guided training, we were concerned that essential training had not been planned by managers. Staff would also benefit from engagement with the physical health leads within GMMH and by seeking networking opportunities within the wider primary care community. We raised this during our inspection and managers assured us this would be acted upon.

The judgement for Delivering evidence-based care and treatment is based on the latest evidence we assessed for the Effective key question.

At our previous inspection, we found the provider had failed to keep an accurate and up to date central record of patients’ external appointments. During this inspection, we found the provider had improved their management and oversight of this function. The provider had spreadsheets that fully tracked a patient’s journey showing referrals, appointment bookings, cancellation and attendance. These were easy to read and follow and provided a quick reference to the status of patients’ referrals and bookings.

However, we saw this was a complex and busy function due to the risk levels in the different prison populations (category A and category B prisoners) and their high level of healthcare needs and demands. A small and busy administrative team actively managed the process, which took a lot of focus, time and skill, and meant reduced capacity to do other administrative duties. Managers were aware of this and were considering how the administration team could be best supported.

The judgement for Supporting people to live healthier lives is based on the latest evidence we assessed for the Effective key question.

At the previous inspection, we found that staff did not scrutinise data, attendance at healthcare appointments was poor and audit outcomes did not demonstrate progress or service improvements.

During this inspection, we found staff had improved processes to identify and record reasons for non-attendance at healthcare appointments. Between 1 November 2024 and 31 January 2025 an average of 25% of appointments were not attended by patients, which is high. However, through regular analysis, staff were now able to accurately identify the reasons for this - patients choosing not to attend appointments and prison enablement were the two main reasons for non-attendance. Information was used by managers to indicate service performance and provide information to the local delivery and partnership board to be discussed with partners and other stakeholders.

Staff told us work remained ongoing to strengthen the process, particularly around how best to inform patients of their appointments and recording reasons for non-attendance.

The provider had introduced specific audits to assess the effectiveness of the changes and improvements they were making. For example, the provider completed monthly audits on the quality of care plans. We reviewed the audits for December 2024 and January 2025 and saw improvements, for example, staff were using a consistent standard care plan template, there were fewer gaps in the care plans, and they were increasingly person-centred.

A senior nurse reviewed external hospital appointments spreadsheets and produced data about the number of cancellations and reasons for them. Managers undertook monthly audits on the complaints they had received to check they were dealt with in line with the provider’s policy. We reviewed the audit for January 2025, which showed that the processed complaints met the expected standards.

Managers developed action plans for any issues identified from an audit, which were allocated for completion and checked at the next audit.

The judgement for Consent to care and treatment is based on the latest evidence we assessed for the Effective key question.