NHS Forth Valley. 3. What is the average cost of healthcare Approximately 3,887.8 per prisoner (based on 1,218 prisoners) Service Manager (Band 8B)

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1 NHS Forth Valley Facilities 1. NHS Forth Valley is responsible for the healthcare provision within HMP Glenochil, HMP YOI Cornton Vale and HMP YOI Polmont. Per head of population there are a significantly higher number of prisons within Forth Valley than in other Health Board areas. The local prisons are all national establishments. Budget and Costs 2. What is the budget for health 2016/17-4,735, What is the average cost of healthcare Approximately 3,887.8 per prisoner (based on 1,218 prisoners) Staffing 4. General Manager Service Manager (Band 8B) Healthcare Manager (Band 8A) HMP GLENOCHIL HMP YOI CORNTON VALE HMP YOI POLMONT Clinical Manager Band 7 1wte Clinical Manager Band7 1wte Clinical Manager Band 7 1wte CBT Nurse Therapist Band wte CBT Nurse Therapist Band wte CBT Nurse Therapist Band wte Team Leader Band 6 1wte (Mental Health) Team Leader Band 6 1wte (Mental Health) Team Leader Band 6 1 wte (Mental Health) Team Leader Band 6 1 wte (Primary Care) Team Leader Band 6 1wte (Primary Care) Team Leader Band 6 1 wte (Primary Care) Addiction/Mother &Baby Nurse Band wte Addiction/Mother & Baby Nurse Band wte Specialist Sexual Health Nurse Band wte Specialist Sexual Health Nurse Band wte Specialist sexual Health Nurse Band wte Practitioner Nurse Band 5 (Mental Health) 4.0 wte Practitioner Nurse Band 5 (Mental Health 5.80 wte Practitioner Nurse Band 5 (Mental Health) 5.8 wte Practitioner Nurse Band 5 (Primary Care) 8.6 wte Rehabilitation Support Worker Band wte Healthcare Assistant Band wte Practitioner Nurse Band 5 (Primary Care) 4.0 wte Healthcare Assistant Band wte Pharmacy Assistant Band wte Practitioner Nurse Band 5 (Primary Care) 5.8 wte Healthcare assistant Band wte Pharmacy Assistant Band wte 1

2 Pharmacy Assistant Band wte Substance Misuse Team Leader Band wte Substance Misuse Worker Band wte Patient Relation Team (Across 3 Prisons) 1.0 Band Band 4 Support Services Co-ordinator Band (Across 3 prisons) Administrator Band wte Administrator Band wte Substance Misuse Team Leader Band wte Substance Misuse Worker Band wte Administrator Band wte Substance Misuse Team Leader Band wte Substance Misuse Worker Band 4-5.0wte Administrator Band wte Administrator Band wte Medical Services are supervised by 1.0 Clinical Lead GP for Prison Healthcare. Medical Services are supported by Portfolio GP s and 1.0 wte Advanced Nurse Practitioner. NHS Forth Valley provides Psychiatry, Dental, Physiotherapy, Occupational Therapy, Speech and Language Therapy, Ophthalmic, Podiatry, Dermatology, Ante Natal and Women s Sexual Health Services into each prison, clinic based. 5. How many posts have been vacant for 3 months or longer. There have been no posts vacant for 3 months or longer Demand 6. How many prisoners have mental health needs HMP Glenochil HMP YOI Cornton Vale HMP YOI Polmont The Mental Health Team currently has a caseload of 63 patients. There are on average 55 referrals to the Mental Health Team per month The Mental Health Team currently has a case load of 41 patients. The prison currently has a population of 82 and 80 of the women are prescribed medication for mental health The Mental Health Team currently has a case load of 50 patients (Young Men and women). The population within the prison is transient and therefore it is challenging accurate numbers. recording 7. How many prisoners have long term conditions HMP Glenochil HMP YOI Cornton Vale HMP YOI Polmont Currently there are approximately 123 patients identified with long term conditions. Many of the women in our care present with poor mental health, alcohol and drug misuse and suffer from poor physical health i.e. low BMI, risk of DVT s, poor circulation, chronic and acute wounds. There are currently 26 patients with physical Many of the women in our care present with poor mental health, alcohol and drug misuse and suffer from poor physical health i.e. low BMI, risk of DVT s, poor circulation, chronic and acute wounds. 2

3 conditions and 25 with mental health/addiction issues 8. How many prisoners have high care needs HMP Glenochil HMP YOI Cornton Vale HMP YOI Polmont There are currently 45 patients with high care needs No Patients No patients 9. How many prisoners have palliative care needs and what arrangements are in place to provide this HMP Glenochil HMP YOI Cornton Vale HMP YOI Polmont 2 patients at present. Patients have care plans in place. Both NHS and SPS staff have received Sage and Thyme training which assists with communication with palliative patients. Primary Care Team Leader has received MacMillan training. Support from NHS Forth Valley Palliative Care Services. At End of Life, arrangement in place for Marie Curie support. SPS provide social care services which provide personal care to the patient as deemed appropriate. Training has been arranged for the development of advanced care planning for all patients identified as having high care needs. No patients No patients Palliative Care Facilitator Post for Prisons has recently been established in partnership with SPS. This post is funded by MacMillan Cancer Care and is hosted by NHS Forth Valley. This is a national post. Performance 3

4 10. How many complaints in relation to a) health and b) social care in prison have you received over the past 5 years by subject of complaint, broken down by year. Data for all 3 prisons in relation to health only. Significant work has been undertaken in the past 2 years on complaints handling with dedicated Patient Relations Officers allocated to prisons. In terms of performance, it is important to highlight that the complex nature of the prison population, particularly in Glenochil, can lead to high levels of complaints regarding drug administration. In addition there can be very small numbers of prisoners accounting for a high percentage of complaints. These are handled on an individual basis. Year Total Total Number of Issues Raised Delay Outpatients/Clinics 2 Environment/Domiciliary/Personal Records 3 Staff Attitude/Behaviour 4 Transport of which relate to medication issues (68%) Waiting Time/Date of Appointment 15 TOTAL Environment/Domiciliary Aids/Equipment 1 Environment/Domiciliary/Catering 1 Environment/Domiciliary/Patient Privacy 2 Environment/Domiciliary/Patient Status 1 Environment/Domiciliary/Personal Records 4 Environment/Domiciliary/Premises 1 Process Issues/Failure to follow Procedure 2 Staff Attitude/Behaviour 5 Staff Communication (Oral) 8 Staff Communication (Written) 2 Staff/Competence 1 Staff/Complaint Handling of which relate to medication issues (59.7%) Waiting Time/Date/Admission/Attendance 3 Waiting Time/Date of Appointment 65 Waiting Time/Test Results 2 Other 2 TOTAL 347 4

5 2014 Environment/Domiciliary Aids/Equipment 2 Environment/Domiciliary/Catering 4 Environment/Domiciliary/Private Privacy 2 Environment/Domiciliary/Personal Records 5 Environment/Domiciliary/Premises 1 Process Issues/Failure to Follow Process 3 Staff/Attitude and Behaviour 24 Staff Communication (Oral) 2 Staff Communication (Written) 5 Staff Competence 2 Staff/Complaint Handling 15 Transport of which relate to medication issues (73.7%) Waiting Time/Date of Appointment 67 Waiting Time/Test Results 5 Other 1 TOTAL Environment/Domiciliary Aids/Equipment 3 Environment/Domiciliary/Catering 1 Environment/Domiciliary/Cleanliness/Laundry 1 Environment/Domiciliary/Patient Privacy 4 Environment/Domiciliary/Personal Records 10 Process Issues/Failure to Follow Procedure 1 Process issues/nhs Forth Valley Policy 1 Staff/Attitude and Behaviour 30 Staff/Communication (Oral) 9 Staff/Communication (Written) 11 Staff/Complaint Handling of which relate to medication issues (69.9%) Waiting Time/date/Admission/Attendance 3 Waiting Time/Date of Appointment 49 Waiting Time/Test Results 5 TOTAL 410 5

6 2016 Delays in Admission/Transfer 1 Delays in/at Outpatients/Clinics 1 Environment/Domiciliary Aids/Equipment 3 Environment/Domiciliary/Catering 3 Environment/Domiciliary/Patient Privacy 11 Environment/Domiciliary/Patient Status 1 Environment/Domiciliary/Personal Records 14 Process Issues/Failure to Follow Procedure 1 Process Issues/NHS Purchasing 1 Process Issues/NHS Forth Valley Policy cont. Staff/Attitude and Behaviour 44 Staff Communication (Oral) 14 Staff Communication (Written) 21 Staff/Competence 2 Staff Complaint Handling 6 Staff/Shortage/Availability of which relate to medication issues (69.5%) Treatment/Consent 1 Waiting Time/Admission/Attendance 4 Waiting Time/Date of Appointment 63 Waiting Time/Results 4 TOTAL What performance indicators do you currently use All 3 prisons use the following performance indicators: Complaints Incidents (IR1 s) Heat Target (Substance Misuse) ISD Returns Substance Misuse Quality Framework Naloxone Training Dry Blood Spot Testing Smoking Cessation ADP Outcome Measures Appointment Waiting Times Mental Welfare Commission Reviews HMIP Reviews Regular audit at local level i.e. Hand Hygiene, Infection Control, Documentation Service Development 6

7 12. Since the transfer of responsibility of prison healthcare in 2011, have you or do you intend to redesign services. A number of service redesign/improvements have been implemented and continue to be implemented. Workforce redesign Pharmacy/medicines management redesign Clinical supervision for staff Improved access to training for all staff Introduction of Rehabilitation Support Workers to support ageing population (HMP Glenochil) Palliative care provision from NHS Forth Valley (HMP Glenochil) Staff training and delivery of Low Intensity Psychological Therapies Recruitment of Clinical Psychology for Prisons Recruitment of substance misuse staff via 3 rd sector agency to replicate community services Staff development as a result of the transfer of women from HMP YOI Cornton Vale to HMP YOI Polmont Development of a balanced scorecard for prison healthcare (in development) Development of Prison Healthcare Clinical Governance subgroup Development of Learning Disability Nurses into each prison, ensuring close links with Community Learning Disability Services Participation in research studies current research ADHD (Polmont), Speech and Language Needs (Glenochil), Psychological Needs Assessment (All 3 Prisons) Later in 2017 Acquired Brain injury in women (Cornton Vale/Polmont) 13. Please could you give examples of innovations in service delivery SMART recovery and integration of Mental Health and Addiction Services (All 3 prisons) Joint training with NHS/SPS OTAGO (Falls Prevention) Sage and Thyme (Communication) for ageing population (HMP Glenochil) Joint training SPS/NHS Dementia training Multi-Disciplinary health improvement/promotion events (All 3 prisons) Development of Low Intensity Psychological Therapies (All 3 prisons) Redesign of pharmacy services in possession medications Weekly pain management clinics managed by Lead GP Introduction of Advanced Nurse Practitioners to support medical and nursing workforce Provision of Mental Health Nurses in Ross Hall, Cornton Vale to support patients with complex mental health needs on a daily basis National Pilot sites (3 Prisons) in partnership with SPS, utilising Do it profiling tool to identify Learning difficulties/disability 7

8 Development of rehabilitative approach to care for older patients (Glenochil) in conjunction with community Occupational Therapy and Physiotherapy services. Integration of Mental Health and Substance Misuse Services Development of Patient Relation Team for 3 prisons to respond to high number of complaints (HMP Glenochil). This team reduces the amount of clinical nursing time spent managing complaints Health Inequalities and Prevention 14. What public health measures do you currently provide and how are these accessed Opt out BBV testing (All 3 prisons) Sexual Health Screening self referral (All 3 Prisons) Opt out vaccination programme (All 3 prisons) Dental Triage/Mouth Matters (All 3 prisons) National screening programmes Triple A ( Glenochil) Breast Screening (Cornton Vale + Polmont) Bowel Screening (All 3 prisons) Well Man/Woman Clinics (All 3 prisons) Social Prescribing (Glenochil) Smoking Cessation (All 3 prisons) Naloxone training and provision on discharge 15. What access do people have to drug treatment programmes such as methadone therapy Patients are screened on admission to each prison and referral made to substance misuse team. Opiate therapy is widely available for those patients requiring the treatment. There is a continuous assessment process for those admitted with an addiction. The healthcare team work closely with community addiction services. 16. What factors would help you address health inequalities in the prison population Greater access to patients the prison regime limits the amount of time patients are available for consultation and therefore limits service delivery. Improved IT system for documentation (Currently VISION) National workforce tool healthcare establishments within each prison are historic and do not reflect the changing landscape of prison healthcare Improved information sharing community to prison to community Improved access to GP notes on admission Electronic prescribing Review of sentencing of vulnerable prisoner groups 8

9 17. What steps do you take to ensure continuity of care on release Provision of 5 day supply of medication Liaison with community addiction teams prior to patients being liberated generation of appointments Support to SPS Throughcare Officer provision of information to assist with successful liberation GP letter to all patients who are on prescribed medication Throughcare appointments through addiction services 9