Offender HealthDirectorate

Summary of successes and achievements since inception

Nottinghamshire Healthcare NHS Trust

NHSPositive about integrated healthcare

Forensic Services Division

“During the reporting year, a newPalliative Care Suite, named asThe Retreat was opened. Thiswas part of a wider scheme,funded by a grant from The KingsFund, to improve care forterminally ill and end of lifeprisoners. The IMB wishes torecord its thanks to the ProjectTeam without whose hard workand dedication over a long periodof time this would never havematerialised. Hence the care forthose who are near to their endof life has been made ascomfortable and dignified aspossible and also provides dayfacilities for their family and closefriends during visits.”

HMIP follow up report March 2010

“ There is no doubt that a verycomprehensive healthcare service is available to theprisoners which, it can be argued, is signif icantly betterthan healthcare they would

receive in the community.”IMB HMP Nottingham

Annual Report

HMP Whatton

• Article published in the End of Lifeguidance which highlightscontribution to evidence base

• Positive feedback on the PHPQIaudit from commissioners

• Integration of Primary andSecondary Mental Health teamsproviding more sophisticatedsystems

• All clinical teams now haveconnectivity to Trust IT systemsincreasing productivity andreducing risk

• Visit from the Butler Trust to thePalliative Care Suite demonstratingrecognition of best practice

• Anti-libidinal work lead byConsultant Psychiatrist as part ofresearch and evaluation programme

• SystmOne expertise and knowledgebased utilisation for improvedmanagement reporting

HMP Nottingham

• Rethink Partnership – ‘Helping YouOut’ project reduces reoffendingrates and has been recommendedfor shadow Payment byResults/Social Impact Bond project

• Ministerial visit provided excellentfeedback on the quality and rangeof services

• Clozapine pathway developmentwill improve patient care

• Pain Management Pilot study willreduce the risk of medicine misuse

• Introduction of the IntegratedHealthcare Model provides betteraccess and movement through thecare pathway

• New Healthcare Centre offers atleast equivalent setting to thecommunity

• Successful absorption of expandedpopulation without increasing risk

• Successful financial management

Offender Health Directorate 3

“ The health care centre haddeveloped excel lent services forprisoners requiring pal liative careand end-of-life programmes.”

HMIP follow up report March 2010

“The model of health service delivery at HMPNottingham by Nottinghamshire Healthcare wasimpressive. The creation of a significant offenderhealth service by the Trust also reinforces my impression that a welcome improvement in the delivery of healthcare to offenders is taking place,with a strong emphasis on addiction and mentalhealth issues. Longer-term, I look forward to seeingthe results from the committed and enthusiastic management who were properly proud of the service their frontline health staff are delivering.”

Prisons Minister Crispin Blunt

HMP Stocken

• Transfer of contract to OffenderHealth and subsequent employmentof consistent and expert GP

• Letter of approval from Leicestershire County and RutlandPCT on GP arrangements

• Patient healthcare forum bi-monthly with representativesfrom all the wings with ‘you said wedid’ follow up newsletter

• Regular service improvement clinicsto speak with patients face to faceabout complaints from the prisonsystem

• In line with Patel Report recommendations increased theamount of patients now on abstinence regimes for IDTS

• Implemented wing dispensing improving security and productivity

• Secured non recurrent funding tosupport IDTS staffing levels

• Improved health promotionthroughout the prison and improvement in Long Term Condition provision

• New multi-disciplinary meetingswith other providers to ensure continuity of care

• Reduction in waiting times for alllists providing better access

• Resolution of historical complaints

• OSCARS nominations for EastMidlands teams

HMP Ranby & HMP Lowdham Grange

• Move to new accommodation

• Improved therapeutic environment

• Secured non recurrent funding foradditional posts

“Managers and staff have maintained an essentiallysafe and secure establishment, as well as improving resettlement provision.”

Nick Hardwick, HM Chief Inspector of Prisons

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Offender Health Directorate 5

Embracing our growth.

• The Yorkshire area has seen thelargest growth with the acquisition oftwo large new contracts and themajority of transferred staff

• These contracts are assertivelymanaged, yet we are able todemonstrate excellent progress anddelivery against 41 of 50 of our KPIs,with continued month on monthimprovement

• Despite a significant number ofSerious Untoward Incidents in theearly days of the contract, there hasbeen a significant reduction in thevolume of these and improvement inthe management of incidents andproduction of reports

• Quarterly Learning the Lessonsworking group to improve servicesacross the Yorkshire cluster

• Service User involvement has improved and 194 userquestionnaires were received fromthe Yorkshire cluster alone in Q3

• A Mental Health Working Group,working towards consistent practice across the whole of theDirectorate is in place, with Directorate Care Programme Approach procedures, paperwork,registers and action plan alldeveloped since June

• All job descriptions re-written andevaluated and all vacancies out to advert

HMP New Hall

• Successful contract mobilisation and integration

• Consistently positive feedback fromCommissioners and Stake-holders

• Open ACCTs have reduced from 70to 20, the prison has stated since wehave taken over and no wing in theprison is perceived as‘unmanageable’

• Working within our agreed budget

• Very low sickness levels over the year

• Having control of our referralwaiting list (meeting our targets)

• No complaints to date

“Always there to listen to me and real ly helpedwhen I was struggling.”

“All staff were dedicated,professional, knowledgeableand above all caring.”

“My mental health worker was always warmand welcoming.”

Patient and service user feedback, July-September 2011

Offender Health Directorate 7

HMP Lindholme and Lindholme IRC

• Overall, the staff team has neededsignificant care, investment and significant management, dealingwith some fixed ideas and difficultpersonalities. This work continues,but staff attitude has significantlyimproved and has been noted bythe prison staff and the IMB

• Recruitment drive commenced, following detailed discussions regarding the costed model andbudget availability

• Induction booklet available for new staff

• Specialist training has commencedand being rolled out across the staff teams

• >80% of the team now how PADsin place, the outstanding ones arebooked

• One-to-one and group clinical supervision is now in place

• Team meetings in place on amonthly basis with standard agenda

• Healthcare management now invited to weekly prison operation meeting

• Head of Offender Health nowinvited to monthly Prison SMT

• Staff handover meetings now held daily to discuss patients ofnote, and documented in handover book

• Staff now fully briefed onstrategic requirements, havean understanding of KPI andPHPQI and work muchcloser with the managementteam to achieve these

• Significant improvementin team work

• Successful collocation ofthe Substance Misuse andMental Health teams

• Successful completion ofthe integration plan for the

Substance Misuse and MentalHealth teams

HMP Doncaster

• Significant improvements to clinicalenvironments following InfectionPrevention and Control Auditsremedial works, including newflooring, decoration, new surfacesand other sundry works

• Mental Health Waiting List reducedto 20 patients waiting

• Routine Appointment waiting timedown from 16.97% waiting overtime to 0%

• Mental Health Assessment,percentage waiting over 5 daysdown from 100% to 19%

• 100% of Mental Health Algorithmsseen within 2 hours of enteringsegregation

• 100% of patients seen within 4hours of reception into the prison

• Now compliant with 90% ofinfection control action plan

• Hep B awareness day – 60+ patientsimmunised in one day

• Dental Waiting list reduced

• Optician waiting list reduced

• 98% staff Resus trained

• Prison/health partnership group forhealth promotion formulated

• Patient focus group meets once amonth this has reduced from everyweek due to issues resolved

“Been advised to take insulin by nurse made bigimprovement to my health.”

“Being diagnosed as apersonality disorder notschizophrenic.”

“Keeping me alive.”

“The MHIT listened verygood and understood how Ifelt. Also gave good advice, plus I now knowmore about mental healthsymptoms, plus I now understand my illness.Thanks for all the help Ihave received.”Patient and service user feedback, July-September 2011

“Got me clean from methadone.”

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“Real ly listened to me and helpedme through a bad time.”

HMP Lindholme and Lindholme IRCcontinued...

• Incidents are well reported, appropriately reported and closed

• All incidents relating to medicinesmanagement are discussed in the D&TC

• All staff have access to Safeguard

• Backlog of well overdue complaintsdealt with appropriately

• Service user clinic held to receivefeedback into the process

• Patients wishing to complain aboutareas that can be dealt with via localresolution can now be seen at a clinicwith Healthcare managers rather thangoing through a formal route

• Only one complaint since April was notcompleted within time scale, thereforewith the exception of June (94%) allother months HMP Lindholme completeand close complaints 100% withinrequired timescales

• All outstanding HMIPrecommendations and PPO reportrecommendations are action plannedand these are reportable on the actionplan tracker

• A process has been produced toenable Offender Health procedures tobe ratified

• A suite of SOPs are being producedand ratified at appropriate forums

• All staff have IT access and ability togain access to Trust policies and havebeen given instruction on how to dothis

• Corporate image has been enhanced, signage has commencedacross buildings the Healthcare teamswork from, staff are now in uniforms,all staff have Trust badges

• All information sent out to patients oron display is branded with Trust and OHcorporate logos

• Infection control standards have beensignificantly improved, with both repainting and re flooring in HMP, and aGeneral Assistant now in post

• Clinical Governance Group bi-monthly

• D&TC monthly

• D&TC sub committee monthly

• Quarterly Learning the Lessons group toconsider staff survey information,incidents, SUIs and complaints – actionplans produced from this and aremonitored on the tracker

Offender Health Directorate 9

• Attendance by staff at Prison meetings such as safer custody/security etc

• We expect all PHPQIs will beachieved (except one) and greenby the end of the financial year

• KPI ratification meetings now in place

• Nurse led wing based clinics havecommenced and run daily

• Well Man clinic sessions

• Security medication audits

• LTC action plan underway andclosely monitored

• Structured nurse led clinics inplace Triage, Asthma, Hepatitis,Wound management

• Care planning sessions

• Robust process for monitoringemergency responses

• Improved record keeping anddata recording and monitoring forKPI capture

• Health Promotion events on amonthly basis across both HMPand IRC, with information inmultiple languages

• Attendance at the Travellers’ group in HMP Lindholme

“Every time I wanted to see CP Nshe was there and available.”

“They talked through everythingabout my treatment aftercare andwhat was available on release.”

Patient and service user feedback, July-September 2011

Nottinghamshire Healthcare NHS TrustDuncan Macmillan House, Porchester Road,

Nottingham, NG3 6AATel: 0115 969 1300

For more information visit:www.nottinghamshirehealthcare.nhs.uk

March 2012

P O S I T I V E