Archived: HMP/YOI Exeter

We carried out an announced focused inspection of healthcare services provided by Practice Plus Group Health and Rehabilitation Services Limited (PPG) at HMP/YOI Exeter on 25 and 26 February 2021, in response to information of concern we received about the safety and staffing of the service. Some concerns received were outside of our scope and have been shared with relevant partners.

We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering how we carried out this inspection and took steps to minimise infection risks due to the coronavirus pandemic.

Following our last joint inspection with Her Majesty’s Inspectorate of Prisons (HMIP) in May 2018 we found that the quality of health services had improved and were mostly good. We did not take any regulatory action against the provider.

The purpose of this focused inspection was to determine if the provider was meeting the legal requirements and regulations under Section 60 of the Health and Social Care Act 2008 and that prisoners 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:

• The provider had managed to maintain minimum safe staffing levels, although staff had experienced significant pressures and additional workloads during a recent COVID-19 outbreak.
• Staff followed safe processes when delivering wound care.
• There were appropriate systems in place to monitor and support isolating patients.
• Staff used appropriate personal protective equipment (PPE) to reduce infection risks when treating isolating and clinically vulnerable patients.
• Several staff had recently engaged in secondary dispensing, or ‘potting up’, of medicines, which was unsafe and illegal.
• Medicines were transported around the prison safely.
• Systems to monitor supervision needed to improve. Staff had mixed views about communication and support from managers, and some primary care staff did not receive regular managerial supervision.
• There were appropriate arrangements in place to manage individual risks to staff.
• There was some good engagement between healthcare staff and patients.

The areas where the provider must make improvements as they are in breach of regulations are:

• Systems to ensure that medicines are administered safely and in line with legal requirements must be fully embedded in practice.
• Systems to monitor and record the provision of staff supervision must be effective.

The areas where the provider should make improvements are:

• The provider should communicate clearly with staff around issues and concerns, including staffing levels and the outcome of concerns raised with managers.
• The provider should consider how to increase capacity for transporting medicines around the prison securely.