HMP Peterborough Prison

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 assessed a total of 4 quality statement from this key question. We found the provider was not providing effective care in accordance with the relevant regulations. The provider had improved systems and processes relating to carrying out second stage health screenings, supporting patients on Care Programme Approach and medicine management. However, concerns remained regarding the clinical observation of patients who misused substances.

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

During the last inspection we found that staff were not always carrying out a second stage health assessment (secondary screening), within the required 7 days and in line with NICE guidance. This meant that potential risks and patients’ treatment needs may not be identified and picked up promptly, some patients had not had a second screening at all, and some patients had been released before having been offered this screening (despite being at the prison longer than 7 days). Managers we spoke with said that there was much improvement for staff completing all secondary screening. They said nursing staff printed off a daily list of all patients needing a screening and specific staff were allocated this task to be done each day.

Since then, managers developed more of a robust process, and had ensured the systems and processes to manage this were in place. Staff on reception are aware that all patients need to have a second screen booked within the next 7 days. Managers in healthcare departments for the male and female site checked that all new arrivals had this booked. Staff have the ability to go to where the patient is located in the prison or use the healthcare facilities to carry out this assessment. If a patient does not attend, this is recorded in patient records and rebooked. We saw that all patients arriving had the secondary screening completed within 7 days of their arrival.

At our last inspection we found that no patients were on Care Programme Approach (CPA) despite some patients requiring a transfer to mental health hospitals meeting the threshold for it. Managers were using the CPA 2019 policy for that establishment, but not following this. This had improved and the mental health team now kept a register of eligible patients and logged all review due dates, this ensured that their care was appropriately reviewed with the patient and other professionals. We saw staff were helping patients to prepare for release and or handing care over to community hospitals. Staff used a CPA template for each patient that clearly outlined how they were meeting the needs of the patient in line with the community and a CPA process. This included ensuring that all patients received a regular review where treatment needs and goals were discussed. Managers carried out regular audits of patient CPA records to ensure each patient had a named keyworker, up to date risk assessments, crisis plan in place and that each record showed how the care plan addressed patient strengths and aspirations. Managers also had oversight of the 6 month review dates and that meetings included teams form the community and other professionals.

The judgement for How staff, teams and services work together is based on the latest evidence we assessed for the Effective key question.

During the last inspection we found there were few medicines on Patient Group (PGD) Directions, which limited what medicines nurses could give out for clinical reasons or symptomatic withdrawal. The out of hours prescribing did not meet the need for patients entering the prison past 22:00. This meant that patients may not receive the appropriate medicine out of hours. At this assessment, we found out of hours medicines management had improved. Staff were now able to access a broader range of medicines to manage detoxification symptoms, which was good. The trust had increased the provision list to include paracetamol, cetirizine and ibuprofen. We checked the out of hours and stock levels and saw that all cupboards were well managed, and stock was organised. The trust was also in the process of implementing a new minor ailments protocol, so that patients can purchase and self-administer medicines for minor ailments. These guidelines allow nursing staff and pharmacy technicians to provide simple General Sales List (GSL) medicines after ensuring patients meet inclusion criteria, without the need for a prescription or a ‘Patient Group Direction. This is in accordance with the Standards for Medicines Management (NMC, 2010). This would help enable patients to manage their own health and wellbeing in line with the community, which is positive.

At the last inspection we found that due to short staffing, not all clinical observations for patients who misused substances were being carried out consistently and in line with the trust’s policy and NICE guidance for monitoring withdrawal symptoms. Managers we spoke with were aware that there was an ongoing issue with staffing not being able to monitor patients overnight. At the time of this assessment managers instructed staff to ensure that they carried out effective arousal observations overnight. Managers said they would review this in line with the staff operational procedure for carrying out both clinical and overnight observations.

The trust policy was updated to include instructions that each patient is reviewed for 5 days for opiate substance misuse and/or 7 days for benzodiazepine and/or alcohol misuse. Clinical observations and withdrawal scales would be completed twice per shift, pre and post opiate substitution therapy (Methadone/Buprenorphine) administration and visual observations completed pre- and post-midnight. However, we found that leaders had reduced the frequency of clinical observations for patients who were detoxing from alcohol or drugs to once per day. This was not in line with the Trust’s own policy and best practice and still held continuing risks for those patients. During this assessment, we also observed that these patients did not have their clinical observations completed for 48 hours due to an incident in the prison. Since our visit, managers have requested staff carry out a minimum of 2 observations daily. We also found risks where patients were not properly monitored overnight. We looked at the paper records for prisoners on their first week who required monitoring. Of the 18 records, we saw that for the first and second nightly checks staff reported ‘appears asleep’. The patient electronic records also showed staff recorded ‘patient appears to be asleep’ which meant that staff were not seeking arousal to help monitor the patients’ safety and for withdrawal symptoms. This was addressed whilst we were on site and staff were asked to ensure they woke patients for arousal checks.

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