HMP Garth

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We found the provider had made sufficient progress to address the regulatory breaches found at our previous inspection. We found improvements in the systems and processes for managing complaints and external appointments, logging staffing shortages and cancelled clinics, and ensuring effective auditing. Healthcare and prison leaders had worked together to improve access to healthcare for patients on E, F and G wings. They had also made changes to the 2 medicines administration points that served A and B, and C and D wings to improve queue management.

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

The judgement for Shared direction and culture is based on the latest evidence we assessed for the Well-led key question.

The judgement for Capable, compassionate and inclusive leaders is based on the latest evidence we assessed for the Well-led key question.

The judgement for Freedom to speak up is based on the latest evidence we assessed for the Well-led key question.

The judgement for Workforce equality, diversity and inclusion is based on the latest evidence we assessed for the Well-led key question.

At our previous inspection, we found delays in collecting and responding to complaints, variable quality of responses, no quality checks in place, and staff had not received training in handling complaints. During this assessment, we found that the service checked the complaints boxes on wings most days. Staff logged complaints on a spreadsheet as soon as they were received and allocated them to a clinical lead. We reviewed 4 complaints and found them to be of good quality. Patients received formal response letters that offered an apology for their poor experience, addressed their concerns, and gave advice on next steps if they were unhappy with their responses. A lead nurse completed monthly checks on the timeliness and quality of the responses. Some staff had received customer care training and there were further sessions arranged. The service had plans to further improve the quality of complaints once all staff had completed the training, for example, by introducing peer review of responses. At our previous inspection, it was difficult to ascertain the number of cancelled clinics as this was not recorded on SystmOne. During this assessment, we found that staff registered any cancelled clinics on SystmOne alongside the reason for the cancellation, such as ‘staffing availability’, and reports could be drawn from the system if needed. Clinics were now scheduled to start at 10am, which helped avoid the need to cancel due to lengthy medicines administration rounds. At our previous inspection, we said that the provider should review policies that are overdue for review or out of date. During this assessment, we found that the provider had plans to review policies that were overdue for review. For example, staff consultation was planned as part of the review of the supervision policy.

At our previous inspection, we said that the provider should continue to work with the prison to address the inequitable access to healthcare for patients on E, F and G wings. At this assessment, we found that healthcare and prison leaders had made huge progress towards improving access to healthcare for patients on E, F and G wings. The prison had allocated wing-based treatment rooms, which were being made fit for clinical purposes. Once ready, healthcare staff would be able to operate clinics on the wings subject to enablement support from the prison, which was a challenge as the prison was experiencing staffing challenges and had recently introduced a more restrictive regime. Healthcare also had plans to deliver ‘in possession’ (IP) medicines in the wings via trolleys during lunchtime lockdowns. They had the equipment needed to do this (trolley, computers) but needed an improved network connection, which was due to be installed soon. At our previous inspection, we said that the provider should continue to work with the prison to improve medicines administration, especially at the points for A and B, and C and D wings. At this assessment, we found that healthcare and prison leaders had attempted to improve medicines administration. The 2 medicines administration points at A and B, and C and D now had plastic barriers installed that helped with queue management, offered privacy, and reduced the opportunity for secretion and diversion of medicines. Prison leaders had assigned dedicated officers to support medicines administration. However, during our assessment, we observed poor queue management, challenging behaviour from prisoners, and high levels of noise and disorder in the corridors around the medicines hatch.

At our previous inspection, we found some audits were not effective. At this assessment, we reviewed several audits including NEWS2, care records, and reception screening and found they were suitable for their purpose and resulted in remedial actions taken on any issues identified. At our previous inspection, data on daily deficits in staffing was not available, the provider had not determined safer staffing levels for primary care and staffing shortfalls were not always reported as incidents. At this assessment, we found a newly developed staff deployment rota that showed planned staffing levels for a 2-week period. The provider had established a safe staffing level of 50%, at which stage business continuity could apply. 70% was deemed manageable. The rota helped with forward planning for shortfalls and mitigating risks. Managers reported as incidents occasions where staffing levels fell below 50%, even when they provided clinical cover themselves. This helped provide an accurate staffing picture. At our previous inspection, we found the spreadsheet for managing external appointments was not up to date and did not provide a complete picture of the patient’s attendance or completed care journey. At this assessment, we found that the spreadsheet had been improved and fully tracked a patient’s journey showing referrals, appointment bookings, cancellation and attendance. We looked at the tracker and found it was easy to read and follow with colour coding providing a quick visual reference to the status of patients’ referrals and bookings. The management of external healthcare appointments was further enhanced by weekly meetings with the local hospitals aimed at improving attendance, reducing waiting times and avoiding wasted appointments; weekly meetings with the prison managers to plan escorts for the following week’s external appointments; and contact with the hospital if a patient was likely to be delayed for their appointment.