HMP Thameside

We carried out a focused announced inspection of healthcare services provided by Practice Plus Group Health and Rehabilitation Services (PPG) at HMP Thameside. PPG took over the contract from the previous provider on 01 June 2023. The provider shared concerns with us regarding the challenges they faced at the service.

The purpose of this 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 patients were receiving safe care and treatment.

At this inspection we found that the provider had worked hard to progress towards a safe service for patients. A significant amount of work had already been undertaken by the provider and regional management support had been brought in to develop the service. More recently an interim head of healthcare had been appointed to continue to advance the service. However we found that the provider was in breach of Regulation 17, Good Governance, Regulation 12 Safe care and treatment and Regulation 18 Staffing.

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:

• Staffing levels across healthcare were not sufficient to meet patient need in a timely manner.
• Staff across healthcare were not up to date with their mandatory training. Completion of all mandatory training sessions was 37% at the time of inspection.
• Staff understood how to protect patients from abuse, although they were not familiar with internal reporting arrangements.
• There was a backlog in the review and investigation of incidents reported internally.
• Staff kept records of patients’ care and treatment, although these were of mixed quality. Some lacked pertinent information. There was no discharge planning for patients admitted to the inpatient unit (IPU).
• The triage process did not work effectively, and patients were not always given an appointment when needed and where appointments were booked this was not always promptly in accordance with clinical need.
• The service did not have access to the full range of healthcare specialists, including an occupational therapist, dietician and speech and language therapist.
• Complaints made by patients were categorised as concerns rather than complaints. There was no monitoring of response times, themes or trends as well as whether the complaint was upheld or not.
• Managers had not provided staff with regular 1:1 supervision.
• There were a number of leadership vacancies in the service, but support had been drafted in from nearby regions for some of the vacancies as an interim measure. Management had not yet provided newly recruited leads with leadership training.
• Leaders did not operate effective governance processes. Meetings lacked structure and the purpose of an agenda item and proposed action, or outcome was not consistently recorded.
• Management information was not complete and could not be relied upon to inform service delivery. Staff could not always access the data required to understand performance, make decisions and improvements.

However, we also found that:

• Management were aware of the risks faced by the service. A risk register had been developed which recorded each identified risk along with mitigating action.
• Staff were kind and caring and had a positive approach towards providing care and treatment for patients. Staff worked hard and pulled together to deliver the service.
• The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.

The provider must:

• The provider must ensure that staffing vacancies are recruited to, so they can meet patients’ needs in a timely way.
• The provider must ensure that all staff complete their mandatory training.
• The provider must ensure the backlog of incidents are reviewed and/or investigated.
• The provider must ensure that patient records are clearly written with all necessary information.
• The provider must ensure there are effective patient triage arrangements in place.
• The provider must ensure patient complaints are correctly recorded as such and that timescales for responses are monitored, an outcome provided, and that this information is reported on.
• The provider must ensure that leaders have the necessary skills to provide good leadership and support for staff.
• The provider must ensure that suitable governance arrangements are in place and that meetings operate effectively.
• The provider must ensure that management information is available and accurate.

The provider should:

• The provider should ensure that staff are familiar with internal safeguarding reporting procedures.
• The provider should ensure staff received regular 1:1 clinical and managerial supervision.
• The provider should review how blood glucose monitoring equipment is managed.
• The provider should review systems for managing medicines to ensure patients have the medicines that they need.
• The provider should continue to work on embedding systems to provide oversight of medicines related risks.