HMP Wakefield

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed a total of two quality statements from this key question. We found the provider was providing safe care in accordance with the relevant regulations. The provider had made significant improvements in relation to safe and effective staffing, medicines management and the management of risk.

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

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe systems, pathways and transitions is based on the latest evidence we assessed for the Safe key question.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe environments is based on the latest evidence we assessed for the Safe key question.

At our previous inspection we found that there were not always sufficient members of mental health staff on duty and that this had impacted service delivery. Managers told us that the mental health team had now been able to recruit to all posts and had a full complement of staff. One member of staff was currently going through pre-employment checks, but this absence was being covered using a long-term bank member of staff. Improved staffing levels and reconfiguration of staff roles had allowed interventions to be delivered. A group work intervention called ‘Making sense of my worries’ had been delivered to four cohorts with further sessions arranged. We viewed positive feedback from patients who had attended this group. Th increase in staffing had allowed nurses to be given a caseload of patients to manage. They now had time to see patients based on their clinical need to carry out individualised interventions. Since April 2024 100% of patients on CPA had received their six-month review as required which was much improved from our previous inspection.

We liaised with NHS England Commissioning team. They had carried out a recent audit of mental health provision at this location which showed that an excellent service was being delivered in line with national guidelines to help ensure that patient needs were being identified and met.

We previously found that were minimum staffing levels had not been met these had not escalated to allow further analysis of this. During this assessment we reviewed the staffing rotas for the previous six months and found that these were much improved. The provider had always been able to meet their minimum staffing levels to provide a service and the majority of the time had exceeded these levels; therefore, they had not needed to escalate this as an issue. It was positive to see that since March 2024 100% of patients needing an urgent mental health assessment had had this completed within expected timescales to help ensure that needs were identified. The provider had worked hard to ensure that those needing a routine mental health assessment had this completed within expected timescales. Where this had not been possible in the main it was due to the patient not attending or issues outside of the provider’s control. We saw that these had been correctly escalated to help address and find a solution and that they continued to strive to improve in this area and embed good practice. The provider had good oversight of where any issues, such as enablement, the prison regime and supporting other areas of the healthcare service had impacted on mental health provision. They had clear records to support this which included the appropriate escalation.

The judgement for Infection prevention and control is based on the latest evidence we assessed for the Safe key question.

On the previous inspection we found that systems and processes were not effective in monitoring and managing risks to patients. On this inspection, staff told us they have place additional checks for people on insulin to ensure that anyone who is not collecting their insulin are followed up appropriately. Staff told us that all Datix reports are reviewed at a bimonthly governance meeting and medicine incidents at local medicines management meetings. We reviewed 21 medicine incidents that were reported between May 2024 and July 2024 which had been investigated and actioned appropriately. Datix incidents are cross referenced with ‘missing meds’ report to ensure reporting compliance.

On the previous inspection we had found that systems and processes were not effective in monitoring risks with regards to in-possession (IP) medicines and did not identify where people had missed their medicines due to routine medicines not being re-prescribed in a timely manner. A local operating policy is now in place for contacting patients who do not collect their IP medicines and we could see this was being followed. On this inspection we found electronic records were completed accurately and routine medicines were being prescribed and supplied so that people did not miss any doses between monthly prescriptions. A ‘missing meds’ report is produced monthly and shared at local medicines management meetings to discuss learning and address any issues. Previously we found that temperature monitoring was not adequate in the areas that stored medicines and staff failed to act when the temperature was recorded outside the recommended range. On this inspection we found that medicines had been moved to an area with air conditioning to ensure appropriate storage and Log Tag thermometers had been installed in all medication fridges. The pharmacy manager completed a monthly audit to ensure compliance and to confirm appropriate action had been taken to respond to temperatures that were out of range. On the previous inspection we found there was no guidance for staff about reporting medicines incidents, the PPG national team have now developed guidance with regards to the definition of a medication incident in line with national guidance.