Archived: HMP Liverpool

Summary Letter

We carried out an announced focused inspection of HMP Liverpool between 11 and 14 September 2017, alongside a comprehensive joint inspection with Her Majesty’s Inspectorate of Prisons (HMIP) under our memorandum of understanding. The focused inspection was in response to previous breaches of our regulations, and to concerns raised by whistle blowers about patients’ experience at HMP Liverpool. Some of these related to prison issues outside the remit and control of Lancashire Care NHS Foundation Trust (LCFT). HMIP will publish the joint report separately at:

https://www.justiceinspectorates.gov.uk/hmiprisons/inspections

CQC do not currently rate services provided in prisons.

The background to inspection activity for HMP Liverpool is:

• In May 2015 we carried out a joint comprehensive HMIP and CQC inspection. Breaches of regulations led to CQC issuing four Requirement Notices to improve care against: Regulation 9, - Person centred care; Regulation 10 - Dignity and respect; Regulation 12 - Safe care and treatment, and Regulation 16 - Receiving and acting on complaints.

• In July 2016 we undertook a CQC-led focused inspection. We found the trust had made some improvements. However, further breaches in some areas led to CQC issuing two further Requirement Notices against Regulation 9, - Person centred care and Regulation 12, - Safe care and treatment.

• CQC decided to follow up these breaches by carrying out a focused follow up inspection alongside the planned joint comprehensive inspection with HMIP in September 2017.

During this inspection, we found that issues identified in the inspection in 2016 had mostly been addressed, and there were improvements in some aspects of care. However, we also found a number of other areas where Lancashire Care NHS Foundation Trust must make improvements. 

Importantly, the trust must ensure that:

• Complaints are investigated effectively and in a timely way with appropriate action to address patients’ concerns.
• Complainants are kept informed of the status of their complaint and its investigation.
• Complaint monitoring actively informs service improvement and learning is shared with staff to improve patient care.
• Appropriate monitoring and recording of prescribing errors is embedded to improve prescribing safety and patient care.
• Patient engagement informs the delivery of services and service improvement.
• Governance arrangements for the dental service are robust; including monitoring the quality of x-rays and sharing learning from audits to improve patient care.
• Clear and accurate records are kept in relation to staffing rotas that support effective monitoring.
• Clinical staff receive appropriate managerial and clinical supervision in line with trust policy.
• Clear and accurate up to date records are kept in relation to staff supervision.
• Staff receive regular appraisal of their performance.
• Staff conducting detoxification reviews are appropriately supported by clinicians.

Additionally the trust should:

• Ensure systems to monitor the safe storage of medicines are effective.
• Routinely update emergency medicine expiry dates where they are stored out of refrigerators, in line with guidance.
• Implement comprehensive reporting and escalation systems in relation to regime activity on the inpatient unit.
• Ensure that patients on detoxification regimes are monitored appropriately in line with guidance.
• Implement an action plan to build on the cultural values assessment carried out in August 2017 to support staff and patient care.
• Ensure there is sufficient management oversight and staffing during the remainder of the service contract.