Nottinghamshire Healthcare
NHS
NHS Trust
Positive about integrated healthcare
Offender Health Directorate
Summary of successes and achievements since inception
Forensic Services Division
“During the reporting year, a new Palliative Care Suite, named as The Retreat was opened. This was part of a wider scheme, funded by a grant from The Kings Fund, to improve care for terminally ill and end of life prisoners. The IMB wishes to record its thanks to the Project Team without whose hard work and dedication over a long period of time this would never have materialised. Hence the care for those who are near to their end of life has been made as comfortable and dignified as possible and also provides day facilities for their family and close friends during visits.” HMIP follow up report March 2010
“ There is no doubt that a very comprehensive healthcare service is available to the prisoners which, it can be argued, is significantly better than healthcare they would receive in the community.” IMB HMP Nottingham Annual Report
HMP Whatton • Article published in the End of Life guidance which highlights contribution to evidence base • Positive feedback on the PHPQI audit from commissioners • Integration of Primary and Secondary Mental Health teams providing more sophisticated systems • All clinical teams now have connectivity to Trust IT systems increasing productivity and reducing risk • Visit from the Butler Trust to the Palliative Care Suite demonstrating recognition of best practice • Anti-libidinal work lead by Consultant Psychiatrist as part of research and evaluation programme • SystmOne expertise and knowledge based utilisation for improved management reporting
HMP Nottingham • Rethink Partnership – ‘Helping You Out’ project reduces reoffending rates and has been recommended for shadow Payment by Results/Social Impact Bond project • Ministerial visit provided excellent feedback on the quality and range of services
“The model of health service delivery at HMP Nottingham by Nottinghamshire Healthcare was impressive. The creation of a significant offender health service by the Trust also reinforces my impression that a welcome improvement in the delivery of healthcare to offenders is taking place, with a strong emphasis on addiction and mental health issues. Longer-term, I look forward to seeing the results from the committed and enthusiastic management who were properly proud of the service their frontline health staff are delivering.” Prisons Minister Crispin Blunt
• Clozapine pathway development will improve patient care • Pain Management Pilot study will reduce the risk of medicine misuse • Introduction of the Integrated Healthcare Model provides better access and movement through the care pathway • New Healthcare Centre offers at least equivalent setting to the community • Successful absorption of expanded population without increasing risk • Successful financial management
“ The health care centre had developed excellent services for prisoners requiring palliative care and end-of-life programmes.” HMIP follow up report March 2010
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HMP Stocken • Transfer of contract to Offender Health and subsequent employment of consistent and expert GP • Letter of approval from Leicestershire County and Rutland PCT on GP arrangements • Patient healthcare forum bi-monthly with representatives from all the wings with ‘you said we did’ follow up newsletter • Regular service improvement clinics to speak with patients face to face about complaints from the prison system • In line with Patel Report recommendations increased the amount of patients now on abstinence regimes for IDTS • Implemented wing dispensing improving security and productivity • Secured non recurrent funding to support IDTS staffing levels • Improved health promotion throughout the prison and improvement in Long Term Condition provision • New multi-disciplinary meetings with other providers to ensure continuity of care • Reduction in waiting times for all lists providing better access • Resolution of historical complaints • OSCARS nominations for East Midlands teams
HMP Ranby & HMP Lowdham Grange • Move to new accommodation • Improved therapeutic environment • Secured non recurrent funding for additional posts
“Managers and staff have maintained an essentially safe and secure establishment, as well as improving resettlement provision.” Nick Hardwick, HM Chief Inspector of Prisons 4
Embracing our growth. • The Yorkshire area has seen the largest growth with the acquisition of two large new contracts and the majority of transferred staff • These contracts are assertively managed, yet we are able to demonstrate excellent progress and delivery against 41 of 50 of our KPIs, with continued month on month improvement • Despite a significant number of Serious Untoward Incidents in the early days of the contract, there has been a significant reduction in the volume of these and improvement in the management of incidents and production of reports • Quarterly Learning the Lessons working group to improve services across the Yorkshire cluster • Service User involvement has improved and 194 user questionnaires were received from the Yorkshire cluster alone in Q3
• A Mental Health Working Group, working towards consistent practice across the whole of the Directorate is in place, with Directorate Care Programme Approach procedures, paperwork, registers and action plan all developed since June • All job descriptions re-written and evaluated and all vacancies out to advert HMP New Hall • Successful contract mobilisation and integration • Consistently positive feedback from Commissioners and Stake-holders • Open ACCTs have reduced from 70 to 20, the prison has stated since we have taken over and no wing in the prison is perceived as ‘unmanageable’
“Always there to listen to me and really helped when I was struggling.” “All staff were dedicated, professional, knowledgeable and above all caring.”
“My mental health worker was always warm and welcoming.” Patient and service user feedback, July-September 2011
• Working within our agreed budget • Very low sickness levels over the year • Having control of our referral waiting list (meeting our targets) • No complaints to date
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HMP Doncaster • Significant improvements to clinical environments following Infection Prevention and Control Audits remedial works, including new flooring, decoration, new surfaces and other sundry works • Mental Health Waiting List reduced to 20 patients waiting • Routine Appointment waiting time down from 16.97% waiting over time to 0% • Mental Health Assessment, percentage waiting over 5 days down from 100% to 19% • 100% of Mental Health Algorithms seen within 2 hours of entering segregation • 100% of patients seen within 4 hours of reception into the prison • Now compliant with 90% of infection control action plan • Hep B awareness day – 60+ patients immunised in one day
“Been advised to take insulin by nurse made big improvement to my health.”
“Being diagnosed as a personality disorder not schizophrenic.” “Keeping me alive.” “The MHIT listened very good and understood how I felt. Also gave good advice, plus I now know more about mental health symptoms, plus I now understand my illness. Thanks for all the help I have received.” Patient and service user feedback, July-September 2011
• Dental Waiting list reduced • Optician waiting list reduced • 98% staff Resus trained • Prison/health partnership group for health promotion formulated • Patient focus group meets once a month this has reduced from every week due to issues resolved
HMP Lindholme and Lindholme IRC • Overall, the staff team has needed significant care, investment and significant management, dealing with some fixed ideas and difficult personalities. This work continues, but staff attitude has significantly improved and has been noted by the prison staff and the IMB • Recruitment drive commenced, following detailed discussions regarding the costed model and budget availability • Induction booklet available for new staff • Specialist training has commenced and being rolled out across the staff teams • >80% of the team now how PADs in place, the outstanding ones are booked • One-to-one and group clinical supervision is now in place • Team meetings in place on a monthly basis with standard agenda • Healthcare management now invited to weekly prison operation meeting • Head of Offender Health now invited to monthly Prison SMT • Staff handover meetings now held daily to discuss patients of note, and documented in handover book • Staff now fully briefed on strategic requirements, have an understanding of KPI and PHPQI and work much closer with the management team to achieve these • Significant improvement in team work • Successful collocation of the Substance Misuse and Mental Health teams
“Got me clean from methadone.”
• Successful completion of the integration plan for the Substance Misuse and Mental Health teams
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“Really listened to me and helped me through a bad time.”
HMP Lindholme and Lindholme IRC continued... • Incidents are well reported, appropriately reported and closed • All incidents relating to medicines management are discussed in the D&TC • All staff have access to Safeguard • Backlog of well overdue complaints dealt with appropriately • Service user clinic held to receive feedback into the process • Patients wishing to complain about areas that can be dealt with via local resolution can now be seen at a clinic with Healthcare managers rather than going through a formal route • Only one complaint since April was not completed within time scale, therefore with the exception of June (94%) all other months HMP Lindholme complete and close complaints 100% within required timescales
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• All outstanding HMIP recommendations and PPO report recommendations are action planned and these are reportable on the action plan tracker • A process has been produced to enable Offender Health procedures to be ratified
• All information sent out to patients or on display is branded with Trust and OH corporate logos • Infection control standards have been significantly improved, with both repainting and re flooring in HMP, and a General Assistant now in post • Clinical Governance Group bi-monthly
• A suite of SOPs are being produced and ratified at appropriate forums • All staff have IT access and ability to gain access to Trust policies and have been given instruction on how to do this • Corporate image has been enhanced, signage has commenced across buildings the Healthcare teams work from, staff are now in uniforms, all staff have Trust badges
• D&TC monthly • D&TC sub committee monthly • Quarterly Learning the Lessons group to consider staff survey information, incidents, SUIs and complaints – action plans produced from this and are monitored on the tracker
“Every time I wanted to see CPN she was there and available.” • Attendance by staff at Prison meetings such as safer custody/security etc • We expect all PHPQIs will be achieved (except one) and green by the end of the financial year
“They talked through everything about my treatment aftercare and what was available on release.” Patient and service user feedback, July-September 2011
• KPI ratification meetings now in place • Nurse led wing based clinics have commenced and run daily • Well Man clinic sessions • Security medication audits • LTC action plan underway and closely monitored • Structured nurse led clinics in place Triage, Asthma, Hepatitis, Wound management • Care planning sessions • Robust process for monitoring emergency responses • Improved record keeping and data recording and monitoring for KPI capture • Health Promotion events on a monthly basis across both HMP and IRC, with information in multiple languages • Attendance at the Travellers’ group in HMP Lindholme
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Nottinghamshire Healthcare NHS Trust Duncan Macmillan House, Porchester Road, Nottingham, NG3 6AA Tel: 0115 969 1300
For more information visit: www.nottinghamshirehealthcare.nhs.uk March 2012
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