Health, well-being and social care

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Effective partnership working between the prison, commissioners and providers ensures that health, social care and substance use services meet the assessed needs of the prison population.
• Effective leadership and governance systems ensure good patient outcomes.
• Health, substance use and social care provision meet the required regulatory standards, including the duty of candour.
• Service delivery is informed by effective prisoner consultation and lessons are learned (for example from adverse incidents and complaints).
• Health staff are easily recognisable. Staffing levels and skill mix throughout the 24-hour period meet service user need.
• Staff are well trained and supported; this includes regular clinical and managerial supervision.
• Every patient has a single clinical record which meets contemporary record-keeping standards.
• Information is shared within the bounds of medical confidentiality to promote continuity of care and maintain patient safety.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• All prisoners have equal access to health, well-being and social care services regardless of location, regime, disabilities or language barriers.
• Patients are treated with dignity, respect and compassion.
• There are sufficient rooms to provide a full range of health services.
• Infection prevention and control measures are robust.
• Patients are seen in private, except in clearly documented exceptional circumstances.
• Competent health staff respond promptly to medical emergencies with appropriate emergency equipment.
• All clinical equipment is appropriately maintained and serviced.
• Arrangements to gain and review service user consent are appropriate. When service users lack mental capacity to make a decision, health professionals make ‘best interests’ decisions in accordance with legislation.
• Service users are kept safe, are safeguarded from abuse and have access to independent advocacy services if required.
• Service users can complain about their treatment in confidence without recrimination. Responses are timely, easy to understand and address all the issues raised.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• There is a whole-prison approach to promoting health and well-being.
• Information about available health services and current national health campaigns is easily accessible in all required formats and languages.
• Well-trained and supervised peer workers and health trainers offer health information and support to prisoners.
• Prisoners can easily access health checks, disease prevention and screening programmes.
• Prisoners can access sexual health services. Barrier protection and related health advice is freely available, including on release.
• Older patients receive proactive care from competent staff who understand their specific needs.
• Prisoners can access community-equivalent smoking cessation support.
• There are robust systems to prevent, identify and manage communicable diseases.
• Prisoners receive individual health promotion advice on release.

The following indicators describe evidence that may show this expectation being    met, but do not exclude other ways of achieving it.

• A competent health professional screens all new prisoners on the day of arrival to identify their immediate needs and make appropriate onward referrals.
• Relevant risk and care planning information is shared between prison and health staff on reception and throughout a prisoner’s sentence.
• With consent, the patient’s community clinical records are obtained promptly.
• Patients receive a secondary health assessment from a competent health professional within seven days of arrival.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Prisoners can access all necessary primary care services, including pain management, memory/dementia support services and effective out-of-hours GP services, within equivalent waiting times to the community.
• There is an effective appointments system.
• Patients with long-term conditions and complex health needs receive appropriate joined-up care. Recorded care plans demonstrate patient involvement and support continuity of care.
• Patients with palliative and end of life needs receive person-centred care delivered jointly by the prison and community services, to national standards, in a safe and decent environment.
• Health services staff provide community-based services on the wings when required.
• Patients receive secondary care services within community-equivalent waiting times and care is not disrupted by prison transfers.
• Security measures on hospital escorts are proportionate and are based on an individual risk assessment which includes a detailed health contribution.
• Timely joint working with relevant internal and external departments/services supports continuity of care.
• Prisoners receive relevant pre-release assessments and interventions and are supported to register with community health services.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Admission and discharge is based on agreed clinical criteria. Staffing numbers and skills mix meet the patients’ needs.
• Patients receive a comprehensive assessment of their care needs and, wherever possible, are involved in developing their own care plans.
• Patients have decent living conditions and access to a normal prison regime alongside therapeutic and constructive activities to maintain well-being and encourage recovery.
• Patients’ ongoing care needs are met following discharge from the inpatient unit.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Prisoners with social care needs are promptly identified and referred for a social care assessment.
• Prisoners’ social care needs are consistently met.
• Sufficient trained, supervised and screened social care staff implement agreed care plans that ensure privacy and dignity.
• Required equipment and adaptations are provided promptly and maintained correctly.
• Peer prisoner supporters do not provide intimate care and are appropriately selected, risk assessed, trained, supported and supervised.
• Prisoners with severely restricted mobility or impaired communication can easily summon assistance in an emergency.
• Effective joined-up planning ensures agreed packages of care are continued on transfer within the prison estate and on release.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

•  Prisoners’ immediate mental health needs are assessed during their reception health screening and appropriate onward referrals are made.
• Prison officers receive training to enable them to recognise when a prisoner requires referral for mental health assessment, and there is a clear referral pathway.
• Referrals are reviewed promptly and appointments allocated on clinical need/risk.
• Competent practitioners deliver a community-equivalent range of evidence-based interventions and support for learning disability, trauma, neurological, mental and personality disorders.
• Prescribing reviews and related physical health checks occur regularly.
• Patients are assessed using a standardised format and additional information is obtained from other sources as required.
• Patients have written care plans which are regularly reviewed with their mental health practitioners.
• Liaison and joint working with other prison departments and health providers, including substance use treatment services, is effective.
• Patients with severe and enduring mental illness are supported within the Care Programme Approach (England) or Mental Health Measure (Wales).
• Patients who require assessment or treatment under the Mental Health Act are assessed and transferred promptly.
• Effective discharge planning and liaison with offender managers, CRCs and community mental health services ensures continuity of care post-release.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Effective joint working between prison departments, treatment providers and other relevant stakeholders embeds a dynamic whole-prison drug and alcohol strategy.
• A regular and comprehensive needs assessment informs the strategy and action plans.
• Prison officers receive training to enable them to recognise when a prisoner requires referral to substance use services, and there is a clear referral pathway.
• Psychosocial and clinical services meet the needs of the population. Service user feedback and outcomes inform service delivery.
• Psychosocial and clinical substance use treatment services are well integrated with each other, the prison and all health services.
• Sufficient competent staff provide effective evidence-based psychosocial and clinical services.
• Service users have personalised recovery plans which are regularly quality-assured.
• Patients with both mental and substance-related problems have prompt access to joined-up, comprehensive support.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Drug- and/or alcohol-dependent prisoners who are newly arrived from the community receive additional monitoring and individualised treatment in their early days.
• Prisoners (including those who develop substance-related problems during their time in prison) have prompt access to appropriate clinical, psychosocial and harm reduction interventions.
• Patients receive flexible prescribing which conforms to national clinical guidelines, meets their assessed needs and is reviewed regularly. All related clinical investigations and checks are completed.
• Newly arrived prisoners receive harm reduction information on illicit substance use in prison and about substance use treatment services.
• Prisoners have easy access to family support services, self-help and mutual aid, including well trained and supervised peer supporters.
• Drug recovery wings have a recovery ethos, competent staff and additional therapeutic interventions.
• Effective discharge planning with relevant internal and community services ensures continuity of support post-release, including releases from court.
• Service users receive information on how to avoid drug- and/or alcohol-related overdose, injuries and death post-release. Additional individualised support is available for prisoners who are vulnerable to overdose or relapse on release.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Patients’ medication histories, including allergies, are recorded during the initial reception screening and a full medicines reconciliation is completed within 72 hours of admission.
• Any disruption in prescribing regimens is minimised and urgent/critical medicines can be accessed promptly.
• Patients have direct access to clinical pharmacy services and advice.
• All medicines are handled, transported and stored legally, safely and securely with effective pharmaceutical stock management and use.
• Robust governance processes are in place to ensure safe and effective medicines management, including monitoring of medication incidents and prescribing trends.
• Patients’ medicines are prescribed safely in line with evidence-based practice and formularies, reviewed regularly and administered at clinically appropriate times.
• Patients’ adherence to medication is monitored. Patients are promptly reviewed when adherence is poor and/or diversion is suspected.
• Subject to a regularly reviewed in-possession risk assessment, patients can store their medicines securely and self-administer.
• Prisoners can access basic self-care medicines safely and easily, including out of hours.
• Medicines are administered from a secure and respectful environment.
• Prison officers manage medication administration queues effectively, including ensuring only one patient is at the hatch at a time and reducing opportunities for bullying and diversion.
• Prisoners receive information about their medicines in an understandable format and have regular clinical prescribing reviews.
• Prisoners going to court or being released/transferred receive adequate supplies of medication or a community prescription to meet their needs.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• All prisoners have timely access to emergency dental services based on clinical need, complemented with through-the-gate treatment plans.
• Patients have timely access to the full range of NHS-equivalent treatment that can be reasonably delivered while they are detained.
• Prisoners receive evidence-based interventions in oral health promotion and disease prevention.
• Patients have prompt access to required medicines following dental interventions.
• Dental care meets contemporary professional standards.