Health Needs Assessment Maidstone finalHealth Needs Assessment Maidstonefinal.pdf

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West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007 1

HMP Maidstone

Health Needs Assessment for 2007- 2010 conducted January 2007 (comparisons noted with HNA carried out in June 2004)

Governor Jane Galbally.

Acting Head of Healthcare Janet HambletonOperational Manager Dave LogueGP Medical Team led by Dr K SinghAddress County Road, Maidstone, ME14 1UZTel No. 01622 775300Healthcare No. 01622 775469

1 Category, logistics and Prison function

HMP Maidstone is a Cat C male prison with a roll of 589, housing 573 offenders at 1 stJanuary 2007 (this is an increase of 29 fromJune 2004), of whom 23 are serving Life sentences. The key function of the prison is as a training establishment offering focusedand timely interventions to offenders to reduce crime. Offenders arrive at HMP Maidstone via transfer from a range ofestablishments. Thanet House (one of four residential houses) is nominated as accommodation for 174 vulnerable offenders.This prison service term covers those who cannot be managed safely in normal house environments, due to their age or mentalcapacity, the nature of their crime (e.g. sex offences), or any combination of the above. Records show that this population is olderand exhibits higher levels of ill health than the average offender population.

Offenders with 4 years or less of their sentence to serve may come to HMP Maidstone from any other prison. They may have beencategorised up or down but must be a Cat C to be accepted into this prison. The prison accommodates across the age range andacts as a resource for disabled offenders who would normally cope at home if they were in the community.


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There were 663 prisoner movements January to December 2006, comprising

New Receptions

162 Offenders Released from custody

This compares with 512 in the twelve months prior to June 2004

2 Ethnic Composition & language

2.1 Ethnic Composition

Ethnic Group Number(total = 573)

Percentage ofpopulationJan 2007

Percentage ofpopulationJune 2004

White 374 65.16 65.6Black 143 24.91 24.6Asian 34 5.92 3.3Mixed 10 1.74 3.7Other 12 2.09 2.8

(As at 29thDecember 2006)

2.2 Nationality

See Appendix 1

2.3 First Language

The first language of offenders is not currently recorded.


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3 Age

Age Range Number (total = 573 )2007 2004

Percentage ofpopulation Jan 2007

Percentage of populationJune 2004

25 and under 90 15.3726-29 103

17218.31

31

30-39 180 210 31.41 37.8

40-49 112 91 19.54 16.450-59 61 45 10.64 8.160-69 34 22 5.93 3.970-79 3 5 0.52 0.1Over 80 0 1 < 0.01

As the table illustrates, the majority of prisoners (84.6%) are aged under 50 (86% in June 2004) but 34 prisoners are aged over 60;this demonstrates a rise on the 2004 figure.

4 Learning Disability: Physical and Sensory Disability

4.1 Learning Disability

It has been observed (Survey of Physical Health of Prisoners Bridgewood & Malbon, 1994) that a disproportionate number ofoffenders suffer from learning disability.There are 29 offenders out of 573 (9.7%) with learning disability in HMP Maidstone as at January 1 st2007

4.2 Physical and Sensory disability

HMP Maidstone is a resource for disabled offenders who would normally live at home if they were in the community.Accommodation has been developed for wheelchair users on each of the wings, including in Thanet House, which hasaccommodation on the ground floor.


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Impairment Cases in 2006 12 months prior to June 2004Visual 7 noneHearing 27 2WheelchairUsers

1 2

Mobility(reduced)

13

All are self-caring and managed in normal locations.

5 on crutches2 with only one leg

Seniledementia 0

1

Stroke 0 1Very old 0 1

All offenders with a disability have care plans, managed by the Disability Liaison Officer. The aim is to apply the social model, notthe medical model of care.

5 Health Status

A disproportionate number of offenders suffer from drugs and / or alcohol addiction, communicable diseases, including sexualhealth related) mental health problems and in older prison populations from chronic diseases such as heart disease, diabetes etc(Bridgewood & Malbon, 1994).

5.1 Substance MisuseHMP Maidstone is not resourced to provide detoxification programmes. Offenders requiring this are expected to have completed aprogramme suited to their addiction, before reaching HMP Maidstone. However, during 2006 we provided 2 x detoxification and 4symptomatic relief treatments (5 in 2004) which has met individually assessed need. If Subutex detoxification were required, the


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patient would be assessed by HMP Elmley Detox Team, a specialist service which supports offenders through detoxification. Todate, records havenot been kept of numbers of Offenders sent to Elmley for detoxification, but from 1ts April 2007 this will be documented.

The main Drug Service in HMP Maidstone, is provided by drug workers and is not a healthcare function. The service is known bythe acronym CARATS which stands for:

C ounsellingA ssessmentR eferralA dviceT hroughcareS ervices

CARATS provide a combination of one-to-one triage assessment (using the Drug Intervention Record - DIR), ComprehensiveSubstance Misuse Assessment (CSMA) and care planning, as well as accredited group work sessions. All offenders are assessedupon arrival at Maidstone (as well as inducted) and a history of substance use is gathered - this includes any potential/identified

impact on physical/mental health, social status (education, employment, housing, etc) and legal status. CARATS offer one-to-onemotivational interviewing to identify potential impact of substance use and the individual's motivation to change their behaviour.This one-to-one work can be further reinforced using CARATS in-cell work packs (which cover a number of specific issues - heroin,crack/cocaine, cannabis, relapse prevention, harm minimisation, etc) and again linked into the CARATS accredited group worksessions (Motivational, Relapse Prevention and Harm Minimisation).

All CARATS group sessions run for 8, two hour sessions over a two week period and are discussion based, encouraging theparticipants to identify their own issues/concerns and recognise ways to adapt or change their behaviour accordingly. CARATS

also refer offenders to other agencies and service providers - including the Drug Intervention Programme (DIP) and RAP-t(Rehabilitation of Addicted Prisoner's Trust) 12-step programme in other establishments, and we refer offenders to the PASRO(Prison's Addressing Substance Related Offending) programme to address links between substance use and offending behaviour.

As well as the work CARATS complete in the prison, potential resettlement needs are identified and CARATS complete a ReleasePlan with all offenders prior to their release; this identifies relevant issues and available support to continue addressing their


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substance misuse issues following release. CARATS have also had talks with representatives from Narcotics Anonymous (NA)who are keen to introduce themselves into Maidstone (security clearance is awaited for this).

5.2 Alcohol MisuseAlcohol abuse is recognised as an influencing factor in the behaviour of many offenders in the community and has detrimentaleffects on health. A Policy for treatment of offenders with alcohol abuse issues has been developed by HealthCare, in line withElmleys policy.

CARATS currently incorporate alcohol awareness into the in-cell work packs and one-to-one motivational work; the skills andstrategies discussed in the Relapse Prevention group are applicable to alcohol use. Alcoholics Anonymous (AA) is due to beintroduced and the Reducing Re-Offending Manager has been taking the lead in this.

Caseload At January 1st2007 June 2004

CARATS caseload (total)Includes

179 Not recorded

CARATS suspended clients (allwork completed and awaitingRelease Planning).

46 Not recorded

CARATS clients with previoushistory of alcohol misuse

65 Not recorded

5.3 Smoking

Smoking cessation courses are delivered by local PCT Health Promotion staff and staff members on a rolling programme. In 2006two staff members were trained to deliver Stop Smoking Interventions. 2 quitters (offenders) were trained to be Peer Advisers.Two Staff focus Groups and one Offender Group have been consulted on the development of the Stop Smoking Policy at HMPMaidstone in preparation for compliance with Smoke Free legislation.


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Hep .B Vacs:Each new reception to the establishment is seen by HC staff and a health screen is carried out. During that interview Hepatitisvaccination status is requested and an offer of the vaccination programme is given. If the new reception takes up the offer then heis called to the HCC to see the specialist in house nurse who counsels and administers the accelerated course of injections basedon informed consent. A blood test is taken at the end of the course to prove effectiveness. Full documented evidence is recorded inthe IMR and the patient is given an appointment follow-up card. HC gives an induction information booklet to all new receptionsexplaining the services available from HC, which includes the Hepatitis vaccination programme. Requesting offenders can receivea confidential (informed consent) blood test for Hepatitis B & C and / or HIV.

Hepatitis Number in pasttwelve months

Percentage ofPopulation (2006)

Percentage ofPopulation (2003-4)

Hep B / C Testing 27 4.88% 5%Hep B Vaccination courses 174 31% 12%

Condom Scheme:

Condoms are available free of charge from Healthcare at any time and a new policy has been developed and implementationarrangements are being negotiated.

5.5 Mental Health

Primary mental healthcare needs

IN 2004 an Assessment of Primary Mental Health Needs of Offenders in HMP Maidstone was undertaken as part of a projectacross Kent and Medway Prisons. Assistant Psychologists carried out the assessments, which included Demographics: PsychiatricDiagnostic Screening Questionnaire (PDSQ) and the Psychosis Screening Questionnaire (PSQ).

Results of note are as follows:


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Demographics (additional) 53 offenders were interviewed, randomly selected.Contact with mental health services in prison 20.8% had contact whilst in prisonContact with mental health services in the past 15.1% had had contact with them in the pastAverage Age left school 50.9% left school under 16 years old

37.7% left school aged 16 years

11.3% left school aged over 16 yearsWhether attended Special School 11.3% attended special school

Whether received a statement of special need 7.5% received a statement of special need

PDSQ and PSQ resultsPercentage of scores on or above threshold

Major Depressive Disorder / Suicidality 15.1%

Post-Traumatic Stress disorder 17%Bulimia / Binge Eating Disorder 1.9%

Obsessive Compulsive Disorder 17%Panic disorder 17%Psychosis 11.3%Agoraphobia 15.1%Social Phobia 17%

Alcohol Abuse / dependence 34%Drug Abuse / dependence 32.1%Generalised Anxiety Disorder 24.5%

Somatisation disorder 15.1%Hypochondriasis 18.9%PSQ - Mania 5.7%

(The number of referrals made by interviewers to the Mental Health Inreach Health Services for HMP Maidstone was 13.)


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In House assessment:

In HMP Maidstone at 1stJanuary 2007 there were a total of 74 offenders with a history of mental ill health (54 with Primary Careneeds).

Primary psychiatric nursing care is provided by the RMN trained staff on the in-house team. Case notes are maintained within thepatients clinical record (IMR).

Intervention required In past twelve months (thro 2006) In twelve months prior to June 2004

RMN informal reviews 50+ Not recorded

RMN residential house ad hocvisits

100+ Not recorded

Prescribing is initiated, upon review, by the visiting psychiatrist, but the primary care doctors and RMN offer invaluable feedback tothe psychiatric team.

Secondary and tertiary mental healthcare needs

Referrals are made between the Trevor Gibbens Unit (MH Inreach Psychologist and psychiatrist) and the MH Inreach CPN team asappropriate.


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The Mental Health In-reach Service provided Mental Health Secondary Care Sessions as follows

Intervention required In past twelve months (thro 2006) November 2003 to June 2004 (8/12)

Seen by Mental Health InreachCommunity Psychiatric Nurse

425 individual appointments(number of clients not recorded)

69 clients seen over 224 individualappointments

Seen by Psychiatrist 38 clients 31 clients seen over 77 individualappointments

Seen by Forensic Psychologist 14 clients 20 clients seen over 56 individualappointments

Seen by General Psychologist N/A to Healthcare Not recorded

Offenders with a history of mentalill-health

74 at Jan 1st2007 54 at June 2004

New referrals seen by MH InreachCPN

Figures not available 59

During the past year emerging evidence has demonstrated a need for increased support and services for serious Mental Healthproblems. The Mental Health inreach Team has already increased psychiatric sessions in response to in-house RMN identificationof need.In 2006 11 prisoners have had to be transferred to HMP Swaleside (under the SLA) for inpatient care (5 in 12 months up to June

2004), and of these none were sectioned and sent to, or await a bed in NHS Regional Secure Units (RSU). (There were 3 in 12months up to June 2004). This illustrates the degree of serious mental illness managed by all the staff at Maidstone. The interfacebetween the In-Reach (secondary and tertiary) and in-house Primary Care Service is carefully managed by the in-house RMN.


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5.6 Chronic Illness (data from Inmate Medical Records [IMR] and prescription sheets)

Type of illness In past twelve months (thro2006)

In twelve months prior toJune 2004

Heart Disease 24 22Diabetes 21 12

Asthma 35 36COPD 5 6

Epilepsy 8 10Hypothyroidism 2 Data not collectedCancer 6 Data not collectedStroke (& TIA) 0 Data not collectedHypertension 22 Data not collected

5.7 Number requiring transfer to NHS Hospitals for inpatient stay

Month(2006)

Numberof patients

Bed-watchnights

Nature of treatment needs Month(2003-4)

Numberof patients

Bed-watchnights

2003Jan 1 2 Plastic surgery July 2 6Feb 2 4 Urology/General Surgery Aug 2 4March 2 13 Gen Surgery/Orthopaedic Sep 2 3

April 0 Oct 2 18May 1 1 General Surgery Nov 2 16

June 5 8 Urology & overnight A&E Dec 1 12006

July 2 10 Gen Surgery & A&E Jan 1 5Aug 3 20 ERCP & A&E Feb 3 5Sep 1 1 Hand surgery (tendons) March 1 4


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Oct 1 15 A&E admission April 2 2Nov 2 8 Overdose & Cancer May 0 0Dec 3 13 3 x A&E admission June 2 4Monthlyaverage

2 8


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In past twelve months (thro 2006) In twelve months prior to June 2004

Number of offenders released 161 Not recorded

Number of offenders releasedwith discharge letters

33 (20%) Not recorded

6 Healthcare Staff and Services

6.1 Staff

Staff HoursHead of Healthcare RGN I Grade 1 WTE

Operational Manager HCSO 1 WTERGN F Grade 1WTERGN F Grade Vacancy

RMN F Grade 1 WTERMN D Grade 1 WTETypist 1 WTE

Bank Staff are used most days of the week to cover the F grade vacancy.All posts are subject to Agenda for Change banding processes

6.2 Primary Care access

The healthcare facilities provided by HMP Maidstone are Type 2, meaning there are no inpatient facilities. The Healthcare Centreis open from 7.45am - 8.15pm weekdays, 8.00am 5.15pm weekends. PCT GP Team Doctors provide surgery appointmentsessions from 9-12 Monday, Tuesday, Thursday and Friday: and a GP is in the prison from 9-12 on Wednesday to provide chronicdisease management clinics. Doctors from the PCT GP team are on call until 5.15pm for telephone advice or exceptionally for


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attendance for medical and on-medical prison specific emergencies. Nights, Bank Holidays and weekends are covered byindependent arrangements between HealthCare and GPs, under individual SLAs.

New Reception offenders are seen on the day of arrival in the reception healthcare screening room by a HealthCare Worker(HCW). A member of the GP Doctor team only sees him if there are concerns raised by the HCW in respect of medication orChronic disease management, but Offenders are advised of the procedures for access to the GP and HealthCare Team.

If an Offender arrives at the prison late on a Friday he is still seen by a HCW and then seen, if necessary, by the doctor on call on

the Saturday. Receptions do not normally arrive on a Saturday or Sunday. Offenders do not arrive at the prison after 20.15 whenthere are no HealthCare staff on duty. The GP on duty holds surgeries on Monday, Tuesday, Thursday and Friday mornings, andconducts review and referral surgeries on Wednesdays.

On average in 2004 250 appointments passed through the HCC in a week.On average in 2004 21 people a day passed through the HCC for non - appointment reasons. Offenders who wanted to see adoctor made a Wing application.

From November 2006 timed appointment slots are available. A 'snapshot' taken at the time of writing showed the following:

Wing Number of offenders bookedfor Doctor appointment

2007 * 2/12months

2004 (twelvemonths)

Thanet 8 n/a

Weald 6 n/aMedway 5 n/a

Kent 11 n/a


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6.4 Other Primary Care Services

Pharmacy servicesPatients are allowed to have in possession medication on a daily, weekly or monthly basis based on clinical judgement, and RiskAssessment. Prescribed medication is issued to patients the same day in some instances but in general it is issued the followingday. The original prescription is faxed to Rochester pharmacy on a daily basis and is delivered from them on a Monday to Fridaybasis. Rochester pharmacy operates an emergency supply service.

Dental services:These are provided on a twice-weekly basis. The level of service offered is on a sessional basis, two mornings per week by anNHS dentist who also provides dental nurse cover. Only treatments available on the NHS are offered. The current waiting time for aroutine appointment is 6 weeks.


Number of offenders treated(Units of Dental Activity)

864 Not recorded

Number of offenders breaching8 week wait for a routineappointment

70Not recorded

On-site X-ray service

A radiography service operates once a week for diagnostic purposes. All urgent needs are referred to the NHS emergencyservices. Over the past year 197 patients have been screened and radiologist report made.

Chiropody clinics:These are held 2-weekly for Diabetic Foot Care checks and patients referred by the GP. About 6 people are seen per session.


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Number of offenders treated 90 Not recorded

OpticianIn 2004, the optician visited once per month and provided between 480 and 500 patient appointments throughout the year.

In 2006, the optician visited once per month and saw 206 patients in the year.

All offenders are advised at reception screening that they may self-refer to this service.In 2006 the maximum wait between self-referral and appointment provision is 6 to eight weeks. However, if referred by GPoffender will be seen at the next available session. Once spectacles are prescribed and ordered, these are sent to the prison toavoid delay.Physiotherapy:Physiotherapy is provided on site under contract from the PCT. Patients are referred by a doctor. The caseload is usually about 6

per fortnightly session of one day. Contracting arrangements are being reviewed in light of PCT changes.

6.5 Health PromotionHealth Promotion is now recognised as a whole prison approach responsibility in line with PSO 3200. The Health Promotion ActionGroup has an action plan which requires review.

6.6 HealthCare Contribution to Holistic Care Planning for OffendersRepresentatives from the HealthCare team take an active part in the following Offender Case Management Review Meetings to

identify individual Offenders needs, and ensure appropriate HealthCare support for them.

CARATS Case Management BoardMulti-Agency Public Protection Arrangements (MAPPA)Safer Custody Group (Prevention of Suicide and Self-Harm)


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Reducing Re-Offending groupResettlement PlanningSegregation Review Board (to review mental and physical fitness for continuing residence in the Segregation Unit).

7. Deaths in Custody

2006 2003-4 (June June)

Age Cause of death Age Cause of death49 Information not yet available 63 Information not reported back to HealthCare from Coroner67 Information not yet available 75 Information not reported back to HealthCare from Coroner

73 Information not reported back to HealthCare from Coroner

New procedures for investigation of Death in Custody by the HealthCare Commission and Prison Health Ombudsman enablelessons to be learned from examination of health care provided prior to death.

8. Corporate approach to Needs Assessment

8.1 Staff Feedback

All HealthCare staff have been involved in gathering the evidence for this Health Needs Assessment. A final Staff briefing tookplace on May 25th2007 to discuss the implications of the Assessment with HealthCare Staff. Discussion took place around theemerging picture that more Nurse-led Clinics would be required in order to meet the Offenders Health Needs.

8.2 Offender Questionnaire Feedback

8.2.1 A Survey of Measurement of Quality of Prisoners Life (MQPL) was carried out at HMP Maidstone between 20thand 23rdNovember 2006 by an independent research team of HMP Prison Service with a random sample of 120 Offenders.. In the report it


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was documented that by comparison with other establishments of all types and by comparison with other training prisons alone, thescore for HealthCare fell just above the mean or middle of the typical range in both comparisons.Sample Mean SDMaidstone 3.15 0.81Whole Estate 3.01 0.36Other Training 3.05 0.38

Strongly Agreed /Agreed

Neither Agreednor Disagreed

StronglyDisagreed /Disagreed

I feel cared for by staff on the HealthCare Unit 48.9% 9.1% 42.0%

HealthCare staff are interested in helping me with my physicalhealth concerns

45.9% 25.9% 28.2%

I am happy with the treatment I have received in this prison formy health problems

47.2% 16.9% 36.0%

HealthCare staff show understanding for my mental health andemotional concerns

36.0% 40.7% 23.3%

The doctors here take time to listen to my physical healthconcerns

52.3% 22.1% 25.6%

The doctors in here believe me when I tell them about my healthproblems

41.9% 30.2% 27.9%

HealthCare staff explain things (treatment and diagnosis) clearlyto me

51.2% 19.8% 29.1%

Responses to all seven statements were recorded for only those 89 offenders who said they had experienced HealthCare services at Maidstone.

8.2.2 In November 2005 a small project was initiated to pilot a system of Nurse Triage before the GP open surgery session.

Offender feedback and discussion was as follows:4 Offenders declined to participate64 offenders were seen over 6 morning clinics28 were given simple analgesics, advice or referral to Dentist, Optician etc (all offenders were pleased at the speed of access,treatment advice and decrease in waiting time spent in HealthCare department).


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36 Assessed, history documented and referred to GP for Meds (not then nurse-prescribable) for further investigation or referral.

9. Data Collection

Health Needs Assessments will be repeated every three years to support the refresh of the Prison Health Delivery DevelopmentPlan. The next Health Needs Assessment Review is planned for January 2010, and will be facilitated by improved data collectionpossibility through the use of Vision Clinical IT systems.

10 Quality Standards of ServiceThe following audit results reflect the standards of HealthCare service provided:

1 November 2005 3-yearly Standards Audit results for Healthcare Standards, 93% Acceptable

2 HMIP Chief Inspector's Brief Unannounced Inspection in 2004, Healthcare described as thriving and vibrant , focused on

innovative development by the Inspectorate. Letter of congratulations received from John Boyington, head of prison task

force

3 Star Rating of the Prison, December 2006. 2 stars Type 2

4 Traffic Light assessment of Healthcare, December 2006 - Green

5. Use of PALS / Complaints / ICAS in 2006 - 3 offenders given PALS information and one given details of ICAS.

Signed Governor..

PCT Prison Lead..


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DateTo be reviewedReferences

Bridgewood & Malbon (1994) Survey of the Physical Health of PrisonersLondon: Office of National Statistics

Hudson, T. and Gray, S. (2006) MPQL Research carried out at HMP Maidstone between 20-23 November 2006. London:HM Prison Service

Kent & Medway Prison Mental Health Inreach Team (2006). Study to undertake a Mental Health Needs Assessment acrossKent and Medway Prison Estate. West Malling: West Kent NHS and Social Care Trust

Appendix 1

Foreign National Offenders breakdown by nationality January 2007

Afghanistan 3 Ireland 3 Slovakia 1Albania 1 Italy 3 Somalia 2Algeria 1 Jamaica 30 St Vincent 1

Antarctica 1 Kenya 1 Tehran 1Austria 1 Kuwait 1 Trinidad & Tobago 3

Bangladesh 6 Latvia 1 Turkey 5Belgium 3 Lebanon 1 Uganda 1Burundi 1 Liberia 1 United States of America 1

Canada 1 Lithuania 5 Vietnam 2Colombia 3 Malawi 2 Yemen 1Congo 1 Montserrat 1 Yugoslavia 2

Cyprus 1 Nigeria 9 Zaire 1France 1 Pakistan 2 Zimbabwe 1Germany 6 Poland 2 Not declared 2Ghana 4 Portugal 3India 3 Romania 3 Total 23% 131


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Iraq 1 Sierra Leone 1 Total Prison Population 100% 573

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