Table of contents

Current services in relation to need

Adults :: Offenders :: Current services in relation to need

HMYOI Cookham Wood

Her Majesty's Chief Inspector of Prisons (HMCIP) has not reported any serious concerns with the provision of healthcare. The most recent report comments on improvements in the service for young men with mental health problems. All offenders who are new in to custody, or are returning to the prison after a change of status, have to be assessed by the health team on admission.

In 2008, HMP Cookham Wood changed from managing adult women to young teenage men. This presented a number of challenges for staff and concerns were noted by HMIP in 2009. The Inspectorate considered the accommodation unsuitable for young teenage men. The follow up inspection in 2010 identified considerable improvement with reduction in bullying and use of force. However, a survey in 2010 showed significant difference in the experiences for black and minority ethnic young men who were more negative about the relationship with staff.

Healthcare is provided from a dedicated suite on the Cookham Wood site with a responder for unplanned incidents in the prison. These incidents have varied between 10 and 44 per month and remain largely unpredictable. Incidents include illness, accidents, use of force, fights and self-harm. The majority of activities take place by appointment, however there is a very high failure to attend rate. The healthcare delivery team is made up of a high number of long term agency staff and one challenge will be to develop a sustainable workforce to deliver high quality services.

Funding for substance misuse is now channelled through the NHS and locally this is managed by Medway DAAT. Drug services are currently provided at Cookham Wood by three staff members who deliver the Substance Misuse Service. These individuals are part of the broader casework team and take the lead on substance misuse. The services that are provided are non-clinical and cover the psychological and social aspects of drug use. Clinical management and detoxification of opiates are undertaken at HMYOI Feltham.

The core tasks for the service include:
• Administration of medication
• Immunisations and phlebotomy
• Reception screening and secondary screening
• Wellman clinic, Access clinic and Asthma clinic
• Emergency response for the core
• Pre/discharge/release assessment
• Health promotion

Most medicines are not given in-possession with the exception of antibiotics and inhalers for the treatment of asthma. Additionally, the following services are offered through providers working in association with the prison health team.
• GP clinics
• Out of hours GP cover
• Optometry
• Dentistry
• Podiatry

HMP Rochester

Healthcare at HMP Rochester is a well-established and well-integrated service. The prison was inspected in February 2011 during which the healthcare service received a generally good review. The inspection team noted that “Prisoners had access to a wide range of health services. Health staff were well trained, highly motivated and prisoner-staff relationships were good.”[1]

All new receptions are seen on the day of arrival for an initial reception assessment and they are all offered a follow up Wellman appointment within a week. Over a six month period there were 950 consultations for young men under 21 and 69 for prisoners aged between 22 and 72. There were on average 10 lost appointments a day through failure to attend. Most consultations were for minor illness or injury.

Healthcare is now shared as the prison has integrated services for Young Offenders and Adults. This represents the recent re-rolling of the prison as a partial Category C Adult prison. The original healthcare site is now used to deliver services to the Young Offender population, whilst a new healthcare facility is dedicated to the adult population. The complement of staff provides healthcare to offenders at all stages of their stay at HMP Rochester.

Core tasks for healthcare include:
• Administration of medication
• Risk assessment for in-possession medication
• Twice daily dispensing of medication at both health care centres
• Immunisations and phlebotomy
• Reception screening and secondary screening
• Wellman clinic, access clinic, smoking cessation and asthma clinic
• On-call GP services
• Pre-discharge for/release assessment, fitting forward/adjudication assessments
• Mental health care
• Emergency and contingency planning for healthcare specific issue, e.g. endemic flu planning

In addition to this, the following services are also delivered to the prison by other providers,
• GP clinics
• Optometry
• Dentistry
• Podiatry
• Mental health in-reach
• Phlebotomy

Sexually Transmitted Infections

A sexual health clinic is run once a week at Rochester with Chlamydia being the most commonly diagnosed condition. It is difficult to establish the exact numbers of those diagnosed as the current information systems do not separate this information. During a nine month period for which data is available, 17 patients attended GUM clinics in the community for testing and diagnosis.

Mental Health and substance misuse

Health agencies in Medway have recognised the higher levels of mental health and substance misuse for offenders and services have improved through adult and CAMHS services. A high proportion of offenders have dual problems and it is not clear how the need for alcohol services is to be addressed though it is identified as a key priority in almost all of the local strategies.

Substance Misuse

HMP Rochester has been a clinical Integrated Drug Treatment Service (IDTS) site since 2008. Medway PCT commissions services in partnership with the prison and Medway DAAT. A newly commissioned IDTS (clinical) and psychosocial Counselling, Assessment, Referral, Advice and Through care teams(CARATs) service will commence in October 2012.
The IDTS aims to expand the quantity and quality of drug treatment available at HMP Rochester by:
• Increasing the availability and range of treatment options, particularly substitute prescribing
• Integrating clinical substance misuse care with the services offered by the Drug Strategy/CARAT team with this including psychosocial treatment
• Develop joint working between Healthcare and CARAT teams
• Develop treatment delivery and joint care planning working to standards of care and models of treatment that integrate services and are agreed
• Integrating prison and community treatment to prevent damaging interruptions to treatment either on reception into custody or on release back home

Current Service Provision for Alcohol Reduction

Rochester currently operates the COVAID (Control of Violence for Angry Impulsive Drinkers) programme. The programme provides ten sessions that are each two hours in length that follow a prescribed timetable. The sessions can be either individual or group. The sessions are structured within a cognitive-behavioural treatment programme. Over an 18 month period 91 young offenders attended the COVAID programme and from the results of the Alcohol Use Disorders Identification Test (AUDIT), we can see that the 91 offenders who completed the programme have scored highly; a score of more than 8 requires intervention.

Chronic Diseases and their Management

Chronic disease management is essential to primary health care and is monitored through performance indicators. There are currently two sessions that are set aside for chronic disease management, which are general clinics rather than disease specific clinics. There is good evidence that supports the notion that imprisonment is not conducive for good health outcomes. Currently there is limited need for chronic disease management but this will change as the establishment has greater number of older offenders. The two sessions currently available for chronic disease management may not be adequate if the prison population increases and there is an increased number of older prisoners.

Outpatient Appointments in Hospital

Over an 18 month period between February 2010 and August 2011, a total of 280 patients attended hospitals as outpatients (source: HMP Rochester). Diagnostic imaging for radiography is the most common reason for attendance at the local hospital. Most patients who required a radiograph were due to suspected hand or face injuries sustained during fights. The reports from the healthcare staff indicate that most of these were soft tissue injuries. It was reported by staff that a high number of the emergency calls were for fights or self-injury. A large proportion of the patients required ultrasound for investigation of testicular lumps, which may be related to the increased awareness due to health promotion during induction. The number of patients requiring escorts has increased and may represent the higher healthcare needs of the adult population. It is anticipated that the number of patients requiring escorts could increase even further as the adult population of HMP Rochester also increases.

Failure to Attend

The number of failed appointments appears to be generally problematic; this was previously identified in the last health needs assessment that was undertaken in 2009. The service providers report that approximately half of all appointments are lost due to failure to attend.

The failed appointments during the period 1st October 2011 to 17th November 2011 totalled 510 appointments, which equated to an average of almost 10 failed appointments per day. These missed appointments represent 109 hours of clinical activity over the 48 days period assessed, excluding failed appointments within mental health.

If prisoners do not arrive at either of the Health Care Centres via the “free flow system” then it is impossible for them to attend their appointment unless they are given an escort; access to an escort is dependent on the availability of prison officers. Prisoners do not get flexible access to clinics as they often arrive at the same time and have to wait together in the waiting room until they are seen. This can lead to prisoners having to wait in the waiting area for long periods of time which can become problematic from an order and control perspective.

The prison will be changing its regime - the free flow period will be available all morning and during the unlock period in the afternoon. This will enable patients to attend their appointments without the need to wait for escorts. This should improve access to services.


[1]   Her Majestys Inspectorate of Prisons. Report on an announced inspection of HMYOI Rochester, 14--18 February 2011 2011; HM Inspectorate of Prisons. .