At a previous inspection of Dental Department HMP Swaleside in April 2014 we had concerns about the length of time patients waited to see a dentist and the number of patients who were waiting to see a dentist. We asked the provider, Dental Department HMP Swaleside to submit an action plan telling us what action they would take to improve patient access to dental service.

We undertook a follow up visit on 24 March 2015 and found that the provider had addressed the issues and there had been an improvement in the delivery of the service to patients. We found that appointment waiting times for dental services were shorter and patient waiting lists were an acceptable length. We found improvements had been made to the service which included access to dental triage clinics, the management of appointments, responding to complaints and managing patient non-attendance.

We spoke to five people about the care and treatment they received. One of these people said they were satisfied with their care and treatment. The remaining people said their treatment was not of a good standard primarily because of waiting for long periods for a check- up and for treatment. Whilst the provider told us there was an issue with people not attending some of the appointments it was recognised this was an issue. Consequently, steps had been taken to increase the availability of dental treatment from two and a half to three and a half days a week.

We also observed one person’s dental check-up. We spoke to one of the dentists and to a dental nurse. We also spoke to the provider’s Dental Clinical Director, Leadership and Quality.

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

We saw the service had safeguarding policies and procedures which staff said they were trained in. Staff were aware of the joint protocols between service providers in the prison regarding those people assessed as being at risk of self-harm. This is called the Assessment, Care in Custody and Teamwork (ACCT) framework.

We saw the service had effective procedures for the prevention and control of infections. We saw the dental treatment room was clean, hygienic and well equipped although we noted the entries on the cleaning schedule showed the floors were not being cleaned as planned.

The provider and commissioner of the service had recognised the need to increase the provision of dental treatment due to a backlog of people waiting to be seen.

The dental service had access to emergency equipment such as emergency medicines and a defibrillator. Staff were trained in emergency procedures and basis life support.

Is the service effective?

The service had recognised that people were waiting too long for both check-up appointments and ongoing treatment. The records made on System One used by the service showed more than 200 people waiting for a check-up and some people had waited 37 weeks to see a dentist for a check- up. One person told us he had waited for 20 months for his dentures which he still did not have. Records confirmed this person had been waiting for dentures since a denture impression was taken more than six months previously. The provider told us this person had additional dental work during the six month wait which contributed to the dentures not fitting.

Another person complained that he could not get an appointment for the dentist to see his loose front tooth and had presented himself to the health centre nurses in order to get an appointment with the dentist.

Staff were trained in relevant subjects and staff confirmed their skills and knowledge were regularly assessed.

Is the service caring?

We observed one person receiving a dental check- up. The dentist and dental nurse took time to explain and converse with the person regarding his dental needs and how he could maintain good dental hygiene. The person was treated in privacy and the treatment door was closed.

Is the service responsive?

We saw the service had a complaints procedure. The service maintained a record of complaints. People told us they were able to make a complaint by using the complaints forms on the prison accommodation units. Complaints leaflets were available in the dental treatment room and the Dental Clinical Director, Leadership and Quality, told us the service provided a translation service for anyone whose first language was not English.

The service was not providing sufficient dental clinics so that the dentals needs of the prison population could be met. The service had, however, recognised this and had increased the numbers of dental clinics.

Is the service well led?

We saw the service took action to address individual complaints made by people. The provider recognised the need to increase its staffing hours and clinics to meet the demand for dental services. At the time of the inspection it was too early to say if this was effective in reducing waiting and treatment times. We identified there needs to be a significant period of increased availability of dental clinics so that people are seen in a timely way and that people get appropriate treatment.