We carried out an inspection at HMP Swaleside in April 2014. We had concerns about the care and welfare of patients who were using the services and how patients accessed the complaints system.

Following this inspection we asked the provider to submit an action plan detailing what action they would take to improve the service.

We undertook a follow up inspection on 23 March 2015. We found improvements in care planning arrangements and patients were consulted about how they wanted their care to be delivered.

We also found that improvements had been made to the complaints system.

We spoke to eight people who received a service from HMP Swaleside. We also observed one person being assessed and treated by a nurse as well as nursing staff interacting with people in the Prisoner Recovery Unit.

We spoke to five staff which included Registered General Nurses (RGNs) and Registered Mental Nurses (RMNs) as well as to the health centre manager whose title was Deputy Head of Healthcare and to the Head of Healthcare.

We also spoke to the health service commissioners, NHS England.

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.

We received mixed feedback from people about the service they received. Five of the eight people we spoke to said they were satisfied with the service. Feedback received by HMIP from prisoners showed 30% of prisoners felt the health care they received from nurses was either “bad” or “very bad.”

Is the service safe?

We saw the service had policies and procedures regarding the safeguarding of people and that staff received training in this area.

There were systems in place to monitor accidents or incidents such as self- harm so that people were safe and re-occurrences minimised. These were carried out with other health care providers in the prison and with prison staff. The service also worked with other providers using an Assessment, Care in Custody and Teamwork (ACCT) framework for those assessed as being at risk of self-harm. We observed staff following one person’s ACCT care plan so the person was safely monitored as set out in the care plan. However, we noted that other risks were not adequately assessed such as when people were supported with moving and handling procedures.

The service had sufficient staff to meet people’s needs. Staff received training in a range of relevant subjects which was monitored by the health centre management using a training matrix.

Is the service effective?

One person we spoke to said he was not consulted about his care and treatment and had not seen a care plan. This was not supported by the person’s care records, which said the person’s care was discussed and agreed with him. Another person said they were fully consulted about their care but were not aware they had a care plan or not. There was no record of this person agreeing to their care plan.

We observed one person being assessed and treated by a nurse. The nurse took time to explain to the person what was being assessed and what the treatment options were. The nurse took time to listen to the person describe their symptoms.

We looked at care and treatment records for six people. There were records of people’s health care being assessed at the time of their admission to the prison. This included an assessment of the person’s mental health and the risk of self- harm plus any action needed. Physical health for each person was also assessed and recorded. For those people who received longer term care we noted that care plans were not recorded in sufficient detail for staff to be able to tell what help the person needed. Moving and handling assessments had not been carried out and recoded which meant there was an increased risk of injury to the person and/or to staff.

Is the service caring?

We observed one nurse assessing and treating a person. The nurse was attentive and listened to the person. We noted the nurse was compassionate when speaking to the person.

We also noted from discussions with other nursing and care staff had a genuine concern for people as well as empathy with people’s background and circumstances.

The majority of people told us they were treated well by the staff. Two people said health care staff were usually but not always polite to them.

Is the service responsive?

One person said they did not receive assistance when they asked for it. However, we observed staff responding to the person’s request for assistance. Another person we spoke to said they received help when they needed it and that staff responded to any requests for help.

Each person had a personalised care plan but we noted these were not always in sufficient detail so that staff had clear guidance to assist people as needed and requested.

People told us they were able to make a complaint by using the complaints forms supplied on the prison accommodation units. People said they were not always satisfied with the response they received to their complaints. We saw evidence of complaints being dealt with but noted there was no information available or supplied to people about the provider’s complaints procedure.

Is the service well led?

The service had systems in place to monitor and review incidents and accidents including incidents of self-harm and deaths in custody. These were carried out in conjunction with other health providers in the prison and with prison staff. These included action plans and consideration of the findings of independent reviews of deaths in custody.

There were 'Patient Forum' meetings where people could express their views about health care in the prison although one person did not feel this was effective. We saw records of daily audits such as of ACCT care plans, daily staff meetings, care plans and medicines audits. Infection control audits were carried out. We saw a strategic health improvement plan which included consideration of information from independent reports such as deaths in custody reports.

There was a management team to oversee the provision of health care. The head of health care said the provider organisation was responsive to the changing demands of the service and gave an example to staffing levels being increased to meet demand. We spoke to the service commissioners, NHS England, who told us the service had improved its governance and management arrangements as well being more effective in recruiting nurse and care staff.