Archived: HMP Wymott

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked at 3 quality statements in this key question. We focused on care and treatment for long-term conditions and access to social care. We found patients received timely assessments and referrals for secondary care services and social care, where needed.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

New prisoners received comprehensive primary and secondary screening assessments, followed by further assessments if needed by the relevant specialism. New prisoners also received useful information on how to access health services while in prison.

Healthcare offered a range of health checks including blood-borne virus screening, age-related screening programmes, and regular condition-specific tests. There was appropriate and timely follow-up if abnormalities or risks were identified.

During our inspection, we looked specifically at the care and treatment of patients with long-term conditions. We found an effective pathway for the assessment of needs and planning of care for patients with complex needs. Reception staff identified patients with a long-term condition and started a care plan. A dedicated long-term conditions nurse ensured that patients received person-centred care and treatment for their long-term conditions. Staff monitored patients in line with the relevant good practice standards associated with their conditions.

Health care staff identified patients with commonly undiagnosed conditions, for example diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation and hypertension (high blood pressure) and ensured they received the appropriate care and treatment as well as advice on how to manage their conditions. For example, patients with asthma were offered an asthma management plan.

We reviewed the quality of patients’ care plans and found a mixed picture. All patients had care plans specific to their needs and conditions, and many were of very high quality such as wound care plans that set out strict care and treatment regimes, potential risks and escalation indicators. However, in some cases, we found care plans that were not sufficiently personalised to capture the complexity of patients’ individual needs. Staff immediately reviewed and revised the care plans we told them about while we were on site.

The service used an electronic system for recording and managing patient information. All healthcare staff, including temporary staff, had access to the system. Staff kept patients’ care records up to date, and in good order. Patients’ notes were comprehensive containing the appropriate assessments, care plans and reviews.

During our inspection, we looked at how social care was managed and found that patients had good and timely access to social care provision. There were clear and effective arrangements for social care between the prison, the local authority and the health care provider set out in a memorandum of understanding (MOU).

The local authority’s prison social care team had an open referral process, which meant the patient or any staff member in the prison could make a referral to the team at any time. For new prisoners, healthcare staff tried to identify any social care needs during reception screening assessments and referred them to the lead nurse for social care or directly to the prison social care team.

The prison social care team comprised social workers and occupational therapists who screened and prioritised referrals and completed assessments under The Care Act 2014. Most referrals were for support with personal care and/or requests for equipment (such as walking sticks and frames, toilet seats, and shower aids). Most assessments were completed within 28 days; in the meantime, the team had agreed that healthcare could offer social care support if it was needed urgently. Patients received a minimum of annual reviews, usually completed in person. The social care team also supported release planning. There were effective arrangements in place to manage urgent and/or changing needs.

The provider (GMMH) was commissioned to provide formal social care on behalf of the local authority. This was mainly provided on the Haven Unit by 2 dedicated health care support workers who helped patients with personal care. They were supported by health care staff when needed, for example, when there were staffing gaps or high demand. These arrangements helped ensure patients’ personal care needs were prioritised and met whenever possible.

The provider had a dedicated lead nurse for social care, palliative care and end of life care, who worked closely with the prison social care team and the Haven Unit’s custody manager to meet the high level of health and social care need in the prison’s population.

At the time of our inspection, the lead nurse for social care had a caseload of 12 patients who were in receipt of a formal social care package. Each patient had an individual care profile that contained a summary of their needs and risks and a care plan. The lead nurse also monitored 181 prisoners who were over 60 undertaking annual reviews, and ensuring key health checks such as eye tests, hearing tests, memory tests, and blood tests were completed. She completed older person’s assessments covering common areas of risk such as falls, malnutrition and hydration; screening assessments of activities of daily living; and had recently started doing continence assessments.

The prison and the local authority had commissioned Recoop (a charity supporting older people with convictions) to recruit, train and supervise social care buddies to provide low-level social care. The social care team assessed patients for low-level social care and drafted care plans that were implemented by social care buddies. Around 190 prisoners were receiving support from social care buddies.

The judgement for Delivering evidence-based care and treatment is based on the latest evidence we assessed for the Effective key question.

We found very good working relationships between the prison and health care managers. There was a recognition from all parties that a strong collaborative approach was required to operate a safe and effective service that met the high level of demand and complex needs in the prison population.



The Haven Unit provided an excellent example of prison, healthcare and social care staff working together to meet patients’ complex needs. The unit had dedicated health care staff who supported patients with social care needs, and dedicated prison staff who understood the purpose of the unit. The prison staff received additional relevant training on topics such as dementia awareness, palliative care and end of life care. The unit operated a multi-disciplinary approach that involved healthcare (for example, the lead nurse for social care and the primary care lead nurse), social worker, and the custody manager. Monthly multi-disciplinary meetings took place for patients in receipt of social care. They also discussed the suitability of referrals to the unit and complex cases.

The service had effective daily handovers. These were well attended with contributions from all specialisms. Staff shared information that included concerns about patients, any risks, urgent matters and service updates. GP-led multi-disciplinary team meetings took place weekly. Patients with complex needs were reviewed regularly at these meetings.

GPs worked closely with health care staff to deliver safe and effective primary care, and often collaborated to develop or improve care and treatment pathways. For example, at the time of our inspection, a GP and the community matron had been reviewing the long-term conditions pathway.

The prison provided officers as escorts for 6 external appointments each day but this was not enough resource to meet the high demand at the prison. Prison and healthcare staff had escalated their concerns to their respective managers and added the risks to their respective risk registers. In the meantime, healthcare and prison managers shared information and worked closely to manage the demand.

Healthcare sought opportunities for working with their partners to improve their service and manage finite resources effectively. For example, they attended weekly meetings with the local hospitals to manage secondary care appointments. The meetings were aimed at improving attendance, reducing waiting times and avoiding wasted appointments. However, they also helped with prioritising and triaging patients when the number of appointments exceeded the number of officer escorts available.

The prison had an ageing population and very high levels of health and social care need. Data from July 2024 showed that 699 men had long-term conditions (LTCs), of which 570 had multiple conditions.

Access to health services was good, with low waiting times for appointments. For example, the average waiting time to see a GP was 4 days. A well-staffed clinical team helped to make sure patients’ needs were met promptly. Health service provision reflected the profile of the prison population including GP and nurse-led triage, a focus on older people’s needs, and regular long-term condition clinics. Healthcare offered in-cell visits for older patients, or those with complex medical needs. The service monitored non-attendance and appropriate actions were taken when necessary.

The service used the Quality Outcomes Framework (QOF) to monitor outcomes for patients with long-term conditions. The QOF helped the service maintain a register of patients with specific conditions and set out the associated monitoring requirements. During our inspection, we reviewed the QOF registers for specific conditions, which showed 150 patients with asthma, 119 patients with diabetes and 189 patients with hypertension.

This meant the demand on healthcare was very high and robust management was required of long-term conditions. The provider had struggled to keep up with need and demand in the past year with patients not always receiving timely follow up of their conditions. However, since the arrival of the new head of healthcare in July 2024, there had been a concentrated effort to improve the management of long-term conditions. The service had made significant progress in a short period towards ensuring the safe and effective management of LTCs, which was evident in the QOF performance data reported to NHS England.

The service now had accurate registers of patients with specific LTCs. The service had addressed most of their backlog of reviews. Most patients received the care and treatment they needed for their health conditions. The service had started to use a recall function on the patients’ database to book follow up tests and reviews. However, the service was struggling to recruit an LTC nurse but in the meantime had engaged a temporary nurse full-time to focus on LTCs and an experienced LTC nurse one day a week.

We found some gaps in service provision that, some of which were outside of the provider’s control. For example, there was a waiting list for diabetic retinopathy. The service was provided by a local trust and the next clinic was scheduled for February 2025. The service could not access diabetic education programmes but had escalated this in the hope of finding an alternative. There was a waiting list for spirometry. The provider had a nurse who had completed spirometry training but was unable to practice due to complexities associated with the registration process. In the meantime, records showed that staff monitored these patients appropriately.

The judgement for Monitoring and improving outcomes is based on the latest evidence we assessed for the Effective key question.

The judgement for Consent to care and treatment is based on the latest evidence we assessed for the Effective key question.