Archived: HMP Wymott

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked at 4 quality statements in this key question. New stable and experienced leadership had led to improvements in staff morale, governance mechanisms, and collaborative working across the prison.

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

New stable leadership in healthcare had set out a vision for improving services, which had been welcomed by health care staff and partners such as prison governors and commissioners. Staff we spoke with were very positive about the new head of healthcare saying that staff morale had improved and the service “was moving in the right direction.” Staff felt supported and listened to by managers and felt able to raise any concerns. However, healthcare experienced challenges associated with their overall capacity and resource compared to the level of need at the prison but staff worked flexibly and cohesively to safely and effectively manage the demand.

Governors and managers had noticed positive changes in healthcare since the new HoHC arrived. In particular, there was a stronger focus on working in partnership to resolve common issues, for example, lengthy medicines administration rounds, high demand for external hospital appointments, and low clinic attendance rates. They developed projects together on specific issues such as low attendance, ran focus groups and issued surveys to understand the reasons, and reported findings and progress to the Local Delivery Board.

The new head of healthcare had brought much needed stable and consistent leadership to the service. Staff welcomed the manager’s commitment to improving the service for staff and patients and had seen significant improvements in a short period of time. Health care staff told us that “a lot has changed” since the new HoHC and primary care manager joined the service. Staff said by improvements in one area such as medicines administration had led to benefits in other areas, such as having more time to run clinics, which had reduced staff frustration, especially when capacity was limited and demand was high.

We spoke with governors who gave positive feedback about healthcare. Governors told us they had been concerned about the lack of stable leadership in healthcare over the past few years, which they felt had hindered progress. They recognised how essential it was to work together in a large prison to safely and effectively manage the high levels of complexity and need. They commented on the difference the new HoHC had made in a few months, in particular, improving the collaboration and communication between the prison and healthcare. One governor said, “My thanks to [HoHC] – as there’s been a real change since she came.” The governor described real performance improvements in attendance rates, the management of external appointments, and medicines administration. She described the HoHC’s ‘can do’ approach as refreshing and progressive, resulting in ‘fixes.’

The health link governor described working as ‘one team’ due to the new HoHC “bringing groups together” and “breaking down barriers.” The custody manager in charge of the Haven unit commented on seeing a “massive difference” since new HoHC came into post. They worked together to plan person-centred care for patients with complex health needs. They used a multi-disciplinary approach to discuss issues and identify options with a view to meeting patients’ needs safely and effectively.

Pharmacy staff described good working relationships and engagement with the new head of healthcare who understood their challenges and workload. Pharmacists felt well supported in their role by the regional pharmacist and the pharmacy team at the trust. Pharmacy staff had access to the Medicines Safety Officer (MSO) at GMMH who disseminated safety information via an MSO newsletter.

The judgement for Freedom to speak up is based on the latest evidence we assessed for the Well-led key question.

The judgement for Workforce equality, diversity and inclusion is based on the latest evidence we assessed for the Well-led key question.

The trust had clear governance structures that supported the healthcare service at the prison. These included an organisational structure and a range of local and provider level meetings, for example, monthly clinical governance meetings, medicines management meetings, monthly local delivery boards, quarterly contract meetings with NHS England, and a quarterly northwest prisons health and social care partnership board.

Staff completed a range of relevant audits to check the quality of care and identify areas that needed improvement. We saw a wide range of audits such as those for complaints, compliance checks on in-possession medicines, and patients’ care records. We found they were completed appropriately with any issues identified resulting in remedial actions. However, we identified some areas that would benefit from the introduction of an audit, for example, prescription stationery.

The judgement for Partnerships and communities is based on the latest evidence we assessed for the Well-led key question.

We found the service was clearly on an improvement journey, driven by the new head of healthcare in collaboration with the prison and other partners. Staff told us they had started to see positive changes to the service in the space of a few months.

Good joint working between prison governors and healthcare managers had resulted in mutually beneficial solutions to shared issues, for example, medicines administration. Dedicated officers supported the administration points, which were now well managed, safe, efficient and timely.

Healthcare, in collaboration with the prison, had a number of initiatives that showed its commitment to improvement and innovation. For example, they had worked with a local hospital trust to set up facilities for a patient to undertake kidney dialysis on site. They already had close working arrangements with a local hospice for the provision of palliative and end of life care. However, they hoped to offer more care on site in line with the Dying Well in Custody Charter. Healthcare was liaising with a local hospital about undertaking a pilot to provide COPD care on site.

Managers took the opportunity to learn from incidents and concerns. For example, they had recognised the need for further training for staff on wound care especially in patients with complex conditions and high risks. They had sourced a tissue viability nurse to provide education and training on wound care, who had also put together an education board. Staff welcomed this.