Warning of risks to prisoners over "potentially dangerous" under-prescribing of methadone at Scots jail

The 751-prisoner HMP Low Moss in East Dunbartonshire says that on-going staff shortages have meant they have had to prioritise cover for "basic healthcare provision" at the expense of other treatments.

Staff sickness, challenges in recruiting to key posts and retaining staff had a big impact at the medium-security jail which opened after renovation of prison accommodation five years ago, the report said.

HM Inspectorate of Prisons for Scotland revealed that at the time of the May and June inspection, only 60 of the 140 prisoners on methadone, were within the current orange guideline recommended dose range of 60-120 mg.

The inspectors said that for some of these patients this dosage may be “clinically appropriate but the numbers still remain high”.

And they warned the practice could be “potentially dangerous for the prisoner on release”, as under-prescribing could lead to the person “topping up” with illicit substances, both within and outwith the prison setting.

HMIPS also raised concerns that healthcare managers had told of occasions when the Scottish Prison Service had denied bank nurses access to the prison for security reasons without discussion or explanation.

The inspectors said the Scottish Prison Service and NHS management needed to develop a solution that ensure delays in allowing bank staff access to the establishment are minimised.

The report also highlighted that there was "little or no capacity" to offer health promotion for addictions and substance or alcohol misuse.

And there was concern that the anti-overdose drug Naxolone had not been given to prisoners since July, 2016. Users of heroin and similar drugs can be given naloxone kits to reverse the effects of a potentially fatal opioid overdose.

Edinburgh Prison issued the highest number of kits in 2015/16 (142, a 19 per cent drop) followed by HMP Addiewell in West Lothian (114, a 97% rise).

Apart from the Blood Borne Virus (BBV) service, no chronic disease management clinics were held in the prison, the report said.

Medical emergency training had been offered to all qualified nursing staff but a review of training records revealed that only 8 out of 31 had attended this and there was not a system in place to ensure that a member of staff who had completed the training was on each shift.

"It is worth noting however that the healthcare staff and management were clearly dedicated to delivering the best possible service but unable to deliver this as a result of persistent and enduring staffing shortages", the report said.

As a result of the findings, HMIPS will return to Low Moss with colleagues from Healthcare Improvement Scotland early in 2018 to check progress on improving healthcare at the prison.

The Prison Reform Trust were disturbed by the report findings.

Mark Day, PRT's head of policy and communications said: "In an otherwise positive report, it is concerning that inspectors found such poor outcomes for healthcare at HMP Low Moss, largely as a result of significant staff shortages.

"Prisoners are entitled to receive the same standard of healthcare in prison as they would normally receive in the community. We hope the health service will now move swiftly to address the shortcomings identified in the report, so that the safety and wellbeing of people held at the prison are not put at any further risk."

The report also said that while the mental health team and the addiction team had good response times to assessments, their follow up of patients examined as being suitable for treatment and support was "inconsistent".

HMIPS said mandatory training and training reviews for staff were not up to date and although an established system for managerial supervision was in place, staff did not receive regular supervision.

The inspection team said it had recognised that since 2011 NHS Greater Glasgow & Clyde and Glasgow City Health and Social Care Partnership had made a "significant investment" and secured additional funding for seven full-time posts.

Four posts had been filled - three primary care nurses and one addiction nurse and had been undertaking their induction at the time of inspection which ran from May 29 to June 9.

"With the NHS board unable to fill some vacancies together with staff on long term sick leave, it was unclear at the time of inspection whether in the long term, this additional staffing will have a positive impact on service delivery and lead to a wider range of services being offered to patients," the inspectorate said.

Responsibility for prisoner healthcare transferred to the NHS in 2011.

The SPS said it "welcomes the largely positive report" and would "work with our colleagues in NHS Greater Glasgow and Clyde to take forward any actions identified to improve the delivery of healthcare in the establishment".

David Williams, chief officer of the Glasgow City Health and Social Care Partnership (HSCP) said:  “We are pleased to note that the report acknowledges the work undertaken to address the recommendations made following their 2013 inspection. There has been significant financial investment in this service over the past year.

“Clearly there is still work to do and we have developed an action plan to address the issues identified during the inspection and expect to be in an improved position when the inspectors revisit in early 2018. We are disappointed that the report graded our service as poor when there were many positives identified and we have reflected that to the inspectors.

“Providing prisoners in Low Moss with healthcare provision which best meets their needs is our priority as is their wellbeing, which is also extremely important.  As well as providing information about healthcare services during the induction process, we also ensure they have access to a range of specialist services.”