Mr Atlantic — HMP Pentonville

At an organisational and cultural level, we recommend that further measures are taken to close the perceived gap between the main prison and the Healthcare unit at HMP Pentonville. This should help create a greater sense that HMP Pentonville is functioning as one organisation, comprised of staff and managers working together towards a common goal.

We recommend that existing mechanisms for ensuring that quality ACCT entries are made at HMP Pentonville be enhanced. This process may involve: making the process easier for staff by OSRR providing guidance notes to accompany the ACCT document. These guidance notes should make explicit what is being looked for and not looked for, providing examples to help convey the key messages; praising individuals who are providing quality entries; utilising the power of peer pressure by making it public when good entries are being made; identifying deterrents against making poor quality entries; increasing staff’s sense of involvement by providing a forum for individuals to talk about what using ACCT is like; connecting staff with the outcomes of their work, i.e. finding a way of demonstrating how quality ACCT entries have actually made a difference. This should help reinforce the idea that making quality entries really does matter rather than making entries because the ‘process’ demands it.

We recommend that HMP Pentonville moves away from the regime of hourly ACCT entries to help encourage the recording of more meaningful entries.

We recommend that HMP Pentonville’s Healthcare unit reviews its use of ‘Special Observation forms’ and clarifies what value, if any, they are adding to the care and management of a prisoner who is on an observation regime.

(a) We recommend that more is done at HMP Pentonville to make it easier for staff conducting ACCT Case Reviews by clarifying for them what they are trying to achieve and how to fill in the form. We suggest this could be achieved by providing accompanying guidelines. Although it’s in a different context, a good example of this approach can be found in the form of the Guidance Notes that accompany the PER form (Person Escort Record form). These guidelines should provide greater clarity and promote greater consistency of approach. (b) We also recommend that staff involvement is enhanced by seeking out their view about how well or otherwise the Case Reviews are working. There is an opportunity to disseminate this feedback to other prison staff, and make ongoing changes to this element of the process. Encouraging involvement should also promote greater transparency and encourage individuals to challenge existing ways of doing things.

We recommend that some impetus be created at HMP Pentonville to ensure that the option of using discipline staff for one‐to‐one supervision is explored (see Chapter 13). Providing clear accountabilities and a timeframe for getting this piece of work done will go some way towards creating this impetus.

We recommend the ongoing use of the record‐keeping audit tool being used on HMP Pentonville’s Healthcare unit, whilst ensuring that it continues to make a tangible difference and informs decision‐making, rather than being seen as a paper‐filling exercise. Showing staff exactly how it is making a difference should further encourage its uptake, giving them a clear reason for doing what they have been asked to do.

(a) We recommend that guidelines be developed and implemented at HMP Pentonville as to what should and shouldn’t be recorded in ACCT and SystmOne. These guidelines could be integrated into existing documentation. To make it easier for staff, we recommend that these guidelines include examples of what should and shouldn’t be recorded. We suggest that an explicit acknowledgment is made that some overlap of information may be inevitable, but that it is important that discipline and clinical staff alike have as full a picture as possible of prisoners in their care. (b) Before developing these guidelines, we suggest that work is done to understand both the clinical and discipline staff’s perspective with respect to accessing what information they need. We suggest that consideration is made to making changes that don’t increase the existing burden of work, but that do ensure that the ‘right’ information is recorded in the right place.

To make better use of pre‐existing information, we recommend that psychiatric assessment guidelines used on HMP Pentonville’s Healthcare unit reference the need to source and consider the results of medical and psychiatric assessments that may have been conducted by other institutions.

We recommend that at HMP Pentonville recently‐made entries in the ACCT document, including triggers, are checked by a member of staff attending morning briefings so that any pertinent issues are identified and discussed in this forum.

We recommend that officers’ attendance at ward rounds is embedded as a norm on HMP Pentonville’s Healthcare unit, if this is not already the case. This should help further improve understanding and promote a sense of collegiate working among discipline and clinical staff.

We recommend that at HMP Pentonville all temporary staff receive a prison induction before working in the prison for the first time. As well as covering safety and security issues, this induction should provide coverage of the ACCT Foundation training module (which has since been superseded by ‘Introduction to Safer Custody’) and the use of a wing’s Observation Book. Alternatively, the onus should be placed on the agency/bank to provide only staff who have experience of working in prisons and who have received ACCT Foundation training in the recent past.

We recommend that, as a matter of course, escort officers at HMP Pentonville are provided with a briefing as to the nature of the circumstances of the prisoner in their charge and what has been learned about that prisoner. This should provide further clarity for the escort officer as to what he/she is being tasked to do, and help to reduce levels of ambiguity and the risks associated with this.

We recommend that following serious incidents, measures are taken at HMP Pentonville to ensure that support is provided, and information is actively disseminated, beyond the day of the incident itself. Responsibility for how this support is provided and how information is disseminated should be agreed at the post‐incident hot debrief so that respective responsibilities are clear, rather than hoping that individuals will take the initiative. This action should help to reinforce the message that the organisation cares about the welfare of its staff.

We recommend that steps are taken at HMP Pentonville to share findings of future internal investigations, whether these investigations are formal or otherwise, with the relevant audience(s). We would encourage the use of face‐to‐face fora for this, rather than simply circulating investigation reports. This approach should help enhance the feeling of staff involvement and would send a clear signal about how transparency is valued and promoted in the prison.

We recommend that efforts are made to ensure that representatives from Healthcare units across the Prison Estate meet on a regular basis. We feel that the key to making this a reality is ensuring that the agenda for such meetings is clear and agreed as a group. Meetings should then be perceived to be productive and therefore worthwhile attending. We suggest that a champion for this initiative be found from either inside or outside HMP Pentonville’s Healthcare unit.

We recommend that HMP Pentonville’s Healthcare unit keeps a log of temporary staff who have received a prison induction, whether they be booked through NHS Professionals or otherwise. We think it’s important that this log is easily accessible and made visible to help promote ownership for the provision of these prison inductions.

Assuming that it’s impractical for non‐permanent clinical staff to attend an ACCT training course as permanent staff members do and long‐term bank and agency nurses could, we recommend that a protocol be developed at HMP Pentonville to ensure that these staff are at least provided with a systematic ACCT briefing. This could be incorporated into a broader prison induction (see Chapter 13). We recommend that this protocol be developed in collaboration with Safer Custody.

(a) We recommend that a single system be introduced at HMP Pentonville that records who has received ACCT training and when the training took place. This system should cover both staff in the main prison and those working on the Healthcare unit. It should also cover both temporary and permanent staff. We suggest that the same system be used to monitor when refresher ACCT training is due. (b) We recommend that a system‐owner be assigned to ensure that action is taken, and that ongoing monitoring takes place. We suggest this owner should be the Safer Custody Senior Officer (SO). We also suggest that a member of staff in Healthcare is made responsible for liaising with the Safer Custody SO to provide this person with the information they need. We suggest that both individuals are involved in the design of the system to help promote clear ownership and to ensure the system is not perceived by users to be burdensome.

We recommend that part of the ACCT training (Foundation and Case Manager) should be modified by the Prison Service to convey an understanding of prisoner non‐communication and how this should be interpreted, particularly when formulating risk assessments.

We recommend that the views of clinical staff with respect to ACCT are sought when they attend ACCT training at HMP Pentonville. By understanding in what regard ACCT is held, ACCT trainers will be better placed to explore with those attending how shared ownership of ACCT might be best promoted. We recommend that serious consideration should then be given to acting on the outcomes of these discussions as a means of creating further buy‐in for ACCT and of promoting shared ownership among discipline and clinical staff.

We recommend that HMP Pentonville’s Healthcare unit takes steps to understand why ACCT triggers are not always given due consideration in prompting Case Conferences and documented discussions among staff. With this understanding, steps should be taken to improve the current situation. We recommend that any steps identified go beyond simply reminding or telling staff that triggers should be given consideration and that other mechanisms for changing behaviour are formulated and implemented.

To improve current audit trails, we recommend making it a requirement at HMP Pentonville that all staff print their name on the ACCT On‐going Record rather than relying on initials or signatures to identify who has made each respective entry. We suggest that amendments are made to the prison’s ‘Guide to Management Checks of Open ACCTs’ to reflect this change.