Local Review of the Quality Governance Arrangements in place within Swansea Bay University Health Board, for the delivery of Healthcare Services to Her Majesty’s Prison Swansea

The health board and prison partnership board must consider how they gain assurance, that any reports or recommendations relating to prison healthcare published by both Welsh Government and Senedd committees, are identified, received and disseminated to the appropriate individuals throughout the health board and prison. In addition, that action is taken to ensure appropriate membership and attendance of the Prison Health Oversight Group.

The health board and prison partnership board must ensure that recommendations made in the report, Health and Social Care provision in the Adult Prison Estate in Wales, are reviewed and considered, and take action where necessary.

The health board and PPB must ensure there are clear lines of reporting and escalation into the PPB terms of reference, to ensure robust governance arrangements are in place for the management of healthcare services at the prison.

The health board and PPB must promptly address the outstanding recommendations made in the Tamlyn Cairns Partnership health needs assessment report and implement any actions and monitor as appropriate.

The Health Board must ensure that it has a clear strategy and plan for the commissioning and delivery of healthcare services, and for the wellbeing and improvement of prisoner health.

The Prison Partnership Agreement must be reviewed and updated promptly by the health board and HM Prison Service. This must reflect current arrangements for commissioning and accountability for the delivery of healthcare services at HMP Swansea.

The health board must ensure quality and safety matters arising from HMP Swansea are defined, reported, and escalated appropriately through the governance framework. In doing so, it must:
a. Ensure that the appropriate groups within the quality and safety governance framework scrutinise and monitor actions taken to address recommendations made in all external inspection reports.
b. Ensure that all outstanding recommendations made within the HMIP Scrutiny Visit reports, CHC report, and DIC report recommendations, are considered robustly, and any actions taken should have regular review to ensure appropriate and timely actions are implemented.

The health board must ensure adequate arrangements to identify, escalate, record, manage, and mitigate risks in relation to healthcare services at HMP Swansea.

The health board must improve visibility and oversight of clinical audit, and ensure this activity is reported to relevant governance groups for monitoring and scrutiny for prison healthcare services.

The health board and prison must consider how it can address the issue identified around staff safety, and the availability of ‘panic alarms’ within the healthcare environments at the prison.

The health board and prison must review and update the memorandum of understanding to ensure that there is clarity around responsibility and accountability for repair of premises and healthcare equipment.

The health board should review the clinical pathways used to deliver care to the prison population to ensure they are appropriate to the secure environment. Consideration should be given to the variety of patient needs, and to ensure appropriate and up to date guidance is available to both substantive and temporary healthcare staff.

The health board and prison should consider commissioning a further health needs assessment to establish what clinical pathways should be in place at the prison.

The health board must explore how individual health records can be accessed by GPs working within the prison, to ensure timely and an up-to-date history of patients is available, and to also provide timely health care and prescribing for prison residents.

The health board should take steps to consider and monitor the service provided by the dental provider ‘Time for Teeth’, to ensure its contractual obligations are meeting the needs of the prison residents.

The health board must consider the impact on the prison population as a result of the prolonged period without access to eye care services, and how it can mitigate against the risk of this occurring in the future.

The health board must take appropriate action to address any issues arising as part of the implementation of the new electronic pharmacy system, and to ensure all staff are adequately trained, and that appropriate support is always available to staff if required.

The health board must ensure that the pharmacy team based at the prison are made aware of the latest HMIP report findings, and that any actions set by the health board as a result are shared with them to ensure improvement.

The health board must undertake a prompt review of its governance arrangements to ensure it is compliant with all medication licensing requirements.

The health board must provide HIW with an update regarding the progress of the CD license application, and when it has been granted.

The health board must review the current staffing establishment of MHIRT to ensure the resources available meet the demand of mental health services, in both HMP Swansea and HMP Parc.

The health board must consider how the performance of its MHIRT service is monitored, to ensure it is meeting the needs of the HMP Swansea residents. In addition, it should consider how it can obtain regular patient feedback from the prison’s residents in order to shape service provision.

The health board must consider how a strengthened approach can be implemented for health promotion within the prison, with a view to promoting the health of prisoners and addressing health inequalities.

The health board PPB must consider:
a. The disparities between staff groups and prisoner perceptions of prison healthcare services and consider whether key information is appropriately transported through its quality framework.
b. How it can obtain and learn from regular prison staff (non-healthcare) and prisoner (patient) feedback, in relation to services available and that provided to HMP Swansea, and act accordingly on the feedback.

The health board must review the adequacy of the prison healthcare nursing establishment, to ensure it is sufficient to meet the current level of demand for health care services in HMP Swansea.

The health board must consider how it can obtain regular patient experience feedback from the prison residents at HMP Swansea, and to consider these findings in line with how this is considered regarding people within the health board’s other communities.

The health board must ensure that its prison healthcare staff are recording prisoner concerns as highlighted within the HMP Swansea Healthcare Complaints Pathway. In addition, that these are accurately reported to the PPB for monitoring and action planning as appropriate.

The health board must ensure the prison residents have access to information relating to NHS Wales Putting Things Right process and are provided with information on how to raise a concern regarding healthcare.

The health board must inform HIW how it will work with the Prison Governor to share the findings of our review with the prison residents. This must also consider how the report’s recommendations will be responded to.