Oxleas NHS Foundation Trust

“we will be developing and distributing new health promotion materials to the prison population at HMP Guys Marsh, but also within the wider Oxleas NHS Foundation Trust prison portfolio. These materials will focus on: - Safe storage of prescribed medication, including the use of personal lockable safes - responsibility of HMPPS. - Proper disposal of unused or discontinued medication.”

“Staffing within the Mental Health In-reach team”

“Following evidence heard at the inquest, you have raised concerns about the appropriate monitoring of prisoners suspected to be under the influence of illicit substances during the night state and that prison staff were not sufficiently briefed about prisoners keeping medication in their possession. You have also raised a concern in relation to healthcare staff sharing relevant medical information with prison staff. I note that you have also addressed your report to Oxleas NHS Foundation Trust”

“1. HMPPS colleagues have responsibility for reducing demand and supply of drugs in prisons, and there is a Governor responsible for Drug Strategy at the prison. The Drug Strategy meeting is attended by healthcare and issues including trends of use of drugs such as psychoactive substances 'spice' are explored. Change, Grow, Live (CGL) are subcontracted by Oxleas to provide psychosocial substance misuse and they have a large caseload at HMP Rochester who undertake group and 1:1 work to address”

“Oxleas Acute Mental Health Patient Flow and Bed Management policy (updated in December 2023) provides guidance on the purpose of an inpatient admission; and actions to be taken when Crisis Resolution and Home Treatment Team (CRHTT) identify that someone's clinical needs indicate that an inpatient bed is required”

“The CRHTT policy and training for staff includes guidance on assessing and managing risk, and changes to the risks and clinical presentation”

“In 2023 an improvement plan was put in pace for this clinical team to address gaps which were identified during the investigation and gaps which were identified as a result of day-to-day oversight. This plan is monitored by the service director and the clinical director for the Acute & Crisis Directorate and will continue until such time that we are satisfied that the care provided is to the standard needed, and for at least until July 2024”

“The Greenwich CRHTT has received DICES training, delivered by Association of Psychological Therapies. DICES Risk Assessment and Management System helps a practitioner assess risk using a system of checklist whereby all the risks that a client in crisis may be susceptible to are asked and explored by the practitioner”

“The most recent audit carried by the Crisis services Manager on 16th January 2024 demonstrated that out of 34 cases reviewed, 28 of the risks assessment were of expected standards”

“Prison Service Instruction (PSI) 32/2011 is the national policy for ensuring equality and it mandates that Governors must ensure that efforts are made to identify whether a prisoner has a mental or physical impairment of any form and that procedures are in place to record this information, while maintaining confidentiality.”

“throughout 2023 HMP Belmarsh will be holding monthly training sessions alongside Oxleas NHS Trust and RGB for all operational staff. These sessions will focus on encouraging staff to think differently about disability, including those that may not be visible, and to take action to improve how they engage with disabled prisoners to ensure their needs are met, and the necessary support is offered.”

“following this inquest the following improvements have now been made. When a patient is identified as requiring adjustments to their disability that these will now be documented on the Prison Nomis (P-Nomis) system. Agreement was reached following senior management review by HMP Belmarsh, Royal Borough of Greenwich Social Care and Oxleas NHS Foundation Trust. All these providers have access to p-nomis. All prison staff have been notified of this development and healthcare administrative staff”

“implemented across the prison estate in July 2021”

“Consideration should therefore be given to the creation of a centralised, formulated, risk document to be entered upon by all clinicians irrespective of their own speciality.”

“we will add a side-effect of suicidal ideation to the lamotrigine monograph in the BNF. We will also add information on this side-effect to the important safety section of the lamotrigine monograph.”

“the Trust has developed a Support Network Engagement Tool (SNET) to help clinicians identify key support networks and engage them in assessment and treatment.”

“All patients with a Long Term Condition (LTC), such as Ms [name redacted], are now held in a LTC register managed by the practice nurse in conjunction with the GP. This is in place and all physical health interventions and scheduled appointments are recorded within this register along with proposed future review dates.”

“All patients with declining physical health are discussed monthly at the complex care forum. The forum is chaired by the Mental Capacity lead for the directorate and attended by the Independent Mental Health Advocate (IMHA) to ensure patients' views are fully represented. This change was implemented at the beginning of this year.”

“All relevant healthcare professionals, including the GP and dieticians where necessary, will be invited to six monthly Care Programme Approach (CPA) meetings for patients on the complex case caseload.”

“All patients' weight and height are now entered to the Malnutrition Universal Screening Tool (MUST) which has been available on our clinical records system, RiO, since June 2017.”

“The named dietician will be responsible for appropriate reviews, follow up assessments and approval of meal plans.”

“In the event that the information, including a detailed discharge plan is not received within 24 hours for patients transferred from an inpatient unit, the Home Treatment Team now contact the referring organisation to request that this is sent immediately and if not available they have a discussion about their recommendation for further treatment.”

“Please note that we have reviewed and re-launched Priory Healthcare Policy HO2: Admission, Transfer and Discharge and made reference to the involvement of family, friends and carers in the discharge planning process (paragraph 5.1e). A rolling programme of training webinars which detail policy and practice is planned for 2018 and discharge planning will feature as part of these webinars.”