HMP Maidstone

Health Needs Assessment for 2007- 2010 conducted January 2007 (comparisons noted with HNA carried out in June 2004)

Governor Acting Head of Healthcare Operational Manager GP Medical Team led by Address Tel No. Healthcare No.

Jane Galbally. Janet Hambleton Dave Logue Dr K Singh County Road, Maidstone, ME14 1UZ 01622 775300 01622 775469

Category, logistics and Prison function

HMP Maidstone is a Cat C male prison with a roll of 589, housing 573 offenders at 1st January 2007 (this is an increase of 29 from June 2004), of whom 23 are serving Life sentences. The key function of the prison is as a training establishment offering focused and timely interventions to offenders to reduce crime. Offenders arrive at HMP Maidstone via transfer from a range of establishments. Thanet House (one of four residential houses) is nominated as accommodation for 174 vulnerable offenders. This prison service term covers those who cannot be managed safely in normal house environments, due to their age or mental capacity, the nature of their crime (e.g. sex offences), or any combination of the above. Records show that this population is older and exhibits higher levels of ill health than the average offender population. Offenders with 4 years or less of their sentence to serve may come to HMP Maidstone from any other prison. They may have been categorised up or down but must be a Cat C to be accepted into this prison. The prison accommodates across the age range and acts as a resource for disabled offenders who would normally cope at home if they were in the community.

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

There were 663 prisoner movements January to December 2006, comprising New Receptions 162 Offenders Released from custody This compares with 512 in the twelve months prior to June 2004

2 2.1

Ethnic Composition & language Ethnic Composition Ethnic Group Number (total = 573) 374 143 34 10 12 Percentage of Percentage of population population Jan 2007 June 2004 65.16 65.6 24.91 24.6 5.92 3.3 1.74 3.7 2.09 2.8 (As at 29th December 2006)

White Black Asian Mixed Other

2.2

Nationality See Appendix 1

2.3

First Language

The first language of offenders is not currently recorded.

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

Age Age Range 25 and under 26-29 30-39 40-49 50-59 60-69 70-79 Over 80 Number (total = 573 ) 2007 2004 90 172 103 180 210 112 91 61 45 34 22 3 5 0 1 Percentage of population Jan 2007 15.37 18.31 31.41 19.54 10.64 5.93 0.52 Percentage of population June 2004 31 37.8 16.4 8.1 3.9 0.1 < 0.01

As the table illustrates, the majority of prisoners (84.6%) are aged under 50 (86% in June 2004) but 34 prisoners are aged over 60; this demonstrates a rise on the 2004 figure. 4 4.1 Learning Disability: Physical and Sensory Disability Learning Disability

It has been observed (Survey of Physical Health of Prisoners Bridgewood & Malbon, 1994) that a disproportionate number of offenders suffer from learning disability. There are 29 offenders out of 573 (9.7%) with learning disability in HMP Maidstone as at January 1st 2007 4.2 Physical and Sensory disability

HMP Maidstone is a resource for disabled offenders who would normally live at home if they were in the community. Accommodation has been developed for wheelchair users on each of the wings, including in Thanet House, which has accommodation on the ground floor.

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

Impairment Visual Hearing Wheelchair Users Mobility (reduced) Senile dementia Stroke Very old

Cases in 2006 7 27 1 13 All are self-caring and managed in normal locations.

12 months prior to June 2004 none 2 2 5 on crutches 2 with only one leg 1

0 0 0

1 1

All offenders with a disability have care plans, managed by the Disability Liaison Officer. The aim is to apply the social model, not the medical model of care.

Health Status

A disproportionate number of offenders suffer from drugs and / or alcohol addiction, communicable diseases, including sexual health related) mental health problems and in older prison populations from chronic diseases such as heart disease, diabetes etc (Bridgewood & Malbon, 1994). 5.1 Substance Misuse HMP Maidstone is not resourced to provide detoxification programmes. Offenders requiring this are expected to have completed a programme suited to their addiction, before reaching HMP Maidstone. However, during 2006 we provided 2 x detoxification and 4 symptomatic relief treatments (5 in 2004) which has met individually assessed need. If Subutex detoxification were required, the

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

patient would be assessed by HMP Elmley Detox Team, a specialist service which supports offenders through detoxification. To date, records have not been kept of numbers of Offenders sent to Elmley for detoxification, but from 1ts April 2007 this will be documented. The main Drug Service in HMP Maidstone, is provided by drug workers and is not a healthcare function. The service is known by the acronym CARATS which stands for: C ounselling A ssessment R eferral A dvice T hroughcare S ervices CARATS provide a combination of one-to-one triage assessment (using the Drug Intervention Record - DIR), Comprehensive Substance Misuse Assessment (CSMA) and care planning, as well as accredited group work sessions. All offenders are assessed upon arrival at Maidstone (as well as inducted) and a history of substance use is gathered - this includes any potential/identified impact on physical/mental health, social status (education, employment, housing, etc) and legal status. CARATS offer one-to-one motivational interviewing to identify potential impact of substance use and the individual's motivation to change their behaviour. This one-to-one work can be further reinforced using CARATS in-cell work packs (which cover a number of specific issues - heroin, crack/cocaine, cannabis, relapse prevention, harm minimisation, etc) and again linked into the CARATS accredited group work sessions (Motivational, Relapse Prevention and Harm Minimisation). All CARATS group sessions run for 8, two hour sessions over a two week period and are discussion based, encouraging the participants to identify their own issues/concerns and recognise ways to adapt or change their behaviour accordingly. CARATS also refer offenders to other agencies and service providers - including the Drug Intervention Programme (DIP) and RAP-t (Rehabilitation of Addicted Prisoner's Trust) 12-step programme in other establishments, and we refer offenders to the PASRO (Prison's Addressing Substance Related Offending) programme to address links between substance use and offending behaviour. As well as the work CARATS complete in the prison, potential resettlement needs are identified and CARATS complete a Release Plan with all offenders prior to their release; this identifies relevant issues and available support to continue addressing their

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

substance misuse issues following release. CARATS have also had talks with representatives from Narcotics Anonymous (NA) who are keen to introduce themselves into Maidstone (security clearance is awaited for this). 5.2 Alcohol Misuse Alcohol abuse is recognised as an influencing factor in the behaviour of many offenders in the community and has detrimental effects on health. A Policy for treatment of offenders with alcohol abuse issues has been developed by HealthCare, in line with Elmleys policy. CARATS currently incorporate alcohol awareness into the in-cell work packs and one-to-one motivational work; the skills and strategies discussed in the Relapse Prevention group are applicable to alcohol use. Alcoholics Anonymous (AA) is due to be introduced and the Reducing Re-Offending Manager has been taking the lead in this.
Caseload At January 1st 2007 June 2004

CARATS caseload (total) Includes CARATS suspended clients (all work completed and awaiting Release Planning). CARATS clients with previous history of alcohol misuse

179

Not recorded

46 65

Not recorded Not recorded

5.3 Smoking Smoking cessation courses are delivered by local PCT Health Promotion staff and staff members on a rolling programme. In 2006 two staff members were trained to deliver Stop Smoking Interventions. 2 quitters (offenders) were trained to be Peer Advisers. Two Staff focus Groups and one Offender Group have been consulted on the development of the Stop Smoking Policy at HMP Maidstone in preparation for compliance with Smoke Free legislation.

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

At January 1st 2007

June 2004

% of Offenders who smoke % of Offenders wishing to stop smoking Successful Offenders 4-week quitters in the preceding 12 months

65% 45% 43

50-60% Not recorded Not recorded

5.4 Communicable diseases known cases Disease Number In past 12 months 2006 2004 4 Hep B 4 tested + Hep C 20 tested + Sexually Transmitted Diseases Immunosuppressed 13 8 25 tested +
No record except in personal medical records

HIV/AIDS 4 15 tested +

Data not collected

Co-operative work is in progress with West Kent PCT to facilitate improved provision of GUM services through Primary Care, working towards providing in-wing, nurse led service

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

Hep .B Vacs: Each new reception to the establishment is seen by HC staff and a health screen is carried out. During that interview Hepatitis vaccination status is requested and an offer of the vaccination programme is given. If the new reception takes up the offer then he is called to the HCC to see the specialist in house nurse who counsels and administers the accelerated course of injections based on informed consent. A blood test is taken at the end of the course to prove effectiveness. Full documented evidence is recorded in the IMR and the patient is given an appointment follow-up card. HC gives an induction information booklet to all new receptions explaining the services available from HC, which includes the Hepatitis vaccination programme. Requesting offenders can receive a confidential (informed consent) blood test for Hepatitis B & C and / or HIV.

Hepatitis Hep B / C Testing Hep B Vaccination courses

Number in past twelve months 27 174

Percentage of Population (2006) 4.88% 31%

Percentage of Population (2003-4) 5% 12%

Condom Scheme: Condoms are available free of charge from Healthcare at any time and a new policy has been developed and implementation arrangements are being negotiated.

5.5

Mental Health

Primary mental healthcare needs IN 2004 an Assessment of Primary Mental Health Needs of Offenders in HMP Maidstone was undertaken as part of a project across Kent and Medway Prisons. Assistant Psychologists carried out the assessments, which included Demographics: Psychiatric Diagnostic Screening Questionnaire (PDSQ) and the Psychosis Screening Questionnaire (PSQ). Results of note are as follows:

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

Demographics (additional) 53 offenders were interviewed, randomly selected. Contact with mental health services in prison 20.8% had contact whilst in prison Contact with mental health services in the past 15.1% had had contact with them in the past Average Age left school 50.9% left school under 16 years old 37.7% left school aged 16 years 11.3% left school aged over 16 years Whether attended Special School 11.3% attended special school Whether received a statement of special need 7.5% received a statement of special need PDSQ and PSQ results Percentage of scores on or above threshold Major Depressive Disorder / Suicidality Post-Traumatic Stress disorder Bulimia / Binge Eating Disorder Obsessive Compulsive Disorder Panic disorder Psychosis Agoraphobia Social Phobia Alcohol Abuse / dependence Drug Abuse / dependence Generalised Anxiety Disorder Somatisation disorder Hypochondriasis PSQ - Mania 15.1% 17% 1.9% 17% 17% 11.3% 15.1% 17% 34% 32.1% 24.5% 15.1% 18.9% 5.7%

(The number of referrals made by interviewers to the Mental Health Inreach Health Services for HMP Maidstone was 13.)

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

In House assessment: In HMP Maidstone at 1st January 2007 there were a total of 74 offenders with a history of mental ill health (54 with Primary Care needs). Primary psychiatric nursing care is provided by the RMN trained staff on the in-house team. Case notes are maintained within the patients clinical record (IMR).

Intervention required

In past twelve months (thro 2006)

In twelve months prior to June 2004

RMN informal reviews RMN residential house ad hoc visits

50+ 100+

Not recorded Not recorded

Prescribing is initiated, upon review, by the visiting psychiatrist, but the primary care doctors and RMN offer invaluable feedback to the psychiatric team.

Secondary and tertiary mental healthcare needs Referrals are made between the Trevor Gibbens Unit (MH Inreach Psychologist and psychiatrist) and the MH Inreach CPN team as appropriate.

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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The Mental Health In-reach Service provided Mental Health Secondary Care Sessions as follows

Intervention required Seen by Mental Health Inreach Community Psychiatric Nurse Seen by Psychiatrist Seen by Forensic Psychologist Seen by General Psychologist Offenders with a history of mental ill-health New referrals seen by MH Inreach CPN

In past twelve months (thro 2006) 425 individual appointments (number of clients not recorded) 38 clients 14 clients N/A to Healthcare 74 at Jan 1st 2007 Figures not available

November 2003 to June 2004 (8/12) 69 clients seen over 224 individual appointments 31 clients seen over 77 individual appointments 20 clients seen over 56 individual appointments Not recorded 54 at June 2004 59

During the past year emerging evidence has demonstrated a need for increased support and services for serious Mental Health problems. The Mental Health inreach Team has already increased psychiatric sessions in response to in-house RMN identification of need. In 2006 11 prisoners have had to be transferred to HMP Swaleside (under the SLA) for inpatient care (5 in 12 months up to June 2004), and of these none were sectioned and sent to, or await a bed in NHS Regional Secure Units (RSU). (There were 3 in 12 months up to June 2004). This illustrates the degree of serious mental illness managed by all the staff at Maidstone. The interface between the In-Reach (secondary and tertiary) and in-house Primary Care Service is carefully managed by the in-house RMN.

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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5.6

Chronic Illness (data from Inmate Medical Records [IMR] and prescription sheets) Type of illness Heart Disease Diabetes Asthma COPD Epilepsy Hypothyroidism Cancer Stroke (& TIA) Hypertension In past twelve months (thro 2006) 24 21 35 5 8 2 6 0 22 In twelve months prior to June 2004 22 12 36 6 10 Data not collected Data not collected Data not collected Data not collected

5.7

Number requiring transfer to NHS Hospitals for inpatient stay Month (2006) Jan Feb March April May June July Aug Sep Number of patients 1 2 2 0 1 5 2 3 1 Bed-watch nights 2 4 13 1 8 10 20 1 Nature of treatment needs Month (2003-4) 2003 July Aug Sep Oct Nov Dec 2006 Jan Feb March Number of patients 2 2 2 2 2 1 1 3 1 Bed-watch nights 6 4 3 18 16 1 5 5 4

Plastic surgery Urology/General Surgery Gen Surgery/Orthopaedic General Surgery Urology & overnight A&E Gen Surgery & A&E ERCP & A&E Hand surgery (tendons)

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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Oct Nov Dec Monthly average

1 2 3 2

15 8 13 8

A&E admission Overdose & Cancer 3 x A&E admission

April May June

2 0 2 <2

2 0 4 5.6

During 2006 no offenders exceeded PCT/NHS target waiting times for inpatient treatments. Also during this period, greater cooperation and understanding facilitated timely discharge from Acute Hospital into secure 24 hour nursing care, alleviating NHS bed pressures and utilizing 24 hour facilities at HMP Swaleside 469 offenders were escorted to NHS hospitals for appointments in 2006 for a range of new referrals and reviews, 60 of these being unplanned hospital attendance via Accident & Emergency Department. (454 in the twelve months up to June 2004). NHS Hospital treatment needs in 12 months 2005-2006 were as follows: Number of NHS Hospital Day cases 21 cases 5 x ENT, 5 x maxillofacial, 4 x biopsy, 3 x OGD, Corneal Transplant x 1, Orthopaedic x 3 Outpatient data will be further analysed in more depth to identify services accessed that could be provided in-house.

5.8 Continuity of Primary Care on Release Out of 161 offenders released from HMP Maidstone during 2006, 33 were released with discharge letters and advised to telephone NHS Direct, to be signposted to a GP in their release area. We are aware that good control of chronic conditions will be facilitated by smooth transfer between primary care and health care teams, in and out of prison. At present we have no way of knowing whether or not a good transfer takes place. Work is planned in 2007 to create a baseline assessment and plan intervention around facilitating access to GP practice list as part of release planning in Health Care.

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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Number of offenders released Number of offenders released with discharge letters

In past twelve months (thro 2006) 161 33 (20%)

In twelve months prior to June 2004 Not recorded Not recorded

6 6.1

Healthcare Staff and Services Staff Staff Head of Healthcare RGN I Grade Operational Manager HCSO RGN F Grade RGN F Grade RMN F Grade RMN D Grade Typist Hours 1 WTE 1 WTE 1WTE Vacancy 1 WTE 1 WTE 1 WTE

Bank Staff are used most days of the week to cover the F grade vacancy. All posts are subject to Agenda for Change banding processes 6.2 Primary Care access

The healthcare facilities provided by HMP Maidstone are Type 2, meaning there are no inpatient facilities. The Healthcare Centre is open from 7.45am - 8.15pm weekdays, 8.00am 5.15pm weekends. PCT GP Team Doctors provide surgery appointment sessions from 9-12 Monday, Tuesday, Thursday and Friday: and a GP is in the prison from 9-12 on Wednesday to provide chronic disease management clinics. Doctors from the PCT GP team are on call until 5.15pm for telephone advice or exceptionally for

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attendance for medical and on-medical prison specific emergencies. Nights, Bank Holidays and weekends are covered by independent arrangements between HealthCare and GPs, under individual SLAs. New Reception offenders are seen on the day of arrival in the reception healthcare screening room by a HealthCare Worker (HCW). A member of the GP Doctor team only sees him if there are concerns raised by the HCW in respect of medication or Chronic disease management, but Offenders are advised of the procedures for access to the GP and HealthCare Team. If an Offender arrives at the prison late on a Friday he is still seen by a HCW and then seen, if necessary, by the doctor on call on the Saturday. Receptions do not normally arrive on a Saturday or Sunday. Offenders do not arrive at the prison after 20.15 when there are no HealthCare staff on duty. The GP on duty holds surgeries on Monday, Tuesday, Thursday and Friday mornings, and conducts review and referral surgeries on Wednesdays. On average in 2004 250 appointments passed through the HCC in a week. On average in 2004 21 people a day passed through the HCC for non - appointment reasons. Offenders who wanted to see a doctor made a Wing application. From November 2006 timed appointment slots are available. A 'snapshot' taken at the time of writing showed the following:

Wing

Thanet Weald Medway Kent

Number of offenders booked for Doctor appointment 2007 * 2/12 2004 (twelve months months) 8 n/a 6 n/a 5 n/a 11 n/a

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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These figures are indicative of the new appointment system, introduced when the Doctor Team commenced. appointment slots are comparable with GP services in a community setting.

Times

Completion of Nurse Prescribing training and reconfiguration of staffing numbers will facilitate expansion of Nurse Led initiatives, providing appropriate services for Minor Injuries and Chronic Disease management.

6.3

Chronic Disease Management Disease Frequency 2006 Frequency 2004 Planned for once a week but not being held at present for staffing reasons One per week on a rolling programme as staffing allows Once a week - nurse-led A Doctor-led clinic is planned for once a week commencing 13/8/2004 Checks monthly and 1 month's prescription given Prescription reviewed 3-monthly Has been held in the past, but staffing difficulties have prevented the clinics being run. Plans in place to resume clinics when staffing is at full complement Presently on a daily basis

Asthma

Needs led provided by use of appropriately trained Bank Nurse 8 clinics provided Diabetes, Hep B, One per week if required on a rolling programme. HIV 19 clinics provided CHD Currently monitored by GP Team Older Person (over 60) Blood Pressure Well Man Reception screening tool identifies need, leading to house care plan as appropriate (non medicalised) Monthly checks, Nurse Led and repeat prescription policy 7 sessions provided by Bank Nurse utilisation

Dressings Clinic (Leg Ulcers etc.

As determined by Wound Care Plan

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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6.4

Other Primary Care Services

Pharmacy services Patients are allowed to have in possession medication on a daily, weekly or monthly basis based on clinical judgement, and Risk Assessment. Prescribed medication is issued to patients the same day in some instances but in general it is issued the following day. The original prescription is faxed to Rochester pharmacy on a daily basis and is delivered from them on a Monday to Friday basis. Rochester pharmacy operates an emergency supply service. Dental services: These are provided on a twice-weekly basis. The level of service offered is on a sessional basis, two mornings per week by an NHS dentist who also provides dental nurse cover. Only treatments available on the NHS are offered. The current waiting time for a routine appointment is 6 weeks.
In past twelve months (thro 2006) In twelve months prior to June 2004

Number of offenders treated (Units of Dental Activity) Number of offenders breaching 8 week wait for a routine appointment

864

Not recorded

Not recorded 70

On-site X-ray service A radiography service operates once a week for diagnostic purposes. All urgent needs are referred to the NHS emergency services. Over the past year 197 patients have been screened and radiologist report made. Chiropody clinics: These are held 2-weekly for Diabetic Foot Care checks and patients referred by the GP. About 6 people are seen per session.

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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Number of offenders treated

In past twelve months (thro 2006) 90

In twelve months prior to June 2004 Not recorded

Optician In 2004, the optician visited once per month and provided between 480 and 500 patient appointments throughout the year. In 2006, the optician visited once per month and saw 206 patients in the year. All offenders are advised at reception screening that they may self-refer to this service. In 2006 the maximum wait between self-referral and appointment provision is 6 to eight weeks. However, if referred by GP offender will be seen at the next available session. Once spectacles are prescribed and ordered, these are sent to the prison to avoid delay. Physiotherapy: Physiotherapy is provided on site under contract from the PCT. Patients are referred by a doctor. The caseload is usually about 6 per fortnightly session of one day. Contracting arrangements are being reviewed in light of PCT changes. 6.5 Health Promotion Health Promotion is now recognised as a whole prison approach responsibility in line with PSO 3200. The Health Promotion Action Group has an action plan which requires review. 6.6 HealthCare Contribution to Holistic Care Planning for Offenders Representatives from the HealthCare team take an active part in the following Offender Case Management Review Meetings to identify individual Offenders needs, and ensure appropriate HealthCare support for them. CARATS Case Management Board Multi-Agency Public Protection Arrangements (MAPPA) Safer Custody Group (Prevention of Suicide and Self-Harm)

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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Reducing Re-Offending group Resettlement Planning Segregation Review Board (to review mental and physical fitness for continuing residence in the Segregation Unit).

7.

Deaths in Custody 2006 Cause of death Information not yet available Information not yet available

2003-4 (June June) Age Cause of death 63 Information not reported back to HealthCare from Coroner 75 Information not reported back to HealthCare from Coroner 73 Information not reported back to HealthCare from Coroner New procedures for investigation of Death in Custody by the HealthCare Commission and Prison Health Ombudsman enable lessons to be learned from examination of health care provided prior to death. Age 49 67

8. 8.1

Corporate approach to Needs Assessment Staff Feedback

All HealthCare staff have been involved in gathering the evidence for this Health Needs Assessment. A final Staff briefing took place on May 25th 2007 to discuss the implications of the Assessment with HealthCare Staff. Discussion took place around the emerging picture that more Nurse-led Clinics would be required in order to meet the Offenders Health Needs. 8.2 Offender Questionnaire Feedback

8.2.1 A Survey of Measurement of Quality of Prisoners Life (MQPL) was carried out at HMP Maidstone between 20th and 23rd November 2006 by an independent research team of HMP Prison Service with a random sample of 120 Offenders.. In the report it

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was documented that by comparison with other establishments of all types and by comparison with other training prisons alone, the score for HealthCare fell just above the mean or middle of the typical range in both comparisons. Sample Mean SD Strongly Agreed / Neither Agreed Strongly Agreed nor Disagreed Disagreed / Maidstone 3.15 0.81 Disagreed Whole Estate 3.01 0.36 Other Training 3.05 0.38 I feel cared for by staff on the HealthCare Unit HealthCare staff are interested in helping me with my physical health concerns I am happy with the treatment I have received in this prison for my health problems HealthCare staff show understanding for my mental health and emotional concerns The doctors here take time to listen to my physical health concerns The doctors in here believe me when I tell them about my health problems HealthCare staff explain things (treatment and diagnosis) clearly to me 48.9% 45.9% 47.2% 36.0% 52.3% 41.9% 51.2% 9.1% 25.9% 16.9% 40.7% 22.1% 30.2% 19.8% 42.0% 28.2% 36.0% 23.3% 25.6% 27.9% 29.1%

Responses to all seven statements were recorded for only those 89 offenders who said they had experienced HealthCare services at Maidstone.

8.2.2 In November 2005 a small project was initiated to pilot a system of Nurse Triage before the GP open surgery session. Offender feedback and discussion was as follows: 4 Offenders declined to participate 64 offenders were seen over 6 morning clinics 28 were given simple analgesics, advice or referral to Dentist, Optician etc (all offenders were pleased at the speed of access, treatment advice and decrease in waiting time spent in HealthCare department).

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36 Assessed, history documented and referred to GP for Meds (not then nurse-prescribable) for further investigation or referral. 9. Data Collection

Health Needs Assessments will be repeated every three years to support the refresh of the Prison Health Delivery Development Plan. The next Health Needs Assessment Review is planned for January 2010, and will be facilitated by improved data collection possibility through the use of Vision Clinical IT systems.

10 Quality Standards of Service The following audit results reflect the standards of HealthCare service provided: 1 2 November 2005 3-yearly Standards Audit results for Healthcare Standards, 93% Acceptable HMIP Chief Inspector's Brief Unannounced Inspection in 2004, Healthcare described as thriving and vibrant , focused on innovative development by the Inspectorate. Letter of congratulations received from John Boyington, head of prison task force 3 4 5. Star Rating of the Prison, December 2006. 2 stars Type 2 Traffic Light assessment of Healthcare, December 2006 - Green Use of PALS / Complaints / ICAS in 2006 - 3 offenders given PALS information and one given details of ICAS.

Signed Governor..

PCT Prison Lead..

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DateTo be reviewed References Bridgewood & Malbon (1994) Survey of the Physical Health of Prisoners London: Office of National Statistics Hudson, T. and Gray, S. (2006) MPQL Research carried out at HMP Maidstone between 20-23 November 2006. London: HM Prison Service Kent & Medway Prison Mental Health Inreach Team (2006). Study to undertake a Mental Health Needs Assessment across Kent and Medway Prison Estate. West Malling: West Kent NHS and Social Care Trust Appendix 1 Foreign National Offenders breakdown by nationality January 2007 Afghanistan Albania Algeria Antarctica Austria Bangladesh Belgium Burundi Canada Colombia Congo Cyprus France Germany Ghana India 3 1 1 1 1 6 3 1 1 3 1 1 1 6 4 3 Ireland Italy Jamaica Kenya Kuwait Latvia Lebanon Liberia Lithuania Malawi Montserrat Nigeria Pakistan Poland Portugal Romania 3 3 30 1 1 1 1 1 5 2 1 9 2 2 3 3 Slovakia Somalia St Vincent Tehran Trinidad & Tobago Turkey Uganda United States of America Vietnam Yemen Yugoslavia Zaire Zimbabwe Not declared Total 23% 1 2 1 1 3 5 1 1 2 1 2 1 1 2 131

West Kent PCT Needs Assessment HMP Maidstone Linda Prickett / Janet Hambleton June 2007

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Iraq

Sierra Leone

Total Prison Population 100%

573

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