HMP Woodhill

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We found that CNWL had implemented effective measures to address the issues we had identified during our previous inspection. Patients’ consent for the use of the digital vision-based health monitoring system was actively sought; the use of NEWS 2 by staff to ensure patients’ needs were identified was now used routinely, and a robust and well embedded system was in place to ensure that patients’ ability to hold their own medicines was assessed.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

At our previous inspection we found that staff did not always follow national guidelines in relation to the recognition and management of the deteriorating patient. We also found that patients did not have up to date risk assessments in place for their in-possession medicines. During this inspection we noted the following improvements. Training records we reviewed showed that 100% of staff had received training in the use of NEWS 2 (National Early Warning System). Key policies in relation to management of patients suspected to be under the influence of drugs had been updated and now included guidance for staff in the use of NEWS2 to monitor patients’ health needs. We checked clinical records for 12 patients who had been coded blue for the use of illicit substances and found in all but one instance, staff had implemented NEWS 2 scoring and undertaken appropriate follow up welfare checks. We spoke with 6 nurses, all were able to describe how they used NEWS2 scoring to determine patients’ needs ,and what level of monitoring would be required as a result. We noted that staff had NEWS 2 prompt cards so they could access the scoring metrics quickly. The daily clinical handover sheet had been updated with a prompt to remind staff about the use of NEWS2. We observed staff being reminded of NEWS2 at the clinical handover meeting we attended. Staff now regularly undertook medical emergency simulation exercises to improve their response to patients whose health deteriorated. They reported the exercises helped them keep their skills up to date. The lead pharmacist had introduced an effective monitoring system on Systemone which flagged when a patient’s in-possession medicines’ risk assessment review was due. Compliance was subsequently reviewed at the weekly senior leadership team meeting and through regular auditing. Information we reviewed demonstrated that 100% of patients had an up-to-date assessment of their ability to safely possess their medicines.

The judgement for Delivering evidence-based care and treatment is based on the latest evidence we assessed for the Effective key question.

The judgement for How staff, teams and services work together is based on the latest evidence we assessed for the Effective key question.

The judgement for Supporting people to live healthier lives is based on the latest evidence we assessed for the Effective key question.

The judgement for Monitoring and improving outcomes is based on the latest evidence we assessed for the Effective key question.

At our previous inspection we found that staff did not actively seek patients’ consent for the use of the vision-based monitoring system. During this inspection we noted the following improvements: CNWL had updated its standing operating procedure in relation to the use of the monitoring system to include detailed information about obtaining patient consent. It also provided guidelines for staff of what to do if patients did not give their permission or did not have the mental capacity to consent to its use. Information about use of the system was displayed clearly by the clinic room door for patients to see. Information was also included in the welcome pack to the prison’s Clinical Assessment Unit (CAU), and patients were provided with a specific leaflet to read, outlining how the system worked to help facilitate their informed consent. We checked clinical records for 5 patients on the CAU unit and found completed patient consent forms on all the records reviewed. We saw that staff had followed the correct procedure for one patient who did not have mental capacity and had involved relevant professionals to make a best interest decision on the patient’s behalf. We spoke with two nurses on the unit, both of whom talked knowledgeably about the patient consent process and how they implemented it. At the time of our inspection, we noted only one of the 10 patients on the CAU had actively agreed for the monitoring system to be used; all other monitoring screens had been turned off, assuring us that patients’ wishes were respected. Regular audits were now undertaken to ensure that staff were following procedures correctly, evidence of which we viewed.