Justice and Home Affairs

Independent Prison Panel Report

The States supported a motion to debate the above report, which is usually only included as an appendix to the Billet. My speech is below.

Sir, As I said in the earlier debate, it is odd that there are concerns raised in this report in relation to healthcare that are not referenced in the governors’ report. 

I any event, I will focus on a few aspects raised by the panel which I think need clarification and put in context.

Data sharing is raised. I find that ironic given the fact that HSC has been trying since before GDPR came in to get some advances in terms of data sharing.

Members may recall that in the Partnerhsip of Purpose we state.

o   good sharing of information, when sharing is appropriate, is as important as maintaining confidentiality. 

o   There is no contradiction between ensuring services rigorously protect the confidentiality of personal information whilst also proactively sharing information to optimise the care delivered. 

o   Sharing information is vital to provide a seamless, integrated service. 

  • Health and care professionals should have the confidence and a duty to share information in the best interests of their patients, in line with the policies of their regulators and professional bodies.

I am actually pleased to say that the issues referenced in this report have been resolved to the satisfaction of both parties. However, 

Now lessons can be learnt from the microcosm of the Prison to inform the wider requirement to embed a system of confident, appropriate sharing for the good of service users. Imagine the challenges in the Prison serving a population of 100 multiplied up to a population of 65,000 with a multitude of different agencies involved and its not surprising that there is this tension in the health and care system. 

–          Its great that in their latest Committee plan Home Affairs specifically acknowledged the role of data sharing in transforming services, but we need to see and feel it. It still feels like we are shouting in a vacuum.

In terms of the appointment of a mental health professional, this has been tried but I understand that it has been very difficult to make it work, It requires someone who is dual trained, which is rare. In addition, if it is a single person then the chance of them being there when needed is rare. A better model is in-reach from the mental health service but only for appropriate individuals. This is what our staff are trying to develop on top of the service already provided.

The Panel reference the need to bring in a primary healthcare system called EMIS. Whilst I agree that the sooner we can digitise records the better, it would not be appropriate to determine what that should be in advance. Indeed, it would be hoped that this could be linked through to the replacement of our current Trakcare system, rather than create a completely standalone system. And I can confirm that this is something that is being actively investigated as part of the digital transformation and integration of health and care records and may be brought to this assembly in the next few months.

Just one other point in realtion to e-burns and the comment that inmates would like to be able to have refills. E-burns are different from standard e-cigarettes with the focus of design primarily about security. The clear body enables staff to see nothing is hidden inside and the semi-rigid bodies make them less likely to be used as a weapon. It is not considered desirable or acceptable to make any changes from what is currently provided and which has worked well to date.

So, sir, an interesting report, and food for thought. I thank the panel for the work they do and raising issues that have been brought to their attention. However, I do believe that the quantity of quality of service from health and care professionals is second to none and whilst we can always do better believe that we should be proud of the support we give to those who find themselves in our island prison.

Prison Governor’s Report

The States agreed a motion to debate the above report, which is normally just added as an appendix to the Billet. My speech on it is below.

Sir, I am pleased that this Assembly agreed to debate this report and that of the IMP. Often these go through without consideration, or worse any negative points are picked up by the media and the public gets a skewed view of reality.

I would just like to build on the health and care aspects raised from this report. Some members may not be aware that under the Prison Ordinance, the Prison Healthcare Manager is required to provide a report to the Governor. Aspects from this report have been included in turn in his report.

However, I thought it was worth adding to what is in this report, bearing in mind comments in the IMP report, in order to give a clearer picture of the extent of work currently being undertaken by a considerable range of healthcare professionals to support prisoners.

Prison healthcare falls under the clinical management of hospital services, medical division. 

It is evident from the healthcare report that there is comprehensive level of care being provided. At the end of 2018 the nursing team consisted of one FTE band 7 Healthcare Manager, x 1 FTE band 6 RGN senior staff nurse and x 3 band 5 RGN staff nurses.  Bank nurses and overtime were used to fill any nursing shortfalls on the rota.

 This is in addition to GP clinics held twice a week, and in-reach support from teams from mental health, community and midwifery.

Daily nurse led clinics are held on a range of matters, New entrants are risk assessed, there is in-reach from key professionals, Bi-weekly dentistry and opticians clinics as well as training on the use of Prenoxad.

The Healthcare Team hold regular meetings throughout the year with 

Prison specific policies and, protocols continually developed and introduced.

The Island Prescribing Advisor visits the prison for 2 hours most weeks, to support and offer appropriate training to nursing and medical staff, audit prison prescribing and assist with the development of pharmaceutical policies.  5 drug administration charts were audited each month and the results fed back through the PHOM.  Medical and nursing staff were proud to continue to achieve 100% on 95% of the audits throughout the year

The nursing team  attend regular and relevant meetings with Prison Pathways and continue to be an integral part of the sentence planning processes.  

Prison nurses are actively involved in the weekly Risk Management Meeting which incorporates a part of the ACCT process for all prisoners at risk of suicide and or self harm. Nurses also attend regular reviews on all prisoners commenced on an ACCT document

The Healthcare Manager, or nurse in her absence, attends the Governor’s daily operational meeting along with regular attendances at HSC Medical Division and Adult Hospital Services meetings, Prison Performance Review, Planning and Development, Finance, Safer Custody and MAPPA Meetings.

There were just 10 complaints out of 2,695 appointments in the year, that’s 0.4%.

Now that number of appointments is interesting and I will finish on that point. Taking a rough and ready calculation of 225 per month and around 100 prisoners at any one time, that works out as an average of 2 appointments per prisoner per month. That is more than the average islander. This is not unexpected and is matched in other European jursidictions. There may be a number of reasons for that but it may demonstrate the link that exists between justice and social policies with those in prison generally coming from more disadvantaged backgrounds with poorer physical and mental health than the general population. 

Not only that, as the healthcare manager states in her report, more prisoners are presenting with highly complex healthcare needs, with one requiring a lengthy admission in hospital and others having to attend the UK for specialist care not provided on island. 

Sir, the sooner we stop blaming the symptoms such as the use of dugs and alcohol and focus on the causes, ie the wider social determinants of health the better and the sooner the justice review is completed the better. It is clearly long overdue and until it is this will just add to the increased costs of health care.

HMIC Report on Home Affairs

I made the following speech in relation the HMIC report that was brought to the States for debate.

Sir, I am going to keep what I have to say brief and focus on just 2 points. 

Firstly, the inspectorate comment that in a small island environment there is a particularly high level of public expectation. This is true for law enforcement as it is for health and care, education and basically any service we provide. 

And as I said earlier, issues can be magnified and people be quick to blame. Those on the receiving end understandably become defensive and can themselves deflect blame The desire to be open and transparent is then reduced, morale in the workforce is hit and issues are consequently hidden and the service doesn’t improve or can even get worse. The HMIC says that there are several areas for improvement, it does not say we have a failing service.

My second point covers just one aspect of the report – that related to domestic violence. I did read the report referenced in the footnote – Everyone’s Business: Improving the police response to domestic abuse, a report that goes back to 2013, incidentally. It states that not all police leaders are ensuring that domestic abuse is a priority in their forces, it is often a poor relation to other policing activity like acquisitive crime and serious organised crime. I have to say, that was the impression I got from this report too.

And on that, I on’t accept Deputy Green’s defence as to why he didn’t grill the previous Head of law enforcement on the recommendations. I think one of those questions could have been over that issue and to understand what his priorities had been.

Anyway, the report I just referred to states that the level of dometic abuse in the UK is shocking and is estimated to cost the 15.7bn a year. And if people think it’s not an issue here, they need to understand that locally, we have identified that 25% of referrals to the MASH are related to domestic abuse. Domestic abuse is an insidious crime that impacts the abused not just physically but mentally. 

I therefore welcome that recommendation in the report that 

By 31 January 2019, the head of BLE should carry out an evaluation of reported domestic violence incidents in the Bailiwick of Guernsey. Based on this data, the most appropriate agency should conduct an evaluation to establish whether DVPOs and DVPNs, if they had been available, would have provided valuable additional protection to victims. If the evaluation shows that they would, the Committee for Home Affairs should consider pursuing changes to legislation to enable their introduction as soon as possible thereafter. 

We have a new BLE and I wish him well. It will be interesting to see if there will be greater focus on domestic violence, as well as also supporting the more vulnerable in our society, than there may have been to date. As far as HSC is concerned, we will be happy to help where we can. But can the President assure me that the evaluation work has begun and that her Committee will also be giving this a higher priority than has been the case to date.

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