Jonathan Drew, HMP Liverpool Service Manager, writes a guest blog on improvement in prison health services

It’s my pleasure to have been asked to write a guest blog this week. For those who don’t know me, I’m Jonathan Drew and I’m the Service Manager at HMP Liverpool. Most of my career has been spent in secure services, starting at Ashworth Hospital in January 1997, qualifying as a registered mental health nurse in 2004 and held a number of clinical and security positions at Ashworth before taking up my current position last year.  

I’d like to concentrate this blog on my work at HMP Liverpool and the progress we’ve made in the last year. As many of you will know, an inspection by Her Majesty’s Inspectorate of Prisons (HMIP) and the Care Quality Commission (CQC) in September 2017 raised significant concerns, identifying numerous recommendations which in return attracted negative media attention and ministerial interest.

Following those inspections a further report by Dr Bill Kirkup was published in February 2018 into the former Liverpool Community Health Trust, who provided health services at HMP Liverpool between 2010 and 2014. Once again this raised serious concerns and numerous recommendations.

It led to Mersey Care being asked to provide mental health services for HMP Liverpool in April 2018 and I was seconded into my current role. It’s proved a very challenging time in my career, being asked to manage a mental health service under constant scrutiny after attracting negative attention from various inspections. To further complicate the situation, I had limited knowledge of prisons and non NHS governance.

My first job at HMP Liverpool was to review the service, which was limited and under resourced. It became clear that significant investment was required to provide a whole wrap around service which included a multi-disciplinary team approach to meet the needs of the patients.

Because of the negative publicity from previous reports in 2017/2018, there was further scrutiny from HMIP, the Quality Surveillance Group (QSG) and post-Kirkup inspections. They were useful in that they captured the progress being made within the service and there have been two further CQC inspections since, in October 2018 and September 2019, which helped with our learning process.

Although prisons don’t receive CQC ratings, the verbal feedback from inspectors last year was that the service was ‘Good to Outstanding.’ Feedback from HMIP last month was that it was one of the best mental health services across the prison system, which was a great reflection of all the hard work put in by all the staff over the last year or so.

When I look back, it’s clear the key to success centred around effective partnerships, working interactively across the sectors and forming strong robust professional relationships. We’ve worked well alongside Spectrum Community Healthcare CIC, who provide primary care/substance misuse services in the prison, Change Grow Live who provide non clinical psychosocial recovery services and prison staff to provide a co-ordinated approach.

By working in collaboration with our partners at HMP Liverpool, we have been able to implement some of our Trust initiatives: zero suicide, least restrictive practice, zero pressure ulcers and just and learning culture, which have all had a positive impact on the services we deliver and have improved patient care.

It’s been a challenging but worthwhile journey for all of us – here are some of the highlights we’ve implemented or improved upon since last year:

  • Management of the Care Programme Approach (CPA) and non-CPA inclusive of family and friends
  • A clearly defined target operating model
  • Critical areas relating to service user voice, communication, care planning and risk management have been transformed to ensure a safe, fit for purpose service
  • The whole service has embraced daily safety huddles, developed training needs analyses, rolled out leadership courses and shifted the culture to that of one of reflection and learning
  • The service has recently started to initiate Clozpaine and assess/treat patients with ADHD, resulting in timely treatment negating transfer out of the prison and improved patient outcomes
  • We’ve also achieved our ambition to engage students in the service and our risk management structure has been recognised by CQC as one of the most robust and innovative pieces of work across the country
  • The service is working towards becoming an accredited establishment for Autism
  • Staff are being recognised for their contributions to the service and healthcare staff have commented about how fantastic it is to nurse again and are proud to work at HMP Liverpool.

I’d like to conclude this blog by thanking all the prison staff, health care staff and other partner agencies who are working hard to care for patients within HMP Liverpool and through the gate. We recognise that we still have improvements to make and are all working together to achieve this goal. 

Jonathan Drew

Service Lead, HMP Liverpool