Oxleas NHS Foundation Trust

Noted (AI summary) HMP Guys Marsh has developed its Incentivised Substance Free Living (ISFL) unit, provides comprehensive staff information on illicitly brewed alcohol, and ensures in-cell medication safes are available and fit for purpose. Oxleas NHS Foundation Trust has committed to introducing regular assurance checks for all prisoners in receipt of IP medication. Oxleas NHS Foundation Trust will be developing and distributing new health promotion materials to the prison population at HMP Guys Marsh focusing on safe storage and proper disposal of medication. They have published a local In-possession Medication Compliance procedure outlining bi-monthly in-cell compliance checks. HMPPS has developed and disseminated materials focused on illicitly brewed alcohol (IBA), including the Drugs in Prison and Probation (DiPP) guide. The healthcare provider at HMP Guys Marsh, Oxleas NHS Foundation Trust, has committed to introducing regular assurance checks for all prisoners in receipt of IP medication, and in-cell lockers will be replaced if damaged. The Department acknowledges concerns about medication held in prisoners' possession, but states that national NHS policies for prisoners are the same as those used in the community. They believe existing processes, contractual monitoring, and learning from serious incidents are sufficient, and that national guidance could further complicate the issue.

Noted (AI summary) NHS England is committed to improving Electronic Patient Records (EPRs) across all NHS Trusts and has provided funding to ensure all NHS Trusts have an EPR implemented. An updated MHLT policy outlines the required documentation the MHLT will provide to acute trusts. CQC acknowledges the concerns raised, and states how they will be reviewed via their internal Specific Incidents Guidance (SIG) and that they will continue to monitor the trusts in line with their internal processes and methodology.

Noted (AI summary) NHS England will request assurance from regional Directors of Commissioning that actions regarding the use of the PSA (proactive systematic assessment) vital signs tool have been implemented and evidenced by April 2023. They will also work with HMPPS on their review of PSO 1600: Use of Force, providing clinical leadership on section 6. A memorandum of understanding has been put in place between healthcare and the prison regarding attendance of healthcare and all planned use of force interventions and healthcare staff are to be trained alongside prison officers. HMPPS implemented a memorandum of understanding with the new healthcare provider at HMP Portland regarding the role of healthcare during use of force incidents. Whitewood furniture beds have replaced metal bedframes at HMP Portland. The Governor of HMP Portland confirms their involvement in the HMPPS response to the Regulation 28 report.

Noted (AI summary) Oxleas NHS Foundation Trust states they no longer have any involvement in the authorship or editing of the Maudsley Prescribing Guidelines since April 2015. Tees Esk & Wear Valley NHS Foundation Trust is developing a Medication Safety Series document regarding prescribing resources and sources of patient information, aiming to have a draft ready for approval on 24th September 2020 and complete dissemination by 2nd October 2020. NICE has passed the concerns regarding lamotrigine to the BNF publishers and will consider moving a footnote about the risk of suicidal thoughts and behaviour into the recommendation of their guideline on epilepsies, currently being updated. BNF Publications will add suicidal ideation as a side effect to the lamotrigine monograph and the important safety section of the lamotrigine monograph in the BNF.

Noted (AI summary) The DHSC acknowledges the lack of a statutory process for recording consent to medication for voluntary mental health patients. They state that the Trust will implement additional safeguards, including pharmacist reviews of medications and capacity assessments, with concerns raised to the responsible clinician and clinical director. The CQC notes the concerns but states some relate to specific circumstances so they are unable to comment, but intends to follow through some areas of concern in more detail during an inspection later in the year.

Noted (AI summary) Oxleas NHS Foundation Trust states that Mr. Vukovic was not referred to the Home Treatment Team and explains why. They note that Lifeline would not have been able to provide support and state Mr. Vukovic was discharged to a family who had been involved in his care.