20. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen.
21. We have done this and have not found any indications that something has gone wrong in respect of the healthcare PPG provided Mr F.
22. We cannot consider Mr F’s complaint point about access to healthcare due to the prison not being able to facilitate a safe escort sooner due to staffing issues or medication being removed by the prison. This is because on the basis of the information he has shared, Mr F has not completed the complaints process in relation to this with the prison.
23. We have explained our consideration of each of Mr F’s points of complaint below.
Mr F says he was refused access to healthcare
24. Mr F complains he was not taken to hospital when he injured his hand due to staffing issues at the prison.
25. As noted above, while the medical care itself falls under the remit of PPG (health complaint), ensuring that Mr F access to this care falls under the remit of the prison itself and is subject to its complaints process (prison complaint).
26. We are the final stage in the health and parliamentary complaints process. As such, we need to ensure that a complainant has exhausted the local or appropriate complaints process prior to coming to us.
27. The prison complaints process exists of two stages: Comp 1 and Comp 1A. If the prisoner remains unhappy having completed these two stages they can take their concerns to the Independent Prisoner Complaint Investigations team (IPCI). This is an independent service that looks at complaints where the complainant has exhausted the local complaints process in the prison but remains unhappy.
28. We can see that Mr F raised his medical complaint with the PPG and completed its two stage complaints process. In his medical complaint he mentioned concerns about access to care. It is important to reiterate that the complaint to PPG is solely in relation to his medical complaint, but the reference to access to care would fall under a prison complaint.
29. As medical information is confidential, PPG would not have shared details of Mr F’s complaint with anyone else. This means in order to raise any concerns about a matter that was about something the prison was responsible for (access to medical care), Mr F would have needed to raise this through the prison complaints process.
30. Within the information Mr F has shared with us, we can see he did complete a prison complaints process. However his prison complaint only related to concerns health and safety training in relation to his accident.
31. There is nothing within the Comp 1 and Comp 1A information Mr F has shared with us that tells us he complained (and completed) the prisons local complaints process about his access to healthcare (or a delay to him being able to access it) due to staffing shortages.
32. As it appears Mr F has not raised any concerns in relation to him being able to access medical services through the prison’s complaint process (or the ICPI), we cannot consider this further.
Mr F says no pain medication provided
33. Mr F complains he was left suffering with no pain relief. Mr F says due to the pain he became depressed and because of this he self-harmed and attempted to take his own life on the 24 June 2024.
34. The guidance from the National Institute for Health and Care Excellence (NICE) and the NHS says that for mild to moderate pain, you should usually start with basic painkillers like ibuprofen. If that doesn’t help enough, then you might move on to weaker opioid painkillers, such as dihydrocodeine.
35. Mr F medical records show on the 13 June PPG gave Mr F one pack of 16 tablets of Ibuprofen and one pack of 16 tablets of Paracetamol.
36. The records also show that on the 13 June PPG offered support to Mr F for his hand with a sling or bandage, but Mr F declined this offer.
37. Records also show on the 14 June, PPG also gave Mr F one pack of 19 tablets of Dihydrocodeine.
38. Records also document that on the 18 June, PPG gave Mr F a further 42 Ibuprofen tablets and 56 Paracetamol tablets.
39. We asked our adviser if PPG initially prescribed the appropriate pain medication to Mr F. Our adviser tells us the medical records indicate that PPG gave Mr F Paracetamol, Ibuprofen, and Dihydrocodeine. This was in line with the guidance above that explained for pain relief you should start with “simple Analgesia” and then working up to stronger opioid related pain relief, which we can see from Mr F medical records that PPG did this.
40. We see no evidence that Mr F was not prescribed the appropriate pain relief for his symptoms and as such, we have identified no failings in relation to the medication PPG’s actions here, and we will not take any further action on it.
41. That said the records show this medication was initially prescribed by PPG as IP (In-possession). This means Mr F had responsibility for holding and taking it himself.
42. However, this status was changed to Non-IP (stored centrally and not in Mr F’s possession) on the 25 June following a cell compliance check where records say a selection of medication was found.
43. From Mr F’s medical records, we can see that it appears it was the prison who initially removed the medication from Mr F’s possession and brought it to a Medical Technical Officer (PPG) and requested it was destroyed at 1240 on 25 June 2024. PPG said they retained a box of each because it had been prescribed and would ask the nurses to change it from IP status to Non-IP.
44. When medications are Non-IP, this means that the resident does not hold the medication themselves (or administer it themselves), but they are held either by the healthcare team or in some instances the prison, and the resident needs to request them when they are required or at specified points during the day.
45. It would appear that while PPG prescribed the correct and appropriate medication, with the view to Mr F being able to access this and take as required, a decision was taken to physically remove it from his cell.
46. We can see that this was following a number of incidents that included, but were not limited to a deliberate self-harm incident, Mr F communicating suicidal thoughts, and an incident with paint.
47. We can also see that a Medical technical officer carried out an ‘in possession risk assessment’ which raised concerns about self-harm and Mr F having problems taking his medicines and appeared to change Mr F’s status to not in possession.
48. However on reviewing Mr F’s correspondence we cannot see he raised this specific concern with either the prison or PPG. AS noted above in paragraph 26, we look at complaints that have completed to complaints process of the organisation complained about. It would therefore not be appropriate or proportionate for us to consider this further, either from the perspective of the actions of the prison or PPG.
Mr F says there was no aftercare provided
49. Mr F also complains there was a lack of aftercare for his injury.
50. From the records we can see PPG’s response said if Mr F symptoms worsened to contact healthcare. They also responded to Mr F to confirm that he did attend hospital at a later date and received Xray and subsequent treatment.
51. Referring to the letter from Worcestershire Royal Hospital dated 22 June 2024, it confirms a stable fracture of one of the metacarpal bones in Mr F hand and that it will heal naturally and should not require any further treatment or visits to the fracture clinic.
52. Records show PPG have apologised that this information was not explained to Mr F at the time and provided him with a copy of the discharge letter from the hospital.
53. PPG also confirmed they visited Mr F on the wing on 29 August to discuss his concerns and apologised for the lack of communication relating to informing Mr F that no follow up appointments were required.
54. PPG also provided Mr F with a physio ball and exercise to aid his recovery.
55. We have considered GMC “Good Medical Practice” (2013) which outlines professional standards. This says guidance doctors should promptly provide or arrange suitable advice, investigations, or treatment where necessary, and refer a patient to another practitioner when this serves the patient’s needs.
56. The records and discharge notes confirm no further treatment was required and Mr F fracture would heal naturally.
57. We asked our advisor if Mr F’s aftercare was appropriate, and they confirmed that the records and documentation tell them that there is no evidence of clinical neglect in Mr F aftercare.
58. As such, we have identified no failings with this point of complaint, and we will not take any further action on it.
59. We are deeply sorry to hear of the distress this injury caused Mr F, and we wish him a full recovery. We thank him for bringing his complaint to us.