Working together to regulate and inspect

Working together to regulate and inspect
Elizabeth Tysoe, HMIP
Sue McMillan, CQC
HMIP Statement of Purpose
We ensure independent inspection of places of detention and report
on conditions and treatment and promote positive outcomes for those
detained and the public.
HMIP value statements
• Independence, impartiality & integrity are the foundations of our work
• Experience of detainees is at the heart of inspection
• Respect for human rights underpins our expectations
• We embrace diversity and are committed to pursuing equality
outcomes for all
• We believe in the capacity of both individuals and organisations to
change and improve and that we have a part to play in initiating and
encouraging change
• Criminal Justice Act 1982 : ‘The Chief Inspector shall in
particular report to the Secretary of State on the
treatment of prisoners and the conditions in prisons’
• ‘Outcomes for Prisoners’ – not ‘Management of Prisons’
• Not a regulator
• Not a complaint handler
• Not an auditor
Why is independent inspection is necessary?
• The power imbalance between the detainee and
• The closed nature of the institution and the supposed
lack of credibility of the detainee
• The normative effects of custody
• The ‘virtual prison'
• Low morale and poor training of staff
CQC’s purpose is to drive improvement in the quality
and safety of care by:
• regulating and monitoring services
• listening to people and putting them at the centre of our
• acting quickly when standards are not being met
• drawing on our information and unique insight to provide
an authoritative voice on the state of care
• working in partnership with other national organisations
across the system.
Legislation and standards
Dept of Health
Care Quality
Regulations 2009
Health and Social
Care Act 2008
Regulations 2010
Health and Social Care Act 2008
NHS April 2010
Adult Social Care
October 2010
Adult social care
Independent Health
NHS 2010
Care October
Dental Care & Ind.
Ambulances Apr 2011
Primary medical
Services April 2012
Single system of
Single set of standards
and extended
enforcement powers
Bringing the two systems together: CQC/HMIP
memorandum of understanding
• Protects and promote the interests and rights of people who
use health and social care services in custodial settings
• Describes how the two bodies' interests and responsibilities will
complement each other and avoid duplication or confusion
• Good regulation
• Respect for each organisation and its independence
• Focus on results
• Pragmatism
• Being as clear as possible
Guidance about Compliance
Prison Act 1952
Criminal Justice Act 1982
Health & Social Care Act
2008 and regulations
Expectations – Prisons
 Courts, escorts, transfers, early
 Bullying, violence reduction, self
harm & suicide prevention,
 Security
 IEP, disciplinary procedures
 Substance misuse
 Res units, staff/prisoner
 Equality, diversity, faith, religious
 Complaints, legal rights, health
services, catering, purchases
Purposeful activity
 Time out of cell
 Learning, skills & work activities
 PE & healthy living
 Strategic management
 Offender management & planning
 Reintegration planning
Specialist units
• Describe the standards of treatment & conditions we expect a prison
to achieve
• Indicators
• Suggest evidence that may indicate whether the
expectation/outcomes have been achieved. The list of indicators is
not exhaustive and they do not exclude an establishment
demonstrating the expectation has been met in other ways.
Safeguarding people who use services from abuse
Plain English
People focused
What should people who use services experience?
People using the service:
• Are protected from abuse, or the risk of abuse, and their
human rights are respected and upheld
Outcome based
That is because providers who are compliant with
the law will:
• Take action to identify and prevent abuse from happening in a
Respond appropriately when it is suspected that abuse has
occurred or is at risk of occurring
Ensure that Government and local guidance about
safeguarding people from abuse is accessible to all staff and
put into practice
Make sure that the use of restraint in a way that respects dignity
and protects human rights, and where possible respects the
preferences of people who use services
Protect others from the negative effect of any behaviour by people
who use services
Prisoners should be cared for by a health service that assesses and
meets their health needs while in prison and which promotes
continuity of health and social care on release. The standard of
health service provided is equivalent to that which prisoners could
expect to receive in the community.
Clinical Governance
Primary Care
Secondary Care
Mental Health
Resettlement – pathway 3
People who use
services, families
and carers
Other regulatory
bodies and
Other bodies
eg. Ombudsman,
Staff and other
Assessors and
Who has to register?
Providers delivering regulated activities in prisons are
subject to registration requirements in the same way as any
other setting; BUT
Exempt if:
Services provided under direct contract with a government
Including where HM Prison Service is the provider (eg
nurses employed by the prison) – part of MoJ
A CQC inspector joins HMIP at all full inspections
and some follow up. Inspection activities are coordinated on site
HMIP and CQC share information to prevent
duplication of effort. This may be used to assess
registration and monitor compliance with HSCA
CQC and HMIP will work together to address
concerns at the appropriate level of enforcement
to ensure improvement
HMIP and CQC meet quarterly to review recent
inspections, share training, support joint work
Good practice
An example of impressive practice found during the course
of an inspection that meets or exceeds our Expectations
and is something from which staff in other establishments
can learn in order to improve outcomes for detainees
Good Practice examples
The use of telemedicine enabled prisoners to have fast access to
secondary care, with little disruption to the prison regime
The systematic approach to ‘prized medications’, including opiates, was
helping prisoners to access evidence-based pain relief, and the prison
to ensure that the availability of tradable medications was at a minimum.
IoW 10/12
The practice of ensuring that prisoners received the outcome of their
diagnostic tests as soon as possible helped alleviate unnecessary worry
Risley 6/11
Good practice examples 2
A designated IDTS gym and individual exercise programmes had been
developed which provided prisoners undertaking methadone reduction
regimes with additional motivation and support.
Moorland 7/11
The named nurse system for triage operated effectively and provided a
good service to prisoners.
Peterborough 9/11
A registered mental health nurse saw every referred young person as
soon as possible and completed a mental health assessment.
Wetherby 8/12
Room for improvement
•Physical environment – stark, drab, lack of infection control measures
•Lack of secondary screening
•Care plans
•Barrier protection
•Information sharing
•Mental health provision
•Not all areas for improvement result in a recommendation – need to
read the report not just the recommendations!
2013 and beyond……
• All full inspections unannounced (with the option to
• Announced follow ups
• Recommendations followed up at all inspections
Elizabeth Tysoe
Sue McMillan