Working together to regulate and inspect Elizabeth Tysoe, HMIP Sue McMillan, CQC

1. . Working together to regulate and inspectElizabeth Tysoe, HMIPSue McMillan, CQC

2. 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 Statement of Purpose

3. 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

4. Inspection • 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

5. Independence • Why is independent inspection is necessary? • The power imbalance between the detainee and custodian • 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

6. 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 work • 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.

7. Legislation and standards CQC Dept of Health Parliament Care Quality Commission (Registration) Regulations 2009 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010

8. Health and Social Care Act 2008 NHS April 2010 Single system of registration Single set of standards Strengthened and extended enforcement powers 1 Adult Social Care October 2010 Adult social care Registration Independent Health Care October 2010 2 NHS Dental Care & Ind. Ambulances Apr 2011 3 Primary medical Services April 2012

9. 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

10. Expectations Guidance about Compliance Prison Act 1952 Criminal Justice Act 1982 Health & Social Care Act 2008 and regulations

11. Expectations – Prisons Safety Courts, escorts, transfers, early days Bullying, violence reduction, self harm & suicide prevention, safeguarding Security IEP, disciplinary procedures Substance misuse Respect Res units, staff/prisoner relationships Equality, diversity, faith, religious activity Complaints, legal rights, health services, catering, purchases Purposeful activity Time out of cell Learning, skills & work activities PE & healthy living Resettlement Strategic management Offender management & planning Reintegration planning Specialist units

12. Expectations • 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.

13. Safeguarding people who use services from abuse Plain English • OUTCOME 7 • 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 • That is because providers who are compliant with the law will: • Take action to identify and prevent abuse from happening in a service • 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 People focused Outcome based

14. 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. General Clinical Governance Primary Care Pharmacy Dentistry Inpatients Secondary Care Mental Health Resettlement – pathway 3

15. DRAFT People who use services, families and carers Providers Other regulatory bodies and inspectorates Staff and other professionals Other bodies eg. Ombudsman, commissioners CQC Assessors and Inspectors

16. 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 department; Including where HM Prison Service is the provider (eg nurses employed by the prison) – part of MoJ

17. A CQC inspector joins HMIP at all full inspections and some follow up. Inspection activities are co-ordinated 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

18. 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

19. 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

20. 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

21. Room for improvement • HNAs • Physical environment – stark, drab, lack of infection control measures • Lack of secondary screening • Care plans • Medications • Barrier protection • Information sharing • Mental health provision • Reintegration • Not all areas for improvement result in a recommendation – need to read the report not just the recommendations!

22. 2013 and beyond…… • All full inspections unannounced (with the option to announce) • Announced follow ups • Recommendations followed up at all inspections

23. Elizabeth Tysoe elizabeth.tysoe@hmiprisons.gsi.gov.uk Sue McMillan sue.mcmillan@cqc.org.uk