Standard 62: Penitentiary Health Services

Why it matters. Many people in custody have higher rates of infectious disease, mental illness, substance use and injury than the general population. The Nelson Mandela Rules (2015, Rule 30) require a medical examination on admission, and WHO Prisons and Health (2014) recommends a systematic reception screening so that needs are found early.

Sample. Review the reception health screening records for every person admitted to custody in the last 6 months. Where there are more than 30 admissions, take a random sample of 30.

1. Every person admitted has a documented health screening on reception.

Method. Compare each admission record with the screening record and check that the screening is dated on the day of admission.

Evidence to show. Reception health screening (PNT-SOP-001); reception health screening record (PNT-FRM-001).

Pass when. Every sampled admission has a dated screening record.

2. A full medical examination is done within 24 hours, with a named clinician.

Method. Check each sampled record for the examination time against the admission time, and the clinician name.

Evidence to show. Reception health screening (PNT-SOP-001); reception health screening record (PNT-FRM-001).

Pass when. Every sampled examination is within 24 hours and names the clinician.

3. Each positive finding has a plan.

Method. Check each positive finding (infection, mental health risk, substance use, injury) for a documented plan and its date.

Evidence to show. Reception health screening record (PNT-FRM-001); suicide risk screening and continuous observation (PSY-SOP-001, existing, reused).

Pass when. Every positive finding has a documented plan.

Immediate fail (any one means the criterion is not met)

• A person with a known infection is admitted, and no examination is done, so the infection spreads on the wing.
• A person with a history of self-harm is admitted without a risk screen, and self-harms in the first night.

Why it matters. The Nelson Mandela Rules (2015, Rule 24) require that prisoners receive the same standard of health care as is available in the community, without discrimination. WHO Prisons and Health (2014) sets out the same principle of equivalence, and that clinical decisions are made by health professionals on clinical grounds.

Sample. Review the clinical records for a sample of 30 people in custody who needed treatment, referral or specialist care in the last 12 months, and compare them with the community referral criteria.

1. Diagnosis, treatment and medicines match community standards.

Method. Compare each sampled treatment plan with the relevant clinical guideline used in the community, and check the medicines given against the formulary.

Evidence to show. Medicines management policy (HOS-POL-001, existing, reused); high-alert medicines (HOS-SOP-006, existing, reused); reception health screening record (PNT-FRM-001).

Pass when. Every sampled plan matches the guideline used in the community.

2. Specialist referral is made on clinical need, with no delay caused by custody.

Method. Compare the date of each sampled referral with the date the clinical need was recorded.

Evidence to show. Reception health screening record (PNT-FRM-001); structured verbal handover (HOS-SOP-004, existing, reused).

Pass when. Every sampled referral is made within the time set for the clinical need.

3. Clinical decisions are made by health professionals.

Method. Check that each sampled clinical decision is signed by a health professional, and that no custodial decision overrides it.

Evidence to show. Penitentiary health governance and independence (PNT-POL-001).

Pass when. Every sampled clinical decision is made and signed by a health professional.

Immediate fail (any one means the criterion is not met)

• A person with a cancer symptom waits six months for a specialist, because the referral is held by custodial staff.
• A person is denied a prescribed medicine on the grounds of custody, and the clinician is not consulted.

Why it matters. Medical confidentiality is a basic right, and people in custody often avoid disclosing illness or mental health needs if they fear that information will be shared with custodial staff. The Nelson Mandela Rules (2015, Rule 32) require health records to be kept confidential, and WHO Prisons and Health (2014) sets out the same principle.

Sample. Review the consultation records and the health record access log for a sample of 30 people in custody in the last 6 months, and observe three consultations.

1. Consultations take place out of the hearing of custodial staff unless security is requested for a clear safety reason.

Method. Observe three consultations and check the security request records for any custodial presence, with the reason.

Evidence to show. Patient data protection and access control (DIG-POL-001, existing, reused); confidentiality of records (PNT-POL-001).

Pass when. Every observed consultation is private, or the reason for security presence is recorded.

2. Health records are kept separately and accessed only by health staff.

Method. Check the record system and the access log for custodial staff access to clinical records in the sample period.

Evidence to show. Patient data protection and access control (DIG-POL-001, existing, reused).

Pass when. No custodial staff access to clinical records is recorded in the sample period.

3. Information shared with custodial staff is limited to what is needed for safety.

Method. Check each sampled information sharing record for the purpose and the minimum information given.

Evidence to show. Confidentiality of records (PNT-POL-001).

Pass when. Every sampled sharing record gives a safety purpose and the minimum information needed.

Immediate fail (any one means the criterion is not met)

• A person’s HIV status is written on a custody file visible to all staff.

Why it matters. Health staff must not become part of custodial control or punishment. The Nelson Mandela Rules (2015, Rules 33 and 34) state that health staff must not take part in restraint or punishment, and must be able to stop procedures they judge unsafe, so that clinical judgement is protected.

Sample. Review every restraint, seclusion and disciplinary event involving a person in custody in the last 12 months, and the health staff involvement in each.

1. Health staff do not take part in restraint or punishment unless a clinician has decided it is needed for the person’s health.

Method. For each sampled event, check whether health staff were present or took part, and whether a clinician decision is recorded.

Evidence to show. Restraint and seclusion (CLN-POL-002, existing, reused); restraint and seclusion record (CLN-FRM-004, existing, reused).

Pass when. Every sampled event with health staff involvement has a clinician decision recorded.

2. Health staff can stop an unsafe procedure, and record the reason.

Method. Check the records for any stopped procedure, and the reason and the action taken.

Evidence to show. Patient safety incident reporting (PNT-REG-001).

Pass when. Every stopped procedure has the reason and the action recorded.

3. Restraint is used only under the written policy, with a clinical review.

Method. Check each sampled restraint for the policy steps, the start time, the clinical review and the end time.

Evidence to show. Restraint and seclusion (CLN-POL-002, existing, reused).

Pass when. Every sampled restraint follows the written policy with a clinical review recorded.

Immediate fail (any one means the criterion is not met)

• A nurse holds a person down for a custody procedure, and no clinician is recorded as having ordered it.

Why it matters. Suicide is a leading cause of death in custody. Infectious disease, and hospital transfer delayed by custody, add further risk. The Nelson Mandela Rules (2015, Rules 26, 27 and 71) require mental health care, review of deaths in custody and prompt transfer to a hospital when needed.

Sample. Review the suicide and self-harm screening records, the infection records, the hospital transfer records and every death in custody in the last 12 months.

1. People at risk of suicide or self-harm are screened and observed under a written procedure.

Method. Check each sampled at-risk person for a screen, the observation level set and the observation log.

Evidence to show. Suicide risk screening and continuous observation (PSY-SOP-001, existing, reused); continuous observation log (PSY-REG-001, existing, reused).

Pass when. Every sampled at-risk person has a screen and an observation log under the procedure.

2. Hospital transfers are made under a written escort procedure with a structured handover.

Method. For each sampled transfer, check the escort record, the time from clinical decision to departure, and the handover sent with the person.

Evidence to show. Escort and written discharge advice (PTR-SOP-005, existing, reused); structured verbal handover (HOS-SOP-004, existing, reused); patient consent and right to decline (PTR-SOP-013, existing, reused).

Pass when. Every sampled transfer has an escort record, a time within the set limit and a handover record.

3. Every death in custody is reviewed and reported.

Method. Check that each death in the period has a recorded review, a report and the findings acted on.

Evidence to show. Penitentiary custody health and transfer register (PNT-REG-001).

Pass when. Every death has a review and report recorded, and actions agreed.

Immediate fail (any one means the criterion is not met)

• A person at high risk of suicide is not observed for a night, and dies in custody with no review recorded.