Medicines management issues had been identified at the last two inspections, where a breach in Regulation 12 had been identified in July 2016. This related to risks associated with the proper and safe management of medicines, which had not been identified or mitigated effectively. Findings included limited medicines administration times and medicines not being administered at the optimum therapeutic dose intervals. At this focused inspection, efforts to address issues raised by the joint HMIP and CQC inspection in September 2015, and the CQC focused follow-up inspection in July 2016 were evident; action plans were submitted with numerous targets achieved. However, at the time of this inspection, these breaches remained, but new areas were also highlighted which caused concern. Although medicines management had improved, there was still progress to be made.

There remained numerous amounts of tradable medicines which were issued in possession, however, work was underway to reduce this.

Despite some improvements, to the prison regime, some prescribed medicines were still not issued at therapeutic time intervals, and night medicines were been administered too early,. This was particularly evident over the weekend period when the clinical staff’s working hours and the restrictions of the prison regime meant prisoners received night time medicines too early.

Medicines administration times were short and at times rushed which put the clinical staff under pressure and increased the risk of errors.

The transport of medicines was not safe as they were not held in a secured container whilst staff located them around the prison.

Documentation was not well maintained in recording the levels of stock drugs and completing the controlled drug register, where discrepancies were found.

On a local level, the service had experienced leadership with a commitment to improve. However, the limited provision of a pharmacist meant overarching operational clinical management was restricted in relation to medicines management. Meetings had been commenced with key stakeholders in the prison to discuss and review medicines management issues, but this was in it’s development stage.

Our key findings were as follows:

• Although progress had been made, issues surrounding the safe storage, transport and administration of medicines were still concerning, which was on on-going breach of Regulation 12.

• Medicines administration remained constrained by the prison regime and the operational hours of the healthcare service, which limited its therapeutic effect.

• The medicines management policy was not prison specific and related to the wider trust. This meant there was no specific guidance on medicines management for prison healthcare staff.