Celebrating and promoting the best in UK prisons, probation and youth justice
COMMENDEE 2011-12: As Healthcare Manager, Marieanne Bubb-McGhee has transformed healthcare provision at HMP & YOI Gloucester, through her dedication and commitment to quality.
[Marieanne Bubb-McGhee gives her account of the work for which she was awarded a Commendation]
‘Significant improvements to the offender health experience and outcomes have been achieved through my passion and ability to work collaboratively with the prison and the community. The development of the healthcare team, environment and the introduction of a full range of services has had a positive impact on all involved’.
I was approached by the local Primary Care Trust in the autumn of 2006 to see if I would accept a secondment into HMP Gloucester as the Head of Healthcare. I accepted the secondment and started my career in March 2007; I very quickly took the role on a permanent basis as I very quickly developed a real passion for the role.
When I came into the team we had a high level of Agency staff and very few permanent staff, this of course leads to inconsistency of care for the patients. I set about building my teams so that we now have fully functioning, stable teams who offer primary care, includes all aspects of physical healthcare, Mental Health including primary and secondary mental health and the implementation of the Clinical Drug Treatment Service, the Integrated Drug Treatment Service, which covers both substance misuse and alcohol.
I have seen a massive improvement in my Prison Health Performance Quality Indicators, moving from 6 areas that were RED, 15 that were amber and the remaining were green. This year I have further improved this to having just 2 areas that are amber and the remaining are all green. These areas are the Hep B Coverage, which I have plans in place to address and reach the required 80% overall coverage on a consistent basis, we often miss this by only 1 or 2%, which is really frustrating. The second area is Sexual Health and again I have a joint action plan with the Governor to address this. The increase in Green Indicators are a good reflection of the improved healthcare provision to the patients over the last 5 years.
I have encouraged joint working across all the departments within HMP Gloucester and my staff all have good working relationships across the jail. We have developed our services in many areas, especially joint working with the Physiotherapist, our Support Worker and the Gym Staff, with them introducing a ‘Back to work fitness class’ which has proven popular with the guys here and encourages an overall health improvement programme for those with chronic back and other physical issues.
There has been some really excellent work around Blood Borne Virus’s, with joint working with the local HIV and Sexual Health Teams, introducing Genital Urinary Medicine and HIV/HEP C Clinics. The staff have also developed link nurse roles working closely with the Specialist Nurses in the community, for Chronic Disease management, including Asthma, Cardio Vascular Disease, Diabetes, Infection Control etc.
I have done a lot of work with the revolving door homeless prisoners and have presented both locally and nationally on this subject for the Queens Nursing Institute (QNI). I was awarded my Queens Nurse Title in October 2010 in recognition of my commitment to this vulnerable and complex client group, I am also a member of the Queen’s Nursing Institute’s Opening Doors Project, which is dedicated to the homeless population and more recently moving its focus towards offenders and their needs on release. Below is a link to an article which I was requested to do by the Nursing Times. One of the many benefits of being a Queens Nurse. http://www.nursingtimes.net/nursing-practice/clinical-specialisms/educators/its-the-type-of-environment-you-absolutely-love-or-you-absolutely-hate/5028173.article
I was nominated locally by the Criminal Justice Board to become a Champion for Offender Health, a role which I take very seriously and has led me to working with the local Police, Probation and Mental Health Trust to put on a ‘Bradley Conference’ to look at the recommendations from Lord Bradleys Review, 2009. This work is ongoing and actions continue to be implemented across Gloucestershire.
The team and I were successful in securing funding from the Kings Fund Project to enhance our environment. The project was a joint piece of work involving the prison estates and project manager alongside members of the healthcare team. This encouraged further positive partnership working and enabled a change in culture as well as an improvement of the patient and staff environment. A good example of these changes was the softening of the patient holding/waiting room, which now sees the guys relaxing in comfortable chairs, with colourful surroundings and access to a Health Promotion TV, instead of hunched up on a hard bench, with white walls. This project has seen a massive improvement in the working environment for both staff and patients. It has seen a change in behaviour from the patients with them being more relaxed and less aggressive and more respectful of their surrounding environment. It has enabled us to reduce our ‘In Patient’ bed numbers and provide a multipurpose group room which currently hosts Anger Awareness, Alcoholics Anonymous and Sleep Groups. The aim is to further develop other groups such as anxiety and depression management.
I am very proud of my team and have led them to winning several local awards from the Criminal Justice Board in 2008 and 2009; the Chief Executive Officer of the Primary Care Trust, as well as being shortlisted for the Regional NHS Awards in 2009. In 2011 one of our Integrated Drug Treatment Service Support Workers was shortlisted for the Chief Executive Officer Award for Innovation and the Patient Involvement Award at the local Award Event. This enables staff to be recognised for their hard work and commitment and fosters an environment of best practice.
I have developed and implemented training for the local Police Custody Staff in Partnership with the local police training department regarding mental health, learning disabilities and physical healthcare needs, especially chronic disease and what to look out for. This has been well received with positive feedback.
In 2010 we were awarded a local County Council Grant of £24k in recognition of the work that we have done with introducing Smoking Cessation, a service which has been very successful. With the money we have introduced Health and Wellbeing Days at the gym for both patients and staff. In 2012 we have introduced the Health Trainer roles for the prisoners here at HMP Gloucester.
I have introduced nurse prescribers into the jail, which has freed up the General Practitioners to spend more direct clinical face to face time with the patients. This and the introduction of Patient Group Directives, prescribing plans also enable first night prescribing for the guys coming into the jail in the evenings, especially those with Substance Misuse or Alcohol needs, this ensures patient safety and continuity of care/prescribing.
We had a sad death in custody, which was the expected death of a terminally ill gentleman who was on a life sentence and wanted to die ‘at home’. The team were applauded for managing his healthcare needs within the confines of the jail, at his request to die with his ‘family’.
We also worked closely with the local end of life teams including the hospice, where he was transferred for the last few weeks of care. We worked closely with the prison staff including the residential staff and the security team to ensure access to the patient at night for medications and care. The Ombudsman noted three areas of best practice following their investigation, those being record keeping, access to Specialist End of Life care and timely referrals to appropriate specialist services.
I have also enabled a gentleman who’s crime was known locally to have his immunoglobulin replacement therapy carried out in the jail. The gentleman had previously been going out to the local hospital every two weeks on the same day for his treatment. This was an issue for the security department a she was aware of his appointments; it also meant that they had to ensure the availability of 2 officers for each appointment, thus restricting the resource for other possible outside appointments that may have been needed. It was also embarrassing for the patient as he did not want to be seen regularly cuffed to prison officers in his local community. The other added embarrassment was that he knew the staff who were treating him at the local hospital and he also knew that they were aware of the nature of his crimes. I met with the Security lead, the General Practitioner’s and the nursing staff and we decided to do the treatment within the Assessment and Treatment Unit. This meant that a couple of nurses had to go and be trained at the local unit. The General Practitioners’ liaised with the Consultant in charge to discuss presentation, medication etc and the prison staff offered officer coverage over the lunchtime period to ensure that the treatment was safe and had the allocated time needed to complete it. There were clear benefits for all involved in this process, from a cost saving for escorts, to improved security, better outcomes for the patient including his privacy and dignity as well as continuity of care etc.
I worked jointly with the prison to introduce a Medical Emergency Response Training programme, which enabled both prison and healthcare staff to train together to deal with different emergency situations such as collapse, overdose, hanging, trauma etc, as well as basic life support and defibrillation. This has fostered good working relationships with the staff in both disciplines.
I have reduced the number of Healthcare beds by working with wing staff, enabling them to manage the more complex presenting prisoners on the wings. This work led the South West Regional work on reducing the number of healthcare beds across the prison estate. We started with 11 and are now down to 4 with the expectation of them all closing in the near future.
[The following article appeared in issue 4 of the Butler Trust’s magazine, Inspire]
Marieanne Bubb-Mcghee won a commendation for massively improving healthcare at HMP Gloucester. Since her appointment as healthcare manager in 2007, the prison has seen a shift from 80 per cent agency staff to a fully functioning, competent healthcare team, including the implementation of the Integrated Drug Treatment Service within the jail.
The team’s performance against Prison Health Performance and Quality Indicators has improved dramatically and under Marieanne’s leadership the team has won several recognition awards. Partnership working has improved massively, with healthcare staff working with gym staff to introduce fitness classes, nutritional advice, and support in areas such as steroid abuse. Marieanne has been credited by her governor with bringing order out of chaos and replacing low staff morale with a ‘can do’ attitude.