Related Downloads
Additional
New recommendations
9. From analysis of the action plan and discussions with the HSCP, it is evident that several areas for improvement have been highlighted. This has resulted in the creation of five additional recommendations as noted below, some of which are continuations of previous recommendations from the report published in October 2024.
10. There is a recognised need to enhance how services capture and report healthcare data and key performance indicators within the context of police custody.
Progress inspection recommendation 1
Argyll and Bute HSCP should establish a monitoring framework to ensure that patients' needs are met, and to collect data on patient outcomes in police custody.
11. Recommendation 7 from the previous report stated:
“Argyll and Bute HSCP should ensure that any paper patient records are stored securely so that only healthcare staff can access them.”
12. During the inspection in May 2024, we found historical and current patient records stored in a locked cupboard in the consultation room. We were concerned that these patient records were not stored securely as non-healthcare staff had access to the consultation room and the keys for this cupboard. The HSCP has since received advice from NHS Highland’s data protection officer to ensure that any paper records are managed in line with NHS Highland’s Records Management policy. During this inspection, all paper records (apart from those from January 2025 to the present) had been moved to the GP surgery to be securely stored.
13. Although the remaining paper records were stored in a locked cupboard, it was concerning to hear that non-healthcare staff still had access to keys for this cupboard. We therefore do not consider Recommendation 7 from our initial report to have been fully addressed. This recommendation will therefore be carried forward as follows.
Progress inspection recommendation 2
Argyll and Bute HSCP should ensure that any paper patient records are stored securely so that only healthcare staff can access them.
14. Recommendation 10 from the previous report stated:
“Argyll and Bute HSCP should comply with Health Protection Scotland’s NIPCM standard infection control precautions to ensure patient and healthcare staff safety.”
15. Following the inspection in May 2024, we made recommendations relating to the environment, compliance with standard infection control precautions (SICPs) and ensuring systems and processes were in place to monitor infection prevention and control practices. It was therefore encouraging to hear that since the inspection, an external IPC audit of the treatment room had been completed by NHS Highland. We were provided with a copy of the audit as evidence. However, not all elements of SICPs were fully implemented during this inspection. This included:
- Sharps bins used to dispose of used needles or sharp medical items were not correctly labelled or had the temporary closures in place.
- Personal Protective Equipment (PPE) not stored appropriately.
- The biohazard bin did not have correctly fitting lid.
16. We therefore do not consider Recommendation 10 from our initial report to have been fully addressed. Therefore, this recommendation will be carried forward as follows.
Progress inspection recommendation 3
Argyll and Bute HSCP should comply with Health Protection Scotland’s NIPCM standard infection control precautions to ensure patient and healthcare staff safety.
17. Recommendation 12 from the previous report stated:
"Argyll and Bute HSCP should implement systems and processes to support healthcare and police custody staff in managing emergency situations.”
18. During the May 2024 inspection, there was no Standard Operating Procedure (SOP) or policy in place to support the responsive management of medical emergencies for both GPs and custody staff. The action plan submitted by the HSCP noted a SOP would be in place by April 2025. However, healthcare staff and custody staff we spoke with during this inspection were clear about the processes for managing medical emergencies and we were assured that medical emergencies would be managed appropriately.
19. Transfer to Oban and Lorne hospital was facilitated for those requiring emergency care, a place of safety, or when observation levels required could not be safely managed in the custody centre. During this inspection, we saw that a respiratory arrest bag was now available in the treatment room. This will ensure that healthcare staff can respond to medical emergencies more effectively. However, we noted that some of the equipment that it contained was out of date. The GP was made aware of this, and action was taken to replace the out-of-date equipment.
Progress inspection recommendation 4
Argyll and Bute HSCP should ensure that checks on emergency equipment and medications are carried out and consistently recorded to ensure that all equipment is within date and ready for use.
20. Recommendation 13 from the previous report stated:
"Argyll and Bute HSCP should review its process for sharing healthcare information on patients with custody staff.”
21. During the inspection in May 2024, we were told that recommendations and information relating to a patient’s assessment, including medications, were verbally given to the custody staff. We were concerned that there was a risk of healthcare information being missed or recorded incorrectly when this information was then transcribed onto the NCS. It was therefore reassuring to hear that the access to Adastra had been improved. Healthcare recommendations and information could now be printed and given to custody staff, reducing the risk of information being missed or recorded incorrectly.
22. A paper system was also available to provide custody staff with written healthcare information. We were told by custody staff that the paper system was the most used method. However, we noted that this paper version contained information relating to the patient’s full medical assessment not just the recommendations and information required by custody staff to keep patients safe.
Progress inspection recommendation 5
Argyll and Bute HSCP should ensure that full medical assessments are not shared with custody staff. To protect patient confidentiality, only recommendations and guidance essential for patient safety should be given to custody staff.
23. Recommendation 15 from the previous report stated:
“Argyll and Bute HSCP should have approved processes in place to support the delivery of consistent evidence-based care including the management of patients withdrawing from alcohol or other substances.”
24. In the May 2024 inspection, we identified that GP’s had access to the appropriate tools for monitoring levels of intoxication and withdrawals and were carrying out physical observations and prescribing detoxification medication where required. However, we saw that there could be inconsistencies in the documentation regarding the use of tools to monitor withdrawal from alcohol and substances and there was no clear process to manage this for custody staff. During our progress inspection, there were improved processes in place, which included the consistent use of validated assessment and screening tools to inform the clinical decision to prescribe detoxification medicines where appropriate for people withdrawing from substances.
25. Recommendation 18 from the previous report stated:
“Argyll and Bute HSCP should ensure standardised risk assessments are available to all healthcare staff and these are completed consistently where required.”
26. During the May 2024 inspection, not all GPs had access to the standardised mental health risk assessments available on Adastra, therefore there was an inconsistent use of standard risk assessments to record patients’ risk of self-harm or suicide. During this inspection, we were assured that despite some challenges with slow connection speed to the IT systems within the custody centre, all FMEs now have access to Adastra and can complete standardised risk assessments.