HMP Doncaster

Section 1. Safety
Substance misuse
Expected outcomes:
Prisoners with drug and/or alcohol problems are identified at reception and receive
effective treatment and support throughout their stay in custody.
1.60 Outcomes for prisoners needing substance misuse treatment were poor, and staffing shortages and
other issues hindered patient care. First night prescribing was inconsistent, prescribing protocols did
not adhere to national guidance, and around half of clinical reviews were not completed on time.
1.61 Clinical and psychosocial drug services were provided by Nottinghamshire Healthcare NHS
Foundation Trust. The provision was poorly integrated into the strategic management and
day-to-day running of the prison. The new drug and alcohol strategy and action plan were
not based on a needs analysis (see recommendation 1.68). Communication between the
substance misuse service and other prison departments was poor (see paragraph 4.30).
Prisoners receiving adjudications for positive drug tests were not routinely referred to the
substance misuse service (see paragraphs 1.47–1.48).
1.62 Drug recovery workers were well qualified but prisoners often had to wait too long to see
them because there were not enough staff at the required local NHS grade to complete
assessments and initiate care plans. The recovery wing had been closed for nearly a year and
all recovery-based groupwork had ceased. Alcoholics Anonymous meetings were not
available. The programmes team delivered lower intensity groupwork focusing on awareness
of new psychoactive substances (NPS), 6 but this was not well integrated into an overall
strategic approach to tackling drugs.
1.63 Of the 213 prisoners receiving opiate substitution treatment, 93 were on maintenance doses
and 120 were reducing. First night prescribing was in place and most new arrivals with opiate
substitution needs were located on the stabilisation wing for their first five days. However,
not all prisoners arriving late had a consultation with a doctor to get a first night
prescription, and some spent their first night with no opiate substitution.
1.64 As at the last inspection, all new arrivals on a community dose of more than 40ml of
methadone had this automatically reduced by 25%. This policy did not reflect individual need
or the national guidelines for substance misuse treatment.
1.65 Methadone was administered from three separate hatches with varying levels of staff
supervision, ranging from very close to lax oversight. While two officers were present at
two of the hatches, there was only one to supervise the third hatch and escort prisoners
back to the wing, leaving other prisoners unsupervised at the hatch.
1.66 Clinical reviews for prisoners on opiate substitution were conducted by a non-medical
prescriber and a part-time consultant psychiatrist, which was insufficient to keep up with
demand. Around half of all reviews were not completed within the 13-week period set out
by national guidance.
1.67 In our survey, only 30% of prisoners, against the comparator of 59%, said they had received
help for their drug problems, and only 38%, against 57%, said they had received help for an
alcohol problem.
6 Drugs that mimic the effects of illegal drugs, such as cannabis, heroin or amphetamines, and may have unpredictable and
life-threatening effects.
28 HMP Doncaster