COMMENDEE 2014-15: Victoria receives a Commendation for the dedication and skill she displayed in transforming the healthcare service at HMP Grendon and Spring Hill into a widely recognised centre of excellence.

Victoria Kurrein took over the management of the Primary Healthcare services in HMP Grendon and Springhall in 2011, during a period of change and instability. Healthcare services for prisoners had been highlighted as a concern. A series of events, including the loss of staff in a reorganisation, resulted in the team responsible feeling considerable stress as well as a standard of care that fell short of expectations. Victoria turned around the situation totally, in a very short period of time, using her dedication and management skills to transform healthcare services in the prison.

The healthcare team is now fully staffed and staff turnover is very low. A recent report concluded that patient care was good and that nurses knew their patients. Prisoners’ feedback on the quality of health care they received has leapt, with 73% (compared to 40% in similar prisons) describing themselves as ‘very satisfied’ with the care provided by the GP and 85% (compared to 54% in similar prisons) as ‘very satisfied’ with nursing care.

The Inspectorate’s 2013 report on HMP Grendon included many positive comments on healthcare, with the draft report for Springhill rating many areas of activity as ‘very good’ and describing feedback from prisoners as not just positive but ‘glowing’.

Delivering and managing healthcare is a complex and demanding process anywhere, and undoubtedly there are additional difficulties in a prison setting. Dealing with the inevitable disruptions of a reorganisation and staff losses exacerbates the problem. The speed with which Victoria grasped the situation, identified problem areas, developed a clear vision and established priorities for action is notable. As one member of staff commented, “If she had been the Captain of the Titanic it wouldn’t have sunk!”

Other members of her team have spoken warmly about her leadership style and a “no blame” culture which encourages problem solving. Organised, persistent, and a critical thinker, she can sound formidable, but as Tim Smart, a member of the Independent Monitoring Board at HMP Grendon & Springhill, notes, “she also has an engaging sense of humour.”

One prisoner commented that he had never experienced such good healthcare in any other establishment. In a note of thanks, another described the staff delivering healthcare at Grendon as “absolutely excellent” adding a remarkable comment: “It’s been a joy to be ill!”

Governor Jamie Bennett points out that the measure of Victoria’s contribution lies in the outcomes she’s achieved. “In just three years,” he says, “she has completely transformed the situation and the healthcare service has now been recognised by the Inspectorate of Prisons, Care Quality Commission and Independent Monitoring Board as very good and an example of excellence.

“This is an extraordinary achievement and one that would be beyond the ability of most managers. To see the positive, engaged, energetic, committed team that is now in place it is clear that Victoria has not only ensured that the basics are in place but that there is a flourishing culture of care.

“Yet she is a modest person, who has quietly got along with the job, absorbing the brickbats and criticism that come with taking over a failing service, painstakingly put in place the procedures, establishing excellent relationships and then unleashing the best instincts of the staff to create a highly performing team. I am full of admiration, respect and gratitude for what Victoria has contributed.”

Victoria reports turning a situation where she had only 1.5 permanent nurses out of a team of ten, half the administrative complement and no permanent GP to one in which there are now 3 permanent GPs, a skilled team of nurses with a diverse mix of skills, and two new treatment rooms.

Prisoner complaints have been replaced with praise like “I am finally in the hands of genuinely excellent medical professionals” and “I actually feel that I’m someone of value when I come here, the information and care is top.”

The annual staff engagement ‘score’ for her team has increased under her leadership from 56% to 92%, and a series of awards have acknowledged the impact she and the team she has built have made.

Victoria’s contribution is part of a philosophy in which she recognises that “poor healthcare in prison impacts on local NHS services on a prisoner’s release. We aim,” she says, “to empower our prisoners to learn to make healthy choices and contribute to breaking the cycle of reoffending.”

IN THEIR OWN WORDS

[Victoria Kurrein gives her account of the work for which she won her Commendation]

Victoria Kurrein, Head of Healthcare at HMP Grendon has created a primary care service that provides high quality individualised care for prisoners. Staff are supported to develop their clinical skills and to achieve their full potential. Prisoners receive compassionate and professional treatment, described up by one prisoner as ‘top dollar’!

The Butler Trust awarded a Commendation to Victoria for the development of good practise in delivering patient –focussed healthcare within the prison setting. Victoria has embedded governance structures that allow clinical staff to focus on providing a range of GP and nurse –led services that support patients to take responsibility for their own health including management of long term conditions.

Victoria manages the delivery of the NHS contract for Primary Care services in HMP Grendon & Springhill. Victoria’s role is to ensure that the Healthcare services are staffed with suitably qualified clinicians and crucially to enable those staff to utilise those skills to achieve best patient outcomes, as well as to coordinate services to take account of the prison regime.

When Victoria started in post in 2011, staff shortages meant that patient satisfaction was low and complaints were high so putting in structures that supported the staff team and increased morale was a priority. Providing consistent leadership and management whilst acknowledging all deficits helped to build prisoner and prison staffs’ confidence that the service was well led and focussed on good quality care.

A focus on recruitment and retention increased full time staffing from one and a half nurses to a full complement of 16 permanent staff. Of the most recent vacancies, 90% have had the position filled though word of mouth which is a testament to the commitment and morale of the team.

A factor that contributed to staff feeling valued and appreciated was the Care UK Annual Staff Awards. Victoria nominated individuals as well as the whole team. The team at Grendon was shortlisted and won awards at the 2012, 2013 and 2015 annual ceremonies. The awards are highly competitive so to get through to the final each year is no mean feat. The success has raised the profile of the team and the great care that they provide. The Governor and member s of the Senior Management Team are proud of the good healthcare service in the prison.

Victoria introduced structures for Clinical Governance introducing regular internal clinical review meetings and audit cycles as well as ‘Multidisciplinary Clinical Governance Meetings’ with partner healthcare providers and prison staff. Sharing governance issues as well as reporting serious and adverse incidents and complaints openly has contributed to building confidence in the service.

Building positive working relationships with prison colleagues was fundamental to the successful establishment of the healthcare services. Victoria understands of the importance of healthcare in terms of its contribution to prisoner’s general wellbeing. The day to day smooth running of the establishment ensured that priority was given to listening to prison staff’s views. Taking account of challenges presented by the need to prioritise patient care with minimum disruption to the prison required a finely balanced approach. Victoria’s ability to be attuned to the needs of the prison, whilst advocating for the needs of patients, was paramount in developing the ser vice to meet the needs of all stakeholders.

Victoria was able to engage staff to develop a shared vision for the service. She was able to provide leadership and persevered with getting improvements made to the physical environment. This allowed the staff team to focus on the development of clinical services. There is now a high standard of provision across a range of disciplines. The service has received praise from Her Majesty’s Inspector of Prisons and The Care Quality Commission who commented it was ‘an environment where clinical excellence can flourish’ – and the Prisons Ombudsman who described the chronic disease care for one prisoner as being ‘better than he would expect to receive in the community’.

A notable challenge that needed to be addressed was the physical environment. Victoria had to fight hard to get the needs of Healthcare acknowledged, in particular the poor standard of clinical areas and the lack of effective cleaning. A lengthy process of audit to gather the evidence that standards were below acceptable levels finally resulted in a cleaning contract being set up. Treatment rooms were refurbished and new treatment areas were built. The new rooms and equipment facilitated the provision of good nursing care, increased confidence and patient satisfaction, and meant a cleaner and more pleasant environment for staff. This resulted in the service becoming compliant with the National Patient Safety Agency standards and local Infection Prevention and Control audit standards.

Challenging perceptions was a significant hurdle to overcome; there was a considerable degree of negative opinion directed towards the service. The cliché ‘resistance to change’ came into play; Victoria’s ability to act as the buffer between the team and negativity allowed clinical staff to get on with what they’re good at and be protected from criticism while those relationships were improved. Victoria’s pragmatism and perseverance won through after a tough period of time; she has been described as coming across as ‘formidable but with an engaging sense of humour’, traits that were probably equally valuable.

A focus on staff training and development resulted in a number of nursing staff being sponsored to complete further training and achieve additional qualifications. This contributed to increased staff retention and the development of a highly skilled workforce. An example of this is the ability of staff to treat minor injuries and illness and provide specialist diabetes clinics. This led to a reduction of patients needing to attend external hospital appointments. This initiative has brought added benefits to prison as the requirement for patient escorts has reduced.

The development of good practice required a whole team approach. Building on staff morale and engaging the team in service improvements ensured all staff had ownership of the service and a commitment to delivering the best quality care. Being rewarded for their hard work (through excellent feedback from patients, prison staff and formally through HMIP and CQC inspection Reports and the Staff Awards for Great Care) facilitated a working environment in which team-work flourished. It resulted in a really positive team dynamic and a supportive and energetic atmosphere.

Strong leadership and joint working ethos created a beautiful thing the team were greater that the sum of their parts. Ideas were generated in collaboration, creativity and innovation resulted from that approach. New ways of working brought benefits to patients. These include but are not limited to :- better systems for making GP appointments; peer smoking cessation services; wellbeing clinics; a health promotion group; reduction in trade-able medication; safer and more efficient medicines administration processes and improved multi-disciplinary working.

Maintaining and improving good practise is assured through practical application of governance systems. This includes embedding open and transparent incident reporting, audit and action planning and learning cycles. A culture has been established that underpins that cycle of continuous improvement.

The former service was failing to deliver its contractual obligations; it had very low staffing levels and a poor reputation. After much had work the Healthcare Service is a model of good practice, able to identify problems and understand them from multiple perspectives.

Providing a consistent strong leadership presence introduced a new way for Healthcare to be seen and gradually changed perceptions. Developing the team culture from one which was defensive to one in which individual clinicians can practise to the best of their skills and abilities has supported the development of a highly regarded service.

Going forward Victoria plans to continue to develop a more patient-focused approach with health and wellbeing at its core. From culture change to paradigm shift will be the next challenge. The aim is to‘re-focus’ the definition of Healthcare from illness to wellbeing. To engage prisoners as partners in their own healthcare is the ambition.