In this briefing, we discuss the risk for healthcare in the context of the ACCT process.
One of the key tasks faced by healthcare staff working in prison healthcare is the Assessment, Care in Custody and Teamwork (ACCT) process. It is an area that frequently arises in reports from the Prison and Probation Service Ombudsman, internal incident investigations and coroners’ inquests.
Knowledge and training
Staff should be aware of any local healthcare policies and the content of ACCT-Policy Guidance Annex to PSI 64/2011. Questions around staff knowledge of policies and awareness of the Annex are often asked at inquests.
It is important that healthcare staff attend ACCT training provided by the healthcare organisation and/or offered by the prison within which they are based. Staff should make sure they are up to date with any training and this should be monitored centrally, with senior management aware of any issues and non-attendance being followed up. Your organisation may be asked to provide staff training records at an inquest.
Maintaining and monitoring staff training when healthcare staff are bank or agency can be difficult particularly when staff work infrequently but it is just as important that these staff members have the appropriate training and are aware of any relevant policies.
Opening an ACCT
Any staff member can open an ACCT if they have concerns about a prisoner or are told of concerns by others. It doesn’t have to be a registered staff member – it can be anyone of any band, grade, or experience. Staff should know how to do this.
All staff should understand that opening an ACCT has a very low threshold. If there are any concerns that someone might harm themselves, an ACCT should be opened. Staff should be careful not to assume that someone else has opened the ACCT.
ACCT reviews
There should be a system in place where healthcare are notified daily of any ACCT reviews taking place within the prison and an identified member of healthcare staff should be tasked with actioning this information. Staff should know how to respond to unscheduled ACCT reviews and should be invited to all ACCT reviews where they are relevant to supporting the prisoner.
The staff member attending the review should be registered.
Those present at the review should consider whether a referral to mental health or substance misuse is required. Any actions agreed should be allocated to a named person.
Observations may need to be reviewed and healthcare staff should input into any discussions. Concerns about the level of observations should be escalated as per policy.
Documentation
It is best practice for healthcare staff to make entries in the ACCT book as well as the medical records.
In the medical records, staff should detail the ACCT review including who was present, what was discussed, risk factors both individual and environmental relevant to the prisoner, the level of observations, any actions to be taken and a rationale for any decisions.
For further guidance on the ACCT process, contact our healthcare solicitors.
