Severely ill inmates at Liverpool Prison often wait days to be seen because of poor care and a lack of staff, a senior psychiatrist says.

His assessment of mental healthcare, seen by BBC News, says staff shortages present a "substantial clinical risk".

Separately, a review of the prison, published on Friday, says conditions are the worst inspectors have seen.

Lancashire Care, which runs healthcare at the jail, said it had spent significant sums on more staffing.

However, in a statement, the trust added that it had found it impossible to recruit enough staff.

'Major deficits'

The review of mental health provision comes exactly two months after we reported that patients at the prison were dying because of healthcare errors.

It was carried out for Lancashire Care by Dr Andrew Forrester, a consultant in forensic psychiatry at the trust.

In a report dated 20 December last year, Dr Forrester said there was a "gross under-supply of psychiatry in the prison".

The lack of staff he says, "presents a substantial clinical risk".

Looking at the service that is provided, the psychiatrist writes: "There are major deficits in the areas of clinical psychology, social work and occupational therapy."

The lack of a system to properly process patients, writes Dr Forrester, means that "acutely mentally ill patients who are admitted to the inpatient unit often wait for many days to be seen, potentially compromising their safety".

Since 2011, there have been 17 suicides at the prison, including three in 2017, one of the highest totals for England according to the Howard League for Penal Reform.

Dr Forrester, who has given evidence to Parliamentary committees on mental health provision in prisons, concludes that while he has worked in many "difficult" prisons, including Belmarsh and Wandsworth in London, "the arrangements I have encountered at HMP Liverpool and their apparent resistance to remediation, are more concerning than in any other place where I have ever worked".

His assessment was written weeks after inspectors from HM Inspectorate of Prisons visited the crumbling Victorian prison.

In their report, which is published on Friday, but which was leaked to the BBC last month, inspectors found the jail, which houses around 1,100 inmates, was infested with rats and cockroaches.

The prison authorities, and the broader prison service, are severely criticised in the report for allowing "squalid" conditions to develop at the prison.

Dr Forrester's report is contained in a tranche of documents released to the BBC under Freedom of Information rules.

Details from the papers demonstrate a fractured and dysfunctional relationship between Lancashire Care and the prison leadership:

• In July, a medic urged the trust to close the healthcare unit because of the refusal of the prison to provide officers to protect healthcare staff during medication rounds

• In lieu of staff, the prison suggested nurses wear body cameras, a recommendation rejected by the trust

• Healthcare staff were regularly overruled by prison authorities on which men were placed in the inpatient unit, with some sent there despite having no healthcare needs. This meant the unit was often unable to take prisoners who genuinely needed to be there.

• Maintenance problems with the contractor, Amey, meant the healthcare unit was regularly described as posing an infection risk, because of broken sinks, damaged cells and deeply embedded grime.

• Lancashire Care is leaving its contract when it expires in March and the BBC understands no other healthcare provider had bid to replace them.

In its statement, Lancashire Care said: "Whilst the level of psychiatry input in Liverpool prison is below the Royal College requirements, it is comparable to their prisons in the north-west.

"However, the experience of some clinicians would suggest that compared to the south, it is low."

On its difficulty staffing the unit, the trust said it "had exhausted all available options to mitigate this".

"Lancashire Care has been proactive in trying to recruit staff to the prison and has spent an additional significant amount of money on agency staff; this is not clinically or financially sustainable."

The Ministry of Justice said HMP Liverpool has hired a "significant" number of new officers and that the prison is "now fully staffed".

A Ministry spokesman added that a joint health and social care improvement board was set up in November to oversee the healthcare action plan for the jail and is "urgently looking at how to improve the running of healthcare services".