Healthy Prisons?

 

What should be done following the horrific report last week about the baby who died at Bronzefield Prison two years ago? There’s a lot to be said for restricting much more tightly, if not banning outright, the use of imprisonment for pregnant women; and for strengthening the criteria which must be met before young adults are remanded to custody – something I argued for in a report for the T2A Alliance earlier this year, but which hasn’t so far led to concrete proposals for change  – in contrast to welcome changes to remand arrangements for children in the Police, Crime Sentencing and Courts Bill.

The Action Plan published alongside the PPO report addresses many of the specific failings which led to the tragedy, but there’s a case for a more fundamental look at the adequacy of healthcare provided in prison, for women, men and children.  Sue McAllister’s conclusion that the care offered to the mother of the baby who died was “not equivalent to that she could have expected in the community” seems something of an understatement.

The standard of healthcare varies widely in prisons – the four most recent Independent Monitoring Board Annual Reports  have suggested it’s as good if not better than that provided in the community at HMP Styal, but not at HMP Hull, while medicine management was “totally unacceptable” at Stafford and problematic at Pentonville.

During the pandemic, many prison health care services were reduced to emergency access only and the Prison Inspectorate reported that the physical health of prisoners has deteriorated in lockdown. The House of Commons Justice Committee is currently in the middle of inquiries into mental health in prisons and women in prison, but there’s surely a case for a post pandemic investigation of how the physical health care needs of prisoners are being met and arrangements could be improved.

It’s true that three years ago the House of Commons Health and Social Care Committee looked at Prison Health and recommended the Government make a “serious attempt to tackle the unacceptable health inequalities present in the current prison healthcare system.” But progress on its recommendations seems to have been limited.

Very surprisingly, in the light of what happened a year later, the report commended the “provision of counselling and support for women in crisis pregnancy and around the loss of a baby or child” at HMP Bronzefield as a best practice.  While as this shows, things can go wrong quickly and disastrously in prisons, it’s the Committee’s recommendations on monitoring and inspection that are none the less among the most significant.

Prison healthcare in England is jointly inspected by HM Inspectorate of Prisons (HMIP) and the Care Quality Commission (CQC), the independent regulator of health and adult social care. The Health Committee argued that greater prominence should be given to CQC’s judgements in inspection reports which should provide a distinct rating about health outcomes rather than merely contribute to a wider assessment of whether prisoners are treated with respect for their human dignity.

They also recommended that CQC should conduct a review of the commissioning of health and social care in a number of prisons and report in 2019; and be given legal powers of entry into prisons. Apparently CQC must notify a prison in advance of any visit which makes something of a mockery of the notion of an unannounced inspection.

I may have missed something, but I’m not sure what if any of these proposals have been taken on board. HMIP and CQC operate to a memorandum of understanding from 2016 and CQC regulate according to a handbook from 2015. HMIP reports don’t yet seem to include a distinct health rating.  The review of commissioning does not seem to have taken place or if it has, it’s not published. It would for example be useful to have an expert view on the model in place at Bronzefield where Sodexo directly employs nurses and healthcare assistants and has a corporate contract to employ GPs from Cimarron UK which describes itself as a locum agency.

If there has been inaction, it may be perfectly well explained by the COVID crisis. But as the pandemic hopefully wanes, there is a case for revisiting the 2018 report. One of its key recommendations was that CQC should assess the range of services provided in prisons, including physical health and the prison environment, against the five criteria they apply in other settings- whether they are safe, effective, caring, responsive and well-led.

Services for pregnant women should be top of that list but there is much else to be looked into. There is a case for an assessment to be made under the aegis of a Parliamentary Committee or an independent Task Force set up for the purpose.  

First New Probation Hostel for 30 years

 

Eden House, a 26-bed probation hostel for women opened its doors this week in Bristol. So-called “Approved Premises” (AP) or half way houses don’t enjoy universal support from reformers but if properly used they can play an important role in supervising remanded or convicted people outside prison. Good luck to all the staff and residents involved in the project.  

I was astonished to read that Eden House is the first new AP to open for 30 years. It’s hard to believe that no new hostels have been built since the fall of the Soviet Union.

During that period, by my calculation, 19 new prisons have been built, providing well over 18,000 new places. In addition, there’s been enormous expansion of capacity within many existing custodial establishments. Some of the existing 100 hostels may have increased their capacity too but the 2,300 odd beds they provide have been increasingly dwarfed by the burgeoning prison estate.

A long overdue Approved Premise Expansion Programme is aiming to deliver 200 additional places, but with plans for a further 18,000 prison places over the next few years, there’s a case for a much more ambitious increase in half way houses. Prison monitors not infrequently mention paroled prisoners waiting for an AP place to become available and the Probation Inspectorate concluded in 2017 that “were extra beds and hostels provided, those places could easily be filled, and this would also enable some prisoners to be released earlier”.

Twenty years ago, a major review of sentencing recommended a review of the “intermediate estate” for accommodating and managing offenders in the community, with the aim of developing a strategic plan for its future use, staffing, management, and development. The review should embrace all types of accommodation, whether owned by the prison or probation services, or the independent and voluntary sectors, and whether used for prisoners on temporary release; prisoners on conditional release; offenders serving community sentences; or ex-offenders receiving support voluntarily”.

I can’t recall whether such a review was ever done, but it’s time for a thorough independent examination of the adequacy of community-based arrangements in the penal system.

Perhaps it’s something for the new team at the Ministry of Justice to commission.

Fire Risk in Prisons

 

On the face of it, shocking findings on fire safety from the Independent Monitoring Board (IMB) at Styal Women’s prison in Cheshire were published this week. In their latest annual report covering the year to the end of April, the IMB reveal “a significant fire risk to prisoners” in 16 of the prison's 17 standalone houses each of which accommodates up to 20 women.

The Board say the fire concerns were identified towards the end of the reporting period.  A “recent survey” classed all 16 buildings as “red fire risk”. These risks include the existence of false ceilings, and ceilings made of lath and plaster, “which would require expensive and specialist repair to be brought within regulations. Fire doors and surrounds, which are not suitable and not fire resistant, are evident in almost 70% of the houses”.

It's possible that the repairs have been undertaken or at least underway. But if not, should 300 women continue to be put at risk in unsafe accommodation?

Back in March, the head of the prison service told MPs that a thousand cells had been taken out of use across the estate because of a fire safety issue. She explained this was:

 “some of our older, originally temporary accommodation that we have been using across the estate. We have had a comprehensive fire safety review across the estate. Following Grenfell tower, we felt that it was absolutely crucial to do this. We have been able to replace those cells by using some of our temporary accommodation and also by maintaining other cells. We have a plan to replace those cells in the longer term, but we wanted to make sure that people were in safe accommodation. We have really stepped up our investigation of fire safety following lessons learnt from Grenfell”.

The Grenfell fire was in 2017 which doesn’t suggest a huge degree of urgency.

I made a Freedom of Information request to see the “comprehensive fire safety review” but was told that there wasn’t one. At least, no overarching Fire Safety Review document existed in the form I’d requested. The Ministry of Justice advised me “on a discretionary basis” that “the safety of our prisoners and staff is paramount” and that since Grenfell “we have undertaken individual building surveys” and that as a result, some buildings have been decommissioned to ensure the safety of prisoners and staff.

From the monthly prison population figures , it doesn’t look like the 16 houses at Styal were among those taken out of use earlier this year. The numbers held at the prison have fluctuated between 360 and 390 since January 2021, with the Operational Capacity constant at 400 - actually a little higher than it was last year, before the fire concerns were raised- if the IMB’s report is accurate.  

Fire is not a theoretical risk in prisons. The Crown Premises Fire Safety Inspectorate said in their annual report for 2018-19 that “prisons and other custodial secure premises are, and continue to be, by far the highest risk from a fire safety perspective. They quoted Home Office statistics showing the highest rates of fire per 1,000 buildings per year were seen in prisons with 5,021 compared to hospitals with 263 and supported/sheltered housing with 158. 9 out of 10 prison fires are thought to be deliberate.

The most recent figures show a welcome fall in fires in prisons- 650 in 2020-21 down from more than a thousand the year before. There were fewer than 500 up until 2012-13, after which the numbers rocketed- as of course did violence and self-harm.

82 “casualties” were recorded in fires last year, although this includes those with injuries requiring hospital attention, those requiring first aid at the scene and those given advice to have precautionary checks (whether they then take that advice or not). Previously, inspectors have found “evidence that the continuing rate of injuries may be due to drug use and perversely the smoking ban which has resulted in prisoners using increasingly innovative methods for ignition sources.”

The Fire Safety Inspectorate consider fire risk in prisons “to some extent inevitable given the nature of the institutions”. Most of the estate was originally built to much lower fire safety standards and before regulations applied to prisons.  HMPPS secured additional funding for 2020/21 to improve fire safety and address the shortfall in automatic fire detection in cells

The inspectors said in their last report they had been working closely with HMPPS and the Ministry of Justice (MoJ) to drive down the fire risk “where it is reasonably possible”. HMPPS had taken steps to improve fire safety, but “even more concerted action is necessary”. Full audits in nine prisons found “serious enough deficiencies to require formal action in all but two". A Prohibition Notice was served at one establishment and an Enforcement Notice at another. In the other five serious cases, the respective Governors had to produce 28-day action plans to address the non-compliance with the Fire Safety Order identified by the inspection.

The Inspectorate said in their last annual report that “this area of our work will continue to be a high priority in coming years”. Their 2019-20 report is overdue but should be published in the next few days. 

It may show whether that priority has been shared by the prison service at prisons like Styal.