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. 

Pulling the Chain Gang

 

Boris Johnson can’t see any reason why lawbreakers “shouldn't be out there in one of those fluorescent-jacketed chain gangs visibly paying your debt to society”. If that isn’t a nod to Britain First whose policies include the introduction of chain gangs to provide labour for public works- it’s at least an evidence free appeal to the public’s baser instincts to punish and humiliate people in conflict with the law.

The Prime Minister is probably unaware of Recommendations made by the Council of Europe about prison and probation services, but if he is serious about this chain gang proposal – which I doubt- they provide a number of important grounds for avoiding it. 

The 2010 European Probation Rules, developed by leading international experts and approved by the 47 CoE member states including the UK, make clear that probation agencies must respect the human rights of offenders, with all their interventions having  due regard to their dignity, health, safety, and well-being. Community service, in particular, “shall not be of a stigmatising nature.”    The Commentary to the Rules  say that “uniforms that identify community service workers as offenders at work are unlikely to support reintegration”.

In 2017, the CoE adopted Rules which require community-based sanctions to be implemented in a way that does not aggravate their “afflictive nature”, because to do so would be unjust. Gratuitously punitive measures “can also be expected to create resistance and unwillingness to co-operate in any attempt to secure the individual’s law-abiding adjustment in the community”. 

The 2017 Rules also require adequate safeguards to protect offenders from “insult and improper curiosity or publicity”, because community-based penalties may expose them to the risk of public opprobrium or social stigmatisation. 

In fact, many people doing unpaid work already wear bibs- Jack Straw introduced the idea in 2008 in one of its  many rebrandings as “Community Payback (CP) ”. 

 A 2016  inspection of unpaid work found that “a small number of offenders expressed concern at having to wear the high visibility tabards as they felt it was stigmatizing” . One told inspectors that “some members of the public see the CP vests and look down on you. I bet they think ‘what’s he done’ or ‘is he a sex offender’. I have said good morning to people and been ignored. But others appreciate what we are doing so that’s good.”

While the Beating Crime Plan may amount to less than the sum of its parts, it actually contains one or two good ideas. The best unpaid work is already delivered in consultation with local partners so requiring schemes to support community objectives and meet identified needs should bolster public confidence.  As the CoE say,  “work should have purpose and wherever possible should be of genuine benefit to the community.”

More problematic is the pledge to increase the use of electronic monitoring. Expanding EM has been promised countless times since then Home Secretary David Blunkett launched the pilot “Prisons without Bars" in 2004. Will this finally be the time for satellite technology to take off?  

The Plan claims that the use of EM has increased substantially over the last year but statistics out this week show that although the number of subjects on EM on any given day has risen over the last 12-months, the number of new orders has not, "indicating subjects are being tagged for longer periods." 

Moreover, in their latest assessments of confidence in various government programmes, the Infrastructure and Projects Authority (IPA) rated the MoJ’s EM project as amber/red. That means it’s in doubt, with major risks in key areas. Urgent action is needed to address problems and/or assess whether resolution is feasible.

The IPA mention specific concerns about delays & the quality of case management being provided by suppliers. Apparently “the Project is working collaboratively with suppliers to identify contingency options”. This does not sound like the strongest basis for the promised expansion.

Late for School?

 

Mixed messages last week about the prospects for the governments flagship Secure Schools initiative. The Infrastructure and Projects Authority reported that the first school  is “on track” to open in December 2022 but the Ministry of Justice Outcome Delivery Plan committed only to a start “by 2023.”  Appearing before the Commons Justice Committee, MoJ minister Alex Chalk gave a somewhat downbeat account of  “of trying to repurpose Medway”, the former secure training centre (STC) which will become the first, and quite possibly only, secure school.

In rather flippant evidence, Chalk told MPs “It is very much more complicated than simply turning the lights on and saying, ‘There you go, it’s a secure school. Off you go.’ There is a huge amount that needs to take place because, as you will appreciate, Ofsted needs to be satisfied that from an architectural point of view it qualifies as a secure children’s home (SCH) , which is materially different from a secure training centre, and there need to be all the paraphernalia of a children’s home—new fire standards and goodness knows what.”

Chalk added that only in September, will there be a final specification “for what it needs to look like, and therefore the final cost. What I can tell you is that the cost is not going down. It is a very expensive undertaking—very, very expensive indeed.”  He complained that “ every time we go round Medway, we find other things that need to be sorted out.”

In terms of further secure schools,  Chalk wondered aloud whether the forthcoming Spending Review would provide the necessary resources. He would not be drawn on whether the currently failing Rainsbrook STC would become the site of the second secure school but thought it likely that the contract for the other remaining STC, Oakhill, would run its course until 2029. That will be  13 years after the Government agreed with Charlie Taylor’s vision that both Young Offender Institutions (YOIs) and STCs “should be replaced in the longer term by smaller secure schools situated in the regions that they serve”.

Chalk raised questions about the viability of that vision even in the long term. “We are going to need to ensure for some time yet that there is a blend of provision, so that all types can be accommodated. In the early stages, the people going into the secure school will be those who are most likely to get the most benefit out of the secure school. We have to keep our wits about us a little. We are talking about 550 of the most complex children anywhere in the United Kingdom, and we want to make sure that there is an estate that reflects that complexity”.

In fact his department’s projections – which don’t include children in STCs or SCHs -are for the population of under 18s in YOIs to rise from 400 last year to 700 in 2026. Given spending constraints, it’s hard to see much scope for reduction in reliance on the use of YOIs. Indeed, MPs were told that the MoJ are already considering placing girls under 18 back into them as a result of the Rainsbrook crisis.

Chalk made some Pollyannaish efforts to reassure the Committee that he would like to see “all our establishments move on a path to saying they are, in effect, places that are rehabilitative and secure, which sounds a bit like a secure school, I suppose, with a strong emphasis on the educational aspects, so that the differences between them do not so much fade away into irrelevance but are perhaps not quite as stark as in the past.” I don’t think that’s quite what Charlie Taylor had in mind.

There is an outside chance that a stalling youth justice reform programme in the MoJ could be offset a little if the Education Department start to expand the number of SCH beds. Since 2002, 16 secure children’s homes have closed. At any one time, around 25 children each day are waiting for a secure children’s home place and around 20 are placed by English authorities in Scottish secure units due to the lack of available places.  

Remedying the shortage of SCH places might prove more sensible than pursuing the Secure Schools programme.  And perhaps  more attractive to Chalk and his Department who would not have to pay for it,  up front at any rate. 

Crisis in Youth Custody?

 

The task of finding alternative placements for the 33 children held at the unsafe Rainsbrook Secure Training Centre (STC) looks more challenging given today’s inspection report about the only other STC,  G4S run Oakhill in Milton Keynes.  

The Oakhill  inspection, prompted by two serious, violent incidents in which several staff suffered significant injuries, found that for a short period in the spring  “senior managers were in danger of losing control across the centre”. Inspectors were told that one of the factors leading to the instability was the arrival of a small number of children originally allocated to Rainsbrook after admissions there were halted.

Although by the time of the inspection at the end of last month, children at Oakhill were experiencing a calm, structured daily routine, because “uncertainties remain in the centre’s capacity to achieve a sustainable reduction in violence”, it would seem risky to move more than a very small number of  Rainsbrook residents there now.  Inspectors report that a high number of staff have left, many without notice after completing their induction programme and “a significant number have been dismissed”. The recruitment of new staff has not replenished the shortfall, which has been compounded by high sickness levels.  

There should be some options instead to move the Rainsbrook children to secure childrens homes, by far the best institutions in the closed estate for under 18s. At 31 March 2021, the Ministry of Justice were contracting  107 places in seven homes but only 55 children were placed in them by the Youth Custody Service (YCS). It is puzzling why the use of SCHs has fallen – 80 children were placed in them by the YCS a year earlier. 

The ultimate decision whether to admit a child rests with the SCH provider who must comply with Children Act regulations requiring them to accept only children whose needs they can meet alongside children already placed within the home. A recent study has found that “in practice, they will resist taking too many children with the same needs or risks, including those with sexually harmful behaviour.”  But most of those who have been at Rainsbrook should be moved to an SCH.

 If the YCS cannot reach agreement with secure childrens homes about all of the Rainsbrook children, they may look at transferring them to one of the five Young Offender Institutions, four of which are run by the prison service and one by G4S. Given that  “STCs hold children who are deemed to be too vulnerable to be put into YOIs”, it would be hard to square such moves with “the aim of promoting children’s safety and ensuring decisions are made with children’s best interests as a primary consideration” as placement guidance requires. But at the end of the day, such decisions are made  “against a view of the available accommodation”.  

At least as far as Detention and Training Orders are concerned , placements could conceivably be made not only in STCs, SCH’s and YOIs, but “such other accommodation or descriptions of accommodation as the Secretary of State may specify by regulations”.  Maybe it is time to explore these.

Ironically, this mess arises in the context of some good news. At the end of April 2021, the number of children under 18 in custody was 493, the lowest since records began. This is a decrease of 23 compared with the previous month and 171 fewer than in April 2020.  Despite this welcome and sustained  fall in numbers - there were nearly 3,000 children locked up 15 years ago- the failure to invest the savings in expanding and developing secure childrens homes together with the glacial progress of the new Secure School has exposed a fundamentally broken system.

Rainsbrook Secure Training Centre: What Next?

 

The Justice Secretary’s decision last week effectively to close Rainsbrook Secure Training Centre marks another low in the recent history of youth custody. Robert Buckland was left with little choice when Ofsted told him that the STC is unsafe for children and staff and had in some respects deteriorated since the end of last year when inspectors condemned a bleak and spartan regime, which despite assurances had not been adequately addressed.

Buckland made clear to the Justice Committee in March that he did not like being played for a fool and this time has taken decisive action. The American company running Rainsbrook  strongly refute Ofsted’s latest findings  and plan to vigorously challenge them but it is not clear how. They might try to seek a second opinion- then provider G4S controversially did this after a critical report in 2015- but it looks too late for that .   

Important questions remain.

First, where will the 33 children currently placed at Rainsbrook be placed?  They have all presumably been deemed too vulnerable to be put into Prison Service Young Offender Institutions . There is only one other STC in operation – Oakhill  run by G4S which at the end of last year was found “to require improvement to be good”.  This year Oakhill has experienced high levels of violence with senior managers "in danger of losing control across the centre". There are not likely to be sufficient places in Secure Children’s Homes to accommodate the children from Rainsbrook.

MPs should ask the Justice Secretary to report on exactly what safe, alternative accommodation has been found for them by the Youth Custody Service (YCS) . The law allows the Secretary of State to designate suitable non secure accommodation in which a Detention and Training Order can be served, and his officials should be advising him to explore this option rather than resort to YOI places.

Second, is Buckland open to giving MTC yet another chance?  He says that negotiations are ongoing on the future of the contract, but it looks like trust has all but broken down. A new MTC managing director - a respected former prison service manager- gave undertakings at the Justice Committee in March but Ofsted’s findings cast serious doubts about their value. Inspectors for example report that the STC director and senior leadership team “are not visible to staff and children, failing to provide them with guidance and reassurance”.  This was one of the main concerns raised earlier in the year which the new management promised to fix.  That they have not done so makes it hard to see how MTC can continue.

Moreover, given the repeated shortcomings over several years, it is still puzzling why the contract with MTC was extended early in 2020 for an extra two years- taking it up to May 2023. The Justice Committee are due an explanation from the MoJ by the end of June for what the MPs consider to be a serious error of judgment. Even if the matter  is overtaken by events, they should pursue it. Not only is there a question about ministers’ involvement in the decision but also about the role of the Head of the YCS, who it turns out used to work for MTC.

Third, what will happen if the contract is terminated?  Buckland says options may include bringing the STC back under public sector control or repurposing the site for alternative use. It has become increasingly clear that the STC model looks broken- two of the four Centres have already closed and the future ostensibly lies in the development of Secure Schools. The first of these – Oasis Restore- is due to open next year on the site at Medway in Kent which housed the first STC. Could Rainsbrook – the second STC- be turned into the second Secure School?

Alternatively, the site may be used as prison accommodation for adult or young adult prisoners. Medway has been used in this way during the pandemic pending its conversion to the Secure School. The government’s plans for 18,000 new prison places includes 400 from “estate conversions” so this cannot be ruled out.

A few years ago while on a visit to North Carolina, I spent an afternoon at the Art Gallery where a neighbouring sculpture park and trail  had been created on the former site of the Polk Youth Prison for juvenile offenders . One of the installations was made from the institution’s bricks. Could that be another option for Rainsbrook ?