Source · IMB Annual Report

Downview

Year: 2023 Published: 1 Sep 2023 Type: Prison · Cat closed women's YOI Recommendations: 19 Key concerns Positive findings

HMP/YOI Downview experienced a challenging reporting year marked by significant operational changes and an increase in prisoners with complex mental health needs, leading to increased self-harm and use of force incidents. While staff demonstrated compassion, issues like delayed mental health transfers, inconsistent medication distribution, and an un-embedded key worker scheme persisted. The Board expressed concerns about population pressures, property loss during transfers, and a reactive approach to the new transgender policy.

Safety statistics

Incidents during reporting year

Indicator	This year	Previous
Deaths in custody	1	—
Self-harm incidents	1,153	752
ACCT cases opened	217	240
Prisoner assaults	24	14
Assaults on staff	31	32

Positive findings

The Board observed a culture of compassion, particularly from Governor level and among CSU officers, despite significant challenges. There was effective work from the new employment hub, leading to positive ROTL opportunities and CV creation. The induction process and library services were praised, and a new bimonthly award ceremony for achievements was well-received by prisoners. A positive development was the allocation of places for lifers on the open wing.

Key concerns

20 items

Mental Health Repeated The continuing arrival of an increasing number of women with more significant and complex (including acute) mental health problems has affected all areas and functions of the prison.

Mental Health Repeated The considerable rise in the number of prisoners being transferred to the prison, often from HMP Bronzefield, who exhibit more challenging mental health symptoms and consequent behavioural issues is causing safety concerns. Prison is not an appropriate environment for these women and staff do not have the appropriate training to manage them.

Mental Health Repeated Severely mentally unwell women arriving at the prison sometimes face long delays in transfer to psychiatric secure units, following assessment.

Overcrowding Repeated Towards the end of the reporting period, we started to see the effect of population pressure, with more women being transferred into the prison, sometimes with unsuitable profiles. This is starting to have a significant effect on the operation and safety of the prison.

Equality/Diversity We are concerned about the effect of the new transgender policy on the operation of, and resource planning, for E wing (and Downview generally). It appears to be managed in a reactive manner by HMPPS centrally.

Resettlement/Release We routinely see unnecessary disruption when women transfer prisons (to their monies; telephone access to family and friends; their property; and educational progress). Transferring between prisons is a stressful event which is being exacerbated by basic administrative processes not functioning.

Other There seems to be some limitations in communication between HMP Bronzefield and the prison (for example, with regards to transferred prisoners with significant mental health conditions and with missing property and medication issues). Is this because HMP Bronzefield is a private prison, and systems and processes may not be compatible?

Healthcare We have been made aware at times of significant resistance from HMP Bronzefield and HMP Peterborough to accepting transfers from Downview of women requiring hospital support.

Other Property applications are rising significantly – the new prisoners’ property policy framework appears to have had no effect in resolving the issue.

Healthcare We understand that there is no commissioned provision for dementia testing in prisons. Given the trend towards a rising ageing population in prison, how will this be resolved?

Other Applications relating to missing property have increased significantly.

Staffing The Board is concerned about the implementation of key working. What local actions are underway to ensure that key working is functioning effectively across the prison?

Other At the end of the reporting period, the meeting schedule was in its sixth iteration since the previous summer. However, meetings are often cancelled at short notice and are often not well-attended. There is minimal process in evidence regarding attendance, the timely circulation of minutes and accountability for action points.

Staffing A lack of consistency in the application of prison rules by staff is frequently mentioned by prisoners during our monitoring. This may be exacerbated by staff inexperience and the ongoing regular staff redeployment.

Healthcare There are no privacy curtains in the consulting rooms in healthcare.

Safety We saw a sharp increase in use of force towards the end of the reporting period.

Segregation The care and separation unit (CSU) has provided a safe regime. However, we have increasing concerns about the use of the unit for women who have acute mental health conditions, behavioural challenges and substance misuse issues.

Healthcare Problems with medication distribution have the ongoing ability to impact every part of the prison regime.

Education/Purposeful Activity Education attendance has remained lower than desired.

Resettlement/Release We saw ongoing evidence of the challenges for the prison offender management team in getting information from and communication with community offender managers. Probation resources in the community appear to be inadequate.

Recommendations

19 items · 7 repeated

#	Recommendation	Addressee
1	As commented on last year, the considerable rise in the number of prisoners being transferred to the prison, often from HMP Bronzefield, who exhibit more challenging mental health symptoms and consequent behavioural issues is causing safety concerns. Prison is not an appropriate environment for these women and staff do not have the appropriate training to manage them. The Board is particularly concerned about the impact of segregation on these vulnerable individuals. Severely mentally unwell women arriving at the prison sometimes face long delays in transfer to psychiatric secure units, following assessment. The Board notes with concern that the draft Mental Health Bill (which would ensure that applicable women are transferred within an appropriate time scale) has not yet been introduced to Parliament. If the prison is to continue to be expected to manage mentally unwell women, it is seriously recommended that a major review of both staffing and facilities takes place. Will the Minister speak to colleagues in the Department for Health and Social Care to ensure prisoners receive timely access to specialist mental health facilities, where required? Repeated Response We were told that the draft Mental Health Bill would improve the support for women with acute mental health needs. We were told that NHS England was working proactively on the issue. The Bill is still awaiting approval. The number of women and the complexity of their needs has increased. We have seen no evidence of this.	Other
2	Towards the end of the reporting period, we started to see the effect of population pressure, with more women being transferred into the prison, sometimes with unsuitable profiles. This is starting to have a significant effect on the operation and safety of the prison. As we raised in our 2019-20 report, the Ministry of Justice Female Offender Strategy (2018) sets out the Government’s vision to see fewer women entering the justice system – can the Minister clarify what steps are to be taken to implement the recommendations in the strategy to manage the rising population pressures in the women’s estate? Repeated	Other
3	We have seen evidence of unhelpful intervention by the Secretary of State for Justice in decision-making regarding women’s progression. We welcome the recent reversal in this area3, but query whether this would also extend to the situation referred to in section 7.3.	Other
4	We are concerned about the effect of the new transgender policy on the operation of, and resource planning, for E wing (and Downview generally). It appears to be managed in a reactive manner by HMPPS centrally. Given that the population in E wing is expanding, as of the end of the reporting period, how can this be more effectively managed?	Other
5	We routinely see unnecessary disruption when women transfer prisons (to their monies; telephone access to family and friends; their property; and educational progress). Transferring between prisons is a stressful event which is being exacerbated by basic administrative processes not functioning.	HMPPS
6	There seems to be some limitations in communication between HMP Bronzefield and the prison (for example, with regards to transferred prisoners with significant mental health conditions and with missing property and medication issues). Is this because HMP Bronzefield is a private prison, and systems and processes may not be compatible?	HMPPS
7	We have been made aware at times of significant resistance from HMP Bronzefield and HMP Peterborough to accepting transfers from Downview of women requiring hospital support – how can this be managed more effectively?	HMPPS
8	Property applications are rising significantly – the new prisoners’ property policy framework appears to have had no effect in resolving the issue. How will the situation be improved by the new national framework? Given that so many other areas of prison operations are managed via national performance indicators, could property management be added to these?	HMPPS
9	We understand that there is no commissioned provision for dementia testing in prisons. Given the trend towards a rising ageing population in prison, how will this be resolved?	HMPPS
10	Does the prison consider there to be a benefit in the healthcare/prison partnership meetings and, if so, will appropriate resources be dedicated to them? Repeated Response We were not provided with a response. See section 6.1.	Governor / Director
11	Applications relating to missing property have increased significantly. Would it be possible to appoint a single point of contact to be responsible for property matters? This may secure better co-operation from transferring prisons and more accountability for the resolution of issues.	Governor / Director
12	The Board is concerned about the implementation of key working. What local actions are underway to ensure that key working is functioning effectively across the prison?	Governor / Director
13	At the end of the reporting period, the meeting schedule was in its sixth iteration since the previous summer. However, meetings are often cancelled at short notice and are often not well-attended. There is minimal process in evidence regarding attendance, the timely circulation of minutes and accountability for action points. Staff have sometimes commented that meetings are arranged for meeting’s sake, with little positive impact on outcomes for the prison.	Governor / Director
14	A lack of consistency in the application of prison rules by staff is frequently mentioned by prisoners during our monitoring. This may be exacerbated by staff inexperience and the ongoing regular staff redeployment. Staff tell us they feel undermined and less confident in maintaining safety, and prisoners cite frustration at perceived unfairness when senior managers overrule decision-making (sections 5.3, 5.6).	Governor / Director
15	There are no privacy curtains in the consulting rooms in healthcare (section 6).	Governor / Director
16	lack of infrastructure for digital education. Repeated Response See letter from the Minister dated 30th November 2022 as published on the IMB website. We have seen no evidence of improvement.	Other
17	healthcare complaints management. Repeated Response We were not provided with a response. See section 6.1.	Governor / Director
18	delivery of the contracted family engagement resource. Repeated Response We were not provided with a response. See section 7.4.	Governor / Director
19	lack of support for the Listeners scheme. Repeated Response We were not provided with a response. See section 4 (Safety).	Governor / Director

Applications to the IMB

Category	Current	Previous
Accommodation (including transfers)	45	38
Disability	0	0
Discipline	6	5
Drugs & alcohol	6	4
Facilities / regime	34	29
Food	3	2
Healthcare	114	91
Legal	56	34
Other	97	26
Pay / earnings / private cash	12	12
Property	87	61
Property – other establishments	122	32
Race relations	0	0
Religion	0	0
Security	3	2
Sexuality	0	0
Staff	51	32
Total	693	378
Transgender	0	0
Visits	0	0
Work / education / training	17	10

Related inspections & investigations

— PPO fatal incident Lee-Ann Stent · Other non-natural

— PPO fatal incident Fay Newman · Natural causes

29 Jun 2024 PPO fatal incident Susan Simpson · Natural causes

24 May 2023 PPO fatal incident Kirsten Hocking · Other non-natural

— PPO fatal incident Niarena Ryan-Harriott

27 Oct 2014 PFD Cherylin Norrell-Goldsmith · State Custody related deaths

Other reports for Downview

2025 Published 3 Sep 2025 Population 319 · Self-harm 728 · Concerns

2024 Published 3 Sep 2024 Population 324 · Self-harm 1,171 · Concerns

2022 Published 10 Oct 2022 Population 265 · Self-harm 752 · Concerns

2021 Published 29 Sep 2021 Population 219 · Self-harm 369 · Concerns

2020 Published 19 Oct 2020 Population 287 · Self-harm 659 · Concerns

Report details

Establishment: Downview
Type: Prison · Cat closed women's YOI
Report year: 2023
Published: 1 September 2023
Responsible body: HMP Downview
Recommendations: 19
MoJ rating (2024/25): 3 — Good

Population

Operational capacity

356

Service providers

Catering

Aramark

Chaplaincy

HMPPS

Cleaning and laundry

Interserve

Custodial staff (training)

Prison Officer Training College (POELT)

Education

Milton Keynes College

Escort contractor

Geo Amey

Healthcare

Central and North West London NHS Foundation Trust (CNWL)

IMB Secretariat

MoJ

Maintenance

Amey

Pharmacy

Alliance Healthcare

Recruitment

HMPPS

Utilities

HMPPS

Source links

IMB report page → imb.org.uk →