Care home safety and capacity

HMP Birmingham has shown significant improvement in safety and stability under new leadership, making it the safest it has been in years, despite challenges posed by the Covid-19 pandemic. Healthcare provision is good, and peer support systems are strong. However, key concerns persist regarding the inhumane nature of prolonged in-cell lock-up, the high levels of use of force, and persistent issues with long stays in segregation. Other areas needing development include support for homelessness on release, addressing learning difficulties, and ensuring equity in the IEP scheme.

The Dover Independent Monitoring Board raises urgent concerns about the continuing and worsening conditions at Tug Haven, Kent Intake Unit (KIU), and Frontier House. Facilities are severely overcrowded, leading to migrants, including vulnerable children, sleeping in unheated and unsanitary tents. Significant issues with undetected injuries, inadequate medical screening, and insufficient healthcare staffing are highlighted, along with staff demoralisation and safety incidents stemming from the challenging environment.

HMP/YOI Styal successfully managed Covid-19 spread and saw a significant reduction in self-harm, with healthcare and perinatal care provision improving. However, the Board highlighted critical staffing shortages impacting regime and services, persistent decency and fire risks in residential houses, and challenges in managing prisoners with severe mental health needs. Concerns were also raised regarding medication administration, changes to resettlement contracts, and the distress caused by the parcel ban.

HMP Whatton, a Category C training prison for sexual offenders, commendably maintained a fair and humane routine amidst Covid-19 restrictions, with staff efforts appreciated. Despite improvements in areas like the complaints system and a decrease in self-harm, significant concerns persist regarding the impact of prolonged 22-hour cell lockdowns on prisoner wellbeing, the substandard B wing accommodation, and backlogs in accredited programmes and transfers. Healthcare faced staffing and facility challenges but delivered community-equivalent services.

HMP Coldingley, a men's Category C resettlement and training prison, has largely recovered from pandemic restrictions, with prisoners now enjoying increased time out of cell and positive staff-prisoner relations. While refurbishment plans are underway and healthcare is well-regarded, significant concerns persist regarding the high volume of illicit items, the continued absence of in-cell sanitation in older wings, and the inadequacy of educational provision. The Board also highlights issues with prisoner property management, disproportionate use of force against Muslim prisoners, and a lack of control for the Governor over infrastructure projects and education contracts.

The IMB has grave concerns about HMYOI Werrington, deeming it unsafe for both young people and staff due to a significant increase in violence, including assaults and weapon making. Low staffing levels and sickness led to a severely restricted regime, particularly at weekends, with young people spending excessive time locked in their rooms. Education provision was inadequate, and staff-young person relationships deteriorated.

The IMB for HMP Wayland concludes that the prison continues to be failed by the Prison Service and the government across multiple areas, from infrastructure maintenance to adequate staffing and training. The report notes a decline in the quality and effectiveness of prisoner treatment, with key concerns including prisoner safety, deteriorating accommodation, and inadequate resettlement support. While some positive initiatives have begun, the Board finds that fundamental issues persist and require urgent, comprehensive intervention.

HMP Brixton experienced significant challenges in the reporting year, emerging from pandemic lockdowns with a loss of momentum in improvements. An unannounced inspection in March 2022 found the prison 'in trouble', noting declines in safety, respect, and purposeful activity since 2019. Key issues included increased violence, inadequate accommodation, insufficient purposeful activity, and significant difficulties with resettlement, particularly regarding Category D transfers and post-release accommodation.

HMP Wandsworth faced severe challenges in the reporting year, marked by chronic staff shortages leading to a limited and inconsistent regime. The prison recorded significant increases in assaults, self-harm, and ACCT cases, underscoring serious safety concerns exacerbated by easy access to contraband. Inhumane living conditions, including overcrowding, poor heating, and inadequate healthcare facilities (with a new centre remaining unopened), persisted, while vital services like library access and resettlement support were also hampered by understaffing.

HMP Belmarsh faced significant challenges during the Covid-19 pandemic, leading to severely restricted regimes and increased pressure on staff. While the Board commended the prison's management of the pandemic and the removal of three-man cells, concerns persist regarding mental health provision, staffing shortages, and the slow reintroduction of purposeful activity. Key areas for development include improving diversity and inclusion, reforming the complaints process, and addressing conditions in the High Security Unit.

HMP/YOI Bronzefield operated under severe Covid-19 restrictions, impacting prisoner well-being and regime delivery, exacerbated by staff absences. Despite these challenges, the prison managed the pandemic effectively, improved mental health transfers, and achieved Hepatitis C elimination. However, concerns remain regarding escalating self-harm incidents, a high number of prisoners released without accommodation, the prison's use as a 'place of safety' for mentally unwell women, and persistent drug ingress.

The reporting year at HMP Brixton was dominated by COVID-19, leading to severe restrictions on the prison regime, impacting prisoners' mental health and resettlement opportunities. Despite significant efforts by staff and healthcare to maintain services and well-being, concerns persisted regarding the suitability of the offender flow system, inadequate accommodation for older prisoners, and a lack of D-category prison places. While self-harm incidents slightly decreased, assaults on staff increased, and substance misuse remained a challenge, with the Board commending positive aspects like food quality, staff commitment, and progress in education.

HMP Berwyn, a category C resettlement prison, experienced its first period near full operational capacity during a reporting year largely impacted by the Covid-19 pandemic. Despite restrictions, the IMB found the establishment safe with generally good staff-prisoner relationships and efforts made to provide education and essential work. However, significant concerns persisted regarding infrastructure defects (heating, paint), lengthy healthcare waiting times, and delays in transferring prisoners with mental ill-health or those eligible for Category D.

The IMB report for Gatwick, Stansted, Luton airports and Lunar House covers the period ending January 2022, noting a significant increase in detained individuals. While C&C officers are generally compassionate, the Board highlights ongoing concerns about the inadequacy of holding rooms at all locations for increasing numbers, extended stays, and vulnerable individuals. Key issues include limited space, lack of natural light, absence of showers, and persistent problems with access to onsite healthcare professionals and timely medication.

The IMB report for Heathrow IRC (Jan-Dec 2021) identifies generally safe conditions but raises serious concerns regarding the management of Short-term Holding Facility (STHF) detainees, particularly South Coast Arrivals (SCAs), which compromised safety and humane treatment. Significant issues include the inappropriate detention of individuals with severe mental health needs, a critical lack of engagement from the Detention Engagement Team (DET), and unacceptably prolonged detention periods for many. The Board calls for urgent policy reviews, capital investment in infrastructure, and improved communication and service provision to address these systemic problems.

This report for HMP Hull, ending February 2022, highlights a challenging period marked by the ongoing impact of Covid-19 restrictions, which limited IMB monitoring capacity and led to significant staff absences. While safety metrics showed reductions in violence, self-harm, and use of force, serious concerns remain regarding healthcare provision, which was deemed failing by HMIP and led to contract termination. Other critical issues include insufficient cell capacity, restricted key worker support, and ineffective resettlement pathways due to poor external agency communication.

HMP Wandsworth, a severely overcrowded reception prison holding 1,385 prisoners against a CNA of 961, faced significant challenges during the reporting period. Critical staff shortages severely impacted regime delivery and contributed to the prison being deemed unsafe due to rising violence and self-harm. Living conditions in the dilapidated Victorian buildings remained inhumane, while healthcare services suffered from long waiting times and poor inpatient facilities, and resettlement support for the majority remand population was inadequate.

HMP Winchester, a complex local B/C category prison, continues to face significant challenges, including high levels of violence and self-harm, a restricted regime with prolonged cell confinement, and critical issues with its outdated building infrastructure. While staff efforts to provide humane treatment are commendable, severe staffing shortages and high turnover undermine consistency and effective key working. The IMB highlights persistent problems such as cell overcrowding, inadequate CCTV, and vermin infestation, which compromise safety and wellbeing despite some recent positive trends in violence reduction and effective pandemic management.

HMP Wymott faced significant challenges from the Covid-19 pandemic, leading to a restricted regime, staff shortages, and increased self-harm incidents. While the Board commended efforts to maintain safety and improve medication delivery, major concerns persisted regarding dilapidated accommodation, persistent issues with prisoner property, and limited access to healthcare, particularly mental health and dentistry. The increasing number of IPP prisoners and challenges with progression and resettlement, including releases without accommodation, remain significant issues for the Board.

The Dover Independent Monitoring Board's 2021 report details critical issues at the Tug Haven, Kent Intake Unit (KIU), and Frontier House Short-Term Holding Facilities. While some initial improvements were noted in induction processes and staff interactions, the facilities were largely unsuitable for their purpose, particularly Tug Haven, which routinely held detainees overnight in overcrowded, unheated tents with inadequate sleeping, washing, and food provisions. Significant concerns were raised about poor hygiene, brief and ineffective medical screenings leading to undetected serious injuries, and excessive lengths of stay, causing distress and confusion among detainees, including vulnerable families and children.

HMP/YOI Sudbury is an open Category D resettlement prison. The Board noted positive improvements in staff-prisoner relationships, healthcare provision, and the availability of work and vocational training opportunities. However, significant concerns remain regarding the extremely outdated accommodation, persistent staff shortages impacting various services, and issues with prisoner property transfers. The report also highlights long dental waiting times and the lack of psychologist services.

HMP/YOI Hatfield, a Category D resettlement prison, was found to be a safe environment with no recorded self-harm, staff assaults, or prisoner assaults during the reporting year. The prison demonstrated excellence in work and education provision, achieving high employment rates on release, and healthcare was well-managed. However, significant concerns persist regarding the poor and unhygienic condition of ablution facilities across both sites and the lack of funding for their essential refurbishment.

HMP Channings Wood reported a largely settled year (Sept 2021-Aug 2022) despite a gradual return to a near-normal regime after Covid-19 restrictions. While self-harm incidents reduced by 17% and total assaults remained similar to the previous year, the use of force increased by 27%. Key concerns highlighted include the persistent challenges in mental healthcare, specifically accessing specialist placements, the ongoing issue of lost prisoner property during transfers, and the ineffectiveness of the key worker scheme in supporting sentence progression. The Board commended efforts in E&D, chaplaincy, and health and wellbeing initiatives while noting that many cells and showers need refurbishment.

This report highlights a period of significant challenges and some positive developments at HMYOI Cookham Wood. While improvements were noted in aspects of healthcare and staff dedication, major concerns persist regarding the inhumane regime, severe staffing shortages, and prolonged periods of isolation for boys. The IMB raises critical questions to the Minister, Youth Custody Service, and Governor regarding these systemic issues, emphasizing the impact on the safety, welfare, and progression of young people in custody.

HMP Chelmsford, a category B local prison, showed mixed performance in the reporting year ending August 2022. While levels of violence and self-harm decreased, and there were no deaths in custody, significant concerns persist regarding overcrowding (49% of prisoners sharing single cells) and long-standing issues with lost prisoner property. Staff shortages heavily impacted healthcare appointments, purposeful activity, and key worker effectiveness, contributing to many prisoners spending extended periods locked in cells.

HMP Hewell, a Category B local prison, has shown continued progress in improving safety, cleanliness, and overall humane treatment. Positive developments include enhanced physical healthcare and the establishment of a mental health unit. However, the report highlights persistent challenges such as overcrowding, the poor physical condition of the estate, delays in court proceedings impacting remand prisoners, and slow implementation of a rehabilitative culture, alongside inadequate provision for prisoners with complex needs and disabilities.

HMP Grendon, a Category B therapeutic prison, saw improvements in its regime post-Covid restrictions, with low levels of self-harm, assaults, and no deaths in custody. Staff-prisoner relationships remained excellent, and initiatives in diversity and family contact were strong. However, the prison faced ongoing challenges from a protracted fire safety project, persistent issues with night sanitation, and a noticeable erosion of its therapeutic culture post-pandemic. Significant concerns remain regarding staffing shortages in key areas, delays in transferring men out of therapy, and inadequate governance of healthcare data, all contributing to a difficult operational environment despite the positive progress in other areas.

Yarl’s Wood IRC experienced a shift to a male-only population, including a significant increase in foreign national offenders, during the reporting year. The Board noted an increase in violence, self-harm incidents, and use of force, alongside persistent challenges with staff recruitment, retention, and communication due to language barriers. While healthcare provision was largely commended, concerns remain regarding the length of detention, delays in bail releases, and the need for more comprehensive planning for release and resettlement, particularly for FNOs.

The IMB annual report for Heathrow Immigration Removal Centre (HIRC) for 2022 highlights persistent issues despite generally safe conditions. Key concerns include the safety implications of processing South Coast Arrivals, the continued detention of individuals with severe mental health issues, and a dilapidated infrastructure leading to major service disruptions and a site evacuation. The report also raises concerns about the quality of food, the inappropriate use of the Care and Separation Unit, and a lack of effective engagement from the Detention Engagement Team.

HMP Wymott faces significant challenges including a rise in violence and self-harm, severe staff shortages impacting safety and regime, and inhumane conditions on A and B wings where refurbishment is repeatedly delayed. Overcrowding forces prisoners to double up in unsuitable cells, while healthcare struggles with inadequate facilities and high agency staff reliance. The Board commends efforts in education and resettlement, and the positive feedback on the new J wing.

The IMB report for Kent Coast STHFs in 2022 documented a year of unprecedented small boat arrivals, leading to significant overcrowding and challenges across Western Jet Foil, Kent Intake Unit, and Manston. A primary concern was the widespread practice of detaining individuals for periods far exceeding the statutory 24-hour limit in conditions deemed unsuitable, particularly at Manston. While staff were commended for their compassion, critical issues persisted regarding lack of privacy for sensitive interviews, inadequate basic provisions, poor sleeping arrangements, and insufficient information for detainees about their processing journey.

This report presents the findings of the Independent Monitoring Board at Glasgow, Edinburgh and Larne House Short Term Holding Facilities for 2020-2021. Overall, detainees are treated respectfully by staff, but the Covid-19 pandemic exposed significant issues, including reactive Home Office guidance, inadequate social distancing, and delayed infrastructure improvements. Key concerns persist regarding healthcare provision (medication administration), disability access, and facility suitability, with numerous recommendations made to address these shortcomings.

Despite a severely restricted Covid-19 regime, HMP/YOI Brinsford is deemed a safe prison where prisoners are treated fairly. While incidents of violence, self-harm, and substance misuse have reduced due to lockdown, persistent issues include delays in transferring prisoners with mental health needs and an education contract that largely failed to meet prisoner requirements for much of the reporting period.

Askham Grange is a safe, open women's prison with a strong resettlement ethos, treating prisoners fairly and humanely, and providing good healthcare. Key concerns include the delayed decision on the prison's future, the potential removal of popular single-occupancy pods, and the ongoing transfer of women with short sentences, which hinders resettlement efforts.

Warren Hill maintained a safe environment despite Covid-19 constraints, effectively managing outbreaks and promoting positive staff-prisoner interactions. The IMB commends the prison's efforts in harmonising regimes and establishing on-site approved premises. However, persistent issues with food provision, the suspension of the ROTL pilot, and challenges related to prisoner property and in-cell telephony remain significant concerns, along with the impact of recent parole changes on prisoner morale and progression.

HMP Whitemoor, a maximum-security prison for Categories A and B men, faced significant challenges in the reporting year ending May 2022, primarily due to a severe staffing crisis affecting all areas, including healthcare. This led to compromised regimes, particularly in the overcrowded segregation unit where severely unwell prisoners were held awaiting hospital transfer, and an inadequate purposeful activity and education offer. The Board also noted persistent issues with food provision and long waiting times for specialist healthcare appointments.

HMP/YOI Bedford faced significant challenges during the reporting year, operating under "restrict" regimes due to COVID-19 and staff shortages, leading to widespread cell confinement. While positive steps were made in safety initiatives, particularly with a new young adults' wing and improved ACCT processes, the prison continues to struggle with high levels of self-harm and violence. Mental health services are critically under-resourced and inadequate, further exacerbated by persistent overcrowding and delays in relocating the inhumane segregation unit.

HMP Bristol has demonstrated positive improvements in safety, with reductions in self-harm and staff assaults, and effective Covid-19 management. However, the prison continues to face significant challenges, including an insufficient staffing budget and high non-effective rates that frequently impact regime delivery, purposeful activity, and key worker provision. Concerns persist regarding the Victorian infrastructure, particularly poor disability access and heating issues, alongside prolonged waits for specialist mental health transfers and an ongoing problem with lost prisoner property.

HMYOI Wetherby faced significant challenges during the reporting year, including persistent staffing shortages which severely impacted the regime, leading to limited time out of cell, particularly in evenings. The Board noted concerning levels of violence, self-harm, and the continued problem of weapon creation. Additionally, there were unacceptable delays in transferring young people with complex mental health needs and significant evidence of racism. Despite these challenges, the Board commended positive staff-young person relationships, good physical healthcare provision, and welcome investments in the estate and engaging educational programs.

HMP Elmley, a local prison, navigated Covid disruptions to improve prisoner experience and reduce violence through increased key work and a young adult strategy. While the Board noted improvements in safety scrutiny, complaint resolution, and resettlement opportunities, significant concerns remain regarding the treatment and information provision for foreign national prisoners by the Home Office. Other challenges include the poor condition of the prison estate, persistent staffing shortages across key departments, and inadequate activity spaces impacting rehabilitation efforts.

HMP Forest Bank transitioned to a reception and resettlement prison, facing challenges from Covid-19 impacts and staff shortages, though a comprehensive reform programme has since improved conditions. Violence and self-harm levels began to decrease, and purposeful activity, alongside time out of cell, increased significantly by the end of the reporting period. While healthcare provision maintained a good standard, mental health transfer waiting times remained a significant concern.

HMP Ford is largely deemed a safe environment with fair and humane treatment, effective healthcare, and strong resettlement efforts. However, significant concerns remain regarding unsuitable prisoner arrivals, chronic understaffing in Probation, and a deteriorating prison estate, including outdated accommodation and delays in new builds. The Board also highlights issues with procurement, the lack of consistency in property rules nationally, and challenges in catering and post-release accommodation.

Hollesley Bay is an open Category D YOI prison commend for its safe and humane treatment of prisoners, effective COVID-19 management, and progress in equality and resettlement. The introduction of the 'sequencing' regime has provided a more structured approach to learning and external employment. However, the report highlights concerns regarding the prevalence of multiple-occupancy cells, significant backlog in estate maintenance, and perceived inadequacy of food provision. Healthcare delivery is generally satisfactory, though high DNA rates for appointments due to communication issues and dental waiting times require attention.

HMP Gartree experienced an increase in assaults and self-harm incidents during the reporting year, alongside nine deaths in custody. The Board raised significant concerns about the lack of progress on essential infrastructure improvements, the quality and availability of purposeful activity, and delays in mental health transfers. Positive developments included improvements in the complaints system and effective detection of illicit items, but staffing retention and the lack of data to assure healthcare equivalence remain challenges.

HMP/YOI Isis, a training prison for young adults and Category C men, housed around 600 prisoners in 2022. The Board noted an encouraging drop in self-harm and decreasing trends in violence and use of force, alongside effective healthcare leadership. However, significant concerns remain regarding persistent staffing shortages, insufficient time out of cell, and poor provision of purposeful activity and accredited rehabilitation programs, which hinder prisoners' progression and resettlement.

HMP Frankland, a high-security training prison, has operated near its 852 capacity. The Board noted positive developments including staff efforts to maintain safety, the continuation of social video calls, and strong educational engagement. Key concerns include chronic healthcare staffing shortages, persistent issues with property tracking, the ingress of illicit drugs, and the impact of heating problems on workshop availability.

HMP/YOI Hindley was deemed a safe environment with reduced violent incidents, but persistent staffing shortages led to extended lockdowns, negatively impacting prisoner wellbeing and mental health. The Board noted an increase in use of force and concerns over delays in parole hearings and inquests. While healthcare was satisfactory, low purposeful activity engagement and a lack of a clear incentives scheme remain significant issues.

HMP Huntercombe returned to a full regime in 2022, and the Board commended staff for their work. However, significant concerns remain, particularly regarding the ongoing detention of foreign nationals beyond their sentence expiry due to Home Office delays in processing deportation orders. The prison also faces challenges with an antiquated heating system, water ingress in healthcare, reduced education provision due to staffing, and issues with inter-prison property transfers.

HMP Garth, a Category B training prison, grapples with severe staff recruitment and retention issues, resulting in a largely inexperienced workforce and an ineffective key worker scheme. The restrictive regime, a consequence of staffing problems and post-pandemic recovery, limits prisoners' time out of cell and access to purposeful activity. Key concerns include the deteriorating estate, inadequate provisions for disabled individuals, and the persistent challenges faced by IPP prisoners, alongside ongoing issues with property transfers and an understaffed Offender Management Unit.

HMP Winchester made steady progress in a challenging environment, marked by improved staff numbers and a positive shift in culture, yet persistent issues with its Victorian infrastructure and overcrowding remain. While self-harm incidents decreased overall, the number of individuals involved increased, and prisoner-on-prisoner assaults rose. Healthcare experienced staffing shortfalls affecting GP and dental waiting times, and activity placements remained inadequate for the population. Key concerns include the dilapidated estate, resettlement support, and delays in critical infrastructure projects.

With the large number of elderly prisoners in the custodial estate (particularly in prisons such as Ashfield), cases of dementia and terminal illness requiring 24-hour care are increasing. The specific needs of these prisoners cannot be adequately met in normal prison conditions. What plans does the Prison Service have for addressing this issue through the creation of specialist custodial centres?

The Government should address the physical needs of the ageing prison population, including social care provision, accessibility, purposeful activity for retired prisoners and end of life care.

That, with regard to Covid-19, an assessment is made of the capacity of the EDI and GLA HRs to provide safe distances between detainees and staff, and that maximum numbers are clearly displayed at the entrance to each HR.

We recommend the Home Office, in conjunction with the facility contractor, review the official capacities in line with standards such as the Health and Safety Executive’s guidance on appropriate minimum workspace standards.

When will the Minister improve the range of support services for an increasing number of very frail elderly prisoners (80+ years) who have complex physical, mental health and social care needs? Does the Minister consider that prison is a suitable environment for this cohort of prisoners? If not, what are the alternatives?

The Board believes that appropriate accommodation for the aged and disabled prison population needs to be a significant consideration in the final decision of the replacement for G wing.

The Board recommends that provision is put in hand to deal with the problems arising from the Victorian infrastructure for the increasing numbers of frail older people, particularly those with dementia, end of life care and disabled prisoners.

In view of the decision taken to increase the capacity of Guys Marsh significantly, will the minister ensure commitment to all the agreed redevelopment, without compromise?

Given the ageing prison population and a growing number of prisoners being diagnosed with dementia, can consideration now be given to providing an appropriate physical environment for this group of prisoners along with suitably qualified care workers (para 6.4)?

Given the issues associated with the Victorian infrastructure of the prison, what alternative provisions are being considered for the increasing numbers of frail elderly, particularly those with dementia, end-of-life-care and disabled prisoners?