Hm Prison Holloway

REPORT ON

A FULL ANNOUNCED INSPECTION

HM PRISON HOLLOWAY

8 – 12 JULY 2002

HM CHIEF INSPECTOR OF PRISONS

INTRODUCTION

We inspected Holloway shortly after there had been major staff and management changes. Following an inquiry which had revealed significant problems of bullying among staff, some staff had been moved. A new Governor had been appointed and had put in place a virtually new management team. The prison had also been promised significant numbers of additional staff.

The inspection therefore took place at a time of considerable transition, and in many important areas we were inevitably presented with promises of change, rather than actual and visible improvements. Nevertheless, important parts of the prison’s negative culture had been tackled firmly, an essential basis for further progress.

However, this report chronicles some severe deficits in the prison as it was in July this year; and it was disappointing that so many of them mirrored what we had found on our last inspection, two years before. We raise two separate concerns: one in relation to the regime in general for women in the prison and one specifically in relation to the girls and young women held there.

Throughout the prison, we found serious deficiencies in the regime for women prisoners. Some related to the real and continuing shortage of staff; but in some instances, this was compounded by a lack of flexibility and imagination. For example, it is unacceptable that women, even those who were pregnant or had recently given birth, were frequently unable to shower more than twice a week; and many women had difficulty in obtaining towels and toiletries. Women were also able to have association only twice a week, and therefore had great difficulty in making telephone calls to their families and children.

Staff shortages were primarily responsible for deficits in the otherwise excellent education, activity and PE provision. Classes were frequently cancelled, and some activities had ceased to function with any regularity, due to the inability to provide staff to get prisoners to activities. Visits, too, frequently started late, and were difficult to book;

3 and it was particularly disappointing that the children’s visiting days had been stopped, as staff were not available or profiled for this work.

There continued to be pockets of excellent work: drug detoxification, the outstanding psychology department, and the work with foreign national prisoners were all models for the rest of the women’s estate. However, many other areas of the prison’s life needed developing: first night procedures, work with lifers, sentence planning, healthcare and resettlement were all important areas that needed direction and improvement if the prison was to meet the needs of its prisoners.

We had specific and serious concerns about the small number of under18 year olds held in Holloway. Girls, and particularly sentenced girls, are not supposed to be held in Holloway, and indeed should not be. But they were there. However, as the Youth Justice Board did not purchase places for them, it appeared that no-one had taken responsibility for ensuring that their conditions met the fundamental requirements for holding children in prison. No assessments of vulnerability and risk were being carried out, the regime was wholly inadequate, staff lacked essential documentation, and no training plan meetings were taking place. Staff were doing their best, but without support and facilities and in the face of the considerable difficulties of the prison as a whole. I considered the situation to be so critical that I immediately alerted the Director-General and the Chairman of the Youth Justice Board to request them to take urgent action.

The situation of young adults (18-21) also caused us concern. Once sentenced, they must be held separately from adult women; but inexplicably this is not mandatory while they are held on remand. We found unsentenced young women being held with older women, and that the prison had no effective risk assessments in place to check whether it was safe to do so.

This Inspectorate’s reports have repeatedly drawn attention to the deficiencies in the care of girls in prison in general, and to the situation of young women in Holloway in particular. It is both inexcusable and depressing that these continue, and that it takes an inspection to galvanise those responsible into action. However, this is symptomatic of a system that has yet to grapple with the needs of damaged and vulnerable girls, and which continues to place them in environments that cannot meet their needs. In our view, girls 4 should not be held in Holloway. It is a difficult and complex establishment, which needs to focus on its primary task of providing a safe, positive and well-staffed environment for the diverse and demanding adult population that it will continue to hold. We do not believe that, in the foreseeable future and despite the best efforts of staff, it can also provide an appropriate environment for children, without compromising their care or the needs of the remainder of the prison’s population.

The scale of the challenge faced by Holloway’s new management team is clear from this report. We were impressed by the fact that the team was approaching its task with energy and commitment, determined not to be over-awed by Holloway’s reputation. There was a sense that the culture of the prison was on the move, and a feeling of optimism among some staff and the very committed Board of Visitors. We believed, however, that managers would need considerable support and reinforcement as the scale of the task became apparent.

We recommended to managers that there should be a staged action plan. There was an immediate need to achieve some small but tangible improvements in the care and conditions of women and girls, such as more frequent showers and access to telephones, in order for them to have confidence that further change would follow. Other areas for improvement then needed to be prioritised and implemented in stages, hand in hand with the Prison Service’s commitment to provide additional staff, support and resources. If the process that had been set in motion can be sustained in this way, there is a real chance for Holloway to break out of its vicious circle; but if that process stalls or slips, it will be very difficult to convince prisoners and staff that change is possible, and achievable.

Anne Owers December 2002 HM Chief Inspector of Prisons

CONTENTS

Paragraph Page

INTRODUCTION 3

FACT PAGE 11

HEALTHY PRISON SUMMARY HPS1-HPS47 13

CHAPTER ONE ARRIVAL IN CUSTODY

Courts and transfers 1.01-1.09 23 Reception 1.10-1.50 25 First night 1.51-1.75 30 Induction 1.76-1.90 35 Legal rights 1.91-1.98 37

CHAPTER TWO RESIDENTIAL UNITS

Introduction 2.01-2.12 39 Mothers and their babies 2.13-2.38 42

CHAPTER THREE DUTY OF CARE

Anti-bullying strategy 3.01-3.09 47 Preventing self-harm and suicide 3.10-3.21 49 Race Relations Foreign Nationals 3.22-3.31 52 Detainees 3.32-3.33 55 Race relations 3.34-3.60 56 Substance use 3.61-3.83 60 Maintaining contact with family and friends Visits 3.84-3.111 65 Telephones 3.112-3.114 70 Mail 3.115-3.142 71 Applications, requests and complaints 3.143-3.161 74

Paragraph Page

CHAPTER FOUR JUVENILES AND YOUNG ADULTS

Introduction 4.01-4.09 78 Reception and first night 4.10-4.17 80 Accommodation 4.18-4.25 82 Regime and facilities 4.26-4.36 83 Child protection 4.37 85 Training planning 4.38-4.63 85

CHAPTER FIVE HEALTH CARE

Introduction 5.01-5.07 90 Environment 5.08-5.20 92 Records 5.21-5.26 94 Staffing 5.27-5.44 95 Delivery of care 5.45-5.97 99

CHAPTER SIX ACTIVITIES

Education 6.01-6.17 110 Library 6.18-6.27 113 Physical education 6.28-6.29 115 Faith and religious activity 6.30-6.37 116

CHAPTER SEVEN GOOD ORDER

Introduction 7.01-7.05 118 Use of force 7.06-7.14 119 Segregation unit 7.15-7.28 121 Incentives and earned privileges (IEP) 7.29-7.36 123 Adjudications 7.37-7.41 125 Public protection and the child protection 7.42-7.49 126 unit (CPU) Life-sentenced prisoners 7.50-7.60 127 Categorisation 7.61 130

CHAPTER EIGHT RESETTLEMENT

Introduction 8.01-8.04 131 Key workers (personal officers) 8.05-8.07 132 Sentence planning 8.08-8.17 133 Probation 8.18-8.28 135

Paragraph Page

Release on temporary licence 8.29-8.36 137 Home detention curfew 8.37-8.44 139

CHAPTER NINE SERVICES

Catering 9.01-9.13 141 Prison shop 9.14-9.22 144

CHAPTER TEN RECOMMENDATIONS AND GOOD PRACTICE

Recommendations Main recommendations 10.01-10.07 146 Director General 10.08-10.13 147 Operational Director of Women’s Estate 10.14 148 Youth Justice Board 10.15-10.16 148 Governor 10.17- 148 10.181

Good Practice 10.182- 169 10.199

APPENDICES I Inspection Team II Summary of prisoner questionnaires and interviews III Dental services inspection report IV Pharmaceutical services inspection report V ALI inspection report

FACT PAGE

Role of the establishment Local prison for women

Area organisation Directorate of Women’s Prisons

Average population 486

Certified normal accommodation 510

Operational capacity Normally 532 (492 during rewiring)

Last inspection December 2000

Brief history Originally a mid-19th century prison for men and women, Holloway became an all-female prison early in the 20th century. It was completely rebuilt in the 1970s and 1980s in a style designed at that time to meet what were considered to be the needs of women prisoners (a hybrid between a prison and a hospital). The newly-built prison has been fully functional for only brief periods during the last two decades, mainly due to alleged staff shortages.

Description of residential units Approximately a 50/50 split between single rooms and multi-occupancy dormitories.

Annual cost per prisoner place £40,020

Annual cost per prisoner1 £41,991

1 HM Prison Service Annual Report and Accounts April 2001 to March 2002 13

HEALTHY PRISON SUMMARY

Healthy Prison Summary of 2002 Inspection HPS1 All inspection reports carry a summary of the conditions and treatment of prisoners, based on the four tests of a healthy prison that were first introduced in this Inspectorate’s thematic review Suicide is everyone’s concern, published in 1999. The criteria are: § Safety: prisoners are held in safety § Respect: prisoners are treated with respect as individuals § Purposeful activity: prisoners are fully and purposefully occupied § Resettlement: prisoners are prepared for their release and resettlement into the community with the aim of reducing the likelihood of their re-offending

Safety HPS2 Our chief concern was over the safety and well-being of girls and young adults. Holloway held 13 girls (8 of them sentenced) and 53 young adults. All but three of the girls were on the juvenile unit (D0); many of the young adults were in the main prison.

HPS3 Holloway is not a suitable place to hold girls, and for that reason the Youth Justice Board did not fund places for them there, or therefore regularly monitor their treatment. As a consequence, essential elements of nationally agreed safety and care for children in custody were absent

§ Vulnerability assessments were not carried out § Nor were risk assessments for cell sharing § Residential staff did not have access to essential documentation about the children § Standard YJB first night packs were not available § Unit staff had little awareness of child protection procedures § There was a grossly inadequate regime and inappropriate physical surroundings § There were no training plan meetings and very little contact with Youth Offending Teams § There was little opportunity for young people to have individual attention.

HPS4 The Chief Inspector was so concerned about the vulnerability of these children that, immediately after the inspection, she wrote to the Director General of the Prison Service and the Chairman of the Youth Justice Board, urging immediate action to address this unacceptable situation.

HPS5 We were also concerned about the safety of those young adults who were not held in D0. Before sentence, they would share facilities and sometimes cells with adult women. Yet no assessments of risk or suitability were undertaken, either of the young adults or the women they shared with (even to check whether they were Schedule 1 offenders).

HPS6 It is not surprising that women prisoners who were confined to their cells for the greater part of all or most days often reported that they were subject to fewer physical threats from other prisoners than if they were required to participate in an active regime. In order to improve prisoner safety, the anti-bullying strategy should be made more effective and permeate every part of the regime

HPS7 There were no indications of physical intimidation from staff towards prisoners, nor any overuse of approved techniques for control and restraint.

HPS8 The safety of women prisoners passing through reception at Holloway had significantly improved in recent years and particularly since the last inspection, partly because the reception process was now quicker but also because staff were seen during this inspection to be more evidently aware of the individual needs of the women. It was regrettable that, once processed, some women were seen to be waiting for a long time to be escorted from reception to their living units. There was excellent support provided by PACT, a voluntary organisation whose members looked after the particular needs of women experiencing prison for the first time. However, there needed to be effective first night procedures for all women, regardless of whether or not they had been to prison before.

HPS9 We had major concerns over the inadequate arrangements we observed for completing the Prison Service’s procedures for assessing the suitability of prisoners to share cells and dormitories: the importance of these arrangements working effectively cannot be overemphasised.

HPS10 Receiving relevant and helpful information about the prison and about what is going to happen to them in the first 48 hours and beyond is crucial in helping women prisoners to feel safe and secure. It was therefore disappointing that arrangements for first night and induction were failing to provide that information in a suitably reliable and effective format, with too great a reliance on informal chats between staff and individual women.

HPS11 A priority for Holloway staff was to do everything possible to prevent suicide and self-harm among a population that included a high percentage of vulnerable women. We were generally impressed, as we had been during the last inspection, with the proper attention being given to the Prison Service’s suicide prevention procedures. The needs of vulnerable women were identified, records were well maintained and night staff were aware of those women on their units who needed special observation. We were particularly impressed by the close attention and counselling given to those at risk of suicide and self-harm by members of the psychology department.

HPS12 More generally, we noted the good use of observation books on the living units and the fact that residential staff appeared to have a good working knowledge of the women on their units.

HPS13 An area of good practice was the care given to the very high percentage of women who were received at Holloway while addicted to Class A drugs, mainly heroin. Indeed, the establishment was following Prison Service instructions regarding detoxification arrangements for prisoners more closely than any other that we have visited recently. We also support the Holloway policy of maintenance by prescription of addicts who were likely to be in custody for very short periods.

HPS14 Another very important responsibility for the establishment was to ensure the safety and well-being of babies (17 during this inspection) and their mothers. Child 16 protection procedures and protocols had been prepared but these had not been implemented: nor had the staff received relevant training. In spite of this the physical, emotional and environmental needs of both mothers and their babies were being as well cared for as possible within a closed prison environment. However, we were critical of the long periods that mothers were confined to their rooms (though not locked in) with their babies and the absence of practical resettlement planning.

Respect HPS15 We saw many examples of good relationships between staff and prisoners. For the most part, women had easy access to unit staff when they were out of their cells, although they were confined to them for far too much of the time. We were impressed that staff responded promptly when we tested the cell call bell system on several of the units.

HPS16 Unfortunately, we also observed examples of poor, unprofessional attitudes on the part of some officers and nurses. We understood how easy it was for properly motivated staff to become overwhelmed and exhausted by the amount of attention that they were required to give to women prisoners to compensate for those colleagues who were not pulling their weight. If progress is to be made at Holloway, there needs to be a general acceptance that addressing the individual needs of women prisoners is a shared task for all staff.

HPS17 Cleanliness varied across the living units, with better standards being achieved in those that had been recently refurbished. We welcomed the work in progress to install electric power sockets in cells. This was due to be completed within 18 months and would then enable all women to hire televisions.

HPS18 The largely bare walls of the health care centre corridors and patient rooms contrasted with the bright and cheerful day centre, the latter being far more conducive to the sort of therapeutic environment that should be expected in a prison hospital. Some units had a serious problem of infestation. Pigeons were a menace in most parts of the prison, while cockroaches were prevalent in several units, as confirmed by both prisoners and staff. There were general complaints from prisoners about the difficulties experienced in obtaining sufficient quantities of cleaning materials, which may in part 17 explain the considerable variation in the standards of cleanliness we observed in the cells. The grounds were cleaner and more attractive than when we last inspected the prison.

HPS19 We were shocked to find that, except for those who were employed as cleaners, women on the residential units were frequently unable to get more than two showers a week; this was also the case for women who were pregnant and those who had recently given birth. Together with the difficulties we observed that women had in obtaining towels and toilet requisites, it was clear that the Prison Service’s own decency agenda was not being followed. Establishing consistently acceptable personal hygiene arrangements for women prisoners should be a priority for the new senior management team.

HPS20 The quality of the meals prepared in the kitchen was generally satisfactory but the food was often spoiled because it had lost heat by the time it was served on the residential units. The serveries were poorly managed. There was scope for more consultation with women about the choice of menu. We considered that the arrangements for women to purchase items from the prison shop did not meet their needs effectively and should be reviewed.

HPS21 We met several women who were being held under immigration legislation and who would have been better placed in removal centres.

HPS22 During the inspection, no staff were available to offer women advice about bail or legal services. This was a very serious weakness in a local prison to which a high proportion of the women prisoners were remanded by the courts.

HPS23 We noted that internal adjudications dealt appropriately with women who had been charged with offences against prison rules. The treatment of women held in the segregation unit was generally satisfactory, although shortages of discipline officers meant that women were only able to exercise in the fresh air every third day.

HPS24 The incentives and earned privileges schemes in prisons are intended to encourage prisoners to take responsibility for themselves but the Holloway scheme was failing and should be revised. 18

HPS25 Holloway was well served by the chaplaincy team, which was supported by a multi-ethnic group of volunteers. The chapels and multi-faith room were well appointed and services both at weekends and on weekdays were attended by large numbers of women. The chaplains had an excellent system for handing over cases to each other, thereby ensuring continuity of care.

HPS26 Holloway was failing to comply with Prison Service standards for life- sentenced prisoners. For example, it had no system for the identification of potential lifers among women who were remanded; there were no public protection meetings about newly-sentenced lifers and no annual reviews of progress for those serving life sentences. In our view, at least half of the eight life-sentenced prisoners did not need to be at Holloway and their needs would have been better met elsewhere in the prison estate.

HPS27 We were pleased to find improved arrangements for foreign nationals: there was good provision of translated information in the excellent library; there was a weekly group for foreign nationals and a specialist service on three days a week from Hibiscus (a voluntary organisation working on behalf of foreign nationals).

HPS28 Health care continued to be extremely complex, diverse and challenging. It lacked any sense of cohesion and although there were pockets of very good clinical practice these were not integrated into an overall system. Primary care was fragmented and lacked basic systems. The in-patient area was under a great deal of pressure. Considerable management effort will be required to deliver consistent, good quality health care from competent, well motivated staff.

Purposeful activity HPS29 A healthy prison for women depends on the provision of a consistent programme of relevant activities that meets their needs. Regrettably, at the time of this inspection, the activity centre and physical education programmes, although supported by excellent facilities, had ceased to function with any frequency or regularity due to shortages of discipline staff.

HPS30 The psychology department, however, continued to provide programmes designed to address the multiple needs of women prisoners at Holloway. In our view, the consistently high quality of relevant work produced by this department made it a centre of excellence for the whole women’s estate.

HPS31 The education department for adult prisoners was bright, airy and welcoming. This contrasted with the learning environment for young prisoners, which was unacceptably impoverished. The library was well stocked with a range of books and in languages that catered for the needs of women prisoners. However, as far as education provision was concerned, there was an inadequate range of subjects on offer with too much emphasis on basic skills and insufficient choice for able learners. There were also very limited opportunities for women to gain vocational skills and qualifications. There had been excessive and unacceptable cancellation of education classes and training courses.

HPS32 Physical education facilities were excellent but too rarely used.

Resettlement HPS33 A resettlement committee had been formed with appropriate representation from within the establishment and from community organisations that would be able to assist the development of practical schemes to help women readjust to their circumstances after discharge and reduce the likelihood of their re-offending. However, there was a great deal for this committee to do because, at the time of this inspection, there was very little of practical value taking place.

HPS34 Sentence planning was almost non-existent and, with the exception of the work of specialist departments such as psychology and probation, we had very little sense of the individual needs of women being assessed and addressed during their stay at Holloway. This should be a key objective in taking the prison forward and a personal officer scheme should form part of the resettlement strategy.

HPS35 On first reception, women received a free telephone card and were able to contact their families within their first hours in the prison. However, it was much more difficult for them to have proper access to telephones once they were located on their 20 residential units. For most women, telephones were only available during association, which, at the time of the inspection, occurred only twice a week on weekdays. This seriously curtailed telephone contact with families, including dependent children. The chaplaincy team and other specialists did what they could to help maintain family links but women should be able to use the telephone daily for such purposes if they have the necessary funds.

HPS36 Access to the booking arrangements for visits was very difficult and needed urgent improvement. The well-run visitors’ centre was a valuable facility for families and friends, not least for children. The waiting area for visitors inside the prison was shabby and needed refurbishment. Visits frequently started late. We observed that the approach of staff towards visitors was both professional and friendly. However, we were disappointed to find that there were no evening visiting times and that the much admired children’s visiting days had also been stopped due to general shortages of discipline staff, particularly at weekends.

Conclusion HPS37 This inspection revealed a large number of weaknesses in the treatment of women prisoners at Holloway: some were fundamental and should be addressed urgently. Equally, there was excellent work to be seen, much of it delivered by specialist staff or voluntary organisations. Readers will note the similarity between the summary of the 2002 inspection and that of the previous inspection carried out in 2000.

HPS38 That report also drew attention to the complexity and multiplicity of tasks Holloway was expected to perform. It also highlighted many issues that were still very relevant during this inspection including: § A recurring problem in the recruitment and retention of staff of all grades to provide a reasonable regime for women prisoners. Activities such as association were being cancelled frequently because of staff shortages § Many good initiatives involving multi-disciplinary work and voluntary organisations § The neglected anti-bullying scheme § The absence of risk assessments for cell and dormitory sharing

§ The cancellation of association leading to unpredictability for women in arranging telephone calls to families and friends § Many examples of good relationships between staff and prisoners § The generally dirty state of the communal areas and the prison grounds § The absence of suitable personal hygiene opportunities for women § Signs of optimism in the development of health care § The generally good quality of education but too few opportunities for women to access it § Excellent physical education facilities § The work of the psychology department and library § The excellent visitors’ centre but the poor quality of other facilities for visits

HPS39 The shortage of available discipline staff and middle managers continued to undermine the regime and the provision of decent conditions for women prisoners. We were also aware however, that it was through the efforts of many good staff, during a particularly difficult period, that Holloway was able to provide as much as we found during this inspection. The main cause for optimism that conditions and treatment of women prisoners would at last be significantly improved came from the determination demonstrated by the Prison Service to deal with Holloway’s problems in a way that has not been attempted for a considerable time. A new Governor and a largely fresh senior management team were starting to introduce new management systems and a huge implant of middle managers and officers were to arrive within three months.

HPS40 The major challenge for this new team will be to establish a well-managed workforce in prison officer and nursing grades to produce acceptable conditions and a consistent regime that meets the particular needs of individual women prisoners.

Main recommendations HPS41 Holloway is an inappropriate place to hold children. If they are to continue to be held there on remand or after being sentenced by the courts, children should be treated properly as befits their age and vulnerability, in accordance with the national policy.

HPS42 Cell sharing assessment procedures should be carried out thoroughly in accordance with Prison Service instructions.

HPS43 All women at Holloway should live in decent conditions, in particular:

§ The living accommodation should be properly furnished, including curtains in cells § Women should have sufficient supplies of towels and toiletries § Consistently high standards of cleanliness should be maintained § All women should be enabled to take a daily shower § They should be offered at least two hours association every day, some of which should be in the fresh air § They should be able to make use of a telephone every day in order to maintain contact with their families

HPS44 An active regime, which includes opportunities for employment, work skills training, education and physical exercise should be consistently delivered.

HPS45 A Bail Information Scheme and legal services should be urgently restored.

HPS46 Practical resettlement arrangements that focus on the individual needs of women prisoners and are designed to reduce the likelihood of reoffending should be introduced.

HPS47 An action plan for prison health care at Holloway should be produced and a time frame for implementation should be agreed. This should include an urgent review of the mental health needs of young people held at Holloway.

CHAPTER ONE

ARRIVAL IN CUSTODY

Expected outcomes The expected outcomes for arrival in custody procedures (reception, first night and induction) are: § Safety: Everything reasonable is done to help prisoners feel safe on their reception into prison; prisoners’ needs are identified, including physical and mental health care, in order that they may be cared for and supported by competent trained staff § Respect: The way in which entry procedures are conducted and the approach of competent staff preserves the personal identity of prisoners, respects their privacy and dignity and is responsive to their individual needs § Respect: Prisoners are made aware of prison routines, how to access available services and cope with imprisonment § Purposeful activity: Prisoners are constructively occupied during their first days in prison, preferably as part of a comprehensive induction programme § Resettlement and reducing offending: Prisoners’ welfare needs are identified and appropriate help offered to deal with them

Courts and transfers 1.01 Holloway served 159 courts. There was a lot of pressure on both the prison and the contracted escort service providers. Prisoners began moving to the reception area en route to court at 6.30am and it was not unusual for prisoners to be received from court after 9pm.

1.02 We were informed that ‘lock outs’ (where prisoners have to be accommodated in police cells) occurred three times a week on average and we met prisoners who had experienced this. As the establishment received prisoners from a wide geographical area, it was not unusual for prisoners to have travelled for several hours by the time they arrived at Holloway. It is our well-established view that the prison’s catchment area is

24 too large, resulting in the unsatisfactory treatment of prisoners, impacting unfairly on the prison’s facilities and services and failing to provide a consistently effective service for the courts.

1.03 Reception officers relied on wing staff to escort prisoners to reception from the wings. This could result in delays to them arriving in reception for the necessary processing and, ultimately, to their late arrival at court. Such delays should be avoided.

1.04 The transfer of prisoners to other establishments appeared to be ‘hand to mouth’, simply caused by the pressure of numbers and in spite of the best efforts of staff on the observation, categorisation and allocation (OCA) desk in the prisoner management unit to address individual needs. Prisoners were frequently transferred to other establishments within 48 hours of arriving at Holloway and often missed their entitlement to a reception visit. Matters were made worse by lack of continuity in the OCA because staff were frequently cross-deployed to other duties. Indeed, at the time of this inspection, no women had been interviewed for allocation purposes for four months.

Conclusion 1.05 Holloway continued to have responsibility for serving too many courts. Delays in processing prisoners for court should be eradicated. Women should be allocated to establishments on the basis of closeness to home to facilitate family contacts and therefore successful resettlement.

Recommendations 1.06 The number of courts for which Holloway is responsible should be reduced.

1.07 Processes to ensure that women arrive at court on time should be improved.

1.08 Women should be allocated to prisons according to their individual resettlement needs.

1.09 There should be improved staff continuity in the observation, categorisation and allocation service.

Reception 1.10 The reception area was extremely spacious, well planned and clean. Large numbers of prisoners passed through on a daily basis and the area was well organised to cope with this. Movement of prisoners both in and out of the reception area was handled efficiently and quickly by all staff involved. Prisoners were supervised effectively during their time in reception.

1.11 The necessary handover of documents and possessions between escorting staff and reception officers was carried out quickly and efficiently, and good relationships were evidenced between them.

1.12 Reception officers did not wear name badges; as with all Prison Service staff, they should do so.

1.13 Two groups of officers were responsible for the reception area and both were organised and efficient in their work. It was noticeable, however, that officers in one group displayed more empathy towards the prisoners, engaged with them as individuals and addressed them more often by their first or full name and/or title. This demonstrated respect. All staff working in reception should adopt this professional approach.

1.14 Reception officers were aware of how many prisoners were due to be admitted and their special circumstances, such as girls subject to a detention and training order, young adults and women with mental health problems. Girls subject to detention and training orders were fast-tracked through the reception area.

1.15 On arrival in reception, women prisoners were held in a large room which had seating and a toilet facility. A large mirror window had been fitted here. This enabled officers to observe the area while at the same time preventing prisoners from watching the activity in the immediate reception area. Individual women were called from here to be strip-searched and interviewed.

1.16 Two small holding cells were used for those prisoners who could not mix with other women in the large holding room. Wherever possible, staff ensured that the doors

26 to these rooms remained open rather than prisoners being locked in. This offered good sight lines for staff and meant that women avoided being isolated in a confined space. Communication between officers and women prisoners was generally easy and relaxed.

1.17 Women were strip searched as soon as possible. A movable screen was pulled in front of the three available searching cubicles. Only one of the cubicles was used to strip- search prisoners at any one time. Searching was carried out sensitively and with patience, although the cubicles themselves were small and should be remodelled.

1.18 After searching, prisoners were interviewed by a reception officer. Valuables and clothing were checked with the prisoner and a photograph taken if necessary.

1.19 Each new prisoner received a paper bag containing two sachets of shampoo, soap, deodorant, a flannel and one towel. In our view, one towel was inadequate allocation.

1.20 It was not unusual for women prisoners to arrive without a change of clothing. If necessary, they were given two pairs of new knickers and one new nightdress, although articles such as socks or bras were not available. A stock of donated clothing kept in the reception area for this purpose was extremely limited in quality, quantity and choice. There were less than six pairs of shoes, for example, although prison-issue slippers were readily available. A further clothing stock was available via an application to the WRVS and this facility could supply a limited change of clothes to prisoners. Such applications were dealt with every Tuesday. We did not view this stock of clothing but were informed that it was similarly limited. Given that decent and adequate clothing is important to women prisoners and is necessary both in terms of their personal hygiene and sense of well-being, the current system was totally inadequate.

1.21 Each newly-arrived prisoner was given the choice of a smoker’s pack, containing tobacco and small sweets, or a non-smoker’s pack, containing a small selection of biscuits and sweets. Each cost £3, which the prisoner repaid at a rate of £1 per week. Both packs contained a telephone card and we observed women using these to contact family or friends from the telephone in the reception area. It was mandatory that women prisoners had to purchase one or other of the packs; it was not possible to refuse both.

1.22 Women were only able to order goods from the prison shop on the day that was normally scheduled for their particular residential wings. Consequently, depending on which wing they were allocated to and on which day they arrived, prisoners might not receive goods from the prison shop for some days. Prisoners should be entitled to make choices once the available options and systems have been fully explained and understood.

1.23 Once a strip search had been completed, kit handed out and reception packs distributed, prisoners waited in a large holding room at the end of the reception area. Here there were tables and chairs, and women had free access to a toilet outside the room. There was also a large mirror window similar to that in the first holding room. Women were allowed to smoke in this room and, with the numbers of prisoners and the length of time they were in it, the air could become very unpleasant.

1.24 With the high number of prisoners passing through, the reception procedure was well organised and completed thoroughly. Two ‘locating officers’ were intended to escort women prisoners to their various wings. However, we were told that delays in these arrangements could mean that women prisoners remained in the holding room for up to three hours. This was excessive.

1.25 Three reception orderlies ensured that all prisoners received a drink and hot meal. The meals were kept frozen and heated up as required in a large microwave. The various dietary requirements were catered for. We were told that these orderlies often worked from 8.30am to 9.30pm. This 13-hour day was too long and could be alleviated by increasing the number of reception orderlies.

1.26 When not actually working in the reception areas, the orderlies ‘room’ was actually a kitchen and laundry room. Three hard chairs had been provided in a small store for cleaning materials that contained a large washing machine (that was in use). A television set was perched on the draining area of the sink. This area was not appropriate for its purpose as an orderlies’ room.

1.27 The orderlies cleaned the holding rooms and reception areas. They also undertook laundry services as well as providing ‘ad hoc’ information and support to the

28 waiting prisoners. This peer support might be a good idea but it appeared to be offered by the orderlies of their own accord; they were not Listeners and did not receive any training.

1.28 A member of the health care staff quickly saw each prisoner for an initial health screening. We did not see prisoners delayed while they waited for this service.

1.29 Information displayed on the notice boards within both holding rooms was in English only. Some of it was out of date, offering services that no longer existed such as the all-day children’s visits. There were no magazines, newspapers or television supplied to help prisoners pass the time. Books were provided in one holding room but these were of a type that seemed an inappropriate resource for women who were simply ‘passing through’. All reception paperwork seen by women prisoners was produced in English. There was little recognition of diversity by nationality, culture and ability, and, as far as providing women with information was concerned, too much reliance on the printed word.

1.30 Information needs to be displayed in a much more creative and wide-ranging manner, utilising the various media available. Equally, the establishment admits high numbers of prisoners from abroad and their needs should be catered for.

1.31 We also noted that both fire extinguishers in the main reception area had not been checked since 23 February 2000.

Conclusion 1.32 The reception area itself was spacious and generally suitable for its purpose, although cubicles used for strip searching should be modified. Staff were well organised and efficient, although some were evidently more effective at engaging with women at a personal level. The support given by volunteers was impressive. The provision of information for women prisoners in reception and the initial allocation of clothing should be improved.

Recommendations 1.33 All staff at Holloway, including reception officers, should clearly display their name badges.

1.34 The professional model of effectively engaging with women prisoners as individuals, as displayed by one group of officers, should be followed by all those working in reception.

1.35 The cubicles used for strip searching should be remodelled to provide more appropriate space.

1.36 Each new prisoner should be provided with two towels.

1.37 Prison issue underwear, footwear and clothing should be made more readily available in appropriate quantities and quality to meet the identified needs of individual prisoners.

1.38 Prisoners should not be forced to purchase a reception pack.

1.39 Newly-arrived prisoners should be able to access the prison shop the day after their arrival.

1.40 A smoke-free area should be developed in the holding room at the end of the reception area.

1.41 The time that newly arrived prisoners wait to be escorted from reception to their allocated wing should be reduced considerably.

1.42 The pool of reception orderlies should be increased.

1.43 A room should be provided that better meets the needs of reception orderlies.

1.44 The establishment should consider developing, supporting and formalising the use of peer support in the reception area. 30

1.45 Laminated information booklets designed to meet prisoners’ needs and in a variety of languages should be made available in the holding rooms. A video should be developed to provide a visual tour of the prison and taped information should be made available.

1.46 Literature and taped information should be readily available in appropriate languages to enable foreign prisoners to understand the reception procedure and the questions asked of them. Translation services should also be made available.

1.47 Regular checks of all fire fighting equipment should be carried out.

Good practice 1.48 Girls subject to detention and training orders were fast-tracked through the reception area.

1.49 Where possible, the doors to the two small holding cells were left open, offering good sight lines for staff and preventing individual prisoners from being isolated in a confined space. Equally importantly, communication between officers and prisoners was easy.

1.50 Telephone cards were provided in both the smoker’s and non-smoker’s packs.

First night 1.51 We were told that, when they arrived in the reception area, women prisoners were risk assessed for their accommodation and a ‘first night cell occupancy risk assessment’ form was included in each of their files. We were also told that reception officers used information from a prisoner’s Prisoner Escort Record, her current charge or offence and any open F2052SH to complete Part A of this form. The prisoner’s demeanour was noted and she was asked how she was feeling. All the women we saw arriving were asked if this was their first time in prison. The officer then noted down on the form what s/he considered was the appropriate accommodation for the prisoner.

1.52 We were told that, if the reception area was busy, this assessment was undertaken by a worker from PACT (Prisoners’ Advice and Care Trust), a voluntary agency working in the prison. This should not happen.

1.53 The rest of the form was completed by: § Medical staff following screening – Part B § PACT staff following interview – Part C § The locating officer – Part D § The orderly officer – Part E

1.54 We viewed 26 wing files on the induction wing. Of these, only one had all sections completed; the rest had only Parts A and B completed. Given that the process includes the contribution of the various staff to such an assessment of a prisoner’s immediate needs, these forms should be fully completed.

1.55 The First Night in Custody project was run by PACT. Prisoners new to prison were identified on admission and referred to one of the agency’s workers in the reception area. The PACT worker met with the individual prisoner in an interview room out of direct sight of the main reception area. This room had no fixed emergency alarm bell and there was no way of viewing what was going on in the room when the door was shut. Given that the women prisoners involved were unknown to the establishment, the safety of the workers should be safeguarded.

1.56 At this interview, each prisoner was given a folder with information about PACT; the Holloway women’s health clinic; the Befrienders team; the prison visitors scheme; maintaining good mental health; and an accommodation guide with housing information. The folder also contained a stamped envelope and two sheets of paper. Unfortunately, the pages of this pack were copied in such a way that they were not in numerical order. We were told that the pack was only available in English.

1.57 Further information was also given to women depending on any identified or expressed need. This meant that a prisoner could leave the interview with numerous sheets of paper and in our view it would be sensible to collate the core information in a single booklet. 32

1.58 The PACT worker was able to refer prisoners to numerous internal or external services, such as CARATs, social services, the probation department, the Women In Prison Support Service and Hibiscus, an organisation that mainly supports Jamaican women. Counselling services could also be accessed via PACT. Women were able to contact the PACT worker for information and support up to five days following their admission. The service appeared to be very supportive and informative, and was operated by workers who displayed empathy and a keenness to support female prisoners.

1.59 The PACT worker could make a telephone call to the prisoner’s next of kin to inform them of her arrival in the establishment. While this was very supportive of prisoners who had not been in custody before, it is important that all women should be allowed a short telephone call during the admission procedure.

1.60 Any prisoner not seen on arrival was interviewed by a PACT worker on her wing the following day. A note was made of the services contacted and action taken on behalf of each prisoner. We were told that one copy of this form was kept by PACT, one was sent to the prisoner and one was sent to the wing file. However, from a random selection of 26 files on the induction wing, only two contained this form. While there may have been an explanation for this, it is important for the establishment to ensure that such information is contained on each prisoner’s wing history sheet.

1.61 We were pleased to note that the PACT manager was a member of the establishment’s race relations management team, the suicide and self-harm team and attended the resettlement meetings.

1.62 There was one occasion during our inspection when PACT was unable to provide a worker in the reception area. Reception staff therefore simply handed out the First Night Folders to the prisoners concerned. Without the individual contribution made by a PACT worker, the folder contained very little information or advice that would actually prepare and support a prisoner during her first night in custody. The literature within the folder gave no details of wing regimes, such as unlock times, how to access medical attention, meal times, personal officer contact, how to access a telephone, what would happen on arrival on the wing that evening or first thing the following morning. There 33 appeared to be an over-reliance on simply giving out the folder with no appreciation of the real needs and feelings of those women who had no prior experience of custody.

1.63 The First Night in Custody Project was aimed at providing support for women who had no prior experience of imprisonment. However, it is also the case that many prisoners who have been in custody before still experience varying degrees of distress, shock or anger. The prison had developed no identifiable first night support procedures for these prisoners. From our initial questionnaire, 30 out of 43 prisoners told us that they did not feel confident on their first night/day and 29 said that they did not feel safe. Many prisoners also informed inspectors that they relied on other prisoners rather than staff to give them information.

1.64 All prisoners received into a prison should be supported by a formal and well- designed first night scheme. Dedicated officers should be tasked to ensure that newly- arriving prisoners, including those transferred from other establishments and those who have had a change of status, are received and settled onto their allocated wings. Time should be taken to engage with individual prisoners and to answer concerns and questions. A variety of suitable activities should be made available to occupy them during their first night, such as television, radio and/or reading material. Information should be given both verbally and in writing about wing procedures and services within the establishment. The services of a Listener should be explained and a simple information booklet and tape explaining first night support should be made available in a variety of languages.

Conclusion 1.65 The Prison Service cell sharing risk assessment process was in operation but in the majority of cases, the processes were not completed thoroughly. They should be.

1.66 The First Night in Custody Project run by PACT was an excellent, worthwhile initiative. This could be further developed. It is also important for the prison to provide proper first night supportive arrangements for all prisoners, whether or not they have been to prison before.

Recommendations 1.67 The risk assessment for accommodation process should only be undertaken by prison officers and should not rely at busy times on staff working for voluntary agencies.

1.68 The accommodation risk assessment form should be fully completed for all prisoners.

1.69 The PACT interview room should be fitted with a fixed alarm bell and should be redesigned to allow observation by reception staff when in use.

1.70 A single booklet should be produced containing all the core information from the initial PACT interview.

1.71 All prisoners should be allowed a short telephone call during the admission procedure.

1.72 The contacts and services provided by the PACT worker should be written directly onto the prisoner’s wing history sheet.

1.73 The establishment should develop a pro-active and supportive first night scheme for all prisoners, which includes clearly defined expectations of the role of first night officers.

Good practice 1.74 The involvement of PACT in the reception process.

1.75 The PACT manager was a member of the establishment’s race relations management team, the suicide and self-harm team and attended the resettlement meetings.

Induction 1.76 Depending on their individual needs, prisoners did not automatically go to the induction wing on D3: many went to the detoxification wing; some to health care; others to the young persons’ wing. The rooms on D3 were large but appeared uncared for. They were bare looking, poorly decorated and many had damaged or unusable furniture. There were no televisions in the cells.

1.77 There was no fully-developed induction procedure.

1.78 We were informed that an induction group was supposed to take place daily on the induction wing at 10am but that this was frequently cancelled due to ‘staffing shortages’. We were also told, however, that staff from the education department came to the wing every day at 3pm to undertake an education assessment on all newly-arrived women prisoners. In our initial questionnaires, many prisoners informed us that their induction had consisted of education and little else.

1.79 A box in the wing office contained a checklist of information to be given to prisoners. This was designed simply to be given verbally by an officer. It was not planned to run over a number of days and did not encompass short videos covering such topics as anti-bullying and/or race relations information, nor did it include verbal presentations from other services within the establishment. We were told that a new induction package was under development.

1.80 If the induction group was cancelled, we were told that an officer would go to each newly-arrived prisoner’s room to give the information verbally ‘in about 10 minutes’. Induction was described to us by an officer as the delivery of ‘basically the prison rules’.

1.81 We examined 26 randomly-selected files on D3 and there appeared to be no mechanism for recording the giving of any induction information, whether in a group or individual format. Some files noted that a ‘boarding’ interview, which appeared to be a form of reception board, had been carried out. The relevant form, however, was only included in 12 of the 26 wing files that we examined and we found this to be poor

36 evidence of a reception board interview. There were no regular review notes from personal officers and little comment from other staff. We found a number of files that had not had any comments written in them since the prisoners concerned had arrived on D3 at various dates in June 2002. Another woman prisoner had not been commented on in the wing file since she was located on the wing in January 2002.

1.82 No compacts were included in the files. On enquiry, we were told that induction prisoners did not sign prison compacts. Some areas did produce compacts: for example we noted a number of signed compacts originating from the detoxification unit.

Conclusion 1.83 Induction arrangements were informal at best and did not begin to address the needs of women prisoners at Holloway to receive quality information about the regime and opportunities available to them.

Recommendations 1.84 A supportive and effective induction process should be introduced to meet prisoners’ needs, and this should be accurately recorded in the establishment regime monitoring forms.

1.85 Information about the establishment should be given to women prisoners that can be forwarded directly to family and/or friends.

1.86 An evaluation form should be created to enable prisoners to comment on the content and usefulness of the induction package in order to improve delivery.

1.87 Compacts detailing both prisoner and establishment expectations should be developed.

1.88 Managers should monitor, evaluate and take suitable action over the quality of officer contributions to individual wing files.

1.89 Information about individual women should be collected and collated during the induction period in order to contribute to sentence planning. 37

1.90 The establishment should develop custody planning and reviews involving prisoners who are unconvicted and those who are convicted but unsentenced.

Legal rights

Expected outcomes The expected outcomes for legal rights procedures are: § Safety: Prisoners are safe from repercussions or recrimination in making any application, request or complaint § Respect: Prisoners are told their rights of access to due process in relation to bail, legal aid, legal representation and appeals and can exercise those rights while in prison § Respect: Unconvicted prisoners are treated as innocent, unsentenced as not having a custodial sentence, and both are given the same opportunities and activities as convicted or sentenced prisoners § Purposeful activity: The regime provides reasonable opportunity to seek release on bail and prepare for trial § Resettlement and reducing offending: The regime provides reasonable opportunity to preserve accommodation and employment and to pursue legitimate business and social interests

1.91 The lack of an adequate induction package impacted on prisoners’ ability to help themselves as they were not made aware of what was available to them.

1.92 It is extremely important that prisoners, especially those awaiting court appearances, have access to advice about legal services. They have a right to be properly informed of their access to bail and appeals procedures, and should be seen by a trained legal aid officer, ideally on arrival and certainly within 48 hours of admission.

1.93 Legal services at Holloway were extremely poor.

1.94 Information about the Prisons Ombudsman and the Criminal Cases Review Committee were displayed but this was primarily in English and often appeared to be involved and lengthy.

1.95 Although we were told that there were two legal aid officers, prisoners were not seen automatically. All applications had to be forwarded to the officers, who were not engaged full-time in legal work but were cross-deployed to other areas. Officers on the induction wing informed us that, as they did not have a key for the legal aid office on the wing, applications were slipped under the door. We were told that officers were unable to access information such as solicitors’ directories that were kept in the legal aid office.

1.96 Legal visits were booked by telephone and mornings were reserved for visits from legal visitors, social workers and probation staff. Nine private booths were provided in an area next to the visits hall. Two of these private rooms were larger than the others and provided facilities for the use of video. All the booths had the necessary power points to enable the legal representative to use a lap-top computer.

Conclusion 1.97 It should be a priority for management to provide sound, consistent information about bail and legal services to all prisoners at Holloway. Current arrangements were unacceptable.

Recommendation 1.98 The establishment should ensure that prisoners are properly informed of their access to bail and appeals procedures. Prisoners should also be seen by a trained legal aid officer, ideally on arrival and certainly within 48 hours of admission.

CHAPTER TWO

RESIDENTIAL UNITS

Expected outcomes The expected outcomes for accommodation and facilities, clothing and possessions, and hygiene are: § Safety: Prisoners live in a safe and hygienic environment § Safety: Prisoners are risk and needs assessed before being placed with other prisoners in shared cells § Respect: Prisoners have their dignity and privacy of life respected while in prison § Respect: Prisoners are encouraged, enabled and expected to maintain an acceptable level of personal hygiene in appropriate, decent residential accommodation § Purposeful activity: Suitable space and facilities on residential units are available and used to permit association activities that meet prisoners’ needs

2.01 Residential provision was under the overall management of the head of residence. The day-to-day operational control was under the residential manager who had recently undertaken a review of accommodation. This review provided the following details:

Unit Description Total Places SINGLE DOUBLE DORMITORY D0 Young adult 39 22 2 15 prisoners & juveniles Level 1 A1 Segregation 12 12 Nil C1 Health care 28 16 (includes 1 Nil 12 special cell D1 Post- 23 9 2 12 detoxification unit H1 Detoxification 40 8 2 30 unit Level 2 D2 Vulnerable 17 3 2 12 prisoners Level 3 A3 Convicted & 33 24 Nil 9 remand (Non-basic on IEP)

Unit Description Total Places SINGLE DOUBLE DORMITORY B3 Remand 33 16 Nil 17 C3 Remand 42 24 Nil 18 D3 Induction 55 13 4 38 Level 4 A4 Convicted 34 24 Nil 10 B4 Convicted 33 16 Nil 17 C4 Convicted pregnant 32 14 Nil 18 women D4 Mother & baby 17 17 Nil Nil Level 5 A5 VTU convicted 33 24 Nil 9 B5 VTU convicted 33 16 Nil 17 C5 Convicted Not in use Total 504 258 12 234

2.02 Those areas that had undergone internal redecoration and upgrading were noticeably improved and this served to illustrate the appalling conditions in those areas awaiting attention. There were no window curtains or other form of screening in any of the residential areas. In a quest for privacy, prisoners had resorted to the use of bed linen as curtains or had painted over glass panes with paint acquired from an unknown source. We were told that window curtains had been withdrawn throughout the prison to reduce the risk of self-harm by ligature. While we understood the concern, the provision of window privacy should be reviewed.

2.03 Flaking paint, damaged plaster-work and dirt ingrained in window ledges gave an air of dereliction in, for example, C4. The dining rooms on each unit lay virtually unused and had in some cases become stores for spare furniture.

2.04 In-cell television was being installed on a rolling programme that, at the time of the inspection, had been completed on A and B units and work was ongoing in C5. The programme of installing electric power sockets in all cells was to be completed within 18 months. Physical conditions in D2 (described above as the vulnerable prisoner unit) were dreary. Separate descriptions of the health care accommodation and the provision for young adults and juveniles are given in Chapter Five.

2.05 Two telephones per unit were available for use during association periods. The frequency of cancelled association had a serious, negative impact on communications with friends and families, including children. This added to an already fraught situation on the residential units and undoubtedly contributed to the kinds of stress that 41 underpinned attempts to self-harm that we discuss elsewhere in this report. The telephones themselves were curiously located in the type of so-called acoustic hoods that we have found throughout the prison estate. We tested these and found that they were ineffective in terms of muffling external noise or providing caller privacy. The hoods were located high on walls and were virtually filled by the telephone unit itself. Both of these factors meant that the caller had to stand away from the hood, often in a thoroughfare, thus defeating the object of installing the hoods in the first place. We have highlighted this problem in other inspection reports and the situation needs to be rectified because, as they are at present, the hoods are useless. Given the importance of enabling telephone calls to take place in decent conditions, the matter deserves attention.

2.06 We were told, and the assertion was backed up by records, that the majority of women prisoners were able to move off units to activities for at least some of the time on most days except Wednesday. This explained why high numbers were in-cell when we checked on a Wednesday during the inspection.

2.07 Screening arrangements for lavatories in shared accommodation were the best that could be achieved in the circumstances, although some women still found the use of shared facilities disconcerting. Some went to extraordinary lengths to clean the facility, often with inadequate materials. Most shared lavatories were used with new sanitary towels being placed as improvised seats on stainless steel fittings. Conditions of some lavatory pans were unacceptably dirty and, we suspect, a health hazard.

2.08 We heard reports from staff and prisoners of cockroach infestation and suspicions in some units of flea or lice infestation. Extreme vigilance was required in these circumstances and cleaning schedules should be reviewed together with procedures for coding and using cleaning equipment.

Conclusion 2.09 Residential units are at the heart of the prison experience for women prisoners: their condition reflects the level of care and consideration offered to prisoners and greatly affects the quality of life for both prisoners and staff. We detected an awareness among current managers about the unsatisfactory condition of much of the accommodation and we were confident that this would lead to improvements in residential conditions. 42

Recommendations 2.10 The provision of curtains should be reviewed.

2.11 Suitable and effective acoustic hoods should be fitted to payphones.

2.12 Standards of cleanliness in the residential units should be improved together with the introduction of procedures for coding and using cleaning equipment.

Mothers and their babies 2.13 We found that children were well cared for by their mothers in the mother and baby unit and that, overall, the unit provided a comfortable and safe environment for the children. The women had monthly meetings with the Governor to discuss issues in the unit. They felt that they were listened to in these meetings and that some changes had been implemented as a result of the consultation.

2.14 The mothers received good support in relation to health care. Health visitors held weekly clinics on the unit and, at the time of the inspection, reported that all the mothers made regular use of these and positively engaged with the service provided. Equally, the mothers reported that they found the advice and support provided by the health visitors very helpful and reassuring. A paediatrician visited every fortnight.

2.15 Women had access to primary health care when needed, although many were less satisfied with this support as they found the general practitioners less helpful in relation to their concerns about their babies. Some women reported that they had not had their six week post-natal check and there appeared to be some confusion among the health care staff as to who would perform these checks.

2.16 Although there were written mother and baby unit child protection procedures and protocols ratified by the Area Child Protection Committee, these had not been implemented. The procedures were not available on the unit and staff had not been comprehensively trained. Two of the four core staff prison officers working on the unit had attended mother and baby training, which included elements of child protection

43 training. Other staff, however, had been waiting for training for some time. Staff coming in to work on the unit had not had mother and baby or appropriate child protection training. There was no evidence of a rolling programme of multi-disciplinary child protection training attended by prison officers and staff from all agencies working in the unit. We were told that a programme of training provided through the Area Child Protection Committee was expected in the near future.

2.17 Women completed an application form to be considered for admission to the unit. Assessment for admission included appropriate consideration and checks, co-ordinated by the probation service, with regard to child protection issues. Social services contributed to the assessment as necessary. Women on the unit confirmed that they had been given information about the unit either at reception or on the pregnant women’s unit. However, some of the pregnant women we met had not received information about the unit or been giving any help in completing the application form. A number of women said that they had relied on receiving information from other prisoners.

2.18 The mother and baby unit maintained a list of those women in the prison who were pregnant and their expected date of delivery. If applications had not been received, the probation officer or unit staff, with direction from the mother and baby liaison officer, followed up and made contact.

2.19 Women in the unit had attended their admissions panel and confirmed that they had seen the written reports to be presented to it. Women also confirmed that they had been informed verbally of the panel’s decision on the same day and later in writing. They had signed a compact that outlined the aims and objectives of the unit, the responsibilities of the Governor and staff and their own responsibilities. They each retained their own copy.

2.20 We found that the mother’s partner, or the person with parental responsibility for the child, was able to be present at the birth. For women without partners or family support, a voluntary organisation provided ‘birthing companions’ who would support them through their pregnancy and the birth. There were difficulties in relation to partners attending hospital with the women for scans and check ups, as partners were not given

44 prior notice for security reasons. There was also an ongoing problem with cancellations of dating scans due to prison staff shortages for escort duty.

2.21 Mothers on the unit were able to develop childcare skills. Women said that they had attended ante-natal classes, parenting skills courses and baby massage classes. They had ongoing support and advice from midwives, health visitors, nursery nurses and other staff.

2.22 Women were also able to attend education classes to meet their own needs. Babies were able to accompany their mothers to education or they could be looked after in the crèche provided. However, we found that education and activities were often cancelled due to staffing difficulties.

2.23 The crèche was staffed by trained nursery nurses and was materially well equipped with access to a pleasant outside play area. While decorations were child oriented, they did not reflect a range of cultures. Arrangements had been made in the last few weeks for mothers to choose and prepare culturally appropriate food for their babies. The women themselves had a choice of food, although this did not often include culturally appropriate provision. A significant number of foreign nationals were in the unit at the time of the inspection. The voluntary organisation, Hibiscus, was relied on to provide support to these women. ‘Baby walkers’ from the Mothers Union visited the unit every Tuesday and Wednesday and mothers could request that they took the baby out.

2.24 Women confirmed that during pregnancy they were provided with a daily milk allowance and with extra fruit on Sundays. Sometimes the kitchen had not sent the extra fruit to the units and the women relied on prison officers contacting the kitchen to ensure that the fruit was sent. This did not always happen. Some women complained about the diet in relation to difficulties with breast-feeding.

2.25 Women with their children were allowed open access to their rooms. However, if there was no association, women were restricted to their rooms with their babies. They did not have televisions in their rooms. This meant that they could be confined to their room with their baby from teatime until the next morning. Given the small size of the rooms, this was particularly difficult for women whose babies were crawling. Women 45 would have benefited from more association time and opportunities to come out of their rooms with their babies and to support each other.

2.26 Women were only able to take showers during association. As association had been restricted, we found that women sometimes had not had access to showers or baths for three or four days. Pregnant women complained about not being able to shower or bath each day and, in particular, before attending a hospital appointment.

2.27 There was only one telephone on the unit and, again, restricted association meant that women had not been able to have regular contact with their families. Fathers and/or partners were only able to visit once a fortnight, as were children. This meant that women were only seeing their other children for up to one hour every two weeks.

2.28 All babies on the unit had a care plan, which all the mothers had agreed at the first meeting. Mothers did not have their own copies. The plans were reviewed every eight weeks. Where it was part of the child’s plan to be separated from its mother before the mother’s release date, there was evidence that mothers had been supported both emotionally and practically in making the arrangements for separation. Support for separation was considered at each review. However, as most of the mothers did not have sentence plans, there was no co-ordination with the child’s care plan apart from addressing the separation issue.

2.29 We found little evidence of resettlement planning for the women on the mother and baby unit. One woman who was released during the time of the inspection stated that she had had little advice about seeking accommodation for when she was released, although she had been given practical support to attend the council housing office. There was little evidence of practical work skills training and job finding arrangements to help the women gain employment on release. None of the women had a thorough individual needs assessment and, consequently, attention was focused mainly on meeting the child’s needs and ensuring support for the mothers in parenting their babies.

Conclusion 2.30 The mother and baby unit provided a comfortable and safe environment that met the needs of the babies. Mothers were able to fulfil their parental duties and 46 responsibilities to care for their children. Improvements in meeting the needs of the mothers themselves were needed, which would, in turn, further improve their ability to maximise the potential for their child’s development. Child protection policies and protocols should be introduced and staff trained in them.

Recommendations 2.31 Senior management should implement the child protection policy and procedures and ensure that all staff are adequately trained. Staff working on the mother and baby unit should be trained in this specialised area.

2.32 The amount of association time should be increased and, in particular, the necessity for women to be confined to their rooms with their babies should be reviewed.

2.33 Women in the mother and baby unit should have daily access to baths or showers.

2.34 There should be greater consistency in ensuring that women have access to easily understood information about the mother and baby unit so that they receive the right information at the right time.

2.35 Management should review the arrangements for dating scans and attendance at hospital appointments.

2.36 The prison should seek to recognise and incorporate diversity and care for the needs of foreign nationals and for women from minority ethnic groups.

2.37 Sentence planning for mothers with their babies should be improved, ensuring that plans are co-ordinated with the child care plans.

2.38 Practical arrangements should be introduced to assist mothers to prepare for release and resettlement in the community.

CHAPTER THREE

DUTY OF CARE

Anti-bullying strategy

Expected outcomes The expected outcomes for creating an environment safe from bullying are: § Safety: Prisoners are as safe as possible from bullying behaviour and bullied prisoners are always given full support in any bullying incident § Respect: Neither staff nor prisoner uses their position or power to bully others § Respect: Bullying and bullied prisoners are treated fairly and are aware of the systems that operate to prevent bullying behaviour § Purposeful activity: Activities take place to develop self-esteem within an environment which discourages bullying and assists those who are or might be bullied § Resettlement and reducing offending: Street and prison cultures are challenged through effective anti-bullying measures and programmes for all who are involved

3.01 In our confidential survey of prisoners, 38% said that they had never felt unsafe and 16% said that they rarely felt unsafe.

3.02 A specific bullying survey commissioned by the anti-bullying committee, through a questionnaire issued to all prisoners by the psychology department, revealed that 16% of women had experienced bullying. A further analysis of the data provided an excellent means of informing policy development and practice. The survey also took special account of foreign nationals and was sensitive to the language needs of non-English speakers.

3.03 A revised anti-bullying strategy was introduced on 1 October 2001. This followed the signing of a document by the Governor and the Operational Manager on 25 July 2001 that reiterated the five main points contained in Prison Service Order 1702. The renewed vigour provided to this area of work was, however, relatively short-lived. At the time of the inspection, the senior manager responsible for the policy had only held 48 the task for two days and attendance at the latest anti-bullying committee (3 June 2002) was down to only three members, with most departments and areas being completely unrepresented. The level of ownership in the committee had therefore slipped. We were told that this followed a period in which the committee had become pre-occupied with matters of staff bullying that had now been addressed through appropriate channels.

3.04 Senior staff changes also interrupted the focus on anti-bullying tasks but the basic policy and structures were sound. The referral and investigation systems were appropriate, although methods of dealing with identified bullies relied on an active and formal personal officer scheme that was not universally available. In our view, the new manager had the capacity to encourage a renewed level of commitment and we hoped that the detail of the policy could be translated into regular good practice.

Conclusion 3.05 A sound anti-bullying policy was in place but there had been difficulty in maintaining the momentum of the anti-bulling strategy through staff shortages and management changes.

Recommendations 3.06 All departments should be regularly represented at anti-bullying committee meetings.

3.07 The anti-bullying strategy should be fully implemented and its effectiveness monitored.

3.08 A review of the personal officer scheme should include specific attention to the role of personal officers in promoting the anti-bullying policy with potential victims and perpetrators.

Good practice 3.09 A specific bullying survey commissioned by the anti-bullying committee, through a questionnaire issued to all prisoners by the psychology department, revealed that 16% of women had experienced bullying. A further analysis of the data provided an excellent

49 means of informing policy development and practice. The survey also took special account of foreign nationals and was sensitive to the language needs of non-English speakers.

Preventing self-harm and suicide

Expected outcomes The expected outcomes for preventing self-harm and suicide are: § Safety: Prisoners are held in an environment in which all reasonable steps are taken to protect prisoners from self-harm and suicide and honouring the prison’s duty of care to every prisoner § Safety: Significant information about individual prisoners at risk of self-harm or suicide is communicated effectively by those who hold it to those who need it and integrated into the support plan § Respect: Prisoners know where to find help and access it in times of crisis or need § Respect: Raising and maintaining prisoners’ self esteem, especially in times of transition or change, should be inherent in the prison’s culture, management, regimes and activity § Respect: The treatment of those at risk of self-harm or suicide shall always maintain confidentiality, preserve or enhance the dignity of the prisoner and shall not itself be dehumanising § Purposeful activity: Those prisoners at risk of self-harm or suicide are encouraged to participate in appropriate purposeful activities including specific programmes for their needs in this respect

3.10 The suicide prevention committee was chaired by the Deputy Governor and met monthly. The membership included a relevant range of prison staff, escort contractor representatives, Samaritan representatives and a Befriender (a prisoner trained by the Samaritans to assist those at risk).

3.11 A protocol existed for response to and management of all incidents of self-harm. This document defined severe incidents and detailed the action to be taken in all such cases. The self-harm co-ordinator played an active role in analysing incidents, updating staff and developing preventive measures.

3.12 The volume of incidents was generally high and significantly so in March 2002 when there were 118 incidents: more than half of these took place in the health care unit. There were instances of severe, repeated self-harm attempts, with seven women accounting for 54 incidents in the period. Three of these women were involved in at least 10 incidents each. We commend the psychology department and the self-harm co- ordinator for the detailed reports that they produced in this testing period. The highest number of incidents occurred on 8 and 9 March (the days preceding Mothering Sunday). No lives were lost.

3.13 We read a number of incident reports prepared by the self-harm co-ordinator. In several cases, these revealed areas for improvement in practice but also highlighted that the vigilance of staff saved lives.

3.14 Our examination of monitoring forms (F2052SH) for prisoners identified as ‘at risk of self-harm’ showed that, in the majority of cases, the entries reflected a good understanding of the purpose and nature of such observation. Most reviews were carried out within the required timescales, although there were some delays at the 72-hour stage that should be addressed. We noted that the accommodation was littered with ligature points and potential hazards to prisoner safety, which added to the stress and anxiety of already hard-pressed staff. We refer to these in our recommendations.

3.15 We noted that, in one case in March, there had been a hurried transfer to D2. This was generally referred to around the prison as the ‘poor copers’ unit. We did not like the term and consider that a more appropriate and positive title for D2 is warranted. However, this highlighted a general concern about procedures for admission to D2 as, by the nature of the special care needed, its residents presented a particular risk. A form used by officers on which to base a decision had departed significantly from the original guidance provided by the psychology department. This should be reviewed as a matter of some urgency.

3.16 We were told that there had been some recent slippage in staff awareness training and that steps were being taken to rectify this. This assumed added importance in the

51 light of expected recruitment of new staff to Holloway who may not have substantial experience of dealing with women in prison and their particular needs.

3.17 The use of Befrienders was an asset but it was sometimes very difficult for helpful communications to take place through the observation flap in the cell doors. We noted the difficulties encountered in maintaining the numbers of trained Befrienders given the turnover of prisoners in Holloway but we commend the committee and the Samaritans for maintaining appropriate quality standards in the face of this difficulty.

Conclusion 3.18 Substantial progress had been made in the past year and an effective strategy had been put in place to ensure the best possible practice in very testing circumstances and conditions. We do not underestimate the challenge faced by staff in ensuring the safety of the large number of women prisoners who demonstrated a high propensity to harm themselves or take their own lives. The suicide prevention committee and its co- ordinator were pro-active and our recommendations below are designed to support them in their ongoing work.

Recommendations 3.19 Safer cells should be made available for the most ‘at risk’ women prisoners.

3.20 A detailed survey of existing potential ligature points and/or other hazards should be undertaken to inform risk reduction. These should include, for example: § Piping in cells and rooms § Window fittings § Door handles § Radiators § Obscured windows (with makeshift curtains, posters etc.) § Light fittings

3.21 Arrangements for admission to D2 (accommodation for those experiencing difficulty with normal prison routines) should be reviewed.

Race relations Expected outcomes The expected outcomes for race relations are: § Safety: Prisoners live in an environment in which they are safe from physical, verbal or emotional abuse, intimidation or victimisation or any discrimination on the grounds of race or culture § Respect: Prisoners experience a culture that values diversity and actively promotes, maintains and monitors good practice in race relations § Respect: Foreign nationals and those for whom English is not their first language are enabled to understand and communicate successfully § Respect: Prisoners, regardless of their ethnic cultural background, have equal access to all appropriate facilities and activities within the establishment. Eligibility for benefits and privileges, e.g. risk assessments, are made without regard for race, ethnicity or culture § Purposeful activity: Prisoners and staff are able to recognise and acknowledge the cultural diversity of the prison population

Foreign nationals 3.22 At the time of our inspection, there were 136 foreign nationals in Holloway, representing about one quarter of the total population. The monthly foreign national committee that dealt with their interests had fallen away, although it was about to be re- instated. In its absence, several initiatives for foreign national women continued, including weekly meetings, although these were often cancelled due to staff shortages. To prevent this, the meetings had been moved from Thursdays to Mondays, when both probation and Hibiscus staff were available to support the event if uniformed staff were not. A quarterly management meeting continued to meet, which included Hibiscus, the senior probation officer, PACT, the head of activities and the race relations liaison officer (RRLO).

3.23 Hibiscus is a charity specifically devoted to supporting foreign national women in prison and Holloway paid for a Hibiscus worker to attend the prison for three days each week. This contract included both direct services to women and the training and support of staff. A very successful three-day training event for foreign national liaison officers

(FNLOs) from each unit had been held 18 months previously. However, this had not been followed up as intended because of staff shortages and very few of the original number remained. The Hibiscus worker had resorted to doing as much as she could for women referred to her. However, the tasks she performed were often more appropriately prison officer jobs and her presence had, to some extent, allowed Holloway staff to abdicate their responsibilities for foreign national prisoners. Thus, the provision of emergency telephone calls abroad, emergency clothing and the changing of currency were all referred to the Hibiscus worker when they could have been addressed by the FNLOs or even prison officers. This was understood by senior managers, who had renewed their commitment to Hibiscus and were planning a further training event in October.

3.24 There appeared to be a shortage of systems for meeting the core needs of foreign national women. Thus, the provision of clothing, a monthly free telephone card and interpreting were addressed when the need arose, although this was often when the situation had reached a crisis point that could have been averted had a system been in place. We were told, for example, that there were two sources of clothing for foreign women arriving in this country with insufficient clothes: § From Hibiscus, including underwear and pyjamas § From the Prison Service, including outer leisure wear that had been procured by a previous head of the race relations management team (RRMT)

3.25 Although this latter source was noted in the minutes of the RRMT, it was impossible to find anyone who knew where it was and there was no system in reception to supply these clothes to women when they arrived. In practice, the women waited until their needs were urgent and they were referred to the Hibiscus worker on one of the three days per week that she worked at the prison. Otherwise, the desperate woman might have to wait a further four days for her basic needs to be met. We met two Jamaican women who had been in Holloway for four days and were desperate for a change of underwear.

3.26 Similarly, there was no system for providing interpreters. The Hibiscus worker spoke five European languages and was often called on to accompany women to the health care centre to interpret for health examinations. Other prisoners were also asked to

54 perform this function. There should be a recognised system for the provision of interpreters for health examinations that does not rely on the goodwill of the Hibiscus worker or other prisoners.

3.27 The library provided an exceptionally good service for foreign national women. Any women identified through the educational needs assessment as being in need of English as a second or other language teaching was offered the prisoners’ information booklet produced by the Prison Reform Trust in one of 20 languages. They were also given a Holloway A-Z as long as they spoke one of seven languages. Given the shortage of foreign language books available through the local authority library service, the London prisons had got together to build their own supply to share between them. Each prison had taken responsibility for building stock in three languages that they then made available to each another as required. Dictionaries were available in every language and were replaced promptly when lost. Foreign magazines and periodicals were supplied to be read in the library. The librarian had also produced an impressive poster in several languages for display on the units detailing what services were available in the library. Unfortunately, not many of the units had this poster on their information boards.

3.28 A common complaint of foreign national women was that there were no incentives for them to achieve enhanced status. They were not able to benefit from additional visits, and televisions were now available to some standard level prisoners. They indicated that the following would act as incentives for them: § National theme days with sport, food and dance from different nationalities § Consultation on how to cook their national dishes § The supply of ethnic cosmetic and beauty products § Being able to cook for themelves § Having more opportunities to exercise responsibility § Being able to express themselves more freely

3.29 The foreign national weekly meetings had identified several problems for foreign national women in custody far from their homes where they often had multiple dependants. These included: § Health care § Language difficulties 55

§ Racism § Food that was inappropriate to cultural tastes § Welfare issues § Family matters § Cultural isolation § Mother and baby unit

3.30 The senior probation officer admitted that they rarely made any progress with these issues and that it was difficult to keep motivation going. She did feel, however, that significant progress had been made with the mother and baby unit where many of the mothers were foreign nationals. There should be a conduit for the concerns emerging from these meetings to reach managers.

3.31 The women themselves suggested that it was inappropriate to expect to meet the needs of all foreigners in one meeting. They pointed out that the only thing they had in common with one another was the fact that they were in prison in the UK and were not British. The recent visit of the Jamaican High Commission, for example, was not relevant to Spanish speaking women from South America. They suggested either having parallel visits from different embassies in an ‘information fair’ format or, perhaps more simply, holding separate meetings for different nationalities.

Detainees 3.32 Holloway held 27 women identified by the Local Inmate Data System (LIDS) as detainees. These women were held under dual court and immigration powers. In practice, they were either passing through the criminal justice system or awaiting deportation having completed their sentences. We interviewed 15 of these women. It became clear that many of them had not been served well by criminal solicitors with regard to their immigration status. Many assumed that their deportation at the end of their sentence would be automatic. This did not happen in reality and women needed legal advice, advocacy and, in complex cases, specialist immigration solicitors to progress their cases. Some did not have the necessary documents to be accepted back into their country. Others had lived for long periods in the UK before breaking the law and wished to appeal against the decision to deport. One was an asylum seeker who had entered the country on a false passport and bore marks of possible mistreatment. Mostly, 56 however, women were desperate to get back to their own countries and needed someone to advocate for them with the Immigration and Nationality Department.

3.33 Staff from the Immigration Service attended Holloway bi-monthly, though this had slipped to an average of quarterly, and held a surgery in the library for those wishing to see them. Asylum Aid and the Islington Law Centre also took turns to attend the monthly information fair to offer legal advice to women facing deportation. These two groups also attended the foreign national weekly meetings. It was surprising, therefore, how many of the women were still awaiting deportation some several months after their sentence had expired and how few were aware of the existence of these services.

Race relations 3.34 While there was a sincere desire on the part of senior managers to take this area forward, competing priorities had again diverted their attention away from it. The RRLO was very committed but felt isolated and was running out of energy. She was acting up as a principal officer and did not have the time to fulfil her duties as she would have liked. Although she was meant to have one full day a week for race relations matters, this rarely happened. She had no deputy and no designated office; nor were there any designated race relations officers on the units who could check the daily observation books for racial incidents. Race relations were not part of the induction programme for new prisoners.

3.35 The RRLO had re-published the procedure for reporting a racial incident every year but had not been able single-handedly to update the notice boards on all the units. We saw outdated notices with photographs of members of the race relations management team who were no longer in post.

3.36 On each unit and along the communal trolley route, the RRLO had introduced yellow boxes where prisoners could post completed race relations incident forms. Copies of the forms themselves were supposed to be held in wooden dispensers next to the boxes, although these were empty on every unit. Prisoners told us that they were reluctant to use the form because it was complex and lacked confidentiality. One part of the form required an officer’s signature before it was passed to the RRLO. The form was indeed very complicated and different parts had to be detached and sent to different 57 people. An examination of the racial incident files indicated that they were rarely completed correctly. The design of this form needed to be simplified and there should be a means of direct access to the RRLO.

3.37 In a three month period, there had been 25 racial incident complaints as follows: § 10 prisoner towards prisoner § Seven prisoner towards staff § Five staff towards prisoners § Two visitors towards staff § One racial remark in a letter

3.38 The outcomes had been: § Seven women were placed on report § Six were discharged or bailed before being dealt with § Five were not completed or the action taken was unclear § In four cases, the RRLO had instructed a member of staff to place the offender on report but this had not happened § One prisoner lost her job § One complaint by a prisoner against a member of staff had not been upheld § One complaint by a prisoner against a member of staff had been upheld and a warning letter had been sent by the Governor

3.39 It would appear that the outcome in nine of the 25 cases (over a third) was unsatisfactory in that it was either unclear what had happened or the women were not placed on report even though the case against them had been established. In very few of the cases were the forms fully completed. The RRLO’s comments and/or witness statements were missing and the final outcome was not always recorded.

3.40 By contrast, ethnic monitoring was carried out to a high standard and prisoners served as members of a prisoner race relations team alongside two members of the psychology department every month. Their purpose was to:

§ Represent the views of ethnic prisoners to the RRMT § Discuss incidents and areas of concern § Offer ideas and suggestions § Increase staff and prisoners’ awareness of race relations issues and advise prisoners on the correct procedures for reporting racial incidents

3.41 We were able to attend a meeting of this group during the inspection. The team was small but active and very helpful in explaining the realities of multi-ethnic life in Holloway. They faithfully staffed a stall at the monthly information fair held in the prison, although there was little interest shown by the women and the event was poorly advertised. They had asked to be supplied with racial incident forms so that they could help women fill them in if they had a complaint. This had not happened. The current issues, listed below, had been ongoing for some time: § The prices in the canteen were very high § There was a very limited range of black skin products and no black hair products in the shop § There were no cosmetics or perfumes in the shop § Remedies for skin problems were in short supply from the doctor (they would appreciate being able to speak with a pharmacist directly as in other prisons) § The food did not meet the needs of the large proportion of Jamaican women § There was no consultation about how to cook Jamaican food § The fruit was not fresh § There was no longer a hairdressing room

3.42 They seemed fairly resigned to this being the way things were and there was little expectation of change. They gave the impression of being a valuable but under-used resource in progressing the area of race relations and cultural diversity at Holloway.

Conclusion 3.43 About a quarter of the population were foreign national women, some 20% of whom were also held under immigration powers. The Hibiscus organisation provided a service for foreign national women in the prison, and this input had shifted from training and supporting prison staff working with the women to meeting prisoners’ needs directly. Systems for providing emergency clothing and telephone calls, changing foreign currency 59 and providing interpreters were lacking. The library provided an exceptionally good service. Meetings for foreign national prisoners continued to be held every week despite staff shortages. Some women prisoners awaiting deportation needed legal advice and advocacy.

3.44 The area of race relations was under-resourced and the RRLO demoralised. There was little support for her role on the units and the yellow boxes she had introduced had fallen into disuse. Over a third of racial incidents were not properly concluded and the racial incident form was complex, under-used and lacked confidentiality. By contrast, ethnic monitoring was carried out to a high standard and a lively prisoner group spoke eloquently of the issues and was an under-used resource.

Recommendations 3.45 The role of foreign national liaison officers on the units should be re-instated.

3.46 Initial and ongoing training for foreign national liaison officers should be provided as per the contract with Hibiscus.

3.47 A system for providing emergency clothing to foreign national women should be introduced and initiated from reception.

3.48 A system for providing interpreters to non-English speaking women for medical consultations should be introduced.

3.49 There should be a conduit for concerns from the foreign nationals meetings to reach management.

3.50 The Prison Service should be aware of the different needs of different foreign national groups and provide for them accordingly.

3.51 Women awaiting deportation should be advised of the importance of taking specialist legal advice on their position before their sentence expires.

3.52 The design of the racial incident form should be simplified and direct access to the race relations liaison officer ensured.

3.53 The race relations liaison officer should be allowed sufficient time to complete her duties.

3.54 A deputy race relations liaison officer should be appointed and a designated office made available with a lockable cabinet.

3.55 There should be more direct consultation between prisoners and staff over race relations issues and diversity.

Good practice 3.56 Hibiscus was contracted to provide an in-house service to foreign national women in Holloway for three days a week.

3.57 A limited number of free telephone cards were provided to foreign national women to keep in touch with family and friends.

3.58 The library provided an exceptionally good service in terms of translated information and foreign books to non-English speaking women.

3.59 Ethnic monitoring was carried out to a high standard.

3.60 A prisoner race relations team met monthly with the psychology department.

Substance use Expected outcomes The expected outcomes for substance use are: § Safety: All prisoners are as safe as possible from exposure to and the effects of substance use whilst in custody § Respect: Prisoners with substance related needs are identified at reception and throughout their time in custody

§ Purposeful activity: All prisoners receive effective drug and alcohol education interventions to meet their needs § Resettlement and reducing offending: Prisoners, according to their individually assessed needs, are provided with the necessary support and treatment both in prison and after release to maintain healthy lifestyles and avoid the harmful effects of drug use

3.61 We reported on the high incidence of chronic drug use among the population of Holloway on our last inspection in December 2000. Since then, the level had continued to increase, with 57% of all new receptions in 2002 requiring a medical detoxification. In 2001, there had been a total of 1,723 detoxification regimes, a figure that was likely to be exceeded in 2002. This established Holloway as the busiest detoxification unit in the Prison Service and possibly in the country as a whole.

3.62 The real extent of problematic drug use was considerably higher than that recorded through detoxification regimes. The detoxification unit had recently undertaken a survey, using reception urine tests, which demonstrated that a significant number of women drug users were not accessing treatment. Significantly, a high number of these were using cocaine. Anecdotal evidence given to us by prisoners and staff during our inspection suggested that the majority of women using cocaine were doing so in the form of ‘crack’.

3.63 The prison had a written drugs strategy for 2001/2002. However, this was out of date and needed to be revised in accordance with developments in the prison. The strategy also needed to identify specific performance indicators that would allow the drug strategy group to monitor and evaluate the various initiatives taking place in the prison.

3.64 The detoxification unit had been expanded in size through pressure of numbers. All new prisoners undertaking detoxification were initially housed in H1 for observation purposes before moving to D1 to complete their treatment. The standard detoxification regime for opiate users was a 10-day course of methadone, although women entering the prison on another regime such as dihydrocodeine remained on this treatment. Research was also being undertaken to evaluate the use of other drugs for detoxification although,

62 for many of the women, methadone would continue to have advantages. Not least of these was that the consumption of methadone was relatively easy to supervise compared to medication dispensed in tablet form.

3.65 Additionally, in line with Prison Service Order 3550 ‘The Clinical Needs of Substance Misusers’, which lays out the standards required in this area, where appropriate, women entering the prison on methadone prescriptions could have these continued throughout their stay. This meant that they could be discharged back into the community without having their treatment disrupted, with some level of stability and being less vulnerable to overdose.

3.66 The detoxification unit offered a daily programme of support groups such as relaxation, acupuncture, and drama and dance therapy. These, however, were only accessible to a minority of the women and it was acknowledged that there was a need for greater support on the unit. In particular, there was little offered to the women on D1 who spent much of their time locked in their cells with little motivational or diversionary input. To provide more support would require a greater staffing commitment but would improve the detoxification regime as well as encouraging the women to engage in treatment services and potentially reduce the incidence of self-harm.

3.67 The prison had been successfully running a peer support scheme that recruited those women who had successfully detoxed and remained drug free. Their role was to help motivate women who were still going through the process and to augment the work of staff. At the time of our visit, the role of the peer supporters was being reviewed and they themselves had a number of ideas and suggestions as to how they could be used most effectively. This was an innovative and valuable scheme but needed to be clearly defined and managed.

3.68 The throughcare service (CARATs) in the prison was provided by Cranstoun, a community-based specialist drug service. Apart from undertaking initial assessments and some one-to-one work, they had until recently been running groups on D1 for those who finished their detoxification programme. This programme had stopped when the detoxification unit had extended into D1, although there were plans to reinstate it in the activities centre in the near future. 63

3.69 While the provision of these support groups was an important element of service provision, it was unclear as to why it was solely the CARAT team that was involved in the delivery. There was officer involvement in a relapse prevention group being run on the voluntary drug testing wings and this multi-disciplinary approach could be extended to other areas. It was also apposite that, given the need to review and revise the prison’s drug strategy, the role and priorities of the CARAT team should be reviewed. In particular, the throughcare and post-release support for women drug users needed to be developed.

3.70 The CARAT team had a part-time member of staff contracted in from another agency to provide specialist crack cocaine services, the main element of which was a bi- weekly support group. This created a number of problems including continuity and the fragmentation of service provision according to the main drug of abuse. This was not an effective use of resources and needed to be reviewed.

3.71 The prison had two voluntary drug testing units based on A5 and B5 where those women who agreed to regular urine testing for drugs were housed. These units were seen as two of the calmest in the prison with very little active drug use or related behaviour problems. We spoke to a number of women who were positive about the lack of trouble on the units and the absence of drugs compared to the rest of the prison. However, testing was not taking place as planned and in the two months prior to our inspection almost none had been undertaken.

3.72 The prison had a number of external groups involved in providing in-reach services to drug users and their families. This was a positive development and needed to be further encouraged to provide greater access to support services for women on their return to the community.

3.73 The normal array of security measures was in place, including CCTV in the visits room, a searching programme and mandatory drug testing. Staff and prisoners told us that the use of drugs in the prison had been reduced over the last two years but that there

64 still continued to be some availability. To some degree this was inevitable as the prison was taking women directly from court, which presented the opportunity to smuggle drugs directly into the establishment.

Conclusion 3.74 While the ability of the prison to offer appropriate medical treatment to drug users on reception was impressive, the provision of motivational and support services was in need of further development on the back of existing good practice. In particular, services needed to be better matched to the identified needs of the prisoners and to develop better links with community-based provision.

Recommendations 3.75 The drug strategy group should agree a revised drug strategy document that includes specific targets and performance measurements for services within the prison.

3.76 Staffing levels in the detoxification unit should be reviewed to ensure that motivational support services are available to all the women housed there.

3.77 The peer support workers should be given a clear job description and provided with an agreed structure for supervision and support.

3.78 The prison should review the role and priorities of the CARAT team to ensure that they reflect the identified needs of the women at Holloway.

3.79 The work of the part-time crack cocaine worker should be reviewed and consideration should be given to integrating the role into the mainstream work of the CARAT team.

3.80 The prison should ensure that those women who choose to sign up to voluntary drug testing are given the opportunity to be tested as agreed in their compact.

3.81 The drug strategy group should take a more active role in developing links with community groups and establishing co-ordinated throughcare systems. In particular, related issues such as re-establishing family links and housing should be given greater prominence.

3.82 The drug strategy group should closely monitor the availability of drugs within the prison to determine whether the security measures and demand reduction services were achieving the aim of reducing availability within the prison.

Good practice 3.83 The standards and protocols of the detoxification unit were equivalent to those of best practice in the community. Despite the pressure of numbers and the complex needs of the women they were treating, they were providing a model of good practice that should be followed across the prison estate.

Maintaining contact with family and friends Expected outcomes The expected outcomes on maintaining contact with family and friends are: § Safety: Prisoners and visitors feel safe in their time together on visits and visitors feel safe within the establishment § Respect: The rights of prisoners to maintain contact with family and friends are upheld and practical arrangements are in place to provide for their visitors, with special consideration being given to children and partners § Respect: Visitors are welcome to the establishment, supported within the prison and recognised as free members of society in order that they may contribute positively to the prisoners’ progress § Resettlement and reducing re-offending: Prisoners are encouraged to build and maintain family and social networks and relationships that contribute to their well- being and help reintegrate them into the community

Visits 3.84 An excellent visitors’ centre, operated by PACT, was sited just outside the main prison entrance. The centre manager was an experienced, able and enthusiastic co-

66 ordinator. Holloway is the largest women’s prison in the country and accepts prisoners from a large catchment area, yet visitors were unable to park by the establishment. This caused enormous difficulties.

3.85 A very wide range of written information was available, some of it in languages other than English. Many local and national support services displayed information about their various services. Such information would be enhanced by the use of different media, such as information tapes or a video tour of the prison. Representatives from ADFAM, a drug support agency for the families and friends of substance misusers, were available at the centre at regular times during the week to speak to visitors in private.

3.86 An unsupervised play area and a variety of refreshments were available. Seating was more than adequate and toilet facilities were available, including disabled access. Nappy-changing facilities were included. The centre was spacious, brightly-decorated and welcoming to visitors, and staff were clearly able to offer verbal information and advice.

3.87 A comments book in the centre was used by visitors. However, it recorded no feedback from prison managers and it was not clear to us how such comment was evaluated and/or acted upon. The experience and suggestions of visitors is valid and important and their involvement in services should be encouraged.

3.88 All visits had to be booked by telephone, and both domestic and legal visitors expressed their frustration in the delays they experienced in accessing the visits booking line. The prison needed to improve its booking procedures.

3.89 The centre staff received the list of expected visitors from the gate staff each morning. Visitors were expected to check in at the centre on arrival by completing a slip with the names and addresses of every adult visitor. Items not being taken into the visits hall were placed in lockers in the visitors’ centre. The centre staff were keen to engage visitors and could provide information about the prison regimes and procedures. We consider that the visitors’ centre could be used in wider ranging and more creative ways.

3.90 The visits timetable was: § 1.45-2.45pm and 3.15-4.15pm: Monday to Friday § 9.15-10.15am and 10.45-11.45am: Saturday § 1.30-2.30pm and 2.45-3.45pm: Sunday (convicted prisoners only)

3.91 The only time available for children to visit, if carers did not wish to withdraw them from school, was the weekend. We were told that all-day children’s visits had been available for prisoners with children and grandchildren but that these had discontinued earlier in the year. Despite this, we noted that information concerning such visits was still contained both in the information for visitors booklet and in one of the holding rooms in the reception area.

3.92 The opportunity for children to visit mothers and grandmothers is important in maintaining their relationships. Imprisoned mothers will worry about their children and children will worry and fret while separated from their mothers. Quality time spent with a child can assist the emotional well-being of all concerned. The existing visiting system placed no importance on the parent/child relationship and demonstrated a disturbing lack of awareness regarding the needs of prisoners and their children.

3.93 As stated earlier in this report many prisoners were transferred out of the establishment within 48 hours of arrival. It was not unusual, therefore, for visitors to arrive for an initial reception visit only to discover that the prisoner was no longer resident. While we were told that family members were not informed of this movement for ‘security reasons’, some information could and should be given to prevent a wasted journey. This could become the responsibility of a family liaison worker.

3.94 Two ‘waves’ of visitors arrived during the afternoon at 1.15pm and 3.25pm. Visitors were not called from the centre but made their own way to the prison entrance when they felt it was appropriate. They announced their names to the gate staff and showed their identification before being moved through a security door to a waiting room. Given that visitors had already checked in at the visitors’ centre, this process appeared to be unnecessary. The establishment should consider calling visitors from the visitors’ centre in numerical order to avoid a large number of people congregating in the gatehouse. 68

3.95 The seating in the waiting room was torn and in some places cushioning was missing altogether. This situation had been mentioned in the last Board of Visitors report as a condition that had apparently existed for some time. The conditions were disrespectful.

3.96 Refreshments and toilet facilities were available in the waiting room. As nappy- changing facilities were only available in the women’s toilet, they were not accessible to male visitors.

3.97 Information for visitors, for example about the assisted prison visits scheme, the suicide and self-harm policy, and how to make a complaint, were produced in English only and were not creatively displayed.

3.98 There were no toys, books or television to help children pass the time. Equally, there was no information about the searching procedure or any child-friendly information about the use of a drug dog. This is important because many children and adults are uncomfortable in close proximity to a dog.

3.99 Prior to handing in any clothing or other articles, the individual concerned first needed to complete a form at the visitors’ centre. The ‘parcels office’ was accessed from the visits waiting room. Clothing or other items could be handed in before a visit or without actually going on to visit a prisoner. Individuals had to stoop at the window to talk to the officer concerned and this was not good practice. As the parcels office was only open during visiting times, visitors could be delayed by queuing to hand items in.

3.100 Visitors were unable to hand in cash. Postal orders could be posted to the prison but these take time to clear. Allowing cash to be placed into the individual prisoner’s spending account would mean it was available for use by the prisoner in a shorter space of time. This is relevant to the needs of women at Holloway given the short period of time that many women were held at the prison.

3.101 Before being searched, visitors were invited by a sign (in English) to deposit any illegal substances without fear of recrimination in a locked ‘amnesty box’ fixed to the wall. We considered that visitors were unlikely to trust this.

3.102 At a signal from staff, the visitors all stood and formed a queue into the search area. It seemed to us inappropriate that visitors were required to check in at the visitors’ centre, repeat this information to gate staff, wait some time in a waiting room and then queue to be searched. The existing procedure appeared to be over-involved and lengthy, and both visitors and prisoners informed us that visits often started late as a result. Such queuing would be unnecessary if a numbered system was adopted and visiting times staggered.

3.103 Two officers searched visitors appropriately and sensitively. We did not see a drug dog in operation and are therefore unable to comment on this procedure.

3.104 After searching, visitors moved to the visits hall, which was accessible via a flight of 16 steps. This would be difficult or impossible for some people to negotiate.

3.105 The visits hall was bright and clean. It contained two closed booths and 23 groups of four fixed chairs. These were grouped around a table that was so small as to make it useless.

3.106 Social workers and probation officers could visit prisoners when there were no domestic visits during the morning. The chaplaincy team could help to organise private visits to discuss, for example, the planned adoption of a prisoner’s birth child or a contact visit. When appropriate, these took place in one of the private booths normally reserved for legal visits or in the chapel area.

3.107 There was some good prisoner art work displayed. There was also information for visitors but it was all in English. Information on the searching procedure was displayed but it was partially hidden by jackets hanging alongside. Appropriate and necessary literature should be made available in a range of relevant languages.

3.108 Photographs of members of the race relations management team were displayed, although five of these had been crossed through. Not only did this look unprofessional, it also raised questions about the establishment’s commitment to this area. We were told that the individuals concerned were no longer involved with the team.

3.109 Although one racist incident report form was held in a folder by a box on the wall, there was no information on how to use it or the purpose of the box.

3.110 Staff in the visits hall were observant and aware of the activity within the hall. They were respectful and professional in their work. Both prisoners and visitors were supervised without unnecessary control. Visitors approached officers for information and were assisted accordingly. Information booklets and the necessary forms detailing the assisted prison visits scheme were freely available.

3.111 There was a suitable play area in the visits hall, although this was not always supervised, which meant that child visitors were not allowed access to the area. Children can quickly become bored and fractious during a visit, especially if they have travelled some distance. A supervised play area is necessary to enable adults to enjoy some quality visiting time free of the necessity for constant childcare.

Telephones 3.112 There were only two telephones on each residential wing. As association was frequently cancelled, this meant that prisoners could not contact partners and children at times suitable to them. Equally, prisoners were unable to plan and/or tell children and family members when they would call because they could never be sure whether or not they would be locked in their rooms. Queues quickly formed when access to the telephones was possible and there were not enough telephones to meet the required need.

3.113 We were informed that there were only two telephones for use specifically by foreign national prisoners. Such prisoners could only access these if they happened to be residing on one of the two wings where they were located. If not, they had to wait to be escorted by officers to the appropriate wing. As a result, access to either of these two facilities was not easy and in practice was often impossible.

3.114 The chaplains informed us that they were often approached by prisoners requesting assistance with such issues as the illness of a close family member/partner/child. In such cases, a chaplain could make a telephone call on the prisoner’s behalf and, if they felt it was appropriate, could also issue a telephone card. These cards were supplied by the Aldo Trust, a prison support group, and could be used to make both domestic and international telephone calls. While this was supportive in meeting a prisoner’s immediate need, prisoners should not have to request the help of a chaplain for such an important matter.

Mail 3.115 Prisoners were given an envelope and paper when they arrived at reception. Remanded prisoners were able to post two letters per week at the prison’s expense; convicted prisoners were allowed one. Mail was received onto, and collected from, the wings on a daily basis. Stamps could be posted in and there was no limit on how many a prisoner could have in her possession.

3.116 If prisoners had children under the age of 16 years, they were able to request a ‘children’s letter’. This was a letter, posted at the prison’s expense, using paper that was not stamped with the prison’s name and address. This ensured that children who did not know that their mother was in prison would not be alerted to this by a letter from her.

Conclusion 3.117 The visitors’ centre was providing an excellent service and could be exploited further for the benefit of prisoners, their visitors and the organisation of the prison itself. The visitor booking system was unsatisfactory. All day visits for mothers with their children, which are a very important service, had been suspended because of staff shortages. These should be restored. Arrangements in the waiting area for visitors should be improved. Procedures for admitting visitors were unduly cumbersome and visits were often delayed accordingly. Staff supervising visits were respectful and professional in their approach to visitors. Women had insufficient access to telephones on the residential units.

Recommendations 3.118 A car parking facility should be made available for visitors.

3.119 Prison managers should ensure that comments in the book for visitors are noted and responded to as necessary. An acknowledgement should be marked in the book so that visitors are able to see that their comment has been considered and noted.

3.120 The booking procedures for visits should be improved and should include increased access to the telephone booking system. It should also be possible for visits to be booked in person.

3.121 The already excellent services provided by the visitors’ centre should be further developed to increase opportunities to assist and support both visitors and the establishment.

3.122 The opportunity for children and mothers to spend a day together should be re-instated and the establishment should create family liaison workers to help and support prisoners in maintaining important family links.

3.123 The damaged seating in the visitors’ waiting room should be repaired.

3.124 Nappy changing facilities should be made available for use by male visitors.

3.125 Information for visitors should be made available in appropriate languages using a variety of media.

3.126 Appropriate, child-friendly details about the searching procedure should be clearly displayed using appropriate media.

3.127 The parcels office should be relocated to an area that is more easily accessible and does not require the visitor to stoop at the window. The system for receiving parcels should not delay visitors.

3.128 A system should be developed that allows visitors to post or hand in cash to the establishment should they wish to.

3.129 The ‘amnesty box’ for illegal substances and the sign inviting visitors to use it serves little purpose and should be removed.

3.130 The establishment should review its current procedures for admitting visitors into the prison with a view to simplifying the arrangement.

3.131 Appropriate facilities to access the visits hall, such as a stair lift, should be provided.

3.132 The post of family liaison officer should be created and their name and contact number should be advertised to both prisoners and visitors. This officer should be responsible for arranging private visits.

3.133 The race relations liaison officer should ensure that information displayed about me mbers of the race relations management team is kept up to date.

3.134 The race relations management team should consider creative ways of informing visitors about the prison’s race relations policy.

3.135 The play area should be appropriately supervised at all times.

3.136 The establishment should ensure that prisoners receive adequate time out-of- cell to enable them to access the telephone services.

3.137 The number of telephones on the wings should be increased to meet the existing demand.

3.138 The prison should increase the number of telephones for use by foreign nationals in the long term. In the short term, it needs to ensure that foreign national prisoners are able to use the two telephones currently available on a regular and planned basis. 74

3.139 Concerns about the well-being of a family member or child should be an issue that is expected and planned for, and should receive automatic assistance from an effective personal officer or family liaison officer. The prison needs to ensure that such support is available. The establishment should also allow the prisoner to make a telephone call at the prison’s expense in cases of genuine need.

Good practice 3.140 Information booklets and the necessary forms detailing the assisted prison visits scheme were freely available in the visits hall.

3.141 Stamps could be posted in and there was no limit on how many a prisoner could have in her possession.

3.142 If prisoners had children under the age of 16 years, they were able to request a ‘children’s letter’. This was a letter, posted at the prison’s expense, using paper that was not stamped with the prison’s name and address. This ensured that children who did not know that their mother was in prison would not be alerted to this by a letter from her.

Applications, requests and complaints

Expected outcomes The expected outcomes for applications, requests and complaints are: § Safety: Prisoners are safe from repercussions or recrimination in making any application or request or complaint § Respect: Prisoners know and are given appropriate help to exercise their right of access both to applications, and requests and complaints; they receive a prompt, courteous and fair response from staff § Purposeful activity: Applications are used to enable access to activities § Resettlement and reducing re-offending: Sentence plans are normally implemented without a prisoner needing to use applications or request and complaints

3.143 Application forms for various services were available on request from wing offices. Once completed, they were returned to the wing office before being forwarded to the necessary service.

3.144 Prisoners informed us that they did not have confidence in the request and complaint procedures, and this was evidenced in our initial questionnaire.

3.145 Information was displayed in various places but this was all in English and not particularly effective. Prisoners may not have received such information at reception and, without a formal induction process, there was no way of ensuring that basic information about the establishment’s regimes and services was given. Contact with a legal aid officer or any member of the observation, categorisation and allocation department was not automatic. Information concerning request and complaint procedures or access to the Ombudsman was obtained by default rather than through a comprehensive information system. We were told that many officers recommended the completion of a request and complaint form to prisoners in an attempt to assist them.

3.146 An application had to be made for a request and complaint form. Prisoners informed us that they were often asked what this was about and, while this may have been asked in good faith to check if any help could be offered, some prisoners could become suspicious of the motive behind it.

3.147 We were told that 26 request and complaint forms had been received in April 2002, 18 in May and the same number in June. The records showed that most complaints received a response within a week and usually within a matter of days. Most of the replies were hand-written.

3.148 It was not clear from the records if some of the confidential complaints had been completed. We were told that the reply may have gone directly to the prisoner without the request and complaints clerk being informed.

3.149 We were told that a new request and complaints system was to be introduced shortly, as detailed in Prison Service Order 2510. Complaints would be separate from requests, and complaint forms would be freely available on the wing. Completed forms 76 would be deposited in a locked box, only accessible by a dedicated senior officer on a daily basis. Requests were expected to be discussed between the prisoner and a wing officer, and anything not satisfactorily agreed would be pursued with a complaint.

3.150 The new system would have three stages. Stage one would be the initial complaint form, which would be answered at prison officer level. If necessary, a stage two form would be responded to by a staff member senior to the person who made the initial response. If still dissatisfied, the prisoner could appeal using a stage three form, which was an appeal to the Governor. If these stages were exhausted, the prisoner would be able to take her complaint to the Prisons Ombudsman.

3.151 Although the new system had been due to be implemented across the women’s estate in April 2002, it had yet to be put into operation at Holloway by July. A booklet entitled ‘How to make a request or complaint’ had been produced for prisoners, although we found this to be overly involved with too much reliance on the printed word. Prisoners need to have an understanding of the process if it is to be successful.

3.152 Applications to speak to a member of the Board of Visitors were available on the wings. These were sent to the mailroom from where they were collected every day by the Board of Visitors clerk. Each application was logged and dated with a short summary of the nature of the application. The necessary action was recorded and signed by the board member concerned. We were told that members of the Board of Visitors would give information verbally to the prisoner concerned. The Board of Visitors members were experienced, realistic and, where appropriate, keen to support prisoners.

3.153 We were told that prisoners could speak to a member of the Board of Visitors by approaching them on the wing and that officers also made referrals on their behalf. However, it was clear to us that prisoners were hesitant to use the various options and we recommend that lockable Board of Visitors boxes be provided on the wings and that these are accessible to Board of Visitors members only.

3.154 All of the literature we saw detailing the role and work of the Board of Visitors was in English.

Conclusion 3.155 Women prisoners did not demonstrate confidence in the existing requests and complaints procedures. The new Prison Service procedures had not yet been implemented. Staff and prisoners needed to understand the new procedures.

3.156 Applications to the Board of Visitors were handled properly but prisoners should be enabled to direct their applications to the board with certainty that they will not be seen by staff.

Recommendations 3.157 Responses to request and complaint forms should be typed to ensure that they can be read easily. The respondent’s name should be made clear, rather than a signature.

3.158 Managers should ensure that each stage of the complaints procedure is dated and logged.

3.159 The new request and complaints system should be brought into operation without undue delay as soon as the prison has developed an information package for both prisoners and staff to enable them to understand and use it. Rather than relying on the printed word, the package should be available as a video and taped information in various languages.

3.160 Information about the role and work of the Board of Visitors should be produced in a range of languages and other media.

3.161 A lockable Board of Visitors application box should be provided on every residential unit and these should only be accessible to Board of Visitors members.

CHAPTER FOUR

JUVENILES AND YOUNG ADULTS

The expected outcomes for juveniles are: § Safety: The regime provides a safe and secure environment in which young people develop the confidence and motivation to improve themselves § Respect: By their respectful approach, managers and staff successfully encourage young people to improve themselves § Purposeful activity: A comprehensive range of relevant purposeful education, skills training, group work and recreational activity successfully attracts young people § Resettlement and reducing re-offending: Young people are effectively encouraged by staff to prepare themselves for release

(Those under 18 years are referred to as children, juveniles or girls; those aged between 18 and 21 are referred to as young adults or young women. When discussed as a whole group, the term young women has been used.)

4.01 Sixty-four young women under the age of 21 were held in Holloway on the second day of our inspection. Thirteen were under the age of 18, of whom eight were girls aged 16, eight were serving detention and training orders and five were being held on remand. These were not places covered by Youth Justice Board funding and consequently monitoring was not happening at the time of the inspection.

4.02 Placement of girls in custody is through the National Operations Unit. With the recent unexpected and unprecedented sudden rise in the population of girls in custody, we were told that there was no alternative other than to place girls at Holloway for as short a time as possible until more suitable accommodation could be found.

4.03 There was however, a designated juvenile wing known as D0 and the majority of those under the age of 18 were located there at the time of the inspection. The exceptions were one girl who was in health care, one on the detoxification unit and one in the mother and baby unit.

4.04 One 17 year-old pregnant girl was located with remanded and sentenced adults. Other than to suggest that she may have been a managerial problem, the establishment was unable to explain why a juvenile had been placed with adults. As no risk assessments were carried out prior to locating juveniles, this caused us considerable concern.

4.05 At the time of our inspection, young adults were to be found in a variety of locations, including the health care centre, the detoxification unit, and residential units A3, B3, B5 and C3. The arrangements for locating young adults were driven by the imperative to locate all juveniles in D0 and the aim of keeping sentenced young adults separate from adults. This produced the anomaly of remanded young adults being dispersed throughout the establishment, sharing facilities, regimes and often rooms with remanded or convicted adults. Holloway staff had no way of knowing if any of these were Schedule 1 offenders.

4.06 Young adults who were not located on D0 were treated as notional adults and no specific assessment of risk or suitability was undertaken prior to locating them in other units.

4.07 Managers were well aware of the implications for the safety of the young adults by failing to carry out risk assessments but told us that they had neither the staffing capability to carry them out nor the capacity within the establishment to place young adults accordingly.

4.08 Three of the girls living on D0 who were subject to detention and training orders were pregnant and likely to deliver their babies in custody. They had access to the anti- natal services provided for the adults and were entitled to an additional pint of milk each day and additional weekly fruit to supplement their diet. These girls told us that they chose not to attend the ante-natal classes as these took place on Wednesday afternoons, which was also the time scheduled for D0 to receive their canteen goods. No system 80 existed to enable these girls to collect their canteen goods at a different time and they were therefore forced to choose between the two. Access to canteen is very important to all prisoners and we were not surprised that the girls chose not to go to their ante-natal class.

4.09 The absence of training planning and effective child protection procedures was particularly worrying in these cases. Insufficient places exist nationally to hold juveniles who require mother and baby facilities. Additionally, we were told that difficulties in arranging escorts for pregnant girls sometimes prohibited their timely transfer to an establishment better able to meet their needs.

Reception and first night 4.10 There were no separate reception procedures for juveniles and young adults. Staff told us that they did their best to keep them apart from adult receptions but clearly this was not always possible. Staff from D0 said that they collected new receptions and brought them to the unit as soon as possible, although several girls told us that they had waited in reception for over two hours.

4.11 Youth Justice Board documentation that accompanied the new arrivals, such as ASSET forms, post-court reports and vulnerability assessments completed by youth offending teams, were retained in the discipline office and were not accessed by staff working on D0. We were concerned that essential information prepared in order to inform staff responsible for the care and safety of these children was not reaching the residential staff who needed it.

4.12 There were no specific arrangements for juveniles or young adults spending their first night in Holloway. Depending on availability, new receptions were located in shared rooms or single rooms on their first night, although staff told us that they did their best to locate new arrivals in single rooms. One 16 year-old girl told us that, as she had never slept in a room on her own before she came to Holloway, she had wanted to sleep with her light on but had not been permitted to do so. The standard first night packs provided by the Youth Justice Board to all juvenile establishments were not available to the girls placed at Holloway.

4.13 Staff confirmed that there were occasions when late new arrivals were locked up on their first night in custody without the benefit of having had a reception interview. When this happened, there would be no opportunity to offer a shower or telephone call, although staff would always make a call on the child’s behalf if necessary. We were pleased to note that staffing arrangements at night included a member of the D0 staff team.

4.14 There was no procedure for carrying out vulnerability assessments in accordance with Youth Justice Board National Standards and Prison Service Order 4950; nor did the staff on D0 complete risk assessments for cell accommodation in relation to suitability for sharing. These omissions had serious implications for the safety of the children and young people at Holloway.

4.15 The majority of the young people on D0 to whom we spoke said that they received information about what to expect and the rules of the establishment from others located on the unit, rather than as part of routine reception and induction procedures conducted by staff. Understandably, this resulted in confusion as girls often unintentionally misinformed each other. This was clearly evidenced in the organised group discussions that inspectors had with the girls during which they could not describe the regime or rules of the establishment with any degree of consistency. The lack of communication was characterised by disagreements and confusion within the group and plainly by one girl, who had been at Holloway for four weeks, who said with exasperation, “I’ve never heard of half of what they’re talking about”.

4.16 There was no specified induction programme for the girls located on D0. The girls said that while they felt safe enough (mostly because they were locked up most of the time), they did not feel secure because they were not fully informed about what was to happen to them and because of the lack of a predictable regime. (See also Regime below.)

4.17 There were frequently occasions when D0 was full to capacity. In these circumstances, the arrival of a juvenile or a sentenced young adult resulted in a remanded 17 year-old being relocated elsewhere in the establishment without prior notice. This 82 often happened following late receptions after 8pm. The location of the displaced 17 year-old would depend on where spaces existed at the time. As a result, the correct location of the new reception created a sudden and potentially destabilising move for another young person.

Accommodation 4.18 The accommodation in D0 was a mixture of shared and single rooms. While the four-bedded dormitories had a separate toilet, the double rooms had no toilet screen to provide any privacy and the girls were forced to improvise with cupboard doors. This was degrading. The unit was poorly decorated and not well maintained. It was austere and bore no signs of age-appropriate information materials, decoration or facilities.

4.19 There were no facilities to study in residential rooms. The association room was small and unwelcoming. The general layout of the unit was not conducive to supervision of, or communication with, the girls. There was a small dining room, although the girls mostly ate their meals in their rooms. There was no hot-plate and staff as well as girls told us that hot meals were usually cold by the time they were served.

4.20 Broken showers, a poor hot water supply to baths and evidence of infestation further impoverished the environment. Although there was a laundry, girls were only permitted to send three items of personal clothing each per week. Staff were unable to explain the rationale of this rule to inspectors, other than to say that it was historical.

4.21 Girls were provided with a small washing bowl that they used to launder their clothes by hand in their rooms. The girls told us that they also used the small bowls for their personal hygiene to supplement the two showers per week that seemed to be the average.

4.22 Staff complained to us about the inadequate supply of toiletries and cleaning materials that were available to give to the young women; this was a problem throughout the prison. Recently, young people on D0 had been eating out of mugs because staff could not get a supply of bowls. We were told that this was not unusual.

4.23 The nominated outdoor exercise area for girls located on D0 was an enclosed Astroturf area, known as ‘the playpen’, which the girls found humiliating. They described to us how they were escorted to this area, passing by the gardens where adults were permitted to exercise and sit. The girls were enclosed in their designated exercise area, which had no seating. They were unable to play games on the Astroturf surface due to the unavailability of physical education staff to supervise them. The girls complained that they were over-looked by adult prisoners in their rooms who shouted comments at them. We verified this from our own observations.

4.24 Moreover, due to frequent staff shortages, time out of doors was often taken with the adults, including people from the health care centre and from the remanded and sentenced wings. While this was favoured by the girls, it was not appropriate to their age or vulnerability.

4.25 The inappropriateness of the location of D0 for children was emphasised by the communication frequently overheard between them and the adult women prisoners in rooms immediately above them.

Regime and facilities 4.26 In the absence of a training plan, little individual assessment of the needs of the girls was undertaken. There was no evidence of regime activity being tailored to reducing the risk of re-offending, planned skills building or preparation for release. A limited number of girls in D0 were offered opportunities to attend the library but this was at the same time as canteen and consequently few took this up.

4.27 An education programme was delivered to small numbers in a cramped and unsuitable classroom. There was no provision for bail or legal advice.

4.28 Association on D0 was scheduled for two evenings a week. This wholly inadequate provision was frequently not delivered due to staff shortages. As showering and access to telephones depended on there being association time, these basic requirements for hygiene and contact with family and friends were frequently

84 undermined. There was no evening association at the weekend; girls were locked up after their tea at 4pm and given no further food or refreshments.

4.29 D0 was an area of the prison that had yet to benefit from electricity in residential rooms for televisions or radios. Consequently, the girls had no televisions and those who purchased their own radios were faced with significant costs for batteries. Some board games were available on the unit but these were in poor condition. Girls complained that association was so infrequent that there was insufficient time to associate with others and play games due to the competing demands to attend to their personal needs.

4.30 Girls in single room accommodation described hours of boredom and loneliness in their rooms. Although, at the time of the inspection, self-harm levels were low and there appeared to be reasonable harmony between the girls, there was clearly considerable potential for bullying, friction and boredom when they were obliged to spend so much time locked up in each other’s company with so little to do.

4.31 Two letters a week were available to the girls on the unit to support family contact. The girls could also keep in touch with family through visits or by buying phone cards; access to the latter was regulated by the incentives and earned privileges scheme. Girls located on D0 showed little understanding of the scheme. It was not designed to accommodate the normal features of adolescent behaviour and there was no imaginative mechanism to manage behaviour without being rigid and/or punitive.

4.32 We observed an adjudication procedure involving one of the girls from D0 who was proving to be a frequent management problem. Despite the best efforts of the adjudicator within the constraints of this adult procedure, the child could not contain her behaviour and ultimately was restrained by the use of force. Adjudications in adult establishments based on an adult model are not suitable for children.

4.33 Relationships between the girls and staff appeared to be affable, although the absence of an effective personal officer scheme meant that there was little proactive engagement in the solution of individual problems.

4.34 The girls were allocated a personal officer by location and details of allocations were on display in the wing office. However, the majority of the girls seemed to be unaware of the identity of their personal officers and uninformed as to what they could expect from them. Many told us that they had never met their personal officer; certainly the scheme did not require that timely introductions were made or that routine contact took place to check on the well-being of the girls in their care.

4.35 Domestic visits were taken with the general adult population and there was no facility available to allow on-wing meetings with external youth offending team workers. No such workers were employed in the establishment.

4.36 The probation service provision on D0 had been reduced and no strategy existed to plan or undertake work with the girls. There were no programmes being delivered to reduce offending or to prepare the girls for release. The probation officer characterised her contribution as ‘fire fighting’ and dealing with immediate domestic and welfare needs.

Child protection 4.37 There were no effective child protection procedures in place at Holloway. No written policy had been promulgated at the time of the inspection and no member of staff had been designated as child protection co-ordinator to develop the work. The senior probation officer retained the child protection log; this should be retained by the Governor. Staff on D0 demonstrated little awareness of child protection issues and this was worrying. Staff told us that, in the absence of a clear policy or procedures, they would ‘use their good sense’ if confronted by a child protection issue. There was no establishment training plan to include child protection.

Training planning 4.38 Girls subject to detention and training orders at Holloway were not having the training planning meetings specified by Youth Justice Board National Standards and Prison Service Order 4950. Consequently, there was no planning taking place to ensure that their time spent in custody was purposeful or appropriate to their needs. Importantly, youth offending teams were not involved in the custodial part of the detention and

86 training order, nor were they being invited to discuss or agree a pre-transfer plan to prepare the girls for the community component.

4.39 The establishment had received many complaints from youth offending teams who were not able to prepare post-transfer supervision/resettlement plans because they had not had the opportunity to work with prison staff and the children throughout the custodial part of the detention and training order.

4.40 Importantly, girls at Holloway would not get early release because they were not having the required training planning meetings. This not only impinged on the rights of the individual girls but also flew in the face of recently-introduced government policy aimed at effective population management.

4.41 The Youth Justice Board was not providing any funding to Holloway, nor was it carrying out a monitoring function of the treatment and services provided to the children there. There was no communication or information flow between the Youth Justice Board and Holloway. Consequently, staff on D0 did not know about the recent instructions relating to the presumption of early release, for example, and this was unacceptable.

4.42 As far as we were able to ascertain during the inspection, the stance of the Youth Justice Board was that it did not want to place juveniles at Holloway. Indeed, approximately 15 to 18 months prior to the inspection, all juveniles had been removed from Holloway and located elsewhere, mostly at that time at Bullwood Hall. With the removal of the juveniles, the Youth Justice Board withdrew funding and Holloway lost resources such as trained staff, who went to work with juveniles elsewhere. In addition to the loss of staff who had been trained and had experience relating to the management and delivery of detention and training order training planning, D0 also lost its own nurse, health adviser, careers adviser, psychologist and probation officer – in other words, all the specialist resources attached to the funding.

4.43 There appeared to be a disturbing lack of clarity concerning the strategic management links between the Youth Justice Board and the Women’s Policy Group; the Women’s Policy Group and the Juvenile Operations Management Group; and the Youth 87

Justice Board and Population Management/National Operations Unit, and how all of them should link together in practice to meet the needs of the children who were in fact held at Holloway.

4.44 We were told that efforts were made to move the girls on from Holloway at the earliest opportunity. Frequently, however, this was not soon enough. Almost all of the girls on detention and training orders missed their initial training planning meeting and many missed what should have been their first review. It was not possible to get an accurate picture of how many girls were being affected because the establishment did not monitor the situation in any way.

Conclusion 4.45 The needs of the girls at Holloway were being neglected because the establishment could not deliver to the required standards of Prison Service Order 4950 or Youth Justice Board National Standards without the necessary funding. Equally, the Youth Justice Board was not providing the funding since it did not want the girls to be there. This stand-off had created a wholly unsatisfactory situation in which the needs of children in custody were being neglected and vulnerable children were being put at risk.

4.46 Most of the unmet needs of the children held at Holloway were also reflected in the much larger population of young adult women who were held on D0 and in other parts of the prison at the time of this inspection. No additional funding was available here or elsewhere in the prison estate, to address the urgent needs of this vulnerable section of the prisoner population. The prevailing conditions at Holloway were having a profound effect on their lives in prison and were likely to have a detrimental effect on their chances of resettling in the community after discharge.

Recommendations 4.47 Children should not be held at Holloway.

4.48 There should be a strategy to manage juveniles who display difficult and challenging behaviour that alleviates the necessity to repeatedly change their location.

4.49 Risk assessments should be carried out prior to initial cell allocation and thereafter whenever it becomes necessary to change location.

4.50 Juveniles should not be located with adults under any circumstances.

4.51 While children are held at Holloway, Youth Offending Teams should be encouraged to work with them and with prison staff to develop relevant training plans.

4.52 There should be a strategy to ensure that all young adults are located in appropriate locations that meet their individual needs. As with the juvenile population, risk assessments should be carried out prior to initial cell allocation and thereafter whenever it becomes necessary to change location.

4.53 Arrangements should be made to ensure that girls attending ante-natal classes receive their canteen entitlement.

4.54 The Youth Justice Board should consider increasing provision for mother and baby units within the juvenile estate.

4.55 Pregnant girls should not serve their sentences in an adult prison. While pregnant girls are held in Holloway, systems should be in place to ensure frequent contact between the child and her parents or carers, and to support multi-agency contact through training planning.

4.56 Child protection systems should be in place and the environment and services should reflect the standards that exist in the community.

4.57 Reception of children into custody and their first night facilities should be managed in a way that acknowledges their fears and vulnerability. Population management should prevent unplanned relocation of young people during the evening.

4.58 More suitable arrangements should be provided for young women on D0 to take exercise.

4.59 Children and young adults should have access to bail information and support, and age-appropriate legal advice.

4.60 Socialisation is an important part of adolescent development and periods of association, including some organised informal activity involving staff, should be facilitated every day.

4.61 Independent advocates should be available to work with children in Prison Service custody.

4.62 Urgent steps should be taken to ensure that child protection procedures are developed in accordance with Annex B of Prison Service Order 4590 – ‘Regimes for Prisoners Under 18 Years Old’.

Good practice 4.63 Staffing arrangements at night included a member of the D0 staff team.

CHAPTER FIVE

HEALTH CARE

Introduction 5.01 Prisoners should be cared for by a health service that assesses and meets their need for health care while in prison and which promotes continuity of health and social care on release.

5.02 Health care at Holloway had been viewed as problematic for some time. The prison had a high political and public profile and had undergone several reviews of health care in recent years. It had been the continued focus of attention from the National Prison Health Task Force.

5.03 The range and complexity of the health needs of the women, their rapid turnover, the size of the catchment area, the significantly high proportion (over 60%) requiring detoxification on admission, the numbers daily on bed-watch (up to 10) and high levels of women on F2052SHs presented unique and demanding challenges for the provision of health care. This was compounded by the design and location of health care facilities. Although to be welcomed, the provision of elements of health care by external agencies added to the management complexity.

5.04 Recent staffing changes had added to the difficulties. The outcome of an internal investigation into ‘cultural problems’ (March 2002) resulted in nine staff being posted out and impacted on health care as elsewhere in the prison.

5.05 Against this background, health care was further compromised by the departure of the senior medical officer and the head of health care. At the time of inspection, three temporary staff had been drafted in to provide senior management capacity.

5.06 There was a history of good partnership working between the prison and the local NHS as illustrated by the short-term secondment of a member of the London Region Prison Health Team as head of health care. Secondary and tertiary mental health services were all provided by NHS agencies.

5.07 Until the recent departure of the head of health care, the prison had participated fully in the health improvement plan partnership work with the local health economy. The challenge now was to sustain this work through the significant organisational turbulence and management capacity pressures being experienced by both partners.

Expected outcomes Inspectors will make judgements about health care against the following outcomes: § Prisoners receive a full range of primary health care, health promotion and disease prevention services in an environment that is clean, safe and conforms with the standards that operate in the NHS § NHS and prisoner records are available to those responsible for the care of the patient § Prisoners receive health care from appropriately trained staff and support and care in meeting their health needs from all prison staff. Their right to refuse treatment is recognised § Prisoners with physical or mental health problems are identified and assessed promptly, receive appropriate treatment and care and, where appropriate, are referred without delay to appropriate secondary care providers § Prisoners’ access to health promotion in primary care is equivalent to that in the community § Prisoners are encouraged to maintain healthy lifestyles while in prison and on release and are linked to community services including GPs prior to release § Prisoners receive in-patient health care that meets NHS standards in an environment that is clean, safe and meets NHS standards § In-patients receive opportunities for purposeful, therapeutic occupation according to their assessed needs and care plan

§ Patients requiring specialist health care are identified promptly and referred to visiting specialists or the NHS § Continuity of treatment and care is not impeded by transfer between prison and the NHS or by inappropriate security precautions

Environment 5.08 Holloway had a 29-bed in-patient facility on C1, supported by a 24-hour first level nursing service. All of the beds are on the Certified Normal Accommodation. The total in-patient capacity of some 92 beds had been significantly reduced with the increase in the number of beds used for detoxification (40 beds on H1 and, recently, 33 on D1). Although six beds on C1 were designated for general in-patients, the pressure on beds from women with mental health problems precluded that use.

5.09 A wide range of services were offered by both in-house and external agencies. These included primary care, in-patient care, a day centre, obstetric services, women’s health, mental health and visiting specialists.

5.10 Primary care and out-patient clinics were provided in purpose-built accommodation off the C2 corridor and there were treatment rooms on each of the wings. The offices for the doctors, the medical typist and the administrative assistant were located in a small corridor off C2. The head of health care had an office on the C2 corridor.

5.11 The primary care clinic areas were generally dirty and poorly maintained. There were inadequate examination and hand-washing facilities and very poor use of the available space. There were two doctor’s surgeries and several rooms, including the visiting consultant room, which seemed to be used primarily as storage. Wing treatment rooms were similarly poorly equipped and dirty. This was in stark contrast to the clean and well-maintained clinical areas in women’s health and the detoxification unit.

5.12 The waiting room was in the primary care clinic area and women were provided with a bank of metal seating in the middle. There was limited health promotion material on view and women had to ask permission to use the lavatory, which was kept locked for security reasons.

5.13 The dental surgery was on the C2 corridor and was very poorly equipped. The equipment was over 17 years old and had reached the end of its useful life. It did not meet current guidelines or health and safety requirements. The cord to the ultrasonic scaler, for example, was dangerous and the fabric on the chair was ripped with a gaping hole. It was understood that, although quotes were submitted to management for the refurbishment of the dental surgery some two years ago, no action had been taken.

5.14 The flooring was dirty and there was a large quantity of debris around the fixed units. It appeared not to have been cleaned since the last dental session. The flooring itself was unsatisfactory with large voids between joints. The units and work surfaces were unsatisfactory with the melamine surface being absent in places and thus not allowing proper cross-infection guidelines to be adhered to.

5.15 The pharmacy, which was located off the C2 corridor beyond the prison shop, was relatively inaccessible and isolated. It was well equipped but rather cramped as it was not purpose-built. The treatment areas and areas from which the medicines were administered were wholly inadequate. As the rooms were not secure, trolleys were kept in a central trolley room and the nurses had to transport them around the prison. The treatment rooms were poorly equipped and some had no sinks. The hatches were poorly constructed and did not encourage communication between nurses and patients.

5.16 The pharmacy department was secure with access restricted to pharmacy staff, the senior medical officer and senior sister. The department provided an out-of-hours cupboard for emergencies that was checked every day by a technician. It was located in the primary care unit and the senior sister could only gain access by using keys in a sealed pouch. The seal number was recorded in a book if the cupboard was accessed and any item removed was returned to the pharmacy with the prescription so that it could be properly labelled for the patient the following day

5.17 The environment of the in-patient unit was as impoverished as primary care and poorly designed for observation. The majority of cells were single with two four-bedded dormitories. The accommodation was poorly decorated and the paintwork, windows and plasterwork of many rooms was extensively damaged. The rooms appeared to be generally clean, as were the sheets and blankets provided.

5.18 All single cells had integral sanitation. There was one gated unfurnished cell that was rarely used and two adjoining rooms, pleasantly decorated as a ‘befriending’ suite, were very rarely used. There were three bath/shower rooms, one of which had appropriate physical disability adaptations. All were reasonably clean. The doctor’s surgery was cramped, there was no handwashing facility and physical examination, if required, had to be carried out in an adjacent and inadequate treatment room.

5.19 The large dining area was light and airy but lacked decoration and was rarely used other than as a staff meeting room. Patients received their food at a small servery area and generally ate their meals in their cells.

5.20 In contrast, the external exercise area was well maintained and pleasant with flower beds and seating. The day centre, which was across the exercise area, was a revelation, being bright, spacious and very pleasant.

Records 5.21 We reviewed a sample of both in-patient and out-patient records and found the completion of these to be variable. There were nursing care plans for in-patients, though not always with up-to-date entries. Similarly, entries were not always complete in the individual medical records (IMRs). This is not acceptable practice. Reception assessments were mostly completed correctly, as were F2052SHs.

5.22 Prisoner IMRs were kept in a cupboard in one of the doctor’s surgeries in the primary care clinic and could only be accessed by clinical staff. In-patient IMRs were held in the nurses’ station on C1.

5.23 Medicines were supplied against the written directions of a doctor using the prescription and administration sheets (HR013 5/96). The 28-day review period appeared to be adhered to. Medication prescribed for in-possession was supplied on a named patient basis, dispensed by the pharmacy staff and signed for by the patient on receipt. The nurses administered not in-possession medication from stock.

5.24 The pharmacist saw all prescriptions, including those that were written up as not in-possession. The latter were routinely checked and a detailed written record of those checks was kept. This system was time-consuming, although the department had been issued with a lap top computer that would speed up the process. This would be in use as soon as compatibility issues with the main computer had been addressed. The patient medication records held on the pharmacy computer were complete.

5.25 The IMRs of women undergoing detoxification were kept on the unit (H1/D1) until the woman went to normal location. Similarly, the confidential records of those attending the women’s health clinic were kept locked in the clinic.

5.26 As they were based on a new charge rather than the patient, a new IMR was opened on each admission. If the woman had been in Holloway before, efforts were made to marry the new IMR with the previous one. This was an extremely difficult task. Old records were stacked on floor-to-ceiling shelves in a locked room on the C2 corridor. It was unclear what, if any, system of cataloguing was in use and it was doubtful if retrieval would be possible in the absence of the nursing auxiliary who usually undertook the job.

Staffing

Medical 5.27 The senior medical officer (SMO) had been suspended some weeks previously on disciplinary grounds. A full-time acting SMO, who was GP-trained and had worked in the Prison Service since 1990, was in situ at the time of the inspection. He had been at Holloway since 1994 and was supported by three part-time male doctors, all of whom were GP-trained and relatively new to the prison and one of whom had come out of

96 retirement. In addition, there was one long-term male locum doctor and a full-time female doctor who had worked exclusively in the detoxification unit since 1998. The latter had a background in psychiatry and was not a trained GP. She had recently completed the Royal College of Physicians course on substance misuse for doctors working in prisons. Out-of-hours cover was provided by each of the primary care doctors (except the locum) on a specific night each week, with a 1:5 rota for weekend cover. The head of health care, the Governor and the Chief Executive of Camden and Islington Primary Care Trust (PCT) had started discussion about the PCT appointing a GP to work in the prison. We strongly support this initiative.

Dental2 5.28 The dental surgeon attended for two sessions per week together with a hygienist. It was understood from the practitioner that a full course of dental treatment under the National Health Service General Dental Services regulations to secure oral health was offered to patients sentenced to over six months. Other patients were offered occasional treatment under these regulations.

Pharmacy3 5.29 The pharmacy service had experienced staffing difficulties over the past two years. At the time of inspection, a long-term locum was in charge of the department on a temporary basis. The pharmacist worked a four-day week and job shared with a colleague who provided cover on the fifth day. The pharmacy department employed two full-time MT02 technicians and one MT03, who was on long-term sickness absence; a locum MT02 technician was covering this absence.

5.30 The pharmacist worked with the local prescribing adviser of Camden and Islington Primary Care Trust, who attended the drug and therapeutic committee meetings and shared prescribing guidelines and formulary work with the department.

2 Full Dental Inspection report is at Appendix 1 3 Full Pharmacy Inspection report is at Appendix 2 97

Nursing 5.31 Several changes to senior nurse staffing had occurred recently. These included the appointment of an accident and emergency nurse practitioner from the Whittington Hospital (12 months from January 2002); a senior nurse manager as head of health care from the London Region Prison Health Team (three months from June 2002); and a H grade mental health nurse from Wormwood Scrubs (three months from June 2002). The head of health care was assisted by an experienced deputy health care manager.

5.32 The nursing complement was 41, which included nine agency staff. All were qualified and consisted of: § Two registered mental nurses § Three enrolled nurses § 36 registered general nurses (including six joint registered general nurse/registered mental nurse qualified and four registered general nurse qualified) § Six health care assistants supported the registered nurses.

5.33 Seven staff worked permanently on night duty; five were dedicated to the detoxification unit (H1); 16 in primary care (covering clinics and wings); and four on the in-patient unit (C1). There were two trained nurses (sister and staff nurse) plus one auxiliary per day shift on C1, and two trained nurses and two health care assistants on HI. We were concerned that the current establishment figure for nurses was not known, nor were the results of the profiling that had determined the establishment.

Other staff 5.34 A principal officer and four prison officers also worked in the in-patient unit during the day and two prison officers at night. The latter could be used elsewhere in the prison and, when this happened, the nurse was left alone.

5.35 One executive officer, an administrative assistant and a medical typist worked in health care administration off the C2 corridor. Primary care clinics were supported by two part-time administrative assistants and a nursing auxiliary who managed the clinic appointments including dental services. The process was mostly paper-based and somewhat complicated.

5.36 We were concerned that there was no integration of the various health care activities into a unified primary care administrative system.

Specialists 5.37 Visiting specialists included an optician and a podiatrist who attended monthly or as required.

5.38 Mental health services were provided as a satellite of the local community mental health team of Camden and Islington Mental Health Trust. The team consisted of two team leaders (job share) and a community psychiatric nurse (CPN). A further two social workers were due to join the team in September 2002. The CPN had worked for four months on C1 as the in-patient manager prior to joining the team in April 2002. There were plans to establish a mental health liaison officer on each level. The Trust had appointed a training and development officer to support the mental health teams across both Holloway and Pentonville.

5.39 A general psychiatrist with forensic training had recently been recruited by the Trust and had started work in the prison the previous week. Prior to this, two general psychiatrists had been directly employed by the prison to provide two and three sessions respectively. They would continue to work in the prison for the time being while the Trust psychiatrist built up his clinical case load.

5.40 Tertiary psychiatric care (four new and eight follow up sessions) was provided by North London Forensic Services. In future, this would be accessed via the community mental health team.

5.41 Obstetric services had been provided via a service level agreement with the Whittington Hospital since 1998. A community-based team of midwives and health visitors visited the prison three days a week and provided ante-natal, post-natal, parentcraft and breast-feeding services. An obstetrician held clinics in the prison every six weeks and a paediatrician visited fortnightly. Women and children were also seen in primary care if needed.

5.42 Two health advisers, employed by the prison but managed by the Royal Free Hospital, had provided a five day a week women’s health clinic for eight years. Four specialists in genito-urinary medicine provided two clinics a week including a colposcopy service. The health advisers were supported by an administrative assistant. There was also a 24-hour post-exposure/needle stick injury service for staff provided by the Royal Free Hospital Occupational Health and Safety Unit.

5.43 Women located in the in-patient unit were visited weekly in the day centre by members of the voluntary organisation, WISH (women in secure settings). A WISH representative also attended the multi-disciplinary team meeting held weekly on a Wednesday.

5.44 The psychology department provided both a forensic and counselling service. The latter was run by a senior psychologist supported by a further counselling psychologist and four post-graduate psychologists on placement from City University. There was also an art therapist who had been working three days a week in the prison for the past two years. Five members of the psychology department were soon to be piloting dialectical behaviour therapy on behalf of the Prison Service’s Women’s Policy Group.

Delivery of care

Primary care and out-patients 5.45 In our view, the provision of primary care was poor. Although we witnessed caring interactions by individual staff with patients, this seemed to be mitigated by the lack of systems responsive to women’s needs. Our pre-visit questionnaire suggested that nearly two-thirds of women interviewed rated the overall provision of health care as ‘bad’ or ‘very bad’. Some 80% said access to medical, dental and optical services was difficult; 50% felt the same about access to nurses. What was somewhat surprising was how few formal complaints were made about health care. However, many of the women would have been homeless and half would not have had a GP prior to admission. The relative lack of complaints may have been a reflection of this.

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5.46 Two GP surgeries (one of the GPs and the locum) were held from 9.30am to noon each weekday morning and on Wednesday and Thursday afternoons from 2pm to 4pm. Women wishing to see health care staff filled out an application questionnaire and handed it to level nurses. This was then entered in a ledger in the primary care centre and an appointment issued. We heard complaints from some women who claimed never to have received an appointment when requested or who had had to wait several days.

5.47 The GPs were accompanied by a nurse in their surgery. This led to delays if the nurses allocated to that duty were themselves delayed while distributing medication on the levels.

5.48 The lack of a female GP in primary care meant that women requiring, for example, an internal examination were referred on to the women’s health clinic. There appeared to be a low threshold for such referrals, exacerbated perhaps by the poor access to and use of examination facilities within the clinic.

5.49 On Friday mornings the acting senior medical officer held a clinic that was primarily administrative, dealing with such things as complaints or correspondence with solicitors.

5.50 There was no proper nurse triage, though level nurses would undertake initial assessment. There was a discrepancy between the levels of responsibility assumed by the nurses on the levels relative to those working in primary care clinics. This may be due to the fact that doctors did not routinely review patients on normal location.

5.51 Nurse-led healthwatch clinics (chronic disease management clinics for, for example, diabetics, asthmatics and epileptics) were on the programme each week, although a review of the diary showed that these rarely occurred. We found no evidence of health promotion (including oral health promotion) being undertaken.

5.52 We were told that nurses undertook continual professional development but the only evidence shown to us was a record of cardio-pulmonary resuscitation training that had taken place in 2001.

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5.53 We were pleased to see the effective team approach to care adopted by the dentist and hygienist. This was hampered by the lack of systems to enable access to dental care. Patients completed a multi-disciplinary health care request form on the wing, which was submitted via officers to the health care office. It was understood that these were sometimes lost in transit. A very confusing method was then used to transfer these requests into a ledger and thus to appoint patients. We were unable to ascertain the actual waiting lists for either routine or emergency treatment.

5.54 The current dental surgery attendance sheet only allowed for the treatment of five emergency and 10 new patients. The demand for treatment, both routine and emergency, was increased by the high turnover of prisoners. It appeared, from the documentation produced and by talking to the providers, that this demand could not be met by two dental sessions per week. There were no formal arrangements for the treatment of out-of-hours emergencies or for periods of absence due to annual leave.

5.55 The pharmacy department was proactive with regard to intervention logging and, if queries arose or an interaction was found, either the prescriber was contacted directly or an intervention note was printed and sent to the relevant prescriber before any medicines were supplied.

5.56 Patient information leaflets were supplied with original pack medication. It is now a legal requirement that patients are supplied with these with their medication and steps should be taken to ensure that this is complied with.

5.57 Written in-possession and special sick policies were in place but they needed review and efforts should be made to simplify access to medicines. Treatment times were three times a day but some thought could be given to using once daily sustained release preparations, where the increased expense would be offset by the time saved in nurses handing out treatments. Paracetamol was not given in-possession because of the risk of self-harm but Paradote could be substituted. The prison had an appointment request form for the prisoner to fill in to see the doctor, nurse, optician or dentist. At present there was no facility on the form to request to see the pharmacist.

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5.58 The pharmacist should take part in triage and be available for ‘over the counter’ consultations. This would enable the doctors to use their time more effectively and would allow prisoners to take more responsibility for their own health. It would also mirror what happens in the community in that individuals have access to a wide range of medicines to treat minor ailments. The use of patient group directives is a possible route of supply/administration for the future once the legislation has been passed to include prisons.

5.59 Both pharmacists appeared to make regular clinical interventions and these were recorded in line with best practice. It was reported that, although the inter-department relationship with the prescribers had previously been fraught, the pharmacists seemed to be making headway with prescribing issues that had caused concern.

5.60 There were plans to relocate the pharmacy to be adjacent to the primary care clinics. This would promote direct pharmacy-patient contact and we strongly support this move to be undertaken as soon as possible.

Reception 5.61 Reception at Holloway was very busy and all women were given an assessment by nursing and medical staff. A counselling service provided by the psychology department was available for all women within 24 hours of reception if they were deemed to be at risk of suicide and for whom a F2052SH had been opened. Women also had routine screening for substance misuse in reception. For those in need of detoxification (over 60%), an IMR was raised and they were admitted to the detoxification unit (H1).

5.62 Women would usually spend seven or eight days on H1 before moving to D1 for a further three days of post-detoxification care. Following this, they would move to normal location and come under the care of primary care staff. Methadone was only dispensed within the detoxification unit. We welcomed the level of cohesive protocol-driven care that women received in detoxification from both discipline and nursing staff who worked well as a clinical team. In view of the levels of women’s needs, we also support the proposals for developing the service further. Clearly, as in primary care, a review of the numbers and skill mix of nursing staff should be undertaken in the light of increasing numbers of prisoners needing the service. 103

5.63 The medication supply function to the detoxification unit was well controlled. The unit used a Baxa dispenser that measured the methadone mixture in multiples of 5ml. The stock was requisitioned from the pharmacy on a duplicate pad and supplied in accordance with the requisition. Each bottle was numbered and when a bottle was used the number was written at the top of the register page so that a running total could be kept. At the end of each bottle, the small amount of overage was destroyed on the detoxification wing under the supervision of the pharmacist. A CD destruction kit was used.

5.64 As well as working well as a team on H1/D1, detoxification staff had developed an excellent working relationship with the staff providing the women’s health clinic, possibly aided by their physical proximity. We were impressed by the quality of care given to women by this latter service in terms of counselling, treatment and follow up. This applied to gynaecological problems (abnormal smears) as well as those related to blood-borne disease. Women, including young adults, could be referred from within any part of the prison or self-refer. Over 200 women were seen each month, of which approximately 30 tested positive for Hepatitis C. The pharmacist was involved with a Hepatitis B pilot scheme.

5.65 At the time of the inspection, the community mental health team was not up to strength and, in fact, its continuing existence had been in some doubt until the recent appointment of a consultant general psychiatrist. In the interim, women were being seen by the two part-time psychiatrists. Once established, the team will operate as other Trust community mental health teams and take referrals from several sources, including GPs, reception screening, women’s health services and self-referral. A new referral form was to be introduced from 15 July 2002 and the first co-ordination and work allocation meeting was planned for 17 July 2002. The team were clear that their role was to provide level-based assessment and treatment services, referring on to, and liaising with, other specialists (for example, general psychology) as required.

5.66 Team members expressed concern about the lack of appropriate services for juveniles or young adults and were planning to discuss this grave omission at the next

104 health improvement planning meeting. We strongly support an urgent review of the mental health needs of the young women in Holloway.

5.67 Detailed inspection of psychology services is covered elsewhere in this report but we were pleased to see how relevant elements of the service were providing primary care.

5.68 Pregnant women had difficulties in relation to partners attending hospital with them for scans and ante-natal check ups. This was largely because partners were not given prior notice of the appointment for security reasons. Prison staff shortages for escort duty sometimes resulted in the cancellation of dating scan visits. We understood that the ultra-sound equipment was available in the prison and that one of the midwives was to undergo training in its use. This should resolve much of the delay and reduce the need for outside visits.

5.69 This should also ensure that the regular hospital out-patients’ slots (two each morning and afternoon Monday to Thursday) remain available for general use.

In-patient care 5.70 The in-patients included women with mental health problems or those displaying chronic self-harm behaviour. They had very little by way of a therapeutic regime, being locked up much of the day. Their only real activity was to attend the day centre, which was open mornings and afternoons on weekdays. This facility was a model of good practice in providing for the diverse needs of the women. The prison officer in charge had close links with the education department, which helped to ensure that women admitted directly to C1 received education induction. The library service visited each week and provided a range of literature, including health-related publications.

5.71 We were pleased to hear of the introduction by the psychology department of a relaxation group for C1 women on Friday afternoons. This had started the previous week and was due to be piloted for a further five weeks.

5.72 Patients also had access to a pleasant garden/exercise area, although we did not observe this being used much during the inspection. Many of the women lacked

105 motivation but we were concerned that some staff expressed the view that the patients who were perceived to be more dangerous did not deserve daily exercise because of their behaviour. This was unacceptable.

5.73 There were two prisoners in health care who were deemed to require three officers to unlock them. Having no additional staff to manage this increased demand had a direct negative impact on the care of the rest of the women. This included a restriction on access to baths/showers and telephones.

5.74 Nursing levels were low considering the high levels of mental health problems of women cared for in C1 and a reprofiling should be undertaken as a matter of urgency. There should be a ratio of one qualified/trained health care worker to a maximum of five patients. In secure NHS units, the staffing ratio for such patients would be 1:2.

5.75 Pressure on the use of in-patient beds was high and this, coupled with the low staffing levels, meant that staff were working under some strain and appeared somewhat frustrated and demoralised. There was some tension between the nursing and discipline staff primarily around job allocations. There was a sense that some discipline staff felt that their input to the care of women was not as valued as that of the nurses. We welcomed the appointment of a senior nurse manager to be in charge of care on C1. We also applauded the fact that his office was on the unit, which should facilitate better communication with and supervision of all staff.

5.76 Pressure on staff was exacerbated by the high numbers of bed watches. This was on average four per day, although it was not unusual for it to be as many as 10 per day.

5.77 The generally poor quality of primary care and a tendency to ‘medicalise’ behaviour, as was evidenced by the high numbers of women on open F2052SHs, further increased the pressure on in-patient care.

5.78 There was no system of a ‘named’ nurse or health care worker for each patient. We were told that staffing levels would not permit this. This was also the reason given for the lack of properly completed care plans. We were deeply concerned for one lifer in- patient who had been on 24-hour watch for 15 months at the time of the inspection. 106

Apart from the considerable cost to the prison (£100k per annum), this was considered very poor practice, showing complete lack of management imagination and effort. While appreciating that there can be delays and difficulties in negotiating with special hospitals/NHS secure units over the most appropriate care setting for an individual patient, we feel that 15 months is totally unacceptable.

5.79 Direct observation of patients by staff was difficult because of the poor physical layout of C1. Those women who were the least disturbed and disturbing were placed furthest away from office as they were deemed at low risk of self-harm following risk assessment.

5.80 We were very concerned at the lack of the presence of doctors, either undertaking routine ward rounds in C1 or on normal location. This, coupled with poor record keeping in the individual medical records and incomplete care planning, led to uncertainty about patient management. The physical location of the doctors’ offices, at some distance from where care was delivered, may well have exacerbated this. We would view wing visits by doctors as being equivalent to house calls in the community. This would not only provide support for nursing staff but would also ensure proper care management of those with physical problems who appeared to be almost exclusively managed on normal location.

5.81 The previous lack of visible health care management was also of great concern. We applauded the institution of a system of duty health care manager to be shared between the health care management team. We also commended the head of health care for instigating a weekly senior staff meeting with representation from all elements of health care, including: detoxification, psychology, the community mental health team, pharmacy, the acting senior medical officer, the deputy health care manager, in-patients (discipline and nursing) staff and primary care. The aim was to improve communication and the co-ordination of work across clinically and geographically disparate areas and is strongly supported from this inspection. The proposed monthly staff meeting was also to be welcomed if this improved cohesiveness of effort.

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5.82 We were also pleased to observe the new format for the weekly (Wednesday afternoon) in-patient multi-disciplinary meeting. The new head of in-patient care had changed the focus to concentrate on developing good care plans for patients.

Conclusion 5.83 The health care needs at Holloway were extremely complex, diverse and challenging. The provision of health care lacked any sense of cohesion and, although there were pockets of very good clinical care, these were not integrated into an overall system. Primary care was fragmented and lacked the basic systems to ensure an effective ‘gate-keeping’ function. The in-patient unit was under considerable pressure. The number and different types of health care provided by external agencies added to the management complexity but could also be seen as examples of good practice. The appointment of a new senior health care team, albeit short-term, was welcomed. Considerable management effort will be required to put in place the basic systems necessary to deliver integrated, good quality health care by well motivated staff.

Recommendations 5.84 The health care management team should review the basic systems underpinning health care provision with a view to developing an overall model of primary and in-patient care that is integrated both within the prison and with the local NHS.

5.85 The Governor and health care management team should take urgent steps to improve the physical environment of health care both in terms of general cleanliness and the effective use of the available space.

5.86 There should be a review of the type and level of secretarial/administrative support, which should be increased as necessary to allow the proper integration of all primary care administrative functions.

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5.87 The health care management team should develop and introduce clinical supervision and a training and development programme for nursing and medical staff within overall clinical governance initiatives with the NHS. This should include the introduction of nurse triage and re-establishment of chronic disease management clinics.

5.88 The health care management team, together with the Primary Care Trust and regional prison health team, should review medical cover in the light of the recommendations of the Doctors’ Working Party. This may include access to a female GP in primary care.

5.89 Medical staff should undertake regular ward rounds on C1, visit the levels as required and complete individual medical records to ensure that continuity of care is regularly reviewed and evaluated.

5.90 A review of nursing skill mix, levels and shift patterns should be undertaken to better meet the needs of prisoners.

5.91 Individual care plans and a ‘named nurse/health care worker’ system should be introduced for in-patients.

5.92 There should be a review of the arrangements for dating scans and attendance at hospital appointments for pregnant women.

5.93 The pharmacist should take part in triage, be available for ‘over the counter’ consultations and be included within the appointments request system.

5.94 All areas used for storing medication should be inspected frequently and out- of-date, discontinued medication and loose tablets should be removed. Properly equipped rooms should be made available for drug storage. Consideration should be given to alternative arrangements for drug distribution to remove the need to transport trolleys around the prison.

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5.95 Specific dental recommendations include: § A complete refurbishment of the dental surgery complex should be carried out as soon as possible § A dental health care needs assessment should be undertaken § A review of systems should be undertaken to clarify the means by which patients access routine dental services, the provision of care for emergencies and urgent cases and to establish the number of dental sessions required to meet the need § An agreement should be put in place with the prison works department to ensure the autoclave, compressor and fire extinguisher are service-date labelled and that electrical plugs are ‘safety-testing’ labelled

5.96 The health care manager, the regional health care task force and the local Primary Care Trust should agree a health promotion strategy to take account of the specific public and individual health needs and set target dates for implementation.

5.97 The Governor, the regional health care task force and the local Primary Care Trust should produce an action plan for prison health care as agreed in the local health improvement plan and agree a timeframe for implementation. This should include an urgent review of the mental health needs of the juveniles and young adults.

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CHAPTER SIX

ACTIVITIES

Education

Expected outcomes The expected outcomes for education are: § Safety: Prisoners receive education and work skills training in a safe, suitable environment in which they are enabled to participate fully § Respect: Prisoners are offered opportunities in education and work skills training that meet their identified needs and different levels of ability, and promote and respect personal responsibility; education is facilitated and valued by the establishment and reflects a sensitivity to equality of opportunities issues § Purposeful activity: Prisoners have the opportunity to engage in a range of education and work skills training that provides constructive and meaningful activity and potential for self-expression § Resettlement and reducing re-offending: Prisoners are involved in education and work skills training specifically to enhance their employment opportunities

6.01 The prison provided a positive learning environment in the education department. Learners looked forward to education sessions in an environment that was clean, bright and welcoming. Staff treated women with respect and provided good teaching and learning.

6.02 The library was well stocked with books in 20 different languages and had a good range of materials to meet a wide range of needs. The links between the mainstream education centre and other training areas were effective and enabled appropriate cross- referencing. Although basic skills of number and communication were accredited through some of the practical work areas, namely physical education, sewing and gardens, this should be extended into other work areas.

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6.03 Communication within the education department itself was effective, productive and demonstrated good teamwork. The communication channels within the department focused on supporting students. Teaching and learning in literacy, numeracy and English as a second or other language was particularly good.

6.04 However, the learning environment for young women on D0 was unacceptably impoverished. The young adult and juvenile unit had an education classroom but this was a poor environment that was not conducive to learning. It was too small and offered cramped conditions. This disadvantage was compounded by poor resources and an unwelcoming ambience that contrasted sharply with the positive conditions in the main education centre.

6.05 Overall, there was an inadequate range and amount of provision to meet the needs of women prisoners. Education at Holloway had not changed for many years – it catered for those with basic skills needs but not for the more able learners.

6.06 We noted very limited opportunities to gain vocational skills and qualifications. Areas such as sewing, painting, cleaning, stores and laundry provided work for prisoners but the skills gained were not formally recognised to assist them in securing employment when released.

6.07 There had been excessive and unacceptable cancellation of education and training. In the six months preceding this inspection, the department has been closed for 26% of its intended opening time. In June this year, the figure was 43%. This prevented learners from making progress and demotivated them to a damaging degree. Training was cancelled when instructional officers were removed from courses such as physical education and horticulture to undertake discipline duties due to staff shortages.

6.08 There was no individual learning planning to ensure that each prisoner received a proper assessment of her needs and abilities in order to properly start her rehabilitation plans while in custody. Consequently, those with the greatest needs were not receiving the learning programmes to address their limitations.

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6.09 The lack of individually planned learning was symptomatic of the fact that prisoners were not being properly prepared for release. They were not provided with training in preparing job applications, CVs or in developing interview techniques.

6.10 Finally, we found an inexplicably flawed system for allocating prisoners to daily education classes. There were 100 education places available for a daily population of 500 women prisoners; the first 100 to arrive in the department were allowed into education and the rest were turned away. This arbitrary process should be replaced with a system that is more professionally defensible.

Conclusion 6.11 The main education centre provided a welcoming and positive environment for learning but the provision for young people and juveniles was woefully inappropriate. This educational deficit further underlined the generally impoverished circumstances in which children and young people were held in Holloway. There were examples of excellent teaching and departmental management but there was scope to give added value to skills training by expanding the accreditation process. Finally, the system for daily allocation of prisoners to education was fundamentally flawed and needed urgent revision. (A separate detailed report on the work of the education department has been produced by ALI/OFSTED inspectors who attended the inspection).

Recommendations 6.12 The accreditation of basic skills of number and communication in some of the practical work areas, namely physical education, sewing and gardens, should be extended into other work areas.

6.13 Improved education provision for young people should be provided with facilities and resources that are sensitive to their particular needs.

6.14 A wider area of skills training should be offered in subjects that could have a direct bearing on future employment prospects.

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6.15 The route to vocational qualifications should be opened up in order that there is added value to existing prison employment for women prisoners.

6.16 Steps should be taken to enable the education contractor to restore the delivery of education to the proper contracted hours.

6.17 Individual learning plans should be introduced for all prisoners undertaking education.

Library 6.18 The library was located in the education department and the service was provided under contract from Kensington and Islington Library Services. The facility was small for the range of services and prison population. Thirty prisoners were allowed in the library at any one time. There were three permanent staff, of which only the librarian was full-time. In accordance with good practice guidelines, the librarian worked on the principle that all prisoners should be able to access the services by visiting the library.

6.19 A mobile facility was provided to health care, the detoxification unit, D2 and the segregation unit. Most residential areas were allocated two opportunities to visit each week but this system did not provide sufficient places for every prisoner to be able to visit once a week. The system was further undermined by any restrictions in regime hours. During a three week period in June, the library had been open for five and a half days. Prisoners reported lack of access to library facilities and this was supported by a general absence of books in residential rooms.

6.20 There was an inverse correlation between regime hours and the need for access to books: as prisoners spent more time in their rooms, the requirement for reading material increased.

6.21 The library provided a very wide range of services to prisoners, their children and families. It had made a significant contribution to family days, which had ceased. The librarians had therefore taken the initiative to attend domestic visits three times a week to support family reading there. The library provided prisoner information booklets in a

114 comprehensive range of languages. We were pleased to see the diversity of languages recognised and the extent of information readily available in these languages. An information notice in 20 languages to inform prisoners about library services had been prepared but, unfortunately, there was no system to ensure that these important notices were appropriately placed and maintained. None were seen around the establishment.

6.22 The library provided specialist information on surviving abuse, family separation, sexuality, women’s health and welfare rights. Notices were on display to inform prisoners that the full range of statutory information was available on request. All Prison Service Orders, prisoners’ handbooks and Archibold were available. The librarian also co-ordinated the monthly prisoners’ information fairs that were held in the gymnasium, and provided the video lending facility for all residential wings.

Conclusion 6.23 The library provided a bright, stimulating environment with a wide range of materials, including computer access, newspapers in a range of languages, information about local and national charities or prisoner assistance groups. This information bank was diverse, up to date and researched, and also provided links with other disciplines within the prison, such as probation and psychology. The material generally available reflected the needs of the prison population both in its breadth and range of educational skills, languages and ages.

Recommendations 6.24 A system should be in place to ensure adequate access to library services for all prisoners.

6.25 The notices providing multilingual information about library services should be displayed in areas where prisoners will be able to see and read them.

Good practice 6.26 The diversity of languages recognised and the extent of information readily available in these languages was an example of good practice.

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6.27 The involvement of the library with prisoners’ children and in supporting the work of other departments was an example of good practice.

Physical education Expected outcomes The expected outcomes for physical education are: § Safety: Prisoners are safe during physical education activities § Respect: The range, type and availability of physical education activities meet the needs of the prison population; prisoners are treated fairly in all aspects of physical education § Respect: Physical education is part of the provision of a healthy lifestyle in promoting personal health, fitness and co-operative and team skills § Purposeful activity: Prisoners are engaged in suitable physical education programmes that are fully integrated with other purposeful activities

6.28 Facilities for physical education and recreation were excellent; indeed in terms of being suitable to meet the needs of women prisoners they were second to none in the women’s estate. An enthusiastic and well trained staff team were keen to exploit the facilities by delivering a programme that was both challenging and enjoyable. It was scandalous therefore that the persistent shortages of discipline officers meant that these excellent resources for physical education were all too rarely made available to women prisoners. Ironically, we were told that they were more frequently used during the inspection than at any time in recent memory. More often than not, the physical education team was cross-deployed to discipline duties away from the gymnasium.

Recommendation 6.29 The excellent physical education resources should be fully exploited to meet the needs of women prisoners by way of a programme that is consistently delivered.

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Faith and religious activity Expected outcomes The expected outcomes for faith and religious activity are: § Safety: Prisoners can safely take part in spiritual activities § Respect: Prisoners of all faiths are able to practice their faith in suitable accommodation with sufficient appropriate facilities § Purposeful activity: Prisoners have ready access to a range of appropriate spiritual activities § Resettlement and reducing offending: Prisoners and groups of prisoners are able to be involved with their faith ministers from the community

6.30 The chaplaincy at Holloway was well resourced, well accommodated and appeared to provide a comprehensive service to individual prisoners and groups. There were three full-time posts, two of which were filled by a male Church of England chaplain and a female Roman Catholic chaplain. The third had been offered to a female chaplain who was soon to take up post. An appropriately wide range of denominations was served by the regular visiting chaplains, including a Sikh priest who provided full afternoon sessions on a weekly basis despite having just four prisoners to see. A female assistant served the Muslim prisoners. Over a dozen trained volunteers visited to provide individual support to prisoners. This was managed well and supported by regular volunteers’ meetings. Volunteers were issued with keys. The chaplaincy resources included religious books in a wide range of languages.

6.31 The chaplaincy team provided a programme of small group worship and study in addition to the two very well attended Sunday services. It was noted that, with the benefit of no other competing regime, the Sunday services were regularly attended by half the prison population. This was one indication of the contribution that the chaplaincy made to the community in Holloway. A member of the chaplaincy team saw every prisoner on her first day in custody and provided a useful information sheet about the department’s facilities and timetable.

6.32 The chapel at Holloway was a large, well-appointed church, which stood alone in the grounds and provided permanent altars for Anglican and Roman Catholic services. In

117 addition, the world faiths room was both well looked after and well used. While acknowledging that women could wash prior to attending the services, an ablution facility should be provided as an integral part of the world faiths room.

6.33 A review of referrals received by the chaplaincy revealed that a significant amount of this work was of a domestic rather than pastoral nature. This could have been completed by personal officers. While the chaplaincy provided a broad and ecumenical service, it is not appropriate for it to shore up deficiencies in the personal officer scheme on a long-term basis as this could give the wrong impression to staff and prisoners about the role of wing staff.

Recommendations 6.34 An ablution facility should be provided as an integral part of the world faiths room.

6.35 The chaplains should work with wing staff and personal officers to assist them in resolving prisoners’ domestic issues rather than undertaking this work directly.

Good practice 6.36 The diversity of denominations visiting regularly and the gender balance of the ministers, assistants and volunteers were examples of good practice.

6.37 There was a good system for tracking the chaplaincy’s contact with and work done with every prisoner.

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CHAPTER SEVEN

GOOD ORDER

Expected outcomes The expected outcomes for good order are: § Safety: Prisoners’ safety is protected by clear rules necessary for the maintenance of good order and discipline and enforced by the properly exercised authority of prison staff § Respect: Prisoners understand the rules of the establishment and are treated fairly; they are able to appeal against decisions § Respect: Segregation, the use of force and application of category and status are used for their proper purposes and not as punishments § Respect: Every opportunity is taken to encourage good behaviour even when enforcing boundaries of control § Purposeful activity: Good order is supported through activities for prisoners which are challenging and well-organised

7.01 For security purposes Holloway was officially regarded as a category B local prison for male prisoners. The Governor claimed that the physical security of the prison did not support this category and that considerable funding would be necessary to make good the deficit. The particular concerns related to the single-skin perimeter wall, cell walls that were not reinforced and the lack of CCTV. Six cells designated as category A had apparently been fitted with reinforced doors, although two of these were on the top landing and three were next to storerooms and therefore did not comply with Prison Service security requirements.

7.02 A consequence of this situation was that necessary documentation was out of date and revision of, for example, the security manual and searching strategy was not taking place pending resolution of the issue.

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7.03 The security department was managed by the head of operations and staffed by a principal officer, two senior officers, two security officers, two mandatory drug testing officers and two dog-handlers. Until recently, a dedicated search team had been responsible for all searching but this had been appropriately disbanded by the new management team.

7.04 Routine searching was co-ordinated by security staff and conducted by residential staff. Night staff searched common areas and wing staff searched cells. It was evident that cell searching was not carried out to required standards. Returns submitted to security showed that the target of 100 cell searches per month was being met, although staffing shortages rendered this impossible. Managers admitted that cells were often searched when empty in order to hasten the process and meet targets, and it is entirely possible that some returns had been submitted for cells that had not been searched at all.

7.05 With security staffing routinely depleted by redeployment to residential areas, the processing of work fell behind. At the time of inspection, the security department was staffed by an officer on light duties whose regular availability had brought the processing of security information reports up to date: they had been six days behind when she took over. Those security information reports inspected were properly completed and appropriately followed up. The majority of these related to drugs matters and the bulk of the remainder concerned threats to staff or other prisoners.

Use of force 7.06 Documentation for use of force was kept in a locked filing cabinet in the security department. The security officer pursued any missing documentation and only logged the file as complete when all necessary statements and the Report of Injury to a Prisoner form (F213) were assembled.

7.07 In most instances, the officer who signed as supervising the use of force also certified it on the second page. This meant that there was no independent managerial check and that the certification was often carried out by an officer or senior officer grade. In other respects, the documentation was properly and fully completed.

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7.08 Recorded instances of use of force over the last six months had averaged 10 per month. Over a quarter of these had taken place in health care, less than a quarter had been in segregation and the remainder had been distributed across the establishment.

7.09 The responsibility to initiate documentation rested with the supervising officer, who could have been almost any member of staff. If that officer either forgot to start the process or did not believe it to be necessary, no-one else in the establishment, including security staff, would be aware that use of force had taken place. Since use of force was not routinely accompanied by an alarm bell or by removal to segregation, segregation and communication room staff were unable to keep a reliable log of all instances. There was, however, no indication from either staff or prisoners that use of force procedures had been abused or misused in any way.

Conclusion 7.10 There was a lack of agreement between the Governor and Prison Service Headquarters about the appropriate security classification of the prison. Security policies and strategies had therefore not been re-written and were effectively not operational. In conjunction with staff shortages, this meant that searching was not being carried out properly and that some recorded searches were probably not carried out at all. The procedure for recording instances where use of force was deployed was not adequate or reliable.

Recommendations 7.11 The question of the security category of the prison should be resolved and the security manual and searching strategy should be re-written accordingly.

7.12 A suitable manager should be appointed to oversee searching procedures and to devise and implement quality control measures.

7.13 Management should ensure that staff are aware that any use of force must be authorised, certified and properly recorded using appropriate documentation.

7.14 There should be a single recording point for all instances of use of force and the recording process should begin immediately after the incident. 121

Segregation unit 7.15 The segregation unit was located on one level on A1 landing. It comprised 13 rooms, one of which was without integral sanitation and was used only as a mandatory drug testing holding room. Two further rooms were dormitory-sized and were used for prisoners awaiting adjudication. The remaining 10 rooms were very similar except that those on one side of the unit had a built-in privacy screen to the toilet while those on the other did not. All these rooms were equipped with a toilet and washbasin, a locker and cardboard table and chair. The rooms were generally of satisfactory decorative order and cleanliness but could have been better. At the time of inspection, one of the women prisoners was engaged in re-painting the rooms. Only two of the rooms were equipped with an electricity supply.

7.16 The unit included an untidy wing office, a rest room with television for staff, an adjudication room, store rooms and a further office that was full of rubbish. A small kitchen was used as a servery for prisoners’ meals, which were delivered from the main kitchen. A bathroom in the unit contained a toilet, bath and shower, all of which were reasonably clean but would have benefited from refurbishment. The unit had a small, dedicated exercise yard, which, although fairly spartan, overlooked the prison gardens.

7.17 The unit was staffed, both morning and afternoon, by a senior officer and three officers. However, staff shortages had resulted in such frequent redeployment of staff that staffing in the afternoon was often reduced to patrol state of one officer.

7.18 The daily routine of the unit was displayed on the notice board and incorporated bathing in the morning, before adjudications, and exercise in the afternoons. With a small resident population in the unit, it was usually possible for all the women to have a bath or shower each day, although reductions in staffing in the afternoon resulted in the frequent cancellation of exercise.

7.19 In the month prior to inspection, prisoners had had the opportunity for exercise on only one day in three. A small selection of library books was kept in the unit and the

122 mobile library service visited every Thursday. A chaplain, doctor and nurse visited every day and a member of the Board of Visitors visited every two to three days.

7.20 A published list of entitlements for prisoners in segregation was not available. Staff said that they were normally allowed all their possessions unless these had been forfeited as part of an adjudication award. Staff also believed that women prisoners retained their incentives and earned privileges status while in segregation unless a governor had specifically stated otherwise. This meant that it was possible for a segregated prisoner to be on enhanced status.

7.21 Four women were resident in the unit at the time of our inspection. Two were on Rule 45, one was on punishment and one was awaiting adjudication but had been deemed unfit by the doctor. In all cases, the documentation was properly completed and up to date. Staff on the unit had a good knowledge and understanding of the women in their care and displayed patience and sensitivity in the way they interacted with them. None of the women made any complaints to inspectors about the way they were treated.

7.22 We saw two prisoners on Rule 45. They had particular behavioural and/or socio- medical issues to be resolved and each case presented considerable challenges to the Prison Service. Staff were aware of the limitations of behaviour modification programmes for isolated individuals and were also seeking to reduce the extent to which special needs cases were moved around the prison estate.

7.23 In the two months preceding the inspection, the unit roll had ranged between two and 10, with an average of three to four most of the time. Although it was acknowledged by staff that there was some difficulty in determining whether a prisoner should be in segregation or in the health care in-patient facility (C1), it was evident that the segregation unit was not routinely used to supplement health care accommodation.

Conclusion 7.24 While staff knew their charges and treated them with understanding, they did not use opportunities to promote behavioural change. Exercise was not offered to prisoners on a daily basis.

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Recommendations 7.25 Long-stay residents in segregation should receive some intervention work to modify their problem behaviour.

7.26 All prisoners should be afforded their statutory entitlements and the prison should comply with its published routine, particularly in relation to exercise.

7.27 Entitlements and facilities for prisoners in the segregation unit should be clearly displayed on the unit notice board.

7.28 All cells should be equipped with privacy screens.

Incentives and earned privileges (IEP) Expected outcomes The expected outcomes for incentives and earned privileges are: § Respect: Prisoners understand the rules of the establishment and are treated fairly; they are able to appeal against decisions § Respect: Every opportunity is taken to encourage good behaviour even when enforcing boundaries of control

7.29 The IEP scheme consisted of three levels of privilege: basic, standard and enhanced. All new receptions entered on the standard level and, at the time of inspection, about three-quarters of the population remained on this level. About 70 prisoners were on enhanced level and those on basic level were in single figures.

7.30 Although no strategy document was available, inspectors were provided with a two-page ‘information to prisoners’ document. This was undated but was signed by the last but one Governor. It set out the privileges available to enhanced level prisoners, which consisted mainly of extra visits, a higher private cash allowance and eligibility to apply for certain jobs. It described the basic level regime as involving fewer of these privileges. It did not explain the behavioural criteria involved in determining decisions

124 on promotion or demotion. Prisoners signed a compact which, in broad terms, outlined the behaviour expected of them; it was not specific about what the prison undertook to provide in return.

7.31 On the residential units, an incentives and earned privileges file was kept on each prisoner in which staff made running notes. This file was used in place of the normal F2052A – a prisoner’s history sheet. Most of the notes lacked any depth and, in some instances, no notes had been made for some weeks. The most critical notes referred to attitude rather than objective behaviour.

7.32 In conjunction with an entry, staff sometimes wrote ‘recommend basic’ or ‘recommend enhanced’. These entries were generally highlighted so that they were easily identified at the review point. While staff opinion varied as to the frequency of the review, it was either weekly or fortnightly. The review involved the senior officer of the day together with an officer checking the number of recommendations and promoting or demoting accordingly. Again, opinions varied as to how many recommendations were necessary for a change of status and whether a warning would be given in advance of demotion. Generally, about three recommendations were regarded as the norm for status change and prisoners’ views were that warnings were seldom given. There was no information published on the wing to indicate to individual prisoners how well or badly they were doing.

7.33 Prisoners’ understanding of the system was very vague, both about what they must do to advance and what privileges they might expect to receive as a result. They did not appear to know when reviews took place. The general consensus on required behaviour was to ‘keep their heads down’, to try to please the staff and not to be rude. There was some, but limited, inclination to try to achieve a higher privilege level. In-cell televisions on all units would undoubtedly have increased motivation, although occupancy of one of the cells wired for electricity did not form part of the scheme.

7.34 Neither staff nor prisoners were aware of an appeals procedure.

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Conclusion 7.35 There was no evidence of a strategy underpinning the incentives and earned privileges scheme and it was inadequately publicised or explained to staff or prisoners. Consequently, there was poor understanding on the part of women prisoners and staff of how it should have worked. In addition, there was little differential between the levels to provide any real incentive to progress. The scheme exerted little influence on prisoners’ behaviour.

Recommendation 7.36 The incentives and earned privileges scheme should be re-written to include objective measures of behaviour, differential rewards and transparency. A strategy document should be constructed and published in accordance with Prison Service Order 4000.

Adjudications 7.37 There had been an average of 110 adjudications per month in the first six months of the year. Segregation unit staff advised on the correct charging and reporting procedures, and perusal of a random selection of completed adjudications suggested that charges were generally correctly laid.

7.38 The adjudication room was light, airy and well appointed. Supervising staff sat behind the prisoner and were not intimidatory. Adjudications were observed by inspectors on two days and on both occasions the adjudicating governor properly enquired into the circumstances, checked understanding and gave time and encouragement for the prisoner to present her account and to seek clarification. The disciplinary rules were followed, although sometimes a little too rigidly. For example, a request for a witness led to immediate adjournment despite the prisoner’s wish to continue and without any examination of the evidence.

7.39 Checking of completed adjudications indicated that conduct reports were variable and that there were considerable differences between adjudicating officers in the way that they conducted proceedings and in the punishments that they gave for similar offences. A commonly used punishment was forfeiture of canteen for periods of up to three weeks.

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A potential consequence of this would be an increase in bullying since it is not reasonable to suppose that a prisoner would manage without any access to purchases for that length of time.

Conclusion 7.40 Disciplinary proceedings were conducted in a relaxed atmosphere and prisoners were encouraged to give their views. Documentation was properly completed but there were inconsistencies between adjudicating officers in the way that proceedings were conducted and the award of punishments.

Recommendation 7.41 Adjudication standardisation meetings should be scheduled to promote consistency in the application of the process and in punishments awarded.

Public protection and the child protection unit (CPU) 7.42 The Governor issued notices to staff (NTS 2/02 and NTS 3/02) on 4 April 2002. These set out procedures to be followed in respect of Schedule One offenders and/or those subject to Prison Service Order 4400. These provisions added to the established arrangements for interagency communications already in place via the probation department.

7.43 Systems were in place for the early identification of relevant prisoners. However, we found that remanded young people might well have been living in the presence of listed prisoners as there was no clear system for tracking internal movements of Schedule One offenders or those subject to registration under the Sex Offender Act. This was exacerbated by the absence of shared accommodation risk assessments.

7.44 A child protection policy, ratified by the local Area Child Protection Committee in March 2002, was not operational at the time of the inspection as the essential staff training had not been undertaken.

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Conclusion 7.45 The building blocks of both a general public protection policy and a specific child protection policy were in place but their complete implementation was delayed. Prison officer and probation officer staffing levels have a significant bearing on the effectiveness of practice and should be commensurate with the responsibilities carried by the Prison Service to protect the public.

Recommendations 7.46 A clear system for tracking internal movements of Schedule One offenders or those subject to registration under the Sex Offender Act should be introduced.

7.47 Shared accommodation risk assessments should be put in place.

7.48 The child protection policy was comprehensive, well developed and should be implemented.

7.49 Prison officer and probation officer staffing levels should be commensurate with the responsibilities carried by the Prison Service to protect the public.

Life-sentenced prisoners

Expected outcomes The expected outcomes for life-sentenced prisoners are: § Safety: Lifers trust that details of their offences and personal circumstances are treated responsibly by staff § Safety: Potential lifers on first entering custody, and newly-sentenced lifers returning from court, are given close attention and support from trained staff § Respect: All lifers are able to address their risk factors and prepare for release within the timescale of their tariffs § Respect: Recalled lifers and licence revokees are dealt with promptly, openly, consistently and fairly and a regime provided for them § Respect: Staff working with lifers understand the lifer system and encourage lifers to maintain a positive approach to their sentence and work towards their eventual release

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§ Purposeful activity: Lifers experience balanced regimes with opportunities for work, education, leisure and social interaction, which afford them choice and require them to take increasing responsibility for themselves § Resettlement and reducing offending: Lifers are able to access help which assists them in coming to terms with their sentence and to take responsibility for their offending § Resettlement and reducing offending: Lifers experience a phased re-integration into the community supported by a resettlement team in the discharging prison which includes input from the home probation officer

7.50 Holloway was intended to accommodate potential and newly-sentenced life prisoners awaiting transfer to a main centre. At the time of the inspection, eight lifers were in custody. Of these, two were relatively recently sentenced and awaiting first allocation and transfer. One of the newly-sentenced women was 19 years old. Of the remaining six, four were prisoners who had served considerably beyond their tariff date.

7.51 The life-sentenced prisoners were located throughout the prison and were well known by the residential staff. Potential life-sentence prisoners were dispersed throughout the remand population and generally not recognised as a group with specific needs.

7.52 Those staff of all grades responsible for identifying and providing services to potential lifers were unaware of their responsibilities in this key area of work and, inevitably, no systems were in place to provide information and support or to undertake appropriate risk assessment processes.

7.53 There was evidence that some of the long-term lifers were benefiting from counselling provided by the psychology department, and that parole reports requested by the lifer management unit were being undertaken within required time limits. However, this was in isolation from the annual life sentence planning system, which had fallen into abeyance at Holloway. All the long-term lifers were inappropriately allocated to Holloway and the majority were disadvantaged by an absence of planning, intervention and direction in their sentences. Holloway did not have the resources to manage the

129 specific needs of the life-sentenced prisoners in its care. These needs included mental health issues for a young offender, self-harm, post-operative gender dysphoria and a prisoner in her twentieth year of sentence who was still in offence denial and who did not speak English. These inappropriate placements disadvantaged the prisoners in their sentence progression and made significant demands on the establishment that it was not resourced to meet.

7.54 Staff of all grades were unaware of the requirement to arrange multi-agency lifer risk assessment panels for newly-sentenced prisoners prior to their transfer. Equally, they had little knowledge of any of the new life sentence plan procedures, although some new format forms were being used for parole reports.

7.55 No systems were in place to provide appropriate room allocation, in-room work, information, employment, induction, peer support or educational, language or other needs assessments for potential or newly-sentenced lifers as a specific group.

Conclusion 7.56 A fundamental review of lifer management at Holloway should be undertaken to include the crucial issue of visits with potential life sentence prisoners.

Recommendations 7.57 A system should be put in place that identifies potential life-sentenced prisoners at an early remand stage and assists the prison in managing their potential risk to themselves or others.

7.58 Sentenced lifers should be transferred to main lifer centres without protracted delay and immediate steps should be taken to allocate those within the current population whose progression within the lifer sentence planning system is at a standstill.

7.59 A system should be introduced to ensure multi-agency risk assessment systems are in place for newly-sentenced lifers.

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7.60 Lifers and potential lifers in Holloway should be identified and provided with services that recognise their individual needs in accordance with the new life sentence planning system.

Categorisation

Expected outcomes The expected outcomes for categorisation are: § Safety: Prisoners are held in accommodation which is appropriate for their own and others’ safety § Respect: Prisoners are located in an establishment that is as close to home as possible and able to meet their identified needs § Respect: Criteria for determining security categorisation and allocation procedures are clear, open and fair and rules governing transfer arrangements are fairly and consistently applied without discrimination § Purposeful activity: Security conditions do not unnecessarily restrict prisoners’ access to purposeful activity

7.61 The observation, categorisation and allocation (OCA) of prisoners was undertaken in an under-resourced prisoner management unit, in which OCA work formed only one of the required duties. Consequently, the OCA process was unsatisfactory and made worse by population pressures. The allocation of women prisoners owed more to pragmatism than professional assessment. Until the extreme pressure on the female estate is relieved the OCA process at Holloway will continue to be meaningless.

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CHAPTER EIGHT

RESETTLEMENT

Expected outcomes The expected outcomes for resettlement are: § Safety: Prisoners are able to trust staff to deal with details of their offending and personal circumstances responsibly § Respect: Sentence planning, offending behaviour and substance misuse programmes and re-integration planning are effective and meet prisoners’ assessed needs § Respect: The approach of all staff encourages responsible behaviour and supports prisoners working on their offending, substance misuse and other problems and preparing for release § Purposeful activity: Access and allocation to purposeful activity is linked to prisoners’ assessed needs and their planned targets § Resettlement and reducing offending: Prisoners address their offending behaviour and related problems and prepare for release whilst in custody

8.01 At the time of the inspection, a specific local resettlement policy was awaiting completion once further advice had become available from the women’s policy group (WPG) of the Prison Service.

8.02 We noted that a resettlement committee had been created, with a wide and varied representation from a range of relevant contributors from within the prison, the WPG and relevant community agencies in both the statutory and voluntary fields.

8.03 The findings of the survey provided a number of useful baselines from which to build services and, in particular, enabled a fresh focus on the needs of short-term prisoners since the average length of stay in Holloway was 28 days.

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Conclusion 8.04 A business-like approach had been adopted and an impressive start had been made by a well-appointed and relevant resettlement committee but the true mark of its effectiveness will be determined by the opportunities that are created to help women address the practical problems they will face when they are discharged.

Key workers (personal officers) Expected outcomes The expected outcomes for key workers are: § Safety: Key workers provide a first line level of care promoting safety in the prison environment § Respect: Prisoners experience relationships with their key workers that are based on mutual respect, high expectations and affirmation § Respect: Prisoners know that their key worker will support them fully in their involvement in the prison system and throughout the progress of their sentence, based on sound knowledge of the prisoner, including any special needs § Purposeful activity: Key workers encourage the best use of their prisoners’ time out- of-cell § Resettlement and reducing offending: Key workers ensure that prisoners start and maintain the process of resettlement from the beginning of the sentence and in each new location

8.05 The personal officer scheme, which was said to be organised by senior officers on the residential units, was extremely limited and lacked any single, meaningful system. This was variously explained by ‘the high throughput of prisoners’ or ‘ongoing staff shortages’. There was a feeling of resignation about the situation among staff and managers. Many said ‘we do the best we can’, or words to that effect. There were literally one or two examples of personal officer work formally influencing outcomes for prisoners but these were due to initiatives of individual officers rather than the existence of a reliable and effective personal officer scheme. We spoke with a senior manager who had inherited responsibility for the scheme only two weeks prior to the inspection and who confirmed the basis of our observations and accepted our single recommendation.

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Conclusion 8.06 There was no effective personal officer scheme.

Recommendation 8.07 A fundamental review of the personal officer scheme should take place to ensure that an effective service is introduced under the auspices of the resettlement committee.

Sentence planning 8.08 Ostensibly co-ordinated from within the prisoner management unit (PMU), in reality there was no sentence planning in existence. All women prisoners were supposed to have a sentence planning file raised by the discipline office and passed to the PMU. Files were sometimes raised retrospectively and, on occasions, after the prisoner had been transferred out of Holloway. The process was an administrative nightmare and meaningless to many women. We examined a random sample of 25 current sentence planning files and found that each one was incomplete and 14 contained virtually blank documents.

8.09 MJ, for example, had been received into Holloway on 25 January 2002. On 9 July 2002, her sentence plan was blank. A sentence planning board that had been planned for 4 April 2002 had been cancelled and not reinstated.

8.10 MP’s sentence plan was raised on 1 June 2001, shortly after first reception. Despite the fact that she had been transferred from Holloway on 21 January 2002, her sentence planning file, with no significant entries, was still in Holloway on 9 July 2002. Previous notes indicated that she had a significant psychiatric history and was serving five years for issuing threats to kill. This had not been passed on to the receiving prison.

8.11 By contrast, CD-S’s excellent sentence plan was well thought out, comprehensively written and a credit to the officer concerned.

8.12 Sadly, this last example was a rare gem in an otherwise bleak landscape of failure to meet even the basic elements of sentence planning. These observations are all the

134 more poignant when viewed against the backcloth of the last Prison Service Standards Audit report, which found that Holloway’s sentence planning performance was ‘acceptable’!

8.13 Prisoners who were subjected to multiple court appearances and remands were frequently shuttled between Holloway, courts and a number of other prisons - some as far afield as New Hall in Yorkshire, Styal in Cheshire and High Point in Suffolk - according to the availability of spaces. This added greatly to the already stressful conditions which accompanied the trials of many women. Some remanded prisoners were completely resigned to their powerlessness to influence what was happening to them and many prison staff shared their sense of despair at a system creaking under the pressure of numbers.

8.14 There was no custody planning for remanded prisoners and, crucially, there was no identification of potential life-sentenced prisoners, about which we have commented under a separate heading.

8.15 The PMU was designed to be staffed by a principal officer, a senior officer and two officers with the support of one administration officer. On several occasions during the week of the inspection, we found the administration officer was the sole member of staff available to deal with diverse internal and external queries about release on temporary licence, home detention curfew, sentence planning, and observation, allocation and categorisation. Indeed, only the administration officer had sufficient continuity of attendance to provide even a semblance of organised response. This was unfortunate for the committed uniformed staff of the PMU, who were only too aware of their inappropriate and heavy reliance on their administration officer across a range of the unit’s responsibilities. The criticism we level at the PMU is, therefore, not aimed at the individual staff but at a system that failed to acknowledge the centrality of PMU responsibilities to a series of outcomes for prisoners.

Conclusion 8.16 Sentence planning was virtually non-existent. The process and systems were superficially in place but there was no cross-referencing to key components of the regime, including education, work training, release on temporary licence and home 135 detention curfew - each of which should have had a significant bearing on life for prisoners. The ineffectiveness of sentence planning in Holloway was compounded by the absence of a personal officer scheme, on which we have commented under a separate heading. We concluded that there was no substantive sentence planning on which to make operational or qualitative proposals and therefore make only one recommendation.

Recommendation 8.17 A fundamental review of sentence planning should take place to ensure that effective systems are introduced under the auspices of the resettlement committee.

Probation 8.18 Seconded probation staff were provided by the London Probation Area of the National Probation Service under the terms of an agreement between the Governor and the Chief Probation Officer. This agreement comprised a business plan to the year ending 31 March 2003 and a rolling three-year development plan. The business plan set out the terms of engagement for probation staff and confirmed the staff establishment of the department as one senior probation officer and seven probation officers. The development plan predicted this staffing level to 31 March 2005, subject to six months’ notice of variation by the Governor.

8.19 We met extensively with the senior probation officer, had discussions at the prison with the relevant Assistant Chief Officer of Probation and spoke with a number of probation officers in the department. We noted that the performance of the probation department was regularly reviewed within the terms of the business plan and we were able to read associated documents.

8.20 This was a very busy and conscientious department whose staff, in common with many others in Holloway, worked with stressful situations in sometimes extremely trying circumstances. Not least of these for probation staff was the impact of long-term sickness affecting two officers and the non-recruitment of staff to fill a post that had been vacant since November 2001.

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8.21 The latter was due to the curbing of recruitment under local rules adopted by the London Probation Area, which impacted in a wholly disproportionate way on the needs of Holloway. We discussed this in some detail with the Assistant Chief Officer of Probation and understood that, until such time as vacancies across the whole of the probation division reached 10% of the establishment figure, a recruitment ban would apply. This policy was dismissive of the special needs of the women in Holloway, failed to take full account of the key partnership roles that seconded probation staff filled in the prison and disregarded the terms of the business plan to which the London Probation Area was a signatory. This was unacceptable and should be remedied to ensure the availability of suitably qualified staff to meet the identified needs of prisoners.

8.22 Many key areas of responsibility showed an increased demand. These examples were illustrative: Area of Work Increase Initial assessments 159% F2052SH reviews 164% Schedule One procedures 250% Homelessness issues 128% Mother and baby reviews 211% Mother and baby reports 209%

8.23 The deployment of probation staff to other key areas of need, such as health care and D2, stretched resources to the limit and meant that only emergency situations were responded to. We noted that a substantial number of inappropriate applications were directed to the probation department. We suspect that the department became the repository for a wide range of queries in the absence of a structured personal officer scheme and given the shortcomings of sentence planning. The shortage of both probation and prison staff had a negative impact on the group-work programme and led to sessions being cancelled.

8.24 It was commendable that seconded probation officers maintained their output in respect of release on temporary licence and home detention curfew assessments, and that reviews of F2052SH cases were covered.

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8.25 The department played a full and active part in resettlement developments and, in particular, was engaged in partnership with Camden Women’s Aid to assist young women involved in domestic violence. There was an urgent need to establish a bail information scheme in such a busy local prison and we detected significant potential to reduce unnecessary remands in custody - a crucial issue given the alarming increase in the prison population.

Conclusion 8.26 This was a positive and achieving department despite the problems outlined in this report. There was a tangible sense of commitment by staff to the work of Holloway prison and a recognition of the scope for further development. If the qualities of the practitioners are matched by London Probation Area action to recruit the agreed staff, the probation department can consolidate and extend the benefits that it brings to the prison. Continued understaffing is both unacceptable and unsustainable.

Recommendations 8.27 Local recruitment rules adopted by the London Probation Area did not take account of the special needs of the women in Holloway or of the key partnership roles that seconded probation staff filled in the prison. It also disregarded the terms of the business plan to which the London Probation Area was a signatory. This should be remedied to ensure the availability of suitably qualified staff to meet the identified needs of prisoners.

8.28 A bail information scheme should be developed.

Release on temporary licence 8.29 There was no regular and consistent means of informing women prisoners about the availability of the various forms of release on temporary licence (ROTL). We were told by a middle manager that ‘the women have ways of finding these things out’ and that ‘the women who know tell the women who don’t’. Prisoners to whom we spoke confirmed that they had little knowledge of the scheme and that they mainly took advice from other prisoners.

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8.30 The ROTL scheme was administered by the single administration officer in the prisoner management unit. ROTL boards, chaired by a senior manager, were held each Tuesday morning or more frequently as required. There was no regular board chair and no meetings to discuss practice or consistency at board level. There were no effective sentence planning or personal officer systems to enhance the operation of the ROTL scheme.

8.31 Risk assessment contributions were made by seconded probation staff and community agencies. The volume of applications was small. During this inspection we had no way of relating volume to eligibility. The following figures applied in the year ending March 2002: Applied: 43 Granted: 37 Not eligible: 3 Not granted: 3

8.32 We noted that, in the absence of a sentence planning system, there was no attempt to use ROTL as a regular feature of resettlement for those released from Holloway. The use of ROTL should be reviewed in the light of the wider review of sentence planning recommended in this report.

Conclusion 8.33 There was scope to better promote the use of ROTL and to inform prisoners of the scheme at an early stage following sentence. Satisfactory administrative systems were in place but the solitary administration officer in the prisoner management unit carried a heavy workload across all areas of the unit’s function.

Recommendations 8.34 Information about the release on temporary licence scheme should be made available and explained to prisoners by staff during induction.

8.35 The use of release on temporary licence should be reviewed.

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8.36 The review of release on temporary licence should include a general review of the staffing of the prisoner management unit.

Home detention curfew 8.37 The system was administered by the administration officer in the prisoner management unit. Daily checks of the local inmate data system were undertaken to identify eligible prisoners and some 30 new home detention curfew (HDC) cases were generated each week. We were satisfied that all eligible prisoners were properly identified, although only limited information was directly available to prisoners at induction. The frequent cross-deployment of officer staff meant, once again, that the main source of continuity and information on HDC matters rested with the administration officer.

8.38 We noted difficulties encountered by the administration officer in obtaining basic documentation, such as the risk predictor and a reliable list of previous convictions. Such difficulties were compounded by the absence of comprehensive, informative sentence planning files.

8.39 In common with many other prisons, Holloway was often working to very tight time schedules in respect of HDC and there was a danger that unplanned transfers could interfere with outcomes for prisoners at quite crucial stages of HDC consideration. Nearly 400 prisoners per year were transferred out of Holloway during assessment for HDC. Every effort was made by the administration officer to ensure that relevant information followed the prisoner without delay. However, the absence of reliable links through sentence plans together with pressures on an under-resourced probation department meant that work started at Holloway could be duplicated by the receiving prison.

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8.40 We looked at the HDC statistics compiled locally for the year to March 2002: Eligible /Applied 606 To ROTL boards 92 Granted 63 Prisoner opt out 95 Unsuitable 20 Transferred during processing 399

8.41 These figures related to a period prior to the introduction of presumptive HDC set out in the Prison Service Instruction 19/2002 and showed that only 10% of eligible prisoners were released on HDC from Holloway itself. We were told that only two additional prisoners had been released as a result of the presumptive arrangements that became operational for those eligible on 1 May 2002.

Conclusion 8.42 The HDC system was well co-ordinated by the administration officer in the prisoner management unit, although reliable information about HDC should be given to prisoners at induction.

Recommendations 8.43 There should be more visible management ownership of home detention curfew.

8.44 Information about the home detention curfew scheme should be made available and explained to prisoners by staff during induction.

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CHAPTER NINE

SERVICES

Catering

Expected outcomes The expected outcomes for catering are: § Safety: Prisoners’ food is prepared and served safely in accordance with Environmental Health regulations and religious requirements § Respect: Prisoners receive a fair portion of healthy, balanced, nutritious and varied meals to meet their physical, gender, health, religious, ethnic and medical needs § Respect: Prisoners have a choice and are encouraged to eat healthily to help them create and maintain healthy lifestyles

9.01 The kitchen looked tired, physically shabby and in need of redecoration. We were told, however, that this was unlikely to happen as there were firm plans to develop a new kitchen elsewhere in the establishment. While accepting that this was a more satisfactory solution in the long term, there remained a need to ensure that the existing kitchen was maintained to a reasonable standard.

9.02 A principal officer ran the kitchen with a team of three catering officers and three civilian chefs. However, two of the civilian chefs had been suspended from work for over a year and this, coupled with long-term sickness among the other staff, had meant the ongoing employment of agency workers. These staffing problems were compounded by the shortage of prisoners available to work in the kitchen. At the time of our inspection, only seven of the full complement of 15 prisoners were in the kitchen. This had severely limited the principal officer’s ability to develop and improve the catering operation.

9.03 Catering operated a pre-select multi-choice menu that ran over a four-week period. Prisoners ordered their meals one day in advance, which allowed the kitchen to

142 cope with the high level of movements in, out and around the prison. Much time and paperwork would have been saved if staff had a computer programme, as used in some prisons, to expedite the meal ordering system.

9.04 The main method of consultation with the prisoners was through surveys, although eight months had passed since the last one of these. Comment slips were supposed to be available at each of the food serving points but there were none in evidence and staff told us that prisoners would have to use the standard request/complaint procedure if they had a problem with the food. Due to their staffing problems, it was also difficult for the catering staff to attend the serveries at mealtimes, which meant that their contact with prisoners was minimal.

9.05 We were concerned that a number of women from minority ethnic groups felt that their normal diets were not being properly catered for. While the catering staff felt that the choices they offered were adequate to cover most diets, this was not confirmed by the women. Greater consultation needed to take place with these women to ascertain how their needs could be better met.

9.06 Breakfast was served at 8am, lunch at noon and the evening meal at 5pm. A snack was also provided to be eaten as supper. Bread was available in the morning and some wings had toasters while others did not. It was not clear why sufficient toasters could not be provided on every wing to allow all prisoners to have toast if they wished. Lunch was soup and a choice of sandwich with a larger meal in the evening, except on Sunday when there were two cooked meals. We had a number of complaints that portions were too small, particularly for those women who were undernourished due to their drug use.

9.07 We received many complaints about the food being served cold. This was feasible as not only were the facilities for keeping the food hot at the serveries primitive but also the procedures for taking and recording the temperature of food at the points of service had broken down. We were also concerned that supervision at the serveries was poor and that some of the servery workers were either unaware of, or not complying with,

143 food handling and hygiene requirements. The prison had 16 operative serving points for food, which made it necessary for wing staff to ensure that there was compliance with procedures.

Conclusion 9.08 Overall, despite the limitations of a restricted budget and ongoing staffing difficulties, the catering staff had been making an effort to turn out reasonable meals. However, this was being undermined by the poorly equipped and unsupervised serveries. Progress needed to be made in satisfying both the Prison Service’s own standards and those required by environmental health. In addition, there needed to be far greater consultation with the prisoners in order to provide the kind of food and diets that they were happy with.

Recommendations 9.09 The kitchen should be redecorated and its physical structure maintained at a level that would satisfy environmental health standards.

9.10 The personnel problems in the kitchen should be resolved and a sufficient number of prisoners should be available to work there.

9.11 Catering staff should attend an amenities committee to consult with the prisoners on issues related to the food.

9.12 We were told that the prison was employing the services of a nutritionist to look at the dietary needs of pregnant women. This brief should be expanded to review the diet offered to the main population to ensure that it is both sufficient and healthy.

9.13 A thorough audit of the serveries should take place and management should ensure that there is compliance with the catering standards laid out in Prison Service Order 5000.

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Prison shop Expected outcomes The expected outcomes for the prison shop are: § Safety: Arrangements to enable prisoners to purchase goods minimise opportunities for bullying § Safety: Items held in the prison shop and store are stored and served according to the requirements of food safety, hygiene, religion and security § Respect: Prisoners have a suitable range of affordable goods available for purchase at reasonable prices to meet their ethnic, cultural and gender needs

9.14 The shop at Holloway was run and managed as an in-house operation. We were told that the turnover was in excess of £450,000, which demonstrated the demand for goods and the shop’s monopoly position in supplying them to the women. We were therefore concerned at the lack of clarity in the way in which the interests of the women were represented.

9.15 There was no committee or other forum for complaints, ideas or suggestions about the shop to be discussed between prisoners and staff. It was unclear how the provision of new items was decided or why one brand of goods was being sold rather than another. In particular, the variety of goods for minority ethnic groups was limited and there appeared to have been little pro-active work in discovering what their needs might be. In our prisoner questionnaire, 59% of respondents felt that the shop did not sell a wide enough variety of products.

9.16 We were told that there was no standard pricing policy and that each item was priced at what seemed ‘reasonable’. While we appreciated that this was an attempt to balance the cost of goods for the women, there had been no analysis to establish whether this cross-subsidisation of goods discriminated against particular groups of prisoners.

9.17 The prisoners were allowed to purchase goods weekly, with the specific day dependent on where they were located. The women were brought down in a group and were allowed into the shop two at a time to make their purchases. This allowed

145 considerable scope for theft or bullying as the general melée made it impossible for staff to supervise everything that was happening.

9.18 Once in the shop, the prisoners had to choose from the display of goods on the shelves in front of them. Although a list of stock goods was available on all the wings, some prisoners were not prepared and were under some pressure to make their transactions as quickly as possible. The efficient running of the shop also relied on the presence of one particular officer who had worked there for some time. At the time of our inspection, she was off work and it was clear that the rest of the team were struggling in her absence. The issues with staffing and time pressures meant that there was little opportunity to resolve any problems that the prisoners raised while at the shop. This normally meant that mistakes were unlikely to be rectified until the following week at the earliest.

Conclusion 9.19 The shopping system at the prison did not serve the best interests of the prisoners or indeed the staff who had to manage it. There were a number of other ways in which goods could be provided more efficiently and which would allow the women to plan their shopping in advance. In particular, a pre-order system that allowed goods to be delivered to the women on the wings would have reduced most existing problems.

Recommendations 9.20 An amenities committee should be established that would allow representatives of the women to discuss issues related to the shop directly with the relevant staff. The needs of minority ethnic prisoners should be a standing item of discussion.

9.21 The prison should have a clear pricing policy that allows goods to be sold at a price equivalent to that available in the community.

9.22 The prison should review the way in which the prison shop is organised. Research should be undertaken to establish a more efficient system that allows the women to plan their shopping and minimises opportunities for bullying or theft.

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CHAPTER TEN

RECOMMENDATIONS AND GOOD PRACTICE

The following is a full list of recommendations that appear in the report. The paragraph references in brackets refer to their location in the main report.

Main recommendations 10.01 If children are to continue to be held at Holloway on remand or after being sentenced by the courts, they should be treated properly as befits their age and vulnerability, in accordance with national policy. (HPS41)

10.02 Cell sharing assessment procedures should be carried out thoroughly in accordance with Prison Service instructions. (HPS.42)

10.03 All women at Holloway should live in decent conditions, in particular:

§ The living accommodation should be properly furnished, including curtains in cells § Women should have sufficient supplies of towels and toiletries § Consistently high standards of cleanliness should be maintained § All women should be enabled to take a daily shower § They should be offered at least two hours association twice every day, some of which should be in the fresh air § They should be able to make use of a telephone every day in order to maintain contact with their families. (HPS43)

10.04 An active regime, which includes opportunities for employment, work skills training, education and physical exercise should be consistently delivered. (HPS44)

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10.05 A Bail Information Scheme and legal services should be urgently restored. (HPS45)

10.06 Practical resettlement arrangements that focus on the individual needs of women prisoners and are designed to reduce the likelihood of reoffending should be introduced. (HPS46)

10.07 An action plan for prison health care at Holloway should be produced and a time frame for implementation should be agreed. This should include an urgent review of the mental health needs of young people held at Holloway. (HPS47)

To the Director General

Courts and transfers 10.08 The number of courts for which Holloway is responsible should be reduced. (1.06)

Self-harm and suicide 10.09 Safer cells should be made available for the most ‘at risk’ women prisoners. (3.19)

Race relations 10.10 The Prison Service should be aware of the different needs of different foreign national groups and provide for them accordingly. (3.50)

Juveniles and young offenders 10.11 Children should not be held at Holloway. (4.47)

Use of force 10.12 The question of the security category of the prison should be resolved and the security manual and searching strategy should be re-written accordingly. (7.11)

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Life-sentenced prisoners 10.13 Sentenced lifers should be transferred to main lifer centres without protracted delay and immediate steps should be taken to allocate those within the current population whose progression within the lifer sentence planning system is at a standstill. (7.58)

To the Operational Director of Women’s Estate

Courts and transfers 10.14 Women should be allocated to prisons according to their individual resettlement needs. (1.08)

To the Youth Justice Board

Juveniles and young offenders 10.15 The Youth Justice Board should consider increasing provision for mother and baby units within the juvenile estate. (4.54)

10.16 Children should not be held at Holloway. (4.47)

To the Governor

Courts and transfers 10.17 Processes to ensure that women arrive at court on time should be improved. (1.07)

10.18 There should be improved staff continuity in the observation, categorisation and allocation service. (1.09)

Reception 10.19 All staff at Holloway, including reception officers, should wear and clearly display their name badges. (1.33)

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10.20 The professional model of effectively engaging with women prisoners as individuals, as displayed by one group of officers, should be followed by all those working in reception. (1.34)

10.21 The cubicles used for strip searching should be remodelled to provide more appropriate space. (1.35)

10.22 Each new prisoner should be provided with two towels. (1.36)

10.23 Prison issue underwear, footwear and clothing should be made more readily available in appropriate quantities and quality to meet the identified needs of individual prisoners. (1.37)

10.24 Prisoners should not be forced to purchase a reception pack. (1.38)

10.25 Newly-arrived prisoners should be able to access the prison shop the day after their arrival. (1.39)

10.26 A smoke-free area should be developed in the holding room at the end of the reception area. (1.40)

10.27 The time prisoners wait to be escorted from reception to their allocated wing should be reduced considerably. (1.41)

10.28 The establishment should consider widening its pool of reception orderlies. (1.42)

10.29 A room should be provided that better meets the needs of reception orderlies. (1.43)

10.30 The establishment should consider developing, supporting and formalising the use of peer support in the reception area. (1.44)

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10.31 Laminated information booklets designed to meet prisoners’ needs and in a variety of languages should be made available in the holding rooms. A video should be developed to provide a visual tour of the prison and taped information should be made available. (1.45)

10.32 Literature and taped information should be readily available in appropriate languages to enable foreign prisoners to understand the reception procedure and the questions asked of them. Translation services should also be made available. (1.46)

10.33 Regular checks of all fire fighting equipment should be carried out. (1.47)

First night 10.34 The risk assessment for accommodation process should only be undertaken by prison officers and should not rely at busy times on staff working for voluntary agencies. (1.67)

10.35 The accommodation risk assessment form should be fully completed for all prisoners. (1.68)

10.36 The PACT interview room should be fitted with a fixed alarm bell and should be redesigned to allow observation by reception staff when in use. (1.69)

10.37 A single booklet should be produced containing all the core information from the initial PACT interview. (1.70)

10.38 All prisoners should be allowed a short telephone call during the admission procedure. (1.71)

10.39 The contacts and services provided by the PACT worker should be written directly onto the prisoner’s wing history sheet. (1.72)

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10.40 The establishment should develop a pro-active and supportive first night scheme for all prisoners, which includes clearly defined expectations of the role of first night officers. (1.73)

Induction 10.41 A supportive and effective induction process should be introduced to meet prisoners’ needs, and this should be accurately recorded in the establishment regime monitoring forms. (1.84)

10.42 Information about the establishment should be given to women prisoners that can be forwarded directly to family and/or friends. (1.85)

10.43 An evaluation form should be created to enable prisoners to comment on the content and usefulness of the induction package in order to improve delivery. (1.86)

10.44 Compacts detailing both prisoner and establishment expectations should be developed. (1.87)

10.45 Managers should monitor, evaluate and take suitable action over the quality of officer contributions to individual wing files. (1.88)

10.46 Information about individual women should be collected and collated during the induction period in order to contribute to sentence planning. (1.89)

10.47 The establishment should develop custody planning and reviews involving prisoners who are unconvicted and those who are convicted but unsentenced. (1.90)

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Legal rights 10.48 The establishment should ensure that prisoners are properly informed of their access to bail and appeals procedures. Prisoners should also be seen by a trained legal aid officer, ideally on arrival and certainly within 48 hours of admission. (1.98)

Residential units 10.49 The provision of curtains should be reviewed. (2.10)

10.50 Suitable and effective acoustic hoods should be fitted to payphones. (2.11)

10.51 Standards of cleanliness in the residential units should be improved together with the introduction of procedures for coding and using cleaning equipment. (2.12)

Mothers and their babies 10.52 Senior management should implement the child protection policy and procedures and ensure that all staff are adequately trained. Staff working on the mother and baby unit should be trained in this specialised area. (2.31)

10.53 The amount of association time should be increased and, in particular, the necessity for women to be confined to their rooms with their babies should be reviewed. (2.32)

10.54 Women in the mother and baby unit should have daily access to baths or showers. (2.33)

10.55 There should be greater consistency in ensuring that women have access to easily understood information about the mother and baby unit so that they receive the right information at the right time. (2.34)

10.56 Management should review the arrangements for dating scans and attendance at hospital appointments. (2.35) 153

10.57 The prison should seek to recognise and incorporate diversity and care for the needs of foreign nationals and for women from minority ethnic groups. (2.36)

10.58 Sentence planning for mothers with their babies should be improved, ensuring that plans are co-ordinated with the child care plans. (2.37)

10.59 Practical arrangements should be introduced to assist mothers to prepare for release and resettlement in the community. (2.38)

Anti-bullying strategy 10.60 All departments should be regularly represented at anti-bullying committee meetings. (3.06)

10.61 The anti-bullying strategy should be fully implemented and its effectiveness monitored. (3.07)

10.62 A review of the personal officer scheme should include specific attention to the role of personal officers in promoting the anti-bullying policy with potential victims and perpetrators. (3.08)

Self-harm and suicide 10.63 A detailed survey of existing potential ligature points and/or other hazards should be undertaken to inform risk reduction. These should include, for example: § Piping in cells and rooms § Window fittings § Door handles § Radiators § Obscured windows (with makeshift curtains, posters etc.) § Light fittings (3.20)

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10.64 Arrangements for admission to D2 (accommodation for those experiencing difficulty with normal prison routines) should be reviewed. (3.21)

Race relations 10.65 The role of foreign national liaison officers on the units should be re- instated. (3.45)

10.66 Initial and ongoing training for foreign national liaison officers should be provided as per the contract with Hibiscus. (3.46)

10.67 A system for providing emergency clothing to foreign national women should be introduced and initiated from reception. (3.47)

10.68 A system for providing interpreters to non-English speaking women for medical consultations should be introduced. (3.48)

10.69 There should be a conduit for concerns from the foreign nationals meetings to reach management. (3.49)

10.70 Women held under Immigration Act powers should be advised of the importance of taking specialist legal advice on their position before their sentence expires. (3.51)

10.71 The design of the racial incident form should be simplified and direct access to the race relations liaison officer ensured. (3.52)

10.72 The race relations liaison officer should be allowed sufficient time to complete her duties. (3.53)

10.73 A deputy race relations liaison officer should be appointed and a designated office made available with a lockable cabinet. (3.54)

10.74 There should be more direct consultation between prisoners and staff over race relations issues and diversity. (3.55) 155

Substance use 10.75 The drug strategy group should agree a revised drug strategy document that includes specific targets and performance measurements for services within the prison. (3.75)

10.76 Staffing levels in the detoxification unit should be reviewed to ensure that motivational support services are available to all the women housed there. (3.76)

10.77 The peer support workers should be given a clear job description and provided with an agreed structure for supervision and support. (3.77)

10.78 The prison should review the role and priorities of the CARAT team to ensure that they reflect the identified needs of the women at Holloway. (3.78)

10.79 The work of the part-time crack cocaine worker should be reviewed and consideration should be given to integrating the role into the mainstream work of the CARAT team. (3.79)

10.80 The prison should ensure that those women who choose to sign up to voluntary drug testing are given the opportunity to be tested as agreed in their compact. (3.80)

10.81 The drug strategy group should take a more active role in developing links with community groups and establishing co-ordinated throughcare systems. In particular, related issues such as re-establishing family links and housing should be given greater prominence. (3.81)

10.82 The drug strategy group should closely monitor the availability of drugs within the prison to determine whether the security measures and demand reduction services were achieving the aim of reducing availability within the prison. (3.82) 156

Maintaining contact with family and friends 10.83 A car parking facility should be made available for visitors. (3.118)

10.84 Prison managers should ensure that comments in the book for visitors are noted and responded to as necessary. An acknowledgement should be marked in the book so that visitors are able to see that their comment has been considered and noted. (3.119)

10.85 The booking procedures for visits should be improved and should include increased access to the telephone booking system. It should also be possible for visits to be booked in person. (3.120)

10.86 The already excellent services provided by the visitors’ centre should be further developed to increase opportunities to assist and support both visitors and the establishment. (3.121)

10.87 The opportunity for children and mothers to spend a day together should be re-instated and the establishment should create family liaison workers to help and support prisoners in maintaining important family links. (3.122)

10.88 The damaged seating in the visitors’ waiting room should be repaired. (3.123)

10.89 Nappy changing facilities should be made available for use by male visitors. (3.124)

10.90 Information for visitors should be made available in appropriate languages using a variety of media. (3.125)

10.91 Appropriate, child-friendly details about the searching procedure should be clearly displayed using appropriate media. (3.126)

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10.92 The parcels office should be relocated to an area that is more easily accessible and does not require the visitor to stoop at the window. The system for receiving parcels should not delay visitors. (3.127)

10.93 A system should be developed that allows visitors to post or hand in cash to the establishment should they wish to. (3.128)

10.94 The ‘amnesty box’ for illegal substances and the sign inviting visitors to use it serves little purpose and should be removed. (3.129)

10.95 The establishment should review its current procedures for admitting visitors into the prison with a view to simplifying the arrangement. (3.130)

10.96 Appropriate facilities to access the visits hall, such as a stair lift, should be provided. (3.131)

10.97 The post of family liaison officer should be created and their name and contact number should be advertised to both prisoners and visitors. This officer should be responsible for arranging private visits. (3.132)

10.98 The race relations liaison officer should ensure that information displayed about members of the race relations management team is kept up to date. (3.133)

10.99 The race relations management team should consider creative ways of informing visitors about the prison’s race relations policy. (3.134)

10.100 The play area should be appropriately supervised at all times. (3.135)

10.101 The establishment should ensure that prisoners receive adequate time out- of-cell to enable them to access the telephone services. (3.136)

10.102 The number of telephones on the wings should be increased to meet the existing demand. (3.137) 158

10.103 The prison should increase the number of telephones for use by foreign nationals in the long term. In the short term, it needs to ensure that foreign national prisoners are able to use the two telephones currently available on a regular and planned basis. (3.138)

10.104 Concerns about the well-being of a family member or child should be an issue that is expected and planned for, and should receive automatic assistance from an effective personal officer or family liaison officer. The prison needs to ensure that such support is available. The establishment should also allow the prisoner to make a telephone call at the prison’s expense in cases of genuine need. (3.139)

Applications, requests and complaints 10.105 Responses to request and complaint forms should be typed to ensure that they can be read easily. The respondent’s name should be made clear, rather than a signature. (3.157)

10.106 Managers should ensure that each stage of the complaints procedure is dated and logged. (3.158)

10.107 The new request and complaints system should be brought into operation without undue delay as soon as the prison has developed an information package for both prisoners and staff to enable them to understand and use it. Rather than relying on the printed word, the package should be available as a video and taped information in various languages. (3.159)

10.108 Information about the role and work of the Board of Visitors should be produced in a range of languages and other media. (3.160)

10.109 A lockable Board of Visitors application box should be provided on every residential unit and these should only be accessible to Board of Visitors members. (3.161)

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Juveniles and young offenders 10.110 There should be a strategy to manage juveniles who display difficult and challenging behaviour that alleviates the necessity to repeatedly change their location. (4.48)

10.111 Risk assessments should be carried out prior to initial cell allocation and thereafter whenever it becomes necessary to change location. (4.49)

10.112 Juveniles should not be located with adults under any circumstances. (4.50)

10.113 While children are held at Holloway, Youth Offending Teams should be encouraged to work with them and with prison staff to develop relevant training plans. (4.51)

10.114 There should be a strategy to ensure that all young adults are located in appropriate locations that meet their individual needs. As with the juvenile population, risk assessments should be carried out prior to initial cell allocation and thereafter whenever it becomes necessary to change location. (4.52)

10.115 Arrangements should be made to ensure that girls attending ante-natal classes receive their canteen entitlement. (4.53)

10.116 Pregnant girls should not serve their sentences in an adult prison. While pregnant girls are held in Holloway, systems should be in place to ensure frequent contact between the child and her parents or carers, and to support multi-agency contact through training planning. (4.55)

10.117 Child protection systems should be in place and the environment and services should reflect the standards that exist in the community. (4.56)

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10.118 Reception of children into custody and their first night facilities should be managed in a way that acknowledges their fears and vulnerability. Population management should prevent unplanned relocation of young people during the evening. (4.57)

10.119 More suitable arrangements should be provided for young women on D0 to take exercise. (4.58)

10.120 Children and young adults should have access to bail information and support, and age-appropriate legal advice. (4.59)

10.121 Socialisation is an important part of adolescent development and periods of association, including some organised informal activity involving staff, should be facilitated every day. (4.60)

10.122 Independent advocates should be available to work with children in Prison Service custody. (4.61)

10.123 Urgent steps should be taken to ensure that child protection procedures are developed in accordance with Annex B of Prison Service Order 4590 – ‘Regimes for Prisoners Under 18 Years Old’. (4.62)

Health care 10.124 The health care management team should review the basic systems underpinning health care provision with a view to developing an overall model of primary and in-patient care that is integrated both within the prison and with the local NHS. (5.84)

10.125 The Governor and health care management team should take urgent steps to improve the physical environment of health care both in terms of general cleanliness and the effective use of the available space. (5.85)

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10.126 There should be a review of the type and level of secretarial/administrative support, which should be increased as necessary to allow the proper integration of all primary care administrative functions. (5.86)

10.127 The health care management team should develop and introduce clinical supervision and a training and development programme for nursing and medical staff within overall clinical governance initiatives with the NHS. This should include the introduction of nurse triage and re-establishment of chronic disease management clinics. (5.87)

10.128 The health care management team, together with the Primary Care Trust and regional prison health team, should review medical cover in the light of the recommendations of the Doctors’ Working Party. This may include access to a female GP in primary care. (5.88)

10.129 Medical staff should undertake regular ward rounds on C1, visit the levels as required and complete individual medical records to ensure that continuity of care is regularly reviewed and evaluated. (5.89)

10.130 A review of nursing skill mix, levels and shift patterns should be undertaken to better meet the needs of prisoners. (5.90)

10.131 Individual care plans and a ‘named nurse/health care worker’ system should be introduced for in-patients. (5.91)

10.132 There should be a review of the arrangements for dating scans and attendance at hospital appointments for pregnant women. (5.92)

10.133 The pharmacist should take part in triage, be available for ‘over the counter’ consultations and be included within the appointments request system. (5.93)

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10.134 All areas used for storing medication should be inspected frequently and out-of-date, discontinued medication and loose tablets should be removed. Properly equipped rooms should be made available for drug storage. Consideration should be given to alternative arrangements for drug distribution to remove the need to transport trolleys around the prison. (5.94)

10.135 Specific dental recommendations include: § A complete refurbishment of the dental surgery complex should be carried out as soon as possible § A dental health care needs assessment should be undertaken § A review of systems should be undertaken to clarify the means by which patients access routine dental services, the provision of care for emergencies and urgent cases and to establish the number of dental sessions required to meet the need § An agreement should be put in place with the prison works department to ensure the autoclave, compressor and fire extinguisher are service- date labelled and that electrical plugs are ‘safety-testing’ labelled. (5.95)

10.136 The health care manager, the regional health care task force and the local Primary Care Trust should agree a health promotion strategy to take account of the specific public and individual health needs and set target dates for implementation. (5.96)

10.137 The Governor, the regional health care task force and the local Primary Care Trust should produce an action plan for prison health care as agreed in the local health improvement plan and agree a timeframe for implementation. This should include an urgent review of the mental health needs of the juveniles and young adults. (5.97)

Education 10.138 The accreditation of basic skills of number and communication in some of the practical work areas, namely physical education, sewing and gardens, should be extended into other work areas. (6.12) 163

10.139 Improved education provision for young people should be provided with facilities and resources that are sensitive to their particular needs. (6.13)

10.140 A wider area of skills training should be offered in subjects that could have a direct bearing on future employment prospects. (6.14)

10.141 The route to vocational qualifications should be opened up in order that there is added value to existing prison employment for women prisoners. (6.15)

10.142 Steps should be taken to enable the education contractor to restore the delivery of education to the proper contracted hours. (6.16)

10.143 Individual learning plans should be introduced for all prisoners undertaking education. (6.17)

Library 10.144 A system should be in place to ensure adequate access to library services for all prisoners. (6.24)

10.145 The notices providing multilingual information about library services should be displayed in areas where prisoners will be able to see and read them. (6.25)

Physical education 10.146 The excellent physical education resources should be fully exploited to meet the needs of women prisoners by way of a programme that is consistently delivered. (6.29)

Faith and religious activity 10.147 An ablution facility should be provided as an integral part of the world faiths room. (6.34)

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10.148 The chaplains should work with wing staff and personal officers to assist them in resolving prisoners’ domestic issues rather than undertaking this work directly. (6.35)

Use of force 10.149 A suitable manager should be appointed to oversee searching procedures and to devise and implement quality control measures. (7.12)

10.150 Management should ensure that staff are aware that any use of force must be authorised, certified and properly recorded using appropriate documentation. (7.13)

10.151 There should be a single recording point for all instances of use of force and the recording process should begin immediately after the incident. (7.14)

Segregation unit 10.152 Long-stay residents in segregation should receive some intervention work to modify their problem behaviour. (7.25)

10.153 All prisoners should be afforded their statutory entitlements and the prison should comply with its published routine, particularly in relation to exercise. (7.26)

10.154 Entitlements and facilities for prisoners in the segregation unit should be clearly displayed on the unit notice board. (7.27)

10.155 All cells should be equipped with privacy screens. (7.28)

Incentives and earned privileges 10.156 The incentives and earned privileges scheme should be re-written to include objective measures of behaviour, differential rewards and transparency. A strategy document should be constructed and published in accordance with Prison Service Order 4000. (7.36)

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Adjudications 10.157 Adjudication standardisation meetings should be scheduled to promote consistency in the application of the process and in punishments awarded. (7.41)

Public protection and the child protection unit 10.158 A clear system for tracking internal movements of Schedule One offenders or those subject to registration under the Sex Offender Act should be introduced. (7.46)

10.159 Shared accommodation risk assessments should be put in place. (7.47)

10.160 The child protection policy was comprehensive, well developed and should be implemented. (7.48)

10.161 Prison officer and probation officer staffing levels should be commensurate with the responsibilities carried by the Prison Service to protect the public. (7.49)

Life-sentenced prisoners 10.162 A system should be put in place that identifies potential life-sentenced prisoners at an early remand stage and assists the prison in managing their potential risk to themselves or others. (7.57)

10.163 A system should be introduced to ensure multi-agency risk assessment systems are in place for newly-sentenced lifers. (7.59)

10.164 Lifers and potential lifers in Holloway should be identified and provided with services that recognise their individual needs in accordance with the new life sentence planning system. (7.60)

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Key workers (personal officers) 10.165 A fundamental review of the personal officer scheme should take place to ensure that an effective service is introduced under the auspices of the resettlement committee. (8.07)

Sentence planning 10.166 A fundamental review of sentence planning should take place to ensure that effective systems are introduced under the auspices of the resettlement committee. (8.17)

Probation 10.167 Local recruitment rules adopted by the London Probation Area did not take account of the special needs of the women in Holloway, failed to take full account of the key partnership roles that seconded probation staff filled in the prison and disregarded the terms of the business plan to which the London Probation Area was a signatory. This should be remedied to ensure the availability of suitably qualified staff to meet the identified needs of prisoners. (8.27)

10.168 A bail information scheme should be developed. (8.28)

Release on temporary licence 10.169 Information about the release on temporary licence scheme should be made available and explained to prisoners by staff during induction. (8.34)

10.170 The use of release on temporary licence should be reviewed. (8.35)

10.171 The review of release on temporary licence should include a general review of the staffing of the prisoner management unit. (8.36)

Home detention curfew 10.172 There should be more visible management ownership of home detention curfew. (8.43)

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10.173 Information about the home detention curfew scheme should be made available and explained to prisoners by staff during induction. (8.44)

Catering 10.174 The kitchen should be redecorated and its physical structure maintained at a level that would satisfy environmental health standards. (9.09)

10.175 Management should ensure that the personnel problems in the kitchen are resolved and that a sufficient number of prisoners are available to work there. (9.10)

10.176 Catering staff should attend an amenities committee to consult with the prisoners on issues related to the food. (9.11)

10.177 We were told that the prison was employing the services of a nutritionist to look at the dietary needs of pregnant women. This brief should be expanded to review the diet offered to the main population to ensure that it is both sufficient and healthy. (9.12)

10.178 A thorough audit of the serveries should take place and management should ensure that there is compliance with the catering standards laid out in Prison Service Order 5000. (9.13)

Prison shop 10.179 An amenities committee should be established that would allow representatives of the women to discuss issues related to the shop directly with the relevant staff. The needs of minority ethnic prisoners should be a standing item of discussion. (9.20)

10.180 The prison should have a clear pricing policy that allows goods to be sold at a price equivalent to that available in the community. (9.21)

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10.181 The prison should review the way in which the prison shop is organised. Research should be undertaken to establish a more efficient system that allows the women to plan their shopping and minimises opportunities for bullying or theft. (9.22)

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EXAMPLES OF GOOD PRACTICE

10.182 Girls subject to detention and training orders were fast-tracked through the reception area. (1.48)

10.183 Where possible, the doors to the two small holding cells were left open, offering good sight lines for staff and preventing individual prisoners from being isolated in a confined space. Equally importantly, communication between officers and prisoners was easy. (1.49)

10.184 Telephone cards were provided in both the smoker’s and non-smoker’s packs. (1.50)

10.185 The involvement of PACT in the reception process. (1.74)

10.186 The PACT manager was a member of the establishment’s race relations management team, the suicide and self-harm team and attended the resettlement meetings. (1.75)

10.187 A specific bullying survey commissioned by the anti-bullying committee, through a questionnaire issued to all prisoners by the psychology department, revealed that 16% of women had experienced bullying. A further analysis of the data provided an excellent means of informing policy development and practice. The survey also took special account of foreign nationals and was sensitive to the language needs of non-English speakers. (3.09)

10.188 Hibiscus was contracted to provide an in-house service to foreign national women in Holloway for three days a week. (3.56)

10.189 A limited number of free telephone cards were provided to foreign national women to keep in touch with family and friends. (3.57)

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10.190 The library provided an exceptionally good service in terms of translated information and foreign books to non-English speaking women. (3.58)

10.191 Ethnic monitoring was carried out to a high standard. (3.59)

10.192 A prisoner race relations team met monthly with the psychology department. (3.60)

10.193 The standards and protocols of the detoxification unit were equivalent to those of best practice in the community. Despite the pressure of numbers and the complex needs of the women they were treating, they were providing a model of good practice that should be followed across the prison estate. (3.83)

10.194 Information booklets and the necessary forms detailing the assisted prison visits scheme were freely available in the visits hall. (3.140)

10.195 Stamps could be posted in and there was no limit on how many a prisoner could have in her possession. (3.141)

10.196 If prisoners had children under the age of 16 years, they were able to request a ‘children’s letter’. This was a letter, posted at the prison’s expense, using paper that was not stamped with the prison’s name and address. This ensured that children who did not know that their mother was in prison would not be alerted to this by a letter from her. (3.142)

10.197 Staffing arrangements at night included a member of the D0 staff team. (4.63)

10.198 The diversity of languages recognised and the extent of information readily available in these languages was an example of good practice. (6.26)

10.199 The involvement of the library with prisoners’ children and in supporting the work of other departments was an example of good practice. (6.27)

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