HMIP Inspection Report Health Summary – HMP Lewes, Jan 2019

Date of publication: 14 May 2019
Report type: Prison and YOI inspections
Location: Lewes

Background and Context.

HMP Lewes is a medium sized Cat B male Local/resettlement prison. The last inspection was in January 2016. Since then there have been 5 self inflicted deaths and reported incidents of self harm have increased 300%.
On the positive side, 78% of prisoners told the HMIP Inspectors that staff treated them with respect. This finding in itself attracted the notable remark of this statistic being an “unusually high figure for this type of prison.”
A recognition surely of the challenges faced within the local/resettlement prisons across the estate?

Healthy Prison Outcomes:

  • Safety = 2 (2)*
  • Respect = 2 (3)*
  • Purposeful Activity = 1 (2)*
  • Rehabilitation & Release Planning = 2 (3)*
Note: *(Previous inspection outcomes in brackets)

Summary – Health, well-being and social care:

Many prisoners were very negative about the health services, with two-thirds of prisoners in the survey responding that the overall quality was quite or very bad. Services had deteriorated since the previous inspection, most notably mental health services and the provision of nurse-led primary care.

Over half of prisoners said they had mental health problems. Waiting lists were lengthy and the under-resourced integrated mental health team could not meet the level of need.

The range of primary care services was limited and the oversight of prisoners with long-term conditions was poor. The application process for health appointments was very poorly managed. Inspectors found 143 outstanding applications, presenting significant risks to prisoner care.

Managers did not have accurate data on waiting times.

The inpatient unit continued to provide good quality care for some of the most seriously ill patients. However, it still lacked a therapeutic regime and some of the cells were in poor condition. There were five prisoners receiving funded social care packages, and they received good quality care.

In relation to Substance Misuse services, The Forward Trust provided good clinical and psychosocial services for prisoners requiring substance use treatment.
Prison officers did not always manage medication queues effectively, which continued to compromise confidentiality and increased the opportunity for medication diversion.

Dental care was good but some aspects of governance needed immediate attention, particularly the maintenance of fixed equipment.

The CQC issued 3 Requirement Notices against Regulation Standards.

Recommendations – Health, well-being and social care:

  • Health governance structures should be robust enough to identify and effectively address key risks and concerns, and should ensure that prisoners have prompt access to all health services.
  • All health care staff should receive regular clinical and managerial supervision, and be up to date with mandatory training.
  • All health care should be delivered in a clinically appropriate setting that meets infection control standards.
  • There should be a prison-wide strategy and approach to support health promotion and well-being activities.
  • Waiting times for patients should be regularly monitored to ensure prompt access to care.
  • Applications for health care appointments should be reviewed and actioned without delay.
  • The reasons for prisoner non-attendance at health care appointments should always be recorded and reviewed.
  • Prisoners with long-term health conditions should receive regular reviews by trained staff, informed by an evidence-based care plan.
  • External hospital appointments should not be cancelled. (Repeated recommendation)
  • The prison should work with key stakeholders to produce an updated memorandum of understanding and information-sharing agreement for social care provision.
  • Prisoners referred to the service should be reviewed and assessed promptly, and offered a suitable range of mental health interventions within agreed timescales.
  • There should be a regular substance use strategic meeting to support the implementation and development of the strategy.
  • In-possession medication should be prescribed, reviewed and administered by health care professionals adhering to an up-to-date policy and risk assessment that reflects the range of medications prescribed, up-to-date prescribing guidelines, robust risk assessment of patient and medication, and appropriate storage of such medicines/doses. (Repeated recommendation)
  • Custody officers should manage queues during medication collection times to maintain confidentiality and minimise potential bullying and diversion of supplies (Repeated recommendation)
  • Prisoners should have access to routine dental appointments within six weeks.
  • All dental equipment, including the x-ray machine, should be regularly serviced and certified.
  • The provider should maintain an up-to-date file to document local arrangements for radiation protection.

Good Practice – Health, well-being and social care:

None Identified.

CQC Requirement Notices Issued:

  • Regulation 9 – Person-centred care
  • Regulation 17 – Good governance
  • Regulation 18 – Staffing

Links/Resources:

Press Release

Full Report

Hepatitis C Report – Prisons In England 2019

In this latest report (published on 9 April 2019), Hepatitis C in England 2019, Public Health England summarises the current data and the impact of action plans in England to drive down mortality from Hepatitis C Virus (HCV) and to reduce the number of new infections. Also included is an outline the actions required to make further progress. It is clear that progress is being made, but there is still much to do.

This post provides a summary of the key points relative to the levels of activity ongoing through the prison estate in England.

Latest modelled estimates suggest that around 143,000 people in England were living with chronic HCV infection in 2015. Prevalence is estimated to have fallen in recent years, and was predicted to decline to 113,000 in 2018 with the advent of new treatments. HCV affects a larger proportion of people in prison and other detention centres than the wider population, principally as a result of the relatively higher levels of injecting drug use that are observed among this population.

Partnership Working – HMPPS, NHSE and PHE.

Since 2013/14, PHE in partnership with NHS England and Her Majesty’s Prison and Probation Service (HMPPS) have overseen the rollout of BBV testing in adult prisons on an ‘opt-out’ basis. A significant milestone was reached in April 2018, when after more than 4 years of implementation, the programme was successfully rolled out across the entire adult prison estate.

Testing and Diagnosis.

Opt-out bloodborne virus (BBV) testing is now fully implemented across the prison estate, and among new receptions to English prisons, levels of testing have risen from 5% in 2010/11 to 19% in 2017/18. In the 2017/18 financial year, Health and Justice Indicators of Performance (HJIP) testing data suggest that, after excluding previously confirmed cases, 75% of new receptions and transfers were offered HCV testing, 26% were tested, 11% of those tested were found anti-HCV positive but less than half (46%) went on to have HCV Ribonucleic acid (RNA) testing. About 40% of those testing positive for HCV RNA received specialist referrals for their HCV infection.


Overall, these data suggest an increasing awareness of HCV in prisons with significant increases in testing, including Dried blood spot (DBS) testing. Whilst testing volumes remain sub-optimal, work is ongoing to move from the implementation of BBV testing to improving the quality of the offer and uptake of testing within prisons.

HJIP Metrics.

Prison Health Performance and Quality Indicators and HJIPs have shown a rise in HCV tests performed, from 5.3% in 2010/11 to 19.4% in 2017/18. It is likely that the recent increase in testing of people in prisons is due to the introduction of BBV opt-out testing, which was agreed in October 2013 by PHE, NHS England and HMPPS and is now fully implemented across the prison estate. While this increase in testing is welcomed, current levels are still below the lower BBV testing threshold proposed by NHS England (50-74%), and well below the target threshold of at least 75% uptake.

Performance in relation to the BBV opt-out testing programme is measured at the prison level by NHS England through the collection of data via HJIPs. These metrics include specific reports on:

  • the number of BBV tests offered within 72 hours of reception,
  • the number of tests undertaken,
  • the number of people newly diagnosed,
  • the number of patients referred for specialist treatment following diagnosis,
  • the number who received treatment.

These data are used by NHS England commissioners to performance manage healthcare providers in prisons and are important for identifying potential attrition points in the testing pathway.

In the 2017/18 financial year, HJIP testing data suggest that, after excluding previously confirmed cases, 75% of new receptions and transfers were offered HCV testing and of these 26% were tested. Of those tested, 11% were positive and 46% of these went on to have HCV RNA testing.

The image with this post illustrates the Hepatitis C testing cascade in the English prison estate (112 prisons).

World Hepatitis Day is held on 28 July 2019.

Read the full report Here

HMIP Report Health Summary – HMP Garth – Jan 2019

Date of publication 09 May 2019
Report type Prison and YOI inspections
Location HMP Garth

Report on an announced inspection of HMP Garth (17 December 2018 – 18 January 2019)

Main Points: Health, well-being and social care.

Several aspects of health care had improved since the previous inspection, but patients still waited too long for hospital appointments. Governance structures and partnership working were reasonable. Staffing levels had improved, but there were still vacancies. However, in some areas they were offset by regular agency staff and an active recruitment programme. Supervision in the health care waiting room was poor, leaving some prisoners at risk from others. The management of long-term conditions had improved and patients now received regular reviews and a good level of care. Waiting times for some primary care services, including dentistry, were still too long, exacerbated by high non-attendance rates. The integrated mental health team mostly delivered an appropriate range of services. Substance misuse services were reasonably good, prescribing was safe and reviews took place regularly. A good range of psychosocial support was also available. The ethos of the substance misuse therapeutic community was undermined by a lack of dedicated prison officers and some prisoners’ use of illicit drugs. Medicines were managed reasonably well and medicines administration had improved since our previous inspection, but governance and oversight needed to be enhanced.

Recommendations: Health, well-being and social care.

  • 5.2 The availability of illicit drugs and associated debt, violence and victimisation should be reduced significantly. (S44)
  • 5.3 Prisoners should be able to access all hospital and primary care services within community- equivalent waiting times. (S45)
  • 5.17 All health and substance use service providers should contribute to a single patient record to ensure relevant information is shared effectively. (2.56)
  • 5.18 All prisoners should be able to wait in a suitable waiting room that provides a respectful and safe environment. (2.57)
  • 5.19 Discipline staff should provide the health care department with adequate support so that a safe environment is maintained. (2.58)
  • 5.20 There should be a ‘whole-prison’ strategy to promoting health and well-being. (2.61)
  • 5.21 An updated memorandum of understanding between all key stakeholders and regular meetings to monitor the provision should be in place to ensure that prisoners receive a good level of social care. (2.71)
  • 5.22 All discipline officers should receive mental health awareness training, to enable them to recognise and support prisoners with mental health problems. (2.79, repeated recommendation 2.81)
  • 5.23 Transfers to hospital under the Mental Health Act should take place within the Department of Health’s established guidelines. (2.80)
  • 5.24 Appropriate options for clinical treatment should be available in line with national clinical guidance. (2.88)
  • 5.25 The TC should have an operating policy and appropriately trained dedicated officers should support the ethos of the unit. (2.89)
  • 5.26 Medicine administration rounds should be supported in all areas by adequate officer supervision. (2.94)
  • 5.27 Robust governance arrangements should be embedded and involve key stakeholders to ensure oversight of medicine management and prescribing practice is effective. (2.95)

Good Practice: Health, well-being and social care.

None.

Full Report Here

HMIP Report Health Summary – HMP Swaleside – Dec 2018

Date of publication 08 May 2019
Report type Prison and YOI inspections
Location HMP Swaleside

Report on an unannounced inspection of HMP Swaleside (3-13 December 2018)

Main Points: Health, well-being and social care.

Health services had improved and were reasonably good but a few areas were still concerning. The chronic staffing shortages had started to reduce. Prisoners could access an appropriate range of primary care services and visiting specialists. Waiting times for primary care services were reasonable but too many prisoners did not attend their appointments. The in-patient unit provided good care for patients with very complex needs. A lack of escorts led to the cancellation of too many hospital appointments, long delays and risks to prisoners’ health. The social care referral pathway was not sufficiently well promoted. Mental health services were good but waiting times for counselling were too long – at up to 32 weeks in some cases. The emotional well-being mentors scheme was excellent, and an example of good practice. Substance misuse services were reasonably good, with flexible prescribing and a range of psychosocial support. Inconsistent supervision of medicine queues by custody staff compromised confidentiality and increased the risk of medicines being diverted. Some tradable medicines, such as dihydrocodeine (an opiate-based painkiller), were prescribed in-possession. In-possession risk assessments were too infrequent. Some prisoners waited up to 11 months for a dentist appointment, which was very poor.

Recommendations: Health, well-being and social care.

  • 5.23 Prison officers should ensure that health service areas, including queues for medication, are safely and effectively managed. (2.57)
  • 5.24 Professional telephone interpreting services should always be used for confidential consultations when a prisoner does not speak good English. Information should be available in a range of languages. (2.62)
  • 5.25 The number of missed appointments should be reduced further, to ensure that patients receive prompt treatment within effective use of clinical resources. (2.72)
  • 5.26 Arrangements for prisoners convicted of a sexual offence attending health care appointments should be safe and respectful. (2.73)
  • 5.27 There should be sufficient escort staff available to ensure that prisoners’ treatment at outside hospitals is not delayed. (2.74)
  • 5.28 Patients on the in-patient unit should have access to a range of therapeutic activities to support their well-being and recovery. (2.75)
  • 5.29 The referral pathway should ensure that all prisoners with social care needs are identified and supported. (2.77)
  • 5.30 Prisoners should have timely access to counselling services. (2.87)
  • 5.31 The in-possession policy should be followed, to ensure that the prescribing of medicines is suitable for patient treatment in a secure environment, overseen by the medicines management committee. (2.102)
  • 5.32 All medication that cannot be held in possession should be administered at times that ensure clinical efficacy. (2.103)
  • 5.33 Risk assessments for in-possession medicines should be regularly reviewed and updated when a prisoner’s circumstances change. (2.104)
  • 5.34 Prisoners requiring routine dental appointments should receive them within six weeks. (2.106)

Good Practice: Health, well-being and social care.

  • 5.53 The ‘Well-being for all’ action group promoted health activities and provided relevant guidance. (2.63)
  • 5.54 The emotional well-being mentors scheme encouraged better understanding and awareness of mental health issues. (2.88)

Full Report Here

Eradicating Hepatitis C In Prisons

In March 2018, the All-Party Parliamentary Group published the report – Eliminating Hepatitis C in England. A report produced with the aim of moving towards achieving NHS England’s ambition to eliminate hepatitis C by 2025 at the latest. A target date some five years before the World Health Organization target of 2030.

One of the key risk factors was the acknowledgment that Hepatitis C disproportionately affects people who inject drugs (PWID) are the group most at risk of becoming infected with hepatitis C, with transmission occurring via shared syringes and other injecting equipment. Approximately 50% of PWID remain undiagnosed, and prevalence of hepatitis C among recent initiates in drug use was found to be 26%. PWID are a key target population for hepatitis C prevention, diagnosis, and treatment initiatives.

There is a high prevalence of hepatitis C among people in prison, due to a high population of PWID in prison, as well as unsafe injecting and tattooing taking place within prison.

Prisons, substance misuse services, and sexual health services have traditionally been the key settings to offer hepatitis C testing to high concentrations of at-risk populations. People in touch with these services are highly likely to have put themselves at risk for transmission, and the aim in these settings should be universal testing and regular re-testing of all service users. There are unique challenges and missed opportunities in each of these settings.

This report puts forward a series of desired outcomes and action-based recommendations to support objectives leading to elimination of hepatitis C, which are specific to prisons and prison healthcare providers:

Desired Outcomes:

  • Increased awareness of hepatitis C among PWID and people in prison.
  • Increased awareness of the ease and short duration of new direct acting antiviral (DAA) treatments among prisoners.
  • Increased awareness of the ease and short duration of new DAA treatments among PWID.
  • Prison staff are an effective source of information for prisoners on harm reduction and prevention.
  • Fewer new infections as a result of improved knowledge of transmission risks.
  • Increased coverage and uptake of testing in substance misuse services.
  • Increased coverage and uptake of testing in prisons.
  • Opt-out dry-blood spot testing for hepatitis C is fully implemented in substance misuse services and prisons.
  • A target of 20,000 people per year treated is set, incentivised, and monitored.

Recommendations & Actions:

  • Awareness-raising talks delivered by peers to be commissioned as an integral part of contracts for substance misuse services and in prisons.
  • Nationally-approved NHS England Health and Justice publicity highlighting the ease of new treatments to be rolled out across HM prison estate.
  • Peer programmes to be commissioned as an integral part of hepatitis C treatment services in commissioning contracts in prisons.
  • Nationally-approved publicity highlighting the ease of new treatments to be rolled out across substance misuse services.
  • Hepatitis C peer programmes to be commissioned as an integral part of commissioning contracts for substance misuse services.
  • BBV training to be made compulsory for prison staff.
  • Peer programmes to be commissioned as an integral part of hepatitis C treatment services in commissioning contracts for substance misuse services and in prisons.
  • Opt-out testing for hepatitis C to be commissioned by local authorities in substance misuse services.
  • Re-offer of testing to all those engaged with substance misuse services every six months to be mandated and commissioned.
  • Testing to be re-offered in prisons to those who did not receive a test at reception.
  • Opportunities to be provided for those who previously tested to re-test in prison.
  • Clear national protocol to be developed surrounding wording of opt-out test offer in prisons.
  • Commissioners to support access for prisoners to second reception screening.
  • Research to be conducted on transmission risk within prisons to determine impact of re-testing.
  • Commissioning contracts for substance misuse services and prisons to have clear mechanisms to hold services to account for failures to meet testing targets.
  • Unnecessary tests and appointments to be reduced, and the use of reflex tested dry blood spot samples, which necessitate only one sample and can be delivered in the community, to be mainstreamed.
  • Proportional prison treatment targets to be set for prisons specifically in every ODN depending on prison population.

Conclusion.

The findings of this inquiry give us much cause for optimism, and the firm belief that elimination of hepatitis C in the very near future is an achievable national ambition. Given the concentration of this at-risk population within the prison setting, these suggested actions offer real opportunities for prisons and prison healthcare providers to make a positive contribution to society for the elimination of Hepatitis C.

Links/References:

http://www.appghep.org.uk/download/reports/Eliminating%20Hep%20C%20APPG.pdf

Photo by Matthew T Rader on Unsplash.

Smoke Free Prisons: What Does A Post-Implementation Smoking Cessation Service Look Like?

Background

All prisons in England and Wales are commissioned to provide stop smoking services in partnerships with relevant health providers.

Nearly 2 years have passed since many (closed) prisons in England and Wales transitioned to becoming smoke free. In January 2019, the MOJ published the Smoke Free Policy Framework in addition to the NHS England Minimum Service Offer that was already in place.

With this in mind, what makes for an effective smoking cessation service?

Post Implemention Prisons

Access to Nicotine Replacement Therapy (NRT), with patches and lozenges being the most often provided, are all too often prone to being abused or misused. Both patches and lozenges are being traded as a form of currency, whereas the boiling and smoking of patches in not an uncommon practice. In the Post Implementation Smoke Free prison estate, those who are serving their sentences have made their choices to vape or use e-cigarettes or not smoke at all.

The challenges lie for those prisoners who arrive on remand, who are smokers. Being a new reception on remand and with some much going on in their lives, e.g pending court case, trying to maintain external relationships, or perhaps some financial worries etc. smoking (to a smoker) would be a reassuring coping mechanism for so many. Being a new reception in prison would most certainly not be the time/place to decree “I’m going to give up smoking!”

Smoking cessation becomes more a matter of something best described as a “Nicotine Maintenance Programme” for those on remand or perhaps serving very short sentences. That is until at least they are released when they can then return to tobacco smoking or vaping, if they so wish.

As prisons are now fully smoke-free, and at the post implementation stage, there will continue to be a need for ongoing stop smoking support and relapse prevention. This is at a very different level to pre-implementation.

A harm reduction option will be more suitable than a programme of cessation for patients transferring into smoke-free accommodation, who intend to return to smoking on transfer or release. All prisoners who are on sentences of less than 8 weeks should initially be offered a harm reduction intervention, to help them manage their addiction whilst in prison.

Those prisoners in a reception or local prison should be offered harm reduction interventions as a first line treatment, with full cessation being offered at the point of sentence or on transfer to another prison, whether that is to another place of detention, or to the community.

Points to consider when delivering an effective service:

  • Smokers identified as vulnerable and at risk of self-harm or suicide due to smoke free policy will have safer custody processes applied to support them whilst in custody.
  • Smokers must be seen by a stop smoking adviser within 48 hours of arrival into custody. Prisoners will be referred to a smoking cessation programme if they wish to participate.
  • Providing a prison regime that encourages and supports abstinence from smoking.
  • Provision of a range of stop smoking support, including harm minimisation approaches, to assist prisoners to abstain from smoking.
  • Developing strategies to address continued smoking seeking behaviour including misuse of Nicotine Replacement Products.
  • Recent popularity of electronic cigarettes (e-cigarettes) and more so vapes, has demonstrated that many smokers are interested in using these as less harmful sources of nicotine.

This level of ongoing need will also be dependent on prisoner movement and turnover within the establishment, whether prisoners are received from smoking or smokefree establishments and consideration should be given to what is required in a reception prison with comparatively high turnover as compared to a training prison with a more stable population.

Conclusion

All this condenses down to 3 simple actions to take when delivering an effective smoking cessation service:

  • For all new reception prisoners, provide access to e-cigarettes or vapes as part of first night reception packs.
  • For all new reception prisoners who are sentenced to more than 8 weeks, see within 48hrs and offer smoking cessation services to all those who’ve not opted to use e-cigarettes or vapes.
  • For all new reception prisoners who are on remand of sentenced to less than 8 weeks, promote harm reduction options.

References/Links:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/773041/smoke-free-policy-framework.pdf

https://www.england.nhs.uk/publication/minimum-offer-for-stop-smoking-services-and-support-in-custody/

Photo by Dev Asangbam at Unsplash

A Summary of the MOJ Safety in Custody Quarterly Bulletin: An Update to December 2018

This bulletin was published on 25th April 2019, and provides a report on the Safety in Custody Statistics, England and Wales: Deaths in Prison Custody to March 2019 Assaults and Self-harm to December 2018. Also included in these figures are Immigration Removal Centres operated by HMPPS.

Deaths – 12 months ending March 2019

In the 12 months to March 2019, there were 317 deaths in prison custody, up 18 from the previous year. Of these, 87 deaths were self-inflicted, up 14 from the previous year, representing an increase on the previous 12 month period.

There were 3 apparent homicides, down from 5 incidents in the previous year. Homicides in prison custody remain relatively rare, accounting for around 1% of all deaths over the last ten years. There were 164 deaths due to natural causes, a decrease of 11% from 184 in the previous year. Natural-cause deaths were at a rate of 2.0 per 1,000 prisoners.

Self-Harm – 12 months to December 2018

Self-harm incidents reached a record high of 55,598 incidents in 2018, a 25% increase from 2017. The number of incidents between October and December decreased by 7% to 14,313 since the previous quarter.

The number of self-harm incidents requiring hospital attendance increased by 5% on the previous year to 3,214 while the proportion of incidents that required hospital attendance decreased by 1.1% to 5.8%.

The most common method for self-harm in prison was cutting/scratching, 54% females and 68% males self-harmed by cutting.

This was an increase of 27% for males and 12% for females in the most recent year. Hanging and self-strangulation both increased by over 35% for males since 2017. Hanging decreased by 7% for females in the previous year, although self-strangulation rose by 32%.

Consistently, prisoners in male establishments who are in prison between 31 days and 3 months were the most likely to self-harm.

Prisoners in both male and female establishments had the majority of self-harm incidents when they had been in custody between 31 days and 3 months, however for the first time in 2018, the majority of self-harm incidents occurred when prisoners had been in their current prison for over one year.

Assaults – 12 months to December 2018

Annual assault incidents reached a record high of 34,223 incidents in 2018, a 16% increase from 2017. Assaults in the October to December 2018 quarter decreased to 8,150, a decrease of 11% from the previous quarter, but a 5% increase on the same quarter of the previous year.

The proportion of assaults on staff increased to 30% of all incidents in 2018, an increase from 29% in 2017, and a steady increase from 20% between 2008 and 2011. The proportion of assaults on staff (38%) in female establishments in 2018 was higher than in male establishments (29%).

In the 12 months to December 2018, there were 3,918 serious assault incidents, up 2% from the previous year. Serious prisoner-on-prisoner assaults decreased by 1% since the previous year (to 2,987), and serious assaults on staff increased by 15% (to 995) in the same period. Serious assaults (by 4%), serious prisoner-on- prisoner assaults (by 5%), and serious assaults on staff decreased in the last quarter (by 4%).

There were 24,424 prisoner-on-prisoner assaults in 2018 (a rate of 293 per 1,000 prisoners), an increase of 15% from 2017, to a new record high.

Prisoner-on-prisoner assaults in male establishments rose by 15% to 23,538 incidents from the previous year, and assaults on staff in male establishments rose by 20% in the same period, to 9,665 incidents.

Female prisoner-on-prisoner assaults increased by 10% in 2018, to 886 incidents, and assaults on staff in female establishments increased 48% to 548 incidents. The proportion of assaults on staff (38%) in female establishments was higher than in male establishments (29%).

There were 10,213 assaults on staff in the 12 months to December 2018 (a rate of 123 per 1,000 prisoners), up 21% from the previous year. This is the highest level in the time series. The proportion of assaults on staff increased to 30% of all incidents in 2018, an increase from 29% in 2017, and a steady increase from 20% between 2008 and 2011.

Prisoners aged 30-39 had the highest proportion of assailants (25%), fighters (21%) and victims (28%) in 2018.

The number of assailants aged 30-39 had increased by 26% since the previous year, to 5,254 incidents. The number of fighters aged 30-39 increased by 7% to 2,966 and the number of victims aged 30-39 increased 12% to 4,040.

The number of incidents involving prisoners who had been in prison over one year has seen the biggest increase across all roles.

The number of assault incidents involving prisoners who had been in custody for 31 days to 3 months had smaller changes from the previous year for assailants (3% increase to 5,199 incidents), fighters (3% decrease to 3,642 incidents) and victims (1% decrease to 3,591 incidents), whereas prisoners who had been in prison over one year has increased for assailants (69% increase to 3,522), fighters (46% increase to 2,131) and victims (60% increase to 2,127).

Bulletin Summary.

  • Number of deaths have increased compared to the previous 12 month period.Self-harm incidents rose to 55,598 in 2018, a new record high, but decreased in the latest quarter.
  • Incidents requiring hospital attendance rose to a record high of 3,214 in 2018, although the proportion of incidents requiring hospital attendance has decreased.
  • Assault incidents increased to 34,223, a record high level in 2018, but decreased in the latest quarter.
  • The proportion of assaults on staff continue to rise.
  • Of the 34,223 assault incidents in 2018, 3,918 (11%) were serious.

Get the full bulletin here:

https://www.gov.uk/government/statistics/safety-in-custody-quarterly-update-to-december-2018?utm_source=e92c3f9b-202f-4a56-9ab0-c3c73d03b8b8&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

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