HMIP Annual Report 2018–19: Health Summary

General Points of Note.

Of the 35 inspections across the male estate, a total of 28 local and training prisons were inspected during the year. In 22 of them, inspectors judged safety to be poor or not sufficiently good.

It was also notable that self-harm had increased in two-thirds of the prisons inspected.

As of December 2018, 17% of the prison population was aged over 50. To date, there is neither a clear strategy nor indication of innovation in how this increasing cohort of prisoners will be catered for in the future. At the moment there are large and growing numbers of ageing and infirm prisoners who are held in expensive and unnecessary levels of security.

Overall, inspectors continued to find that outcomes for women held in prison were better than for men. Safety, respect and resettlement were good or reasonably good at all three of the women’s prisons that inspected during this reporting period. However, gradings for purposeful activity had deteriorated at two of the women’s prisons, and had declined to not sufficiently good at the third.

It remained the case that women were far more vulnerable to self-harm than men, and levels had increased significantly. The levels of victimisation suffered by many women before entering custody emphasised the need to continue and develop the vital trauma-informed work that has been implemented in recent years.

There had been 83 self-inflicted deaths in male prisons in England and Wales in 2018–19, an increase of 15% from 72 the previous year. There were 45,310 reported incidents of self harm in 2018, an increase of 25% from 36,347 incidents in 2017. A common theme across all prisons.

Self-harm had increased in two-thirds of the adult male prisons inspected during this reporting year. Main recommendations about serious deficiencies in suicide and self-harm prevention measures were noted at 14 establishments. The Prisons and Probation Ombudsman (PPO) investigates all deaths in custody and makes recommendations to improve care. Once again, inspectors found that PPO recommendations had not been adequately addressed at about a third of prisons.

At more than half of inspected adult male prisons, the quality of support for prisoners in crisis, delivered through assessment, care in custody and teamwork (ACCT) case management, was weak. In the surveys undertaken, only 47% of prisoners who had received this support had felt cared for. Too often, care planning did not target concerns or support was ended without the proper resolution of issues.

Key Points of Interest: Health, Well-Being and Social Care.

Male Prisons

This year, more prisons were found to be breaching CQC health regulations. This resulted in one warning notice and 16 requirement notices to 10 of the 35 adult male prisons inspected, with four prisons receiving more than one notice.

In 2018–19, most health services were reasonably good with 50 instances of good practice highlighted, including 11 for substance use services. However, there were problems with cleanliness – 10 prisons failed to meet minimum standards of infection control compliance and cleanliness – and seven prisons had poor resuscitation equipment, which was a concern given the increasing number of medical emergencies.

Generally, there was an improvement in health staffing levels, most staff felt supported and a majority participated in clinical and managerial supervision.

All prisons provided new arrivals with an initial health screening by a clinician but only two-thirds offered a second follow-up assessment to help identify key health issues.

HMIP inspectors found improving health services for older prisoners, with a growing awareness of dementia, and patients with long-term conditions received good planned care.

In over half the adult male prisons inspected, it was noted that the lack of assessment and treatment for prisoners with mental health, learning disabilities or emotional needs. Many prisoners were held in conditions that were in no way therapeutic, and which often clearly exacerbated their condition.

We remained concerned about the continuing plight of prisoners experiencing severe delays in transfer to secure mental health beds. In the vast majority of prisons, the 14-day target for transfer was not met.

An emerging theme this year was poor governance of medicines management, with many prisons lacking on-site pharmacists to provide oversight of medicines. Overall, there were 86 recommendations made to improve the quality and safety of medicines management across all 35 prisons inspected. Too often there was inconsistent supervision of medication queues to prevent trading and bullying, no lockable storage for in-possession medication, and risk assessments of prisoners for in-possession medication not being completed or reviewed.

In almost a quarter of adult male prisons there was poor monitoring of patients during drug and alcohol stabilisation.

Psychosocial support for patients with substance use needs remained variable; while a third of prisons did not deliver adequate interventions, the rest provided an excellent service. Positively, some prisons provided drug-free, recovery-focused wings.

Women’s Prisons

Levels of self-harm were very high and had increased throughout the women’s estate by 24% in 2018. However, a small number of prisoners often accounted for a large number of these incidents, with an estimated 8.3 incidents per individual, which reflected the complex needs of those in women’s prisons. Patterns of self-harm were well analysed in each prison, and the use of assessment, care in custody and teamwork (ACCT) case management for at-risk prisoners was good overall.

Staff–prisoner relationships were good in all three prisons and had a positive impact across all aspects of prison life.

Health provision and governance were reasonably good in all three prisons, and most prisoner needs were met. In the surveys, 67% of prisoners said they had mental health problems, and Inspectors found good support for them.

Healthy Prison Outcomes:

…..And this is what I find the most interesting. The average breakdown of outcomes across each of those prison types:

Local Prison Averages (across 14 sites):

  • Safety = 1.6
  • Respect = 2.3
  • Purposeful Activity = 1.7
  • Rehabilitation & Release Planning = 2.6

High Security Prison Averages (across 2 sites):

  • Safety = 3.0
  • Respect = 3.0
  • Purposeful Activity = 2.5
  • Rehabilitation & Release Planning = 3.0

Training Prison Averages (across 14 sites):

  • Safety = 2.2
  • Respect = 2.6
  • Purposeful Activity = 2.1
  • Rehabilitation & Release Planning = 2.4

Open Prison Averages (across 3 sites):

  • Safety = 4.0
  • Respect = 3.3
  • Purposeful Activity = 3.0
  • Rehabilitation & Release Planning = 3.0

Women’s Prison Averages (across 3 sites):

  • Safety = 3.7
  • Respect = 3.7
  • Purposeful Activity = 3.0
  • Rehabilitation & Release Planning = 3.7

Young Adult Prison Averages (1 site only):

  • Safety = 3.0
  • Respect = 3.0
  • Purposeful Activity = 2.0
  • Rehabilitation & Release Planning = 2.0

Therapeutic Community Averages (1 site only):

  • Safety = 4.0
  • Respect = 4.0
  • Purposeful Activity = 3.0
  • Rehabilitation & Release Planning = 3.0

Children’s Establishment Averages (across 5 sites):

  • Safety = 3.0
  • Respect = 3.6
  • Purposeful Activity = 3.0
  • Rehabilitation & Release Planning = 3.6

Extra Jurisdiction Averages (1 site only):

  • Safety = 2.0
  • Respect = 3.0
  • Purposeful Activity = 2.0
  • Rehabilitation & Release Planning = 4.0

Immigration Removal Centre Averages (across 5 sites):

  • Safety = 3.3
  • Respect = 3.3
  • Purposeful Activity = 3.8
  • Rehabilitation & Release Planning = 4.0


The range of variance in the Outcomes against the Healthy Prisons test tells its own story. Contrast the average ratings in the local and training prisons against much of the rest of the prison estate.

The HMI Chief Inspector notes

“the continued displays of extraordinary dedication of those who work in our prisons. Their work is difficult, often dangerous, largely unseen by the public and, as a result, little understood. Many worked through a period in which reduced resources, both in terms of staff and investment, made it extremely difficult to run some of our jails.” – Peter Clarke

The healthy prison test averages give an overwhelmingly clear indication as to where the additional staff and investments need to be placed. If additional is not an option, then a reallocation of these resources is surely a must.


Full Report Here – HMIP Annual Report 2018–19

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