Winchester Prison - the full report - Part 2

3.1 Although bullying did not appear to be a significant problem, there was no effective anti-bullying strategy and not all incidents were identified or monitored. Some staff were reluctant to engage with the safer custody issues and the safer custody manager needed more support to challenge this. Vulnerable prisoners were inappropriately accommodated with other prisoners and felt less safe.

3.2 A safer custody committee met monthly except there had been no meetings in August or December 2006. It was responsible for overseeing policy and practice in the areas of bullying, violence reduction and the prevention of self-harm and suicide. Most meetings were chaired by the deputy governor. Attendance was not consistent and some key players such as the escort contractors, reception managers, the chaplaincy and the counselling, assessment, referral, advice and throughcare (CARAT) service were not represented. Residential officers were also not adequately represented but there were plans to introduce wing safer custody liaison officers. Of the last six meetings, Listeners had attended only the three most recent. Violence reduction and anti-bullying was a standing agenda item but little substantial discussion was recorded and the area had received little management attention. Some meetings referred to statistics on adjudications and use of force but potential indicators of violence, such as suspicious injuries and requests for protection, were not consistently reported.

3.3 A new anti-bullying and violence reduction strategy had been agreed with the area manager the week before the inspection. It had been implemented some months previously but without training or publicity. There was little evidence that residential staff had taken ownership of it and little to demonstrate its effectiveness. It gave a definition of violence but there was little to describe the prison-wide approach to reducing violence. It did, however, detail comprehensive procedures for responding to bullying. These included a four-stage approach and described how staff should report, monitor and review cases. It also included personal action plans for bullies but no specific resources were available to challenge bullying-related attitudes and thinking, and there was little about support for victims. The emphasis was on punishment through the incentives and earned privileges (IEP) scheme or transfer from the prison.

3.4 The safer custody manager, a senior officer, had been in post for five months. He had an extensive job description but no deputy. His main task was to check the operation of safer custody strategies and compliance with local and national policy. He produced a monthly report for the safer custody committee. His was a difficult role as it required him to challenge colleagues of the same rank and influence change among a well-established group of residential managers. Half of all senior officers had been at Winchester for 11 years or more and some were reluctant to embrace an ethos of care.

3.5 A log was kept of safer custody-related incident reports. Some suggested that bullying could have been a factor in incidents but these had not been referred for further investigation. The under-reporting of bullying incidents had been identified at the safer custody committee. No prisoners had been monitored on the anti-bullying strategy in 2006 and only four incidents had been acted on in 2007. In the most recent incident in April, an apparent gang assault on a prisoner, the safer custody manager had placed five prisoners on monitoring. Only one of these prisoners was actually being monitored; staff on the wing where the other four prisoners were located were unaware of this and the files, when they were eventually found, contained no entries for over a week.

3.6 Despite the few bullying incidents identified, our survey indicated that prisoners' perceptions of safety in the main prison were similar to the comparators, while those in West Hill were more positive. In the last prison bullying survey (September 2005), 52% of the 180 respondents said they felt safe from harm by other prisoners but 55% thought their possessions were vulnerable to theft by other prisoners. Eighty per cent had never been threatened with violence and 87% had never been hit, kicked or assaulted by another prisoner.

3.7 Each wing notice board contained information about safer custody and the help available through the Listeners and Samaritans, and offered support for prisoners who were bullied. Similar information was included in the induction booklet.

Vulnerable prisoners 3.8 About 85 vulnerable prisoners were among those held on D wing and all their cells were identified by blue cell cards, although we had previously pointed out the dangers of identifying vulnerable prisoners by cell cards at our 2004 inspection. Vulnerable prisoners had a separate regime designed to avoid contact with other prisoners but some said others on the wing had shouted abuse at them. In our survey, 41% of prisoners on D wing (including the prisoners who had not asked for protection), compared to 19% on other wings, said they had been threatened or intimidated by another prisoner or group of prisoners, and 26%, compared to 14%, said they felt unsafe.

Recommendations 3.9 Attendance at the safer custody committee should be improved and should include representatives from key areas of prisoner safety.

3.10 The safer custody committee should analyse all indicators of violence and bullying to inform policy and strategy.

3.11 Interventions to challenge bullying and support victims of bullying should be developed.

3.12 Training in the anti-bullying and violence reduction strategy should be developed and should emphasise the important role of wing managers in promoting it.

3.13 The safer custody manager should be at least at principal officer level to allow sufficient management authority to challenge staff.

3.14 Wing-based safer custody liaison officers should be established and given profiled time for the task.

3.15 Vulnerable prisoners should not be identified by their cell cards.

3.16 Vulnerable prisoners who have asked for protection should be held separately from other prisoners.

Self-harm and suicide Expected outcomes: Prisons work to reduce the risks of self-harm and suicide through a whole-prison approach. Prisoners at risk of self-harm or suicide are identified at an early stage, and a care and support plan is drawn up, implemented and monitored. Prisoners who have been identified as vulnerable are encouraged to participate in all purposeful activity. All staff are aware of and alert to vulnerability issues, are appropriately trained and have access to proper equipment and support.

3.17 Assessment, care in custody and teamwork (ACCT) procedures were insufficiently multidisciplinary. Action plans from previous deaths in custody were not periodically reviewed. Listeners did not have adequate facilities and did not feel properly supported.

3.18 The suicide prevention policy, last reviewed in April 2005, outlined clear ACCT procedures and described the roles of various staff. Winchester had been one of the earlier prisons to adopt ACCT procedures. While there had been no ACCT training in the previous six months, over 90% of staff had completed some training and regular notices to staff about ACCT procedures had been issued during 2006.

3.19 The safer custody manager provided a monthly statistical report on incidents of self-harm to the safer custody committee. This included the location and type of self-harm, and highlighted some short-term trends such as an increase in drug overdoses. The report also commented on the operation of ACCT procedures. Individual cases were brought to the attention of staff. We met prisoners who felt vulnerable due to a lack of information about their recall to prison or the implications of an indeterminate sentence for public protection but there was no indication that they had been identified as particularly risky groups.

3.20 There had been four self-inflicted deaths in 2003 and one in 2005. Progress had been made on many of the recommendations arising from the subsequent investigations but action plans were not maintained as live documents or periodically reviewed. There were no established prison-based procedures to investigate serious near-fatal incidents of self-harm. On average, there were 12 incidents of self-harm and around 24 ACCT forms opened each month. A central log recording all open ACCT forms had been held in the centre office but had not been kept up to date and had recently been moved to the control room.

3.21 Ten prisoners, seven of whom were in the healthcare centre, were on open ACCT forms. Healthcare staff found it difficult to persuade some residential managers to agree to such prisoners returning from the healthcare centre (see section on healthcare). Since January 2007, the prison had been included in an Oxford University research study into prisoners who seriously self-harm but none had yet been identified.

3.22 The 12 ACCT assessors were officer grades. One had a healthcare background but none were chaplains or drugs workers and two probation officers had been withdrawn from this task. Most ACCT forms contained little evidence of multidisciplinary work in assessments or reviews.

Appropriate departments were not always involved in reviews. Sometimes only the senior officer was present and one ACCT form had been closed by the senior officer who was the only member of staff to attend. In one case involving a prisoner with mental health problems, there was no contribution from healthcare and no one from activities to help develop a meaningful care plan. The prisoner spent most of his day in his cell with nothing to do despite the fact that ACCT reviews had acknowledged the importance of keeping him occupied. The action plan developed following the last death in custody claimed that reviews were multidisciplinary. Concerns that they were not had been noted by the safer custody committee in January 2007.

3.23 There was little continuity of case management. In one ACCT, opened for just over three months, 10 different case managers had been responsible for chairing reviews. Most daily entries recorded only observations rather than any interaction or evidence that prisoners were asked about their well being. Care plans were poor and too little attention was paid to the importance of prisoners being occupied, although some good mental health support was available through the community mental health team. There was no psychology or day centre provision for those at risk. Managers regularly checked the supervision case record but did not always comment on the quality of entries. The safer custody manager reviewed each closed ACCT form but this was not recorded.

3.24 In West Hill, there had been no incidents of self-harm and only two ACCT forms had been opened in the previous year. Prisoners deemed at risk of self-harm were transferred to the main prison, where they could be more effectively supervised at night. This could inhibit prisoners disclosing their vulnerability.

3.25 Three landings on A wing contained reduced risk cells where most obvious ligature points had been removed. There were three similar cells in the care and separation unit (CSU), and the healthcare centre had two gated cells for constant observation of prisoners at high risk but there was no record of their use. There was no evidence that strip conditions had been used for prisoners at risk.

3.26 Although there was some confusion about the number of Listeners, the safer custody manager believed there were eight trained Listeners with training for more planned. None were resident on A wing or immediately available to prisoners in the healthcare centre. One Listener supported vulnerable prisoners and the reception orderly was a Listener. Listeners did not provide a direct input at induction. A rota had recently been established but some staff preferred to use whichever Listener was closest to the caller and sometimes untrained prisoners had been used. In a group, most Listeners said governors supported their work but some landing officers did not. They said some officers limited the time they spent with prisoners and did not always facilitate requests to see a Listener, particularly at night. Concerns about this had been raised at the safer custody meetings. Listeners in the CSU were routinely asked to listen outside cell doors without an individual risk assessment to justify this.

3.27 Rather than care suites, Listeners used two 'centre boxes' that were very small and offered little confidentiality. Listener suites in healthcare and on A wing had been used as store rooms for several months. The suite on A wing had been cleared as a result of representations from Listeners but was still not adequately equipped for two Listeners to support a prisoner overnight. There was no agreed protocol or log of its use. The safer custody manager acted as the Listener liaison officer and provided a link between Listeners and the Samaritans. Most Listeners met weekly with the local Samaritans but minutes of the safer custody meeting noted that a Listener from West Hill was not always able to attend due to lack of escorts. The Samaritans also saw Listeners individually, provided training and attended the monthly safer custody meetings.

3.28 On two of the three main residential wings, the portable telephones with direct lines to the Samaritans were broken. This had been raised at the safer custody meeting in July 2006 but the situation was unchanged. We were told that the telephone on D wing had not worked for two years. The telephones were mentioned in the induction booklet but their availability was not well advertised. Prisoners could call the Samaritans using landing telephones but these could not be used in private and the calls were charged. Posters on each wing and information in the induction booklet advertised the support available from Listeners and Samaritans.

3.29 The majority of officers had been issued with ligature cutters and most wore them on their belts. In our overall survey, 45% of prisoners, significantly higher than the comparator, said their cell bell was answered within five minutes. There were clear radio alerts indicating the severity and nature of self-harm incidents. Wing senior officers were responsible for checking first aid and first response boxes but there was no audit of these checks. Few residential officers were first aid trained and there were no arrangements to ensure that one would be on duty at night.

Recommendations 3.30 There should be increased awareness of the need to support prisoners who have been recalled or have indeterminate sentences for public protection.

3.31 Actions plans developed following death in custody investigations should be periodically reviewed by the safer custody committee.

3.32 Residential managers and healthcare staff should work together more closely to improve the care and management of those at risk of self-harm.

3.33 Procedures should be developed to investigate serious, near-fatal incidents of self-harm to establish what lessons could be learned.

3.34 Alternatives to returning 'at risk' prisoners in West Hill to the main prison should be developed.

3.35 Listeners should be readily available to prisoners in areas of the prison such as A wing and healthcare where vulnerability and risks are greater, and should not be required to listen outside cell doors unless a risk assessment indicates otherwise.

3.36 Residential managers should ensure that all Listeners feel supported and valued. In particular, limits should not be imposed on time spent with prisoners at risk, the use of Listener suites should be encouraged and managers should ensure that prisoners have access to Listeners at all times.

3.37 All direct telephone lines to the Samaritans from residential units should work and the facility be advertised to prisoners.

3.38 Calls to the Samaritans from landing telephones should be free of charge.

3.39 At least one first aid trained member of staff should be detailed to work each night.

Housekeeping points 3.40 The central ACCT log should be kept up to date.

3.41 Protocols should be developed for the use of Listener suites.

3.42 Auditable checks should be made of first aid and first response boxes in wing offices.

Diversity Expected outcomes: All prisoners should have equality of access to all prison facilities. All prisons should be aware of the specific needs of minority groups and implement distinct policies, which aim to represent their views, meet their needs and offer peer support.

3.43 There was a full-time diversity manager but no overarching diversity policy describing how the needs of minority groups would be identified and met. The disability equality policy was displayed on all wings but was not informed by a needs assessment and did not include an action plan. There was no formal monitoring or analysis of disabled, older or other minority groups of prisoners to ensure that their needs were addressed or that they were not unnecessarily excluded from any activity.

3.44 In our survey, 1% of prisoners described themselves as transgender or transsexual and 3% described themselves as gay or bisexual. Seven prisoners said they were registered disabled and 15% considered themselves to have a disability.

3.45 There was no diversity policy to describe how the needs of minority groups would be met. A full-time diversity manager was also the disability equality officer. An equal opportunity meeting was chaired by the governor but this covered staff rather than prisoner issues. There was no monitoring to ensure that prisoners from minority groups were not victimised or excluded from any activity. There were no officer or prisoner diversity leads on the wings. Some wing staff believed that wing race equality officers and prisoner representatives were also diversity leads but this was not the case.

3.46 All new arrivals completed a disability questionnaire and these were sent to the diversity manager. He had been collating the information since November 2006 and produced monthly statistics for senior managers but these were not used to inform policy decisions or actions. Information about disability was also sent to the offender assessment system (OASys) clerk. Wing staff knew who had a permanent or temporary disability but this information was not passed to the fire officer. There was no regular and formal monitoring to ensure that the needs of disabled and older prisoners were identified and met.

3.47 The diversity manager saw some but not all prisoners with disabilities. He included an informative note in their wing files about their situation and needs and worked with healthcare staff to develop care plans. There were no adapted cells or special aids to help prisoners with mobility problems (see section on residential units). The diversity manager could provide cutlery grips as required and was working with community occupational therapists to develop a protocol for assessing prisoner need. Older and disabled prisoners were not consulted about their individual needs or care, although this was being planned and a patients' forum was being developed.

3.48 A published disability equality policy was displayed on all wings. This included details of the diversity manager's role, disabled prisoners' rights and types of discrimination and defined relevant terms. However, it did not include a strategy for action, was not based on a needs assessment and did not indicate how disabled prisoners had been or would be involved in its development or how the impact of policies and practices would be assessed.

3.49 The diversity manager provided staff training in diversity and disability awareness, and challenging behaviour. All workshop staff had been trained in supporting prisoners with dyslexia, learning difficulties, attention deficit hyperactivity disorder and Asperger's syndrome. Seventy-five per cent of staff had received diversity training but there was little evidence of awareness of wider diversity issues among many staff. Twenty staff had attended disability awareness training and seven challenging behaviour training.

3.50 The diversity manager gave a presentation to new arrivals in West Hill but not in the main prison.

Recommendations 3.51 All prisoners who identify that they have a disability should have their needs assessed and a care plan drawn up.

3.52 Prisoners with disabilities and older prisoners should be consulted about their needs and care.

3.53 The disability equality policy should include an action plan and be based on an assessment of prisoner need.

Race equality Expected outcomes: All prisoners experience equality of opportunity in all aspects of prison life, are treated equally and are safe. Racial diversity is embraced, valued, promoted and respected.

3.54 Race relations structures were reasonably well managed but some black and minority ethnic prisoners reported a lack of cultural awareness. Investigations into racist incident complaints were mostly prompt and thorough. Race equality action team (REAT) meetings were regular and well attended but did not examine issues in sufficient depth or systematically follow up identified problems.

3.55 Black and minority ethnic prisoners constituted approximately 16% (84) of the population. In groups and interviews, prisoners raised few concerns about overt racism by staff, although they did cite stereotyping and carelessly ignorant behaviour. However, black and minority ethnic prisoners in our survey reported worse perceptions than white prisoners against a range of indicators. Some were clearly evidenced problems, such as a lack of suitable products in the canteen; others, such as the unsupported perception that more black and minority ethnic than white prisoners felt unfairly treated under the incentives and earned privileges (IEP) scheme, suggested a need for prison staff to build greater confidence in prison and race relations systems.

3.56 There was a part-time race equality officer (REO) and a full-time assistant race equality officer (AREO) who also had some responsibility for foreign national prisoners. Race relations boards had recently been put up in prominent places around the prison. These contained pictures of race relations staff and some prisoner representatives, and included information on how to make racist complaints. Race relations prisoner representatives had been appointed and most black and minority ethnic prisoners could name one or more. They provided reasonably effective support for prisoners and met regularly with the AREO. Race relations staff and prisoner representatives had made particular attempts to identify and assist travellers, including distributing copies of a national travellers' magazine. Three-quarters of staff had received diversity training and four had completed race relations management team training.

3.57 The REAT meetings were well attended and normally chaired by the deputy governor. Prisoner representatives attended and were invited to contribute but there were no representatives from the outside community. The minutes showed that a wide range of areas were covered but that issues were often only shallowly examined. For example, the minutes simply recorded the numbers of racist incident reporting forms (RIRFs) investigated. Issues, trends and learning points were not explored. Systematic follow up of concerns raised was also lacking. The REO accepted this and considered that meetings were designed to meet audit baselines rather than ensure full consideration of relevant issues.

3.58 Ethnic monitoring was efficiently completed and discussed at REAT meetings but the level of follow up was unclear and there was little evidence of appropriate investigations into the disparities identified. One set of monitoring figures showed that only four of 98 wing workers were from black and minority ethnic groups, and the head of learning and skills was to be asked to comment. Minutes of the next meeting, however, simply quoted an unspecified source that 'there is no discrimination on the wings. All prisoners treated fairly'. This was unlikely to inspire confidence among prisoners.

Managing racist incidents 3.59 There were on average approximately 10 RIRFs each month. RIRF forms were freely available to prisoners and staff, and post-boxes for completed forms were on the wings. Investigations were usually thorough, with relevant people, including witnesses, interviewed and feedback letters sent to the victim and alleged perpetrator. Cases were followed up after closure and the RIRF updated to show what had happened.

3.60 In some cases, however, racist behaviour was not addressed. In one case, the REO of another prison had written to warn that a prisoner was a risk to Asians. Winchester staff appropriately updated his cell-sharing risk assessment (CSRA), warned staff of his potential risk and warned the prisoner that appropriate behaviour was expected. However, the prisoner's attitudes were not challenged and there was no available resource or guidance on this to assist staff.

3.61 A race relations helpline was advertised on the display boards but did not make clear that it was only for visitors. Cards with the telephone number were distributed in the visits area but simply connected to the AREO's answerphone, which did not relay a specific message. The AREO could remember very few calls and even these were general queries rather than race-related issues.

Race equality duty 3.62 Some impact assessments had been completed in 2006 and were shortly due to be reviewed. Many of the concerns identified during the inspection were highlighted in the assessments.

Progress had been slow but some changes had been made, including the introduction of a canteen list for Muslim prisoners. The impact assessment on access to work had identified important issues and action points, including the need to be open with prisoners about selection procedures and to oversee the work allocation procedures more effectively to counteract favouritism. There was little evidence of any action on this. An establishment action plan incorporated the Commission for Racial Equality's identified failure areas and the recommendations of previous inspectorate reports as well as the results of impact assessments. A review of this was overdue.

3.63 There were no racially diverse displays.

Recommendations 3.64 Black and minority ethnic prisoners' forums should be established to allow prisoners and staff to investigate and discuss the different experiences and perceptions of black and minority ethnic prisoners.

3.65 The race equality action team meetings should include representatives from the outside community.

3.66 Race equality action team meetings should identify and examine in depth issues of core importance to good race relations outcomes in the prison. Discussions and progress on action points should be reflected in the minutes.

3.67 The race equality action plan should be updated, record progress or lack of it, and specify further actions to be taken.

3.68 Any disparities identified by ethnic monitoring should be systematically investigated and reported back to the race equality action team meeting and prisoner forums. The details of investigations and outcomes should be recorded.

3.69 Interventions should be in place to address the attitudes and beliefs underlying identified racist behaviour.

3.70 Pictures and displays should reflect the racial diversity of the establishment.

Housekeeping points 3.71 The race relations helpline should announce itself as such and invite information. It should either be made accessible to prisoners or clearly indicate that it is for external callers only.

Foreign national prisoners Expected outcomes: Foreign national prisoners should have the same access to all prison facilities as other prisoners. All prisons are aware of the specific needs that foreign national prisoners have and implement a distinct strategy, which aims to represent their views and offer peer support.

3.72 Provision for the significant foreign national prisoner population was recent. Foreign national prisoner representatives had been appointed and were providing useful assistance, and prisoner groups had just started. Despite good relations with local immigration staff, people were being held under Immigration Act detention for long periods. Substantially more foreign national than British prisoners felt unsafe and this appeared to be linked to uncertainties about their immigration position.

3.73 About 15% (82) of the population was identified as being of foreign nationality. In our survey, 60% of foreign national prisoners compared to 32% of British prisoners said they had felt unsafe at some point in Winchester, and 33%, compared to 15% of British prisoners, currently felt unsafe. Subsequent discussions with prisoners suggested that the uncertainty surrounding immigration cases was the most common reason for feelings of insecurity.

3.74 The clerk responsible for immigration detainees diligently informed the Border and Immigration Agency's Criminal Casework Directorate (CCD) of foreign nationals in the prison. She also passed details of detainees and potential detainees to two immigration officers who visited the prison weekly. The immigration officers, from offices in Southampton and Portsmouth, reviewed cases regularly and had seen all detainees in the prison. They contacted the CCD as necessary.

3.75 The prison was holding four people solely under immigration powers. One became a detainee during the inspection but the others had been detained for substantial periods of nine, five and four months. The reason for the slow progress was unclear but in at least one case there was evidence of poor case-working by the CCD in Croydon. With regard to the man detained for over nine months, the immigration officers had contacted the CCD two months into his detention to complain of inaction. At one point, his file was also misplaced by the CCD. It had taken almost nine months for a decision to deport to be served. The visiting immigration staff were capable and had good access to the prison but were not able to give independent immigration advice or significantly assist prisoners challenging immigration decisions. The prison did not have links with an independent advice agency.

3.76 Two foreign national prisoner representatives had been in post for less than a month and, unlike the race relations representatives, had no specific job description. Many foreign national prisoners knew who they were and held them in high regard. One had designed a basic assessment form for all new arrivals covering issues such as whether they needed to see an immigration officer or needed monthly international telephone calls. As with most aspects of foreign national provision, this initiative was too recent for its effectiveness to be judged.

3.77 Some foreign national groups had been held by the AREO the week before the inspection. Prisoners had interpreted for others and helped each other to ask questions. Minutes for one of these groups indicated that it was a useful way for prisoners to ask questions about their own situations but did not provide general information on basic policies and provision.

3.78 A foreign national committee had also been set up the month before the inspection and was chaired by the residential governor responsible. It had no prisoner representatives and did not consider wider strategic oversight of foreign national prisoner issues, focusing only on immigration case updates. The new foreign national policy was basic and contained some out-of-date information such as on how deportation decisions could be appealed. There was no action plan to show how and when it was to be implemented.

3.79 Foreign national prisoners were not routinely offered international telephone cards in exchange for visits as described in the policy. Many either had no knowledge of this provision or had not received a call for many months. We were told that the telephone system was about to change so that foreign nationals would receive separate accounts for their monthly calls with the cost of making a call to their declared home country credited to it. The AREO offered to take photographs of foreign national prisoners and send them to families but this was not systematic.

3.80 A list of prisoner interpreters was kept by the prisoner representatives and they were sometimes used. Reasonable use was made of the telephone interpreting service. The service was also used across the prison, mainly by residential and healthcare staff but also by the offender management and bail information department.

3.81 Resources were not always put to best use. For example, funding had been obtained to translate menu sheets but these were changed immediately after the translations were produced, making them redundant. Six multi-lingual touch screens were positioned around the prison. They contained a range of information but some of it was out of date and the six languages available did not cover all needs. No information on usage was available.

3.82 The AREO was effectively the foreign national coordinator and did most of the prisoner contact work. He was reasonably well known but had little knowledge of foreign national issues and wanted guidance.

Recommendations 3.83 The prison should make links with an independent immigration advice agency to assist immigration detainees and potential detainees.

3.84 Foreign national information and support groups should continue to take place weekly.

3.85 The foreign national committee should include prisoner representatives and have a wider strategic oversight of foreign national prisoner issues.

3.86 The foreign national policy should be revised and have an accompanying action plan.

3.87 Foreign nationals should be able routinely to obtain a free monthly international telephone call and should be informed of this provision.

3.88 The foreign national coordinator should be enabled to develop knowledge and appropriate skills for the role.

3.89 Immigration casework should be progressed speedily and information conveyed to prisoners and detainees regularly and in good time.

Housekeeping points 3.90 The foreign national prisoner representatives should have a job description.

3.91 The information and available languages on the multi-lingual touch screens should be updated in line with the needs of the population.

Contact with the outside world Expected outcomes: Prisoners are encouraged to maintain contact with the outside world through regular access to mail, telephones and visits.

3.92 Telephones could not be used in private and access was poor. Visitors reported difficulties getting through to the telephone booking line. Preliminary procedures began too late to allow visits to start on time. There was no visitors' centre and very limited shelter in bad weather. Visits furniture was fixed and uncomfortable and toilet facilities were poor. Closed visits arrangements were inadequate. The supervised play area was well equipped but fathers were not able to join their children there.

3.93 There was no restriction on the amount of mail prisoners could send and receive. All post was opened by operational support grade staff. Cash, cheques and postal orders were removed and recorded and the amount received recorded on the envelope. Post room staff read any post targeted by security, including all the post of prisoners subject to public protection procedures. They also randomly read 20 letters in and out, and any legal letters opened in error were recorded. Although in our survey significantly fewer than the comparator said they had problems with mail or with staff opening legal post, at 44% and 37% respectively this was clearly an issue for prisoners.

3.94 The telephone system and call monitoring procedures were explained to new arrivals. Each wing and West Hill had four telephones while Hearn unit had two. On B and D wings, this did not represent one telephone to every 20 prisoners. Telephones were not enclosed in booths and could not be used in private. Thirty-seven per cent of prisoners, including 25% of men in West Hill, said they had problems accessing the telephones. There were significant differences between the other wings and prisoners on B wing reported most difficulty. Telephones were activated only during association, which often took place during the day when children and other family members were likely to be at school or work. There were no telephones for prisoners to use at their workplaces off the wings. Evening association was often cancelled with little or no notice, further reducing the opportunity to make a telephone call.

3.95 New arrivals in the main prison were automatically given a reception visiting order the day after their arrival. This was completed and given to visits booking staff. Visitors could book a first visit by telephone without waiting to receive the visiting order. Visitors for unconvicted prisoners did not need a visiting order to book a visit. Visiting orders included information about identification and the Assisted Prison Visits Scheme. Visitors were informed that no jewellery except wedding rings could be worn at visits, which was unnecessarily restrictive.

3.96 Visits ran every day between 2pm and 3.45pm but the times given in the prisoner information booklet were wrong. Enhanced prisoners were allowed two extra visits a month and Listeners one extra. Most visits were booked by telephone. Visitors could use a telephone provided in the waiting room to book their next visit. The booking line was open every morning and afternoon. All visitors we spoke to complained that it was difficult to get through to the booking clerk. We rang three times and got through immediately on one occasion but waited some minutes without a response on the other two. Visitors could not leave a message asking to be called back.

3.97 There was no visitors' centre and visitors waited outside the main gate. The shelter provided was inadequate and there were no toilets. The waiting room did not open until 1.45pm. This contained lockers, toilet and baby change facilities and seating. It was clean but displayed only a small amount of information. Three operational support grades checked identification and visiting orders, dealing with visitors for unconvicted prisoners first. All visitors went through an electronic portal and received a rub-down search. There was nowhere to lay a baby while the carer was searched. Visitors were searched one at a time so most had to wait for a group to form before moving on to the drug dog search area. Anyone indicated by the dog was offered a closed visit or the option of leaving and no other security intelligence was required. The procedures delayed visitors' arrival in the visits room. Some visitors who had been waiting outside the prison before the waiting room opened at 1.45pm did not arrive in the visits room until 2.20pm.

3.98 The visits room was clean with lots of local and national information displayed. The furniture was fixed and uncomfortable and allowed a maximum of three visitors per prisoner plus children under 10. Children over 10 were counted as adults which was unreasonable and had the potential to impact on family contact. It was designed to prevent easy contact between prisoners and visitors, and conversations could be overheard by those at surrounding tables. Prisoners wore coloured bibs, had identified seats and had to remain seated. Visitors were issued coloured wrist bands. Prisoners whose visitors did not turn up could return to their wing and would be brought back if the visitor arrived before 3.30pm.

3.99 Visitors said they were generally well treated. Supervision was not excessive and the atmosphere was relaxed. Officers were aware of prisoners subject to child and public protection procedures. The only immediately accessible toilet was for visitors with disabilities. Other visitors had to use the toilets in the waiting area and the visit came to an end if the prisoner needed the toilet.

3.100 A well equipped play area managed by the Kids VIP charity was supervised by two volunteers at all visit sessions. Prisoners were not allowed to join their children in the play areas or take any drawings done by their children back to their cells. Another two volunteers staffed a refreshment bar offering a limited selection of hot and cold drinks, biscuits and sweets. Tap water was charged at five pence a glass.

3.101 Prisoners and visitors using the closed visits area could be seen by everyone in the visits room. Closed visits were not held in separate booths and there was little privacy if more than one was taking place.

3.102 West Hill had separate visits facilities. The visits room contained 11 tables with fixed furniture and a small play area. There was capacity for three closed visits but these were not used. Prisoners had to wear bibs but were not restricted to where they sat. Staffing shortages meant that West Hill visits were sometimes transferred to the main prison.

Recommendations 3.103 Prisoners should have daily opportunities to use telephones to make social and official calls.

3.104 Telephones should be placed in booths. Additional telephones should be provided on B and D wings to meet prisoner need.

3.105 The ban on visitors wearing jewellery should be lifted.

3.106 Visits procedures should be carried out efficiently so that visits are not delayed.

3.107 Closed visits should be authorised only when there is significant risk justified by security intelligence.

3.108 Children under the age of 10 should not be considered as adults for the purpose of visits.

3.109 A visitors' centre should be provided outside the establishment to provide support and information to prisoners' families.

3.110 The visits waiting room should open at least one hour before and after visits.

3.111 Access to the visits booking line should be improved and callers should be able to leave a message to be called back when no one is available.

3.112 Prisoners and visitors should have access to toilets in the visits room.

3.113 Prisoners and visitors using the closed visit facility should be able to do so in private.

3.114 The fixed seating in the visits room should be made more comfortable.

3.115 Prisoners should be able to play with their children in the play area.

Housekeeping points 3.116 The prisoner information booklet should contain the correct visiting times.

3.117 The display of information for visitors in the waiting room should be improved.

3.118 Search staff should have somewhere safe to lay a baby during searching.

3.119 Prisoners should be able to take their children's drawings back to their cells.

3.120 Tap water in the visits room should be provided free of charge.

Applications and complaints Expected outcomes: Effective application and complaint procedures are in place, are easy to access, easy to use and provide timely responses. Prisoners feel safe from repercussions when using these procedures and are aware of an appeal procedure.

3.121 Application forms were readily available and most prisoners said applications were dealt with fairly. They were less positive about formal complaint procedures. Both processes were managed efficiently and complaints were answered quickly. There was no analysis of wing-based application forms, although a new system had been introduced to improve tracking and accountability.

3.122 In our survey, most prisoners said it was easy or very easy to get a general application and a complaints form and half said applications were sorted out fairly. Prisoners in West Hill were more positive than those in the main prison. Prisoners across the prison were less positive about the complaints procedures. The reason for the poor perceptions was unclear, although many prisoners complained about recall processes and were dissatisfied with how these were dealt with.

3.123 About 15 to 20 applications were received in West Hill every day and up to 30 per wing in the main prison. All were logged in wing registers. Under a new system in the main prison, application forms were produced in triplicate to stop them from going missing. This was in the early stages but was working well.

3.124 Complaints procedures were well advertised in West Hill and incorporated in the main wing compacts. Information on how to make an application and complaint was well advertised and complaint boxes were visible on all wings. Information was reinforced through the touch-screen information centres. There was little information about contacting the Prisons and Probation Ombudsman, and fewer prisoners than the comparator knew how to do this.

3.125 A total of 1,205 complaint forms had been submitted in the previous year. The main topics of complaint were canteen, property and transfer issues. Most were dealt with within the correct timescales. Some replies were typed and most were detailed and respectful. Efforts were made to rectify issues promptly. Complaints that were sent outside the establishment, such as to the NHS trust or other establishments, were not tracked and there was no evidence that replies had been received (see section on health services). Information was routinely analysed for trends and ethnicity.

Recommendations 3.126 A question and answer document for queries relating to recall processes should be available to residential staff.

3.127 Information about contacting the Prisons and Probation Ombudsman and external bodies should be reinforced through additional wing notices.

3.128 External complaints should be subject to monitoring and tracking for timeliness of reply.

Legal rights Expected outcomes: Prisoners are told about their legal rights during induction, and can freely exercise these rights while in prison.

3.129 The legal visits area was small and did not allow sufficient privacy. Some applications to the legal services officer were not dealt with quickly or personally. Experienced bail information staff provided a good service.

3.130 In our survey, significantly fewer prisoners than the comparator said it was easy to communicate with their solicitors and only 48%, against a comparator of 62%, said it was easy to attend legal visits.

3.131 The trained legal services officer (LSO) was given two days a week for his duties but some staff and prisoners were unaware of the level of service available. Legal services information was included in the prisoner information booklet and covered at induction.

3.132 There was no evidence of a log to track legal applications and staff on duty did not think there was one. It was not therefore possible to determine how many were received but it appeared that most were dealt with quickly and efficiently. However, some matters that could more easily have been dealt with in person were unnecessarily delayed by the LSO's reliance on written replies. Some responses also lacked sensitivity, including one that made no reference to the fact that a prisoner's family member had a serious illness. Some applications appeared to be held up for several weeks on the wings. One asking for help with completing adoption forms had been written on 6 March and signed as received by the wing officer on 8 March but had not arrived with the LSO until after 16 April.

3.133 Two experienced part-time probation service officers provided a good bail information service. They routinely saw all those remanded for the first time. They received about 50 applications a month and kept a spreadsheet to record outcomes, a reasonable number of which were the granting of bail. During a recent month, 61 of 64 eligible men were seen by one of the bail information officers, resulting in 43 completed reports and 10 referrals to hostels. Six were bailed with reports and four bailed without.

3.134 The legal visits area comprised six rooms and was open from 8.30am to 11.30am and from 1.30pm to 4.30pm. It was small and stuffy and the walls were too thin to allow sufficient privacy.

Recommendations 3.135 Staff should be made aware of the available legal services so that they know where to refer prisoners.

3.136 Urgent queries should be dealt with in person and due note should be taken of extra information provided in legal services applications, and personal officers and other staff informed as necessary.

3.137 Wing staff should pass applications to the legal services officer quickly.

3.138 A well-ventilated and more spacious legal visits area that allows sufficient privacy should be provided.

Housekeeping point 3.139 A single accessible log of applications for legal services should be kept by all staff dealing with legal services and reviewed regularly by managers to check that resources meet need.

Substance use Expected outcomes: Prisoners with substance-related needs, including alcohol, are identified at reception and receive effective treatment and support throughout their stay in custody. All prisoners are safe from exposure to and the effects of substance use while in prison.

3.140 A comprehensive and flexible clinical provision was available, with one landing dedicated to such support. The landing was not separated from others and there was no psychosocial provision. Mandatory drug testing (MDT) rates across the prison were fairly low but areas with the greatest likely drug misuse were under-represented in the number of prisoners tested.

Clinical management 3.141 Winchester had developed a dedicated detoxification unit on the top landing of A wing. The 34-bed unit was staffed by specialist nurses consisting of a team leader and deputy along with three others. Provision was available for prisoners experiencing dependence on opiates, tranquilisers and/or alcohol.

3.142 All prisoners were subject to an initial healthcare screen on arrival and, where appropriate, access to one of the detoxification nurses. Specialist provision was available until 7pm during the week and prisoners arriving outside this time were offered symptomatic relief if necessary prior to accessing one of the drug clinics available each weekday. At the weekend, prisoners requiring support saw a general practitioner (GP). Methadone and buprenorphine (subutex) regimes were available but at weekends prisoners were usually given lofexidine, a non-opiate medication, until they could access the specialist service on the Monday. In our survey, 55%, against a comparator of 51%, said they had received support for their drug problems within 24 hours and 53%, against a comparator of 40%, had received help for alcohol problems.

3.143 The detoxification unit had a monthly target of 50 programmes, which it rarely failed to achieve. At the inspection, 28 prisoners were subject to some form of clinical support. Most were held on A4 landing, three of the six receiving alcohol detoxification were in healthcare and two vulnerable prisoners were on D wing. New arrivals were allocated cells wherever spaces were available and this meant that some prisoners who were not withdrawing from drugs and did not require clinical support were living on the detoxification landing. The landing was not segregated from the rest of the wing and allowed free movement throughout. Voluntary testing figures and anecdotal reports indicated that A wing was one of the most prolific drug-using wings and those trying to remain drug-free were therefore subject to fairly consistent temptation. While we were subsequently told that a small number of staff on the wing had received some general drug awareness training, other than the clinically trained and dedicated staff, none had received any training in treatment awareness which would have helped them support men withdrawing from drugs.

3.144 The drug treatment available was fairly flexible and the opportunity for a maintenance programme of either methadone or buprenorphine was available for prisoners who were likely to be released within a month. Four prisoners were on maintenance programmes.

3.145 Prisoners on the detoxification unit spoke positively of their experiences, although a few complained of lack of activity. The regime on A4 landing was limited to clinical support. Prisoners on the programme could not work or attend education and most were locked in their cells for much of the day. No psychosocial programme or peer support was available and contact with the counselling, assessment, referral, advice and throughcare (CARAT) service was inconsistent. Prisoners who finished detoxification were moved to any of the other wings. There was no voluntary testing unit.

Drug testing 3.146 The year-to-date random MDT rate for the previous 12 months across the whole prison was 9.8%. Figures broken down by wing were available only for the previous four months. Throughout those four months, 65% of all such tests had been undertaken in West Hill or D wing. D wing contained a significant proportion of vulnerable prisoners who tend not to misuse drugs, and all prisoners in West Hill were expected to be drug-free as a condition of residence. Consequently, the overall random figure was unlikely to have been an accurate reflection of drug misuse at the prison. This was reinforced by the fact that only 15% of all voluntary testing positive results were generated from these two locations, even though West Hill accounted for over half of all such compacts (see section on resettlement pathways). In our survey, 36% said it was easy or very easy to get illegal drugs in the main prison while only 8%, significantly lower than the comparator of 28%, said the same in West Hill.

3.147 The main prison and West Hill had separate MDT facilities. Those in the main prison had been relocated to the basement while C wing was refurbished. The area was very poor and dirty with no holding cells, which meant only one prisoner at a time could be tested. Testing in West Hill was relatively easy. Thirty prisoners from a random list of 55 were selected for testing each month and, given the problems in the main prison, prisoners in West Hill were usually selected first.

3.148 Suspicion testing also appeared disproportionately biased towards West Hill. In the previous four months, 17 of the 19 tests undertaken had been in West Hill, with a positive rate of only 26% (5). Twelve requests for suspicion tests in the main prison, dating back as far as mid-January, had not been completed and were effectively out of date. No frequent testing programmes were available and no reception testing was undertaken.

3.149 The prison had a reasonable strategy for reducing supply of illicit drugs. The security department was represented on the main drug strategy group and had an agreed information-sharing protocol with the CARAT service. There was one active and one passive dog with another three dogs in training. Drug finds remained quite low with little opportunity for packages to be thrown over the perimeter. Only three visitors were on closed visits.

Recommendations 3.150 The detoxification landing should be segregated to reduce and restrict potential contamination of those subject to support.

3.151 Psychosocial support, including peer support and group work, should be developed for prisoners subject to clinical management.

3.152 The prison should create a voluntary testing wing to offer appropriate post-detoxification support.

3.153 All staff on A wing should be trained in drug awareness and treatment awareness to help facilitate their role in supporting men withdrawing from drugs.

3.154 The prison should ensure that prisoners identified for mandatory drug testing random tests are an accurate reflection of the prison population.

3.155 Mandatory drug testing should be appropriately staffed to ensure that all testing, including suspicion and frequent testing, is carried out appropriately within identified timescales.

Section 4: Health services Expected outcomes:

Prisoners should be cared for by a health service that assesses and meets their health needs while in prison and which promotes continuity of health and social care on release. The standard of health service provided is equivalent to that which prisoners could expect to receive in the community.

4.1 Some improvements in the provision of healthcare had been made but some aspects of care had not kept pace with advances in standards of health service provision. Dental services were good, as were pharmacy arrangements. There were inadequate therapeutic and rehabilitative day care options for people with mental health problems. Prisoners who did not require 24-hour care were held in the inpatient beds. There was inadequate nursing cover at night. Wing-based treatments and medicines administration facilities were poor. Much of the healthcare accommodation was unsuitable and the poor state of some patient areas created a negative and unwelcoming impression.

General 4.2 Nurse-led primary care, inpatient care and a pharmacy service were provided by the prison. Primary medical care services were provided by a local general practice. Mental health services including in-reach, psychiatry and medium secure services were provided by the local mental health trust. Health services were commissioned by the recently-formed Hampshire Primary Care Trust (PCT). No service level agreements were available. Relationships with the local NHS were reportedly good but the two most recent prison health partnership board meetings had been cancelled following recent NHS reorganisation. A multi-agency group was acting on the findings of a 2006 comprehensive health needs assessment that included an assessment of mental health needs.

4.3 The health centre was separate from the main wings and included the inpatient unit. The pharmacy, dental and treatment rooms were well equipped and furnished. In addition to consulting rooms, there was a servery for prisoners, telephones, resources for education and leisure activities including a small kitchen area, computing facilities and a pool table.

4.4 The inpatient unit had 22 beds in 10 single cells, one three-bed cell, one two-bed safer cell, a single safer cell (usually reserved for short-term observation as it had no electricity), a larger single cell with en suite shower for prisoners needing close observation, and a dormitory for up to five prisoners. The latter had a shower, toilet and sink but the adjoining bath area was in a poor condition. A Listener suite had never been used.

4.5 There was a lift suitable for wheelchairs but no adapted toilet. One former cell had been converted into a waiting room for vulnerable prisoners and another small room was used as the main waiting room. Both were bare and poorly decorated with inadequate seating. The main waiting room smelled strongly of smoke and the window had been bolted shut.

4.6 Some healthcare and treatment took place in wing-based treatment facilities on A and B wings and a temporary room (C2) adjoining D wing. These rooms, particularly the one on C2, were small and cluttered. Medicines were properly stored and separated, although some medicines on C2 had been left out of a locked cupboard over lunch and the fridges on B wing and C2 were not locked. A new, larger but still temporary treatment room to replace C2 was nearing completion. West Hill had two treatment and consultation rooms, one of which was too small and had emergency equipment on the floor.

4.7 A prison health promotion committee was implementing a prison-wide action plan. Progress was being made in areas such as smoking cessation and links with the gym. A health fair for prisoners was to be held the following week. Health noticeboards on the wings contained health-related information, and there were some health promotion leaflets in the health centre waiting room but these were not well displayed. The dentists provided a range of appropriate oral health promotion material as part of their consultations.

4.8 In our survey, 33% of prisoners in the main prison, similar to the local prison comparator, said the overall quality of the service was good or very good. In West Hill, only 30% of prisoners agreed, which was significantly lower than the training prison comparator of 44%. Dissatisfaction expressed appeared to be mainly because they did not know what was happening to their case rather than poor treatment. A patients' health services forum was expected to start imminently.

Clinical governance 4.9 Healthcare staff were represented on a range of prison committees. A prison clinical governance committee met regularly and included representatives from all health service providers, the PCT and the governor. Deaths in custody, complaints and untoward incidents were discussed and staff had made changes after a self-inflicted death in 2005. Drug prescription and administration errors were monitored and investigated. However, there were no untoward incident policies or procedures in place and no mechanism to monitor trends or identify when an incident or injury needed further review. Copies of injuries and self-harm forms were kept in one file. Over the previous four months, 31 forms had been completed but in over a third the body diagram had not been completed to show the injury location. Only five forms had been countersigned by a doctor and a further two had a doctor's stamp, which was inadequate.

4.10 Complaints about health services were made through the general complaints system, which was not confidential. These were passed by complaints staff to the deputy head of healthcare, who investigated and responded promptly in writing, although sometimes used language that the complainant might not understand. Complaints about services not provided by the prison were passed on, with the prisoner's agreement, to the relevant service head. Healthcare did not systematically review the nature of the complaints made or the quality of replies to prisoners. A policy specified that the NHS complaints procedure was to be used but there was no easy-to-understand information about this on display.

4.11 Ethnicity was not routinely recorded in clinical notes but staff had just started entering the ethnicity of patients attending the health centre in the appointments book using local inmate database system data. The proposed new electronic clinical record system was not due to include a field for recording ethnic origin, which was unfortunate. Staff reported using telephone interpretation services and face-to-face interpreting. One of the touch-screen centres with information in other languages was available in healthcare.

4.12 The head of healthcare had a background in mental health nursing and had been in post for two years. Her deputy acted as clinical nurse manager and lead for the care of older people. Administrative support was provided by one temporary full-time and two part-time administrators. A full-time senior healthcare officer led a team of officer staff, and a clinical team leader (0.5 whole time equivalent F grade mental health nurse) led a team of nurses and officers. Both reported to the clinical nurse manager. A recently agreed reprofile had led to an increase in the staff establishment and recruitment was underway. Eight of the 14 discipline officers had prison healthcare qualifications, two had recently completed nursing training and three were away on full-time nursing training. Vacancies, including the practice nurse post, were covered to some extent by bank staf