A prison system still in crisis?

1. A prison system still in crisis? Nigel Newcomen Prisons and Probation Ombudsman 15 June 2017

2. Agenda • About the PPO • A system still in crisis • Still a rising toll of despair • Still no sense of direction for older prisoners • Still plenty to complain about • PPO 2011-17 • Conclusion

3. About the PPO • Roles • Independent investigation of complaints from prisoners, immigration detainees, children in STCs and those under probation supervision • Independent investigation of all deaths in prisons, IRCs, STCs, SCHs and probation approved premises • Newer emphasis on thematic learning, library of 40 publications since 2012 • Vision: carry out independent investigations to make custody and community supervision safer and fairer

4. A system still in crisis? • In 2016-7,PPO started investigations into 361 deaths (up 19%) • 115 self inflicted (up 11%) • 208 natural causes (up 19%) • 4 homicides (down from 6) • and 34 “other” • Of all deaths, 88% were adult males • Female deaths more than doubled (23) • 11 deaths in APs, 3 in IRCs, 2 in SCHs • 5,026 complaints (up 5%), of which 2,569 eligible (up 10%) • Many of the same issues recurring and lessons either not being learned or learning not being sustained

5. Still a rising toll of despair • 11% rise in self-inflicted deaths compared to 34% rise 2015-16 – but no grounds for complacency • Still unprecedented numbers and all theoretically preventable • Hard to be definitive about cause of continuing rise: • Staffing cuts, crowding and regime restrictions must all play a part in reducing protective factors against self-inflicted deaths • So must troubling levels of mental ill health • And the epidemic of new psychoactive substances • But each case is an individual crisis, an individual story and no simple, single explanation suffices

6. Still a rising toll of despair • In a complex context, effective safety net of suicide prevention procedures key. • PPO investigations show much commendable work by staff but, in a strained prison system, suicide and self-harm procedures (ACCT) not being consistently applied. • As a result, investigations often repeat the same lessons. • This is not good enough and I frequently have to call on prison staff to redouble their efforts • Given repeat failures – and what staff say – I continue to question whether effective ACCT still deliverable within current resources.

7. Still no sense of direction for older prisoners • Reason for 19% rise in natural cause deaths much more explicable – a rapidly ageing prison population due to longer sentences and late in life prosecutions for historic sex offences • Projections all up: 14,000 over 50s by 2020 • Prisons designed for young men having to manage age related conditions - and death itself • Some excellent examples of humane care by individual staff, some much better palliative care services and glimpses of improved social care (including aspects of caring by prisoners)

8. Still no sense of direction for older prisoners • But still no strategic grip resulting in variable provision and slow response to seismic demographic shift • Estate not age-friendly • New and burgeoning healthcare demands, including dementia • Prisons competing with community for scarce social care resources • Tensions with standard security expectations, particularly use of restraints on infirm and terminally ill • Badly need a properly resourced older prisoner strategy

9. Still plenty to complain about • Ability to complain integral to a legitimate and civilised system • Particularly important when prison experience as poor as now • But internal complaint process weak and prisoner confidence low • One consequence was a 5% rise in all complaints to PPO and a 10% rise in eligible complaints 2016-17 • Including more complaints about the complaint system • Another, consequence was a 39% uphold rate 2016-17 – not because PPO now more sympathetic - because prisons got so much wrong (compared to only 23% 2011-12)

10. Still plenty to complain about • Prison reform needs to require robust local complaint processes • Need to resolve more issues at source to avoid next complaint, and avoid unnecessary escalation to PPO • Similarly, if reform involves more devolution, this needs to be balanced by a national code of standards or • disparity between prisons entrenched • legitimate expectations dashed • tensions increased • rehabilitation inhibited • and, of course, risk of swamping PPO (and courts)

11. The PPO 2011-17 • Focus on getting basics right • Almost attained statutory footing • Had to do more for less • Despite 89% increase in deaths 2011-17 • And no let up in complaints • Budget 2016-17 same as 2011-12 (and cut 5% 2016-17) • Have done some things better • 100% fatal incident draft reports on time (only 14% 2010-11) • 82% of complaint assessments on time (target 70%) • New serious case team – no longer one size fits all • 39% uphold rate (only 23% 2010-11) • Improved approval ratings • FII won national civil service customer service award 2016

12. The PPO 2011-17 • But repeated recommendations suggest difficulty in ensuring traction and sustaining improvement • Ongoing efforts to increase PPO impact • Shorter, clearer reports • SMART recommendations • Challenge any rejections (require personal letter from HMPPS CEO) • Action plans or proof of redress required • Inspectorate follow up to give independent assurance • Should not underestimate number of significant local and national improvements and individual complaint redress driven by 690 FII and 963 complaint investigations recommendations 2016-17 • But inherently piecemeal

13. Recommendations following deaths, by issue (2016-17)

14. Recommendations following complaints, by action (2016-17)

15. The PPO 2011-17 • Key development to go beyond piecemeal recs has been new agenda of Learning Lessons publications - 40 since 2012 • 6 publications 2016-17 • Complaints about use of force • Dementia • Homicides • Complaints and deaths of transgender prisoners • Complaints from young people • Deaths of female prisoners • New staff orientated LL communications strategy • Bulletins\Posters\Info graphics • Annual series of learning lessons seminars • But still long way to go in gaining traction for learning, needs to be built into prison reform.

16. Conclusion • Prisons in England and Wales still facing huge challenges • unacceptable increase in self-inflicted deaths, repeated failings and doubts over deliverability of ACCT • a burgeoning older prisoner population, inexorable rise in natural cause deaths and need for a strategic grip • much still to complain about - need for better internal systems to achieve fairness and legitimate ventilation of grievances • Much hinges on prison reform • but without improved safety and fairness, progress will be limited • without better learning of lessons, safety and fairness limited • need to avoid perverse consequences of devolution to governors • PPO independent investigations and thematic learning will continue to support search for improvement.