A report from HM Inspectorate of Prisons revealed poor safety outcomes at HMP Foston Hall – an unusual finding for a women’s prison. Among the concerns were record levels of self-harm, a perception that illicit drugs were easy to get hold of, and a doubling in the use of force by prison guards since the inspection two years earlier. Natalie Davies reports on this story for International Women’s Day 2022.

In 2021, the prison inspectorate for England and Wales conducted an unannounced inspection of HMP Foston Hall – a women’s prison in Derbyshire, which holds under 300 residents. The inspectorate’s report drew the stark conclusion that safety at this prison was “poor” – the lowest assessment of a women’s prison in the ten years since the grading system had been introduced.

“This is a rare and unexpected finding in a women’s prison.” HM Chief Inspector of Prisons, Charlie Taylor

Conditions at the prison were found to have deteriorated on a number of fronts since its 2019 inspection. Since that time, the COVID-19 pandemic has affected almost every area of public and private life. However, none of the other four women’s prisons inspected during the same period received the same ‘record low’ rating, so the pressures of the pandemic were not perceived to account for all of Foston Hall’s shortcomings.

What made the prison an ‘unsafe’ environment?

Key findings

  • nearly a third of women said they felt unsafe
  • the prison had a crisis hotline, but these messages had not been checked for six weeks
  • residents made over 1,000 calls each month to the Samaritans
  • Alcoholics Anonymous (AA) groups had been suspended during the pandemic
  • the use of force by staff had doubled since the last inspection
  • levels of self-harm in the prison were the highest recorded in the women’s prison estate and two women had taken their own lives since its last inspection

A lack of safety in any prison is concerning as residents are under the ward of the state, and do not have the choice to leave. In a women’s prison, however, a lack of safety draws more scrutiny because women in prison are particularly vulnerable, and are rarely in prison for a violent offence.

HM Inspectorate of Prisons found that women’s safety at Foston Hall prison was compromised by factors including high levels of violence, undue force by prison staff, and inappropriate care for women in crisis. This was portrayed as ‘remarkable’ for a women’s prison – presumably because, by contrast, high levels of violence and force by prison staff are seen as being within the norms of men’s prisons.

At the time of the inspection, 30% of women in the prison said they felt unsafe. Assaults among residents had decreased since the previous inspection but remained higher than similar establishments. Furthermore, rates of violence against staff were very high and had increased significantly since the previous inspection.

Segregation, the policy of separating residents from the general population, had also increased since the previous inspection, and many women were found to have been segregated while there were concerns about their self-harming behaviours. The report labelled the oversight of segregation as inadequate, and the inspectorate said that it could not be confident that all instances were recorded.

Foston Hall and its approach to drugs

Women and drugs in prison

  • A 2017/18 survey of prisoners by HM Inspectorate of Prisons found that 42% of female prisoners and 28% of male prisoners had a problem with illicit drugs when they arrived in their current prison.
  • In 2015 HM Inspectorate of Prisons reported that the misuse of prescription drugs was particularly prevalent in the women’s prison estate and could be more difficult to detect.

Mental health and substance use services at Foston Hall were provided through Practice Plus Group, which sub-contracted the Midland Partnership NHS Foundation Trust drug and alcohol team to deliver psychosocial interventions.

Clinical assessments for substance use problems were found to be “prompt” and the delivery of opioid substitution treatment (e.g. methadone) was “good”. “Notable positive practice” from Foston Hall included testing for hepatitis C and other blood-borne viruses:

  • All new arrivals were offered a test for blood-borne viruses including hepatitis B and C, and if women declined the offer was reiterated and supported through health education.
  • Results were followed up and treatment was promptly offered.
  • Women who tested positive for a blood-borne virus received co-ordinated care from the healthcare team, with follow-up from specialist services.
  • Testing and treatment services were maintained throughout the pandemic.

However, the report also found that illicit drugs were available in Foston Hall; a third of women (36%) said that illicit drugs were “easy to get hold of”. In prison this typically occurs through drugs being smuggled in, and prescribed medications being diverted for non-prescribed use.

Prisons in England and Wales promote a ‘zero tolerance’ approach to illicit drugs, and seek to address the problem through restricting supply (e.g. mandatory drug tests, gate and perimeter security, searching) and reducing demand (e.g. opportunities to engage in meaningful activities, incentivising being ‘drug free’). Prisons have been less sympathetic to providing harm reduction – interventions that reduce the harms to people who continue to use illicit drugs.

In Foston Hall, practitioners visited women who had reported using illicit drugs to deliver harm reduction advice, and facilitated training in the use of naloxone, although this was only provided on release from prison. Other evidence-based measures that are available in the wider community, such as needle exchange services, were not provided.

An overview of harm reduction in prisons in seven European countries from 2016 (not including the UK) found that harm reduction in prisons was largely inadequate compared with the progress achieved outside prisons. All seven countries provided a wide range of harm reduction services in the community, but most failed to provide these same services, or the same quality of services, in prison – a situation that stands in violation of international human rights law and minimum standards on the treatment of prisoners.

In 2015, the Scottish Prison Service published a framework for the management of substance use in custody, the detail of which sets Scotland apart from England and Wales. This framework included a pledge to “take all reasonable measures to reduce the availability of illicit substances and provide services broadly equivalent to those available in the community”, such as “offering a range of harm reduction measures to reduce the transmission of blood borne viruses”.

Women in prison

Providing healthcare services in prison settings is challenging, but it remains disheartening that safety standards were allowed to fall to such an extent in this UK prison that women’s mental health and physical wellbeing were jeopardised.

Responding to the Foston Hall report, Dr Kate Paradine, Chief Executive of Women in Prison, said:

“This is not about the desperate situation facing women in one prison but a stark reminder that prisons will never be safe. […] The Government can and must divert the money set aside for new prison places to invest in community solutions, like Women Centres, instead. Here, women can be supported to tackle the issues that sweep them into crime in the first place, like mental ill-health and domestic abuse.”

Recommendations that continue to resonate for supporting and safeguarding women in the criminal justice system come from Baroness Corston’s 2007 report, which called for a “distinct, radically different, visibly-led, strategic, proportionate, holistic, woman-centred, integrated approach”. As Baroness Corston found, many women involved in the criminal justice system have substance use and mental health problems, histories of sexual and physical violence, and are the primary carers of young children. They are incredibly vulnerable when they go into prison, and without the right conditions, are at risk of further harm inside prison.

by Natalie Davies

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