National Preventive Mechanism Eighth Annual Report 2016–17 At its most recent inspection of HMP Pentonville, HMI Prisons and its partners noted that the range of transfer times from referral to arrival at a hospital was 0–187 days, with only 15% of prisoners transferred within the 14-day guideline. We were unable to obtain data for Northern Ireland, but NPM members report delays beyond 14 days, sometimes lasting weeks, due to bed availability and the need for a consultant from the receiving hospital (usually the Shannon Clinic in Belfast) to come to the prison to assess the person and determine if it is a suitable case. We understand the experience in Scotland to be that, in most cases, a hospital place can be found reasonably quickly for a prisoner who needs to be admitted, although there are pressures in the medium secure hospital estate, and delays can occur, particularly for prisoners with complex needs. Evidence from various sources available to the NPM, including complaints from prisoners to NPM members, indicate that there are often delays in the process of assessment for transfer, essentially before the 14-day guideline starts to be counted. This was also commented on by the PPO who indicates that the recording of the length of wait for transfer to secure hospital does not generally begin until an assessment has taken place, which opens up the possibility of assessments being pushed back until there is the prospect of a place being available.122 Some of the difficulties in achieving timely transfers of prisoners to mental health hospitals reported to NHS England health and justice quality surveillance groups were shared with HMI Prisons. These included: disagreements about transport arrangements, ineffective communication between mental health teams and prison officers, contradictory policy and good practice guidelines (e.g. between Department of Health guidance, health and justice performance indicators, and contract specifications). A forensic psychiatrist interviewed by HMI Prisons reported many frustrations and ‘incessant time on the phone’ attempting to expedite transfers to secure hospitals. More specifically, she cited problems arising from clinicians taking different views on cases, ineffective communications between medium secure unit staff acting as ‘gatekeepers’ to accessing other secure hospitals, and the fact that some psychiatric intensive care units will not take transferees from prisons.123 122. Prisons and Probation Ombudsman, 2016, Learning from PPO investigations: Prisoner mental health. 123. Further analysis of the problems and difficulties associated with the transfer process is detailed in RCPsych, 2011, Prison transfers: A survey from the Royal College of Psychiatrists. Occasional Paper OP81. 44