National Preventive Mechanism Tenth Annual Report 2018–19 section 2).20 The Act strengthened the regulation and inspection of social care with the aim of improving the quality of care, support and well-being outcomes for people using services. Healthcare Inspectorate Wales received additional funding during the year to enable the appointment of additional inspection and support staff; the benefit to the work programme will not be fully realised until the following year. mental health units for children and young people under 18 years old outside England.22 In March 2019, the Scottish Government launched a review of forensic mental health services to examine demand for such services and their delivery in prisons, secure mental health facilities and rehabilitation services.21 There are particular current challenges in providing for female patients who require high security services and children who need secure mental health care, resulting in cases being transferred to England. The issue of cross-jurisdiction transfers for female patients and children, in particular, was highlighted by the NPM following its cross-cutting work examining transitions and pathways between different mental health settings. These issues also affect Wales and Northern Ireland. The NPM documented that there is only one hospital which provides high secure provision for women in the UK and there are no secure Audit Scotland identified that the Scottish Prison Service (SPS) was operating beyond capacity in terms of prisoner numbers, following a rise in the population from 7,200 in April 2018 to over 8,100 in March 2019, with forecasts projecting further growth.23 There was a projected deficit in budget with potential operational implications in achieving and maintaining prisoner and prison officer safety and security. Increased levels of sickness absence placed additional pressures on staff. These pressures led the SPS to temporarily suspend throughcare support services – under which prison officers support short-term prisoners in preparation for and following their release – so that experienced staff could be moved to core operational duties. The Government was working with the voluntary, third sector and local authorities to address this shortfall. Prisons and reform Questions have been raised about the sustainability of the prison populations in Scotland and England and Wales, with concerns over the capacity and infrastructure of the existing prison estate to accommodate projected increases. 20 A person managing a prison or other similar custodial establishment is exempt from the definition if they are directly providing care and support to the individuals detained there. However, if care and support is being provided to detained individuals by a Domiciliary Support Service (for example a Domiciliary Support Service within a local authority) and not by a person managing the prison, then they are required to register with CIW. 21 Scottish Government, March 2019, Improving mental health services, https://news.gov.scot/news/improving-mentalhealth-services-1 [accessed 04/12/19] 22 UK National Preventive Mechanism, February 2018, Monitoring places of detention. Eighth Annual Report of the United Kingdom’s National Preventive Mechanism, https://s3-eu-west-2.amazonaws.com/npm-prod-storage-19n0nag2nk8xk/ uploads/2018/02/6.4122_NPM_AR2016-17_v4_web.pdf, [accessed 04/12/19] 23 Audit Scotland, June 2019, Scottish Prison Service 2018/19 Annual Audit Report to the Accountable Officer and the Auditor General for Scotland, https://www.audit-scotland.gov.uk/uploads/docs/report/2019/aar_1819_scottish_prison_service.pdf [accessed 04/12/19] 18