Section two Focus on detention issues place a prisoner on a ‘basic’ regime, which in some cases led to significant isolation and even solitary confinement, was at a lower level than that applied to prisoners put in segregation. Furthermore, there were no safeguards for prisoners identified as at risk through the ACCT process. In one prison where inspectors found informal isolation on a wing, prison staff had discussed and agreed a ‘compact’ for the arrangement with the prisoner. Formal health care arrangements that apply in segregation units in England and Wales are not in place for informal isolation on the wing, which means these prisoners are not regularly reviewed to assess the impact of segregation or to offer support. It is possible that informally isolated prisoners might not engage with health care as they rely on staff escorting them to that department, which could lead to health needs not being met. Reintegration Many isolated prisoners are reintegrated into the main prison, and some are transferred out, or sent from formal isolation units to health care units or hospitals. In Scotland, management plans are usually prepared for prisoners held in isolation for long periods, but these were found to be of variable quality. In England and Wales, several prisons only had ad hoc reintegration planning, or this was not written down. One NPM member noted that there were no plans or support to ensure ‘self-isolating’ prisoners could reintegrate into the prison regime. Conclusion The evidence gathered in this review highlights a number of concerns about the practices amounting to isolation and solitary confinement in prisons. NPM members have identified a wide variation in the conditions in the designated facilities where prisoners are formally isolated. The regime that prisoners can access also varies widely from prison to prison, and NPM members have identified several situations where access to even a minimum regime is inconsistent and/or has been adversely affected by staffing levels. The number of instances where prisoners are informally isolated, and in many cases in conditions that amount to solitary confinement, over long periods of time is of great concern. Governance of the basic regimes or of unemployed prisoners does not provide safeguards against the impact of isolation or solitary confinement, and the lack of specific health care reviews could leave prisoners at risk. The extent to which prisoners are isolated and even in solitary confinement as a result of restricted regimes and staff shortages warrants greater attention. Although the idea that there should be formal procedures to ensure segregated prisoners do not come to harm as a result of isolation, and to ensure appropriate reviews, is well embedded in prison processes, all NPM members reported concerns with their implementation. NPM members have frequently raised their concerns about the number of vulnerable prisoners who are formally segregated, and the numbers of deaths that have occurred in segregation units are a reminder of the serious risks. Oversight at management level to ensure monitoring of segregation, which should guide efforts to ensure the appropriate use of segregation and address any disproportionate representation of black and minority ethnic and Muslim prisoners among other issues, also varied. 29