Prison Cat C Key Concerns Identified Positive Findings

Coldingley

IMB Annual Report 2025 · Published 30 September 2025

HMP Coldingley, a Category C resettlement and training prison, faced significant challenges this year due to accelerated prisoner churn, impacting safety, healthcare, and purposeful activity. While improved staffing led to better regime and communication, issues like widespread drug availability, delayed cell refurbishment, and slow mental health transfers remain key concerns. The Board noted positive efforts in staff-prisoner relationships and education but highlighted the need for systemic improvements in property handling and monitoring of progress.
Population
513
CNA (Designed For)
513
100% occupancy
Deaths in Custody
0
ACCT Cases Opened
189
prev: 145
Assaults on Staff
3
prev: 21
Drug Finds
139
prev: 142
Positive Findings
The Board noted progress in overall safety management and coordination, along with improved communication channels, including the Governor's video blogs and library availability. Staffing levels eased after high attrition, leading to fewer unplanned lockdowns and improved time out of cell. Efforts in prisoner safety, including safer custody team changes and UoF training, showed positive signs. Healthcare staffing improved, and GP/dentistry waiting times were reduced. Education received praise for new courses and literacy promotion, while library usage steadily increased.
Key Concerns
Safety
The churn of prisoners is having many impacts, including more men at risk of self-harm and arriving on ACCTs.
Regime/Time Out of Cell
The churn of prisoners means more men are coming to a category C when they are not ready.
Resettlement/Release
Many men are without sentence plans due to population churn.
Safety
Poorer behaviour and many more adjudications are linked to the churn of prisoners.
Healthcare
More men are arriving with health needs the prison is ill-equipped to care for due to population churn.
Education/Purposeful Activity
There is no time to meaningfully engage with education courses or vocational training due to population churn.
Substance Misuse
Too little time to treat cases of addiction and substance abuse due to population churn.
Resettlement/Release
Offender managers are struggling to cope with early release schemes and have less time to help progress those on long sentences due to population churn.
Resettlement/Release
Resettlement services have more work and less time to do it due to population churn, often resulting in recalls.
Estate/Conditions Repeated
The collapse of ISG and re-letting of its contracts has halted the work installing in-cell sanitation since last September.
Resettlement/Release Repeated
A lack of further plans to help IPP sentenced men still in prison.
Staffing
Staff whose visas and jobs are threatened by the recent changes to immigration regulations.
Staffing Repeated
Coldingley has witnessed an extreme case of operational staff attrition.
Other Repeated
Current property handling systems always generate the most complaints, and the last policy framework has had little impact.
Mental Health Repeated
Mentally unwell men are being held in unsuitable accommodation, awaiting transfer to secure hospitals, a process which is too slow.
Resettlement/Release
The national cancellation of the Sycamore Tree restorative justice programme has left a keen void and a long waiting list for an appropriate substitute.
Substance Misuse Repeated
Widespread availability of drugs and other illicit substances around the site.
Other
Lack of clear monitoring and measurement of progress in actions to curtail illicit substances.
Safety Repeated
Too many moments of potential conflict and incidents of use of force are not being recorded on camera.
Regime/Time Out of Cell Repeated
Too many men are still to be found around the site neither fully engaged in purposeful activity or in their accommodation during core hours, contributing to a ‘loitering culture’.
Board Commentary
Staffing
The extreme rate of staff attrition observed last year has eased, leading to improved frontline staff availability benefiting the regime. However, about half of these staff have under two years' experience. Recent immigration visa rule changes in July pose a risk, threatening the jobs of 24 newer staff. Staff visibility on wing landings remains a consistent challenge, with some areas becoming 'self-policed'.
Healthcare
Healthcare, provided by CNWL NHS Trust, noted an improvement in overall staffing levels and a broader range of services. However, rapid prisoner turnover brings more complex medical and mental health needs, often with incomplete records or unmeetable prescribing requirements. Transfers for acutely mentally unwell prisoners to secure establishments remain slow, leading to prolonged stays in unsuitable CSU conditions. Substance misuse services are under pressure and short-staffed, despite a significant rise in prisoner engagement and pharmacological interventions.
Regime & Daily Life
Increased staff availability has led to the virtual elimination of unplanned lockdowns and significant improvements in time out of cell, including the sustained introduction of an hour of daily open-air exercise. However, weekend boredom remains a key complaint, though some measures were introduced to address this. There is a persistent shortage of qualified PE instructors limiting team sports. The prison continues to struggle with a 'loitering culture' where too many men are not engaged in purposeful activity during core hours.
Applications to the IMB

Prisoners can apply to their IMB about any aspect of their treatment. This table shows application counts by category.

Category Current Previous Change
Accommodation (including transfers) 45 38
Discrimination 6 9
Family visits 0 1
Food 4 2
Healthcare 38 32
Offender management 10 14
Other 12 10
Property 40 61
Purposeful activity 2 3
Safety and wellbeing 7 4
Staff relationships 15 11
Work/pay 1 0
Recommendations (12)
Ministry of Justice: 4 HMPPS: 4 Governor / Director: 4 8 repeated
Recommendation 1
The Minister should propose actions to alleviate the destabilising effects of population churn on the resettlement and training estate, which include more men at risk of self-harm and arriving on ACCTs, men coming to a category C when not ready, many without sentence plans, poorer behaviour, more adjudications, more men arriving with health needs the prison is ill-equipped to care for, no time for education/vocational training, too little time to treat addiction/substance abuse, offender managers struggling with early release schemes and having less time for long-sentenced men, and more work with less time for resettlement services.
Ministry of Justice Resettlement and Regime
Recommendation 2 Repeated Prev. unaddressed
Prioritise and speed up the project for installing in-cell sanitation, following the collapse of ISG and re-letting of its contracts, which has halted work since last September.
Ministry of Justice estate
Response
The Minister previously responded that the date for all men to have in-cell sanitation had slipped to November 2026 and this element was prioritised. However, the failure of ISG caused further delay, now forecasting late 2027 for completion, indicating the previous recommendation was not effectively addressed.
Recommendation 3 Repeated Prev. unaddressed
The Minister should provide further plans to help IPP sentenced men still in prison.
Ministry of Justice resettlement
Response
The Minister previously responded that the Victims and Prisoners Act (November) 2024 and refreshed IPP Action Plan would shorten licences and reduce recalls. However, there has been no clear impact on IPP numbers, which remained around 25 throughout the year.
Recommendation 4
The Minister should take action to help those staff whose visas and jobs are threatened by the recent changes to immigration regulations.
Ministry of Justice staffing
Recommendation 5 Repeated
The Prison Service should outline what is being done to improve and stabilise staff retention, as Coldingley has witnessed an extreme case of operational staff attrition.
HMPPS staffing
Recommendation 6 Repeated
The Prison Service should implement fundamental and effective systemic changes to property handling systems, which currently generate the most complaints and where the last policy framework had little impact.
HMPPS other
Recommendation 7 Repeated Prev. unaddressed
The Prison Service should take action to get mentally unwell men out of unsuitable accommodation and into secure hospitals far more quickly.
HMPPS mental_health
Response
The Prison Service previously responded by stating long-term segregation had reduced, support was available from mental health teams, and new facilities like B-wing and a constant observation cell would help vulnerable men. However, the situation may have worsened this year, B-wing proved unsupportive for vulnerable men, and the new cell is not the full answer.
Recommendation 8
The Prison Service should implement a replacement for the Sycamore Tree restorative justice programme.
HMPPS resettlement
Recommendation 9 Repeated Prev. unaddressed
The Governor should outline how the widespread availability of drugs and other illicit substances around the site is going to be curtailed and eliminated.
Governor / Director substance_misuse
Response
The Governor previously stated that a new local Drug Strategy was launched, the ISFL wing was reduced, and MDT returned. While these measures are welcome, the Board notes that the ingress and use of illicit substances remains a major concern and it is too early to assess consistent impact.
Recommendation 10
The Governor should establish how progress in curtailing and eliminating illicit substances is going to be monitored and measured.
Governor / Director substance_misuse
Recommendation 11 Repeated Prev. unaddressed
The Governor should ensure that far more moments of potential conflict and all incidents of the use of force are recorded on camera.
Governor / Director safety
Response
The Governor previously responded that staffing levels and retention were improving, and further CCTV improvements were coming. However, while staffing improved, lack of staff visibility on landings was still noted, and CCTV coverage, despite improvement, still has priority sites out of action.
Recommendation 12 Repeated Prev. unaddressed
The Governor should take steps to stop Coldingley’s ‘loitering culture’, where too many men are still to be found around the site neither fully engaged in purposeful activity or in their accommodation during core hours.
Governor / Director regime
Response
The Governor previously responded by attempting to increase allocation, challenge non-attendance, improve staffing, and address facility issues. While there was some upturn in attendances in the last two months, too many men still stay on wings, educational facilities are not fully utilised, and purposeful activity targets have not been met.
Other IMB Reports for Coldingley
2024 Published 3 Oct 2024 507 71
2023 Published 5 Oct 2023 500 60
2022 Published 13 Oct 2022 471 100
2021 Published 13 Oct 2021 452 163
2020 Published 29 Sep 2020 438 86
PPO Fatal Incidents

Prisons and Probation Ombudsman fatal incident investigations for this establishment.

Haydar Jefferies
5 Mar 2023 · Self-inflicted · Report published
Colverson, Frederick
21 Dec 2020 · Natural causes · Report published
Individual at Coldingley
28 Oct 2019 · Other non-natural · Report published
Individual at Coldingley
18 Aug 2018 · Other non-natural · Report published
Prevention of Future Deaths Reports

Coroner PFD reports issued to this establishment.

Haydar Jefferies
20 Dec 2024 · State Custody related deaths | Mental Health related deaths