Prison based Mother and Baby Units: a case review of social work decision making

Isabelle Trowler, Chief Social Worker for Children and Families (England)

24 November 2022

I am sharing this on the day we publish a case review which examines admissions decisions for prison based mother and baby units (MBUs) and the integral role social workers play. Before getting into the review findings, I want to give a massive thank you to everyone involved! This has been a two year process which would not have been possible without the support, knowledge and frankness of those we engaged with. I would like to thank and recognise women with lived experience, the MBU Board chairs, the prisons and prison governors with whom we engaged and the panel of senior social workers whose time, expertise and insights were instrumental in reaching our findings and recommendations.

As the Chief Social Worker for Children and Families in England, I have the privilege to see how passionate and committed social workers make a difference for the children and families they work with every day. I have a unique opportunity to scrutinise social work practice at a national level and for this review, an aspect of social work practice that often goes unnoticed. That is, the work social workers do with families when a parent goes to prison. Following Lord Farmer’s 2019 review of the importance of family relationships for women in prison, he recommended that I undertake a review of cases where children are separated from their primary caregiver, which is the basis for this report.

Prison sentences, by their very nature, result in the separation of children from their primary caregivers. Yet, there is an opportunity for babies to remain with their mothers whilst their mother serves her custodial sentence, through being granted a place on an MBU. These MBUs, within the prison grounds, offer a safe space for the baby to live with their mother up to the age of 18 months, with an on-site nursery where the baby can be cared for whilst mothers engage in any prison programmes.

In this review, I worked with a panel of senior social workers, with the support of the What Works for Children’s Social Care team, to examine a sample of MBU applications. We focused on the social work contribution to the decision-making process to determine if outcomes were reasonable and made in the best interests of the child. At the outset of this review, I knew very little about the MBU application and admissions process and have really enjoyed the learning experience. I am proud that the review helps shine a light on the current process; it is only through understanding the issues that currently exist within a system that we can improve it and in turn improve experiences for children and their families.

Most decisions to place a mother with her baby were found to be reasonable, with examples of fantastic multidisciplinary working. However, we found that for around a third of rejected applications, there were aspects of the decision making process which could be improved. In a small number of cases at least one reviewer indicated that a different decision could have been made. Inconsistency was a common thread running through the review’s findings with women experiencing the MBU application and admissions process differently.

In undertaking the review, in the applications which involved judgements about actual or likely significant harm, I was struck by the differences between the MBU application process and the Family Proceedings Courts process : in both systems, decisions are being made about where the child should live, yet there are stark differences between how these decisions are reached. In the Family Proceedings Courts, there is an army of professionals: psychologists, social workers, paediatricians, psychiatrists, sometimes with second and third expert opinions, and the child is always provided with a CAFCASS Guardian.

In contrast, the MBU Board relies on a much smaller group of professionals to help reach its conclusions, often with little knowledge about the history of the mother, or the child’s wider family. While the HMPPS policy for the operation of MBUs states that social work attendance at the Board should be encouraged, it is not a requirement. In a quarter of the rejected cases we reviewed, there was inconsistent social worker input: in some cases there was no social work report written, no evidence from a social worker and no social worker attendance at the hearing. This meant that in some cases, the MBU Board made life-changing decisions without access to information which would have provided the full picture.

One area the review did not directly focus on but that we need to better understand is how women are made aware of MBUs and their rights as a parent when in prison, particularly what types of support should be on offer for women going through the tremendous stress of the MBU hearing.

A further area that our review highlighted was the fact that there is no inspectorate or other external body with responsibility for periodic oversight of the decisions made, and no method to monitor the quality of the decision making process, nor to moderate across Boards to check consistency of decision making. Our review found several instances of inconsistency between the level of risk different MBUs were willing to accept, and the basis on which decisions were made.

Using the findings of this review, I have made 13 recommendations to improve the system, prevent unnecessary inconsistencies and hopefully improve outcomes for children and women alike. My recommendations include further clarity for the roles and responsibilities of those involved in the process; formalising the role of the Board Chair with their decisions subject to scrutiny and peer review; ensuring women are informed of their rights during the application process and reviewing what types of support are available to them throughout the process; and setting out the responsibilities of social workers more clearly, with mandatory involvement in all applications and improved relationships between prisons and local authorities.

I have been inspired by the passion and relentless advocacy for women in prison and their children, both from organisations within the third sector and prison staff alike. If these changes are implemented, I am hopeful that the current system and the consistency of decision making will improve and that, crucially, more women and children may have more opportunity to stay together and build a relationship for the future.

Read WWCSC’s review

Read the Chief Social Worker for Children and Families’ full report