Dr Elizabeth van Horn, an experienced prison psychiatrist left her job at Woodhill and alleged that staff shortages prevented change. The courts, the Prisons and Probation Ombudsman and the prison's independent monitoring board all expressed concerns over regular understaffing, too much reliance on agency and temporary staff, assaults on both staff and inmates have also risen in the last few years as have suicides see below. Van Horn claimed no real changes happened despite promises management made, they knew what needed to be done but did not know how to achieve improvements. Staff shortages meant prisoners were often locked in their cells for 23 hours a day which added to stress for prisoners with mental health issues.