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Prisons: Healthcare

My Lords, I join those who have congratulated my noble friend Lord Chan on securing this timely and important debate. I declare an interest in that it is almost nine years to the day since, as Chief Inspector of Prisons, I published a report called Patient or Prisoner?, in which I recommended that the NHS should take over responsibility for prison healthcare. Six and a half years later, that was realised. I appreciate that this is a debate when we should be looking forward and not back, but I cannot help reflecting that 2003 was 58 years after the foundation of the NHS. I believe that many of the problems that I and other noble Lords will be discussing stem from the fact that for those 58 years the NHS was not responsible and the problems of prisons were not included in the estimates made by the Department of Health. Those problems particularly affected the mentally ill and those who were then coming out of prison, who were hoping that treatment that might have been started might have been continued. My contention is this. Although I am very glad that the Government accepted that recommendation and that the NHS is now responsible, I feel that there is a need for a proper strategy to decide what happens everywhere in every prison consistently, even though individual contracts are let. In the context of individual contracts, I was surprised when I saw the document, Creating a Patient-led NHS—Delivering the NHS Improvement Plan, published by the Permanent Secretary, Sir Nigel Crisp, on 31 July, in which he said that primary care trusts were no longer responsible for providing community-based services but would concentrate on the commissioning role. The prisons, of course, were hoping that there would be provision—that was why they let the contract. Then, last week, I understand that the Secretary of State overturned that. To me, that suggests that in the strategy-making in the Department of Health, prisons do not feature as highly as they might. I believe that there is a need for an understanding of strategy. Not long ago, I had a disturbing discussion with a senior civil servant in the Home Office, who said, ““I wish you’d stop talking about strategies. We don’t need strategies; all we need is strategic direction””. I asked, ““What do you mean by that?””, to which she replied, ““Top down, of course””. I said, ““That is lunacy. Just because something is said from the top, it doesn’t make it a strategy. A strategy is something which binds people together in doing something which points everyone in the same direction””. Prison health is a public health issue. Of the 78,000 people in prison, all except 30 will come out. The mental and physical state of those prisoners when they do so matters to the public. It does not make any sense to discuss prison reform without addressing prison health. I am not sure, from all that I have heard about the development of the National Offender Management Service, that prison health delivery has featured as strongly as I would have expected and hoped for when I suggested that the NHS should take over to give a central thrust and consistency. I am glad that the noble Lord, Lord Rea, referred to the Natural Justice nutrition study. It is an example of what I mean. That evidence was proved in 1997, and was then proved to be 92 per cent pure by a Home Office statistician, since when we in Natural Justice have been fighting Ministers to get it introduced. By the same token, we put two speech and language therapists into young offender establishments for the Hamlyn Trust. They were immediately accepted by governors, who said they were able to make a 100 per cent difference by assessing the needs of young people. In January, I warned Ministers in the Home Office and the Department of Health that the money would run out at the end of July, and that they would lose this priceless asset which has undone a lot of problems in health and education. Nothing has happened, because neither the Home Office nor the NHS can come to a decision as to who is to pay. The speech and language therapists come from the NHS, and the Prime Minister has raided the Home Office budget and taken £30 million for his respect agenda. Something which could have done a great deal for the health of young offenders has been lost. I declare another interest, in that I am involved with the Sainsbury Centre for Mental Health. It has recently done a survey of the London prisons, and its six findings are worth reflecting on. There is no standard model for mental health ““in reach”” teams, who think that they are community teams going in to deal with the most severely mentally disordered. When they do, they find that they are dealing with the 70 to 90 per cent of prisoners who have some form of mental health problem, some less serious than others. There is a marked variation in the range of provision between prisoners. The problems of transferring prisoners to the National Health Service have already been mentioned. Yet, in 1992, Dr John Reid recommended that at least 500 places a year were needed. There has been no provision for them since then, and that was an NHS paper. There is a poorly developed primary mental healthcare service, as my noble friend Lady Murphy has already said. There are difficulties in meeting the needs of the prisoners with the most severe problems. There are high levels of co-morbidity, including a correlation between drugs and alcohol abuse and mental health problems. I am delighted that the NHS is there, because it gives a solid basis for going forward. I hope, however, that the Government will take note of the points being made. They are made constructively to improve what is badly needed by this neglected part of our population.