---

Prisons: Healthcare

My Lords, I thank the noble Lord, Lord Chan, for securing this debate. It is a great honour to be surrounded by others who have expertise in the NHS, prisons or both. I shall focus on the issue of drug treatment, which has been mentioned by others. I declare an interest as the chair of the National Treatment Agency for Substance Misuse, mentioned by the noble Baroness, Lady Murphy. I am sorry that she has had a bad experience of us. I will write to her in more detail about what we actually do. We do not deliver treatment; we are there to co-ordinate delivery systems. Therefore, I think there is some misunderstanding. We were set up in 2001 to increase numbers in treatment, reduce waiting times for treatment and build up the workforce. In all of this, we have had a great deal of success, verified by the Audit Commission. We realise, however, that numbers are not the end aim. We have recently launched our effectiveness strategy, to ensure that users are retained in treatment for as long as there is need, and that treatment is a co-ordinated journey, leading to better outcomes. Prisoners, too, have a right to better outcomes. We are concerned that those who misuse substances in whatever context, including prisons, should receive timely treatment that is appropriate to the individual, and that the workforce should be able to deliver the best possible options. The NHS, the criminal justice system, housing and employment all have their part to play. We have been concerned that prisons have difficulty coping with this agenda. Yet vast numbers of those going into prison have problems of substance misuse, mental health, and literacy and numeracy. They are complex cases, which also involve cultural diversity and gender difference. We have not always taken into account the full needs, with negative consequences. With new structures and new funding for prison health, we have a great opportunity to improve things and we must not let it slip. Too often in prisons, we have seen one option for treatment: detoxification, with all the attendant concerns about what happens on release. Some people who are detoxified in prison have, on release—sometimes after a short sentence—gone out and killed themselves by overdosing. Clinical drug services have to date often been under-resourced and have delivered inadequate or inappropriate clinical treatment practices, particularly with regard to substitute and maintenance prescribing. In many prisons, there are often poor links between counselling and referring services and clinical services and community treatment. International evidence shows that integrated, comprehensive drug treatment services in prison can positively influence reconviction rates, levels of uptake of community treatment programmes, rates of fatal overdose and rates of transmission for HIV and viral hepatitis. What has been needed for a long time is an integrated drug treatment system. The national treatment agency, with government departments, has developed the models of care system that recommends a care pathway starting from referral and continuing until discharge or stabilisation. Such a model must include links with housing, education, employment and so on, so that people are not treated in isolation. How much more true is this for prisoners? Can the Minister confirm that additional funding for drug treatment in prison under SR2004 is forthcoming, and can she comment on the pathfinder prisons that will explore the extent to which existing investment might be realigned to contribute towards treatment expansion? An integrated system for drug treatment in prisons should include the following by 2007–08: improved clinical management, with greater use of maintenance prescribing; intensive counselling and referral; psychological support during the first 28 days of intense clinical management; greater integration of treatments, with emphasis on multi-disciplinary teams; better targeting of interventions to match individual needs; the achievement of recommendations set out in models of care to ensure that, following assessment, there will be a range of fully co-ordinated and structured services available; and a firmer link with drug intervention programmes. This is ambitious, but work has begun. I understand that an agreement has been reached by the cross-government board overseeing the initiatives that funds will be allocated to primary care trusts, but will be ring-fenced and commissioned through local drug action teams. They have already been asked to ensure that they commission sufficient community-based clinical treatment to ensure continuity of care for prisoners being released into the community. Considerable progress is being made. I hope that the Minister will agree that prisoners must be an important target for drug treatment, if we are to avoid the revolving door of prison, treatment, release, relapse into crime and drug use, and back into prison. This is demoralising for prisoners, their families and professionals who work with them, and the cycle has to be stopped.