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Prisons: Healthcare

My Lords, I too am grateful to the noble Lord, Lord Chan, for securing this important debate. I am very glad to see the participation of the noble Baronesses, Lady Royall and Lady Barker, and the noble Earl, Lord Howe, who are all, I understand, health people and not prison people. That at least is a sign that something has changed. It is a great pleasure to be able to say a few warm words to the Government on one aspect of their penal policy. I have not had that pleasure for a very long time. The transfer of responsibility for prison healthcare to the National Health Service was long overdue and had been advocated in my memory for at least 25 years. It was powerfully argued for by the noble Lord, Lord Ramsbotham, in his 1996 report Patient or Prisoner?, which he mentioned. The reason the provision of healthcare to prisoners should be part of the National Health Service was set out clearly in the preparatory work done by the responsible unit in the Department of Health. A joint NHS/Prison Service working group started the process of transfer in 1999. That group found serious weaknesses in the provision of prison healthcare, and,"““lack of direction, poor lines of communication and confused accountability””." The staff suffered from ““skill decay””, ““professional isolation”” and low morale. Some staff succumbed to a traditional prison culture which put emphasis on security rather than nursing practice, and health improvement, staff training and performance measurement were inadequate. The working party set out the aims of the new system—to ensure that,"““care is distinct from custody””;" to establish healthcare standards in prisons at the same level as in the NHS with comparable outcomes; to end the isolation of prison staff; and to put in place arrangements to enable continuity of care from the moment prisoners go into custody through to the day they are released. The Minister will tell us what progress is being made in achieving those objectives. I tend to agree with earlier speakers that we are probably not there yet. Only today I heard of the publication of the report of the Chief Inspector of Prisons on Feltham young offender institution. One example was of a prisoner with an injured finger who was left untreated for six weeks and the finger became untreatable. I look at, in particular, how far we have succeeded in establishing healthcare standards in prisons to the same level as in the NHS and with comparable outcomes. I suggest that that means that when there is a policy conflict between the health view of the world and the prison view of the world, health considerations and public health imperatives will carry considerable weight. In that context I look first—with apologies to the noble Baroness, Lady Massey, who knows much more about this than I do—at drug problems, since imprisonment and drugs policy are inextricably linked. Dealing with drugs is the area where conflict between prison policy and public health policy is likely to be the sharpest. In April 2005 the Scottish Prison Service announced that it planned to abandon the mandatory testing of prisoners to see whether they had drugs in their system and to concentrate instead on treatment. A senior Scottish prison source said:"““The existing approach to tackling drugs in prison simply isn’t working. People are continuing to use drugs. In fact, mandatory drug testing pushed people on to other drugs which do not stay in someone’s system for so long—like heroin, which only stays in the urine for three days. Mandatory testing only really works if people are willing to be treated, but if they aren’t then it isn’t much use””." My first question is: what is the Minister’s reaction to the Scottish policy, and is it being considered by the service in England and Wales? We know from research—the noble Baroness, Lady Massey, mentioned this—that in the week following their release prisoners are 40 times more likely to die than people in the general population, and 90 per cent of those deaths are associated with drug use. Women are 70 times more likely to die. I understand that in Scotland they deal with the problem of prisoners leaving prison, taking drugs and dying because they have lost their tolerance, through what they call a ““retox programme””, which offers a supply of methadone to prisoners determined to continue their drug use on release. My second question is: what are we doing about the deaths of drug users on release? We have already heard from the noble Baroness, Lady Massey, about the excellent work being done in prisons to provide drug treatment. I understand that there is firm research showing that to maintain any benefits from treatment in prison, excellent although it may be, it must continue in the community otherwise it is a waste of time, money and resources. So my third question is: does the Minister have any figures for the number of people who, having received drug treatment in prison, have left prison recently and are now undergoing drug treatment in the community? Yesterday in the other place, Charles Hendry MP introduced a Private Member’s Bill on mental health and prisoners. He cited the government response to the Home Affairs Committee report on the rehabilitation of offenders, published in January 2005, which stated that there were firm commitments that, by 2004:"““All prisoners with severe mental illness would be in receipt of treatment and that no prisoner with a serious mental illness would leave prison without a care plan””." My fourth question is: is that commitment being met? Finally, on 30 November, there will be a judicial review of the Government’s decision not to have a public inquiry into the sad death of 16 year-old Joseph Scholes. I remind the House that on arrival at Stoke Heath young offender institution, Joseph was stripped of his clothing, including his underwear, and placed in a garment like a horse blanket with stiff Velcro fastenings. At the inquest, the strip clothing was described by a childcare expert as dehumanising. The childcare consultant who inspected the cell in which Joseph died said that it would have been closed down if it had been a room in a local authority secure children’s home. Can the Minister assure me that today, as we have this debate, not one child is being held in the conditions in which Joseph was held and in which he sadly took his own life?