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Prisons: Healthcare

My Lords, we owe a considerable debt of gratitude to the noble Lord, Lord Chan, on bringing this Question to the Floor of the House. The powerful contributions that we have heard, including his own, demonstrate amply how important an issue prison health is, not only in its own right but also for what it can mean for rates of reoffending and the wider well-being of society. If you were to go and look for the worst possible combination of adverse circumstances to influence health outcomes, you could hardly do better than choose the inside of a prison. As a population prisoners are disproportionately afflicted with a range of serious health problems. The most prevalent and well recognised of these, as we have heard, are mental illness, sexually transmitted diseases, including HIV, and drug addiction. Apart from illness and addiction, prisoners are prone to general unfitness and weak health. A sizeable proportion of offenders, particularly young offenders, have experienced homelessness or have lived on the streets. Many are poorly educated and have existed on bad diets. Heavy smoking is prevalent. When you crowd people together—as we do in our prisons—deprive them of opportunities for recreation and add in all these negative tendencies, you have a recipe for serious ill health. Prison healthcare is not easy; nor has it been remotely adequate. The woeful state of healthcare in prisons has been the subject of trenchant criticism since the early 1990s, not least from the noble Lord, Lord Ramsbotham, during his time as chief inspector. I was a bit of a sceptic when we passed the legislation to create a partnership between the Prison Service and the NHS because I felt it was a half-way house and that nothing major would be achieved until we had a complete integration of prison healthcare with the NHS. I still believe that but, in fairness, I think there are at least incipient signs, as the noble Baroness, Lady Murphy, said, that the changes of the past couple of years are beginning to bear at least some fruit. But there is still a long way to go. Her Majesty’s inspectorate is still talking in terms of a wide variation in healthcare provision from prison to prison. Several prisons have no dentists attached to them; in others there is a high percentage of vacancies in healthcare posts. The majority of prisons have no register of chronic diseases, such as diabetes and heart disease, partly because of the lack of IT, as the noble Baroness, Lady Barker, mentioned, and partly because, as the annual report revealed,"““nobody had thought about it””." As we have heard today, one area where a lot more thought is needed is drugs. Figures show that 60 to 70 per cent of all prisoners were drug users immediately before imprisonment. That is a staggering statistic. Mandatory testing for drugs is one of the key planks for controlling drug use in prisons, yet some establishments have little or no weekend drugs testing and have as a consequence come in for some strong criticism from the chief inspector. There is also a big question mark over the reliability of some drug detection by sniffer dogs. Some 12.5 per cent of prisoners failed drug tests last year. I am not the only one who wishes that we had a precise breakdown of the amount of each class of drug being used. Can the Minister tell us what the known trends are in prisoners’ use of class A drugs in particular? One of the most powerful ways in which the Government could show that they really are tough on the causes of crime would be for them to deal effectively with drug dependency in prisons. We are still a very long way from achieving that aim. Closely linked to drug use is mental illness. It is thought that about 70 per cent of prisoners have two or more mental disorders, and the statistic is even higher among remand prisoners. The sad evidence of that lies in the figure for prison suicides: 95 last year, equalling the melancholy record for 2002. Perhaps the most worrying group of prison inmates are teenage boys. Research was published a few weeks ago which showed that teenage boys in custody are 18 times more likely to kill themselves than those in the general population. Let me ask two things: what special precautions are being taken in recognition of that risk to minimise the opportunity for self-harm among this group of prisoners and among prisoners more generally? As regards treatment, how does the NHS propose to ensure that assessments, care plans and the full range of mental health services are available consistently inside all our prisons? Do strategic health authorities monitor these services and, if so, how? Without an improvement in care for the mentally ill and in the conditions in which prisoners are held, we will not see a great advance in the drive to reduce suicides. For it is prison conditions that have a huge bearing on mental and physical well-being. Within the past three weeks, the prison population has risen to 77,599, leaving just 676 prison places available. The juvenile secure estate is working to almost full capacity. Prison overcrowding is now a seemingly intractable feature of the criminal justice system. Without more exercise, more recreation and more purposeful activity, the efforts of the NHS to raise the standard of prison health will be severely limited in their effect. What analysis, if any, has the Home Office carried out on overcrowding and its effect on prison health? If it has not done so, why not? We need to keep reminding ourselves that healthcare in our prisons presents challenges of a different order of magnitude from those anywhere else. That means that when it comes to the commissioning and provision of service, we need a different order of effort.