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Prisons: Healthcare

My Lords, I add my thanks to the noble Lord, Lord Chan, for raising this very important issue today. I am grateful to all noble Lords who, with their wealth of invaluable experience and expertise, have contributed to this debate. It is an honour for me to reply to it. Let me stress that healthcare for prisoners in England really is a partnership arrangement between the Home Office and the Department of Health in England. That partnership is growing from strength to strength, for the benefit of offenders, staff and, ultimately, the community. When the noble Lord, Lord Ramsbotham, was Her Majesty’s Chief Inspector of Prisons, he pointed out in the much mentioned Patient or Prisoner? that all prisoners requiring healthcare must be seen as patients, and given the same care as is provided in the community. We have made huge progress, but there is a long way to go. Of course prisons are and must be part of the local community, and being part of the NHS is a huge step forward. Prison health is a public health issue and care is distinct from custody. Since 2000, the Department of Health and the Prison Service have been working together as Prison Health. Their work has included programmes to develop the workforce and infrastructure, improve clinical services such as those for mental health, substance abuse, harm minimisation and health promotion, and to strengthen systems for managing and monitoring change. The Department of Health is working to ensure that black and ethnic minority prisoners have their needs properly catered for. I note the examples given by the noble Lord, Lord Chan. Care plans must be available where appropriate. In answer to my noble friend Lady Howells, no patients are held on compulsory orders in prison .In response to the noble Lord, Lord Chan, there are three public prisons in England which are yet to have a relationship with PCTs, but they will enter the system by next April. I understand the concern expressed about changes which will result from commissioning a patient-led NHS and the implications for prison healthcare. For the moment, I would merely say that while reconfiguration may result in changes to PCT boundaries, this is likely to have a positive effect on prison health, as it will present an opportunity to make better use of existing expertise. Evaluation of Prison Service performance continues to be robust, as it must be. In her report for 2003–04, Anne Owers said:"““Prison healthcare has shown considerable improvement. It has moved from a shamingly inadequate service to one that increasingly bears comparison with practice outside. It has benefited from the skills, resources and professionalism of the National Health Service””." We are not there yet but we are on the way. I take this opportunity to mention today’s report on Feltham young offenders’ institution, which several noble Lords mentioned. The Health Partnership Board has recognised the need to improve the standard of primary care service. In response to this need, it has developed a service specification and is considering alternative providers under a competitive tender process. Being part of the NHS family clearly increases the prospects of receiving healthcare of a similar standard to that received by all of us from the NHS. Naturally, this includes access to a GP within the same timescales as those that the general public might and must expect. At the national level, all initiatives have a prisoner dimension. All the National Service Frameworks—for example, for coronary heart disease, diabetes, children, older people and mental health—apply to them and underpin work carried out locally to ensure that appropriate services and standards are commissioned and provided. So if a prisoner needs assessment, treatment and care, be it for an STD, a difficult pregnancy, a chronic condition such as diabetes or asthma or for the effects of ageing, the means exist so that those needs can be addressed. Services must be developed to meet needs. I assure my noble friend Lord Harrison that more prisoners now have access to high-quality diabetes care, but there is still a long way to go. Cases such as those he cited must not occur. My noble friends Lord Rea and Lord Ramsbotham spoke about the importance of nutrition in prisons and about the research on the effect of diet on behaviour. The Government are not convinced of the need for more research in the custodial setting, but more research is needed on the impact of diet in the community setting, in particular whether it can reduce reoffending rates. If Natural Justice can provide proposals on how this could be achieved, the Youth Justice Board will consider pursuing it. The needs of the workforce are also being addressed. Better integration has meant less isolation, more opportunities to work across the sectors and better training and development opportunities. Indeed, the multi-skilled nurses in prisons, to whom I pay tribute, are now part of the wider healthcare team. The noble Lord, Lord Chan, expressed concern about inadequately trained staff. Now that they are part of the NHS, their qualifications are comparable to those in the NHS and they will receive the appropriate training. The Department of Health’s ““Choosing Health”” public health initiatives have major implications for prisoners. Prison plays an enormous role in tackling the problems posed by illegal drug use and provides, and will continue to provide, a key programme of clinical services for substance misusers, be it detoxification or opiate maintenance. Some 55,000 cases of drug and alcohol dependence are treated each year. Prisons have made a considerable contribution to the national quit smoking targets following the successful NHS-funded programme, Acquitted. They are leading providers of hepatitis B vaccinations. Some 90 prisons have programmes, and around 1,200 prisoners are vaccinated each month. Prison Health is now one part of the wider health and offender partnerships programme under the national offender management programme. This partnership enables colleagues to work together to maximise opportunities better to integrate health, social care and criminal justice programmes. The new integrated drugs programme, the work on suicide and self-harm management, and the work on all aspects of mental health are examples of this. As many noble Lords have said, mental health problems dominate, but much progress has already been made, including 360 mental health ““in reach”” staff in post, which exceeds the NHS Plan commitment for 300 being in post by the end of 2004. Ten million pounds is being spent on provision, with just under £20 million available for 2005–06. Regional pilots have been delivered, including for black and ethnic minority services. Action is also being taken by Prison Health and NOMS to divert from court all those for whom hospital treatment is the more appropriate option and to ensure the capacity to be able so do. They are taking action properly to treat those for whom prison is the appropriate option: on the wings and with the care of mental health ““in reach”” teams, and through the care programme approach, so that continuity of care occurs when offenders are released. I must mention at this point the excellent example of best practice which I saw in Gloucester prison, which I visited last week. On drug strategy and clinical treatment for substance misusers, I am happy to confirm to my noble friend Lady Massey that, from April 2006, there will be a substantial Department of Health and Home Office investment—the final details are yet to be confirmed—to develop a jointly integrated drug treatment system for prisons which will be consistent with the National Treatment Agency’s model of care framework. I do not have the statistics requested by the noble Earl, Lord Howe, on class A drugs, but I shall seek to ensure that he receives them in future. Overall, the drugs-related needs of prisoners are being met through co-ordinated initiatives, such as expansion of maintenance prescribing for opiate dependency; improving the range and responsiveness of current detoxification services; and establishing a structure under which all prisoners undergoing clinical management of drug withdrawal will have access to a package of interventions for their first 28 days in custody. The noble Baroness, Lady Stern, spoke of the different attitudes in England and Scotland towards mandatory drugs testing. That is devolution in action, I am afraid; in England we are going to continue with it, because we believe that its function in deterring misuse, supplying better information on patterns of misuse and identifying those in need of treatment are the best means of detecting the general level of drug misuse in custody. I well understand the concerns expressed by many noble Lords about continuity of care on release. No matter how good the healthcare in prisons, the benefits can be lost within weeks, if not days or hours, if the appropriate care is not available on release. The prisoner loses out, and so does society. We are in the process of issuing guidance to prisons on how prisoners can be helped to access primary care on their release from prison. The Government are committed to enhancing through-care and aftercare to ensure fewer instances of harm and reduced reoffending rates. The key to achieving this is the drug interventions programme. In the first six months of this year, some 14,500 prisoners have been identified in prison and gone on to engage with criminal justice integrated teams. Noble Lords asked when health in prisons would be reviewed. It is early days yet, but Her Majesty’s Chief Inspector of Prisons has recently agreed a memorandum of understanding with the healthcare people to ensure that the two systems of inspection work in tandem. On information management and technology, which is extremely important for the whole system, a prison health IT programme has been established within NHS Connecting for Health, which is responsible for the procurement and implementation of the clinical information system for the public prisons in England. Funding has been identified and the project is under way. That is very good news, I believe. The contracted-out estate is being included in the project, and the Welsh Assembly expressed an interest in having compatible systems. The Prison Service has no plans to introduce a needle exchange scheme, but I know that the idea is popular in many prisons. The noble Lord, Lord Chan, asked about private prisons. The project was initiated in April 2005 to ensure as far as possible that health service provision in privately managed prisons was equivalent in terms of service and patient entitlement, via inspection, to that provided in the public estate. On having a strategy to decide what happens in every prison, partnership boards involving PCTs and the governor are responsible for ensuring and monitoring standards locally. The noble Baroness, Lady Barker, mentioned the traffic light system; apparently, it is under review. In the light of changes of responsibility brought about by the commissioning transfer, the review will ensure that both locally and nationally there is an established performance management framework to monitor healthcare in every public sector prison. The treatment of young people in seclusion is a subject that was also raised. In 2004, David Lambert, the former Chief Inspector of Social Services, was commissioned to examine various operational issues identified at the inquest into the death of Joseph Scholes. His remit also includes considering the appropriateness of safer cell clothing for young offenders at risk of self-harm. We are waiting for his report to be published. I wish that I could go on, as there is so much to say. There have been so many examples of good—but also bad—practice. Bad practice reflects on us as a society. We have a huge programme in train, and we welcome the support that noble Lords have given today, but we recognise that there is much more to do. We welcome support from all noble Lords who are actively involved in the work itself, which I believe includes most people in this Chamber, and all those able to make the connections that are necessary across the services if we are to help all those whose lives present so many challenges. It is an enormous challenge, but it is one that we have to meet as a society.