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Mr. Ruffley: Conservative Members have consistently asked about the wallet versus purse argument in respect of working families tax credit, which is a big issue for many of our constituents. What is the Government's response to the basic criticism of their proposal?

Mr. Robinson: As the Conservative party continued to make child benefit payable to the mother, it clearly endorsed the policy that we have embedded into every measure that the Chancellor unveiled on Tuesday--we want the maximum amount to go to the children, who are at the centre, through the mother, so that families benefit. I can assure the hon. Gentleman that when we go into the details of how the tax credit will work and how we can achieve our objectives, that will be absolutely at the forefront of our concern. [Interruption.] Time is pressing, and the points made by a number of other hon. Members need replies--if I can find time, despite the sedentary interjections of the hon. Member for Chingford and Woodford Green, I shall be pleased to answer them.

I entirely agree with what the hon. Member for Beckenham (Mrs. Lait) said about deregulation. I ask her to reflect on the thought that what she proposed might entail much paperwork, as I fear is often the case at the centre of Government. Deregulation units do not always achieve exactly what they set out to do.

Mrs. Lait: Will the hon. Gentleman give way?

Mr. Robinson: I really cannot--it is too late now. No doubt there will be other occasions on which we can discuss the matter, as well as the hon. Lady's personal experience in the exponentially growing business of smuggling--hers is a particular sphere of experience, but it was interesting to hear about.

In the last moments of this debate, I must mention the speeches of my hon. Friends the Members for Bolton, West (Ms Kelly), for Colne Valley (Kali Mountford) and for Pontefract and Castleford (Yvette Cooper)--all new Labour women Members of Parliament who paid tribute to the fact that we have got this about right. Indeed, I think that my hon. Friend the Member for Pontefract and Castleford said that the Budget would benefit women five times more than men. I am not sure whether that appears in our briefing, but if not, well done; I am pleased to use the statistic in my contribution to the debate.

We inherited a situation caused by the Conservatives, who doubled the national debt. We were in a cyclical deficit and a structural deficit and had accelerating interest rates--all because of their failure to act. In the interim, we have acted. We have set in place an economic and social reform framework that will stand this country in good stead and I commend it to the House.

It being Ten o'clock, the debate stood adjourned.

Debate to be resumed tomorrow.

19 Mar 1998 : Column 1511

Prison Health Service

Motion made, and Question proposed, That this House do now adjourn.--[Mr. Pope.]

10 pm

Helen Jones (Warrington, North): I am grateful to have the opportunity in this short Adjournment debate to raise the problems of the prison health service. I recognise that it is not a popular subject for debate and would not be so even if it were not held at 10 o'clock on a Thursday evening. Prisoners are not a favourite cause, and their welfare is not at the forefront of most people's minds. However, the strength of the House can be measured by the way in which it deals with unpopular subjects. Similarly, the health of our society can be gauged by the way in which it deals with those who have offended against its laws.

For that reason, my first premise is that we ought to expect for prisoners the same standards of health care that we expect for ourselves. Their punishment is to serve their sentence. They have not been sentenced to be deprived of adequate health care. Yet it is clear that the present system that operates within our prisons fails to deliver the standard of care that we ought to expect and is fatally flawed. That is recognised by prisoners and by many of the staff who work in the service, and it was recognised most of all by the chief inspector of prisons in his report, "Patient or Prisoner", which was published in 1996. That report ought to be commended not only to hon. Members, but to anyone interested in the Prison Service. I am sure that my hon. Friend the Minister of State will be looking into its conclusions carefully and considering how to take them forward.

From that document and from every other source, it is clear that the prison health service fails on three counts. It fails to provide proper health care for prisoners and an adequate career path for staff, and it also fails to meet the needs of society.

The two major problems that we have to deal with in our prisons are addictive behaviour and mental health. If a prisoner goes into prison addicted to drugs and comes out addicted or goes in with mental health problems that are not dealt with in prison, that prisoner is much more likely to reoffend, and we must bear that in mind.

Instead, we should be creating a system that ensures that those problems do not occur, as far as possible, and are tackled in prison. We must also ensure that staff working in the system--we have to admit that theyare working in difficult and sometimes dangerous conditions--are adequately trained and properly managed. While the dedication of many of those staff is not at issue, the real problem with the prison health service is that it lacks proper central direction and is not clear about its aims and objectives.

In some areas, we have no idea what is happening. In a written answer, the Minister said:


That is right and commendable, but the answer goes on to say that, while many institutions observe those standards,


    "statistics are not available centrally about the proportion that do this."--[Official Report, 20 January 1998; Vol. 304, c. 518.]

Responsibility for health care in prisons is left to the governor, who is not obliged to follow any particular model of care. No patients charter is applicable in prison

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to ensure minimum standards. I do not seek to apportion blame for the situation. To be honest, the system has persisted regardless of which party has been in power.

The Prison Service and the national health service have established a joint working group to consider the way forward in prison health care, but it is amazing that we cannot even say which establishments follow the central aims of the Prison Service in that regard.

Another cause for concern is the lack of suitably qualified staff in our prisons. I learned from a written answer in November that there were 14 prison establishments with vacancies for either full-time or part-time medical officers. That is bad enough in itself, but the situation regarding the qualifications of staff in our prisons and the training that they are offered is even worse.

As anyone who has ever visited a health care centre in a prison knows, the staff work with very difficult patients who are demanding and can be violent, so it is essential that they have adequate training and are properly managed, yet medical officers get only a two-week induction course in prison health care, and many prisons still do not have health care managers as recommended in the chief inspector's report.

Data are not collected centrally, but the Minister told me in a written answer that


are registered nurses. We do not know how many nurses or other health care staff are undertaking national vocational qualifications or other courses in health care management. I fail to see how the prison health service can function properly with a lack of NHS-trained managers. The fact that we do not even have adequate data is extremely worrying.

The lack of qualified staff to deal with mental health care and addiction is apparent. Because mental health problems are so widespread, it is important to have staff who can cope with them; yet of 197 doctors employed in the Prison Service, only 21 are members of the Royal College of Psychiatrists or hold a diploma in psychiatric medicine.

The training of other staff in dealing with mentally disordered offenders is very patchy, and only 21 per cent. of all health care officers and nursing grades employed in prisons are registered mental nurses. Under those conditions, the service cannot be expected to cope with the number of prisoners with mental health problems.

There are further grounds for concern about how we deal with mentally disordered offenders. The Mental Health Act 1983 does not apply in prisons, so the code of practice on seclusion does not apply either. The guidelines are issued for guidance to prison doctors, but they are not bound by them. I suggest that that is yet another example of the standards of health care that we expect outside prisons not applying within them.

There is also a real problem with the transfer of prisoners to psychiatric institutions. It is true that, once the warrant is issued, those transfers take place very quickly. However, I have talked to prison staff who have made it clear that it sometimes takes a long time to reach that stage. It is often difficult to get doctors to assess prisoners and find proper placements for them. At one time,

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the Prison Service estimated that 2,000 prisoners should be transferred to NHS psychiatric care, but could find places for only about 700. The situation was so bad that the chief inspector recommended the establishment of new units for day care centres and 24-hour nursing. However, there has been little progress towards those objectives.

We all recognise that there is a widespread problem with drug abuse in our prisons, yet only 25 per cent. of doctors who work in prisons are trained to deal with addictive behaviour. While I welcome the research carried out in our prisons into drug treatment programmes and the assessments of the impact of mandatory drug testing on the patterns of drug abuse, much remains to be done. Risley in my constituency is in the process of establishing a drugs treatment centre. The officers involved in that project are very enthusiastic about it. They recognise that, while prisoners are rightly punished for drug use in prison, we are not tackling the real problem unless we do something to break the cycle of drug dependency.

Unfortunately, initiatives such as that are few and far between. The same is true in other areas of prison life. For instance, it is clear from the chief inspector's report that care for young offenders is very patchy. There are also serious problems with the care of pregnant women in prison. The Royal College of Midwives' guidelines for prisoners, on pregnancy and childbirth, have yet to be implemented in many establishments.

A further concern is general health promotion and health education in prisons. Some basic awareness training in the area of HIV and AIDS is provided--usually in the first weeks of imprisonment--but much more must be done to educate prisoners about healthy life style choices, treatment and how to prevent ill health. I was heartened to meet recently some nurses from Winchester and to hear what they are doing. They are working in a wing of the prison rather than in a health care centre, so that they are available for appointments with prisoners and can answer questions about any aspect of health care.

Such initiatives point the way forward. However, the real problem with the current system is that it depends on individual staff and governors to take action. We need consistency and co-operation throughout the service, so that standards can be improved and best practice can spread. That is what we are trying to achieve in the national health service, and we should try to achieve it in prisons as well.

I accept that the problems facing the prison health service cannot be put right overnight. However, we must face the fact that health care for prisoners is below the standard of that received by the ordinary population, in terms of both quality of care and access to services. The question is how we should move forward. We must recognise that recruiting more qualified staff is the key to progress. As things stand, there is little incentive for doctors or nurses to work in prisons. There is no real career path, and there are fewer promotion prospects than there are outside.

We also have to be honest and say that prison staff face real ethical dilemmas concerning privacy, confidentiality and the exercise of their clinical judgment; and whether they might appear in conflict with the prison authority.

There is no continuity of planning between the NHS and the Prison Service, and there are no common standards for health care. That is why it is vital in the long

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term that the prison health service is integrated into the NHS. Such a move would have major benefits for the quality of patient care and for the training and professional development of staff.

I also recognise that that is not so easy to achieve. Major resource implications should be recognised. The prison population is a significantly higher user of the health service than people of the equivalent age and sex elsewhere. In addition, as I hope I have pointed out, prisoners have hidden health care needs that are not being met and which will increase costs.

It is clear, too, that other issues will have to be tackled, such as the lines of managerial accountability and the relationship between primary and specialist care, which is probably needed more in prisons than outside.

In that situation, it is not easy to move forward, but I hope that the Government will accept that doing nothing is not an option. I hope that when my hon. Friend the Minister of State replies, she will consider some of the ways in which we could progress. If we cannot arrive at the point that we would wish immediately, I hope that the Government will at least consider some pilot projects from which we could learn, and move on from there.

There are many possibilities. For example, prisons could be linked with local trusts. We could consider linking prisons with psychiatric care outside, perhaps a regional secure unit. Such a system might provide easier transfers and better opportunities for research and staff development.

But whatever we do, we must ensure that qualified staff are attracted into our prisons and that we tackle the major health care problems. There are opportunities as well as problems. For example, there are opportunities to consider multi-disciplinary health care within our prisons, involving nurses much more in health care.

If we do not do something, the service will continue to fail to meet the needs of those in prison and of society. I hope that, in the end, we shall be able to tackle the problem. It is not an easy one and it is not a popular cause, but it must be tackled urgently. I hope that my hon. Friend will suggest some ways in which we might go forward and tell us her thinking on these issues.


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