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10.17 pm

The Minister of State, Home Office (Ms Joyce Quin): I congratulate my hon. Friend the Member for Warrington, North (Helen Jones) on her good fortune in securing this Adjournment debate and on her choice of subject. I welcome the opportunity to speak to the House on the subject of the prison health care service and how the Government see its future.

My hon. Friend has taken an active interest in the matter during the past year, particularly through her various written questions on the subject, which I welcome. It is an important subject, in which many hon. Members have a keen interest.

The Prison Service, in its statement of purpose, has the duty of imprisoning those sent to prison by the courts, and also owes a duty of care to the people in its custody. It must also prepare them for release.

I was glad that my hon. Friend recognised that the provision of health care is an important dimension of that duty. However, I do not want the House to be under any illusions about the difficulties involved in that task, or the challenges that it presents to staff.

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Perhaps I could give some statistics as a background. In the last financial year, 1996-97, about 200,000 prisoners passed through the prison system. The average daily population rose from 53,740 at the end of March 1996 to 59,161 at the end of March 1997. The most recent figure is slightly over 65,000. During that period, the prison health care service handled more than 2 million health-related consultations with inmates. Around 190,000 of these were with visiting NHS consultants providing treatment and care in a variety of specialisms: psychiatry, dentistry, optometry, radiography, and so on.

On 37,000 occasions, prisoners were sent to NHS hospitals as out-patients or in-patients. That represents a good deal of work. Prisons are closed and secure institutions, and, as my hon. Friend recognised, many of the things that are simple and straightforward in the community take on a more complicated character in prison.

My hon. Friend also recognised that, as a group, prisoners are not typical of the general population. That is perhaps obvious, but it is particularly true in health terms. The prison population is predominantly young and male, with a higher incidence of mental disorder and a higher propensity to suicide. They are more likely to smoke--80 per cent. of prisoners do--and to have a drug-taking habit.

By contrast, the equivalent male age group in the community at large tends to make comparatively few demands on health services. All these factors, coupled with the facts and necessary consequences of custody--security, control of medication, particular care for the vulnerable, depressed or suicidal and mentally disordered--make providing health care in prisons a challenge both to health care professionals and to uniformed staff.

An Institute of Psychiatry survey showed that around 38 per cent. of sentenced prisoners suffer some form of mental disorder, although it is important to recognise that, within that figure, we also include those who have some degree of substance misuse or addiction.

A similar survey completed in 1993-94 found that the incidence of mental disorder in the remand population was much higher, at around 66 per cent. In terms of the current population, that translates to around 20,000 sentenced prisoners and 8,300 remand prisoners having some kind of mental disorder: psychosis, neurosis, personality disorder, substance misuse or addiction.

I am glad that random mandatory drug testing appears to be having an impact on drug misuse. The figures available for this year show that 21 per cent. of tests are proving positive--against 24 per cent. last year. The great majority of positive results are for cannabis, but 4 per cent. prove positive for opiates. The fact remains that some prisoners continue to take part in risky behaviour--taking drugs and sharing needles.

We are in the relatively fortunate position that the human immune deficiency virus is not prevalent in our prisons, but we know from experience in other countries that prisons could readily become reservoirs of communicable diseases--HIV, hepatitis B and C, tuberculosis and others. Therefore, we cannot afford to be complacent. Unless care and precautions are taken,

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there is potential for a serious threat to prisoners' health, the health of their families, prison staff and, ultimately, the wider community.

Improving the effectiveness of the health care that prisoners receive makes obvious sense: a large number of prisoners spend relatively short periods in custody, during which time effective health care and the prevention of disease can make a positive impact when they return to their home community.

I should underline that good work is being done in response to those challenges. In my visits to various prisons, I have seen the commitment and dedication of prison staff and those who provide health care in prisons. Indeed, they have managed well against the pressures of a rising population, which makes special demands. None the less, many tasks are being taken forward, and there are plans for the future. I hope that I shall be able to refer to these briefly.

The Prison Service is pressing forward with work to develop prisons as places where the promotion of health measures as well as treatment of health problems can take place so that we can encourage prisoners to adopt healthier life styles. An internal awards scheme, which was run for the first time last year, has shown early positive results, with 20 prisons receiving some form of commendation.

A range of pilot drug treatment and counselling programmes has begun. About £6 million was spent in centrally funded projects in the current year, and about as much again was spent by prisons from local budgets. My hon. Friend referred to that work, and the Government want to increase the number of voluntary testing units, at which people in our prisons can live and be supported in a drug-free environment. About 4,000 places are currently available, and the Under-Secretary and I have visited operational schemes.

Plans are in hand to increase the number of therapeutic community places, similar to those available at Grendon prison, which my right hon. Friend the Home Secretary and I visited recently. A range of research suggests that Grendon-type therapy courses have beneficial effects in terms of psychological change and reoffending behaviour.

The number of prisoners transferred to NHS hospitals for in-patient treatment for mental disorder has increased significantly in the 1990s. It is difficult to cope with demand; there has been a fivefold increase in transfers since 1986. The NHS is playing its part in expanding facilities--a growing number of services in prison are provided by NHS specialists.

A range of training is in place or being developed to improve the skills and knowledge of health care staff and prison doctors. I agree with my hon. Friend that the central collection of statistics could be strengthened to make the position clearer, and the Government are keen to address the patchiness and variability of provision.

Training in dealing with communicable diseases is being stepped up, and prisons are required to have multidisciplinary teams to manage HIV and AIDS treatment. Their training is being extended to other communicable diseases. I have visited good induction schemes for prisoners in which HIV and AIDS awareness plays an important part. The schemes are imaginatively delivered in some prisons via video programmes, which effectively communicate the message to prisoners.

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Historically, health care in prison has been the responsibility of the Prison Service, and has been organised outside the NHS. Ultimately, accountability rests with the Home Secretary, alongside that for prisons and the management of prisoners. In practice, as statistics show, the NHS has been drawn into providing some health care, particularly of a specialist nature. Indeed, the pattern of provision is quite varied. The majority of primary care is provided by directly employed staff, but, increasingly, NHS or private sector health care providers play a complementary role.

The pattern of organisation and provision reflects in part an attempt by prisons to meet local needs, but is also in large measure the result of history, and inadequately co-ordinated development. There are good examples, which might serve as models that could be applied more generally, but also rather poor ones.

My hon. Friend referred to the thematic review undertaken by the chief inspector of prisons, Sir David Ramsbotham, who highlighted his anxieties about prison health care in the report, "Patient or Prisoner?" He recommended that responsibility and, ultimately, the budget for the delivery of prisoner health care should move to the NHS. We have not yet reached a view about

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whether that is the right way forward--it would raise a range of organisation, management and resource issues for the Prison Service and the NHS--but the working group to which my hon. Friend referred, involving the Home Office, the Prison Service and the Department of Health, is important in that respect. I have received an interim briefing from it, and look forward to receiving its recommendations in the near future.

The group's remit is to consider jointly the future organisation and delivery of health care to prisoners. The objectives are to secure improvements in meeting the health needs of prisoners, to tackle the problems and weaknesses in standards, and to deal with the isolation of health care staff. I agree with my hon. Friend that prison health care staff must feel part of a career structure, and must not be isolated from other health care providers and professionals. Prison health responsibility should be seen not as a career cul-de-sac, but as an important part of career development.

The motion having been made at Ten o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.

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