Examination of Witness (Questions 120 - 139)
TUESDAY 10 MARCH 1998
SIR DAVID
RAMSBOTHAM
120. 20,000?
(Sir David Ramsbotham) 20,000 out of 65,000. That
is not to say they are all acute and some of them are substance
abuse related and so on. If you went and looked at them all, you
are talking about something like just over a third of the whole
of the prison population have got some mental health problem.
Prisons simply are not geared to take them. In particular at the
top end of the scale what worries me is that the most acutely
personality disordered prisoners who are sent to Broadmoor, Rampton
or Ashworth are frequently sent back to prison on the grounds
that they are untreatable. Now if they are not treatable in Broadmoor,
Ashworth or Rampton, what the hell are prisons going to do who
have got no facilities? Then there is the question of people coming
into prison, the prison needs to know all that has happened to
them before they come in in order to make a sensible needs assessment
and sentence plan and so on. There is medical information there.
Medical information is denied to the prison because the GP cannot
pass his notes to somebody who is outside the NHS. Similarly at
the end of the sentence you find that there are masses of prisoners'
notes about what has gone on which go into the bowels of the prison
service archive and then there is a horrendous procedure which
has to go on to get them out, now this is nonsense. Also the standard
of nursing in the prisons is not up to the standard in the NHS
hospitals. The prison service is actually duplicating a lot of
work by having huge organisations in prison where actually all
they need is a sort of nurse practitioner from the hospital who
runs a minor injuries unit in the morning and a doctor who comes
in and does it. I discovered that particularly the contract prisons
said "To hell with this" and they had gone to the NHS
and they were hiring and buying NHS facilities in. I felt it was
high time you removed this anomaly, it was not an anomaly created
by the last Government or the Government before, it has been there
since the health service started and I cannot think why it was
allowed then. Also you have the problem that in theory remand
prisoners are entitled to the NHS but others are not but it cannot
be delivered only to remand prisoners. Foreign nationals allegedly
are entitled to NHS provision and so on. It is a muddle. What
has happened is I set this as a discussion document because I
thought it would take two years to work through because the immediate
reaction was "They cannot afford it". I said: "Well,
steady, at present £59 million is spent a year by the prison
service on the provision of health care in prisons now I wonder
whether it would actually cost £59 million to provide the
same amount of cover from the NHS, let us go and have a look at
it". One attempt was made at the three prisons in the Isle
of Wight which are all grouped together on one spot and on the
other side of the road there is a massive NHS hospital trust complete
with a mental health unit. They set up an attempt to get support
for those prisons from that trust. They produced a very good bid,
half the price of what the mental thing was costing in the prisons
but then it got inflated by bureaucrats and got into a muddle.
What I think must happen now is that the debate being moved forward
in the way it is I hope will come to fruition and to you. The
NHS were approached by the Home Secretary the moment they took
over. He spoke to the Secretary of State for the Department of
Health. The Minister has met with a Minister of Health and a Minister
of Public Health. A working party has been set up between the
NHS Executive, the Director-General of Health Care in the Prison
Service and my own Chief Inspector who happens to be a great expert
on mental disorders and the last discussion that I was told about
was not whether the NHS would take over but which Minister would
be responsible. Now I find that very encouraging. I would just
like to see the thing moved on faster. I think it will remove
an anomaly and you can go to the local hospital and make arrangements
that one ward, for example, will contain prisoners from a number
of prisons so you get over this hideous problem of nine prison
officers every day a prisoner goes into bed watch which eats into
prison time.
121. Nine prison officers?
(Sir David Ramsbotham) Nine prison officers every
24 hours. You need three prison officers for each of three eight
hour shifts every time a person goes into hospital.
122. No wonder it is so expensive.
(Sir David Ramsbotham) It has a hideous impact on
the running of the prison. It was that which brought Holloway
to a halt because every time a woman went into hospital to have
a baby they had to take nine prison officers with her.
123. What do they do in the private prisons?
(Sir David Ramsbotham) The private prisons contract
to the NHS to do this work for them.
124. How do they deal with the security business?
(Sir David Ramsbotham) They send Securicor guards
out to a ward, the Securicor guard can sit on there just as well.
125. That does not bite into the staffing of the prison service?
(Sir David Ramsbotham) It does not bite into that
anything like as much.
126. Perhaps you would like to tell us to tell the Home Secretary
he ought to expedite the recommendations you have made.
(Sir David Ramsbotham) He knows about it, I have talked
to him frequently.[1] I
was talking to the Prison Minister only the other day about it
as well.
127. Can I go back to the question of 20,000 offenders with
mental disorder, that is a very serious number of people.
(Sir David Ramsbotham) Yes.
128. I think it is a matter which is of great concern to
the public.
(Sir David Ramsbotham) Yes.
129. Have you got some ideas on how that specifically could
be addressed? That is a really big problem. If Broadmoor are turning
people away and sending them back into the prison—I have
visited Broadmoor myself and seen what it is like, it is very
specialised and specialist institution—if they say: "No",
you cannot send offenders back into ordinary prisons.
(Sir David Ramsbotham) That is what they do.
130. It is mad.
(Sir David Ramsbotham) Exactly. If the NHS were responsible
for all of these people and if you said now to the NHS "there
are 20,000 people with a mental health problem whom it is your
responsibility to do something about", if they decided, "Okay,
there are these people who are severely personality disordered
and we do not want to have them in the Broadmoor, Ashworth and
Rampton because we are doing specialised work there", we
could set up a special unit for these people inside the grounds
of a prison and run it as a special mental part of it, fine. I
do not see any difficulty in this. I see no difficulty that if
they decide that there are a number of people who are in that
grey area, they are not quite certifiable but they are certainly
not normal, and all that happens in prison, as the prison medical
staff will tell you, is they watch them deteriorate. Why do you
not set up in those prisons or in a number of prisons equivalent
to a medium secure unit as built out by the NHS anywhere, running
day centre type regimes and treat them in the prison? Do not leave
them in the so-called prison service health care unit which is
completely the wrong place. Give them activities which are designed
to acknowledge that they are mentally ill. If the NHS had responsibility
for doing it I believe all those things are open but they are
closed at the moment because the prison either cannot design or
fund or man or staff these things and the NHS have got no responsibility
so they have washed their hands of it.
Mr Cranston
131. The Suicide Prevention Strategy of the prison service,
how is that going now? You commented a couple of years ago that
it was excellent but it was patchy in implementation.
(Sir David Ramsbotham) At the moment I am launched
on a study of suicides because I was sufficiently alarmed by the
figure last year㭂 -and I was particularly alarmed by the
young offenders where 20 committed suicide, ten in remand and
ten centres.[2] In theory
the procedures are fine. They require people to identify people
who are risk, to look after them when they are at risk, to record
the fact and so on and people should be trained. The fact is the
procedures are simply not being exercised. What I am anxious to
do in going round and checking all the suicides that have happened,
all the procedures in all the prisons, is to come up with a system
which does not just say that those are the things which happen
but actually makes people accountable for the fact that they do
happen. It is all very well saying staff are to be trained but
somebody has got to insist that they are trained. It is no good
saying there is to be somebody who is permanently on duty who
has been trained, you have got to make certain that every shift
does include them and that you check the register. You have got
to make certain that training is updated. There is another whole
side to it which does not do the good name of the prison service
any favours and that is the way that the prisons handle the bereaved
afterwards. We have had some disgraceful examples of insensitive
handling of relatives who after all are coming to terms with bereavement
and defensiveness about saying what happened or whatever. I shall
be including that in my report. In order to make it wide-ranging,
as I told the Minister, I am not just doing it for the prison
service, I am including the Portman Clinic who do a lot of work
in this area with mentally disordered people, I am including the
Samaritans, I am including the Trust for the Study of Adolescence
who have done a very good study of adolescent suicides which I
know is a worry in the community, and I am involving a whole lot
of outside experts as well. What we are looking at is saying to
prisons "you must not compare your figures with the figures
outside because your figures are meant to be figures in a supervised
environment where if people are doing their job they should have
a much better chance of preventing it happening".
132. When is your report going to be ready?
(Sir David Ramsbotham) We are working on it now. I
told the Minister I hope to give it to her in early August. We
are so pushed. We have got the Maze on our books as well. We will
try to do it by early August.
133. From what you say, until there is the implementation
of procedures we are not going to see a fall in the number of
suicides in prisons?
(Sir David Ramsbotham) I hope the fact that we have
let it be known the sorts of things we are looking at the ripple
has gone round the prison service and they will look to tighten
up their procedures. One suicide is too many. We cannot prevent
them all but I hope that we can reduce them.
Chairman: One or two miscellaneous questions now that Mr
Allan is going to deal with.
Mr Allan
134. Just a brief question on one group of foreign nationals
who are under prison service control: asylum seekers. Is it your
view that asylum seekers who have not been either convicted nor
accused of any criminal offence should be held in prisons like
Rochester?
(Sir David Ramsbotham) I do not think that the prison
service should be responsible for holding any asylum seekers or
immigration detainees at all. If they are to be held they should
be held by the immigration service in totally different accommodation.
For example, you may remember last year 18 asylum seekers went
on hunger strike in Birmingham. I went to see them and they were
complaining that they were locked up for 23 hours a day and that
was not appropriate. I had to point out the fact that the poor
old Birmingham that is meant to have 800 people had 1,300 in it
and everyone was locked up for 23 hours a day and the prison was
simply not capable of designing a separate regime for 18 people.
But they should never have been there. I do not want the prison
service to have to run Rochester, I do not want the prison service
to run Haslar, I would like the Immigration Service to run them
all.
135. The 500 places that are held supposedly for disruptive
prisoners or prisoners with serious criminal records, do you believe
the system of transferring people out from the Immigration Service
to prison is working fairly or is that an arbitrary system?
(Sir David Ramsbotham) I comment on this in the Campsfield
Report. There are some who turn disruptive but, you see, by the
same token some of the people who are causing disruption should
never have gone to an immigration centre in the first place. Very
often they are the people who served a prison sentence and should
have been deported at the end of the prison sentence. All the
asylum applications should have been made while they were in prison
and the decision on their future made while they were in custody.
It is very interesting how many of the disruptions and riots in
immigration centres are caused by those people. I have recommended
that in return for getting Rochester and Haslar back the prison
service should surrender the prison at Aldington in Kent, which
is right beside Ashford Railway Station, to the immigration authorities
because it is very conveniently placed and ideally designed which
could take more accommodation for immigration detainees.
Chairman
136. A quick one on the Prison Inspectorate Review by the
Home Office, what outcome would you like to see?[3]
(Sir David Ramsbotham) As I say, I would like to see
the firm direction towards community clusters and I would like
to see the firm direction towards functional management within
prison service headquarters. I think those two things would transform
the way to do it. Then, within the prison service I would like
to see a very serious drive to recruit many more younger managers
than they are doing. They have opened the graduate entry again
but I think that they have suffered by not having the graduate
entry for the last eight years or so. The average age of the Governors
Five in the prison service at the moment is 51 and I think that
a service whose junior officers' average age is 51 is terminally
ill. I would like to see much more young blood brought in at the
junior end. There are some marvellous people coming into the prison
service who have got experience of dealing with hunger in Ethiopia
or crises somewhere and they come in with a motivation to work
with prisoners. We want to bring those persons in and exploit
them.
Mr Winnick
137. Sir David, the Prison Officers' Association have said
that they want the right to strike and we know the views of the
Government on that, as indeed the views of the previous government.
Do you think it would be at all practical if they were given such
a right in law?
(Sir David Ramsbotham) No, I do not. I agree entirely
with the Home Secretary on this. To have the prison officers having
the right to strike I think would be intolerable. I am speaking
from the condition and treatment of prisoners which it is my responsibility
to look after because it would mean that in order to substitute
for them you would be bringing in people who are untrained and
that would affect their treatment and conditions.
138. Yes.
(Sir David Ramsbotham) I am concerned about the whole
industrial relations' situation within the prison service generally.
139. What do you mean by that?
(Sir David Ramsbotham) I think it is uneasy. I think
it is very uneasy. I think there is too much confrontation in
it. Also I think that it is not the same in every prison. I go
to some prisons where the POA are absolutely on side with the
Governor, they feel part of the management team. Manchester which
I was quoting to you, the strongest protagonists of the service
level agreement were the POA because they felt they had some ownership
of what was going on. Where you find prison governors who have
had the good sense to include the POA in the management of the
prisons so they feel some ownership, the relationships between
them are good and constructive but where that has not happened
there are prisons around the country which people know about where
the relationships are bad. Now the personalities come into this
of course and there are some very difficult governors and there
are some very difficult chairmen of POAs and I do not think the
fault lies on only one corner. A prison whose report is coming
out tomorrow, Glen Parva for example, is an absolutely classic
case in point where the management had a confrontational relationship
with the staff, the staff has had a confrontational relationship
with young offenders but it all started with management. The POA
did not help. I am not an expert on industrial relations but I
have seen places where it works. I am in frequent contact with
the POA, my door is always open to them and I have addressed their
annual conference and so on, and I make it my business to do so,
they say some very constructive things to me about the things
that they would like to do and in return I say "I hope to
God you are not going to cause even more problems for the poor
old prison service which has got a job in the public, like this
right to strike, because I do not think it is on". My background
to that, of course, is coming from the Army where we did not have
a right to strike.
1 Note by witness: I should explain that I have
not spoken to the Home Secretary frequently about private prisons,
but that I have talked to him frequently since he took office
about the recommendations in my reports. Back
2 Note
by witness: This study was undertaken at the request of the
Director General, with whom I have discussed my alarm, which I
know that he shares, and which matches his worries. Back
3 See
Annex. Back
| 
