APPENDIX
MEASURES TO DEAL WITH VISITORS AND PRISONERS
WHO SMUGGLE DRUGS THROUGH VISITS
Headline figures 1 April to 31 March 2000
| | Total 1st
Quarter
| Total 2nd
Quarter
| Total 3rd
Quarter
| Total 4th
Quarter
| Annual
Total |
| Number of incidents | 777
| 706 | 673
| 644 | 2,800
|
| No. of visitors involved in suspicious actions
| 838 | 812
| 800 | 694
| 3,144 |
| Number of visitors banned | 626
| 634 | 623
| 581 | 2,464
|
| No. of decisions not to ban a visitor | 200
| 197 | 126
| 127 | 650
|
| No. of decisions to ban a visitor for less than three months*
| 24 | 52
| 33 | 18
| 127 |
| No. of visitors made subject to closed visits instead of ban
| 101 | 84
| 76 | 61
| 322 |
| No. of visitors made subject to closed visits following a ban
| 361 | 351
| 440 | 362
| 1,514 |
| No. of visitors not banned and not made subject to closed visits
| 111 | 94
| 101 | 52
| 358 |
| No. of prisoners made subject to closed visits
| 547 | 529
| 489 | 509
| 2,074 |
| No. of prisoners found guilty at adjudication of offences involving drug smuggling through visits
| 322 | 227
| 277 | 260
| 1,086 |
Note: An incident can involve more than one visitor.
*The figures for visitors banned for less than three months
were taken from Annex B of the data collection return, "Number
of visitors banned" section, which are believed to be more
accurate.
32. There is a need for continuous attention to be
paid to improving the effectiveness of the MDT programme as a
means of assessing levels of drug use in prison. . . but unless
and until the MDT results are sufficiently reliable there is a
need also for continuing research into levels of drug use by other
methods, including survey evidence (paragraph 92).
The Government shares the Committee's view that it is necessary
to supplement the MDT programme with other research methodologies
but has seen no evidence to show that the MDT results are unreliable—the
key issue is their interpretation.
Two independent pieces of research have already been conducted
and did not support the contention that MDT causes prisoners to
switch from cannabis to opiates. However we remain concerned about
suggestions that switching is taking place and a further piece
of research is planned to look at the overall effectiveness of
the MDT programme.
34. The levels of drug use—whether at around
20 per cent or higher than this—are still high, and there
are still prisoners (though not necessarily significant numbers)
who use drugs for the first time while in prison. The levels of
use entirely justify the continuing development of a major anti-drugs
programme and the sums, which have been directed towards it (paragraph
93).
The drug strategy adopts an integrated and balanced approach
in dealing with drug misuse among prisoners. The key components
of the strategy are: improving the availability and quality of
treatment; increasing the availability of voluntary testing places;
reducing the supply of drugs into prisons and integrating the
work of different departments and agencies involved in working
in prisons.
Significant progress has been made in pushing forward the
drug strategy. On the supply reduction side, drug seizures are
down from 4,375 in 1999 to 858 to date.
The percentage of random drug tests proving positive continues
to decline. From 24.4 per cent in 1996-97, the figure has reduced
annually to a provisional 14 per cent last year.
35. Steps need therefore to be taken to improve the
efficacy of the random MDT process. These steps include:
— An audit of the extent to which the procedures
set down for the actual administration of the tests are being
followed by all staff;
— An increase in weekend testing (and we accordingly
welcome the fact that the Prison Service has already issued instructions
for the rate of weekend random testing to rise to 14 per cent
of all random tests);
— Further research into whether alternative kinds
of tests, such as hair tests or saliva tests, might be more reliable
and/or might record traces of opiate use for significantly longer
periods than the current urine tests (paragraph 96).
An audit system is in place. 14 per cent of all mandatory
drug tests must be conducted at weekends. A revised manual of
guidance is in preparation.
As for other methodologies, the evidence is as follows.
— Hair has some advantages over urine as a medium
for drug testing:
— hair sampling is less invasive in terms of
privacy and it is more difficult to interfere with samples;
— depending on its length, a hair sample can
provide a history of drug misuse over several months, while urine
testing can detect a drug for, at most, 30 days;
— speed of collecting a sample, eliminating
the need to wait up to five hours for the donor to provide sufficient
urine.
However, the problems with hair testing outweigh those advantages:
— principal among these would be the exclusion
for Sikhs, Rastafarians and Hare Krishnas. We would anticipate
a large number of conversions to those faiths if mandatory hair
testing were introduced. There are no religious exclusions from
urine testing. Drug misusers might also resort to shaving off
any hair which could be taken as a sample;
— dark-coloured hair retains drugs in greater
concentration than light-coloured hair. At present, methods for
correcting results to account for hair colour are only at the
research stage.
— hair testing would be prohibitively expensive.
It has been estimated that screening hair would cost five times
as much as screening urine. There is no cheap and effective screening
method;
— it takes up to seven days after use for drug
traces to enter the hair system, so hair testing is no good for
detecting very recent misuse; and
— difficulties in setting an accurate time frame
for the misuse due to variations in distance from the scalp that
the sample is cut and in rates of hair growth. An accurate time
frame is important in MDT because it must be established that
the prisoner was in prison custody when an offence of drug misuse
took place.
— Sweat—analysis is expensive and the result
can prove difficult to interpret conclusively;
— blood—although blood samples provide the
most immediate picture of drug misuse, collection of blood samples
is an invasive procedure which requires a trained phlebotomist
and much more stringent health and safety procedures.
— saliva—the range of drugs that can be tested
is more limited and the results difficult to interpret.
We are therefore satisfied that urine is the best medium
for testing for the required range of drugs of abuse.
36. We recognise that random MDT may have a limited
deterrent effect on drug use by prisoners serving medium or long
sentences (though any such effect can only be weakened by the
reduction to a 5 per cent testing rate per month). But we doubt
very much that it can be having any significant deterrent effect
on those serving only a few months, the very group which is in
some ways the most important target for the drive to reduce drug
use (paragraph 99).
The Government believes the reverse is true. Additional days
are likely to be more impactive on short-term prisoners. The Prison
Service is therefore looking at ways of making sanctions more
impactive on longer sentence prisoners. It is important to deter
drug misuse by all prisoners no matter what the length of sentence.
The reduction to a 5 per cent level of random MDT testing
per month in prisons with an average population of more than 400
is designed to allow an increase in targeted testing of those
at greatest risk. Evidence shows this should enhance the deterrent
effect.
37. We accept that there are severe practical obstacles
in the way of introducing a system of 100 per cent drug testing
of prisoners at least if the tests are to be used as the basis
for disciplinary proceedings as well as for measurement of overall
levels of use. Nevertheless, there might be merit in the Prison
Service assessing the feasibility of running occasional tests
of a much higher proportion (than 10 per cent) of the inmates
of a single prison, using the simplest and cheapest test available
(paragraph 103).
The proposal is still under consideration. The practical
obstacles to urine testing come not from the testing process itself
but the logistical difficulties of obtaining urine samples. Where
a prisoner has difficulties in providing a sample, this can take
up to 2-3 hours per prisoner.
38. We conclude that this [relative or actual shift
from use of cannabis to harder drugs] has arisen from a variety
of different factors, of which the MDT programme is only one.
But we acknowledge that the MDT programme has failed if it has
reduced cannabis use but has had no effect on heroin or has even
increased its use. Further examination of this issue must form
a part of the continuing research into levels of drug use in prison
for which we have called above (paragraph 108).
The Government rejects the Committee's view. There is no
evidence of a shift from cannabis to more harmful drug use in
prison. While the MDT results shows a fall in cannabis use, they
do not show a rise in the use of other drugs. Furthermore, the
MDT programme is only one element in the fight against drug misuse.
Much more influential are good security and good treatment. But
we are not complacent. Further research is being commissioned
into the effectiveness of MDT, including the effect on heroin.
39. [A number of general principles about punishments
and disciplinary responses have emerged from the evidence:]
— The use of "added days" must be available
as a punishment for drug use but its use must be kept to a minimum.
— Significant use must therefore be made of alternative
responses such as loss of privileges, with corresponding incentives
for drug-free behaviour; one of the main ways of achieving this
is through linkage to the Incentives and Earned Privileges Scheme.
— There should be a reasonable consistency within
the system in the response to positive MDT tests and other drug
offences in prison and responses must distinguish between the
level of seriousness of different cases, particularly between
the supply of drugs and the use of drugs.
— The response regime must be linked also to
the process for identifying those in need of treatment and to
the provision of treatment; and it must be sufficiently flexible
to recognise that all drug users cannot necessarily be expected
to stop drug use at a stroke (paragraph 112 to 116).
It is important that Governors should match the penalty to
the severity of the offence and make full use of the wide range
of sanctions available. Adjudications have tended to rely on additional
days as punishment rather than the wider range of options available.
There may be more scope to use cautions for less serious offences.
Governors must also take into account the effect of the offence
on the regime and the general good order and discipline of a closed
community. The effects of cannabis misuse and the trade in it
on the prison community justify higher levels of punishment than
is common outside.
Work is in hand to provide further guidance on punishments
for drug offences in order to ensure greater consistency and proportionality.
40. There is a danger that instead of developing a
strategy which successfully targets hard drug use (and reduces
cannabis use in the process), a strategy is developing which successfully
targets cannabis use but leaves hard drug use virtually unchanged
(paragraph 117).
The Government does not accept the Committee's conclusions.
The fall in MDT positives reflects the effect of the previous
drug strategy. The Committee concluded its enquiry at the beginning
of a 3-year programme of work to implement the new drug strategy.
The Committee has no evidence on which to base its conclusion.
Deployment of security measures in prisons is based on a
rather different principle to community law enforcement agencies.
The objective is to deter the smuggling of all contraband—weapons,
currency, drugs, alcohol, other prohibited objects. Given that
cannabis is the predominant drug of misuse, it is inevitable that
it will be discovered proportionately on more occasions. That
does not mean prisons seek to target cannabis in a disproportionate
way.
Whilst the strategy targets hard drugs, different considerations
apply to the prison environment compared with the community. For
example, consumption of alcohol is prohibited in prisons. The
misuse of cannabis in a prisons environment can lead to bullying
and coercion and raises issues about good order in prisons.
41. We do not agree that cannabis use in prison should
be the subject of a policy of quasi-tolerance. We do however think
it right that the primary objective should be a reduction in the
use of hard drugs, and that the elements of the prison anti-drugs
strategy should reflect this (paragraph 121).
The Prison Service drug strategy seeks to discriminate between
more and less damaging drug misuse. However, turning a blind eye
to cannabis misuse would inevitably lead to an increase in use,
an increase in bullying and smuggling. It would undermine all
we are trying to do to encourage prisoners to turn away from drugs.
42. We think that further steps may be needed to ensure
that the new strategy impacts more powerfully on hard drug use
than cannabis use (paragraph 123).
MDT figures do not support the argument that the Prison Service
is focusing disproportionately on cannabis reduction. By its nature,
MDT exerts a greater deterrent effect on cannabis misusers owing
to its longer detection period in urine. New treatment and support
initiatives are designed to tackle opiate drug misuse.
43. We welcome the moves being taken towards greater
differentiation in punishment for use of cannabis and for use
of harder drugs . . . The automatic application of targeted frequent
testing on those who have tested positive for harder drugs (already
being introduced) should be combined with greater targeting of
such users for places on treatment and offending behaviour programmes
(paragraph 124).
Drug strategies of individual prisons must ensure that all
prisoners identified as drug misusers are offered appropriate
treatment. The expansion of treatment programmes will increase
the possibility of this happening.
44. Work on developing improvements in methods of
detecting drugs on visitors and addressing other modes of entry
for drugs must concentrate on harder drugs (paragraph 125).
The Government agrees that the priority is to tackle the
drugs that do the greatest harm. A discriminating approach enables
the Prison Service to concentrate its efforts on identifying those
with more serious problems and providing treatment services appropriate
to their needs. However, turning a blind eye to cannabis misuse
would send the wrong signals, lead to an increase in use, an increase
in bullying and smuggling, and undermine all we are trying to
do to encourage prisoners to turn away from drugs. A number of
the searching techniques deployed do not discriminate between
hard and soft drugs and incidents are therefore likely to be in
proportion to the pattern of drug misuse.
45. In the continuing process of identifying better
tests and testing procedures priority should be given to possible
developments which are more effective in respect of harder drugs
(paragraph 125).
Please see comment on Recommendation 44 above.
46. We recommend that the Key Performance Indicator
used for addressing drug abuse be recast in such a way as to give
greater emphasis to the fight against harder drugs; this could
be done either by setting a target for harder drugs alone, or
by setting a separate sub-target for harder drugs within the overall
target (paragraph 126).
The concept of separate KPI's by drug type is not straightforward
and is still under consideration.
The Prison Service is reviewing the data it provides to establishments/Area
Managers with the aim of providing more enhanced management information
reports which will provide a clearer focus on differential levels
of drug misuse.
47. Overall, we agree that the planned expansion in,
and overall design of, provision of treatment services under the
new strategy builds well on the foundations laid under the previous
strategy and represents a major step forward. It should in particular
reduce the inconsistency in provision around the prison system.
The Prison Service must take steps to ensure that this consistency
enables prisoner to maintain continuity in treatment across their
time in prison (paragraph 132).
The introduction of CARATs and increase in the number of
treatment programmes will allow prisoners' needs to be fully assessed.
If necessary, they will then be referred to an appropriate treatment
programme. The CARATs worker will have a continuing role in ensuring
a prisoner's needs are met throughout the period of custody and,
if necessary, for up to eight weeks post release.
48. We recognise that the sums made available under
the Comprehensive Spending Review were relatively generous in
public expenditure terms. Nevertheless, we cannot rule out the
possibility that time may yet prove that further sums are needed.
Certainly there will be a need for sustained funding beyond the
present CSR period (paragraph 135).
The Prison Service bid for and has been awarded a further
£88 million in 2001-04 to maintain existing services and
to meet recognised shortfalls in service provision. The funding
is needed to:
— Maintain CARATs in every prison and increase both
the number of prisoners dealt with and the quality of intervention.
— Maintain rehabilitation programmes in 43 prisons;
increase both the number of prisoners dealt with and the quality
of intervention; and provide six new programmes.
— Maintain therapeutic communities in eight prisons
and increase both the number of prisoners dealt with and the quality
of intervention.
— Maintain detoxification services in all remand
centres and local prisons, and increase throughput.
— Continue the MDT programme.
— Increase the number of prisoners on voluntary
testing compacts.
— Operate post-release hostels.
— Meet the additional costs arising from the introduction
of drug testing of arrestees.
— Meet the policy, monitoring and research costs
to support the strategy.
50. We welcome [the Government's stated intention
to commission independent research on the longer-term effectiveness
of UK prison treatment programmes], and call for the research
to be commissioned as soon as possible. In the meantime, we note
that the Prison Service's bid for funds for drug work beyond the
CSR period must be assessed against forecast results, and not
against conclusions drawn prematurely from existing outcomes (paragraph
136).
Although the priority so far has been to set up CARATs and
the new rehabilitation programmes, the Prison Service is committed
to using research to inform and develop its drug strategy. The
research strategy is now in place and work has been commissioned.
Four areas have been identified for study:
— The effectiveness of mandatory drug testing.
— The treatment needs of particular groups, eg juveniles,
young offenders, women and ethnic minorities.
— A comparison of different methods of treatment,
in terms of who they help, what help they provide and what impact
they achieve in reducing drug misuse and reoffending.
— Finally, the Prison Service needs to evaluate
the cost effectiveness of the strategy as a whole and its overall
impact on drug related crime.
The last piece of research is a major study which is likely
to take two or three years to complete. The other studies should
be shorter and findings could start to emerge as early as next
year.
52. We strongly endorse the need for any Prison Service
staff deployed to the new treatment programmes and services under
the new strategy to be properly trained and qualified. We recommend
that the training strategy currently being devised should include
the setting of minimum standards (or competencies) for such staff,
and that the training is externally audited (paragraph 141).
The Prison Service has already developed an induction course
for incoming drug workers, probation and prison staff linked directly
to CARATs and treatment programmes. The expansion of treatment
and support functions in prisons relies heavily on contracted
in drug workers from the community. It is particularly important
therefore for the Prison Service to liaise closely with community
providers in the development of core competencies. DrugScope is
currently consulting on an early draft of a series of core competencies
for drug workers and the Service is linked into that process.
The accreditation of treatment programmes is likely to include
the need to audit the training of staff involved in programme
delivery.
A training package is being developed in conjunction with
the revised Health Care Standard 8 to ensure that clinical staff
keep up to date with developments in clinical aspects of drug
treatment in the NHS.
All training will need to be ongoing to cater for new staff
involved in CARATs work.
54. We support the process of requiring accreditation
for drug treatment programmes in prisons. We would however be
surprised if courses recognised as successful in tackling drug
use were not able to gain accreditation. We call on the Prison
Service to consult closely with outside course providers on the
criteria on which accreditation should take place, before taking
action not to accredit any otherwise successful courses (paragraph
144).
All drug treatment programmes are required to achieve accreditation
with the Joint Prison/Probation Panel by March 2002. The panel
determines the criteria to be met. In addition, consultation is
taking place with the Panel to see if QuADS (Quality in Alcohol
and Drug Services) can be used as an interim prior to full accreditation.
The aim is to emulate the good practice of meeting recognised
minimum standards in programmes which are progressing towards
accreditation. The programme run by RAPt in seven prisons is provisionally
accredited and should gain full accreditation by October 2000.
Links will be made with Probation Services involved in the development
of Pathfinder Substance Misuse programmes in the community.
55. It seems that almost all observers have pointed
to a need for assessment procedures on induction to be improved,
through better exchange of information, through ensuring that
correctly trained staff and health professionals are available,
and through ensuring that procedures are such as to enable the
new prisoner to be confident that information he imparts will
be used for therapeutic rather than disciplinary purposes . .
. We recommend that it should be mandatory to subject all prisoners
on admission to dip tests for the more widely used hard drugs.
Prison and indeed probation provide a perfect opportunity to tackle
drug addiction and this can only be done if drug addicts are identified
as soon as they come into contact with the criminal justice system.
This can only be done by a system of 100 per cent testing. The
objective should be to ensure that all regular users of hard drugs
are identified on admission (paragraph 149).
The case for 100 per cent testing on arrival is not straightforward.
There are constraints in resources and pressure of numbers. I
am not convinced that dip and read testing of all prisoners on
reception represents the best use of available resources. Although
the testing process itself is fairly rapid, logistical difficulties
arise in obtaining urine samples. The initial assessment of the
CARAT process is designed to identify addicts on reception in
prisons and 100 per cent testing would duplicate this process.
CARATs' proactive liaison with external agencies such as health,
probation and community drug projects will ensure the provision
of more comprehensive information on drug users. The high profile
of CARATs amongst both prisoners and staff and the skills of CARATs
workers should encourage prisoners to feel more confident in acknowledging
their drug misuse problems.
56. Provision of appropriate prescription courses
for drug misusers is, quite correctly a matter ultimately for
clinical judgement; nevertheless it is clear there is continuing
dissatisfaction from qualified observers as to the lack of consistency
in present practice. We trust that the new strategy, through increased
availability of services, will enable some of the inconsistencies
to be removed, but the Prison Service needs also to review whether
further guidance needs to be prepared and distributed and whether
implementation needs to be more closely monitored (paragraph
152).
The Department of Health revised and re-issued its management
guidelines on the clinical management of substance misuse last
year. The Prison Service follows the same general treatment guidelines
and will re-issue its own standard shortly. Decisions about individual
cases are clinical matters for the judgement of the responsible
prison doctor. Compliance with the standard will be reviewed as
part of the Prison Service's normal audit procedures.
Clinical detoxification is available for opiates, alcohol
and benzodiazepine users. It is not usually necessary for cocaine,
amphetamines, LSD, ecstasy, cannabis or solvents. But the Prison
Service provides throughcare guidelines for use in the treatment
of misusers of these substances. Some 24,654 prisoners completed
drug detoxification courses in 1998-99; an increase of about 25
per cent on the previous year.
The Service is committed to providing good quality detoxification
services in all local prisons and those which hold remand prisoners.
At the end of April, 42 of these establishments provided full
detoxification services, 14 were partly operational and three
were yet to start.
58. We concur with the Prison Service's present position,
namely that at this stage disinfection materials should be provided
but not needle exchanges. This issue should be kept under review,
depending on evidence of prisoner behaviour and the prevalence
and spread of the relevant communicable diseases (paragraph
154).
The pilot project to make disinfecting tablets available
for cleaning illicit drug injecting equipment, established in
eleven selected prisons, was completed last year. The report and
recommendations of the team from the London School of Hygiene
and Tropical Medicine, which was asked to evaluate the project,
are currently under consideration.
The purpose of disinfecting tablets is to encourage the small
number of prisoners who persist in injecting in prison to clean
their equipment. This appears to have worked well in Scotland
for some years. The Scottish experience also suggests that where
injecting equipment is not cleaned there is a risk of serious
infection. Information leaflets and other material make it clear
that this is a risk reduction initiative but only abstinence
will eliminate risk.
The Prison Service has no plans to introduce needle exchange
schemes at present. The arguments in favour are outweighed by
the risk of increasing the number of needles in circulation and
undermining the need to deter and prevent drug misuse. However,
we are monitoring the operation of such schemes where they exist
in other prison systems.
59. Drug treatment in prisons has focused on longer-term
prisoners. The same attention needs to be paid to remand and short-term
prisoners. They are more likely to be in prison for drug-motivated
crime and treatment is more urgent because they will be released
sooner. They are the greatest challenge if the cycle of addiction,
crime and imprisonment are to be broken. We recommend that the
Prison Service should make more drug rehabilitation programmes
available to remand and short-term prisoners beyond what is currently
envisaged under the CARAT service. We commend the suggestion of
the Magistrates' Association that short-term custodial sentences
for drug-related crimes should be combined with a requirement
to receive treatment in the community on release (paragraph
159).
The Government shares the Committee's view about the importance
of treatment for remand and short-term prisoners. There is however
a limit to what can be provided in prison. Rehabilitation programmes
are typically of three months duration. For many of these prisoners
there is insufficient time to deliver a recognised treatment programme.
If these people are to be helped, it is vital that community drug
agencies are willing and able to accept them immediately on release.
CARATs has a key role to play in assessing the prisoner's needs
and arranging with a community drug agency for care to continue
after release.
61. If a VTU is not run effectively, so that drug
use is not identified and dealt with, and at the same time there
are non-drug related incentives for going on to a VTU, then there
is a risk that the VTU will attract drug users who will negate
the benefit of the VTU for those genuinely seeking to remain drug-free.
Access to a VTU should not therefore be directly linked to the
"enhanced" level of privileges unless the prison authorities
have satisfied themselves that its procedures are robust enough
to identify drug users (paragraph 166).
Access to a VTU will be the subject of a robust admissions
process with residency dependant on continued good behaviour.
The behaviour required of a prisoner resident in a voluntary testing
unit is equivalent at least to the standard level defined under
the incentives and privileges scheme.
Access to a VTU will not be linked directly to the enhanced
level of privileges which would have the effect of excluding prisoners
who would otherwise benefit from residency.
62. It is clearly of vital importance for the effectiveness
of the rest of the strategy that aftercare for prisoners is more
than just an afterthought. The extension of a limited form of
support, in the form of continued contact with the CARAT Service
in prisons for up to 8 weeks following release, is a move in the
right direction, and the stronger links envisaged between prisons,
probation services and Drug Action Teams should also be beneficial
. . . The Prison Service must establish procedures for the effective
monitoring of how the new strategy is performing in this area,
and be ready to take the steps necessary to address any deficiencies.
The ultimate target must be that there is an automatic right of
referral to a place on a relevant programme in the released prisoner's
home area, and that, where appropriate, contact has been made
between the prisoner and that programme before release (paragraph
171).
CARATs has not yet been running long enough to draw any conclusions
about its effectiveness. However, unless treatment is maintained
in the community for appropriate cases there is an increased risk
of relapse, with offenders returning to crime and prison.
The Prison Service cannot increase the number of community
agencies or compel them to accept ex-offenders. Moreover, it was
a condition of the additional CSR funding received by the Prison
Service that the money could not be spent outside prisons on community
services.
The Prison Service is working with Drug Action Teams to identify
deficiencies in local provision.
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