Select Committee on Home Affairs Third Special Report



Headline figures 1 April to 31 March 2000

Total 1st
Total 2nd
Total 3rd
Total 4th
Number of incidents
No. of visitors involved in suspicious actions
Number of visitors banned
No. of decisions not to ban a visitor
No. of decisions to ban a visitor for less than three months*
No. of visitors made subject to closed visits instead of ban
No. of visitors made subject to closed visits following a ban
No. of visitors not banned and not made subject to closed visits
No. of prisoners made subject to closed visits
No. of prisoners found guilty at adjudication of offences involving drug smuggling through visits

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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