Examination of Witnesses (Questions 100-119)
MR
JOHN GIEVE
CB, MR MARTIN
NAREY AND
MR WILLIAM
NYE
15 JULY 2003
Q100 David Winnick: If I can turn
briefly to prison health care, how far would you say prison health
care falls below general NHS care?
Mr Narey: I think acute care,
the typical care that you or I would get from a GP, is now pretty
much matched in most prisons. In 1999 the Department of Health
helped me do some work which estimated that there were 19 health
care centres whose levels of treatment were simply unacceptable
and we have reduced that year on year and that figure is now zero.
In terms of access to a nurse or a doctor if someone feels ill
in a morning, I think that care is quite good, and I think secondary
acute care in hospitals is good. We are still struggling desperately
to care adequately for the mentally ill and the number of prisoners
who are suffering from severe or profound mental illness are now
more than 5,000. Although as Director-General I had the benefit
of about 300 psychiatric nurses from the NHS coming to work in
prisons, it is still an upward struggle. The Prison Service are
caring for people who would have been cared for in long term psychiatric
prisons before care in the community was introduced in the late
eighties.
Q101 David Winnick: One way of not
improving your health is by taking drugs in prison or outside.
We were told at one stage in a previous inquiry that in every
prison there are drug tzars. This was about two or three years
ago. Would you say it was the same situation now?
Mr Narey: I do not agree that
there are drug tzars as such in most prisons. I know that
David Ramsbotham made that comment and the then Minister, George
Howarth, disputed it. There are clearly prisoners trading in drugs
but the term "drug tzar" suggests that there are the
equivalents of Harry Grout from the Porridge series prevailing
over the prison, which is not the case.
Q102 David Winnick: It is the word
"tzar" that you are unhappy about?
Mr Narey: It has connotations
that it is somehow out of control.
Q103 David Winnick: Drug barons or
just drug criminals?
Mr Narey: There are people dealing
in drugs, certainly, but levels of drug abuse in prisons have
more than halved over the last three or four years. Instead of
four treatment programmes four years ago there are now 60 and
there is some very firm research from the introductory drug treatment
programmes, such as the RAPT programmes which you will remember,
Miss Widdecombe, that the re-conviction rate of graduates from
those programmes is 20% down after one year of freedom.
Q104 David Winnick: If I can go back
to the question, would you accept that in most of our major prisons,
if not all, there are drug criminals who are actively involved
in drugs?
Mr Narey: Oh yes, I would, Mr
Winnick, undoubtedly.
Q105 David Winnick: You would accept
that?
Mr Narey: Yes.
Q106 David Winnick: On the question
of the possible merger of the Prison and Probation Services, has
any conclusion been reached by ministers?
Mr Narey: No. In fact, it is not
a subject which ministers have yet discussed. There was an article
in The Times recently which suggested that I said that
this was something under consideration. What I said was that that
was a possibility for the future. My new job working for ministers
is to try to bring the Prison and Probation Services closer together
to get a better premium in terms of reduced re-offending. One
option for the future may be a merged service but that is not
something which I have had any discussions with ministers about
at all. It is not something which they have given thought to.
Q107 Chairman: On the health issue,
can you remind me, Mr Narey, who inspects the quality of prison
health services?
Mr Narey: The Inspectorate of
Prisons, who have health specialists as part of their team and
visit every prison.
Q108 Chairman: What is the logic
for prison health services if they are funded by the NHS not being
inspected by the Commission for Health Improvement or the successor
that will shortly come into place?
Mr Narey: The Commission for Health
Improvement are now working very closely with the Inspectorate
of Prisons but my view is that the Inspectorate of Prisons has
a particular expertise on measuring health care within the difficulties
of a penal setting and are working closely with CHI in doing that.
Q109 Chairman: If somebody has a
mental health problem they have a right to the same quality of
treatment if they are in prison as they would if they were in
the community or, indeed, if they are sectioned. Should they not
be inspected by the same people to the same standard?
Mr Narey: I think the important
point is that they are inspected adequately and thoroughly and
critically and they are certainly inspected to that regard at
the moment by the current Chief Inspector and her staff.
Q110 Chairman: Why not use the same
body?
Mr Narey: Because Ann Owers is
using the same people. She is using health professionals as part
of her team. She goes in and looks at every part of the prison
and she does that for health in co-operation with CHI, for education
in co-operation with the Adult Learning Inspectorate and so forth.
Every prison gets an inspection of everything and every activity
which is taking place rather than inspections taking place on
a fragmented basis.
Q111 Chairman: When was the last
report specifically on the quality of mental health provision
in prison hospitals?
Mr Narey: There has not been a
thematic report of that nature that I recall but the care of the
mentally ill in prison is commented on in a large number of Ann
Owers' reports.
Q112 Chairman: So, despite the fact
that there are 5,000 prisoners with significant mental health
problems, there has not actually been a thematic inspection of
the quality of mental health provision in prisons?
Mr Narey: No, there has not.
Q113 Mrs Dean: Before I move on to
the Criminal Records Bureau can I ask whether the Health Service
within private prisons operates in the same way as it does in
public prisons?
Mr Narey: The responsibility of
the unit in the Department of Health covers all prisons, public
and private. What we have been doing with public sector prisons
is transferring responsibility to Primary Care Trusts and getting
them to take responsibility for their local prison. We are moving
to that with private prisons as well. Some at the moment have
contract-out facilities with private companies and it will take
some time for contracts to be amended, but I think it is vital
that we make sure that the local community takes responsibility
for the health care of people in custody within that community.
Q114 Mrs Dean: Moving on to the Criminal
Records Bureau, do you think it is right that bodies such as care
homes, some of which are in the voluntary sector, having waited
to apply to the Criminal Records Bureau for their staff, should
then be penalised by the increase in the amount they are charged
by the Criminal Records Bureau?
Mr Gieve: I think it is legitimate
for them to pay the new charges, yes, and that is what we intend.
Q115 Mrs Dean: Even though they have
co-operated with the Criminal Records Bureau by delaying the application
for staff already employed by them?
Mr Gieve: Yes. The position is,
as you know, that the Criminal Records Bureau started in a fairly
disastrous way. It could not deal with the volume of requests
for clearance. The costs of providing the service have proved
very much higher than expected and we have had to make a choice
as to how to meet that additional cost. What we have decided is
to increase the charges although also to continue the subsidy
for another two years from the Department for Education, the Department
of Health and the Home Office. It is not desirable. Of course,
it would be much better to offer the service more cheaply but
that is the situation we face.
Q116 Mrs Dean: I understand the philosophy
of the need to charge sufficient to cover the cost of the service
but I am concerned about those who have been asked to delay applications
in order for the service to get established and who then find
themselves having to pay twice the amount that they were going
to have to pay had they not co-operated and put their requests
in earlier.
Mr Gieve: I agree. I sympathise
with that concern. We did not delay them so that we could charge
them more. We delayed them because we could not handle the volume
of applications. If we now said, "This sector can have last
year's prices", we would have to make up the shortfall somewhere
else, either by putting up the prices to other applicants or by
increasing the subsidy from central budgets, and all of those
have opportunity costs. I can well understand that this sector
will feel hard done by but I do not think there is a fairer way.
Q117 Mrs Dean: Do you anticipate
the disclosure fees of the Criminal Records Bureau rising again
before the Bureau becomes self-financing?
Mr Gieve: I do not want to make
any promises on this but we are hoping that these fees will be
sufficient certainly for the next year. As you know, we have got
the Criminal Records Bureau back on to an even keel in that they
have reduced the backlog to small levels, they are dealing with
cases as they come in. We still have to re-negotiate our contract
with the private sector partner. Those negotiations are still
ongoing and it is not clear yet how much extra investment will
be required to move the service forward, so I cannot make a complete
promise on this but we have calculated these fees as our best
estimates of what is needed.
Q118 Mrs Dean: When will Capita be
able to pay the Home Office the penalties incurred against the
contract?
Mr Gieve: We have already withheld
payment over the year or so that it has been running, so it is
not a question of paying back. It is a question of withholding
service credits and some damages.
Q119 Mrs Dean: So is there any outstanding
money owed to the Home Office?
Mr Gieve: I do not think so. The
contract provides for certain service performance and for the
reduction of payments if that is not met and it has not been met
and we have made reductions. I do not think there is any further
bill.
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