House of Commons - Home Affairs

Select Committee on Home Affairs Written Evidence

CHAPTER 3 REHABILITATION AND RESETTLEMENT

3.1 TACKLING DRUG RELATED OFFENDING

I. Contextual Overview

Prevalence of drugs misuse

3.1.1 Provision of drug rehabilitation programmes—as well as delivery of the wider drug interventions that benefit offenders—needs to be seen against the backdrop of the number of problematic drug-misusers be (PDMs) being received into custody. Whilst published data—such as that from the Criminality Survey and Office for National Statistics—show between 40% and 55% of new receptions to be PDMs, indicative feedback shows some prisons reporting up to 80% testing positive for opiates on reception. The Prison Service has the greatest concentration of PDMs present in one place at one time either in the healthcare or criminal justice systems—with around 39,000 drug-dependent offenders present at any given time.

3.1.2 The Service is necessarily tasked with addressing the needs of individuals who are both dysfunctional and often incapable of engaging effectively with others. Effective delivery of drug interventions is, therefore, key—until offenders' drug-dependence can be broken, less scope exists for them to engage effectively with the wider rehabilitation programmes that, collectively, can help them lead law-abiding lives on release. It is important to remember, however, that the link between drugs misuse and crime is more complex than is often assumed—with the two behaviours often co-existing and amplifying one another, rather than drugs misuse alone being the cause of other criminality.

Provision of drug treatment

Drug Strategy

3.1.3 The Service's Drug Strategy, introduced in 1998 and updated in line with the Government's national drug strategy in 2002, has a dual focus—reducing supply (through security measures and drug testing programmes) and demand (through a comprehensive range of interventions that target the needs of low, moderate and severe drug-misusing prisoners).

Drug interventions

3.1.4 Drug rehabilitation programmes and drug Therapeutic Communities (TCs) are only one element of a raft of measures designed to address PDMs' needs. Rehabilitation programmes are not necessarily always the most suitable response—rather, the key requirement is to draw up individual Care Plans that are supported by structured treatment matched to individual need and strong community links to throughcare and aftercare. Treatment delivery is structured in a way consistent with the National Treatment Agency (NTA) Models of Care.

3.1.5 The Service continues to offer PDMs a wide range of drug interventions—underpinned by a number of auditable and external quality standards—that are at least comparable to treatment provided in the community:

— detoxification: available in all local and remand prisons;

— intensive drug treatment programmes—rehabilitation programmes and hierarchical Therapeutic Communities (TCs), the latter designed to meet the needs of those with the most severe drugs misuse problems and related offending behaviour: the number of sites providing such programmes has increased from nine (1996-97) to 60 (2002-03), which comprise 40 cognitive behavioural treatment programmes, 15 "12-Step" programmes and five TCs.

3.1.6 Prison-based drug interventions are intended to be a platform for the longer-term work needed in the community. Key to their success, therefore, are effective throughcare links that enable PDMs' drug treatment to be continuous on release back into the community and that, together with wider elements of aftercare such as housing and employment initiatives, will collectively contribute to reducing overall levels of re-offending.

Throughcare and aftercare

3.1.7 It has not always proved straightforward to put effective throughcare arrangements in place. Part of the CARATs intervention includes pre-release planning, providing offenders with harm-minimisation advice and, where needed, because links to community treatment cannot always immediately be made, offering offenders, where practicable, a degree of support for up to eight weeks post-release. This latter element of CARATs, never planned as more than a "safety-net", has not always worked as well as intended; it was certainly never meant as a substitute for engagement with community treatment providers. Additionally, prisoners' widespread release patterns, their failure to keep community treatment appointments, and the lack of consistency in provision of treatment in the community for ex-offenders in some areas have all rendered effective throughcare difficult to achieve in many cases.

Criminal Justice Interventions Programme

3.1.8 In response to these challenges, and to strengthen throughcare and aftercare links more generally, the Government has introduced the Criminal Justice Interventions Programme (CJIP), a Home Office-led initiative that aims to channel PDMs into drug treatment at all stages of the criminal justice system (CJS) and to keep them in treatment as long as necessary. CJIP provides the mechanism for much-improved delivery of drug services to PDMs across the CJS. Initially, it is being targeted at the 25 Drug Action Team areas with the highest levels of acquisitive crime. Further information is included in briefing from Home Office CJIP team attached in an annex at the back of this memorandum.

II. Areas of Specific Interest

Adequacy of provision

3.1.9 In terms of the coverage provided by the Service's Drug Strategy, the aim is to meet the wide-ranging needs of low, moderate and severe PDMs. In addition to drug rehabilitation programmes and drug TCs, PDMs benefit from detoxification and CARATs, as well as a range of mandatory and voluntary drug testing programmes that help identify those PDMs that need specific, targeted drug interventions.

3.1.10 Numerically, the Service is resourced to provide 5,700 intensive drug rehabilitation places by March 2004; this figure will rise to 7,644 by March 2006, on the back of SR2002 funding. In the absence currently of centrally defined needs-analysis data, local drugs misuse treatment need is determined operationally by Area Drug Co-ordinators, who allocate available resources in line with the overarching Drug Strategy's aims. Research on needs is under consideration to help inform future Spending Reviews and the allocation of treatment resources.

3.1.11 The Service recognises that more needs to be done to meet the potential treatment need that exists, in line with the Prime Minister's statement to the House of Commons on 4 December 2002 that a "huge unmet need" exists not just in prison but also in the community as a whole. There were 4,386 entrants to intensive drug treatment programmes in 2002-03. There has been some slippage in meeting the current year's target of 5,700 entrants and the Service is working hard to extend existing drug treatment capacity by:

— introducing measures to improve the efficiency of existing programmes;

— converting some existing OBP capacity to delivery of accredited drug treatment programmes;

— considering the scope for enhancing accredited general offending behaviour programmes to make them more effective for PDMs; and

— developing a drug treatment programme specifically for "short-term" prisoners (covered in detail below).

Accredited drug treatment programmes and programmes in development

3.1.12 The following drug treatment programmes have been accredited by the Correctional Services Accreditation Panel:

— P-ASRO—running in 11 establishments.

— Focus CBT—running in five establishments.

— Prison "12-step"—running in four establishments.

— Drug therapeutic communities—running at four establishments.

— Lee Community.

3.1.13 The following programmes are in the development portfolio seeking accreditation:

— Gartree programme—running at HMP Gartree.

— Kent programme—running in five establishments.

— A programme for women prisoners running at four establishments.

— A programme for juveniles running at HMP & YOI Warren Hill.

Effectiveness in reducing re-offending

3.1.14 There is increasing evidence that the Service's Drug Strategy is proving successful overall in reducing levels of drugs misuse within custody, as well as re-offending rates post-release:

— the overall level of drugs misuse, as measured by the Mandatory Drug Testing programme, has halved—from 24.4% (1996-97) to 11.7% (2002-03). Opiates' positives have declined by over 20% from 4.6% (2001-02) to 3.6% (2002-03)—the lowest annual rate ever recorded;

3.1.15 Further information on the effectiveness of prison-based drug interventions in reducing levels of re-offending is included in briefing from the Home Office's Research, Development and Statistics Branch. This is attached in an annex at the back of this memorandum.

Programmes aimed at "vulnerable and difficult groups"

"Short-term" prisoners

3.1.16 Time spent on remand, taken alongside reductions in custodial time as a result of Home Detention Curfew arrangements, can mean that PDMs sentenced to two years or less will be in prison for too short a time to engage with intensive drug treatment programmes. The needs of such PDMs has, so far, primarily been met through engagement with CARATs teams and by undergoing detoxification.

3.1.17 However, the Service has accepted recommendations made by the National Audit Office and the Public Accounts Committee that the "stage army" of short-term prisoners needs addressing more effectively. To this end, the Service successfully bid for SR2002 funding to develop a low-intensity Short Duration Drug Treatment programme that can be targeted at "short-termers" as well as those offenders nearing release after a long period in custody. A generic model—being devised in accordance with CSAP requirements—is on target to be ready around the start of 2004. In the meantime, some prisons have developed a range of short non-accredited programmes specifically to meet this need.

Diverse needs

Women, young offenders & black and minority ethnic prisoners

3.1.18 The Service is also progressing work to meet the diverse needs of women, young offenders and Black and Minority Ethnic (BME) prisoners. Both detoxification and CARATs are flexible and based on individual need and, as such, can address many diversity issues. The Service is conscious that CARATs is perceived predominantly as an opiate service, although many CARATs workers are trained to deal with crack and other stimulants. The Service is working closely with colleagues in the NTA to improve treatment for crack-cocaine misusers and work will commence shortly on a prison-specific Crack Intervention package.

3.1.19 The ongoing CARATs Review is also addressing diversity and the Practice Manual will include chapters on working with women and young offenders. The Service remains aware of the need to provide more intensive drug treatment programmes for women and it is, therefore, currently piloting an adapted P-ASRO programme at Low Newton. If successful, this could be rolled out more widely across the female estate.

3.1.20 The Service's Drug Strategy Unit has also commissioned a major piece of work from the Centre for Ethnicity and Health at the University of Central Lancashire. This work will examine access to prison drug treatment by BME prisoners, identify barriers and recommend practical steps to improve access. The aforementioned work on crack will also help to address the needs of BME prisoners.

Compulsory drug treatment

3.1.21 There is a growing debate about the merits of compulsory drug treatment. At present, compulsory treatment is available only under the provisions of the Mental Health Act. Compulsory clinical treatment would be in breach of medical ethics.

3.1.22 There is a widely held view that psychosocial interventions available for drug misusers are only effective when individuals are ready for change and are, therefore, receptive to support. In any event, there would be a high risk of individuals who had not volunteered disrupting the smooth running of programmes and group work sessions, thereby reducing their effectiveness for those drug misusers willing to engage.

3.1.23 There is, however, a distinction to be drawn between compulsory and coercive treatment. Prison provides the opportunity to incentivise participation in treatment; a key incentive is provided by the reduced availability of drugs. It is important that the Service continues to maximise all opportunities to engage drug misusers in treatment.

III. NATIONAL PROBATION SERVICE WORK IN TACKLING DRUG RELATED OFFENDING

3.1.24 The link between problem drug misuse and offending is now well established. By some estimates, for example, around 80% of the prison population and 52% of persistent offenders (applying the national definition) have misused or are misusing illicit drugs. Equally, however, there is good research to show that drug treatment also works.

Achievements so far

3.1.25 Achievements so far are:

— NPS and the Prison Service are undertaking a joint project to develop a comprehensive resettlement strategy for short-term prisoners who have had substance misuse problems. The project (known as Prospects) involves contact with the offender during the custodial component of the sentence, followed by a post release programme in approved accommodation and then supported move on to independent living. Five pilot sites have been identified and funding has been secured.

— NPS has supported the CJIP programme and will continue to be a key player as this initiative is rolled out nationally.

Proposed work

3.1.26 Proposed work includes:

— NPS, as part of the Home Office Criminal Justice Intervention Programme (CJIP), is working with the Prison CARATs service and community providers to pilot new casework management and integrated throughcare and aftercare provisions. This will initially be in the 30 high crime BCUs in 2003-04, and will subsequently roll out nationally.

— NPS will introduce the drug testing requirement for post custodial licences according to a timetable agreed by Ministers and subject to Parliamentary approval for the Criminal Justice Bill. This will build on offender progress to become drug free during the custodial component of the sentence. Where there is relapse into drug use, NPS will assist the offender into suitable treatment.

— NPS will work with the National Treatment Agency, to research and develop treatment programmes to meet the needs of crack cocaine and other stimulant misusing offenders.

— NPS will continue to manage the development of the Prospects project and ensure evaluation informs any expansion to the national pilots.

3.2 TACKLING ALCOHOL RELATED OFFENDING

3.2.1 The Government's main focus continues to be on tackling drugs misuse. Conscious that more needs to be done to provide support to prisoners with an alcohol problem, the Prison Service is currently preparing an alcohol strategy, which is expected to be finalised by December 2003.

3.2.2 In the absence of additional funding to boost treatment for those with an alcohol problem, the main thrust of the alcohol strategy will be on ensuring consistency of approach and spreading good practice.

3.2.3 To date, alcohol services have developed locally in prisons on an ad hoc basis, dependent not least on the availability of funding:

— detoxification is available on reception to all who need it;

— some prisons run alcohol awareness courses;

— those for whom alcohol is part of a wider problem of poly-substance misuse are eligible for support from drug treatment interventions;

— Alcoholics Anonymous (AA) run services in around 50% of prisons but with varying degrees of frequency. When prisoners engage with AA, good opportunities for aftercare are also provided; and

— more intensive courses are run in nine prisons, with the majority of courses meeting the standards for Tier 2 of the National Treatment Agency Models of Care.

3.2.4 Alcohol is a problem for a significant number of those entering prison—a study conducted by the Office for National Statistics reported that 63% of sentenced males (37% of women) were classed as hazardous drinkers. The Prison Service is fully committed to doing more when resources allow.

3.2.5 To complement the work being done by the Prison Service on the control of alcohol and treatment for alcohol misuse in a custodial setting, the National Probation Service is also developing an alcohol strategy. This will include work with the health and voluntary sector to deliver interventions for alcohol misusing offenders, including the accredited substance misuse programmes (ASRO, PRISM) and OSAPP, for which accreditation will be sought. The suite of interventions available, however, is neither comprehensive nor fully tested.

3.3 LEARNING AND SKILLS

3.3.1 We know that the majority of offenders have low basic skills, few qualifications and unproductive prior educational experience:

— 52% of male and 71% of female adult prisoners have no qualifications at all;

— half of all prisoners screened on reception are at or below level 1 in reading, two-thirds in numeracy and four-fifths in writing. Level 1 is what is expected from an 11 year old;

— 30% of all prisoners have been regular truants;

— almost four out of five young prisoners have been temporarily or permanently excluded from school; with at least 6 months' education lost in nearly half of all cases; and

— 89% of male prisoners and 84% of women prisoners have left school at 15 or 16, compared to just 32% of the general population.

3.3.2 At the same time, research makes a link between repeated criminal offences and poor literacy skills. It has shown the benefits of learning in supporting successful resettlement and rehabilitation, in its own right and as a route into stable employment following release from custody.

3.3.3 Considerable progress has been made in recent years. For example:

— in 2002-03, nearly 100,000 screening tests were carried out to identify possible weaknesses in prisoners' literacy, language and/or numeracy skills;

— in 2002-03 prisoners gained over 41,500 basic skills qualifications, and over 89,000 work skills qualifications; and

— in the period April to August 2003, prisoners have achieved 20,216 basic skills qualifications and 43,037 work skills qualifications.

3.3.4 In addition:

— funding for education in prisons was ring-fenced for the first time from 2001-02 and transferred to the Department for Education and Skills. Funding for dedicated vocational training was similarly ring-fenced and transferred from 2003-04; and

— substantial additional investment is being made available to support learning and skills provision in prisons:

2003-04<nt2004-05<nt2005-06<et£97 million<nt£122 million<nt£137 million<et

3.3.5 Most of this expenditure will fund new Prison Service contracts for the delivery of learning and skills. Other specific areas of spending include:

— capital expenditure to improve equipment and build capacity;

— the appointment of Heads of Learning and Skills for all prisons;

— ICT;

— a Standards Fund targeted on improving delivery; and

— enhanced advice and guidance services for young people in juvenile establishments.

3.3.6 The Offenders Learning and Skills Unit in DfES co-ordinates the development and delivery of change, working in partnership with the Home Office, Prison Service, National Probation Service, Youth Justice Board, Learning and Skills Council and others. It also supports improvement at individual establishments. As well as focusing on prisons, this partnership is now undertaking planning and development work prior to DfES assuming, in April 2004, policy for and funding of learning and skills provision for offenders in the community.

3.3.7 The vision governing Government policy on learning and skills in prison, as well as for offenders in the community, is:

"Our aim is to deliver substantial improvements in learning and skills opportunities for offenders, both in prisons and in the community, so that they are less likely to re-offend and have a better chance of moving into jobs and playing a positive role in society."

3.3.8 As work towards realising this vision proceeds, learning, in addition to supporting the Home Office reducing reconvictions target and its development of a national rehabilitation strategy, will contribute to and benefit from the DfES:

— Skills for Life strategy to improve adult literacy, numeracy and, now, ICT skills;

— Skills Strategy published in July; and

— Success for All strategy whose objectives around meeting needs, teaching and learning leadership, and quality and success apply in prisons and for offenders more generally, as they do in other learning and skills sectors.

3.3.9 The management and organisation of learning and skills provision in prisons now has a single champion in every establishment in the person of the Heads of Learning and Skills. These key posts will enable establishments to make progress across a number of areas in which they have generally been weak:

— bringing together colleagues from across the prison to ensure that learning opportunities are maximised in all parts of the regime;

— ensuring that this partnership, supported by comprehensive and routine self-assessment, is reflected in 3-year development plans reviewed and rolled forward annually;

— ensuring the existence and implementation of a quality assurance framework for learning and skills in the establishment; and

— promoting a transformational change in delivery practice that takes account of prisoners' needs and offers a wide range of methods to encourage and maintain participation.

3.3.10 New contracts, which reward outputs and achievements rather than paying for inputs, will be in place from September 2004 and will support wider objectives. The delivery specification and its detailed requirements focus on the journey which prisoners will take to improve their personal level of learning and skills, including actively supporting prisoners' transition into continuing learning after release.

3.3.11 The outset of that journey will be reflected by requirements around:

— information, advice and guidance to inform the choice of learning programme and provide continuous guidance throughout prisoners' learning;

— individual assessments, to inform the content and delivery of the learning programme: this will address issues around dyslexia and other learning difficulties and/or disabilities; and

— individual learning plans for prisoners.

3.3.12 There will be a major delivery focus on:

— continuing to provide literacy, language and numeracy provision which meets the requirements of the national Skills for Life strategy;

— implementing national ICT standards following the decision announced in 21st Century Skills that ICT should become the third skill for life;

— developing work-related learning so that it becomes more labour market-relevant, and better able to provide learners with the job skills and qualifications that will enhance their prospects of gaining meaningful employment on release;

— exploiting the contribution which the arts, personal and social skills development and other subjects can make to support prisoners' learning objectives; and

— developing distance learning, resource-based learning and e-learning insofar as it is practicable to do so.

3.3.13 Preparation for release and resettlement requires different areas in prisons to work together and with external statutory and voluntary organisations. Continuity of learning is important now, and will become more so as sentencing policy moves towards a different balance of time spent in prison and the community. Specifically, the Government is providing funds to support:

— up to 600 day-release enrolments for male category D prisoners and their female counterparts in England to take up learning opportunities in the community, particularly vocational training places; and

— greater partnership between the Youth Justice Board and the Connexions Service to target extra resources at brokering access to suitable community learning and skills provision for young offenders.

Information, advice and guidance

3.3.14 Work is in hand to join together the efforts of different public services, including Prison Service and Probation Service and bodies responsible for the provision of information and advice about learning and work. The aim is to develop a strategy as the basis for a more coherent service to offenders in prison and in the community by providing them with essential information to help plan learning during their sentence and to help gain work or go on to further learning at the end of sentence.

Learning and skills for offenders released on probation

3.3.15 Ministers have asked the Department for Education and Skills (DfES), in partnership with the National Probation Service (NPS) and the Learning and Skills Council (LSC), to develop a new strategy and organisational model for probation education and training in England and Wales, with appropriate targets, for operation from April 2004.

3.3.16 To support this development the current running and programme cost funding for NPS-organised basic skills education will transfer to DfES. In addition there will be an extra £10 million a year from April 2004 to extend these programmes. The LSC will assume responsibility for the funding and planning of learning programmes for offenders under supervision from April 2004. The NPS will retain a key role in identifying and referring offenders; and targets for referral and learning outcomes will be shared between the DfES, LSC and NPS.

3.4 RESETTLEMENT/CUSTODY TO WORK

3.4.1 Prisoners are less likely to re-offend if they get and keep a job on release and if they have stable accommodation. The Prison Service Custody to Work initiative is tackling this agenda.

3.4.2 There are three main strands to this work:

— bringing together what the Prison Service is doing to make prisoners more employable by addressing basic skills, vocational training, prison work, drugs, offending behaviour and motivational programmes;

— connecting more prisoners with jobs or training places and accommodation on release by closer joint working with employers, Jobcentre Plus, housing providers and the voluntary sector. With employers and with the help of the CBI and others, we are focusing particularly on sectors with feasible job opportunities like construction, utilities, catering, industrial cleaning and transport; and

— connecting unemployed prisoners on release with the employment, training and benefits advice and support available from their local Jobcentre through the FRESHSTART initiative.

3.4.3 A major survey of prisoners about to be discharged, conducted in December 2001, showed 24% with a job to go to. A further 6% were released to a training or education place.

3.4.4 Much earlier research had suggested a baseline of 10% with a job to go to, which the Prison Service committed in September 2000 to doubling. The commitment was therefore discharged, although it is now clear that the 10% baseline considerably underestimated the September 2000 reality.

3.4.5 The Resettlement KPI target for 2002-03 was that 28,200 prisoners should get employment, training or education (ETE) places after release. A further major resettlement survey was conducted in April 2003, on a comparable basis to the 2001 survey, which again showed 30% of prisoners with an ETE place on release. The estimated outcome for the year, extrapolating from the survey findings, was 32,992, 17% more than the target. 14,173 unemployed prisoners attended a FRESHSTART interview at their local Jobcentre on release, scoring half a point each towards the target, to help incentivise this joint initiative. Previous outcomes from work with the Employment Service were reflected in the KPI baseline, to enable the FRESHSTART initiative to be counted against the target.

3.4.6 This represents a significant step up in the Prison Service's work to connect released prisoners with the job opportunities and the employment and benefits advice and support available through Jobcentre Plus. Work is underway to improve the tracking of FRESHSTART outcomes through the Working Age database. However, from the information available for April-October 2002, 14% of attendees found work within 13 weeks of discharge compared with 8% of non-attendees. Others were helped into the New Deal or other training places and connected with appropriate benefits advice and support.

3.4.7 We are aiming to consolidate this encouraging start with a target of 31,500 employment, training or education outcomes for released prisoners in 2003-04. This represents a 5,000 increase over two years on the 2001-02 baseline from the December 2001 resettlement survey. A further survey will be conducted in April 2004.

3.4.8 The Prison Service is investing an additional £14.5 million a year from April 2003 in the Custody to Work initiative. The extra resources have been allocated to Area and Operational Managers, and are being invested by them in their Resettlement or Custody to Work Strategy to deliver their Area or Functional Estate target under the Resettlement KPI. The new services being developed with this money include more accredited skills training, alongside new investment from DfES; job search training and support; through-the-gate job placement; and housing advice and support services. Examples of practice in these areas are summarised in the Custody to Work Practice Framework, which enables establishments to learn from others' experience.

3.4.9 The Prison Service partnership with Jobcentre Plus is central to the approach. It includes:

— FRESHSTART, the investment by Jobcentre Plus of £1 million a year to strengthen its links with prisons and ensure that all released prisoners who need one have a New Jobseekers Interview at their local Jobcentre arranged for discharge to help them return to the labour market.

— Jobcentre Plus surgeries, now being rolled out across the prison estate to provide employment and benefits advice and support at induction and pre-release. Jobcentre Plus is investing £4.5 million a year in these surgeries across Great Britain.

— Progress2work and LinkUp, targeted investment by Jobcentre Plus over three years to help those with a history of drug misuse and other hardest to help groups into the labour market. Ex-prisoners are a key focus of this.

— The piloting in eight prisons of the new Jobpoints and Worktrain, giving prisoners electronic access to information on job vacancies and training places across the country. Jobpoints will be introduced in a further 10 prisons from April 2004.

— Action Teams for Jobs providing focused employment help and support in areas of the country where these are most needed.

— Targeted initiatives like "Ambition Construction" and "Ambition Energy", helping us meet the employment needs of specific sectors.

3.4.10 We also have a substantial agenda of action in hand to help deliver stable housing for released prisoners. This includes:

— statutory changes—in the Homelessness Act 2002 and an Order under the Housing Act 1996—to underpin the importance of this in local authority decision-making;

— the development of prison-based housing advice and support services, drawing on the experience of prison projects originally developed with the Rough Sleepers Unit. A NACRO good practice guide has been produced from these and other examples. Around 50 establishments now operate some form of housing advice and support service. Some of the Custody to Work investment is being used to develop these services;

— the development in some areas of regional and local links between prisons and housing authorities and other housing providers to develop this strand in homelessness strategies and negotiate practical solutions to released prisoners' housing needs in individual cases; and

— the Supporting People programme which, from April 2003, is pulling together the planning and development of all supported housing.

3.4.11 In the resettlement survey conducted in April 2003, 71% of prisoners had accommodation arranged for their release, compared to 67% in the survey conducted in December 2001.

Resettlement estate

3.4.12 The resettlement estate caters for the resettlement needs of prisoners who have received longer sentences, including life sentence prisoners preparing for release. In particular, it provides opportunities for prisoners meeting the risk assessment and other criteria to undertake community placements and paid work on day release on licence. The resettlement estate comprises three adult male resettlement prisons (Blantyre House, Kirklevington Grange and Latchmere House) and resettlement units or regimes in 29 male and female open and closed establishments, with a total of 3,100 places.

3.5 PAID WORK

3.5.1 Around 31,485 prisoners on average are employed in prisons each week, including 1,281 women and 3,123 young offenders. The majority of this work is to meet the Prison Service's own needs. It covers a wide range of activities, with cleaning and maintenance, industries workshops and laundries, prison kitchens, agriculture, gardens and horticulture the main sectors.

3.5.2 In addition, voluntary sector organisations and charities are involved in providing work for prisoners in a number of prisons. This work enables prisoners to give back to society and contributes to the Government's restorative justice agenda.

3.5.3 Work provides purposeful occupation, undertaken out of cell, and is an important element in ensuring decent conditions for prisoners. It contributes both to individual prisoners' well-being and to good order and security in establishments. It enables prisoners, many of whom have no history of stable employment, to experience the disciplines of regular work.

3.5.4 The Prison Service has recognised that work also provides the opportunity to give prisoners key work skills and experience, which will help to prepare them for work after release. Much work has been done over recent years to link both basic skills education and vocational and key skills training to prison employment and, through the Custody to Work initiative, to use prison work to prepare prisoners more effectively for realistic job opportunities.

3.5.5 In a number of establishments, prisoners working in cleaning or kitchens are obtaining accredited training leading to industry-recognised qualifications which can lead to employment after release. Examples of good practice in catering include Glen Parva YOI, which provides NVQ Levels 1 and 2 training in Food Preparation and Cooking, and High Down prison where potential employers are invited in to a lunch prepared by students taking the NVQ Level 2 Food Preparation and Cooking.

3.5.6 Holme House is an example of good practice in the delivery of accredited contract cleaning training through the industry-recognised Cleaning Operatives' Cleaning Certificate. The prison has shown that training in cleaning is improved by moving it from workshops into the more demanding environment on the prison wings.

Prison industries

3.5.7 The Prison Service has around 300 workshops covering a wide range of industries including clothing and textiles, woodwork, engineering, printing, laundries and contract services. These industries have a major role in occupying prisoners, inculcating good work habits, and keeping down Prison Service costs by producing goods to meet its internal needs and to supply to external markets. An example of good practice is Ranby prison, where shift working has been introduced into the injection moulding workshop, replicating working practices in outside industry and improving efficiency and productivity. At the same time, 10 prisoners are undertaking a level one NVQ and others are learning basic and key skills in conjunction with their work.

3.5.8 The Prison Service has accepted that, while there are many examples of good work being done, across prison industries there needs to be a greater focus on meeting prisoners' resettlement needs and providing opportunities for accredited training through industries work.

3.5.9 The Prison Service has just completed the first stage of a review of prison industries, which looked at their purpose, planning, operation and management. The Prison Service Management Board has endorsed the review's strategic objectives and recommendations, covering key issues of principle and strategy as well as more detailed and specific points. A new framework will increase the contribution of workshop-based activities both to occupying prisoners in a way that contributes to their well-being, and to helping prisoners develop work skills and prepare for employment after release.

3.5.10 The Prison Service has now adopted a statement of purpose which will be promulgated across the Prison Service and against which existing activities and future proposals for development can be assessed:

"The aim of Prison Industries is to occupy prisoners in out of cell activity and wherever possible to help them gain skills, qualifications and work experience to improve their employment prospects upon release. The management of industries must weigh the true costs and benefits to the organisation and constantly strive for greater efficiency in providing developmental opportunities for prisoners."

Pay

3.5.11 It is Prison Service policy that all prisoners receive payment if they participate constructively in the regime of the establishment. The purpose of paying prisoners is to encourage and reward their constructive participation. It must not act as a disincentive to participation in activities which meet a prisoner's rehabilitation needs, for example education, and is only one element in the process of motivating prisoners.

3.5.12 The Prison Service sets minimum rates of pay, but each prison sets its own pay rates for particular industries and other work. Prisoners are also paid for attending education and other approved activities. The minimum employed rate is £4 a week but average pay is around £8 a week. This needs to be seen in the context of a generally short working week. Higher rates of pay may be available in some workshops in return for higher productivity.

3.5.13 The Prison Service will be looking at ways of encouraging Governors to set prisoner pay at levels which encourage prisoners to participate in education and other programme activities which are known to have positive effects on their rehabilitation.

3.6 PRISONERS WITH MENTAL HEALTH PROBLEMS

3.6.1 A high proportion of prisoners come from socially excluded sections of the community, with 90% having a mental health or substance misuse problem and many both. The principal purpose of the programme of reform and improvement of health services for prisoners begun in 2000 is to meet the Prison Service's published objective of providing them with access to the same range and quality of health services that the general public receives from the NHS. However, ensuring that prisoners have access to good health care can improve not only their mental and physical health but also the extent to which they can take part in the educational, drug treatment and other rehabilitative programmes available in prisons. Thus, improving health services for prisoners can make an important, albeit unquantifiable, contribution to their rehabilitation and resettlement, and so reduce their chances of re-offending.

3.6.2 The work currently underway to improve mental health services in prisons should be seen in the context of the Government's overall strategy for improving prison health care generally, and is being taken forward within that framework. Concern about the quality of health services available to prisoners increased during the early and mid-1990s. The Home Secretary and the Secretary of State for Health jointly set up a Working Group of officials from the Prison Service and the NHS Executive to consider the future organisation of, and ways of improving, prisoners' health care. The strategy that is now being implemented stems from the findings and recommendations of that Working Group, as set out in its Report "The Future Organisation of Prison Health Care" (1999). The basic principles were succinctly summarised as follows:

"Healthcare in prisons should promote the health of prisoners; identify prisoners with health problems; assess their needs and deliver treatment or refer to other specialist services as appropriate. It should also continue any care started in the community, contributing to a seamless service and facilitating throughcare on release."

3.6.3 One of the source documents used by the Working Group was an earlier Report of the Independent Standing Health Advisory Committee for the Prison Service, "The Provision of Mental Health Care in Prisons" (1997). That report stressed the importance of "equivalence", that is, that the mental health services available to prisoners should be of the same type and range, and of the same quality, as those available to NHS patients in the community. The Joint Working Group accepted this principle, both in terms of mental health services and of prison health care generally, and it formed the starting point of all their recommendations, and of the prison health care strategy developed subsequently.

3.6.4 The prison population is now around 74,000, and over 140,000 are received into custody each year, most only staying for a short time before being released back into the wider community. It has been estimated that around 90% of prisoners can be diagnosed as suffering from at least one of the five main categories of mental disorder (psychosis; neurosis; personality disorder; alcohol misuse; drug dependency). Around 20% of those on remand and 12-15% of those serving sentences suffer from four out of the five. On any one day in prisons in England and Wales there will be around 5,000 prisoners with a severe and enduring mental disorder.

3.6.5 The Department of Health's NHS Plan (July 2000) included the following specific commitments on the provision of mental health services for prisoners:

"Within the new partnerships between the NHS and local prisons, some 300 additional staff will be employed.

By 2004, 5,000 prisoners at any time should be receiving more comprehensive mental health services in prison. All people with severe mental illness will be in receipt of treatment, and no prisoner with serious mental illness will leave prison without a care plan and a care co-ordinator."

3.6.6 The Government's strategy for developing and modernising mental health services in prisons, "Changing the Outlook, a Strategy for Developing and Modernising Mental Health Services in Prisons" was published in December 2001. It set out a vision of where prison mental health care was expected to be in three to five years time and identified the steps that would have to be taken if it were to be realised.

3.6.7 The basic principle underpinning the prison mental health strategy is that services should be provided, as far as possible, in the same way as they are in the wider community. Prisoners who, were they not in prison, would be treated in their own homes under the care of Community Mental Health Teams (CMHTs), should be treated on the wings, their prison "home". Those needing more specialist care should be able to receive it in the prison Health Care Centre, and there should be quick and effective mechanisms to transfer those requiring specialist in-patient treatment to hospital. Any prisoners already receiving treatment for mental health problems in the community through, for example, the Care Programme Approach, should continue to have access to that level of service while they are in prison and, if appropriate, on release.

3.6.8 The prison mental health in-reach project, which began in 2001, is the mechanism through which the specific commitments in the NHS Plan are being implemented. Dedicated funding has been made available from the NHS budget to support the introduction into prisons of multi-disciplinary teams which are designed to provide mental health services for prisoners along the lines of the community mental health teams which already provide mental health services in the community at large. The project began at 18 establishments in England and the four in Wales in 2001-02, and was extended to another 26 sites during 2002-03. During this financial year in-reach teams are being developed in another 46 establishments. So far more than 150 additional NHS staff have become involved in providing mental health services in prisons. That number will double by the end of 2003-04, as the target in the NHS Plan is met. Between March 2004 and March 2006, it is expected that NHS mental health in-reach investment will double. This should mean that within the next three years there will be in-reach type services available to every prison in England and Wales. The extra investment will also support many of the existing teams in expanding the services they can offer.

3.6.9 There is, however, more to the mental health strategy than the in-reach project. Following publication of "Changing the Outlook", all establishments, in collaboration with their local NHS partners, undertook a detailed review of their mental health needs and developed action plans to fill any gaps in service provision they identified. When doing so they were expected to review their existing mental health services to establish whether they both met the needs identified in the Health Needs Assessment and were consistent with the principles and standards of both the National Service Framework for Mental Health (1999) and "Changing the Outlook". Implementation of the strategy will mean a period of major change for virtually every establishment. Change will not happen overnight but will be an evolutionary process over several years, with some establishments making faster progress than others. We expect over the next three years or so to see all, or at least most, of the following outcomes:

— Fewer mentally disordered prisoners accommodated in prison health care centres, with resources re-deployed to provide day care and wing-based support.

— A reduction in the average length of time mentally disordered prisoners spend in those prison health care beds that remain.

— A more appropriate skill mix among those who are providing mental health services in the prison setting.

— Quicker and more effective arrangements for transferring the most seriously ill prisoners to appropriate NHS facilities and receiving them back.

— Closer collaboration with NHS staff in the management of prisoners who are seriously mentally ill, including those who may be vulnerable to suicide or self-harm while they are in prison.

Reception arrangements

3.6.10 Research indicated that the Prison Service's reception screening processes were failing to identify up to three-quarters of the prisoners who had a severe mental illness. To rectify this, new triage-based reception screening arrangements were developed and piloted during 2001-02 at 10 local prisons. They focused on identifying and managing a prisoner's immediate and significant health needs on first reception into prison custody, so that more effective use can be made of existing staff resources and skill mix. This work has been closely linked to development of the Prison Service's suicide prevention strategy and four of the reception screening pilots also form part of the Prison Service's Safer Locals Programme. Evaluation of experience at the pilot sites showed a substantial improvement in the identification of prisoners with a severe mental illness. The new reception health screening system is being phased in at all local prisons over a 12 month period that began in April 2003.

Transfer to hospital

3.6.11 Prisoners who need in-patient treatment for their mental disorders should be transferred to hospital as soon as possible. Generally speaking, the arrangements for assessment and transfer in such circumstances work smoothly and very many prisoners get transferred to hospital quickly. But problems of apparently excessive delay can still occur in some individual cases. This can give rise to distress in the prisoners themselves, their families and friends and also the prison staff responsible for looking after them while they wait for a hospital place. Prison Health and NHS Regional Commissioners of Forensic Mental Health Services have looked at ways to reduce the time prisoners may have to wait for a hospital place. In parallel, tighter regular monitoring has been introduced to identify prisoners who have been waiting unacceptably long periods for transfer to hospital. All establishments must provide regular returns to the headquarters Prison Health team showing how many prisoners are awaiting either assessment or transfer and, of the latter, how many have been waiting for more than three months following acceptance. A protocol has been issued which sets out the actions required of both the Prison Service and the NHS when a prisoner reaches that three-month deadline.

2 Counselling, Assessment, Referral, Advice & Through-care services-a low-level intervention that provides gateway assessment, referral and support services to prisoners in custody, and establishes through-care links prior to and on release. Back

3 Prisons-Addressing Substance-Related Offending is a Cognitive Behavioural Treatment programme adapted by the Service from the Probation Service's ASRO programme. Back

4 Rehabilitation for Addicted Prisoners trust. Back

5 European Association for the Treatment of Addiction. Back

6 Rehabilitation for Addicted Prisoners trust, a "12-Step" drug treatment programme. Back

7 ASRO has yet to receive full accreditation. Back



© Parliamentary copyright 2005	Prepared 7 January 2005