Examination of Witnesses (Questions 80-99)
RT HON
BARONESS SCOTLAND
OF ASTHAL
QC, MS CHRISTINE
KNOTT, MR
PHIL WHEATLEY
AND MR
JOHN BOYINGTON
8 NOVEMBER 2005
Q80 Mrs Dean: Can I just ask, will ACCT
and NOMIS be rolled out to the private prison sector as well as
the public prison estate?
Ms Knott: Yes, NOMIS will.
Q81 Mrs Dean: And ACCT as well?
Baroness Scotland of Asthal: We
certainly know that ACCT is good practice and I think that it
will be rolled out, but I am not absolutely sure, so we ought
to check, particularly in case they call it something else.
Chairman: I think the Committee would
find it very useful to know whether this applies to only part
of the estate.[7]
Q82 Steve McCabe: I want to ask a few
questions around the theme of mental health in prisons. What do
you think are the major gaps between the provision of services
in prisons for mentally ill people?
Baroness Scotland of Asthal: Well,
we have a gap in terms of identification and you know that we
are trying to make sure that those who do have severe mental illness
are identified early and diverted to appropriate health provision.
There are lots of things we can talk about as to what we have
done to make that better, but that still is an issue. Getting
better support at the court stage in a more integrated way, which
covers holistically the whole panoply, is an issue for us, and
we have got coverage, but it is not as consistent as we would
like it, so we need to work on that, and then enabling the inhouse
provision, which has materially improved our ability to cope with
mentally ill offenders in our prison estate, getting that to a
stage where we can divert people out of the prison estate more
quickly, all of those areas are areas where we have had significant
improvement and all of those areas are areas in which we have
to work further. We are working very hard with the National Health
Service and we have been able to make significant inroads and
improve, but I think we still have a lot of work to do.
Q83 Steve McCabe: I understand that it
is the Government's aim to try and make mental health provision
in prisons at least equivalent to that in the community. Some
of us might think that that in the community is not always as
good as it could be, but, that aside, I just wondered how far
do you think you have got to go to achieve that aim?
Baroness Scotland of Asthal: I
think we have made some really significant improvements. We have
invested £10 million in 2003-04, we have doubled that to
£20 million for this year, 2005-06, and we have employed
360 NHS staff and mental health professionals, working as members
of health inreach teams, serving in 105 prisons in England and
Wales. That is a real quantum leap forward. We have also created
over 300 specialist beds in the high-security hospitals for people
with dangerous and severe personality disorders. However, there
are still institutions where that is not the case and we have
to increase that. I think we are doing that rapidly. If you compare
where we were in 1997 to where we are now it is a real improvement.
I do not know whether John wants to say a little bit more just
to talk about the processes in which we are currently engaged
in trying to drive that forward more quickly. It is something
I have been very anxious about.
Mr Boyington: I think the major
policy shift over the last three years has been the decision to
transfer responsibility for commissioning health services in prisons
to the National Health Service and that is probably something
which was 50-odd years out of date. Having done that, we are now
in a position to say to the commissioners of health services,
whether they be for people in the community or in the local prison,
that the services should operate to a uniform standard and should
match need. The clear issue in relation to people in prison is
that the levels of need are significantly concentrated and we
are very aware of that. I think your original question was how
far have we got in addressing those gaps. In terms of on the ground,
I would think we are probably 25 to 30% along the road, in terms
of those things that we know we need to do that we have active
plans for, I would think we are probably 40 to 60% along the road,
and there are a number of things that we still need to unwrap
and understand, including issues to do with court diversion and
how we can better effect the reduction of vulnerability to prisons.
Q84 Steve McCabe: If you were to put
a timescale on it, when would you be able to come here and say
you had closed the gap?
Mr Boyington: I am confident that
we are going to make a huge inroad, an additional inroad into
that gap by the turn of the decade.
Q85 Steve McCabe: Can I ask about the
Court Diversion and Healthcare Project. Are you familiar with
the NACRO report which was fairly critical of the delivery? It
said that it is a good service where you could get it, but it
is extremely patchy. Do you accept that criticism and, if you
do, what are you going to do about that?
Baroness Scotland of Asthal: We
do accept the criticism that it is patchy. We have approximately
139 court liaison and diversion schemes operating across England.
They vary greatly in their scope, some being little more than
a single member, others being much more comprehensive, and we
have committed ourselves to creating a system which is far more
uniform, far more comprehensive. There is good-quality information,
I think, about court liaison schemes, although the Department
of Health, the Home Office and the Office of Criminal Justice,
OJCR, are now jointly sponsoring a study to assess the number
of mentally disordered offenders passing through so we can better
address that. Yet again this is an area where we have identified
where the problem is, we know the pathway we need to take in order
to improve it, we are working extremely hard with our NHS and
other colleagues to address that, and we are hopeful of being
able to make a really quite significant step change in the reasonable
and foreseeable future. Is that going to be easy? No. A lot of
it is going to be persuasion, a lot of it is going to be driving,
but I think we are making the case for why this is actually the
best and most progressive way.
Q86 Steve McCabe: Is it a resource problem?
Baroness Scotland of Asthal: I
think it is about rearranging the way in which resources are currently
spent because if you look at what we have learnt about early intervention,
if you can identify earlier, if you can assess with a greater
degree of acuity, you will be able to divert people into the most
appropriate form of care. If they are diverted into the most appropriate
form of care, it usually means that you will end up spending less
in terms of dealing with their level of disadvantage. If you allow
the psychosis or mental illness to ripen by putting them into
prison and they are not addressed properly, then by the time they
come out, their level of need is normally hugely increased and
you end up spending more money.
Q87 Chairman: In which case, to push
Mr McCabe's question on the timescale, how long in the future
is a "reasonable, foreseeable period", which I think
is the term you used? When will we be in a position to add this
set of questions to Mr Prosser's, when no one turns up when they
are first managed in prison without firstly having been in the
court process which has properly identified them as a mentally
ill prisoner and secondly there has been a proper assessment with
OASys which, it is clear from the vast scale, is not happening
at the moment? When we will be in a position to say that will
not be happening any more or hardly ever?
Baroness Scotland of Asthal: I
think that is a very difficult answer to have to give and I think
John is right when he says that we hope by the end of the decade
we will have everything in place. My aspiration would be that
we will do that earlier, but whether that is achievable or not
is difficult, and let me explain why—
Q88 Chairman: Can you explain exactly
what the obstacles are because you have rehearsed an argument
which the Committee is familiar with from its last report about
cost-effective systems for sentencing?
Baroness Scotland of Asthal: Well,
if you look at what we have done since 2003 in terms of joining
up the criminal justice system, the creation of the National Criminal
Justice Board, the creation of the local criminal justice boards,
the working together on the crime and disorder reduction partnerships,
the ability that we now have to work in strategic partnerships,
all of those do two things: they are looking at reducing the level
of crime; but also early identification of the causes and nature
of the criminal activity in that area. Now, the changes that we
are making and have already made just in relation to charging,
the fact that the prosecutors are now responsible for charging
means that there is an early opportunity to assess the needs not
only of victims, but also the needs of offenders and to get in
that information earlier. That has meant that we have been able
to deal with the court process more quickly, so if you look at
the ineffective trials, that rate has gone down significantly.
Now, one of the things about ineffective trials is that of course
the witnesses, whether they were there, mental health issues,
play a real part in that.
Q89 Chairman: That is great, but can
you come specifically to what the problems are in getting the
systems in place which would make a difference? You talk about
the reform of the criminal justice system, about which the Committee
is very clear, but what specifically are the two or three big
obstacles to getting healthcare diversion and things in place
to make sure the medical records go to the prison with the prisoner,
both of which would seem to be relatively straightforward things
if there was a real push behind them?
Baroness Scotland of Asthal: Well,
the implementation of OASys will make a big difference and that
will be there by the end of the year. The implementation of NOMIS
will make a big difference and that will be there next year because
it will mean that we will have better information to make better
decisions. There then has to be an enhancement both in the community
of programmes and in the interventions that can take place in
the community because if there are more interventions available
in the community, it means that there will be hopefully a greater
reluctance to use prison as an appropriate way of containing those
who are dangerously ill, so that will make a quantum shift. We
then have to develop, using the model that we have already got,
with the National Health Service a greater spectrum of provision
both inhouse in prison and transferring out. Now, that is the
difficult bit that we are going to have to do with the NHS and
that is why John Boyington is absolutely right to say that we
have already made the big quantum shift of making the National
Health Service primarily responsible for health provision in prisons,
so whereas before there was a feeling that this was part of the
relay and you just pass it over and wait until they come out the
other end, that continuity has been the biggest shift we can make
and we will be driving it hard with colleagues and it is why Rosie
Winterton will be coming to join me on the Round Table on this
issue, but we have got a whole plethora of other initiatives with
our health colleagues to help make this a reality.
Q90 Mr Malik: You said earlier on that
sharing cells, because of the burgeoning prison population, can
sometimes help in terms of suicides. Is it not also true that
if you get the wrong kind of sharing, it can actually lead to
suicide and indeed lead to murder in some cases, as we saw in
the Zahid Mubarek case at the Feltham Young Offenders' Institute?
Baroness Scotland of Asthal: I
think it is absolutely critical to have proper needs-based assessments
and proper analysis as to who you have got because that means
you make better-informed judgments as to how people are placed.
There are some people who will be advantaged by sharing a cell,
provided the person with whom they share is the right person,
so if you look at some of the things that we have been able to
implement in the adult estate through the Listeners Programme
and indeed the support mechanisms, quite often what will happen
is you have a vulnerable person and you will invite someone to
be with them overnight to be a protector, so I think you have
to risk-assess appropriately and then the sharing of cells can
be an advantage. If that risk-assessment is inappropriate, then
of course there can be aberrant consequences.
Q91 Mr Malik: The Government has a strategy
for the protection of juvenile prisoners, but have regimes, training,
support and facilities for children in custody improved as a result
of this strategy?
Baroness Scotland of Asthal: We
certainly believe that it has because our ability to care for
children has enhanced. Is it perfect? Absolutely not. Are there
more things that we need to do? Absolutely, yes.
Q92 Mr Malik: Where would you say the
biggest gap is? Where do you think the area that needs the most
attention is in that strategy not delivering in the way it ought
to?
Baroness Scotland of Asthal: In
terms of caring for young offenders?
Q93 Mr Malik: Yes.
Baroness Scotland of Asthal: Well,
it is very similar to the issues we have with the adult offenders.
It is making sure that only those, and I know it is only 3 to
4% of all those who are known to the criminal justice system who
actually end up in the custodial estate, but it is making sure
that we actually have explored all the community options which
will deal with this before young offenders are placed in young
offender institutions, so that is the last port of call, if you
like, and only there for those who absolutely need to have to
be. I think the challenges that we have seen in terms of high-risk
behaviour in the juvenile estate has to be acknowledged because
we are here too dealing with young people who have multiple needs.
I think this Committee only knows too well the number who need
care, the number who have committed suicide, the number with dysfunctional
behaviour, and they are some of the most needy, but also some
of the most dangerous young people we have. Therefore, are there
policy gaps we have identified that need to be plugged? I think
we have plugged most of them. Is there a real challenge to implementing
those policies? Yes, there are. I cannot immediately think of
identified issues which we have not yet addressed, although this
Committee knows only too well the issues which have not yet been
conquered.
Q94 Mr Malik: Can I turn to custodial
institutions and is it the case, in your view, that children are
being housed in the right type of institutions?
Baroness Scotland of Asthal: I
think they are, but you know that there are some significant differences
we have got, the young offender institutions, the secure training
centres and the secure children's homes. There is a debate as
to whether the sentencing that is actually taking place is getting
the right people in the right place. Are those three the correct
options for us to have? Yes, they are, but it is another issue
as to whether the system always get the right people in the right
place and that is a different question.
Q95 Mr Malik: How would you respond to
the view that was expressed by the witnesses prior to you that
actually what is needed is an investment in secure children's
homes and their concern at some of the disinvestment that is going
on in that particular type of institution?
Baroness Scotland of Asthal: I
think that it is a real issue as to secure children's homes. You
will know that secure children's homes are provided by local authorities
and there is the whole issue as to the use to which those secure
children's homes are being put. I know, for example, that there
is a concern that many authorities, whether it is true or not,
are more content to use the criminal justice avenue rather than
the welfare care avenue and that is an issue with which we are
going to have to grapple and there is a real opportunity for us
to do that, but then again it is going to be in partnership with
local authorities and many of the local authorities are making
choices over which we do not have control.
Q96 Mr Malik: Just on the issue of bullying,
what are you doing to tackle this? We heard from the evidence
earlier that there is some kind of direct correlation between
a lack of activity and an increase in bullying and it was said,
"They've got nothing to do but torment each other".
Baroness Scotland of Asthal: In
terms of the level of activity, you will know the anti-bullying
policies that we are putting in, the changes we are trying to
make to the improvement in the general culture of these institutions,
the changes that have been made in relation to how prison officers
and others relate to the young people, the change of dress, and
all of that is having a beneficial impact. For example, a number
of institutions are doing things like cutting out smoking and
cutting out smoking seems to have had a beneficial effect on the
YOI estate. We are hoping that that will be spread more widely.
There are many policies which we think have been beneficial and
which we are trying to do as energetically as we can to make sure
that good practice is spread right the way through the whole estate.
Q97 Mr Malik: Finally, Minister, to save
my best question to last, as it were, why is the Government still
resisting the calls from the Joint Committee on Human Rights and
the General Synod of the Church of England and others for a public
inquiry into the death of Joseph Scholes and the lessons to be
learned from it, and indeed the coroner into that particular death
also called for a public inquiry?
Baroness Scotland of Asthal: Well,
you know that we are going to be issuing very soon the Home Secretary's
response to that. I think it would probably be inappropriate for
me to pre-empt what he is going to say, but we have taken these
issues very seriously indeed. The thematic learning that has been
possible has already been implemented and I hope that when the
Home Secretary makes his statement, the Committee will be able
to fully understand why he thinks this is the most appropriate
way forward.
Q98 Chairman: The Home Office's record
on resisting judicial review is not a brilliant one, is it?
Baroness Scotland of Asthal: Well,
I think the Home Office's ability to implement change though,
I hope you will agree, Chairman, is a good one.
Q99 Mrs Dean: Minister, why do a higher
proportion of women than men commit suicide in prison? What can
be done to address the specific needs of women prisoners?
Baroness Scotland of Asthal: I
think when one looks at the risk factors for women, they are significantly
greater. If you look at the level of self-harm, the incidence
of suicide, the fact that many women are primary care-givers and
the stress that that creates when they are in prison is quite
significant. One of the things I find quite distressing is the
high level of abuse that many of those women have experienced,
and I think it is almost 36% or more of women in our prison estate
have been subject to some form of domestic violence or other abuse
before, so we are dealing unfortunately with some extremely needy
and exceptionally damaged women. That presents us with huge challenges
and difficulties, but also opportunities because if you look at
what has happened, for instance, in the way in which we have changed
the procedure in Styal, we have had a dramatic reduction in terms
of the numbers of self-inflicted deaths and self-harm. It also
means though that we have got to be really targeted in the sort
of community-based options that we provide for women, so the strategy
to reduce offending in women is incredibly important to us, particularly
if you look at the level of acquisitive crime we have with women
and getting targeted interventions which will deal with that.
You will know that we have allocated £9.15 million in relation
to that strategy and we are now seeking to pilot some programmes
which will help us to learn some of the things we might be able
to deliver to try and address more aggressively the specific needs
of women which are actually fundamentally different from the needs
we have identified for the male population.
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