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UNCORRECTED TRANSCRIPT OF ORAL EVIDENCE To be published as HC 656-i House of COMMONS MINUTES OF EVIDENCE TAKEN BEFORE HOME AFFAIRS COMMITTEE
PRISON SUICIDES AND OVERCROWDING
Tuesday 8 November 2005 MS FRANCES CROOK, MS PAULINE CAMPBELL, MS DEBORAH COLES, MS JULIET LYON and MR GEOFF DOBSON
RT HON BARONESS SCOTLAND OF ASTHAL QC, MS CHRISTINE KNOTT, MR PHIL WHEATLEY and MR JOHN BOYINGTON Evidence heard in Public Questions 1 - 105
USE OF THE TRANSCRIPT
Oral Evidence Taken before the Home Affairs Committee on Tuesday 8 November 2005 Members present Mr John Denham, in the Chair Mr Jeremy Browne Mr Richard Benyon Mrs Ann Cryer Mrs Janet Dean Nick Herbert Steve McCabe Mr Shahid Malik Gwyn Prosser Mr Gary Streeter Mr David Winnick ________________ Memoranda submitted by The Howard League for Penal Reform, INQUEST and Prison Reform Trust
Examination of Witnesses
Witnesses: Ms Frances Crook, Director, Ms Pauline Campbell, Trustee, The Howard League for Penal Reform, Ms Deborah Coles, Co-director, INQUEST, Ms Juliet Lyon, Director, and Mr Geoff Dobson, Deputy Director, Prison Reform Trust, examined. Q1 Chairman: Good morning. Thank you very much indeed for coming this morning to give evidence to us. As you know, this is a one-off hearing that we are holding today looking at the issue of prison suicides and their causes and, in particular, their relationship to overcrowding in prisons. I would be grateful if each of you could introduce yourself and the organisation you are from. Ms Lyon: I am Juliet Lyon and I am Director of the Prison Reform Trust. I worked in adolescent mental health for 15 years prior to taking this post. Mr Dobson: I am Geoff Dobson. I am Deputy Director of the Prison Reform Trust and a former Chief of Probation Officer. Ms Coles: I am Deborah Coles. I am Co-director of INQUEST, an organisation that works with the families of people who die in custody. We conduct policy and research arising out of those deaths and investigations. Ms Crook: I am Frances Crook and I am Director of The Howard League for Penal Reform. Ms Campbell: I am Pauline Campbell and I am a Trustee for The Howard League for Penal Reform, and I am the mother of Sarah Elizabeth Campbell, aged 18, who died at Styal Prison in 2003. Q2 Chairman: Mrs Campbell, we are particularly grateful to you for coming here this morning. I wonder if we could start with you and you could set the scene for the whole of our session today by telling us about the circumstances in which your daughter died and what lessons you think can be learned from that tragedy. Ms Campbell: My daughter, Sarah Campbell, aged 18, was sentenced at Mold Crown Court on Friday 17 January 2003 and found guilty of a non-violent offence. She was taken to Styal Prison in Cheshire and put in the segregation block, which I believe was a highly unsuitable place given that she was seriously depressed and physically ill as well. It was on the segregation block the following day, 18 January 2003, that Sarah collapsed dying. However, before collapsing Sarah did tell prison staff that she had taken a quantity of anti-depressant tablets. Unfortunately there was a delay of between 20 and 40 minutes before staff summoned an ambulance, and this evidence was highlighted at my daughter's inquest in January this year. Unfortunately there was an argument between a prison officer and a nurse about whose job it was to call the ambulance. When the ambulance finally arrived at Styal Prison it could not get through the prison gates and was held up for eight minutes. Consequently, when paramedics reached Sarah she was already unconscious. She was taken to Wythenshaw Hospital in Manchester, where she died later that evening without regaining consciousness. The cause of death was dothiepine poisoning. Let me set her death in the context of the deaths at Styal Prison. Sarah's death was one of six deaths that occurred at Styal in the 12 months ending August 2003. Sarah's was the third death and she was the youngest at age 18 to die. That is a summary of Sarah's death in the so-called care of Styal Prison. Q3 Chairman: So many things went wrong according to that account. What is your view about the lessons that can be learned and how systems could be changed so that it was not possible for so many things in a row to go wrong, leading to Sarah's death? Ms Campbell: I think there are three main points arising as far as I see it. Firstly, there are far too many women being sent to prison for non-violent offences. Nine out of ten women are convicted of non-violent offences. Q4 Chairman: Would you mind telling us what sort of offence Sarah was convicted of? Ms Campbell: Unusually, Sarah was convicted of non-violent manslaughter. Sarah and another woman hassled a man for money, it was a non-violent offence, but he had a history of heart disease and, tragically, he collapsed and died immediately following the incident. The court accepted that Sarah had played a lesser part in the offence and so she received a shorter sentence than her co-accused. I must stress that it was non-violent manslaughter. She would have had to have served 12 months at Styal. In my opinion the women should be given community sentences if only because they are usually more effective and they cost less. Secondly, women offenders who are mentally ill should not be sent to prison. Prison is a place of punishment and these women actually need care, treatment and support. Thirdly, in the case of someone like Sarah, I remain incredulous that she was taken to the segregation block, the punishment block, on her arrival at the prison when, in fact, she was seriously ill. Q5 Chairman: So your emphasis is as much on changing the patterns of sentencing and the appropriate accommodation for offenders as it is on what happens inside the prison, although that was clearly itself a significant factor? Ms Campbell: Yes, that is right. Q6 Chairman: Deborah, the Government has said that "suicide prevention efforts are proceeding with unprecedented energy and commitment and with some success". Do you agree with the Government's assessment? Ms Coles: A lot of work has been done by the Safer Custody Group to address the issue. The figures are shocking for us all. There are some very, very good policies on paper; it is their translation into practice that is the problem. I want to pick up on something that Pauline said. We monitored the six inquests into the deaths of women at Styal. One of the problems that the inquests exposed was the fact that five out of six of those women were poly-drug users, ie they had serious drug misuse problems. The majority of the women had been recognised as having mental health problems. What the inquests also exposed was the fact that the Prison Service had been warned by the Inspector of Prisons, Anne Owers, of her concerns about problems at Styal, particularly in terms of the treatment of women with drug problems and the fact that there was a serious lack of detoxification facilities available, and they had been warned about that over a year before these six women died. Pauline waited two years before the inquest was held into her daughter's death. That is the only public forum in which these deaths are investigated and looked into and scrutinised. What those inquests highlighted was the fact that there was a real lack of awareness in suicide prevention within Styal Prison, there were problems with staff training and there were problems with staff's ability to work with some very, very damaged women. All the policies and procedures were there. They had the F2052 suicide screening forms. The problem was that the policies were not being implemented, which resulted in women, who were at serious risk of suicide, being kept in the segregation unit. There are some extremely good policies that have been worked on and they are involving more people with mental health expertise. The problem is how you translate those. While you continue to put women in prison who are mentally ill I really do not think you can expect the staff, who have really poor training and who do not have any training in working with mentally ill women, to keep women alive. Q7 Chairman: Juliet Lyon, what is your view about the Government's overall claim of "unprecedented energy and commitment"? Ms Lyon: I think it is a fair claim, but the results are still not as any of us would hope. A success would be to radically reduce the number of suicides. Although things are looking very much better this year, which I think is a testimony to that unprecedented effort, it is still true to say that we have got a very poor record in relation to other countries. It is still true to say that people are not only dying in prisons but also injuring themselves repeatedly every single day. The levels of self-harm are extraordinary, particularly in Young Offender Institutions and women's establishments. The latest figure that we have from the Women's Team is that 587 out of every 1,000 women in prison injure themselves repeatedly while they are in custody. Q8 Mr Streeter: Can anyone actually say what the trends of suicide in prisons are like compared to trends in suicide in people who are not in prison? Obviously that is a troubling trend. Has anyone done any work on that? Ms Crook: There is quite a lot of work being done on that. There are lots of ways of calculating it depending on whether you take the daily population or the throughput of population. What is apparent is that the suicide rates in the community are going down and suicide rates in prison are maintaining their level and continuing to be extremely high, particularly for people who have mental health problems and they are very, very vulnerable. The other thing is that self-injury in prisons is extremely high, much higher than it would be for the same sort of population in the community and this is often a sign of distress because of the nature of imprisonment, it is a reaction to custody, so it is prison that is causing the self-injury. If you are in a prison that is so grossly overcrowded and staff are so pressed they cannot give you attention, the only way to get attention is to do something dramatic and desperate and that behaviour is carried out into the community afterwards. Whatever happens in prisons is not separate from what goes on in the community afterwards. Mr Dobson: There was an article in the Lancet published earlier this year looking at suicide levels in male prisoners from 1978 to 2003 and it found that the suicide rate for men in prison is five times that for men in the community and that boys aged 15 to 17 are 18 times more likely to kill themselves in prison than the community. That obviously reflects to a large extent the degree of vulnerability of the populations. Chairman: You have a huge amount of information, but it would be very helpful if we could stick to answering the questions that the members have rather than sharing all the information, much of which is in the written evidence, otherwise we will not get through many of the areas we would like to get on to. Q9 Mr Streeter: We have heard the Government is concerned about this and they are doing some good work. Do you think their suicide prevention policy is embedded in every aspect of prison life? Ms Lyon: Since the new forms have been introduced as a new way of trying to look at suicide prevention it has raised self-awareness, there is no doubt about that, and 40 prisons are already implementing the new ACCT forms. I also think it is fair to say that staff get a basic eight weeks training in terms of their professional training, but that is so slight. I think we are asking too much of our staff. We are asking them to run a second rate health service within prison confines. Ms Crook: Sometimes policies have unintended consequences in practice. For example, the design of safer cells means that there is virtually no ventilation in the cells. For example, over the summer in Holloway Prison there were pregnant women who were fainting and the Governor had to provide fans and bottles of water for them. Last year when we had the ministerial meeting there was virtually a riot going on upstairs in Nottingham in the summer because the prisoners could not open the windows. We were having a meeting on suicide prevention and people were rioting in the safer cells upstairs. Sometimes the policies are too mechanistic and not based on human need. Q10 Mr Streeter: Is the crucial thing a connection between overcrowding and suicide or are there other measures unconnected with overcrowding which we also need to look at? Ms Lyon: I think it is possible to prove a set of links between overcrowding and deaths in custody. I do not think there is a single linear link. If you were to look at staff knowing their prisoners, which must be one of the critical things in relation to keeping people safe, because people are moving from one jail to another people are not getting to know their prisoners. Personal officer schemes have broken down in very many prisons as has sentence management. All of these things are ways of helping people see that they have a future and that they have someone connected to them. Overcrowding in terms of the pressure on staff and the high level of movement of prisoners is one of the areas in which we can demonstrate the links and although you could improve that slightly with staff training, without reducing numbers and reducing this continual movement you cannot create a climate of safety which is needed. Q11 Mr Streeter: The new ACCT care-planning system, is that good? Is it going to make a difference? Is that the way forward? Ms Coles: I think it is another example of something that looks very good on paper. My concern is the issue we have raised about staff training. It is a new form, it requires another layer of assessment and it talks about the importance of assessors who carry out the in-depth screening of vulnerable prisoners. The concern is, in terms of overcrowding and the impact on staff time, whether or not staff are going to have the time to implement the policy as it is written on paper. I think the policy has come about because of concerns about the previous policy and it is supposed to be an improvement on that, but unless we can actually ensure that staff are trained and aware of the importance of the policy and have the time and resources to implement it it will have similar problems to what the F2052 did in terms of staff not being aware and not being able to implement it. Q12 Gwyn Prosser: I want to stay with the incidence of recently admitted prisoners committing suicide. We have heard from Pauline Campbell about the need for extra training and there has been some discussion about safer cells. Looking at the various remedies, better training, safer cells, more staff, which means more resources, is there a pecking order amongst those which would have a bit more of a beneficial effect or does one stand out starkly among the others, or do you have any other means you might want to suggest to prevent a suicide in the first few days and hours? Ms Coles: It almost starts before the prisoner actually arrives in the institution. One of the concerns we all share is about what happens at court and the process of either remand or sentencing particularly of people who are vulnerable, be it because of drug and alcohol problems or because of mental health problems. Information going from the court to the prison establishment is very important. I cannot tell you how many inquests I have attended where the prison has not been made aware of someone's vulnerability because the relevant paperwork has not accompanied the prisoner or the paperwork has arrived in the wrong bit of the prison and so the person doing the assessment for suicide has not got that information in order to carry out the assessment. We need to go right back to the process of who actually arrives in those prison gates and what information comes with those prisoners. One of the concerns that I have is that when you have an inquest all the attention is on the prison and the Prison Service. We have got to look at the role of the judiciary here in terms of the kind of people they are sending to prison so that we have a more holistic way of trying to stop these deaths happening. Q13 Gwyn Prosser: On that important point of transmitting information, what is going wrong? Is it a system which is not being used properly or is the system not working? How would you improve that communication? Ms Coles: I think it is a combination of factors. Sometimes it is just individuals failing to ensure that that information is physically passed to the right person, sometimes it is forms not being filled out at all, people not understanding their obligation and duty to fill out a form and make sure that that accompanies the prisoner into the institution, sometimes it is pure bureaucracy, administrative blunders because people are not aware where that information should go or a fax comes into the prison and it does not end up on the prisoner's file. It is a variety of factors that is causing that problem. Ms Crook: And a system under such strain. It would be impossible to design an administrative system that would cope with the numbers. The most important thing is time for people. When you talk to prisoners they say that nobody ever has the time to sit down and talk. We all sit down to talk to each other. In prison nobody ever sits down to talk to somebody, they are always standing and on the move. If you are coming into prison from court - and do not forget, people kill themselves in court cells and in transport in between, the transport system itself is pretty awful - you arrive distressed, coming down from drugs, you have a catalogue of problems and fears, you are very, very frightened and lonely and you are whisked through a system. If the administration works that helps, but in the end you need someone to support you, you need someone to spend time with you and explain things to you. Many prisons have first night centres but many of them are run by charities. This is not the state providing a decent service to people for whom it is accepting responsibility at all. The system is very strained right from the beginning to the end. Mr Dobson: I do think one needs a national system of what some people call psychiatric assessment panels and others call diverging schemes, one that is linked not just to courts but to police stations, because often vulnerability is displayed when people are first arrested and they are in the process of being charged. A great deal is known about many of these individuals in the community by families and by community agencies. I think that sort of assessment panel at that very early stage can bring the information together and then when those people do eventually go to prison that information can go with them. Ms Lyon: You asked what would improve things. The introduction of the insider scheme is a very important one which has been introduced by the Safer Custody Unit. It is modelled on the Samaritans Listeners' work which is where prisoners are available to help one another. I was talking to insiders at Exeter Prison. I was very impressed with the work the men are doing there and the seriousness with which they held their job. I would like to echo what Frances said about transport. I have heard complaints from staff continually about late arrivals from court. Either they are very late, which makes the assessment far too short and far too risky, or people are being held now, because of overcrowding, overnight in police cells. A couple of weeks ago on one particular night there were more than 100 people detained in police cells simply because there was not the time to get them from the court into transport and to a jail with places. The overcrowding links are there. Q14 Gwyn Prosser: Given the present system and its weaknesses in terms of transmitting information, if a new prisoner arrives in prison and his documentation is not in place, what guidelines should there be for prisoners being received without any background information? Ms Lyon: Every prisoner should be treated as at risk. It is a very inexact science trying to predict the risk of suicide. If you look back at the deaths that have occurred in custody, very many of them are not people who have been identified as at risk. There are particular points in their time in prison, early on and before leaving, when there is an increased risk, but there is a bit of a danger in thinking you can perfect the ability to predict rather than focus on improving the overall environment and the procedures within it. Ms Coles: The procedures are all there. The policies that you are seeing make it quite clear that everybody should be looked at as being a potential risk, but obviously the benefit of having information from other outside agencies is crucial in terms of carrying out a full assessment. I think there should be a greater use by prisons of contacting prisoners' GPs or drug counsellors or people from the outside to glean as much information about the person as possible, but obviously that has to take place in the early days of somebody being in the institution. Q15 Mr Benyon: I want to talk specifically about mental health provision. Based on the number of women prisoners who are harming themselves and the horrific statistics from the Prison Reform Trust about the number of prisoners who are admitted with mental health disorders and you have talked about training or the lack of it, what do you identify as the key gaps and how does it compare with the provision that is available out there in the community? Ms Lyon: There is a commitment, as you will know, given by the Department of Health and the Home Office to provide equivalent mental health care within the system to that outside in the community. We are about to publish a report about men and mental health which I think reveals quite how wide a gap there is to breach between community services and prison services. I think the issue is principally how far we should be trying to turn our prisons into healthcare centres and how far we should be looking to the Department of Health to provide either high level secure, medium secure or community psychiatric services for offenders. In some ways I feel that we are looking in the wrong place. Staff are now getting basic mental health awareness but it is incomparable to the training nurses and doctors would get entering the health service. It feels to me that we could pour an awful lot of resources into the prison environment to try and make it better at caring for the mentally ill, but the question is why would we want to do that? Q16 Mr Benyon: What effect does overcrowding have in relation to mental health issues? Have you identified this prison by prison? Ms Lyon: We have done a number of different pieces of research, one of which was to talk to all the independent monitoring boards about what concerned them about overcrowding in general and then specifically what concerned them about the 18 to 20 year olds, which is a group that has been particularly neglected in the prison setting. Again and again people were pointing to increased distress, distance from home and a failure often for prisons to understand the importance of family as a potential resource. Certainly outside there has been a lot of very good research at the University of Manchester in terms of how families can help particularly young people in distress and vulnerable to suicide, but that has not reached the prisons or it stopped outside the gate in many ways. I think there are clear gaps that could be improved there. Mr Dobson: Particularly the amount of movement of prisoners between prisons. It takes a while for a prisoner to feel reasonably comfortable in an establishment to be able to build up relationships with staff and other prisoners. The number of movements is very disruptive and the incidence of suicide after a movement is very high. Ms Crook: I do not know whether the Committee is aware that The Howard League also has a law department and we act on behalf of individual children in custody, taking individual cases. We have been acting for some years for a young girl who epitomises many of the problems both of juveniles, for woman and for adult men as well who have mental health problems. What we are asking for, as a result of her case, is a public inquiry. This is unusual in that usually people ask for a public inquiry once someone has died. "SP", as I am going to call her, is not dead, she is still alive, but because her case is so tragic we think it could illuminate many of the issues that you are drawing attention to. She had mental health problems as a child and was not picked up and dealt with properly and appropriately by Social Services and by other services and she ended up in custody having committed a rather nasty violent offence. She has got a five year sentence. In her time in prison she had to be taken for something like 20 blood transfusions because her self-injury was at such a level. Eventually, after we took judicial review action, we got her transferred to a secure mental hospital, but it took two years and concerted legal effort to get her out of the prison and into an appropriate place. This is the first time she has got appropriate mental health care. There are many cases like her. She is at the severe end. Getting people transferred from prison to an appropriate mental health setting, whether it is secure, semi-secure, open or whatever, is incredibly difficult. The courts keep using prisons as a dumping ground for people who sometimes have committed relatively minor offences, but it is a health issue, it is not a criminal justice issue that is at the heart of it. Q17 Mr Benyon: The Home Office has commissioned a Court Diversion and Healthcare project with the aim of spreading this out across the prison system. How well do you think it is working and what is its potential? Ms Lyon: We are not sure this has started yet. What we are aware of is that NACRO has done some work to try and map out the existence of court diversion schemes across the country and revealed an extremely patchy picture. These court diversion schemes are the responsibility of the Primary Care Trusts, but we cannot see any evidence that Primary Care Trusts have these as any sort of priority. It is not a target for chief executives of mental health trusts. Clearly unless it becomes something that PCTs feel that they absolutely must do it is going to slide down the list of priorities. Although we welcome this new project, we are not clear it has begun. It certainly needs to begin. Chairman: We will ask the Minister about that. Q18 Mrs Dean: Frances, in your paper you urge the Government to take concerted action now to reduce the numbers entering custody, so as to get suicide numbers down. You urge the need for more secure and semi-secure psychiatric beds. Is the lack of such beds the reason for delays in transferring prisoners to hospital? Have you done any estimate on the number of extra beds that are required? Ms Crook: We have not done an estimate on the number of beds, but what we found is it is incredibly difficult to find the range of care that is appropriate for young people. We have represented a number of young people who have had very serious mental health problems and they have been imprisoned and it is very difficult to get them into some kind of accommodation which is appropriate for them. There is a lack of that nationally. I do not know how many beds there should be, but there should be more because there are many children who are in penal custody and who really need appropriate care and support because otherwise their condition will not be dealt with, which is deeply unkind to them, but, also, it will create dangers for their community in the future because these young people could be potentially quite dangerous unless they are helped. Q19 Mrs Dean: What do you think is most needed to ensure practical support and follow-up care when mentally ill people leave prison? Ms Lyon: We have been trying to find schemes which demonstrate good practice. There is a scheme in south-east London where there is a pathway worked out. Efforts are being made, undoubtedly so, with the transfer of responsibility to the Department of Health for prison healthcare, so trying to make sure that people are registered with a GP, for example, trying to make sure that they have got local links. There are certain perceptible gaps. We know that when people leave jail and they need to have drug treatment they need that there and then, they do not want to be queued up for months waiting. There is a high association with drug abuse and suicide. There is more work that could be done. There are some examples of good practice around the country. We think the North West NOMS pathway may have some helpful findings on this. I could give the Committee some further information on that afterwards. Chairman: That would be helpful. Thank you. Q20 Mr Streeter: I appreciate what you are saying and all the work that you do. Is it not true that we do not care for people with mental health challenges outside of prison very well in parts of the country under any government, we have a problem knowing what to do with people? Is that not part of the problem with prisoners, that there is not much capacity or knowledge of what is the best thing to do outside the system and we have got to tackle them both at the same? Is that a fair comment? Ms Crook: Yes. Ms Lyon: I think it is better outside. It is certainly a comment that one of our trustees makes continually when we are focusing on the prison system because she chairs one of the health trusts and in her view there is a lot of work needing to be done outside. If you look at people sleeping rough, people who have left the Armed Services, the sort of people who get swept in and out of prison often for short periods of time, there is a high degree of mental health need. If they do not have an address they somehow do not exist and that would be true for many health services as well as prison response. Q21 Chairman: In general most people seem to have said that the transfer of health responsibilities from the NHS to the Prison Service has been a good thing. Given the circumstances you have all recently described, is there a case for these prisoners of giving the new NOMS system some formal responsibility for arranging or commissioning mental healthcare given that there does not seem to be a really sharp ownership anywhere in the health service for meeting the needs of this particular group of prisoners? I float that as an idea. I am not quite clear whether the NOMS approach with its focus on offender management has the potential to do things differently or whether that is a side issue. Ms Lyon: I would worry about that because I think that we should be calling on NOMS - and indeed it is aware of it - to track their offender management pathways alongside and in line with health pathways, but to ask NOMS to take on a health task or to take lead responsibility would take us backwards. The fact that we recognise that healthcare belongs with health is right and really the pressure should be much more with the health trusts, the PCTs, those who do carry the responsibility now to take forward the reforms that they say that they are planning but remain in policy rather than in practice. Q22 Nick Herbert: I would like to turn to the issue of children in custody and specifically to you, Deborah, because of your submission. In the submission you raise a number of cases of awful incidents of young people dying in custody and you mention the incident of Joseph Scholes who died over three years ago at the age of 16 in custody. The Coroner called for a public inquiry into that incident; the Government has said no. That is now going for judicial review. Given that another five children have died in penal custody since, three in the last 18 months, I wonder if you could explain what issues that case gives rise to and why a public inquiry would be the right way forward? Ms Coles: Joseph Scholes was an extremely vulnerable, disturbed young boy who was sentenced to a Detention and Training Order at a time when there was much public disquiet about mobile phone theft. At his court hearing the judge felt that he had to give Joseph a custodial sentence. At the time of giving the sentence he said that he wanted Joseph's suicidal history and vulnerability brought to the attention of the authorities. He was sentenced to Stoke Heath Young Offender Institution where he spent an extremely difficult nine days, many of the days in strip clothing, in a strip cell and in virtual isolation. There was a very well-conducted inquest. The family had good representation. We had a very sympathetic Coroner. He recommended a public inquiry because the remit of the inquest meant that very important questions could not be addressed, in particular about the sentencing policy, about why it was that a very vulnerable young boy ended up in prison accommodation rather than in a local authority secure children's home accommodation where there would have been a more child centred approach to his many problems. He also mentioned the whole issue about vulnerability, about working with some very, very damaged, troubled children and particular concerns about the use of strip cells and strip clothing for children. There were a number of issues that could not properly be explored at that inquest. I think everybody who attended that inquest, particularly the jury, were very shocked by what they heard. The Coroner obviously felt, as we did, that there needed to be a broader inquiry into learning the lessons to try and ensure that these deaths did not continue. Obviously you have identified the fact that since Joseph died there have been another five children's deaths. We are working with the families of four out of those five. All of those cases raise very, very similar questions as the death of Joseph Scholes raised, which is why we really think that there is an opportunity within a public inquiry to have a proper holistic look at the whole issue of children in the criminal justice system and particularly the way in which we deal with very, very vulnerable children who are at risk of suicide and self-harm. Q23 Nick Herbert: Are those questions essentially about where children are sent to in the first place or are they questions about the handling of children once they are in custody? In its memorandum to us the Home Office has said that it has put in place a suicide prevention strategy that has better ways of dealing with children, support groups and so on. Could you comment on those strategies and be more specific about which of the two elements the public inquiry should be looking at, the sentencing or the treatment of children afterwards? Ms Coles: Both. You are absolutely right on the allocation of children, where do children go? Do they go to Young Offender Institutions? There is evidence that the Youth Justice Board brought out yesterday saying that the secure children's estate is running at 97.7 % capacity. They have not got the places to send children which means that more of them are ending up in prison rather than in local authority secure children's homes that are being closed down. The whole point about the public inquiry is it needs to look at all these different issues and that is the big problem about the current investigation process, it cannot address the wider issues. Those wider questions about allocation, where children end up and suicide prevention strategies you need to look at in a holistic way. The problem at the moment is that these things are looked at either in isolation or not at all and that is what is frustrating the learning process. Q24 Nick Herbert: Juliet, would you like to comment on the prevention strategies themselves? Ms Lyon: I would. I would just like to support INQUEST's call for this public inquiry. I learnt from Joseph's mother that the reason he was sent to custody was because he had a serious offence in his past. The serious offence in the past occurred while he was trying to kill himself. He took an overdose, jumped from a window, had a tussle with the ambulance driver and was then convicted of assault. That is my understanding of what happened. The offence involved his already trying to take his own life. I feel nothing less than an inquiry is going to shine a light on the fact that our institutions for young people are not full of happy, healthy adolescents; they are full of the most damaged and the most ill. We know that one in ten has a psychotic illness, which is far higher than in the general population. What we are doing is putting severely mentally ill children into conditions where staff do not have any chance of trying to protect them and keep them safe. I would just like to read you a tiny bit from the research I did for the Home Office which was the young people speaking. It came up because there was a research project proposal looking at whether you can have a controlled group of young people who have not been exposed to the distress of other youngsters and can you look at youngsters who have been exposed to suicide attempts and the distress of others. There was no control group available across the prison system because all these young people had been exposed to distress. This is what a tiny group of young men under 18 said. One said, "Well I can understand people banging themselves, but when people cut their wrists that's just nasty. It was just coming out of his arm ..." Another one said, "When I was in one YOI about three people tried hanging themselves." Another one said, "Everyone used to be at their doors laughing. But it ain't funny, they're mad." One said, "If you see for yourself mate, you get a shock." The last one said, "When you hang yourself all your problems are solved." That is just a tiny snapshot of what young people talk about when you give them the chance to talk. Q25 Nick Herbert: Could one of you comment on the Government's programmes for suicide prevention, their safeguards prevention programme and the suicide prevention strategy that they have and the effectiveness of that? Ms Crook: On young people specifically? You cannot design out misery, particularly with young people. I visited Feltham recently and these young people never go outside. You can tie the beds to the floor and you can have a bureaucracy that supports it and you can have as many forms as you like, but if you have got 800 teenage boys who never go outside and who never run and who never see the sky or feel the rain on their face and are cooped up in what amounts to a modern dungeon, because that is what it is, then you are going to have high rates of bullying and high rates of self-injury. Q26 Nick Herbert: Do any of the witnesses have any comment to make on the effectiveness of the Government's specific strategies for suicide prevention or their Safeguards Development Programme? Ms Lyon: In Young Offender Institutions? Q27 Nick Herbert: Yes. Ms Coles: The suicide prevention guidelines that were in operation for Joseph were exactly the same ones that would be in existence for an adult prisoner. There is not a specific emphasis and recognition about the vulnerability of children. That is slightly different in secure training centres where two of the five children have died since Joseph. This is a strategy that does not recognise and appreciate the difference. In terms of staff training, the staff are not trained to work with damaged, vulnerable children, they are trained to work with prisoners across the board. I think that would be another point about the suicide prevention strategies and about the specific vulnerability of children, that staff do not have the benefit of such training or awareness. Q28 Nick Herbert: To what extent is bullying a problem in all of this? I think you have drawn attention to the problem of mental health in all of this, but is there another aspect which is peer group bullying? Is this a contributory factory to the incidence of suicide? Ms Crook: Yes. We dealt with the case of a young boy recently who was in a big YOI. We were representing him because he was being punished because he refused to go to education. When people go from education and there is a free flow system that is when all the bullying happens. Again it is about high numbers but low staffing levels. Sometimes the staff have training but they are not educated. I think education and training are different things. If you have people coming in who are not well educated, you can do a two-day training course, but they do not have the range of skills, the sociological understanding and the childcare understanding to see when these things are happening. There is a lot of bullying in YOIs partly because there are low levels of activity. In this particular YOI there is a new education block but it is only used half the day, so the other half of the day the kids are milling about with nothing to do except torment each other. They have got all this energy and that is where they put their energy, into tormenting themselves and each other. You cannot deal with that unless you put in a very busy regime including lots of exercise. The Howard League has got an inquiry, which is going to be reporting later on this year or early next year under Lord Carlisle, looking specifically at the use of restraint and it was triggered partly by the death of Gareth Price in the training centre and segregation punishment and forcible strip searching. Bullying happens partly amongst young people bullying each other, but the institutions bully young people too. Q29 Mr Streeter: Is part of the problem that people who become prison officers traditionally tend to be fairly tough, rugged, macho people, male or female, who would not look out of place in the All Blacks front row? Is the problem that some of the skills that one is seeking to be taught, the intuition skills, do not sit very comfortably with this macho image, is that part of the issue or am I completely barking mad? Ms Coles: I think you have raised an important point about the difference between staff working in a Young Offender Institution and staff working in a local authority secure children's home where the staff are there and they know they are there to offer a child centred, focussed regime and approach. I do not whether you are hearing evidence from the POA. I am sure that they would be interested in what you had to say. A couple of weeks ago there was concern raised by somebody quite senior within the Prison Officers Association about the fact that we needed to stop treating children in prison as children; in other words, we were getting too soft on kids that were ending up in Young Offender Institutions. I think there are some who think that that kind of culture towards recognising children as children is not the one we should be adopting within YOIs, so it would be worth seeking more evidence about that. Mr Dobson: There was some research published this week by the Centre for Criminal Justice Studies which showed that many prison officers would welcome the opportunity to become more involved in education and I think that is something that we could look seriously at. Q30 Mrs Cryer: The statistics show that 6% of the prison population are women, but 15% of the suicides are among women, and more than half of those resuscitated have been women. There seems to be an imbalance. Why do you feel there is this disproportionate desire to commit suicide amongst women than amongst men? What do you think can be done to address the specific needs of women prisoners? What steps could the Government take to reduce the number of women who are being sent to prison? Ms Coles: We are currently conducting research based on the number of women who have died since 1990 and what that research is highlighting at this early stage is the fact that the majority of women who have taken their own lives and the high numbers who self-harm have either drug and alcohol problems or mental health problems, and I think that is fully recognised and I think it is becoming increasingly recognised across Government. The Fawcett Society has been commissioning some research into women and the criminal justice system. I think the answer to the first question would be the kind of women that we are sending to prison. The specific issues affecting women are that they are often primary carers of children and the fact that they are accommodated great distances from home which means it is difficult to maintain family ties. There is some harrowing evidence about the number of women who try and kill themselves or self-harm around, for example, Mother's Day. I think there has been a serious problem - and the Styal deaths highlighted that - around the treatment of women with drug problems, particularly the lack of properly run detoxification facilities and the whole way in which drug withdrawal is monitored, the regimes and conditions operating within many of the women's prisons in terms of out-of-cell activity, particularly issues around abuse, domestic violence and sexual abuse, very particular needs of women that I think it is very, very difficult for the prisons themselves to deal with. I have put in my submission about the death of the woman in Durham, the most recent death. That is an institution that the Chief Inspector of Prisons has called for twice to be shut down because of her concerns about the regimes and conditions. You only need to read the inspectorate reports to get an idea of the kind of women that are being sent to prison and the very difficult job that staff have in trying to keep these women alive. Q31 Mrs Cryer: We are being told that we need more prisons; there just is not enough space. Instead of building new prisons should we be building more hospitals, more treatment centres, for women who are on drugs? Ms Coles: I could not agree with you more. We have looked at this across the globe in terms of the fact that people with mental health problems should not be in prison. In terms of women, there is very, very grave concern about the lack of alternatives to custody, about the fact that there are very few women-only bail hostels, there is very limited numbers of secure psychiatric hospitals. I am not talking about the big hospitals like Rampton and Broadmoor, women do not need that type of security, but there is a need for some women to have secure community provision. We also need to make magistrates and the judiciary generally aware of the alternatives to prison that could better deal with the reasons why these women got into prison in the first place and their many complex needs. Ms Campbell: With the six women who died at Styal Prison, Cheshire, in that 12-month period, four of those women were actually mothers. There is no disputing the fact that the separation of the mother from her children causes a great deal of distress to a woman. When a lot of these women leave prison they have perhaps lost their home, they have lost their job and sometimes their children have to go into care. Women entering a prison situation generally seem to take with them a greater mix of problems than many male prisoners do. The main thing that concerns me is that most of these women just should not be in prison at all. Nine out of ten women offenders have been convicted of non-violent offences. Two-thirds of women prisoners are mothers. It really begs the question what are these women doing in prison? Most of them should not be there. It exacerbates their problems. Q32 Mrs Cryer: We are also punishing the children. Ms Campbell: Absolutely. Q33 Mrs Cryer: Let me just move on to remand prisoners. Remand prisoners tend to commit suicide at a much greater rate than the sentenced population. What steps can be taken to reduce suicides among remand prisoners, and should the number of bail hostels be higher? Ms Crook: It is very difficult to get more bail hostels because people do not want them in their local area, they are not popular. How many of you would like them in your constituencies? Q34 Chairman: I have got one and I voted for it when I was a councillor, too. Ms Crook: It is a very difficult issue. Offenders are not popular people and these are very serious issues. I think the lead given by politicians to support and encourage community-based systems, whether it is bail hostels or sanctions for people who have been convicted, is incredibly important, particularly for people who are on remand and who have not been convicted of an offence and who are still theoretically innocent before the law. The number of people on remand is going up and that is true of juveniles as well and it is the most vulnerable time. They are the people who suffer the worst prison conditions in the most overcrowded prisons. They get very little activity or support in prison because they cannot be made to work and anyway there is not any work in most of the local prisons. We would like to see more support systems in the community, whether it is hostels or other kinds of support, but my appeal is to turn it back to you as politicians and your responsibility for encouraging that both at a national and local level and we will work with you to support that. Mr Dobson: There was a call a few years ago in what was called the Halliday Report for a national review of what was dubbed the intermediate estate, which covers all hostel provision approved premises. That was one of the few recommendations in the Halliday Report that was not looked taken forward and not looked at seriously. I think this Committee might well want to have a look at that. If you look at the approved premises at the moment, increasingly places are being used for sex offenders, understandably, because they are difficult to place elsewhere and many of whom are sex offenders on release from prison. There is a need to keep a careful eye on what remains available for bail places. Just to link the remand question with the questions about women in prison: about two-thirds of women going into prison are received on remand and many of those are received for psychiatric reports and that seems quite wrong, the fact that they are received into prison for psychiatric reports. Q35 Mrs Cryer: What do you think about the Government's strategy for dealing with self-harm and suicide amongst remand prisoners? How widespread do you believe the use of tagging is as a condition of bail? Ms Crook: I think we have dealt to some extent with the Government's strategy already. There is no difference in it for remand prisoners or for sentence prisoners. We are all part of the ministerial group that has been reviewing this and we have gone through more Ministers than I can remember! The policies have been developing and that is to be welcomed and there is training and there is support. People who are on remand face particular problems because they face such an uncertain future and they have got the worst conditions. We know that the death rate amongst prisoners, not just suicide but other deaths, is that eight people have died this year from other suspicious circumstances as well as the suicides and some of them may have been suicides, some of them not. That was particularly amongst people who are on remand or who have just been received into custody. They are very vulnerable people. The only way to save those lives is to reduce the unnecessary use of custodial remand. Tagging may be one way, bail conditions and support may be another, but the courts will not take that risk with children or with adults if the atmosphere is so vengeful and punitive that they are frightened of being vilified in local newspapers. Every single decision made by magistrates and by the higher courts is open to scrutiny, which is absolutely right, but they are under enormous pressure. At the moment if they decide, "Well, I'll just be cautious this time and use a custodial remand as opposed to a community tagging or something else," it can lead to a death. It only takes one decision a year by each magistrate to have 30,000 extra prisoners. Mr Dobson: I did just want to follow up a question on tagging. If you look at electronic monitoring and the way its use has developed in this country, it is largely a back-end use that is after use of custody. There has been relatively little emphasis to date on it as part of a community penalty or associated with remand and I think that we could make much more use of it provided it is for short periods and coupled with supervision. For people on remand there has got to be some kind of safe accommodation. It is worth thinking about the Supporting People strategy which was supposed to give some priority to offenders and ex-offenders and I think in some parts of the country that is not producing the necessary accommodation. Q36 Mr Browne: We were told earlier that 587 out of every 1,000 women prisoners self-harm, that is more than half of women prisoners self-harm. Ms Coles: I am sure that the Government will give you this. The new edition of Safer Custody News gives a breakdown of self-harm trends amongst women and young people. You can have a look at this. It gives you it in graphic detail. The fact is that women account for 58% of all self-harm incidents even though they form only 6% of the prison population, and that is another figure in terms of the number of women who have been killing themselves, it is a disproportionate number. Q37 Mr Browne: Self-harm gives a wider picture of the levels of despair whereas the suicide levels give you a very thin top picture. 58% of prisoners who self-harm are women but more than half of women prisoners self-harm. Ms Coles: Yes. Q38 Nick Herbert: I wanted to pick up on the points about electronic tagging because Frances mentioned the vengeful atmosphere which you felt was preventing the use of non-custodial alternatives, such as tagging, which are important if we are going to deal with some of these issues of suicide. Would you not accept that there is some legitimate public concern about incidents where people who are on tags have committed other crimes and that public confidence in the system is going to be very important if those alternatives are to be pursued? Ms Crook: Of course, every crime committed, particularly any serious crime committed, while somebody is on any kind of early release scheme is much to be regretted. However, these people would have been released anyway. I am not convinced that taking people to the end of their sentence and then releasing them with no support or monitoring or supervision at all is a safer way than what we have at the moment. I have never been a great fan of electronic surveillance. I think human support and the Probation Service and other kinds of human networks are preferable, but that is more expensive. All the prisoners, apart from 20 or so, are going to be released. The question is how do you release prisoners into the community to give them the kind of support which enables them to re-integrate successfully and to be useful citizens and not to commit further crimes? They do need support on release. Tagging can be part of that. Human support to make sure that they have got somewhere safe to live, that they have got enough money to make sure they do not have to steal to get it, that they have got proper drug rehabilitation facilities and they have got alcohol use support are absolutely essential if they are not going to commit further offences and not going to kill themselves because the hidden death toll is amongst ex-prisoners who go on and kill themselves on release. This was drawn to our attention when a friend of one of my staff members was released from Holloway Prison and within a week had jumped off a bridge in Archway Road. As a result of that, we did the first research into how many ex-prisoners have committed suicide and it is an increasingly high death toll. Q39 Chairman: Can I ask a question myself and it takes us slightly back to the beginning of the session and I am now wanting to try to draw together some of the strands here. We have had a lot of discussion at the beginning of this session about suicide and overcrowding, but having established at the beginning that overcrowding is a factor in suicides, much of what we have discussed in the last quarter of an hour really seems to be centred on things which are inherent in sending this particular group of people or these particular groups of vulnerable people to prison as opposed to overcrowding. We will have the Minister here in a very short time, so to what extent would it be fair for the Minister to point to efforts to reduce overcrowding as a key element in their strategy to reduce suicides, whether they are trying to do that by building more prisons or more community centres or whatever, or are they really in the wrong place if they are trying to reduce suicides? Ms Cook: You cannot build your way out of the problem. It is as simple as that. If you build more prisons, they are full up before they are built because the message is to the courts and to the public, "Prison is the answer, therefore, use it". The history over the last 30 or 40 years has been that you cannot build your way out of the problem; you have to stem the flow, you have to stem the supply because prisons get overcrowded before they are built and that is why you have the list of the top 20 overcrowded prisons with 90 deaths in them, very simply. Q40 Mr Malik: I just have a very small question. I am going to be asking about children in custody. If there are two things, or perhaps three, that you could say in a few words that were key in terms of dealing with some of the issues around children in custody, what would they be? Ms Coles: Stop sending them to custody in the first place, stop closing down local authority secure children's homes and invest in more secure children's homes, which I think would not only save lives, but I think would address a lot of the issues of concern to us all about children who get in trouble with the law and what we do with them. At the end of the day, those children grow up and I think that if we invest the resources and the staff support at that early stage, we might well prevent offending in the future, and we also would save lives. Q41 Chairman: Ms Campbell, if you had one question you would like to hear the Committee ask the Minister, what would it be? Ms Campbell: Why can we not have a greater initiative from the Government to encourage a better use of non-custodial sentences? Chairman: Thank you very much indeed, everyone. Memorandum submitted by the Home Office Examination of Witnesses
Witnesses: Rt Hon Baroness Scotland of Asthal QC, a Member of the House of Lords, Minister of State for Criminal Justice and Offender Management, and Ms Christine Knott, Acting Head of NOMS, Home Office; Mr Phil Wheatley, Director General, Prison Service; and Mr John Boyington, Department of Health, examined. Q42 Chairman: Minister, thank you very much indeed for joining us this morning. It is the first time that you have appeared before the Home Affairs Select Committee, so it is a particular pleasure to have a Lords' Minister in front of the Committee; it does not happen particularly often. I know you would like to make a brief opening statement, but I wonder if, just before you do, your officials could introduce themselves for the Committee and then perhaps I could invite you to make your opening statement. Mr Wheatley: I am Phil Wheatley, Director General of the Prison Service, that is, the public sector prisons. Ms Knott: I am Christine Knott, I am the National Offender Manager and currently the Acting Chief Exec of NOMS. Mr Boyington: I am John Boyington, Director of Health and Offender Partnerships which is a joint post between the Home Office and the Department of Health. Q43 Chairman: Thank you. Minister? Baroness Scotland of Asthal: First, may I say what a pleasure it is actually to appear before this Committee, not least because you are dealing with an issue that is absolutely critical to all of us. I would very much welcome this few minutes to update the Committee on what the figures currently are. Now, as many of you will know, recent trends of self-inflicted deaths in prison are going on a downward trend rather than an upward trend and that is quite a positive thing, but we think it is probably because of the combination of reasons: the effect of giving a high priority over the last four years to addressing sentencing issues; the introduction of improved risk identification and care arrangements, and I know that we will later on talk about the ACCT change which has come about; and really a stress on mental health, inreach and detoxification. That is one of the reasons, I think, why John Boyington is here with us because they have made a really important advance. This year's numbers are thankfully down by about 25% at present in the calendar year, that is 66 compared to 88, and 20% in the financial year, that is 47 compared to 59. However, I must make it absolutely plain that we are by no means complacent because we have to keep on driving these figures downwards, but I think the short-term trends can be quite misleading, so what we have tried to do is to look over the wider pattern. The rate has reduced two years running, that is from 148.3 in 2002/03 to 126.2 in 2003/04 and 113.7 in 2004/05. I think the prisoners we are looking at are a recognised high-risk group within the Government's wider strategy. The overcrowding issue is obviously a matter of concern, but it does not appear at the moment necessarily, as such, to lead to more deaths. As many of you know, cell-sharing can in fact be a protective factor and it is one of the factors we have to take into account. I think also, just to highlight the nature of the prison population that we currently have, we are dealing with a very vulnerable, highly vulnerable group, many of whom have life experiences which make them innately vulnerable and have had quite a high incidence of attempted suicide before they get into the prison estate. More than 40 prisons now will implement the new ACCT during 2005 and they are doing that in close collaboration with the regional mental health fora, so the inreach teams working together with prison staff and the greater training has started to make a difference. Those are just the sort of preliminary issues I wanted to touch on because I think they do go to many of the things which you may be interested in. Chairman: That is very helpful, thank you. Q44 Mr Winnick: Minister, you have been mentioning, as indeed did your memorandum to the Committee, the numbers involved in suicides and your own memorandum, as far as the numbers are concerned, says that in 2001 it was 95, the following year 94 and last year 95. Where is the improvement? Baroness Scotland of Asthal: Really if you look at the numbers coming into our prison estate, they have gone up, so if you look then at the percentages of people who are attempting or committing suicide, those figures, relatively speaking, demonstrate a downward trend. Q45 Mr Winnick: So it is an average of the prison population with the actual total number of course, as your memorandum stated, the figures which I have just quoted, being the loss of lives involved? Baroness Scotland of Asthal: That is right. Q46 Mr Winnick: But you are saying it is an improvement of a kind, and I am sure you, no less than anyone else, deplore suicide. Baroness Scotland of Asthal: Absolutely. Q47 Mr Winnick: Exactly, but that is not in question, Minister. Your position is that if you take the prison population, it is an improvement? Baroness Scotland of Asthal: Yes. Q48 Mr Winnick: In fact this year, as you say, 64 so far unfortunately have taken their lives and there were 13 in June alone. Is that not a much higher average in a month of such tragedies and is there any particular reason for it, as far as you are concerned? Baroness Scotland of Asthal: We looked very carefully to see whether there was any pattern. As you can imagine, up until June the picture did look much better than it had been. There was a growing degree of confidence that the sort of new approaches that we were putting in place were having a beneficial effect. We looked very carefully to see whether there was any particular trend which would have caused this quite sudden acceleration, and we could not find or identify a particular reason, although we are continuing to look with great care. What you will notice is that after June the picture returns to one of a more normal level. One of the really difficult things we have found is making any judgment which is simply focused on one particular month; you end up having to look over a longer period to see where the trends are going, but it was a matter of huge concern. I certainly can assure the Committee that what happens every morning is that I have on my desk the numbers who have died or been injured the night before and we keep a really tight view on what is happening and I was extremely alarmed during that month. It was a very hard month for the Service, all of whom were trying really hard to understand what was actually causing this one. Q49 Mr Winnick: And very hard of course for the loved ones left behind. Baroness Scotland of Asthal: Absolutely, because I think it is their families, but also I think, just to share this with the Committee, the sense of commitment and bereavement that happens with the family and indeed with those inside who were trying to care for them because some of the prisoners who will have befriended those who commit suicide and take their own lives also thereafter need quite a lot of care because they are adversely affected too, so every death has a real impact. Q50 Mr Winnick: June, if I can just for a moment concentrate on June when 13 took their lives, was that not a month when the prison population increased more than on previous occasions? Baroness Scotland of Asthal: I think the prison population has continued to increase. Q51 Mr Winnick: In June in particular? Baroness Scotland of Asthal: In June there was an increase, but I think if you look at the trend, you cannot say it was so out of kilter with the increase thereafter to make it particularly significant. You know that our highest prison number was in November and it continued to rise, so I understand the concern that is expressed there, but there is not a direct correlation between the increase in number and the number of deaths because if you look at the different establishments in which those occurred, the picture is very different in each of them. Q52 Mr Winnick: But you agree that in June the prison population went up more in that particular month than in previous months? Baroness Scotland of Asthal: I am not sure. I know that impressionistically that is not my view, but I must say it is because I have been watching the way in which the prison population has been rising and, therefore, June, when I look back on it, does not seem to be the highest point. The highest point actually was reached on 1 November. Mr Wheatley: It went up 700 in June. Q53 Mr Winnick: That is more than usual in a month? Baroness Scotland of Asthal: I have just been told it was less than a 500 jump, but we will check the maths. Chairman: Perhaps you can come back to us on that. Q54 Mr Winnick: The position of the Government, and I suppose in this respect it is almost identical to previous governments, is that it is the same effect, but it is very difficult to demonstrate causal links between prison numbers and deaths in custody, but do you not accept that it is very difficult for people outside the Home Office really to accept that there is no link between the ever-increasing numbers in prison and those unfortunately tragically taking their lives? Baroness Scotland of Asthal: I think it is absolutely reasonable for people to raise that question because we raise that question ourselves and we are looking very carefully to see what the empirical data tells us, not least because we need to use that information to recast our response to it, what we do about it. One of the things we have been able to do is to look at the changes that are necessary in terms of the overall culture that takes place, but also the effect that ACCT has had because it is a different way of dealing with a number of the issues that arise from people who do take their lives, for example, having better training, having a better link with the healthcare services, creating an environment which lessens the degree of stress on the population as a whole, but taking a much more caring and therapeutic approach towards the management of the risk. Now, in those prisons where ACCT has been rolled out, we do see a marked difference and a reduction, so we know, the early indications are, that this method of working can have a material effect. The reason I am saying that there is not a direct correlation between the overcrowding is almost perversely that the sharing of cells can act as a disinhibitor for those who want to take their lives and indeed cushion them, so you have quite an interesting difference in that and that is why we cannot say that overcrowding as such causes an increase, but there are a lot of other things that may be a consequence of overcrowding which can add to the risk factors and those are things we have to look at. Q55 Mr Winnick: In your speech in the recent debate in the House of Lords, you make the point about shared cells as a possible deterrent to suicide, but would you accept that if anything possible in any way had been done to stabilise the prison population, say, over the last ten years, then there would have been a real reduction in suicides or do you not accept that at all? Baroness Scotland of Asthal: It is not a case of accept or not accept; there is not the data to justify that conclusion, but what we must know is that if you have a greater amount of time, if there is an opportunity to skill people in a way that enables them to meet the needs of prisoners in a more holistic way, one would hope that that would materially affect the atmosphere, the culture in prisons and one would hope that might have a reduction in the self-harm and in those who take their lives. All I can say to you is that there is no empirical data that I have which demonstrates that and in fact the evidence that we have been able either to keep stable or reduce the numbers committing suicide and taking their own lives during a time when we are increasing the numbers tends not to justify that. I am saying that I understand the way people feel about it, but I am looking incredibly hard at the data and the data does not justify that conclusion. Q56 Chairman: One of the things which has been put to us by the non-governmental organisations is that at a time when 50% of prisons are overcrowded, actually a disproportion, more than 50%, of suicides took place in the overcrowded prisons. You say there is no empirical data, but that surely gives some suggestion that the conditions of stress, which might help to encourage suicide, are greater in the overcrowded prisons, otherwise, there really should be no difference between the suicide rates in the two kinds of prison. Baroness Scotland of Asthal: The difficulty of course is that those prisons are quite often local prisons. The local prisons have a greater degree of churn and the local prisons tend to have prisoners who, by their very nature, are likely to be on the more vulnerable lists, so if you look at the numbers who had tried to commit suicide before coming into prison, the other risk factors which will make up the likelihood of someone taking their life, those factors, if put in any situation, tend to increase the number who then want to commit suicide. Therefore, what I am saying is that it is a really complex issue. It is too easy a correlation to make to say, "Oh well, therefore, overcrowding equals an increase in suicide", because it does not. If you disaggregate those issues, you see that it is those issues which will influence whether or not the rate goes up or down. Q57 Mr Winnick: Lady Scotland, you chair what is known as the Ministerial Round Table on Suicide. Baroness Scotland of Asthal: Yes. Q58 Mr Winnick: How often does it meet and what precisely does it do? Baroness Scotland of Asthal: What the Round Table does is to bring together all of those who are responsible for suicide reduction so that we can look at the policies that go right across the piece. One of the things we have absolutely understood is that the changes that need to be made are not changes which simply are within the prison estate, but it is the way we work with health and the way we work with other organisations that makes the difference, so the Round Table is really our opportunity to learn best practice and seek to implement it. The importance of the Round Table is that the people who are actually participating in that Round Table are the ones who are going to have to implement the changes in order to bring about the success we hope to achieve together. Q59 Mr Winnick: So it is the Prison Service basically? Baroness Scotland of Asthal: It is not just the Prison Service. It was established by the Prison Service five years ago, and it covers deaths in approved premises, but it also has its discussions increasingly extended to related issues affecting deaths and vulnerabilities of offenders in the community. There are generally three meetings a year and frequently in the prison setting because holding the meetings in prisons enables prisoners to attend, it provides members with an opportunity of seeing the prison at first hand and talking to prisoners and the Samaritan-trained listeners in particular make a very valuable contribution. Q60 Mr Winnick: We have had evidence just before you from the Howard League and the Prison Reform Trust. Are they involved with, and invited to, the Round Table? Baroness Scotland of Asthal: Yes, they are. Q61 Mr Winnick: They do sit on the Round Table? Baroness Scotland of Asthal: Yes. Membership is Her Majesty's Chief Inspector of Prisons, the prisoner and probation officer representatives, the Youth Justice Board, the National Probation Service, Prison Health, the Samaritans, the Howard League, the Prison Reform Trust, INQUEST, the Independent Monitoring Board, the Custody Group, which was formerly part of HM Prison Service, and we have now migrated to the headquarters of NOMS the Secretariat of the Round Table, and we are inviting too my colleague Rosie Winterton from Health to come and join us on that Round Table, so it is really all of those people who have been properly exercised about this issue for quite some considerable time. We are looking, and we looked at the last Round Table, at a programme to try and drive this agenda forward over the next few months and we are going to continue to meet three times a year, and we will be able to report back and see how far we are going. We have taken very seriously a recommendation made by the Committee in terms of having a group who really focus on this and deliver it. One of the things we were conscious of, however, is that it is important that the practitioners, the people who are going to be responsible for delivering, should participate in this so that we really have an engine to drive it forward and people do not say, "It's not me, it's somebody else". Q62 Mr Winnick: Will the minutes be given to this Committee? Baroness Scotland of Asthal: We can certainly look at that. What we have tried to do in the Round Table is to create an environment where people are brutally frank about what they think and certainly we would be very happy to look at sharing with this Committee the results of that rather than necessarily who said what to whom. Q63 Mr Winnick: I think all of us understand that. The Government has rejected a recommendation by the Joint Committee on Human Rights for a cross-departmental expert task force on deaths in custody. Baroness Scotland of Asthal: Yes. Q64 Mr Winnick: Would you reflect again on that position? Baroness Scotland of Asthal: Well, we have reflected and, as I have tried to say, we took very seriously, and agree with, the recommendation and the kernel of that recommendation that we have to have a group driving it forward. What we have looked at is that there are already now three different entities who are doing that and the question was: do we create a fourth or do we try and galvanise the work that has already been done in such a way as to deliver what was actually requested? We have taken the view that it would be better to make those who are currently charged with that responsibility actually deliver on it because, otherwise, you have got, if you like, something coming in between. I am conscious that what we want is for people to accept responsibility for it and it is easier to accept that responsibility if the people around the table are not reporting and exhorting others to do it, but actually saying, "I will now, on behalf of my Department [or my group] take the following forward", and do it. Q65 Mr Browne: Minister, in your introductory comments you placed high store on what could be achieved with the new ACCT system. Baroness Scotland of Asthal: Yes. Q66 Mr Browne: I was hoping you could expand on that and explain what difference it will make, what timetable you have for rolling it out across the system as a whole, and then estimates of the cost implications of this whole project. Baroness Scotland of Asthal: As I hope you are all aware, the ACCT aims to improve the quality of care by introducing flexible care planning that is prisoner-centred, supported by improved staff training in assessing and understanding the risks that prisoners pose. The reason we are confident this is having a positive impact on the care provided to vulnerable, at-risk individuals is that already there are some really good signs of improvement in prisons that are early implementers of ACCT. Since April 2005 there has been a 5% drop in the rolling three-year numbers of annual self-inflicted deaths in the first 30 establishments to start using the new system, with the five ACCT pilots seeing a 10% drop since starting in January 2004, so we have got real evidence already that it works. Now, it works because it is seeking to bridge the gap between the crucial inter-relationship between suicide prevention and mental health provision. For example, it is linking with reception screening, mental-health awareness training and mental health inreach, bringing those three things together and, significantly, implementation is taking place in close partnership with the National Institute for Mental Health in England. ACCT, therefore, I think involves a significant commitment for staff training where all staff in contact with prisoners are going to be trained in ACCT to foundation level, with specific training for case managers and selected assessors, and that has really meant that we have been able to drive forward the figures in a way that has made a difference. Q67 Mr Browne: That is interesting because, although the specific subject that we are addressing today is suicides in prison, one of the witnesses that we saw prior to your coming to the room said that more than half of women prisoners self-harm, and we did not probe what the definition of "self-harm" was, but nonetheless it is an extraordinary figure. Do you see evidence with ACCT that it is going to bring in enough of a cultural change rather than just a few people ticking boxes to say that they have been on enough training courses to get a certificate, that it will bring in enough of a cultural change that we will see a turnaround of all of these various indices within a reasonable timescale? Baroness Scotland of Asthal: I certainly hope that will be the case. Certainly when I have had reason to visit a couple of prisons where they have had the training, one of the things that people said to me which was really exciting was that having health professionals, prison officers and others being trained together meant they had a really in-depth understanding and what was happening was that that understanding was transferring to how prison officers were dealing with all the prisoners. The level of sensitivity, the level of care and the level of training seeped into not just looking after those who are at risk of self-inflicting death, but also in terms of the general management. That is particularly important because you will know that many of those who in fact take their own lives have not given any indication of vulnerability, so being able to change the culture is very, very important. We really think this is helping. Q68 Mr Browne: You are confident, and again this has been touched on, that the time that it needs to have to effect this cultural change will not be compromised by ever-increasing prison numbers, so it will not be that just the day-to-day processing of the activities within the prison and making sure that prisoners are supervised will not be so all-consuming in the more crowded prisons that some of these considerations will slip backwards? Baroness Scotland of Asthal: I think it means it is taking place in a more challenging environment. All I can tell you is ---- Q69 Mr Browne: So that is a yes? Baroness Scotland of Asthal: ---- in those prisons where it is actually happening, it is making a difference and in those prisons where it is actually happening, prison numbers have gone up. What is my reasonable expectation? My reasonable expectation is that this is a lot better than that which we had. The training is making a difference, but this is not a silver bullet and there are lots of other things that we have to do at the same time and some of the changes that we have made in the 2003 criminal justice legislation and some of the ways in which we are now giving sentences with greater options for community sentencing we hope will in fact mean that only those who absolutely need to be in prison will be in prison, and that of itself will obviously mean that we will have more space to deal with those people. Q70 Mr Browne: You said it was a more challenging environment, having more prisoners, but I think there is a conflict, and I do not particularly blame government ministers from this particular Government, politicians respond to a public desire, and you may say it is a misplaced public desire, to see more people sent to prison and more speeches and other items of political propaganda will be made to that effect, "We will be tough on crime and tough on the causes of crime and send more people to prison". At the same time, other parts of the Home Office are having lots of meetings with the Howard League and groups of that sort to see how they can address some of the effects, some of the consequences of the overcrowding that is actually a direct result of government policy and the whole way government approaches criminal justice. Do you see a contradiction here, or not necessarily a contradiction, but a sort of sense that the right hand and the left hand are not working together? Baroness Scotland of Asthal: I can understand the perception, but I think I need to be very clear about how we see it. We see that it is absolutely important for the safety and security of the people of our country, that those who are dangerous and prolific offenders receive appropriate prison sentences which will reduce their level of risk that they pose to the community. However, there are a large number of people who are currently in prison who do not fall into that category and for those offenders, through the new Criminal Justice Act 2003 and the much tougher community penalties that are now available, Community Payback, the fact that we can have a home detention curfew, the fact that we can make better inroads in terms of the risk element in reducing drug and alcohol dependency, those issues which go to the root of the offending pattern of behaviour and the things that we need to do to reduce recidivism and enhance our opportunity to resettle people, all of those things are very much within the heart of what is now available. In the past, as many of you will know, courts have said that they have not had a broad enough menu, they have a very restricted number of things that they can do with offenders to interrupt that pattern of behaviour, so it is a combination of doing those things and making community penalties really tough so that they are a real alternative to prison which will maybe help us drive the numbers down. Q71 Mr Browne: So you anticipate, as a consequence of that, that prison numbers will fall and you will be able to reassure people at the Howard League and other organisations of that sort that there will be a less challenging environment in terms of ACCT and other measures of that sort because all of these proposals which you have just described will see a trend downwards in the prison population in the year ahead? Baroness Scotland of Asthal: Well, we certainly hope that there will be more appropriate sentencing which will mean that those who are dangerous will go inside, but those who can be safely managed in the community will be. Q72 Mr Browne: Does that mean yes or no then? Baroness Scotland of Asthal: That will mean that there should be fewer people in prison if that is what comes out and we think it will, we think it will. Q73 Chairman: I do not want to sound cynical, but I wonder if our earlier witnesses might say that what you have just said, which I think is very much in line with what the Howard League and other organisations would like to hear, is the sort of thing that select committees hear from ministers when they are talking about prison overcrowding and suicide, but it is not what we hear from ministers the rest of the time when they are talking to us, for example, about crime. Is there the chance for some greater consistency in the message from the Government over this question of sentencing and the balance between custodial and non-custodial sentences? Baroness Scotland of Asthal: Well, I hope what I am saying is actually very much in tune with what Charles Clarke said and has been saying repeatedly. It is very much in tune with what we said at the Prison Reform Trust speech which concentrated on community prisons, on resettlement, on reducing recidivism and on doing those things which are actually pretty tough about making sure that community penalties are understood by the public, the public participate in framing them, and that is what the Community Payback initiative is about, the community having a say in the sort of community penalties that make sense so that it will have greater confidence, and it is what we have done in terms of making sure that we rehabilitate fines which had fallen into disuse because people did not think they were going to be responded to. Therefore, I certainly hope that you will always hear a consistent message from me. I think if you went through every speech I have ever given, I doubt if you would find anything inconsistent, but I would be happy to have it highlighted to me if there were inconsistencies. Q74 Mr Browne: Maybe in elections we will have big posters saying, "Vote for us and fewer people go to prison". Baroness Scotland of Asthal: "Vote for us and we will have more effective imprisonment". Q75 Mr Browne: I have two things to ask and one of them is about what can be done to reduce suicides among prisoners in their first days, week, month in prison because that is the time when the figures show that it is particular prevalent, and the other is a related point about the greater number of safer cells which make it harder for prisoners with suicidal intentions to harm themselves - what has been taken in both of those regards? Baroness Scotland of Asthal: One of the things we absolutely understand is that the early period in prison is the period when people are most vulnerable, so it is improving our ability to assess, improving the early reception procedure, making sure that there are better joins in relation to that, and the stuff I have already talked about in terms of ACCT. In addition, it is improving and implementing the safer cells policy. We know that having safer cells which limit the number of ligature points, et cetera, limits the opportunity that people have to self-inflict. If I can say just a little bit about safer cells, from 4 December 2003, the Prison Service Investment Board confirmed our existing policy. It meant that all Cat A and B and local prison establishments would be fitted with 100% safer cells to a full Property Services Group specification, but Cat C prison establishments would be fitted with 25% safer cells, and we gave consideration also to include a safer cells provision in all business case permission of estate planning. What that means is that to date we have installed 4,200 safer cells. I cannot give you precise numbers in terms of how many of the 56 prisons of Category B prisoners have safer cells as we have not done that audit, but I can tell you what we have done in terms of new safer cells. The new house-blocks being built in public sector prisons will contain new safer cells, and the percentage of such cells will depend on the risk levels of each prison. The cost to put a safer cell into a new build compared to a normal cell is about £8,500. It is more expensive than a normal cell. The cost of converting one existing cell to a safer cell is £31,000 and the cost of converting multiple existing cells is £21,000. Q76 Chairman: I am sure that this article is not immediately available, but given the focus on prisoners newly admitted to prison and remand, is it possible to tell us now or in writing afterwards what at the moment the chances are of a new person going into the prison system actually being placed in a safer cell than a traditional one? Baroness Scotland of Asthal: I certainly have not got the figures here. Q77 Chairman: Perhaps you can provide us with those so that we have a measure of how far the programme has got. Baroness Scotland of Asthal: Yes. Q78 Gwyn Prosser: Minister, we took evidence this morning from the NGOs and they were critical frankly about the failure of the system in communicating medical evidence and other information about the prisoner from the courts to the prison and then from prison to prison and they put that quite high on their priority list for improving matters. There was a notable case last year when a judge contacted ministers and expressed his concern about that failure and made various recommendations. Can you tell us what you have done about that? Baroness Scotland of Asthal: First, I think everyone will know the issue of transferring information from one part of the criminal justice system to another has been an issue for quite a long time. I hope that the Committee is aware of the work we have done on OASIS, which is the assessment process, which all participants are going to be using. That will now be available for roll-out across the criminal justice system by the end of this year. NOMIS, which is the National Offender Management IT Service, will be available across all estates by the summer of next year, that is July of 2006, and we hope that the combination of those two will mean that we will have much better access to the type of information which will enable people to make better-informed judgments for keeping people safe. It has been a real issue for a considerable period. Those areas which have already got the benefit of OASIS are seeing clearly the advantages that that brings and we know that having access through NOMIS, which is the joined-up IT process, will allow us to have a quantum leap in information because it is not simply, though very importantly, families who are saying this, but if you talk to practitioners across the piece, they are all saying that they need better-quality and quicker information to be able to make the informed choices that they need, and we have made a massive investment on IT throughout the whole of the criminal justice system where we will be spending more than £2 billion, I think, overall, but it is coming now at last. Q79 Gwyn Prosser: What about the suggestion by the judge that prisoners should be given a unique number which would follow them from prison to prison? Baroness Scotland of Asthal: Well, one of the things that may well happen through NOMIS is that the same data will pass from police to CPS to courts to probation and then to prisons, so we will have a way now for tracking information which we simply did not have before. Quite often what would happen is that there would be valuable information buried in the reports, but they would not get there at the right time at the right moment. What NOMIS, we hope, will do is enable all the people in the criminal justice system who should have access to that information to have access in real time and that will make a huge difference to our effectiveness and our level of efficiency, so we are to capture that information. For instance, if I can give an example, it will mean that someone who may have been in prison just a month or two before who will come into our prison estate, in the past we might not have been able to know unless he or she told us that was the case, that information, now when the whole system rolls out, which, as I say, is the summer of next year, we should be able to have direct access to that information and I think it will make a big difference to us. 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. 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 OASIS 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 OASIS 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 style, 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. Q100 Mrs Dean: Is it true that women are more likely to be sent to prison for a second offence than men and do you accept that a smaller proportion of women offenders should be sent to prison and, if so, what is the Government doing to achieve that? Baroness Scotland of Asthal: I think a similar number of women are being sent. If you look at the number of women we have in our prison estate at the moment, there is a huge disparity between the number of men who get sent to prison and the number of women who get sent to prison. There are just over 4,500 women in prison at the moment and you know that our prison population is over 77,000 overall, so if you look at the percentages, it is actually a relatively small percentage of women who are going to prison. However, the consequences for those who do go are stark and I think that is something that we are looking at very carefully. The increase and change which has come about by virtue of the new community sentences which have become available as a result of the Criminal Justice Act 2003 we think will be very helpful because it will, we hope, enable the court to better target the offending pattern of behaviour for women in a way that need not necessarily involve a custodial sentence. I think one of the things we have to be really frank about though is that many courts almost give up on someone and there are so many offences, and they are minor offences, but there are sometimes hundreds of them, so they think, "Well, what else can we do? We will put this woman in prison". What we have to find is a better way of addressing those women's offending patterns of behaviour and interrupting those patterns of behaviour in a way that will perhaps keep them in the community, lessen the consequences for their children, lessen the consequences for themselves and get them back into circulation, but in a way that actually bites on their offending patterns because the courts will have no choice, but to send some of these women to prison even if the actual offences are themselves not huge, but because of the number of them, and that is a real challenge for us and we are really concentrating on seeing what we can do about it. Chairman: We will turn to the last section now. Q101 Nick Herbert: Another group where the incidence of suicide is relatively high is those prisoners on remand. As you know, there has been a huge increase in the remand population over the last decade. What steps are you taking to deal with the problem of suicides in remand prisons? Baroness Scotland of Asthal: Really it is in relation to the attempts we are making for better assessment when they come in; many prisoners go to first night centres, putting in programmes which will involve the use of insiders who, as you know, are prisoners who give information but also they are put on to the Samaritans who are the listeners, and trying in those first few days to make sure we have better assessment, better support and better opportunities to pick those people up very quickly. Also of course we are hoping that by working with the courts we will be limiting the number of people who will be coming to prison on remand. There are greater opportunities now by tagging, by curfews, by other steps, which will be better able to keep people secure in the community and monitored as opposed to putting them into prison. But it is in those early days, making sure we have better ways of assessing which will make a difference. Q102 Nick Herbert: On your point about trying to reduce the remand population and the use of tagging, I notice in the Home Office's written evidence you said you had notified the courts of the availability of tagging, but can you tell us more about what the take-up of that has been specifically in relation to remand as opposed to early release? Baroness Scotland of Asthal: Basically this is an issue of confidence. You will recall at one stage the availability of tagging was perceived to be patchy. It was also seen by many to be very expensive. It is no longer expensive and it is universally available right the way across the country. It is making sure that sentencers are aware of that availability, are aware of the effectiveness of it and can therefore have greater confidence in using it. The Sentencing Guidelines Council of course has a real role to play in terms of the advice it gives to judges in the sort of interventions they should look for, and we are hoping that they will assist also. We can write to you on the figures. Chairman: That would be very helpful. Q103 Nick Herbert: Can I ask quickly about bail hostels which are another potential alternative to remand prisons? Baroness Scotland of Asthal: You will know the majority of bail hostels we have now are really identifying the top end of activities, so that we can get the security and confidence for those who are more difficult to manage in the community. However, there is an issue as to what further or other provision we need to make in relation to bail hostels for those who are not perceived to be dangerous but are in need of accommodation and monitoring and that is an issue we intend to continue to look at. For those who have secure accommodation we now believe that the sort of tools that there are to monitor them in the community are sufficiently robust and sound to make prison for many of these offenders no longer a necessity in the way it was before. Before we had tagging, before we had the combination of tools, I think it was a more reasonable resort to have prison, but we think the need for it will and has diminished. Q104 Chairman: We were told by our earlier witnesses that one of the recommendations from the Halliday Report which had not been implemented was the one for the review of that part of the estate which deals with remand prisoners and bail hostels and so on. Apparently that has not been implemented. In view of what you have just said, is there any prospect there will be a wide ranging review of remand prisoners and bail hostels and other provision for people pre-sentence or outside of sentencing? Baroness Scotland of Asthal: I do not know whether review means setting up a separate body. Q105 Chairman: To develop an overall strategy for the type and location of property, the type who can be sent there? Baroness Scotland of Asthal: You will know, I hope, that we hope to launch a five year strategy in relation to reducing reoffending, and one of the things we are going to be looking at is the needs across the estate, what sort of estate we will need to build up, what sort of interventions will we have, because we do need that needs-based assessment so we have a real understanding; what is the nature of offenders, what is their offending pattern of behaviour, what is the level of interventions they will need, what sort of interventions are likely to make a difference and then what sort of accommodation will we need in the community in order to deliver some of those things. So that review of our overall provision is going on at the moment. Chairman: Thank you. This has been a very helpful session. Thank you very much indeed. I think my own impression from the chair is that the direction of travel you have set out is not so far from the areas urged on us by some of the organisations earlier, but you have also given the Committee a number of aspirations for the Government which we will want to come back to in the months and years ahead to see how much progress is being achieved. Thank you very much indeed. |