Examination of Witnesses (Questions 220-239)
MR PHIL
WHEATLEY CB, MR
PAUL FOWEATHER,
MR PAUL
THAIN, MR
IAN HULATT
AND MR
PAUL CORRY
17 NOVEMBER 2005
Q220 Mike Penning: You were talking
earlier on about the significant amount of money that is spent
in prisons on trying to get people off smoking and alcohol.
Mr Wheatley: Yes, we do.
Q221 Mike Penning: What percentage
of your inmates are smokers?
Mr Wheatley: I think about 80%
of our prisoners smoke on entering prison, or it is about that.
Q222 Mike Penning: And your success
rate of weaning them off it?
Mr Wheatley: I do not know whether
Paul would know.
Q223 Mike Penning: You do not have
to tell us exactly.
Mr Wheatley: No, I cannot give
you exact figures. I am told that we are getting about the same
success on the quitting as we do in the community, so if we go
for a quitting programme—[2]
Q224 Mike Penning: So it is quite a high
proportion.
Mr Wheatley: We have about the
same proportion as you get with ordinary members of the public.
In other words, prisoners are not special. With the evaluation,
we will be able to give you decent figures of the scheme in the
North West that is being done with Health and at that point we
will have real figures. The early indications are that we get
roughly the same proportion as if you work hard on people in the
community.
Q225 Mike Penning: Prisons are starting
at a much higher threshold though.
Mr Wheatley: Yes, but prisoners
have every incentive to give up because cigarettes are expensive
and we do not pay them a lot of money, and there are other things
they might spend their money on. Just like the public or in fact
more than the public, probably a greater proportion of their money
goes on cigarettes and, if they can get more of the other things
they might want to buy, like phone cards and so on which give
them access to home, they have every incentive of trying to break
free as well as the health reasons.
Q226 Chairman: If this legislation
is perhaps passed and we have a situation where smokers and non-smokers
are sharing cells, you are exempt, so the smoker can actually
smoke, would you be concerned that you may have a human rights
challenge against you by the non-smoker in that situation?
Mr Wheatley: Well, I am always
concerned that there is always that risk of a variety of legal
actions being brought against us and this might well be another
one, but I would not speculate on that. I would expect to gain
support for a policy that says that smokers and non-smokers should
not be together. The consequence of that is that we would hold
slightly less prisoners because we would be making slightly less
efficient use of our accommodation, so there is a real implication
for government and, therefore, for Parliament as well as to how
many people we can hold. It would make a significant, but not
enormous, difference because we would end up with a non-smoker
and a smoker arriving, there are two cells and they are put in
two separate cells, so we would lose the mixing of people as the
wrong sort of prisoners arrive. We cannot order from the courts
the required numbers of smokers and non-smokers in advance.
Q227 Chairman: We have seen written
evidence sent in by another organisation of prisoners having to
share. The one that stuck in my mind was the individual who was
in there for a number of years, had never smoked in his life,
and yet here he is in a confined space effectively smoking a percentage
of the cigarettes that are smoked in that cell. That presumably
will become an issue once this legislation is enacted, however
it turns out.
Mr Wheatley: It is and, as I say,
I would like to move to a situation where we do not have to do
that. The effect is that a slightly smaller number of prisoners
can be fitted into the number of cells because we make less efficient
use of them.
Q228 Chairman: Can I move on to Mr
Foweather. I actually saw on my regional television news during
the recess that you have been given the National Clean Air Award
at Wetherby Young Offenders' Institute and, in part, I was quite
surprised. Having visited prisons on occasions, they tend to have
a tobacco "thing" about them, as it were, so I was very
surprised you got that. Why did you take the decision to go towards
getting the National Clean Air Award, was it an easy passage and
what difficulties did you find in relation to that?
Mr Foweather: It certainly was
not an easy decision to take because it is a major step for any
institution, something of that magnitude, but, as a governing
Governor, I have got responsibilities both to the trainees in
my care, that is 15- to 17-year-olds, bearing in mind for 15-year-olds
it is illegal to buy tobacco and smoke, yet we find them in the
presence of smokers, so there are unique issues for juveniles,
but also I have a legal obligation under the Health & Safety
Act 1974 where I need to ensure the safety and decency of my staff
and trainees and also the Health & Safety Act 1999 about risk
assessing and managing it. When you combine all of that, given
the unique needs of the juveniles that I have to take care of,
what you see is a high incidence of bullying because tobacco is
a currency, you get incidents of fire and other aspects related
to tobacco. Because of that, I did an in-depth study and we have
researched the issue concerning juveniles, we have weighed the
risk and I thought that it was worth taking that risk and we planned
a move towards it, so it was not an easy decision, but one I can
say I would not have taken if I was managing one of the larger,
more secure establishments. The majority of my background is working
in the high-security estate, for instance, where taking that decision
would have been even harder and much more difficult to impose
because the risks would have been significantly greater. Therefore,
as we moved to it, there was an eight- to 10-month lead-in period,
and that included consultation with other agencies and particularly
the primary care trust and smoking cessation organisations, and
there was significant money placed in terms of support, developing
staff training, literature and it was not an easy path. The implementation
date was 1 January and I coincided that with New Year's resolutions
and, as silly as that may look, that had a beneficial effect,
so I had 45 staff who were training and I had quite a number of
staff that took patches as well as trainees who did. Then you
have got to put the systems and processes in place because it
is not just about stopping it and having the contingency in place
to manage the potential for serious unrest, but also once you
have got over that, it is the new trainees coming in and some
of them are extremely young and vulnerable and how we manage that
process, particularly if they have got mental health needs or
other unique needs, so it is the systems and support in place
which are all expensive as well. I suppose I am fortunate in that
it was a juvenile site and that certainly impacted on my decision-making
and I was extremely pleased and proud of the staff who introduced
it for Wetherby, the first in the country to introduce it, and
Ashfield then followed Wetherby's template and introduced it later
on, so it was very successful, but unique to juveniles, I think.
Q229 Chairman: What has been the
effect on the institution from going smoke-free? What is different?
Mr Foweather: I think it is a
more decent and healthy environment and the staff and trainee
surveys I have done would conclude that. There have been some
initial benefits, although it is still early stages, in terms
of things like reduced fires because trainees, by their normal
sort of impulsive behaviour, tend to play with matches or lighters,
if they have them, so we have reduced the number of fires. A third
of the bullying was attributed to tobacco and, as a consequence,
trainees tell me that there has been a reduction in bullying for
tobacco. That does not mean to say that something else, toiletries
or other things, has not replaced that currency, but what we have
done is reacted to that. There have been instances where we have
caught tobacco trying to be smuggled into the establishment. Well,
from a governing Governor's point of view, if the worst of my
problems with this is stopping the odd bit of tobacco coming in
when it is not drugs, hard drugs or other illicit substances,
then I think I can cope with that because it is the lesser of
the evils. I have now got a smoke-free environment which is healthier
for staff, it is healthier for trainees, and there are some spin-offs
for the juvenile agenda inasmuch as 69% of my trainees say that
they have tried to stop before and been unable to.
Q230 Chairman: Has there been a move
in smoking cessation? Has it been measured? Are you getting more
cessation than the norm?
Mr Foweather: Well, the cessation
is total, but what we have done is I have put to all the courts
and to all the other agencies involved, "If you send a trainee
to Wetherby, they will not be smoking", and all my staff
recruitment is, "If you want to work at Wetherby, you will
not be smoking inside the establishment", so the smoking
cessation is total and 80 to 85% of my trainees arriving smoke
and a growing number of those say they will not smoke on release,
although when you look at my survey results, the average cost
for a trainee smoking is £110 and most of these are unemployed,
so there are some real benefits. The point for me, I would stress,
is that if I was managing somewhere like Leeds or Hull or one
of the big opens, I do not think, irrespective of all the planning
and management, that it would have gone as smoothly and you could
be looking at some significant costs and injuries.
Q231 Chairman: You use smoking shelters
inside the perimeter fence for staff and for prisoners—is
that right?
Mr Foweather: Not at Wetherby
because what I said is that it is very difficult to police a no-smoking
policy in part. For instance, if staff are still carrying tobacco
around in their pockets or if trainees or prisoners have got it
on them, would they restrict themselves? You have to police it.
If you are going to have a healthy environment and if you are
going to take that measured response, which we took, then I saw
it as an issue with staff that if they are not smoking on duty,
and we do not pay staff to take smoke breaks, then that should
be outside of the establishment and in their own time. That in
itself is controversial, but nonetheless we have put the support
system in place where there is covered shelter outside of the
establishment. I suppose Wetherby is unique and it is early days,
but that has been accepted by the union and it has also been accepted
by staff and trainees, although it was not as positive at the
outset because there was some resistance to that.
Q232 Chairman: What would be the
big risks of attempting to do this at adult jails as opposed to
a young offenders' institute?
Mr Foweather: I think I would
mirror what the Director General said inasmuch as you have got
a fairly sort of more intransient population who have probably
been smoking for a long time. A lot are doing long sentences,
a lot have been deprived of privileges, probably a lot are feeling
aggrieved and this will compound any feeling of aggravation. I
think you would run the risk of potential unrest, potential serious
unrest, and that would accumulate maybe in individual incidents
or maybe lead to a larger-scale incident, depending on, establishment
to establishment, how it is managed and the severity of the impact
of either the legislation or the local policy. However, what you
will see across the estate generally is that governing governors
are managing as they are required to under current health and
safety legislation and managing smoking policies and some are
more successful than others, but I would endorse the Director
General's comments that it should be looked at very carefully
and the establishments seen as special cases.
Q233 Dr Naysmith: I would like to
ask Mr Corry some questions, particularly in the area of mental
health and mental health premises because it is one of the proposed
areas of exemption in the legislation. What do you think are the
main issues that arise from smoking with regard to mental health
and particularly in mental health premises?
Mr Corry: I think you have to
set the question in some context. Up to 70% of people with severe
mental illness who are in institutional care of one kind or another
will smoke. People with severe mental health problems are unique
amongst health groups in the sense that they can be subject to
compulsion, whereas people with other health problems cannot.
We are concerned in the legislation that the definition of "premises"
is open to local interpretation and we are not quite clear from
that quite how that is going to be interpreted. We are also concerned
that the smoking cessation work that is being done across the
NHS at the moment is very often for the general population rather
than targeted at groups with particular needs. People with severe
mental illness can very often have problems with their desire
to give up smoking first of all, which I think is something where
more thought is needed. There are also issues for people with
severe mental illness about the effects of giving up smoking in
the short term where some of the medications that can be used,
the anti-psychotic drugs that are used for the treatment of schizophrenia
and other illnesses, can be adversely affected if someone gives
up smoking and the dosages have to be changed and so on. Zyban,
which is a drug that is used to help people who find it particularly
difficult to give up smoking, is unsuitable, for instance, for
people who are using anti-psychotic medication. If you take that
in the round, then I think you have got a group of people for
whom the legislation needs to be particularly tailored.
Q234 Dr Naysmith: Are you suggesting
then that smoking is an ineradicable part of the culture of psychiatric
hospitals?
Mr Corry: No, I do not think so
at all. We have worked very hard and Rethink runs some 370 services
across England and Northern Ireland. We have something of a no-smoking
policy in our services where it is possible to actually enforce
that, but we find it very difficult to get support from the local
primary care trust and other health bodies to help us to run smoking
cessation policies in our services. To give you one instance,
we have a day service in the Amber Valley, called "The Croft",
where the service manager there used a service in the PCT herself
and asked the PCT if a similar service could be run inside the
day service, and it took over 18 months of negotiation before
the PCT would agree to do it inside the service and to tailor
it to the particular needs of people with severe mental illness.
However, when it was done, we all discovered that the quit rate
was actually higher than the PCT was achieving in the community
generally, so it certainly can be done.
Q235 Dr Naysmith: So really that
is what we should be trying to do rather than applying for an
all-out exemption for premises. Perhaps you could also touch on
your problem about defining "premises" as far as mental
health institutes are concerned?
Mr Corry: We, as an organisation,
just need to be clear about what the Government's intention here
is. You have a number of different facilities in mental health
where people may reside for short or long periods of time and
you need to find a way of balancing the interests of people who
are using a psychiatric unit on a voluntary basis and may not
wish to be in a smoking environment against those who are there
under compulsory detention who may have a long history of smoking
and their needs need to be addressed as well.
Q236 Dr Naysmith: Is there any possibility
of separating the two in terms of having smoke-free and smoking
rooms, for instance?
Mr Corry: It is something that
we encourage in our own services and we encourage the NHS to do
as well, but I think this Committee will be well aware that, despite
seven or eight years of increased investment in mental health,
some of the psychiatric units and health facilities that are around
are still in need of repair even to the extent of reducing suicide
in them. Some of them, I think, would find it difficult to find
the money to be able to introduce entirely smoke-free areas for
people.
Q237 Dr Naysmith: I am going to bring
Mr Thain in in a minute because he has some slightly different
experiences from you, but it does sound as if you are not saying,
"We need this exemption", but what you are saying is
that you need more resources and you need more will perhaps behind
it all to change things within the institutions.
Mr Corry: I think it is difficult
to imagine a situation at the moment where you could introduce
a complete smoking ban in all psychiatric units given that a significant
proportion of the people who are using them will be there under
compulsion. However, what I do think we need to do is move from
a situation where we are today to a point in the future where
we have a complete smoking ban and that will require specific
targeted interventions for people with severe mental illness to
help them and encourage them, rather than coerce them, to give
up smoking.
Q238 Dr Naysmith: Finally for you
on this point, how do you feel about the workers, the people who
work in these places—do they not deserve protection from
second-hand smoke from other people?
Mr Corry: Absolutely. We employ,
as an organisation, something like 1,500 staff across our services.
A number of our services are delivered directly into people's
homes and there is a whole issue there which is obviously not
covered by this legislation. The people who are employed by us
who work in institutions do need protecting and it would be fair
to say that we, as an organisation, are struggling to find a way
to actually deal with their needs.
Q239 Dr Naysmith: Could I move on
then to Mr Thain because your experience, as I have said, is different.
We understand that you have made your institution smoke-free,
so can you tell us how you have managed to do that?
Mr Thain: That is not quite accurate
and I need to be accurate. I can only talk about my Trust, not
the wider mental health services. Eighteen months ago we introduced
a smoking cessation policy and we did that for two reasons fundamentally:
one, to reflect our responsibilities and duties under the Health
and Safety At Work Act because our view is that mental health
staff should be treated no differently from any other staff and,
therefore, should be afforded exactly the same protection as other
staff; and, secondly, because those who suffer from severe mental
illness have added health difficulties if they are also addicted
to tobacco, so we felt we should do something in respect of supporting
and helping our patients with those difficulties. Those were our
motives. We introduced the policy, it has been running and we
do allow for some smoking within our Trust. When a patient is
brought to our Trust and they are a smoker, it is recorded on
their care plan as a clinical issue, and then that clinical issue
is addressed at the appropriate time, so there has to be a period
of time where people are able to smoke. We do have within our
Trust a 66-bed forensic medium-secure unit and it has been our
surprise that that has actually taken the lead in smoking cessation
rather than, as we expected it to be, towards the end of the journey
we are undertaking, and patients within our secure unit who are
there for many years do not smoke. The fundamental principle is
that they do not smoke within the building itself, but in fact
are allowed to smoke one cigarette at a time under supervision,
not at night, in small courtyards. Our emphasis has been wholly
on trying to support people who do not smoke because it is anecdotally
viewed within the service that people have in the past entered
the service in some numbers as non-smokers and come out of the
service as smokers because of the culture, so we have focused
our attention on supporting non-smokers and also on trying to
support people who smoke into a position where they do not smoke.
We have found that, working with our service users on this issue
and with our trade unions, we have made great progress and we
are now considering moving in fact to being completely smoke-free.
The one issue, I have to say, that has actually made it more difficult
for us has been the social context, the fact that there has been
no wider legislation which of course does not help if you find
yourself as an island trying to move forward in this area.
2 The Prison Service later informed the Committee
that their latest research indicates that smoking cessation is
delivering about 4,000 successful quitters from the prison population
over a single year. Back
|
