Examination of Witnesses (Questions 260-281)
MR PHIL
WHEATLEY CB, MR
PAUL FOWEATHER,
MR PAUL
THAIN, MR
IAN HULATT
AND MR
PAUL CORRY
17 NOVEMBER 2005
Q260 Anne Milton: For the psychiatric
services, you hang on to them like grim death really, knowing
that the relationship is very tenuous at any point. Of course
visiting people in their own homes, they are entitled not to allow
admission if they do not want to. Do you feel that asking people
not to smoke when you visit would actually put at risk that relationship,
damage, if you like, the therapeutic relationship that the psychiatric
nurse might have with their patient?
Mr Hulatt: I think it is a potential
risk, but I think that mental health nursing is founded on that
collaborative relationship with the client, it is pivotal, and
those long-term relationships can be such that difficult and sensitive
issues can be discussed, and I think this may well just be another
one of those.
Q261 Anne Milton: As you say, there
is a holistic approach to people with mental health problems and
maybe, and I value your comments, a partial ban is suggesting
otherwise, that somehow people with mental health problems do
not deserve attention to the rest of their wellbeing.
Mr Hulatt: That is, I think, perpetuating
that inequality which, as a college, we are concerned about.
Q262 Charlotte Atkins: I would like
to go back to Mr Foweather and ask about the young offenders'
institutions. Very often the health of people in the institution
is not the highest priority for governors, so I am interested
in how you came to look particularly at health. What was the role
of the primary care trust here, or was it the role of maybe the
service-level agreement you have with maybe the local GP? Who
was your support network in terms of trying to introduce a higher
priority for health for the prisoners and indeed for smoking cessation?
Mr Foweather: Firstly, the health
and wellbeing of the young people in my care is my priority and
I think it is probably the priority of other governors in other
juvenile settings. In terms of the close liaison with the primary
care trust, we have heard mixed views this morning. I would endorse
the view that we had an extremely close working relationship from
the outset and that manifested itself in clear, practical support,
and it is part of the planning process, it was embodied in the
training, the development, getting smoking cessation tutors in
the establishment and even smoking awareness days when we had
big, red buses coming in and engaging the trainees and staff.
Q263 Charlotte Atkins: And that was
the PCT that organised that?
Mr Foweather: That was the PCT
and the smoking cessation services. I think it reflects, where
there is real partnership working, what you can achieve and I
think that was an extremely influential part of the successful
implementation at Wetherby.
Q264 Charlotte Atkins: There are
a number of institutions around the country, indeed I have one
in my own constituency. How many of those have now gone smoke-free?
Mr Foweather: Total institutions?
Q265 Charlotte Atkins: Yes.
Mr Foweather: My understanding
is that I think Warrington went some way towards that, Wetherby
was the first of its kind to do it fully from 1 January of this
year, and since that time we have promoted it to a range of other
establishments, including the private sector, who have taken away
our information and our template, if you like, our footnote on
how to do it, and there are others looking at it as we speak,
and Ashfield have taken it on several months later. Therefore,
to my knowledge, there are two juvenile sites which are fully
no smoking and the rest have all got smoking policies in place,
as has the prison estate because it has been left to the discretion
of governing governors within their legal remit to implement,
but each have different interpretations of that.
Q266 Charlotte Atkins: I am interested
that you mentioned Warrington, one, because you say that they
are going for a partial ban, two, because it happens to be in
my constituency, and also because we are looking at the whole
issue of exemptions here. What have they done which is almost
like going down the partial ban route and what is your view of
how easy it is to introduce a partial ban?
Mr Foweather: My personal view,
as a Governor of a juvenile establishment, is that juvenile establishments
should not allow smoking on the premises. I think that is detrimental
to that particular age group and I also believe there is something
along those lines in the prison rules, that juveniles should not
smoke, and that is because there are various complications. We
have 15-year-olds for whom it is illegal to buy tobacco, although
not to smoke it, and then you have the bullying issues of those
who do get tobacco because they cannot procure it through the
canteen route. There are some unique issues surrounding juveniles
and we have also got some further complications because some of
the sites are in part juvenile and in other parts YOs, which are
up to 21, so there are these added complications.
Q267 Charlotte Atkins: What was the
worst moment in your bid to ensure that the institution went smoke-free?
Was it opposition from staff or was there a particular event during
that process? There must have been some difficult times.
Mr Foweather: Yes, I think the
main resistance that I found was from staff and that is probably
in part because my trainee turnover in a place like Wetherby,
for instance, is maybe 1,100-1,200 trainees coming through, so
when I announced that we were going to be totally no smoking from
the 1 January with a ten-month lead, quite a high number of those
trainees were not going to be at Wetherby when the policy came
in, so it was a case of identifying those boys who were going
to be there past that date and then you are actually working on
a small number and you are bringing it in through transition.
The biggest resistance that I found was that initially there were
some union implications and then it was from a hard core of staff.
Incidentally, the staff surveys and focus groups which I held
showed that quite a high percentage of staff were in favour with
a hard core vehemently against, so it meant challenging those
staff appropriately, engaging with them, offering support, guidance,
occupational health, smoking cessation services, free nicotine
patches and other sort of support mechanisms. I think part of
the success was the time that it had in which to come in because
it was a long process and I think that assisted it. I think we
were lucky in terms of juveniles because they are a lot more susceptible
to change when it has been managed and well-communicated, whereas
for the older adult population, smoking is more entrenched, they
have been smoking for years, it is probably seen more as a privilege
or entitlement and that would be a harder population to get it
across to, I think.
Q268 Charlotte Atkins: Did you have
any staff leave?
Mr Foweather: I have had no staff
leave as a direct consequence of that. I have had a few staff
who have left the establishment as a consequence of not necessarily
wanting to buy into the juvenile agenda, and the smoking cessation
may well be part of that process because there is a raft of initiatives
and change programmes in order to make establishments, such as
Wetherby, more juvenile-appropriate to better meet the individual
needs of juveniles.
Q269 Mr Burstow: I just have a couple
of very quick questions and the first was to Mr Thain. Picking
up something you were saying earlier on, you said that one of
the drivers for your move to a smoke-free working environment
was the protection of the workers and you particularly made reference
to the Health and Safety at Work Act. Did you have any advice
at the time that you were framing your policy and beginning to
implement it which would have suggested that for you not to have
this policy in place, you would be legally liable to challenge?
Mr Thain: Not specifically, no,
but reading all around the subject, thinking about how we could
improve the health and safety of our workforce and being part
of an NHS initiative called Improving Working Lives, which
encompasses trying to make the workplace better, this was the
direction that we decided to go in, but it had this health and
safety feel about it.
Q270 Mr Burstow: Given that you accept
that we have got to the point where we know the effects of environmental
tobacco smoke in terms of health, have we got to the point where
the legislation possibly does mean that people can take action
against those who still have workers in smoking environments?
Mr Thain: Yes, we are very much
aware of that and in fact our trade union supported us on the
basis that we needed to take account of health and safety.
Q271 Mr Burstow: I have a question
for Mr Wheatley and this was something you said in response to
Mike Penning's question about the percentage prevalence of smoking
within prisons. You said 80%, but you then went on to say that,
in terms of cessation, there was an equivalent success rate amongst
smokers in prison to that in the general population, smokers outside
prison.
Mr Wheatley: Yes. The DoH has
put money centrally into our PCTs, so it has been distributed
in order to make sure that we have got support to get prisoners
off tobacco, and with those who are engaged with that smoking
cessation process, we do as well as people who are engaged in
the community.
Q272 Mr Burstow: Is the level of
engagement as good as it is in the community?
Mr Wheatley: I cannot give you
comparisons on that, so I could not give you an accurate account.
Q273 Mr Burstow: The reason I ask
that, and it is interesting to tease that out now, is because
if the level of engagement had been as good, presumably the level
of prevalence would be going down very rapidly and I assume you
are saying that the prevalence has not been going down rapidly.
Mr Wheatley: Well, the population
is not static.
Q274 Mr Burstow: No, no, but we have
also established that quite a lot of people are there for quite
long periods of time.
Mr Wheatley: The population is
an interesting mix. About 56.7% of the adult male population are
serving four years and over and over 6,000 are serving life sentences
or indeterminate sentences, but the short-termers move through
very quickly and there are a lot more short-termers, so if you
look at the population over the course of a year, there have actually
been hundreds of thousands of short-termers through the system,
but the long-termers are stuck for a very long period of time,
so it is quite sharply divided population. Probably the biggest
problem, from our point of view, are the people who are coming
in, arriving for a week, two weeks, three weeks and then off again
and with different people being recruited because it is not always
the same people that come back, though far too often it is some
of the same people we have seen before.
Q275 Dr Taylor: Mr Wheatley, the
whole point of the proposed legislation is obviously to protect
the health of staff. Have you any idea of the proportion of prison
staff that are smokers and non-smokers?
Mr Wheatley: I have not got any
accurate statistics on that. My impression is that amongst younger
staff, there are less smokers, people are less inclined to smoke,
and amongst the older staff group, there are probably rather more
smokers, and smoking was very much what happened in prison. We
are aiming to protect staff and our policy already says that staff
do not smoke in offices, and that is single offices, not just
shared offices, and staff should not be smoking in the public
areas of the prison, and my office staff cannot smoke in their
offices, so they have to go outside to a sealed smoking room,
which is a rather unpleasant place in the bowels of Cleland House
that is best avoided, so we have already got a series of moves
designed to protect staff. There is of course the question that
if prisoners are smoking in their cells, staff will occasionally
have to go into cells, mainly to search and to do a security of
cells, staff do not spend a lot of time otherwise in prisoner
cells, and at that point I would expect them to say to prisoners,
"You don't smoke while I am in here", so it is possible
to have a situation where in effect the prisoners are smoking
as if it is their own home without great risk for staff, although
I take the point that there may be powerful things that hang around
in the air for some time, but we can avoid the straightforward
smoking in the face of staff, I think.
Q276 Dr Taylor: I was very impressed
with the evidence that you gave us from Wetherby about involving
staff as well as customers. Obviously you have had unique cooperation
with your PCT. Is there cooperation, Mr Wheatley, with PCTs for
smoking cessation services widespread throughout the prison service
as a whole?
Mr Wheatley: Yes, because the
DH has helpfully centrally put some central money in order to
encourage PCTs, working with prisoners, to regard prisons as somewhere
where smoking cessation can take place. There is support. I think,
as Paul was describing, Wetherby has much more successful cooperation
than is being experienced everywhere, but there has been quite
a lot of smoking cessation work done. I think Paul has achieved
an exceptional level of support and his PCT is to be congratulated
on putting that effort in.
Q277 Dr Taylor: Would your smoking
cessation services be open to staff as well as prisoners?
Mr Wheatley: No, we have not spent
the money on staff. Paul's experience at Wetherby, where the whole
prison has gone completely smoke free, is unique.
Chairman: Could I thank all of you very
much indeed for coming along this morning. We are hoping to publish
this inquiry before Christmas.
Q278 Jim Dowd: Can I ask one question
of Mr Wheatley. Earlier you said 80% of the prison population,
in your estimation, were smokers. That is about the reverse of
the national picture. Do you have any view as to why that would
be?
Mr Wheatley: I think the sort
of people who are going for crime are often not thinking a long
way ahead—if you did think a long way ahead you would not
go in for the sort of casual crimes that people do—and they
are living very risky lifestyles. Sixty per cent of them are probably
using hard drugs. Again, 60% of the population are not using hard
drugs, at least I hope not. This is a group who do risky things.
Q279 Jim Dowd: You are not saying
that smokers are more likely to indulge in criminal behaviour?
Mr Wheatley: I am not saying that.
I am saying that our criminal population appear to have a larger
proportion of smokers amongst them. I think our criminals do engage
in risky behaviour without looking at the long-term consequences
in many cases. If they looked at the long-term consequences they
would not engage in the crimes that they do.
Q280 Chairman: It is almost on the
basis of social class well.
Mr Wheatley: That may be part
of it.
Q281 Chairman: Again, thank you all
very much indeed for coming along this morning and assisting with
the inquiry. Hopefully it will be in your stockings for Christmas,
but you will have to wait and see what next week brings as well
as this week. Thank you.
| 
