Examination of Witnesses (Questions 140
- 159)
TUESDAY 24 JUNE 2008
PROFESSOR CYNTHIA
MCDOUGALL
AND BARBARA
BARRETT
Q140 Alun Michael: Forgive me; I
think I would like a concrete example. It all seems very muddy.
What would you do if you were given the opportunity to change
things in the criminal justice system? We are talking about justice
reinvestment, and that means saying, "Let us not spend money
the way we are doing now, let us spend it better." What would
you do?
Professor McDougall: I would spend
more money at a local level. I think that is where it is going
to have most impact. It has already been done to some extent,
I do not know how much it has been reinforced, but all the different
agencies in the community need to work together and they need
to have the same targets as well, and that is starting to happen.
They are starting to have the same targets and they are being
encouraged to work together to deal with the problem. I do not
think crime is just a police and probation problem. I think it
is a community problem and we ought to be putting money into—
Q141 Alun Michael: Can I be clear
what you are suggesting? Do you mean that you would split up the
criminal justice budget at a national level and divide it amongst
the local crime reduction partnerships, or something like that?
Professor McDougall: I would put
money into schemes that these particular people come up with that
they think will be beneficial and that will reduce crime. Part
of the problem for offenders coming out of prison, for example,
is that they come out, they get a small amount money to come out
with, some of them drink it in the first five minutes and then
they are left for a couple of weeks until they get their benefit
money, and so on. Why is that not done when they are in prison?
Why are we not making sure that when they come out the ability
is there, so we work with those people, for example, through Jobcentre
Plus? Why are we not looking for jobs for them and giving them
incentives to take jobs?
Q142 Alun Michael: You are the researcher.
Why are we not doing it?
Professor McDougall: I have the
idea that is what we should be doing. You are asking me, but nobody
is doing that.
Q143 Chairman: Can I pursue a point
that you made in reply to Mr Michael. If you take the resources
that you currently spend in Durham, the biggest slice of criminal
justice resources being spent in Durham is being spent in Durham
Prison and Frankland Prison, not in the Probation Service.
Professor McDougall: Yes.
Q144 Chairman: If you were the policy-maker
in Durham, should you have access to those funds to decide whether
to continue spending them in Durham and Frankland Prisons or whether
to do other things with them? Is that a feasible proposition?
Professor McDougall: It is back
to talking about costs and benefits. I would be looking at how
the money is being spent and how beneficial it is that it is being
spent that way. Frankland Prison may be a special case, there
are a lot of very serious offenders there, and they should be
there, and I am not arguing at all they should not be, but in
some prisons there will be offenders who it is not cost-beneficial
to have in prison—the cost of their offending has a nuisance
value but the cost of keeping them in prison is huge and it is
not a cost-beneficial way of spending the money—but we do
have to recognise that if we take them out of prison and the funding
comes to probation, then there has to be a credible alternative
to dealing with them, and I think the public would not accept
saying put them on a probation order and they can talk to their
probation officer once a week. It has got to be something much
more rigorous than that.
Q145 Alun Michael: That is why I
am trying to tease out what it is, because I think we could all
agree with that, but what does that mean in terms of what we ought
to do? If we take the Prison Reform Trust's seven-point plan,
the first two are the ones that probably to most of us would seem
blindingly obvious, which is if you can deal with mental illness
in prison and addiction in prison, you would actually be dealing
with quite a serious chunk of the problems that are there for
prison and for society. Given, particularly, the title of your
role, what would you do to tackle mental illness and addiction
in prison?
Professor McDougall: I think they
should be diverted. I am not sure what Juliet said particularly,
I have not looked at her submission, but I think that they should
be diverted. I do not think they should be going to prison. There
are too many people in prison. There is a diversion provision,
there are circulars instructing people to do that, but the facilities
on the ground do not support it. They work in some areas but they
do not work in other areas. I can understand why judges or magistrates
have not got a lot of confidence in the system if nobody can say
what is actually going to happen to this person if they get diverted.
You need to have the systems in the community that are there so
the person does not become criminalised from the beginning and
gets diverted into more of a treatment ethos.
Q146 Alun Michael: So it is a question
of the matching of resources to the programmes for diversion?
Professor McDougall: Yes.
Q147 Alun Michael: What would your
measure of the cost-effectiveness of moving in that direction
be?
Professor McDougall: The cost-effectiveness
of diversion, are you saying?
Q148 Alun Michael: Yes.
Professor McDougall: I think one
of the measures we should be looking at is the cost of offences
saved, and if what you do saves offending, then you have a prediction,
and we have got some very robust predictive measures of what the
offending rate would be of those individuals, but if we then look
at the offences we have saved and look at what it has cost to
the community, what it has cost to victims as well as the criminal
justice system, then you can work out in an objective fashion
how much you are saving by this particular intervention.
Q149 Alun Michael: Is your research
giving us the sort of answers that would allow us as parliamentarians
and ministers the measures to shift in that direction?
Professor McDougall: There is
evidence that these systems work, that these schemes work, when
they are done appropriately, and there is some research evidence
of that, but it is not done in a structured way, it is very piecemeal
again.
Q150 Mr Heath: It seems to me that
there is still a missing component here though. Once you have
reduced the scale of Durham Prison and increased your diversion,
you have still got Durham Assizes going on in the middle, and
you have got a judge handing down sentences, not on the basis
of the evidence that you have, but on the views that he or she
has formed about the individual and the way in which they wish
to dispose of them. In the health model that does not happen because
the consultant physician or the surgeon, in terms of a particular
procedure or therapy, is effectively run by the NICE assessment
and, certainly within the Health Service, cannot engage Health
Service resources for a therapy which does not work.
Barbara Barrett: I was going to
make that point. If you go to your GP and you have symptoms of
depression, they might not always do it but they are meant to
follow a certain route. You are meant to see them a few times
and, if appropriate, you will be referred on to someone else.
That should happen at every single general practice in the country.
That is because NICE exists. It reviews available evidence and,
on the basis of that review, it makes guidance which has to be
followed—there is nothing to say that this should not happen
in the criminal justice sector, that there should not be a review
of the evidence at a national body by an independent organisation—and,
on the basis of that review, guidelines are made which should
be followed.
Q151 Chairman: Like the Sentencing
Commission, for example?
Barbara Barrett: Yes.
Professor McDougall: They do get
guidelines, do they not, in the Sentencing Commission? They get
guidelines, but they are not on cost-benefits, they are not economics
guidance, they are value judgment about the offending.
Q152 Chairman: You made the interesting
point that there are a whole lot of other areas of cost, like
victims' costs, which are relevant in these calculations.
Professor McDougall: Yes.
Q153 Chairman: On the health side,
how far have the costs to the individual of a failure to deal
with a health problem been factored into the sort of calculations
that are made in policy-making?
Barbara Barrett: Economic evaluation
in this country tends to be done according to the NICE guidance.
So, in terms of the costs that you include, you only include the
cost to the NHS and social services, but in terms of outcomes,
I do not know if you are familiar with this generic outcome measure
that has been used in health, which is a QALY (quality adjusted
life year), which takes into account health and general well-being.
It is a measure that means that, if we undertake research using
a QALY as an outcome, we can compare, for example, an intervention
for depression with a pill for heart disease. It is this comparison
across different diseases that can be made with this sort of generic
measure.
Q154 Chairman: You could have quality
of life outcome measurements for what happens to a community.
Barbara Barrett: You could.
Q155 Chairman: If you have succeeded
or failed in restraining particular patterns of crime.
Professor McDougall: We already
have models of that. We have models of public safety, for example,
and you can find out what the public safety measure is for your
area based on how much crime happens there and what the cost to
victims and the criminal justice system is. So there is a measure.
In my view, it is a much more positive measure than measuring
offending. We are continually grappling with the fact that the
actual crime figures and the fear of crime reports are completely
different, and it may well be that people do not relate to these
offending figures but they would relate to a measure of public
safety based on the local environment and what they see round
about them.
Q156 Alun Michael: The comparison
with the medical model is quite an interesting one. If diversion,
for instance, into mental health or into rehabilitation for somebody
with a problem of addiction is cost-effective, as you were saying,
and you suggested there was plenty of evidence of that—
Professor McDougall: Not plenty,
but some.
Q157 Alun Michael: I was not suggesting
that you were implying that there was not a need for more research,
if that is what you mean, but would the step of placing an onus
on the prison authorities to place people into mental health or
into rehabilitation rather than into prison create an alternative
model? We are supposed to be looking at different models of doing
things. Would that work?
Professor McDougall: I think it
would. I think that is the way we should be going. Barbara is
saying we should be looking at a similar model that happens in
health, and I think that would be excellent. If we could draw
up guidelines the same way they have been drawn up in health so
that they can advise people on how they should handle these situations,
then we should be doing that, and I cannot see why we could not.
Barbara Barrett: One thing that
is perhaps of note is that it is different pots of money; so the
healthcare budget is different from the criminal justice budget.
I am not quite sure how PCTs would feel about suddenly being responsible
for all sorts of people.
Q158 Alun Michael: With respect,
that was not the model I was suggesting. The model I was suggesting
was if it is going to save the criminal justice system because
it is better to refer somebody to mental health, why do they not
do it and pay for it we give them the freedom to do that?
Professor McDougall: Yes.
Barbara Barrett: So a sort of
more general care commissioning and general well-being commissioning
from PCT type people rather than specific healthcare commissioning.
Q159 Chairman: It could be argued,
could it not, there is a more rigid division in who is disposing
of resources in the criminal justice system than there is in the
health system?
Barbara Barrett: What do you mean
by that?
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