Examination of Witnesses (Questions 40-55)
12 JANUARY 2004
MS FRANCES
CROOK, MS
JULIET LYON,
MR ENVER
SOLOMON, MS
DEBORAH COLES,
MS HELEN
SHAW AND
MS SARAH
CUTLER
Q40 Mr Woodward: My second question relates
to the impact of overcrowding and dealing with mental health issues
in relation to self-harm and self-inflicted deaths. Very clearly,
there is an extraordinarily disproportionate level of mental health
issues for prisons compared to the general population. Given the
consequences of overcrowding and given the consequences of this
vast turnover of people between prisons—"churning",
as you describe it—what is the impact of that on ensuring
that to a reasonable degree we are meeting fairly the mental health
needs of these prisoners? Are we managing to do that or is that
an area that is now really in crisis?
Ms Lyon: I think the latter. It
is almost impossible to visit a prison and not meet prisoners
waiting for mental health beds, although the service has done
its best with the NHS to try and reduce the wait. The lack of
uniform court diversion schemes is important because those would
screen people out at the point of entry. In relation to what you
were saying about Liverpool, the role of the governor, whether
in regard to looking after people who are mentally ill or the
whole prison, is absolutely essential. One of the things the Prison
Reform Trust and others here are concerned about is the level
of turnover of governors. A parliamentary question revealed that
out of 138 prisons 44 had had four or more governors or acting
governors in the last five years. Where there is a governor who
is likely to stay put and genuinely care for his or her staff
and for the whole institution, which is palpable, it feels like
a safer place.
Q41 Lord Plant of Highfield: Could I
ask about the relationship between all of this and human rights?
As you know, there is a duty to look after prisoner integrity
and respect the dignity and privacy of people in prison. There
is also a positive duty to safeguard their right to life. These
two things can obviously pull in rather different directions.
I wonder how far you think we have got things right or are there
wide variations in practice, where in a sense surveillance of
prisoners, interference with their daily routines and so on is
going too far in order to prevent self-harm or suicide? Do you
think on the whole it is going the other way and there is not
sufficient of that kind of intervention? On the more specific
question of force feeding, what is your view of force feeding
as a way of preventing self-harm or suicide? Would you draw a
distinction between forcefully feeding someone who was using abstaining
from food as a way of pursuing a grievance against the authorities,
as opposed to someone who was trying to starve themselves to death
because they thought death was in their own interests, because
they were in such desperate circumstances?
Ms Crook: My organisation would
be opposed to force feeding. It is not an issue that arises very
often in prisons. The cases you are referring to are to do with
mental health facilities. They arise very rarely. It has happened
as self-inflicted death through self-starvation in the last five
years or so, but it is very unusual. If people are going to protest
like that, they usually do a dirty protest or something else.
Of course, there are other human rights which we feel are breached
quite commonly—the right to protection from arbitrary detention.
My organisation would argue that our system of choosing who to
sentence to prison is often capricious, unfair, unjust and I would
urge you to invite some members of the judiciary and magistrates
to talk to you about that and how they see their role of protecting
life in their sentencing practice. We cannot answer for them.
They should be questioned about their policies.
Ms Lyon: There are some practices
that have been brought in that are questionable in relation to
human rights, certainly in terms of physical wellbeing. If I mention
one: sealed windows. I was in a prison in the Midlands in August,
probably the hottest day of the year. The windows were sealed
and there were small, perforated ventilation strips at the bottom
of them where air, if there were any, would circulate. There was
not any air. If you did that to a dog in a car, people would do
something about it. This is about reducing the opportunity for
ligature points in jails. It has been done presumably with the
best intentions to try and reduce availability of means. I am
glad to say that the Safer Custody Unit on the whole has also
been concentrating on cultural changes. We were talking earlier
about reception arrangements and also Samaritan listeners, encouraging
prisoners to help one another, treating them as human beings in
an institution, allowing them to respond to others in distress.
I think the sealed windows are an example of an intervention that
is really very poorly thought out and grossly inconvenient at
the very least for prisoners, freezing cold in the winter and
boiling hot in the summer.
Q42 Lord Bowness: Can I ask whether you
think that the reports of the Prisons Inspectorate and the Independent
Monitoring Boards dealing with the prevention of suicide are taken
seriously by the Prison Service? Have those reports led to improvements
and changes?
Ms Coles: Do you mean the prison
investigation reports?
Q43 Lord Bowness: The Prison Inspectorate
and Independent Monitoring Board reports.
Ms Coles: The Prison Inspectorate
and Independent Monitoring Boards tend to look at the whole regime
rather than individual deaths. The Inspectorate reports in particular
are very important in giving people an illustration of what the
regimes are like. In terms of how helpful they are in preventing
deaths, we need to look at the investigations into the Prison
Service which are being changed now that the Prison Ombudsman
has taken over that role. We are yet to see what contribution
that makes. Our concern has always been in the way in which deaths
are investigated. They are too concerned with the individual pathology
of the person who has died rather than looking at the wider systemic
issues that the death may raise. Also, the findings and recommendations
of those reports are not shared within the whole prison estate.
Inquest after inquest and investigation report after investigation
report raise very similar issues but yet the policy changes and
the passing on of those recommendations is not shared across the
prison estate. We have yet to see what contribution the Prison
Ombudsman will bring. I hope that it will result in more robust
investigations that are shared within the prison system. The Safe
Custody Group do a lot of valuable work in improving the investigations
but it is very often dependent on the individual investigator.
Our concern still is that, particularly in relation to Article
2 about the right of the family to effective participation, families
are too often marginalised from the investigation and other prisoners
are not given the proper opportunity to contribute. The important
learning does not take place.
Q44 Mr Stinchcombe: Perhaps I can declare
my own interest as a trustee of the Prison Reform Trust. Can we
turn on to non self-inflicted deaths and in particular might I
ask about three areas? Firstly, how marked is the disparity between
the provision of health care to prisoners and to the general population?
Is it anticipated that that will level out following April and
the transfer of health care to the NHS? Secondly, are there adequate
detoxification programmes in the prison estate, both for drugs
and for alcohol, with sufficient ongoing support? Thirdly, could
more be done—and if so, what—to prevent the spread
of HIV and hepatitis B and C?
Mr Solomon: One of the key issues
on detoxification is the fact that the quality of detoxification
in prison is not always the same that you would get in the community.
A particular area where the Prison Service is struggling to cope
is in relation to crack cocaine. It has been pointed out to me
by prison staff and governors that they are not able to provide
adequate detoxification when it comes to the increasing numbers
of prisoners coming in who are heavily addicted to crack cocaine.
In relation to alcohol, alcohol detoxification does take place,
normally in a health care setting as opposed to on the wing which
is where the majority of drug detoxification takes place, and
in that sense it is a more appropriate setting. However, the big
issue is follow-up treatment. There is no ring fenced money available
to any prison for any kind of dedicated alcohol based programme
or long term treatment. It is an area which has been woefully
neglected and ignored as large amounts of money have been pumped
into drugs. In relation to drugs, the Prison Service does not
collect statistics for the number of prisoners who complete detoxification.
They can tell you the numbers who enter a detoxification programme
and there is a failure often to follow up whether they (a) complete
and (b) whether there is any follow-up treatment on the programme
provided.
Ms Crook: There is a group of
people in this country who die who are just released from prison.
There are two groups of deaths. One is the self-inflicted death,
people coming out of prison who kill themselves, and then there
are the people who come out of prison and die for other reasons.
There is a significant number of people who come out of prison
having detoxified inside prison and gone through all these programmes
very successfully. They will come out of the prison gates. They
get another fix and cannot take it so it kills them. Nobody has
collected any statistics for that. Nobody has collected any meaningful
statistics about the number of people who come out of prison and
take their own lives within, say, the next three months or so.
I am pleased that the probation service is starting to take this
seriously and is looking at improving care in hostels but that
is only the people who come out who go into registered probation
hostels. A huge number of people come out of prison every year
who have served a short time in prison, whether they have detoxed
or not, and we know that there is a large number of deaths, self-inflicted,
accidental or drug or alcohol related. Yet, nobody knows how many
or how to prevent them. Those are hugely neglected, very vulnerable
people who desperately need services, support and research and
it is simply not done.
Q45 Mr Stinchcombe: Presumably you could
prevent some by investing in naltrexone implants for former heroin
addicts, for example?
Ms Crook: Yes.
Q46 Mr Stinchcombe: What about the disparity
between health care provision within the prison estate and the
general population and also HIV and hepatitis?
Ms Lyon: There is no doubt of
the commitment to level up standards in the Prison Service to
match those outside in the community. In the prison population,
10% of young people have some kind of psychosis, probably schizophrenia,
compared with 0.2% in the same age population outside. You can
look at different slices of the population to understand that
there is very severe clustering of mental health problems. The
feeling is that it is very early days. The policies are in place
and are good. Some PCTs are involved with prisons and Strategic
Health Authorities. We would like to see both PCTs and Strategic
Health Authorities involved in any investigation of deaths in
custody alongside the Prisons Ombudsman, but it is too early to
estimate. It is not there yet. On the plus side, it means that
very many prisoners who were not registered with a GP, once they
reach the same as outside standards, can have the support of a
GP. As far as HIV goes, I know there is a harm minimisation programme
underway and the Prison Service has just started to issue sterilisation
tablets across the prison estate. The problems primarily seem
to be in relation to hepatitis B and C and the spread of blood
borne diseases of that kind is more important than AIDS and HIV.
Q47 Lord Judd: I understand there has
been some scepticism in NGO circles about the arrangements that
are now being made for the Ombudsman to be the person responsible
for investigation of deaths in prison or detention. I wondered
whether there was anything that you wanted to say about that and,
given that it is likely to go ahead whatever the feeling is, whether
there is anything you want to say about how it could be made to
be effective. Surely what matters most is that lessons are learned
from any investigation and those lessons are applied. Do you see
any prospects for this being better in the future than it has
been in the past or what can be done to make sure that it is better?
Ms Coles: Dialogue with NGOs like
ours is absolutely essential and with bereaved families because
they can best describe the concerns about the existing system.
Some of the reservations that we have had as an organisation have
been because we felt it was perhaps a financially expedient solution
to mounting criticism of the fact that the current way in which
deaths are investigated has been widely criticised in domestic
courts and in European courts. In terms of learning the lessons,
you are absolutely right. There must be some cultural shift away
from the dependence on Prison Service investigators, greater involvement
of bereaved families, NGOs working with bereaved families, proper
training of investigators about how to listen to families and
prisoners to get their information about what possibly has contributed
to the death; more robust, searching investigations that do not
just concentrate on the individual who has died but look at things
like regime, conditions, sentencing policy, possible alternatives,
published recommendations, properly monitored investigations and
a commitment from the Prison Service to enact those or at least
explain what has happened to them. At the moment, the recommendations
are not publicly accessible. The investigation reports are of
limited value in terms of the whole learning experience and we
very much hope that dialogue with the Ombudsman will result in
them taking these things seriously and concerning bereaved families.
They have to do that in terms of compliance with Article 2 because
effective participation of families means being involved from
the outset.
Q48 Lord Judd: Are you confident that
sufficient resources are available?
Ms Coles: We are not confident
at the moment but the announcement was only last week so we do
not know what resources will be available. It is a concern that
it is not on a statutory footing, although that was expected to
be announced. We are hopeful, with dialogue and the appointment
of investigators, of getting a cultural shift away from the way
in which it is being done at the moment, which very few people
have confidence in.
Q49 Chairman: Are you continuing to look
at inquests? I think it is probably agreed that there has been
widespread dissatisfaction with the way the inquest system has
worked in the past. Would you say though that if the recommendations
of the Fundamental Review of the inquest procedure were implemented
they would adequately protect Article 2 rights? Would there be
any remaining shortfalls?
Ms Shaw: We are looking forward
to the government's response to the Fundamental Review and the
Shipman Inquiry report. What we are quite concerned about is that
in the Fundamental Review there was not a focused look at the
issue of investigation of death in custody because the Fundamental
Review was having to look at the whole inquest system. We still
feel that there needs to be a lot of work done into modelling
the mechanisms that have been proposed. I know that the Luce Report
and the Shipman Report do propose different things and we are
yet to see which direction the Home Secretary is inclined to go.
We need to look at Luce, Shipman and the recent judgment in the
House of Lords of Amin. In a sense, we have moved from
publication of the Fundamental Review into new territory. What
we are hopeful of is that there is positive dialogue with lawyers,
with NGOs, working in this area with those who are working on
the reforms. What we are worried about is the timetable and we
really hope that this does get implemented soon.
Q50 Chairman: In your evidence, you acknowledge
that there have been some recent improvements to the availability
of legal aid to families. Are there any serious shortcomings that
still remain?
Ms Shaw: Yes. In relation to legal
aid for families for representation at inquests, the current situation
is that, with deaths in police and prison custody now, if families
are financially eligible, their lawyers are able to automatically
apply for legal aid. We still think that is inadequate because
where the state is involved in a death there is automatic access
to unlimited public funding and yet the family is penalised. Indeed,
we have had recent cases where families have been outside the
financial eligibility criteria because they own their own homes
and we think that needs to be looked at. The other thing that
is positive is the recent judgment in Khan and the introduction
of a statutory instrument that allows a lawyer to ask the Legal
Services Commission and empowers the Legal Services Commission
to ask the Secretary of State at the Department for Constitutional
Affairs to waive financial eligibility criteria where Article
2 is engaged in a case. We think that is a positive move but we
also think that it is complex. There really should be a level
playing field between all parties involved in an inquest and families
ought not to have to go through these kinds of hoops where the
state does not have to do likewise. If we are to move towards
a more level playing field, our other concern is that we make
sure that those lawyers that are doing the representation have
proper quality assurance so that families are getting legal representation
and advice from people who really know what they are doing.
Q51 Chairman: With regard to the range
of verdicts available in inquests, do you think they are satisfactory?
Ms Shaw: Our general view is that
we support the move of the fundamental review to go to a more
narrative verdict. However, we still think it is important that
there is also a short form verdict for families.
Ms Coles: It is coming back to
trying to learn the lessons and have meaningful outcomes both
for families and in terms of identifying any systemic or individual
failings, and incorporating that within a verdict, within a narrative,
that can be disseminated amongst coroners, amongst the relevant
government departments, so that the inquest becomes something
that not only is of benefit to the public but to the family as
well, so it is very much a learning mechanism. There is a case
coming to the House of Lords in two weeks' time which again is
looking at precisely this issue.
Q52 Mr Woodward: There would seem to
have been a significant increase in the number of deaths in custody
relating to immigration detention in the last year. I have two
brief questions for you, Sarah. First, is immigrant detention
adequately adapted to the particular situation of the people detained?
Secondly, in relation specifically to torture survivors, is it
appropriate that they are detained at all?
Ms Cutler: Torture survivors should
not be detained according to the instructions issued to the immigration
service by the government. Unfortunately, because of the complexity
of torture as an experience, people often do not disclose they
have been tortured until they feel they are in a safe environment.
It may not be known that someone has been tortured when the decision
to detain is made Once detention is in place, it is very difficult
to challenge it. Certainly the Medical Foundation for the Care
of Victims of Torture, an organisation that we work very closely
with, have done reports that have shown that, even where very
clear, independent evidence of torture is passed to the immigration
service, detention is maintained, despite the fact that at a policy
level it is acknowledged that detention is not appropriate for
torture survivors, because of the retraumatising effect it can
have. Torture is a very complex issue. This is a problem particularly
in the fast track procedures for determining asylum claims in
Oakington and Harmondsworth. Because of the disclosure issue,
there are people who have experienced torture who are not only
unable to remove themselves from detention but they are not able
to disclose their torture in order to influence their asylum claim.
On whether removal centres are adequately adapted for immigration
detainees, the government changed the name from detention centre
to removal centre in the last Immigration Act. I think that reflects
their intention that detention is for a short period, as a last
resort and only where necessary. Unfortunately, in practice, we
find that detention is employed in cases where it does not need
to be, where people have maintained contact, where they still
have an appeal outstanding in their case, where they have a family
or very strong community ties. I would echo what was said at the
beginning about why we detain people in the first place. I think
the government is clearly committed to having some removal capacity.
Whether or not you agree with it, that will happen and if people
are detained for a short period, if they know how long they are
going to be detained and can have access to independent advice,
someone they can talk to in a language they can understand, and
they have an opportunity to challenge their detention in line
with the rights under Article 5 of the European Convention, my
concerns about the broader adequacy of detention would be met
in some part. The problem is that it is a very closed environment
and the immigration service is very reluctant to allow scrutiny.
For example, there are no figures published on levels of self-harm.
We do not even know how many people are detained every year. We
do not know how many children are detained because the government
has consistently failed to provide any information that allows
the policy to be monitored. When we are looking at immigration
detention and what can be done in terms of putting systems in
place to protect people who are detained, what has to be done
first is a fundamental review of the whole process of detaining
people who have not committed any offence.
Q53 Chairman: This is a question specifically
to our witnesses from INQUEST. In your written evidence to us
you recommend the establishment of an over-arching standing commission
into custodial deaths. You say it ought to have a remit covering
all forms of death in all forms of state detention. Given the
announcement last week about the new role of the Prisons Ombudsman
and the establishment of the new Independent Police Complaints
Commission which will happen later this year, do you still think
that that is the right way forward and is it a realistic prospect?
Ms Coles: Yes. We were extremely
pleased that this Committee was using such a broad definition
of "custody" to include deaths of detained patients
and deaths of immigration detainees. One of the reasons why we
recommend setting up a standing commission is it would not be
a commission to do the investigations. It would be a commission
to have an over-arching responsibility to look at the investigations
that have taken place into the different deaths. In a sense, it
comes back to trying to learn the lessons, extracting the key
policy issues that the deaths and investigations are raising.
If there is a pattern of deaths that it sees happening, it could
then do a thematic review. Dealing with deaths, we see examples
of extremely bad, worrying practice. We are aware of good practice
in some establishments and the fact that the Prison Service in
particular is struggling to deal with a huge problem. The frustration
for us is the lack of joined up thinking within government departments.
A particular area of concern has been restraint related deaths
and the fact that they are continuing to be a real issue in psychiatric
detention and in police custody. Yet, one government department
does not talk to the other. There are good standards in the Prison
Service, recommending clear standards and safety in the use of
restraint in prisons which are not being adopted within psychiatric
hospitals and within the police. The reason for a commission would
be to observe what is going on and be able to launch separate
inquiries and publish research arising out of the different agencies
to ensure that we are moving forward and learning. It is a model
that could be quite effective because it would be at arm's length
from these investigation bodies and might well do something to
gain some of the public and family confidence that these deaths
are being taken seriously and that we are learning from the investigation
and inquest processes.
Q54 Chairman: Can I ask whether the other
organisations represented here support the notion of a standing
commission or have you no policy?
Ms Crook: We have not considered
it. It sounds like a good idea.
Ms Lyon: I do not think we have
considered it adequately.
Q55 Chairman: I want to ask each of you
the same question and I want a one word answer. Has the Human
Rights Act made a difference to detention conditions?
Ms Lyon: Yes.
Ms Crook: Yes.
Mr Solomon: A qualified yes. It
is too soon to say.
Ms Coles: Yes.
Ms Shaw: Yes.
Ms Cutler: No, I do not think
it has.
Chairman: That is helpful. Thank you
very much. I am conscious that the session has gone on a little
longer than some may have wished but it is extremely important
to us to cover as much of the ground as we possibly can. I want
to thank all the Committee Members and our six witnesses for the
very patient way you have tried to deal with the many questions
that have been raised with you. Thank you very much. Obviously
this inquiry, in terms of evidence, is only just starting and
we are very grateful to you for your interest.
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