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Baroness Blatch: My Lords, I am grateful to my noble friend for his comments. I understand my noble friend's reticence in referring to a particular case. It was nevertheless raised by the noble Lord, Lord McIntosh of Haringey. It was the medical advice in that particular case which was discussed with members of the Prison Service which resulted in what I believe was a positive outcome. I know my noble friend will accept that I believe the process could have been smoother than it was. I believe that some of the contents of the Statement today and the pledges made by the Prison Service, the institutions and the Royal College to work together in a more practical way in the future, will ensure that that will be the case.

I absolutely agree with my noble friend that the degree of security that is necessary for prisoners must be a consideration for the Prison Service. That is an essential consideration as regards making judgments about how a person should be escorted to prison. For some time now it has been a part of the system that the advice of medical staff to the Prison Service should be taken into account. However, we believe it has not always been properly taken into account. Certainly under these new arrangements that advice will be taken into account. I totally agree that dignity in treatment is also an important factor in this regard.

I can reassure my noble friend in relation to his concern about escorts being female prison staff. The intention is that only female prison staff--two prison officers--will escort a female prisoner. However, we had to add the caveat concerning the possibility of not always being in a position to comply with that intention. For example, if a female prisoner became very sick in the middle of the night it might be impossible, without any flexibility, to find two female prison officers. We shall guarantee that one staff member will be female, but for the sake of getting someone to hospital quickly one of the escorts might be a male prison officer. However, neither the male prison officer nor the female prison staff would be present in the treatment room unless that was requested specifically by the female prisoner herself.

Baroness Hayman: My Lords, I should also declare an interest as chairman of the Whittington hospital,

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which provides the majority of maternity care for Holloway Prison. I thank the Minister for her Statement today. Is she aware that the changes she announced will be very much welcomed by medical and midwifery staff? They have had great difficulty reconciling their professional duties to their patients within the rigid strictures imposed recently by the Prison Service. Is she aware that the issues of balance are very well understood within hospitals where the potential danger is felt very strongly at first instance by the staff and other patients within the hospital community and that this is not an issue in respect of which hospital staff are in any way cavalier? Therefore, will she look with some urgency at the proposals that have been made for taking more NHS services within prisons? I speak particularly about community midwifery services, but there are also opportunities for outreach clinics and the use of technology such as telemedicine for improving the medical services at present available within prisons without in any way endangering security?

Baroness Blatch: My Lords, I thank the noble Baroness for her welcome of the Statement. She made some important points. The first that she made goes to the heart of why this is a vexed issue, namely reconciling the professional concern of medical staff for the patient with the proper concern of the Prison Service for the security of both the public and of the prisoner when not in custody inside the prison walls. There is a tension there that needs to be reconciled. I do not believe that there is a difference between us. We want to see a reconciliation which is in the best interests of everybody, particularly, in this case, the mother and the baby.

The other point which the noble Baroness raised is equally important. I believe that there is scope for considerable improvement in services provided within prison for female prisoners. We know that the Royal College of Midwives will focus its mind on what can be done. We expect that the Prison Service will co-operate as fully as possible so that the tension in moving female prisoners outside prison for medical services is reduced.

Baroness Williams of Crosby: My Lords, in thanking the Minister I echo the remarks of the noble Lord, Lord Glenarthur. The House owes a debt of gratitude to those members of the hospital staff and the midwives who drew attention to their anxiety over this matter. We should not let that go unrecorded.

Will the Minister ask the Prison Service to consider seriously the issue of those female prisoners who go to hospital for medical treatment at times other than when they give birth? The majority of women prisoners are not serving time in prison for any act of violence. Many are in prison for civil debt such as default on poll tax and television licences. They have no violence in their record, and they go to prison at considerable public expense. Physical restraint is a humiliation and a demeaning of human beings, as the noble Lord, Lord Glenarthur, indicated. Therefore, will the Minister consider with the Prison Service looking at the whole issue of whether we should apply physical restraint to prisoners who have no history of violence or previous escapes? I say that in the light of the fact that I believe

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that I am right in saying that the total number of escapes from escorts by women prisoners in the past two years is six.

Baroness Blatch: My Lords, there will always be a need to balance security, the public interest and the medical needs of the prisoner. We have said that if the medical advice is that a prisoner should not be restrained then we believe that that advice should be heeded in the interests of the patient. The very people described by the noble Baroness, Lady Williams of Crosby--those who are not pregnant and who go to hospital for other reasons--are often more capable of escaping. I said that in five years 20 female prisoners had escaped. Seven of those female prisoners were pregnant. It is very difficult for prison Ministers to account to the other place or the House of Lords for prisoners escaping when security has been relaxed and to find good reasons for saying that they were not restrained because they were females. It will be necessary from time to time to restrain female prisoners. Approximately 50 or 60 children are born to female prisoners in any one year. We have met all the safeguards relating to the medical needs of the female prisoner and we have gone to great lengths to make sure that babies are not born in prison because that would be very undesirable in the interests of the baby.

We believe that risk assessment will go a long way to satisfy the noble Baroness. If the risk assessment indicates that the prisoner should be secured, then, I am afraid, the prisoner should be secured unless that is inconsistent with medical advice.

The Earl of Longford: My Lords, I applaud the statements from the Opposition Front Benches. I shall leave my further comments until I raise the matter again in the House on 30th January. Perhaps I may put one question of some importance to the noble Baroness. Do the Government take responsibility for the changes which, so far as they go, are welcome, or was the decision taken by the Prison Service without interference from the Government?

Baroness Blatch: My Lords, the decisions were taken by the Prison Service. My honourable friend in another place said in her Statement to the House earlier this week that the Prison Service would be meeting with the Royal College of Midwives. That meeting took place. It was a constructive meeting. It was the Prison Service which made the recommendations, and it is the Prison Service which will be responsible for carrying them out.

The noble Earl is being very discourteous, commenting from a sedentary position, especially if I heard him right. I can tell the noble Earl that I, my honourable friend who is responsible for prisons, and my right honourable friend fully support the changes that the Prison Service has agreed with the Royal College of Midwives.

Lord Monson: My Lords, in the light of the contention of the noble Lord, Lord McIntosh, that the revised procedures are still excessively strict, does the noble Baroness agree that throughout history, and in countries all over the world, prisoners plotting to escape have more often than not plotted to escape from

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hospital, whether it be the prison hospital or any other hospital, for obvious reasons? In prisons, security is an overriding consideration; in hospitals it is not and never can be a primary consideration. In view of that fact, I suggest that it will seem to most fair-minded people that the Government have now got it about right.

Baroness Blatch: My Lords, I welcome what the noble Lord says. He is right. If one is plotting an escape it is relatively easier to do so from hospital than from prison. I am acutely conscious of the experience of my noble friend Lord Ferrers, who occupied this particular post before me and who was derided in this House when he had to come to the Dispatch Box to account for a prisoner escaping from hospital. On one occasion it was through a toilet window and on another from a wheelchair. Guffaws of laughter went round the Chamber as he tried to defend the Prison Service's role on those occasions.

It is difficult to address the proper considerations for the Prison Service: the security of the public and of other patients in hospitals. In 150 escapes from hospitals in the past five years, guns, sharp instruments and blunt instruments have been used as well as physical violence without instruments. It is a difficult position for prison staff to be in. The balance between the safety of prison staff, of other patients in the hospital, hospital staff and sometimes the safety of the prisoners themselves is difficult. Some prisoners even attempt self harm and restraining them is one way of preventing it. We need a balance in understanding, recognising and respecting the dignity of the prisoner in such circumstances, as well as proper consideration for security in other circumstances.

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