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Baroness Masham of Ilton: At this time, and for several weeks now, I have had down for Written Answer a Question concerning the healthcare unit at Wandsworth Prison. It is in need of a new unit. Noble Lords would have to see it to believe how diabolical it is.
The unit is totally inadequate. Mentally ill and sometimes very dangerous prisoners are mixed with physically ill patients. The situation is quite unsatisfactory. A few weeks ago I visited Wandsworth Prison and met a young man with two broken legs. He had been assaulted by one of the prisoners who is mentally ill. I told the young man that I would tell noble Lords about his case.
At the present time there is a 60 per cent shortage of nurses at Wandsworth. That is due partly to the great expense of living in London. However, I was impressed with the work being done to tackle drug abuse, which has been helped by the drugs strategy. But they have no facilities to help those with severe problems with alcohol, and we have been told that the strategy will be out in two years' time. I hope that, in that time, something will be done to alleviate the very severe problems within the Prison Service. At the moment there is a vacuum. Alcohol presents just as much of a problem as drug abuse with regard to violence in the community and wife beating. Many alcoholics land up in prison.
Many prisoners are sent off to other prisons quickly and often their medical notes do not accompany them. A much smoother facility should be provided for this. Out of sight is out of mind, but this is a serious problem and we should do more to help prisoners who have problems.
I was serving on the Yorkshire Regional Health Authority when many of our mental hospitals closed down. One had to ask what would happen. I knew then that many of those patients would turn up in the prison system. That has happened. We must do something about this. Much better links should be established within the community because prisoners are let out into the community without links, without notes and without access to a GP. Many do not have GPs because they live such chaotic lives.
I could discuss this at length. We must look at this matter very seriously. There is a great need and many people currently in our prisons have serious problems of illness.
10.15 p.m.
Baroness Finlay of Llandaff: I support the amendments. The proposals in the Bill are to be welcomed and will address some of the problems in the Prison Service. However, I should like to reiterate the problems of the people working in the service and the lack of a career structure. It is not attracting high calibre doctors because there is not an adequate career structure within the Prison Service. Prison medicine per se is in its infancy and there is no developing research base—which there should be—to look at the best ways of improving the healthcare of prisoners.
I was involved in carrying out a study among young male remand prisoners. It was very difficult to carry out the study in the prison, although we did get some co-operation from the prison governor and from some prison officers. We found an alarming level of unresolved grief among the young lads on remand. They had had horrific losses and bereavements and had never had any help or support to resolve them. As a result, they have ended up, through various routes, inside and on remand. Some of these young prisoners reported that they were frightened of being in the sick bay. They preferred to go back to their cells if they were ill because they were frightened of the other prisoners.
The problem for prison doctors is that they do not have the support infrastructure. Care assistants are recruited partly from those with a nursing background, but many are recruited from the ranks of the prison officers themselves, who come through with a slightly different approach and different mentality.
I can understand the fear that doctors might possibly jeopardise security but it is important to remember that doctors, through their duties outlined by the GMC, particularly in its document on confidentiality, have a duty to the individual. But they also have a duty to society, and they must weigh up the balance between the duty to the individual and the duty to society in taking clinically-related decisions.
If the Prison Medical Service were to be properly incorporated into, and viewed as a part of, the NHS structure—with an adequate career structure—it might stand a chance of recruiting higher calibre staff and of attracting people who want to undertake research into the area and look for ways of improving some of the terrible outcomes that we currently see.
Lord Filkin: A number of noble Lords have spoken powerfully about the importance of healthcare in prisons and the severity of the challenge facing the health service, however it is organised, in the Prison Service.
The noble Earl, Lord Howe, drew attention to the constellation of drugs, sexually transmitted diseases, basic poor health and mental health problems which forms a very serious and dire cocktail of pathology. It causes considerable problems to many people in prisons and presents a great challenge to the public service in its attempts to improve services.
The argument put forward by the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, is, in essence, that there is only one solution—that is, the immediate and forthwith transference of all prison health functions to the NHS. While the Government's mind is not totally closed to that, we believe—certainly at this point in time—that as an immediate action it is too simple and would not be effective.
As the noble Earl, Lord Howe, recognised, however health services are funded and accountable, in a prison context there has to be a strong partnership arrangement between prison management and health service provision. It would be impossible otherwise to function effectively. That is why the Bill as it stands puts an enormous pressure and focus on making partnership arrangements work better in the health service in prisons in the future.
For example, as part of the partnership arrangements that we have established, all prisons have completed joint health needs assessments with the active involvement of their local NHS partners. Those assessments are forming the basis of joint prison health improvement programmes. They will be completed by the autumn and will set out local plans for joint work to improve services for prisons. This represents a far closer and more systematic approach to partnership working between prisons and their
NHS partners than has ever existed before. It is clear also that there is a significant improvement in the resources going into prison healthcare. The Government hope that will go further.Clause 19 is aimed at opening up new opportunities for further partnership working between the NHS and the Prison Service to improve health services for prisoners. Amendments Nos. 151 to 153, 155 and 157 to 158 would turn that partnership flexibility into something of a one-way street. Amendment No. 150 goes further, by attempting to bring to an end existing partnership arrangements and make the NHS solely responsible for the healthcare of prisoners—a position advocated by the noble Lord, Lord Clement-Jones, on Second Reading and this evening.
Amendment No. 151 fundamentally alters the scope and purpose of the duty of co-operation. As it stands, that duty promotes joint working between NHS bodies and the Prison Service, with a view to improving the way that both exercise their functions in relation to securing and maintaining the health of prisoners. The amendment removes any reference to improvement and envisages only the transfer of Prison Service functions to the NHS.
Amendments Nos. 152 and 153, 155, 157 and 158 would effectively prohibit delegation of specified NHS functions to the Prison Service but would retain the provision for the Prison Service to delegate its health-related functions to the NHS. I will be open with the Committee about the way we see those new flexibilities working. We envisage that the greatest local demand for use will be for delegation of health-related Prison Service functions to NHS bodies—for example, in the area of mental health. But those are partnership provisions and we felt it right that they should be even-handed in allowing delegation in both directions where that would improve the way that services are delivered.
The emphasis in the clause is on responding to local proposals developed by the Prison Service and the NHS in partnership. We do not wish to rule out the potential for sound and beneficial proposals that may involve an element of delegation from the NHS to the Prison Service. The amendments would restrict the options available to local services for improving healthcare for prisoners, so we oppose them.
Amendment No. 153 deletes the lines which specify that the new flexibilities for delegation and budget pooling can be used only if they are likely to lead to an improvement in the way that those functions are exercised in relation to securing and maintaining the health of prisoners. I cannot see how removing that qualification could be thought desirable—notwithstanding the other amendments suggested by Opposition Members.
A fundamental principle of the duty of co-operation in Clause 21(1) and the delegation of flexibilities in subsections (2) and (4) is that they are about improving the way that functions are exercised—which, broadly speaking, should have the effect of improving services. That principle is important because it makes clear that the main purpose of the provisions and of the arrangements made under them is to improve services for patients.
Amendment No. 150 goes one step further in its intention of passing full responsibility for the healthcare of prisoners to the NHS. I appreciate the reasons for that suggestion. We considered that option carefully at the time of the review that led to the publication of The Future Organisation of Prison Health Care in 1999. That review left open the option of a transfer at some point in the future but concluded that for the time being the best way to improve prison health services was through a close partnership between the Prison Service and the NHS. There are a number of reasons, but principally we believe that neither the NHS nor the Prison Service can provide healthcare for prisoners without the active co-operation of the other.
Healthcare activity in a prison—as the noble Earl recognised—is inextricably linked with other aspects of the establishment's operation. Issues of security, discipline and the wider prison regime all need to be managed alongside the delivery of the effective and improved health services that are the Government's aim. The prison governor and the Prison Service more widely must retain a stake in health services. At present, the formal partnership that we have established between the Prison Service and the NHS to improve health services for prisoners represents the best way forward.
Perhaps I should mention at this point, as the noble Baroness, Lady Masham, made specific reference to Wandsworth, that my step-daughter has recently been appointed deputy governor there. Therefore, I have a strong personal interest in these issues.
We have not ruled out such a transfer in the future—although, because health issues and wider aspects of the prison regime are so closely linked, such an arrangement would need to incorporate a strong partnership element to stand any chance of success.
The policy document, The Future Organisation of Prison Health Care recommended that the partnership arrangements that we have put in place should be kept under active review, and we shall do just that. However, we believe that these arrangements should first be given an opportunity to demonstrate what they can achieve. I therefore oppose Amendment No. 150.
In opposing the amendments tabled by noble Lords opposite, I nevertheless share their aims of ensuring that the NHS has a greater stake in the delivery of health services for prisoners, and that we secure significant improvement in the quality of those services, as has been so strongly advocated in the debate. That we are agreed on those aims is in itself valuable. We differ only on the matter of how they are best pursued at this time.
I believe that the arrangements that we adopt for the prison health services, both now and in the future, must include a strong element of partnership. Perhaps I may take this opportunity to provide a further illustration of the way in which the partnership between the NHS and the Prison Service is helping to improve the standard of care that prisoners receive.
The NHS and the Prison Service are working together to help to deliver the Government's commitment to supporting doctors and protecting patients. I am pleased to announce that the National Clinical Assessment Authority will, from this month, be providing the full range of its advice and assessment services to the Prison Service for those doctors the service employs.
The NCAA is at the heart of the Government's co-ordinated approach to improving the quality of healthcare and ensuring better protection for patients and better support for doctors. As the noble Baroness, Lady Finlay, rightly remarked, such an approach is necessary if patients are to receive the quality of care that they have a right to expect in prison. It provides a central point of contact where concerns about a doctor's performance arise and will give extra support to doctors where necessary. The NCAA currently provides advice and makes recommendations to NHS hospitals and health authorities so that they can take appropriate action to check poor performance, to ensure that doctors are practising safely and to discipline or suspend doctors whose practice gives rise to serious concerns much more quickly.
As part of the formal partnership that we have forged between the Prison Service and the NHS, the benefits of these important services will be brought to bear on health services in prisons. This is a concrete example of the way in which we believe that partnership working is fundamental to improving healthcare in prisons.
In conclusion, the provisions in the clause will enable closer partnership working and emphasise the shared responsibilities that both the NHS and the Prison Service have in this crucial area. They strengthen the foundations that we are laying for real, sustained improvements in health services for prisoners, and widen rather than curtail the options for longer term development of these services.
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