Prison-based Addiction Treatment Pathways

Wednesday 2nd March 2022 Westminster Hall

15:59

[Dr Rupa Huq (in the Chair)]

I call Dan Carden to move the motion. The Minister will respond, but there is no right for the mover to respond at the end, as is the norm in 30-minute debates.

[Dan Carden (Liverpool, Walton) (Lab)]

I beg to move,

That this House has considered prison-based addiction treatment pathways.

It is a pleasure to serve under your chairmanship, Dr Huq. Too many people with drug dependency

“are cycling in and out of prison. Rarely are prison sentences a restorative experience. Our prisons are overcrowded, with limited meaningful activity, drugs easily available, and insufficient treatment. Discharge brings little hope of an alternative…life. Diversions from prison, and meaningful aftercare, have both been severely diminished and this trend must be reversed to break the costly cycle of addiction and offending.”

Those are the words of Dame Carol Black in her groundbreaking independent review of drugs—a damning observation.

The treatment system and effective recovery pathways from addiction in prisons are in desperate need of repair, yet the effectiveness of evidence-based, well-delivered treatment for drug and alcohol dependence is well established. When it is properly funded, it works: it cuts the level of drug use, reoffending, overdose risk and the spread of blood-borne viruses.

Analysis of Her Majesty’s inspectorate of prisons data from 2019 reveals that 48% of men surveyed by the inspectorate who reported having a drug problem said that it was easy to get drugs. The proportion of prisoners who said that they developed a drug problem while in custody more than doubled between 2015 and 2020.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. This is not the responsibility of the Minister, but in the papers last week it was reported that the drug uptake in prisons in Northern Ireland has risen to an astronomical height. It is therefore clear that what the hon. Gentleman is saying about the UK mainland also applies to us back home. Does he agree that the premise of prison is to rehabilitate and that addiction pathways are the absolute foundation for the rehabilitation that he and I want to see and that, to be fair, I think the Minister wants to see too? That can work only if funding is sourced and allocated UK-wide to make sure that it happens.

[Dan Carden]

The hon. Gentleman is spot on. I will come on to the function of prisons. Modern, progressive society should aspire to something more than having prisons there for punishment. The function of prison should be to rehabilitate, reduce reoffending and help those in prison to build productive and meaningful lives. I think the Minister will agree that without tackling drug dependence, that function cannot be fulfilled.

Part 2 of Dame Carol’s review calls for improved

“transparency and accountability of the commissioning and delivery of substance misuse services in prisons, including through publishing how much money is spent each year on these services”,

and ensuring that

“everyone leaving prison has identification and a bank account and that those who cannot claim benefits online get the opportunity, from the day of release, to access DWP’s telephony service.”

It calls for ending Friday release dates and for making sure that

“prisoners with drug dependence can access and receive drug treatment in the community as soon as possible after release.”

It also calls for additional prison staff to ensure that prisoners’ experience is improved, and for

“earlier interventions for offenders to divert them away from the criminal justice system, particularly prison.”

I am pleased that the majority of Dame Carol’s observations and recommendations have been embraced by the Government in the form of the 10-year drug strategy, “From harm to hope”, and the prisons strategy White Paper. Diversionary schemes are rightly encouraged by Dame Carol and endorsed by the drug strategy and the White Paper, despite the Government’s heavy “tough on drugs” messaging, because we cannot simply arrest our way out of the country’s addiction crisis, we cannot punish the already marginalised into recovery and we cannot end the pointless cycle of harm without evidence-based policy.

One in four people are placed in prison for committing an offence relating to their drug use. They are often given short custodial sentences of up to six months, most commonly serving as little as six weeks behind bars. Those on short-term sentences are the least likely to have access to drug and alcohol treatment, and prisoners serving seven-day sentences almost always pass through the system without support.

There are many innovative diversionary schemes and community sentences in use in different parts of the country. They reduce prison numbers, focus on treatment, recovery and rehabilitation, and stop small-time offenders losing access to housing, employment and family ties, which too often push them only further down the path of addiction, reoffending and homelessness, and exacerbate that vicious cycle of harm. I hope the Minister will touch on that in her reply.

For those who do reach the threshold of a custodial sentence and enter prison, the only answer to deliver change and break the cycle is to ensure there is access to treatment services within prison and on release. Sadly, the sharp decline in recovery services, particularly in prisons, mirrors the sharp decline in recovery services in the community. That has been further exacerbated by the pandemic, where prison regimes have entered strict lockdowns.

One practical challenge is that efforts to tackle drug use in prison are often undermined by the widespread availability of drugs across prison estates. Time, energy and resources end up being consumed by cracking down on the illicit supply. How can policy deal with that challenge, while also dealing with the demand for these substances and the root cause of that? Security can do only so much without a parallel commitment to reducing demand. The Government should ensure that they are committed to acting on both.

I am yet to meet anyone in addiction and recovery who has not experienced trauma. For those fortunate enough to have no personal experience of addiction, it is difficult to comprehend that the drug of choice is, at first, a solution, before it becomes a problem. Prisoners with drug and alcohol problems tend to have high rates of trauma, and trauma begets trauma.

Trauma has been shown to impact on cognitive functioning and on an individual’s ability to build and maintain social relationships. To be drug or alcohol dependent is a harrowing and hopeless ordeal; it is not a choice. To quote Dame Carol, a

“widespread sense of boredom, hopelessness and lack of purposeful activity in custody”,

coupled with little access to meaningful support in prison, is perhaps the worst possible environment the state could create to deal with this growing problem.

We know that, with access to properly resourced, person-centred, trauma-informed care, people can and do make positive changes to their lives. For prisoners, that care cannot stop when they walk from the prison gates. Many prisoners with drug problems are still being released on Friday afternoons, with nowhere to stay, no access to appointments at probation or drug services, no Naloxone and nothing but £46 in their pocket, with predictable results.

Transition between prison and the community must be prioritised to ensure a significant increase in engagement and community treatment on release. Every person in recovery is proof of the transformational change that is possible. For those who doubt whether someone in prison can address their addiction and make positive changes, I recommend taking the time to look at the fantastic “More Than My Past” campaign by the Forward Trust.

The sad reality is that the UK was once a leader in offering accredited addiction and recovery programmes in prisons. At the beginning of the last decade, there were over 100 programmes in England and Wales in prison settings, with over 10,000 prisoners participating. Today, access to accredited addiction and recovery programmes is a prison postcode lottery. There is no national standard, and the latest figures suggest that the number of people participating in accredited services in prisons is below 200 per year.

In 2012, the Rehabilitation for Addicted Prisoners Trust—now the Forward Trust—managed 14 intensive accredited addiction and recovery programmes in prisons across England, serving around 1,200 people per year. Independent evaluations showed that those programmes helped thousands of people into recovery from addiction, and that prisoners who completed those programmes were 49% less likely to be reconvicted compared with those who completed other programmes. By 2020, most of those programmes had closed due to lack of funding, and only around 300 people were able to access them. As it stands today, after two years of covid restrictions, only four programmes of this kind are still running, with only one currently operational. Despite the evidence, access is sparse, and prisoners have to transfer in order to access such services.

The Health and Social Care Act 2012 transferred responsibility for commissioning health services in custody from Her Majesty’s Prison and Probation Service to NHS England. Funding for prison healthcare and substance misuse services fared well compared with the local authority funded services in the community, but there have been other consequences. Physical healthcare services in prisons have improved, but as Dame Carol pointed out, the arm’s length approach to commissioning substance misuse services in prisons has been widely criticised. Contracts are often placed with general healthcare providers, then further subcontracted out, and the system becomes fragmented and unaccountable.

Since that transfer, there has been an alarming reduction in the range of provision in prisons, particularly in recovery-oriented services. Fewer than 200 prisoners are accessing accredited, structured addiction and recovery programmes, and in its “Alcohol and drug treatment in secure settings” report, the Office for Health Improvement and Disparities showed that there were 43,255 adults in alcohol and drug treatment in prisons and secure settings between April 2020 and March 2021—a drop of around 3,000 from the previous year. However, that figure of 43,255 prisoners accessing the treatment system does not tell us anything about how many were accessing recovery-oriented services. Can the Minister tell me what that treatment consists of, considering that accredited addiction and recovery course attendance has plummeted so drastically? With this new strategy, will the Minister also commit to restoring accredited addiction and recovery programmes to former levels and making them available in every prison?

When discussing addiction treatment pathways in community and secure settings, there is an unproductive and recurring debate: harm reduction versus abstinence. Each has its own set of benefits, yet they represent completely different approaches to recovery. Both approaches to treatment have their perceived pros and cons, but there is no right choice or correct pathway; after all, addiction has many causes, and recovery can be supported in a number of ways. Opiate substitute treatment, needle exchange, and the life-saving naloxone are important interventions—harm reduction saves lives, but so does recovery. It is time to take seriously the challenge of turning people away from drugs and crime.

I understand that the Secretary of State for Justice’s promotion of abstinence-based programmes in the prisons White Paper has caused confusion and some upset. Some believe that his approach goes against evidence-based research and the Government’s own 2017 “Drug misuse and dependence: UK guidelines on clinical management” document. The guidance is clear:

“any plan for reduction and cessation of OST should be based on the clinical judgement of the prescriber in collaboration with the prisoner and the wider team. Reduction and cessation should not be on an arbitrary or mandatory basis but rather requires careful clinical assessment and review…There should not normally be mandatory opioid reduction regimes for dependence…The purpose of healthcare in prison, including care for drug and alcohol problems, is to provide an excellent, safe and effective service to all prisoners, equivalent to that of the community.”

This should not be an either/or. When we think about recovery from any other health condition, that way of thinking would not be accepted. Clinicians would be focused on combinations that give people the best possible chance to make a full recovery. The Government say in their drugs strategy:

“We will treat addiction as a chronic health condition”.

I welcome that. As with many other health conditions, there needs to be a wide range of interventions and services that provide those in need with real choice.

For many people, harm reduction is the start of the recovery journey, but recovery is much more than, “Are you clean or not?” Recovery is not binary, recovery is not linear, but recovery is possible. To support it, there needs to be greater allocation of physical space on the prison estate to carry out therapeutic interventions that all people can access. That must include space for psychosocial, not just clinical, interventions. Well-designed recovery wings create a much less violent and more co-operative population who are focused on rehabilitation. Every prison should have recovery-focused wings. I wonder if the Minister is considering that possibility.

I welcome the commitment from the Ministry of Justice to expanding the use of recovery-focused areas in prison, which pointed to Her Majesty’s Prison Holme House as an example of good practice. The early outcomes from recovery wings have identified a reduction in violence and substance use, and a link to increased employment opportunities on release. Despite the support from addiction treatment charities for recovery wings, and despite their inclusion in the prisons White Paper, I have been made aware of a growing sense of open resistance in the Department of Health and Social Care to the expansion of recovery wings in prisons.

I would be grateful if the Minister could shed some light on those worrying reports. Is that the case, and if so, will she put a stop to it? Will her Department deliver on the reforms set out in the drugs strategy and the prisons White paper to improve addiction treatment in prisons and not stand in their way? Will the Minister tell us how the new spending allocation will reflect the priorities set out in both papers?

To conclude, I will quote Charlie Taylor, Her Majesty’s chief inspector of prisons:

“To lead successful, crime-free lives when leaving custody, prisoners must change the way they feel about themselves and develop a belief that they can take control of their future.”

I hope that officials in the Department of Health and Social Care take heed of the chief inspector’s words as the final decisions are made on what has the potential to be positive progress under this Government’s reforms. Lives depend on it.

16:18

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship for the first time, Dr Huq, and I look forward to doing so on many more occasions. I am grateful to the hon. Member for Liverpool, Walton (Dan Carden) for raising this important issue, which I know matters to us both. We come from a similar area and have seen similar challenges, which is probably one of the reasons why we are both here to try to help people live their best lives.

Addiction is a chronic condition with damaging and far-reaching consequences for individuals, their loved ones and wider society. A high proportion of the individuals who go into prison already have a substance misuse problem, but some may develop an addiction while in prison, as the hon. Member for Strangford (Jim Shannon) outlined. This Government are committed to ensuring that we take the opportunity while people are in prison to get them the treatment they need and to get them out of crime. However, tackling addictions in prison requires a collective effort at both national and local level. The Department of Health and Social Care is committed to working with partners across health and justice to ensure safe, timely and effective care that improves health outcomes and reduces health inequalities for prisoners, as well as reducing reoffending.

In prisons and in the community, the NHS is focusing on integrating substance misuse and mental health services, to ensure that we provide joined-up, trauma-informed care that addresses an individual’s complex and interrelated problems, as the hon. Member for Liverpool, Walton, pointed out so eloquently. This is an important blend—to ensure that the mental health services and support are there, as well as substance misuse support. Investment in those services in prisons has increased from £184 million in 2016-17 to £203 million in 2020-21, with NHS England and Improvement committing a further £21 million over the next three years.

The NHS has also just commenced the roll-out of something fundamental—the GP2GP functionality. This will ensure that 100% of GPs working in the adult prison estate will be able to transfer clinical records to and from GPs in the community, allowing greater continuity of care for people entering and leaving the prison estate, and safeguarding health gains made when people go to and from prison. Ensuring continuity of care is vital, but it does not happen well in all cases today. The roll-out is being made in six tranches, with all of the male prison estate to be completed by June 2022.

Providing appropriate intervention and treatment at the right time and in the right place is vital to improving outcomes for people with substance misuse and mental health problems. NHS liaison and diversion services work at police stations and criminal courts to identify and assess people with substance misuse issues so that they can be referred to appropriate services and, where appropriate, out of the justice system all together. We are working with health and justice partners to increase the use of community sentence treatment requirements, which can help to reduce reoffending and custodial sentences by offering drug or alcohol treatment as part of a sentence.

In February 2019, the Government commissioned Professor Dame Carol Black to conduct an independent review of the issues and challenges relating to drug misuse, which exposed the stark scale of the national challenge. The hon. Gentleman referred to that vital piece of work a lot. I thank Dame Carol for her thorough review and for championing this important agenda. The Government accepted all of her key recommendations and are committed to supporting individuals suffering from addictions in prison.

To that end, we recently announced a number of initiatives that focus on recovery and rehabilitation, some of which the hon. Gentleman mentioned. The new drugs strategy, “From harm to hope”, was published on 6 December 2021. It sets out how we will significantly increase the number of drug and alcohol treatment places, and therefore increase the number of people in long-term recovery from substance addiction. The strategy aims to reverse the upward trend in drug-related deaths and to bolster the crime prevention effort by reducing levels of offending associated with drug dependency. It is important work. The hon. Gentleman questioned whether the DHSC is in any way reluctant to carry out that work. Not at all; I am very committed to that outcome and, as far as I am aware, we are working well with partners across and in the community.

To deliver the strategy, we have made available an additional £780 million, which represents the largest ever single increase in treatment and recovery investment. Of the £780 million, £530 million will be spent on enhancing drug treatment services, while £120 million will be used to support offenders and ex-offenders to engage with the treatment that they need to turn their lives around. There is specific funding for that purpose.

The hon. Gentleman made a point about abstinence-based treatment versus methadone prescribing or other treatments. Both have their place. Not everyone’s addiction is the same and nor is their pathway to recovery. The clinical evidence guidelines—including National Institute for Health and Care Excellence guidance—and clinical consensus will support a balanced and integrated approach. Those bodies will be the ones deciding what is best for the individual concerned.

The prisons White Paper, which was published on 7 December 2021, has a specific focus on tackling barriers to rehabilitation and reform by deploying the full range of treatment options to support recovery from drug dependency. For example, we are exploring the benefits of making long-acting buprenorphine available to prisoners by assessing the impact on engagement with treatment, protection from overdose, and relapse after release. We are also supplying life-saving naloxone medication to staff in prisons and approved premises to prevent unnecessary deaths from opiate overdoses.

Crucially, we want continuity of treatment once an offender is released back into the community, so that they do not slip back into using drugs and into the life of crime that they have often followed. The NHS long-term plan introduced the NHS Reconnect service to work with individuals who would otherwise struggle to engage with community-based healthcare services. The service works with such individuals pre-release to ensure that there is no disruption to their care. Reconnect is the largest health and justice investment to be delivered by the NHS long-term plan, with an annual spend of £13.8 million in 2022-23, rising to £20 million in 2023-24.

As well providing health and care support, we need to tackle the wider issues that can hinder a person’s ability to recover and turn back the clock on their crime. Prison programmes for drug rehabilitation, skills and work will be more closely linked to the support services available in the community when offenders are released. We are working with the Department for Work and Pensions and the Ministry of Justice on that. Through those initiatives, we are ensuring that every day that an offender spends behind bars involves purposeful reform and rehabilitation to help them to recover and turn their life around, and to ensure that they have the building blocks in place to maintain that recovery and make a positive contribution to society after they leave prison.

Our focus on recovery is unprecedented in its ambition and in the level of funding backing that ambition, and it forms a key part of the Government’s plans to cut crime and make our communities safer as we build back better, stronger and fairer after the pandemic.

Question put and agreed to.