Prisons and Courts Bill (Third sitting)

Liz Saville Roberts Excerpts

Committee Debate: 3rd Sitting: House of Commons
Wednesday 29th March 2017 Public Bill Committees

[Michael Tomlinson]

I have listened carefully to the Minister and am grateful for his considered response to my amendment. All I ask is that when Lord Farmer’s report is widely disseminated, he does not close his mind to the possibility of the amendment’s wording being in the Bill. Obviously that will depend on timing. At present I am content not to press the amendment. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

I beg to move amendment 4, in clause 1, page 1, line 14, at end insert—

‘(e) provide for the wellbeing and healthcare of offenders, including treatment for drug and alcohol misuse and assuring access to continued relevant support upon release.

(f) liaise with the Probation and other relevant services to ensure coordinated rehabilitation of offenders.’.

This amendment ensures that it is within the purpose of a prison to ensure offenders receive the appropriate physical and mental healthcare, as well as necessary rehabilitative support upon release.

[The Chair]

With this it will be convenient to discuss amendment 12, in clause 1, page 1, line 14, at end insert—

‘(da) maintain and promote physical and mental health of prisoners.’.

This amendment requires the purposes of prisons to include the wellbeing of prisoners.

--- Later in debate ---

[Liz Saville Roberts]

The amendment concerns the wellbeing and healthcare of offenders, the relationship with bodies such as probation and the co-ordinated rehabilitation of offenders. Despite reforms, the evidence is clear that the physical and mental healthcare we offer our prisoners still needs to be addressed. The purpose of prisons is undoubtedly to protect the public, rehabilitate and keep prisoners safe and prepare them for a life outside the institution. I welcome the inclusion of those concepts in this part of the Bill. However, it seems to be an obvious omission not to recognise specifically prisoners’ healthcare needs, both mental and physical. Equally, although the need to prepare offenders for life outside of prison is stated in the Bill, there seems to be somewhat a lack of foresight when it comes to expressing how prison should ensure a smooth transition into our communities by liaising with external organisations.

Let me inform the Committee of the statistics on healthcare: prisoners are 12 times more likely to suffer a personality disorder and 16 times more likely to suffer from psychosis; 10% to 14% of prisoners suffer a major depressive illness; two out of three have a personality disorder; seven out of 10 have alcohol abuse issues; and a third have a drug addiction on entry. I shall raise hepatitis C specifically under a later amendment.

The Government’s own regulator on the standard of healthcare in prisons, the National Guideline Centre, which is funded by the National Institute for Health and Care Excellence, said last year that it had become clear that healthcare provision in prisons was typically poorer than in the general community and not sufficient to meet prisoners’ needs. If we do not recognise that most basic of obligations, healthcare in prisons is likely only to slide. That in turn will mean a risk of significantly worse outcomes, both for offenders in prison and those leaving prison. By not recognising the need for a prison to cater for the basic needs of its inmates, we will continue to fail to address key issues that contribute to criminal and disruptive behaviour inside and outside prisons, which of course will only burden the state further in the long run.

The amendment would add new paragraph (f) to proposed new section A1 of the Prison Act 1952; that relates to the need for prisons to look outwards as well as inwards, to properly reintegrate offenders back into communities. The Bill indicates that it is entirely within the prison that an inmate will become proficient in skills and learn to deal with demands in the way that reintegration requires. The reality is of course very different. A prison must liaise with a plethora of organisations across the public, private and third sectors to ensure that offenders have the best possible chances of reintegrating. New paragraph (f) would ensure that that reality was reflected in the Bill.

I recognise, of course, that clause 1 could become a list as long as my arm; however, I feel that the two relatively modest additions in the amendment would reflect the necessity and reality of the way modern prisons function, which is not, of course, in isolation. I will not press the amendment to a vote now, but I hope that the Government will give it proper consideration and a full response.

[Mr Gyimah]

The Government are very aware of the serious challenges that mental health, drug and alcohol issues pose for offenders and the prison system. The Ministry of Justice is committed to working closely with my colleagues at the Department of Health, NHS England and Public Health England, to help to provide the right support and healthcare in prisons.

There is already a statutory underpinning to the health of prisoners; ensuring that prisons are safe is already one of the aims contained in the statutory purpose. Our duties under the Human Rights Act 1998, which, as I have said already, incorporates the European convention on human rights, are also relevant to prisoner wellbeing and healthcare. For instance, under article 2 we must take active steps to prevent suicide and self-harm in custody. Under article 3 prisoners must be detained in conditions compatible with respect for their human dignity and not be subjected to distress or hardship that goes beyond the suffering inherent in detention; the article also requires that, given the practical demands of imprisonment, prisoners’ health and wellbeing should be adequately secured.

There are also already many processes and protections in place in prisons to protect prisoners’ health. For example, health needs assessments help to ensure that accurate information is available on the provision of healthcare needed in each prison; and we are introducing new training for prison staff, including awareness training on supporting prisoners with mental health issues, so that governors and staff better understand the mental health issues of the prisoners they are helping to support.

As set out in the National Health Service Act 2006 as amended by the Health and Social Care Act 2012 and regulations, healthcare in English prisons is commissioned directly by NHS England. That is important because it is right that healthcare in prisons should be delivered by clinical experts. Governors do not have the qualifications or the capability to make clinical decisions about patients, so it is right that responsibility for those decisions should lie with those professionals who can ensure that patients receive the best care.

Governors are already under a legal duty, under prison rule 20, to work in partnership with local healthcare providers to secure access to the same quality and range of services as the general public receive from the national health service. Part of that involves making sure that governors facilitate access to the healthcare provided by NHS England, including giving security clearance to the right people and providing escorts to appointments. However, as set out in the Government’s “Prison Safety and Reform” White Paper in November 2016, we want to go further.

--- Later in debate ---

[Mr Gyimah]

I thank the shadow Minister for her points; I will make a couple of brief points in response. I agree that the level of violence—particularly violence related to the use of new psychoactive substances such as spice and mamba—is too high. In September, we rolled out a new drug test for psychoactive substances—the first and only such test in the world—so we are aware of the issue and we are dealing with it.

We are all aware that prisons are difficult places with some very difficult people to manage. The question is whether we need provision in the Bill to manage these issues. I contend that we need effective practice. When it comes to mental health, for example, we should ask whether processes work well in every prison and whether our prison officers are properly trained to identify how people present when they have mental health problems. I spoke to one of the people who works in our prisons about these issues, and they said that when a prisoner has a mental health problem or is considering taking their life, they enter a dark place and seek to cover their tracks and not really show what is happening internally. These are issues that we really need to train people on the ground to deal with.

I suggest that the amendment be withdrawn. This is about effective practice on the ground. We are alive to these issues, and we will get to grips with them by empowering governors to work closely with the agencies that matter, rather than by adding another list to the Bill.

[Liz Saville Roberts]

I thank the Minister for his comments. I note that he referred exclusively to NHS England. Healthcare is devolved in Wales; prisons are not. That in itself raises the question: to what degree are we consistent in our approaches, and does this issue really need to be raised?

Others eloquently made the point that mental health problems and alcohol and drug addictions are so significant among the prison population that their treatment is surely critical to both rehabilitation and reducing reoffending. The Bill refers to prisons aiming to

“maintain an environment that is safe and secure.”

That does not seem to fully reflect the gravity of the situation, which we need to respond to. I hope that the Government will consider that. However, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: 12, in clause 1, page 1, line 14, at end insert—

‘(da) maintain and promote physical and mental health of prisoners.’—(Yasmin Qureshi.)

This amendment requires the purposes of prisons to include the wellbeing of prisoners.

Question put, That the amendment be made.

--- Later in debate ---

[Yasmin Qureshi]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Liz Saville Roberts]

I beg to move amendment 5, in clause 1, page 2, line 12, at end insert “and

(b) steps taken in relation to meeting health targets specified by the Secretary of State on—

(i) blood borne viruses, and

(ii) substance abuse,

including the provision of testing and treatment for hepatitis C.”

This amendment ensures that the Secretary of State’s annual report on prisons includes targets on blood borne viruses and substance abuse and analysis of whether they are being met.

This probing amendment seeks to create an obligation on the Secretary of State to include in the annual report on prison governance an analysis of progress in meeting health metrics on blood-borne viruses and substance abuse, including the provision of testing and treatment for hepatitis C.

Hepatitis C is a blood-borne virus affecting the liver that can cause fatal cirrhosis and liver cancer if untreated. Around 214,000 people are chronically infected with hepatitis C in the UK. Around 90% of cases arise through injecting drug use, although there are other potential causes including overseas medical care, tattooing and receipt of a blood transfusion in the UK prior to 1991. People are able to live without symptoms for decades after infection, but untreated cases can lead to severe liver problems. Liver disease is one of the five big killers in the UK, and the only one of those where mortality is rising, and hepatitis C is the third most common cause of it.

Why are prisoners particularly at risk? Hepatitis C disproportionately affects disadvantaged and marginalised communities, and around half of people who inject drugs are estimated to have the virus. With around a third of the people in prison having injected drugs, rates of hepatitis C infection are particularly high among prisoners. A 2012 study from Scotland estimated rates of hepatitis C among prisoners to be almost 20%, and we might expect that rate to be similar in other prisons. Offering testing and treatment for hepatitis C is therefore a highly effective way of contributing to prisoners’ rehabilitation; indeed, by allowing them to focus on improving their health and wellbeing it is often found that they are better placed to address other issues contributing to their offending, such as substance misuse. It is also essential that this is carried out if prison governors are to meet the commitment to improve health outcomes.

In October 2013, the UK Government agreed to implement blood-borne virus opt-out testing in prisons. Testing rates for hepatitis C in prisons have improved as a result, rising from 5.3% in 2010-11 to 11.5% in 2015-16. That figure is still too low, however, and progress needs to be made on fully implementing the opt-out testing policy.

The prison environment is an ideal one in which to test and treat people who lead chaotic lives and may not have previously been in contact with healthcare services. With new oral drug treatments becoming available in recent years, which have considerably shorter treatment durations and markedly fewer side effects than previous treatments, the opportunity to treat people in prison is greater than ever before. Achieving a cure for hepatitis C can be a trigger for long-term addiction recovery and help people to take control of their lives. Offering treatment for hepatitis C can therefore be an important step in helping to prepare prisoners for their release.

I prepared that speech with the help of the Hepatitis C Trust, and I would very much like to hear the Minister’s response.

--- Later in debate ---

[Mr Gyimah]

This is a probing amendment concerning a duty on the Secretary of State to include as part of her annual report to Parliament the steps taken to meet targets on blood-borne viruses and substance abuse.

Healthcare in prisons is provided by NHS England, which already uses health and justice indicators of performance and other data to report the performance of substance misuse services and blood-borne viruses. Those data inform NHS practice in commissioning and providing healthcare to prisons. For example, Public Health England, NOMS and NHS England introduced opt-out testing for blood-borne viruses for people in prison in the first national partnership agreement published in 2013. Full implementation across the whole adult prison estate in England is planned by the end of the 2017-18 financial year.

Data on the offer and uptake of testing and referral for treatment are measured through the health and justice indicators, which are based on information provided directly by healthcare teams in prisons to NHS England and shared with Public Health England. Additionally, data on people treated for substance misuse in prison and in the community are collected by Public Health England through the national drug treatment monitoring system.

Using those data, under the programme of co-commissioning that the Government are implementing, prison governors will be able to work with NHS England to commission healthcare services that meet their individual prison’s needs. That, of course, can include elements that provide testing and treatment for blood-borne viruses and substance misuse. I hope I have provided sufficient assurance to the hon. Member for Dwyfor Meirionnydd that placing this requirement on the face of the Bill is unnecessary, as a programme of work is already under way in this area.

[Liz Saville Roberts]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

[Mr Gyimah]

We have had a full and detailed debate on clause 1. It will not surprise hon. Members to know that in drafting the clause, the Government thought long and hard about what it should contain in view of the fundamental changes it makes to the current legislative framework.

The clause reforms the framework of the prison system, providing aims for the system as a whole to unite behind, clarifying the role of the Secretary of State and sharpening accountability. It modifies the Secretary of State’s overarching responsibility for prisons, removing the outdated duty to superintend prisons. The clause also reforms and modernises the Secretary of State’s accountability to Parliament for the performance of prisons. It replaces the existing archaic requirements to report on operational detail, such as hours of work completed in each prison and number of punishments, with a requirement to account to Parliament for the extent to which prisons are meeting the statutory purpose created by the clause.

[Yasmin Qureshi]

We have raised our concerns about the issues we think are important and should be covered in the clause. We hope that the Minister will reconsider some of those things on Report.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2

Her Majesty’s Chief Inspector and Inspectorate of Prisons

[Liz Saville Roberts]

I beg to move amendment 6, in clause 2, page 2, line 18, leave out “a” and insert “an independent”.

This amendment ensures the person appointed as Her Majesty’s Chief Inspector of Prisons has the necessary independence from Government and associated bodies.

[The Chair]

With this it will be convenient to discuss amendment 15, in clause 2, page 2, line 18, at end insert—

‘(1A) Before Her Majesty makes an appointment under this section, the Chair of the Justice Committee of the House of Commons shall recommend for Her Majesty’s consideration an appropriate person who in its view could satisfactorily carry out the functions of the Chief Inspector by moving a name on the floor of the House.”

This amendment provides that the Justice Select Committee should make a recommendation on the appointment of the Chief Inspector of Prisons.

[Liz Saville Roberts]

At the moment, there is no statutory obligation for the person appointed as Her Majesty’s chief inspector of prisons to be independent of Government and associated bodies, and I think we would all agree that it is essential that the chief inspector of prisons is independent. There are provisions in the Bill to empower prison governors to deliver on extra responsibilities, so it is more important than ever that independent chief inspectors of prisons are able to scrutinise and hold prison governors, as well as the Ministry of Justice, to account in a way that is beyond any question of bias.

We already have the Independent Police Complaints Commission, which in legislation is clearly stated to be just that—independent. In the Police Reform Act 2002, through which the IPCC was created, there are stringent tests precluding candidates with particular backgrounds, which might bring into question their independence, from becoming a chairman or member of the commission. The Government must recognise that that imposed, and legislated for, distance between any appointee to the IPCC and a body that that person might investigate is required also for senior prison inspectors. The inspectorate is already advertising itself as an independent body. Surely now is the time to enshrine this common-sense policy in law, both transparently and explicitly.

I will not press the amendment to a vote at this stage, but I hope that the Government will give a detailed answer explaining why they have not chosen to include this wording in the legislation and whether on reflection they might be amenable to a more specific and stringent statement.

[Yasmin Qureshi]

We support any attempt to ensure the independence of the inspectorate from the Government, so we support this amendment.

--- Later in debate ---

[Liz Saville Roberts]

It is right, I am sure everyone will agree, for the chief inspector of prisons to be beyond any doubt in relation to the independence of his role and of his judgment. It seems to me that this should be stated explicitly in the Bill. Amendment 15 would make changes to the appointment procedure. That would put what is proposed into effect and on to a robust footing. There would then be no doubt in that respect. I have some difficulty in understanding the Minister’s response, particularly in relation to the explicit use of the terminology of independence. None the less, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: No. 15, in clause 2, page 2, line 18, at end insert—

“(1A) Before Her Majesty makes an appointment under this section, the Chair of the Justice Committee of the House of Commons shall recommend for Her Majesty’s consideration an appropriate person who in its view could satisfactorily carry out the functions of the Chief Inspector by moving a name on the floor of the House.”—(Yasmin Qureshi.)

This amendment provides that the Justice Select Committee should make a recommendation on the appointment of the Chief Inspector of Prisons.