Criminal Justice and Courts Bill

Lord Patel of Bradford Excerpts

Monday 14th July 2014 Lords Chamber

Moved by

[Lord Patel of Bradford]

19: Clause 14, page 15, line 24, at end insert—
“(4) Before this section comes into force, the Secretary of State shall lay before Parliament a report describing his plans to ensure that safe and supervised places are provided in which prisoners can take medication which has been prescribed to them.”

[Lord Patel of Bradford (Lab)]

My Lords, in moving Amendment 19 I shall speak also to Amendment 20. Amendment 19 should have been tabled in my name, but unfortunately due to an administrative error my name was not added to sit alongside those of my noble friends Lord Beecham and Lord Kennedy.

Clause 14 enables the Secretary of State to specify in prison rules and rules for other places of detention non-controlled drugs which can be tested for under the existing mandatory drug-testing programme. I generally support the intention behind Clause 14, but I would like to see greater clarity on two aspects: first, on what plans are being made to ensure that suitable provision is in place for people in prison to be able to take prescription drugs safely and so limit the scope for abuse; and secondly, on the incidence of drugs in prison and in particular the effectiveness of drug testing.

In tabling both of these amendments I should declare an interest as the former chair of the independent cross-ministerial committee on the review of drug treatment in prisons which resulted in the publication some years ago of The Patel Report. At the time we were very much focused on the development of the integrated drug treatment system in prisons which commenced in 2006. It has had a considerable and positive impact on reducing the use of heroin and illegal drugs in prison. However, we know that since that time, the demand for prescription and over-the-counter medication in prisons has been increasing, and we have also seen an increase in the use of psychoactive substances, the so-called “legal highs”. We need to consider the use of legal highs alongside the problems around prescription drugs in our attempts to deal adequately with these issues. For that reason, I intend to address both issues together.

Amendment 19 requires the Secretary of State to lay a report before Parliament,

“describing his plans to ensure that safe and supervised places are provided in which prisoners can take medication which has been prescribed to them”.

Amendment 20 requires the Secretary of State:

“Within 12 months of section 14 coming into force … report to Parliament on the incidence of drugs in prisons and the effectiveness of drugs testing of prisoners in prisons”.

Let me first explain why these two amendments are important. Although accurate prescribing data for analgesics are unavailable, a report entitled Managing Persistent Pain in Secure Settings, published by Public Health England last year, gives some startling figures on the scale of analgesic prescribing. A snapshot of just two institutions with populations of 751 and 859 respectively suggested that between 55,000 and more than 350,000 analgesic tablets, excluding paracetamol and ibuprofen, were prescribed in just one month. The Chief Inspector of Prisons highlighted in his annual report last year that the diversion of prescription drugs, such as Tramadol, Gabapentin and Pregabalin was taking place in high security and vulnerable prisoner populations. I know from my own work with NHS England on conducting health needs assessments in a wide range of prisons just how serious an issue this is, and that the growing demand for and diversion of prescription drugs is viewed by both prison staff and the prisoners themselves as a major problem.

--- Later in debate ---

[Lord Mancroft (Con)]

My Lords, I listened with great care to the noble Lord, Lord Patel of Bradford, in moving his amendment, and he laid out very accurately for your Lordships the perceived problem of misadministration of various sorts of drugs, particularly prescription drugs, in prison, and the manner in which they are prescribed and taken. The problem that the noble Lord describes to the House is probably entirely right. However, it may not have come over that it is merely an extension of the problem of prescription drugs outside prison. Often in your Lordships’ House we discuss drugs and drug-related crime, but we rarely get around to talking about the fact that, however many people may be taking illegal drugs, many more are addicted to prescription drugs, which causes immense problems for them and their families, as well as for society as a whole. Whether or not that addiction to prescription drugs is causing crime or is related to crime in some way, it is an enormous problem. All those drugs are prescription drugs, which means that they have already been prescribed by a doctor—and probably, as a consequence, misprescribed, or they would not be resulting in addiction and all the problems that stem from it.

We are not dealing with that problem outside prison, with the ordinary population—we are dealing with it incredibly badly. The Department of Health is wrestling with it in a rather inadequate way, and it is bouncing backwards and forwards between the Home Office and the Department of Health, as it has been for many years. I am not entirely sure why, if we cannot deal with it outside prison, we should dump that problem into prison and say to the prison authorities that we cannot deal with it when prisoners are ordinary citizens living in our society, but now that they have been convicted of a crime and are going to go to prison we expect the prison authorities to deal with a problem that we cannot deal with outside.

The noble Lord has accurately identified a problem, but I have some concern over whether Amendments 19 and 20 contain the solution. Perhaps it is the start of a solution—but if we cannot deal with it outside, asking the Secretary of State to lay a report, the results of which we can all guess, even if we do not know the details, does not seem even to get to the start of resolving this problem. I look forward to what my noble friend says in response, and perhaps the noble Lord, Lord Patel, would like to respond before then. However, although I accept the problem, I cannot see that this even remotely touches on a solution.

[Lord Patel of Bradford]

I completely agree with the noble Lord, Lord Mancroft, about the issue of prescription drugs out in the community, given the ludicrous figure of literally 50 million prescriptions—I think—having been issued last year. However, there is a clear distinction between that situation and the situation in prisons. Mandatory drug testing was introduced to test prisoners for heroin in particular. However, following the introduction of mandatory drug testing, many prisoners who had been using cannabis, which stayed in the system for longer, started to use heroin, which stayed in the system for a shorter time. We got over that problem through introducing into the prison estate a very good integrated drug system, which has worked exceptionally well.

However, the drug abuse problem has shifted to prescription drugs. In prison after prison, prescription drugs are used as a commodity. People are being bullied on account of these drugs and violence is associated with them. We do not have the measure of this problem or know the extent of prescription drug abuse. Indeed, we have no idea about the problem of the so-called legal highs, which is clearly a problem in prisons, because the mandatory drug testing simply does not pick up those drugs. Merely to say that we will conduct mandatory drug testing for all drugs will not solve the problem. We need to analyse further how prisoners can safely take the prescription medicines they are prescribed and what policies need to be put in place to provide safe places for them to do so. We need data on prisoners’ prescription medicines and on the incidence of abuse to enable us to move forward on this issue. The intention behind the amendment is to obtain that data and for the Secretary of State to present them to Parliament in a report. That would give us the opportunity to improve the situation.

[Lord Beecham]

I should like to add a further thought and thank my noble friend for putting the case for these amendments so capably. The responsibility for providing medical services in prisons belongs ultimately to NHS England as the commissioners. Therefore, it is not a matter solely for the Ministry of Justice. It seems to me that some interdepartmental discussions on this issue would be timely, if they have not already taken place. There is the sheer cost, of course, of providing prescription drugs for prisoners as, indeed, for anyone else, which, obviously, will be a factor in the mind of NHS England. As regards the general health problems of prisoners, particularly mental health problems, it seems to me that the involvement of the Department of Health and NHS England in looking at the aspects to which our amendments refer would be very helpful. I am not asking for any response on that tonight except perhaps for a nod in the direction that some discussions will be held with NHS England and the department to see whether a more holistic approach can be adopted across the relevant agencies. It would be helpful if such an indication could be given.

[Lord Ahmad of Wimbledon]

My Lords, I thank the noble Lord, Lord Patel, for tabling these amendments. I must admit I was somewhat surprised that he was confused that the name of the noble Lord, Lord Beecham, was added to the amendments rather than his. Perhaps it would have been more palatable had he said he had been confused by my good self but, accents aside, there may be more similarities there. The noble Lord raised some very pertinent issues, as did my noble friend Lord Mancroft, in talking about drug issues more generally in society. I have often spoken about this issue at the Dispatch Box in responding to Questions. We also heard briefly about legal highs.

Amendments 19 and 20 both relate to the use of drugs in prisons, although from two different perspectives. I know that the noble Lord, Lord Patel, has laid Amendment 19 in good faith to support the well-being and security of prisoners. However, in all prisons where prisoners are being supplied medicines for the management of either long-term conditions or for the treatment of acute clinical conditions, the safe use of medicines is taken extremely seriously. The noble Lord, Lord Beecham, rightly talked about the role of the NHS. Clinical governance of this process in England and Wales is undertaken by qualified pharmacists commissioned by the National Health Service not the National Offender Management Service or Her Majesty’s Prison Service. I assure all noble Lords that dispensing complies to national guidelines and is risk assessed by pharmacists on a case-by-case basis to ensure that medicines are dispensed in a manner that is safe and appropriate to a custodial environment, including the risks of the diversion of medicines and decisions over whether appropriate medicines can be “held in possession”. These processes are subject to routine audit and assurance in line with guidelines for the management of medicines in the wider community.

Moreover, prison staff are very much aware of prisoners attempting to take medication without swallowing in order to sell or pass on that medication to other prisoners. This is sometimes done in reaction to bullying from other prisoners. Every effort is made to prevent this. The noble Lord, Lord Patel, gave several examples of good practice. I give him the assurance that I will share that with my honourable friend the Prisons Minister and perhaps we can arrange a meeting to explore how this issue can best be addressed across the board. The Government have always held the opinion that where good practice can be shared across the prison estate it should be taken on board. I hope that, given that reassurance, the noble Lord will be minded to withdraw Amendment 19.

Amendment 20 would require the Secretary of State to report to Parliament on the incidence of drugs in prison and the effectiveness of drug taking. I assure noble Lords that the Government take the issue of drugs in prison extremely seriously. Therefore, Clause 14 represents an immediate step to address the challenges facing the Prison Service with the different types of drugs that are being abused by prisoners. I totally take on board the fact that legislation alone, either drafting it or applying it, will not deal with the issue, as the noble Lord, Lord Patel, said, but it is the way forward.

In regard to the incidence of drugs in prisons and the effectiveness of drug testing of prisoners, it is assumed that the question refers to the number of positives for drug abuse found by the mandatory drug testing programme across the prison estate. The effectiveness of the MDT programme is kept under constant internal review, including the range of drugs tested, which will be extended as appropriate. The number of prisoners being tested under the MDT programme and the percentage found to be positive are already published in the NOMS management information addendum. All this information is available on the government website.

As noble Lords are aware, the Ministry of Justice is ultimately accountable to Parliament for the discharge of its responsibilities, including those on the prison estate. Bearing in mind that the information is publicly available, and that noble Lords and honourable Members in the other place can hold the Government and the Ministry of Justice to account, we do not believe that the addition of further reporting requirements is necessary. Given the assurances and the explanations I have provided and the offer of a discussion on how we can introduce best practice, I hope that the noble Lord will be minded to withdraw the amendment.

[Lord Patel of Bradford]

I thank the noble Lord for his response. I agree that he and I are slightly more similar than I am to my noble friend Lord Beecham as we both have hair.

[Noble Lords]

Oh!

[Lord Patel of Bradford]

I assume that was what the noble Lord meant. There was a reason why I grouped together Amendments 19 and 20. One has to have a safe place where prescription drugs can be taken. I accept that there is no problem with qualified pharmacists or GPs giving out the medication; I do not question that at all. What I question is the number of safe places that exist across the prison estate in which that medication can be given out. I still think that there is a major issue with prisoners being able to take prescription drugs safely without facing intimidation and the prospect of being bullied to pass them to others as a commodity.

I understand that the provision on mandatory drug testing was taken from a Private Member’s Bill and, therefore, no impact assessment was undertaken. It would be really helpful, now or at a later stage, to hear whether the impact assessment will take place, especially in relation to MDT. We do not know whether the testing is driving people to use other drugs, and it would therefore be important to have some kind of impact assessment on the use of MDT.

I welcome the meeting with the Prisons Minister to share a number of examples of good practice across the country, but I also ask whether the noble Lord will speak to his colleagues in the Department of Health, as my noble friend Lord Beecham said. This is a major health issue because the doctors and nurses are constantly saying that it is they who have to put up with bullying and are unable to prescribe effectively.

It would therefore be helpful if we could take this to the next level. The wording of these amendments may be improved and demands may be high, but there is some scope for looking further at the level and impact of mandatory drug testing. With that in mind, I beg leave to withdraw the amendment.

Amendment 19 withdrawn.