Clause 20

Offender Management Bill – in a Public Bill Committee am 10:45 am ar 23 Ionawr 2007.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Removal of requirement to appoint a medical officer etc

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

Photo of Edward Garnier Edward Garnier Shadow Minister (Home Affairs)

Again, I want to highlight an issuethat the Government need to demonstrate increasing awareness of, namely, health provision for the mentally   ill inside prison. I started the debate last week, but the matter is perhaps more appropriately dealt with under clause 20.

Under clause 20(1), the Prison Act 1952 is amended where section 7(1) makes appointing a medical officer for each prison a requirement. That provision will now be omitted. I can understand the policy, because now health services are provided within prison by the national health service through the local primary care trust. Patients in prison are on the list of a local GP practice, or covered by some other arrangement made by the PCT, so a dedicated prison doctor is no longer necessary. However, if we are not to have a dedicated prison doctor, we must surely have proper facilities for the treatment of the mentally ill.

The problem cannot be just brushed under the carpet. Lord Phillips, the Lord Chief Justice, speaking to the all-party parliamentary group on substance abuse in March 2006 in this building, said:

“Many actual or potential criminals are dangerous because they suffer from personality disorders or other mental conditions which can be diagnosed as illnesses. Prison is not the best place to detain those who are mentally disordered.”

Sadly, however, all sorts of people with mental disorders are sent to prison, partly because the national health service no longer has provision for residential care of the mentally ill, which, in fairness, partly flows from the failure of the care in the community systemto cope with many of the people who have mental illnesses. A number of people who live rough or commit crimes of violence are mentally ill. They may be mentally ill because they have a mental problem that has occurred naturally, or the balance of their mind has been affected by drugs. It does not matter why they are ill, however; what is important is that once diagnosed, they receive the appropriate treatment. It is regrettable that prisons are used—I say this not only as a politician but as a Crown court recorder—as adjuncts to the national health service.

Mental health problems are worryingly prevalent among those entering prison: 72 per cent. of males and 74 per cent. of females in prison suffer from two or more mental disorders, compared to only 5 per cent and 2 per cent. respectively of the general population. What is more, 20 per cent. of men and almost 40 per cent. of women entering custody say that they have attempted suicide. In the past decade, one prisoner has committed suicide every four days.

There is no point in saying that mentally ill offenders would be better managed outside prison and would be better off if they never entered prison in the first place. That is uncontroversial and has been stated by Anne Owers, the chief inspector of prisons. Her estimate, based on visits to prisons, is that 41 per cent. of prisoners held in health care centres should be in secure national health service accommodation. The Lord Chief Justice agrees. In relation to prisoners suffering from mental disorders, he says that

“many of these would be better detained in mental hospitals.”

Treatment of the mentally ill in prisons is far from ideal. I appreciate that the ordinary prison officers who do the health work in prisons do their best, but they are not trained to deal with mentally ill people. As a result of overcrowding in prisons and the insufficient number of prison officers looking after prisoners, particularly at weekends, the mentally ill are left in their cells instead of being given appropriate treatment.

There are mental health in-reach teams in 102 prisons, but at any one time there are likely to be at least 40 prisoners who, having already been assessed, must wait three months or longer before being transferred to hospital. Many more have a long wait before an assessment takes place.

Far from helping to cure mental health problems, the environment and the regime of prison seem likely to exacerbate them. Research has shown that 28 per cent. of male sentenced prisoners with evidence of psychosis reported spending 23 hours or longer in their cells each day—more than twice the proportion of those without mental health problems who spend that length of time in their cells. Suicide attempts and incidents of self-harm are frighteningly high. Nearly a third of women in prison injure themselves an average of five times, and 6 per cent. of men do so twice.

Jonathan Aitken, who involuntarily became something of an expert on prisons, has written this about his time in prison:

“On the wing, there was plenty of evidence of behaviour brought on by mental distress...one young man only ever wore the same pair of jeans and a green nylon cagoule. He never wore shoes or socks, never went out on exercise, hardly ever spoke to anyone and was understood to have been taken advantage of sexually by predatory prisoners...Another had a habit of inserting objects into his body: a pencil in an arm, matchsticks in his ankle.”

The conclusion that he drew, and that I draw, is that prison does little to address the many and severe mental health problems of its inmates. That has consequences for the resettlement needs of released prisoners with mental health problems, because those needs are not being identified or met. Some 96 per cent. of mentally disordered prisoners, including 80 per cent. of those who have committed the most serious offences, are put back into the community without supported housing. More than three quarters are given no appointment with outside mental health experts or carers. According to the Government’s social exclusion unit, more than 50 prisoners every year commit suicide shortly after release.

Hidden behind the apparently uncontroversial clause is an enormous problem that is getting worse and needs to be tackled. If the Government are not to have a dedicated medical health officer in every prison because of the new arrangements with PCTs, it is incumbent upon them to ensure that there is, not merely some mental illness care, but more than adequate mental illness care for people going into prison, those in prison and those coming out of prison. I do not attach personal blame to the Minister, but the Government can no longer say, “Well, this is something we have inherited.” They have been in office for 10 years. I look forward to some words of reassurance from the Minister.

Clause 20(3) makes ineffective section 17 of the Prison Act 1952, which bans painful tests carried out by medical officers on prisoners in order to detect malingering or for other purposes. Why is a painful test for any purpose necessary? Will the Minister explain precisely what is the purpose of removing section 17, and therefore the ban on such tests, and say what will happen instead? I cannot believe that any humane medical officer would deliberately hurt anyone, although some investigations clearly require discomfort  to be inflicted on a patient. I look forward to hearing the Minister’s explanation of clause 20(3) and ofthe removal of obligations under section 28(5) of the 1952 Act.

Photo of Gerry Sutcliffe Gerry Sutcliffe The Parliamentary Under-Secretary of State for the Home Department

I shall deal first with the reality of the clause and how it affects the Bill and then return tothe hon. and learned Gentleman’s concerns about mental health provision and to the wider debate about mental health issues.

The clause removes the requirement for prisonsto appoint a medical officer. The role of the medical officer in prisons is long outdated; its creation in legislation reflected the custom and practice in prisons long before the creation of the national health service and before the Prisons Act 1952 in which it appeared was passed. It represents the old way of providing health services to prisoners.

With the recent transfer of responsibility for prison health services in public sector prisons to the national health service, the great majority of prison health services are now delivered under the general provisions of the National Health Service Act 1977. Local primary care trusts now commission those services and the continued existence of the prison medical officer is at odds with the modern national health service.

When it was first implemented, the medical officer role represented a mix of managerial, practical and clinical duties, some of which we would now view as inappropriate for a clinician. Over the years, the role has in practice evolved considerably to keep pace with the modernisation of the service. It has moved from the tradition of the person with that role being an officer of the prison towards a more appropriate role, equivalent to that of a community GP.

The removal of the medical officer role servesto support the significant improvement and modernisation of prison health services that has taken place in recent years. It also reflects the enormous cultural change that needed to take place in prisons to effect those changes. The clause removes outdated, unhelpful terminology that acted as a barrier to the delivery of practical and cultural change in prison health services. The change ensures that the future of the prison health service is within the NHS, with health services provided via the 1977 Act, in line with services for the rest of the population. That is the reasoning behind the clause, which hon. Members will understand in relation to the purposes of the Bill.

Rightly, and understandably, the hon. and learned Gentleman raised the issue of mental health problems in prisons. I agree with him that there are people in prison with mental health problems who do not need to be there and we should make every effort to ensure that their needs are addressed.

Photo of Rob Flello Rob Flello PPS (Rt Hon Lord Falconer of Thoroton QC, Secretary of State), Department for Constitutional Affairs

Will the Minister give me reassurance and comfort that the flexibilities in the Bill will allow some of the superb work with people who have mental health problems that is carried out by the not-for-profit sector in an almost non-statutory, much more easily approachable manner, to be developed and applied in the Prison Service?

Photo of Gerry Sutcliffe Gerry Sutcliffe The Parliamentary Under-Secretary of State for the Home Department 11:00, 23 Ionawr 2007

Very much so. I am grateful to my hon. Friend for pointing out the role of the not-for-profit sector and I would hope to see that work not only continue but develop in the way that he outlined. The hon. and learned Member for Harborough said that prison officers were not trained in mental health awareness. He is wrong. We have invested close to £500,000 in training 9,000 prison officers in mental health awareness, so there are prison officers with the skills. Clause 20 does not affect the current ability of prison officers to develop health and safety training and to look at how they deal with a situation. It does not affect the chain of command if there is an attempted suicide and the medical officer needs to be called. The procedures are all in place.

The hon. and learned Gentleman concentrated on the role of the Prison Service in relation to mental health problems. He will know, because he deals with some of the issues in his other role, that the disposal of people with mental health problems who have committed an offence is a matter for the courts. So the courts have a major role to play when they receive the reports on individual cases.

Photo of Edward Garnier Edward Garnier Shadow Minister (Home Affairs)

Of course the Minister is right, but the problem is that there is a difference between being in such a mental state that one needs to be sectioned and placed in a secure hospital and being mentally ill but still short of needing to be sectioned. Many courts frequently have to send to prison people who are not, if I may loosely use the expression, “McNaghten mad”, but who are none the less not well. While it would be better and preferable to send those people whom I loosely described as not being well into the national health system, there is not room or there are not the beds available.

For goodness’ sake, there are not even spaces for mentally ill people who do not commit crimes; we know that as constituency Members of Parliament. When we send people to prison, we have to do so irrespective of our private wish that they could go somewhere else. As a judge, one has to do what the law requires one to do. Once they get to prison, the judge has no say over how the individual is cared for, and if there is an absence of proper care there is nothing that the judge can do about it.

Photo of Gerry Sutcliffe Gerry Sutcliffe The Parliamentary Under-Secretary of State for the Home Department

I am grateful to the hon. and learned Gentleman, who brings to the Committee experience of the role of a judge. I am not making the case that it is all down to the courts, but there is a role for the courts to play in terms of some of the diversion schemes that have been put in place for mental health assessments to be undertaken so that the courts can be provided with information about an offender’s mental condition and any treatment that may be appropriate. I take the point that it does not meet all circumstances and some of the needs may not be apparent at that court process.

I am not labouring the point and saying that it is all down to the courts and it is no one else’s responsibility, because clearly it is a responsibility and we have as a Government tried to make significant improvements to the mental health services available within prisons through the development of the new NHS mental  health in-reach services, which are backed up by an investment of more than £20 million a year. As the hon. and learned Gentleman says, there are in-reach teams in 102 prisons, including 60 staff now in post. They ensure that mentally ill prisoners are assessed as too ill to remain in prison so that they can be transferred to a hospital setting appropriate to their care and security under the requirements of the Mental Health Act.

In 2005, 24 per cent. more prisoners with mental illness too severe for them to be in prison were transferred to hospital than in 2002. The figures were up to 896 from 722. There has also been a decrease in the number of people waiting more than 12 weeks for a transfer to hospital. In the quarter ending June 2006, 44 prisoners were waiting, down from 62 in the same quarter in 2005, so we are showing a significant improvement. We are also running pilots that explore the possibility of reducing the 12-week waiting standard to just 14 days.

The hon. and learned Gentleman asked about prevention of suicide and self-harm. Suicide rates in prison remain higher than in the general population, although they have declined. Some 78 apparently self-inflicted deaths occurred in 2005, 95 in 2004 and94 in 2003. That must be put in the context of the number of individuals passing through the prison system each year—more than 130,000. Every death in prison is a terrible tragedy affecting families, staff and other prisoners deeply. Ministers, the National Offender Management Service and the Prison Service are committed to reducing the number of such tragic incidents. I am a member of a group of stakeholders looking at ways in which we can do that.

Self-inflicted deaths in custody are subject to highly random and large cyclical swings. The most reliable measure is the three-year rolling average. From 2003-04 to 2005-6, that stood at 121 deaths per 100,000 prisoners, which reflects the stabilisation of the figures over recent years. The Safer Custody Group, whichI reported on earlier, works with the prison andhealth services, and a variety of agencies, looking at assessment, care in custody and teamwork—ACCT—to help at-risk prisoners. ACCT will be extended to all prisons in 2007.

The hon. and learned Gentleman asked also about what we were doing for people with mental health problems when they leave prison. Continued treatment in the community is vital for such people and in February 2006 the Home Office launched a five-year strategy for protecting the public and reducing reoffending. That contains a commitment to look at ways in which offenders receive effective mental health treatment, whether in prison, hospital or the community. Offenders identified as having severe or enduring mental health problems are subject to the care programme approach during their stay in prison and on release.

The hon. and learned Gentleman is quite right. This is not a party political issue. He will accept that there have been mistakes with care in the community and that the past 10 years have seen improvements. However, we need to go further. During the short time that I have been in my post, I have been concerned about mental health problems in prison, particularly among young offenders. A great deal more needs to be,  and can be done. I am working with health Ministers to improve the situation and the Committee will be aware of the improvements in the Mental Health Bill, which is going through the Lords.

Mental health is an important issue, not only for the Committee, but for those tackling reoffending and looking at a range of health needs. The hon. and learned Gentleman talked about the number of women in prison with mental health problems. I saw that first hand on a visit to Holloway. It was distressing to see some people who could have been dealt with in another way and I look forward to Baroness Corston’s report on vulnerable women, which will come out soon. He referred to subsection (3), which repeals the “painful tests” provisions in the Prison Act. If he requires more details on that, I shall be happy to write to him and to the Committee. However, with that explanation ofthe Government’s policy on mental health and the particular issues relating to clause 20, I hope that the Committee will support it.

Question put and agreed to.

Clause 20 ordered to stand part of the Bill.

Clause 21 to 23 ordered to stand part of the Bill.