Offender Management Bill

I am grateful to the noble Lord, Lord Ramsbotham, for tabling the amendment. Although it has been only a short discussion, there has been a lot of support for his concern. I well understand that concern. I must confess that when I started undertaking prison visits about 20 or 30 years ago—in a completely different capacity from when I became a Minister at the end of the 1990s—I was not greatly enamoured by what I saw. Although things had improved by the time that I became a Minister in the Home Office, I still thought that there was considerable room for improvement. The noble Lord, Lord Ramsbotham, has played an important role historically in helping the service to think more imaginatively about how services can be provided. He referred to his report back in 1996, which formed part of that discussion and debate. There is a degree of misunderstanding about why Clause 22 is there. Yes, Clause 22 removes the requirement for prisons to appoint a medical officer, but it does so for a sensible reason. The National Health Service, through PCTs, now has responsibility for health services in prisons. That move was widely welcomed; it was supported by the noble Lord, Lord Ramsbotham; and a very important move it was. The noble Lord is right to draw attention to the issue, because that enables us to think more about what needs to be done to improve those services. I understand where he is coming from in wanting to see some functional responsibility, but the progress that is being made is being made for a reason. Perhaps as I go through the issues that have been raised, that will become clear. Given what I have said, we do not think that it would be appropriate for prisons to appoint a manager for services over which they have no authority, nor to dictate to the National Health Service the appropriate structure under which those services should be provided. The original intention of requiring the appointment of a medical officer in legislation was to represent a specific role that had specific health-related responsibilities in a prison. Now that health services in prisons have been modernised, those responsibilities are no longer automatically the responsibility of one individual. Today, prison health services are provided by a multi-disciplinary team, so that the different medical needs and issues that have been referred to in this debate—whether relating to drugs, sickle cell or other such matters—can be picked up. Individual responsibilities belong to team members as appropriate. If the intention behind the amendment is to ensure the continued engagement of the governing governor and the rest of the prison in health matters, our argument is simply that that does not necessitate legislation. Governing governors are shortly to be issued with a new Prison Service performance standard against which they will be audited and which is intended to ensure that they support the delivery of health services in the prison and recognise their continuing responsibility to contribute to improving the health of that prison population. That standard will include a requirement for a member of the prison board to be allocated responsibility for health issues and will contribute to ensuring that health issues remain high on the agenda of governing governors and their prisons. Having heard the debate, I should have thought that that move would have been widely welcomed in the House. I hope that the noble Lord, Lord Ramsbotham, will agree that decisions on how healthcare is provided in the Prison Service are best handled by the National Health Service. After all, the noble Lord was one of those who put us in that general policy direction. I also hope that he will be reassured that adequate mechanisms are in place to ensure that the level of healthcare provision and the prioritisation of healthcare in prisons is suitably maintained. Other issues were raised in the debate. The noble Baroness, Lady Stern, asked whether the clause we intended to put into the Bill contravened human rights. We responded to the report by the Joint Committee on Human Rights, which was entirely happy with our response. At paragraph 48, the committee states: "““The abolition of this requirement supports the continued improvement of prison health services, exemplified by their recent transfer to the NHS, and brings them into line with health services available to the general population””." The noble Baroness, Lady Masham, made the point that some prisoners suffered from long-term drug addiction and mental health issues; what is known as a dual diagnosis. Our approach as a government to addressing people’s mental health and substance misuse treatment needs is set out in the Department of Health’s recent guidance on the issue, Dual diagnosis in mental health inpatient and day hospital settings, which was published last October. It is our belief that providing people with mental health and substance misuse problems with the treatment they need should be the norm, not the exception. The draft guidance on dual diagnosis services for prisoners should be issued for consultation by the Department of Health this summer. Finally, I think that the transfer of prison health services to the NHS has been a success and that we have a good case to make. Obviously, we are in a paradigm of continued improvement, and that is right, but it is worth saying that in 2003 £118 million was transferred from the Prison Service to the health service. Since 2006-07, £200 million per year has been invested in healthcare. Some £20 million of that investment has been spent on mental health in-reach services to provide professional services inside prisons for the first time. They are based in 102 prisons, and 360 new whole-time equivalent staff have been introduced, whose services are available across the entire prison estate. The last two reports from the Chief Inspector of Prisons, Anne Owers, make specific mention of the improvements made in prison healthcare, saying that the involvement of primary care trusts has, "““undoubtedly assisted the progress towards equivalence of service””." My case is not that everything in the prison estate is absolutely hunky-dory and as it should be, but it is an improving picture and one that is recognised not just by Anne Owers but more widely. We should seek to build on that. The amendment has usefully enabled us to discuss the issue, but I do not believe that it is the right direction of travel. We are now improving healthcare provision for a range of health needs, and the service is more directly tailored to the needs of the prison population. I hope that the noble Lord will feel able to withdraw his amendment.