Select Committee statement: Health and Social Care Committee - Prison Health - Nov 1

I would like to present a report on “Prison health” by the Select Committee on Health and Social Care. I start by thanking my fellow Committee members and the Committee staff, particularly Huw Yardley and Lewis Pickett. I also particularly thank all those who gave evidence to our inquiry, both in person and in writing. We visited HMP Isis, HMP Belmarsh and HMP Thameside, and I thank the staff, healthcare staff and all the people in prison who spoke to us about their experiences.

 

A prison sentence is a deprivation of liberty, not a sentence to poorer health or healthcare, yet sadly that was the picture that we found in our inquiry. Too many prisoners are still in overcrowded, unsanitary prisons with overstretched workforces. Those poor conditions contribute to even worse outcomes and health for those who arrive in prison, who are often from very deprived backgrounds and suffering from serious health inequalities. Violence and self-harm are at record highs, and most prisons exceed their certified normal accommodation level, with a quarter of prisoners living in overcrowded cells over the last two years. Staffing shortages have led to restricted regimes that severely limit prisoner activity, as well as their access to health and care services, both in and outside our prisons.

 

Too many prisoners still die in custody or shortly after their release. Although deaths in custody have fallen slightly since peaking in 2016 as a result of increased suicides, so-called natural-cause deaths are the highest cause of mortality in prisons and, I am afraid, reflect serious lapses in care. Every suicide should be regarded as preventable. It is simply unacceptable that those known to be at risk face unacceptable delays while awaiting transfer to more appropriate settings. We see that happen time and again, without appropriate action being taken.

 

Our report refers to the impact of the increasingly widespread use of novel psychoactive substances, not just on prisoners but on prison staff; dealing with violent incidents takes time away from the work that we would otherwise expect prison staff to do. We heard time and again from people in prison who we met of not being able to attend appointments, either within or outside the prison, because there simply were not the staff there, because they had been diverted to other cases.

 

We have made recommendations for the National Prison Healthcare Board. We would like it to agree a definition of equivalent care, and to tackle the health inequalities that we know prisoners face. It also needs to take a more comprehensive and robust approach to identifying and dealing with the healthcare needs of people in prison. However, many of our recommendations will not be met until sufficient prison officers are in post. That is an overriding issue, because the cut in prison officer numbers—I know the Government are starting to address that—lies at the root of so many problems in our jails.

 

Health, wellbeing, care and recovery need to be a core part of the Government’s plans for prison reform. It is in all our interests to care about the health and wellbeing of prisoners, because they will later be back in our communities. If more of them become dependent on drugs during their time in prison, and these problems worsen, they will come back into our communities with even worse health issues, health inequalities and mental health problems. I know it is difficult, because it sometimes seems that the public do not care about our prisoners, but it is absolutely in everybody’s interest to care about the health and wellbeing of our prison population.

 

I am afraid that our report highlights a system in which, time and again, reports from Her Majesty’s inspectorate of prisons are not acted on. We need those reports to have real teeth, and for people to be able to take action, or to be held accountable for not taking action. We heard time and again of governors not having the levers—even if they had the financial powers—to take the necessary action.

 

We call on the Government to regard the health of our prison population as a serious public health crisis requiring a whole-systems approach that takes root in sentencing and release, making sure that people are only in prison if absolutely necessary, that those with serious mental health problems are transferred in a timely manner and that sees time in prison as an opportunity to act and to address serious health inequalities. That is not only in their interest but in all our interests.

Given the picture the hon. Lady just described, she will be aware of the serious problems in Exeter Prison, which the staff there are doing their utmost to try to address. Does she agree that, as we face voting on the Budget later this afternoon, it might have been better, rather than giving tax cuts to the richest 10%, for the Chancellor to spend that money on helping our prisons to deliver the kind of services that she would like to see?

I thank the right hon. Gentleman for his contribution towards the report. He identifies that this is an area that is often deprioritised in favour of other issues. However, we absolutely have to prioritise the health of our prison population. I agree that we should address staffing levels. We should also look at the health and wellbeing of our prison staff. Too many leave because of the pressures and the violence that they face in prison.

Although a disproportionate number of prisoners are young males, as the hon. Lady will know, the prison population is ageing, with more much older prisoners serving custodial sentences than previously. What observations did her Committee make of healthcare provision for that ageing prisoner population, and what does she think the Government need to do to make sure that those people are properly cared for?

I thank the hon. Lady for drawing attention to that. Our report mentions that the prison population is ageing, particularly as a result of older sex offenders coming into our jails. It is about dealing not only with healthcare in our prisons but with social care. We call on the Government to look specifically at how we commission for that age group and their special needs. She will also know that the average age of death in prison is 56. We really have to look at the excess mortality, which is 50% higher for people in prison than for the background population.

It is a pleasure to see you in the Chair, Sir Henry. I very much welcome my hon. Friend’s statement and the report, which I thank her for involving Select Committee on Justice. The evidence that she received entirely mirrors that which the Justice Committee is receiving for our inquiry into the make-up of the prison population in 2022. Does she agree that it is absolutely essential that we turn around the inadequate provision of health services across our prison estate, not only because it is morally right but because it is impossible to effectively rehabilitate people when there is endemic ill health in many parts of the prison population? That means that people are discharged back into the community often in poor health and leads to cycle of reoffending that costs the community more, as well as destroying and blighting lives.

I absolutely agree with what my hon. Friend has said and I welcome the ongoing interest that the Justice Committee is taking in this issue. He will know that one very depressing aspect of this situation is that report after report is published highlighting the issue, but we are just not seeing the progress needed. There needs to be real accountability and consequences for progress not being made on all these issues.

We all know that the suicide rate in prisons has increased markedly, but also, because of ageing prisoners and addiction problems, more people are dying. Was the Health and Social Care Committee able to assess whether the standards of healthcare mean that people go into prison and simply do not come out?

I thank the hon. Gentleman for his question. The point is that if someone goes into prison with a serious underlying medical problem, it is simply unacceptable that they cannot access the healthcare that they should be receiving. That is what we heard time and again: people’s appointments are cancelled, issues are not addressed and thing are not followed up. Sometimes an outside appointment with a specialist, for very serious conditions at times, will simply be cancelled, and then there is no continuity and follow-up, so the person simply falls out of the system. Undoubtedly, therefore, people’s health is suffering and, as I said at the beginning, no one is sentenced to worse healthcare when they are sentenced to deprivation of their liberty. The situation is unacceptable.

I thank the hon. Lady not just for her presentation today, but for so ably chairing the inquiry. Her presentation put across very eloquently the fact that we put in prison a population of people who are very unhealthy already, but unfortunately our prison environment makes them even less healthy instead of taking the opportunity to reduce health inequalities and improve their health. It makes them even less healthy for two reasons. One is the prison environment that they are in, which is very unhealthy. The second is prison health services. Despite some excellent prison health services that really work, we found that on the whole prison health services are not adequate. The hon. Lady has already talked about the need for accountability and consequences. Can she say something about the role that we recommend the Care Quality Commission might play in that?

I thank the hon. Gentleman for his own really important role in the course of our inquiry. He highlights the point about the CQC. The CQC has no powers of entry into our prisons. We now know that it can carry out unannounced inspections just about anywhere else, but it cannot in prisons. The other challenge that it faces is being able to take a whole-system approach to the way services are commissioned. We heard from it again, in relation to a separate inquiry, earlier this week that it would like to have the powers independently to look at a whole-system approach, rather than just very narrowly looking at one aspect of it. It was very clear to us that a whole-system public health approach needs to be taken to the commissioning and provision of healthcare.

 

The hon. Gentleman’s other point was about the conditions in our jails. Keeping people in conditions where there are broken windows, cockroach infestations and so on is wholly unacceptable. No one should be living in those conditions in Britain today.

The Select Committee on Welsh Affairs is undertaking an ongoing inquiry into the prison estate in Wales, and one issue that has been raised is the fact that health is of course devolved, but there appears to be relatively little consideration of how health is managed differently there from how it is managed in English prisons—of the difference between Wales and England. There is a particular anomaly with the only private prison in Wales, the question of answerability to the health ombudsman, and to whom actually that prison is answerable. Has the hon. Lady made any assessment of accountability between the Welsh and English regimes and to what degree we should perhaps be measuring the difference between health provision in prisons in Wales and that in England?

I thank the hon. Lady for making that point. We did not look at devolved issues, because the remit of the Health and Social Care Committee is England only, but the hon. Lady makes a very important point. As the Justice Committee has an ongoing interest in this issue, there might be an opportunity for that Committee to take the matter up more quickly than we would be able to, but I would be very interested if the hon. Lady wanted to write to me about it.

 

I again thank all those who contributed to the inquiry, and I look forward to hearing the ongoing thoughts of the Justice Committee.

Would the Minister like to say anything?

Thank you, Sir Henry. I really welcome the report. My hon. Friend the Member for Totnes (Dr Wollaston) alluded to the fact that this issue lies within the bailiwicks of both the Department of Health and Social Care and the Ministry of Justice; I am glad that the Under-Secretary of State for Justice, my hon. Friend the Member for Charnwood (Edward Argar), is here beside me. We are seized of the importance of this issue and recognise that silo culture is often the enemy of good policy making. Rest assured that we will take away the report and reflect on it. We are very grateful for the interest that the Health and Social Care Committee has shown in this very important subject, because we do need to do a whole lot better.

I am very grateful to the Minister for those words.