A matter of conviction

Tony Margetts looks at whether prison reform is heading in the right direction.

For all the wrong reasons prisons are in the news. Hardly a week goes by without a major incident, adding further pressure on governors, staff, prisoners and the still relatively new lord chancellor and secretary of state for justice, Liz Truss. While there is a great deal of consensus about the cumulative impact that budgets and staffing cuts have had since 2010, the increased presence of novel psychoactive substances – particularly synthetic cannabinoids such as ‘spice ’ – have also undoubtedly exacerbated a difficult situation.

As part of a group set up by the Royal Society of Arts (RSA) I was involved in suggesting some key reforms. A matter of conviction set out to develop a blueprint for a future community-based rehabilitative prison (DDN, November 2016, page 4). It argued that the potential impact that prisons could have on reducing reoffending and community safety has been undermined by a lack of consistent political leadership and clear purpose and that this has led to reactive policy, which has disempowered the workforce and undermined public confidence. We argued for a national rehabilitation strategy with health and wellbeing as a key component.

So what lessons can recent history on drug policy and practice have to offer in rising to this challenge and how does the Prison safety and reform white paper, published in November, seek to learn from these?

Some of our ideas have found their way into the white paper, including introducing a new duty on the secretary of state to ‘reform’, along with additional freedoms for governors and an enhanced inspection regime. But it fails to address wider links to the community or aftercare in detail and has not embraced our proposals for a phased process of devolution and the introduction of local prison boards. This approach leaves the central grip – of the National Offender Management Service – intact, while introducing greater accountability on governors, risking, we believe, a mismatch between local decision-making and central directives.

The additional investment in prison officers and some focus on workforce development is welcome and, alongside a greater emphasis on education and employment, should help to reduce demand; if people are bored, miserable and locked up for most of the time, drugs have a greater pull. Also welcome were some of the longer-term proposals including attempts to control the supply side of drug taking in prisons. The increased emphasis on local commissioning and decision-making will be accompanied by a target to reduce reoffend­ing, and more governor involvement in health services in custody.

Prisons are not healthy places and have always had a high proportion of drug and alcohol users among their population. The provision of treatment has had to balance three considerations – the health of prisoners, reducing reoffending and the good order and running of prisons – which can create conflicts in management.

Back in the real dark past, prisons had the Prison Health Service. This responsibility was then moved to the NHS, and health services were effectively commissioned between Primary Care Trusts with the prison service acting as co-commissioners, often through local partnership boards. The prison service also directly commissioned a drug service in prisons, known as Counselling, Assessment, Referral, Advice and Throughcare, or CARATs, from the turn of this century, provided by trained prison officers in some prisons and by voluntary organisations in others. From around 2006 additional funding was provided via the NHS to commission drug treatment in prison.

In 2013 drug and alcohol treatment became part of prison healthcare and was commissioned through NHS England, reducing the role both of local drug and alcohol commissioners and prison management. Since this happened, I have been concerned that the focus on the treatment of illicit opiates, particularly heroin, in healthcare contracts left prison drug treatment services slow to respond to new patterns of drug use in prisons and did not recognise the significance of alcohol use and dependency. Prison drug treatment has been slower in adapting to changes in drug use than community services, in particular the emergence of novel psychoactive substances in prisons since 2009, the use of image and performance enhancing drugs (IPEDs), particularly anabolic steroids – whose prevalence has greatly increased in both prisons and the community – and the misuse of prescription medicines.

So what can be done? The RSA report proposed prison and community boards as a way of breaking down barriers between prisons and communities, driving longer-term strategy and enabling a locally accountable approach. It argued for an increased role for local and regional government including city mayors and police and crime commissioners (PCCs), in commissioning probation and prison services. This approach would bring services closer to communities, encourage co-commissioning and the pooling of resources and address some of the concerns regarding disinvestment.

Despite Theresa May being a champion of PCCs while at the Home Office, the white paper does not go this far and it remains to be seen what the Ministry of Justice review of probation will suggest. The focus on rehabilitation by prisons, and by implication the rest of the criminal justice system, is very welcome. It is to be hoped that we can edge towards good quality, evidence-based drug and alcohol services in prisons, which are linked to the community and are part of a wider package of measures designed to reduce further reoffending.

Tony Margetts is the substance misuse manager responsible for commissioning drug and alcohol treatment for the East Riding of Yorkshire