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Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Health, Social Care and Sport Committee

27/03/2019

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Dai Lloyd AM Cadeirydd y Pwyllgor
Committee Chair
David Rees AM
Dawn Bowden AM
Helen Mary Jones AM
Janet Finch-Saunders AM Yn dirprwyo ar ran Angela Burns
Substitute for Angela Burns
Lynne Neagle AM
Neil Hamilton AM

Y rhai eraill a oedd yn bresennol

Others in Attendance

Dr Robert Jones Canolfan Llywodraethiant Cymru
Wales Governance Centre

Swyddogion Cynulliad Cenedlaethol Cymru a oedd yn bresennol

National Assembly for Wales Officials in Attendance

Claire Morris Clerc
Clerk
Sarah Hatherley Ymchwilydd
Researcher
Tanwen Summers Ail Glerc
Second Clerk

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Dechreuodd y cyfarfod am 09:30.

The meeting began at 09:30.

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introductions, apologies, substitutions and declarations of interest

Croeso i chi i gyd i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Senedd. O dan eitem 1, cyflwyniadau, ymddiheuriadau, dirprwyon a datgan buddiannau, allaf i estyn croeso i'm cyd-Aelodau o'r Cynulliad? Dŷn ni wedi derbyn ymddiheuriadau oddi wrth Jayne Bryant a hefyd dŷn ni wedi derbyn yr ymddiheuriadau arferol gan Angela Burns. Ac mae Janet Finch-Saunders yma heddiw yn dirprwyo ar ei rhan. Croeso, Janet. Allaf i bellach egluro, yn naturiol, fod y cyfarfod yma'n ddwyieithog? Gellir defnyddio'r clustffonau i glywed cyfieithu ar y pryd o'r Gymraeg i'r Saesneg ar sianel 1, neu i glywed cyfraniadau yn yr iaith wreiddiol yn well ar sianel 2. Hefyd, mi wnaf i'ch hysbysu chi dŷn ni ddim yn disgwyl larwm tân i ganu, felly, os bydd yna larwm tân yn canu, dylid dilyn cyfarwyddiadau'r tywyswyr.

Welcome to you all to the latest meeting of the Health, Social Care and Sport Committee here at the Senedd. Under item 1, introductions, apologies, substitutions and declaration of interests, may I welcome my fellow Members? We've received apologies from Jayne Bryant and also we've received the usual apologies from Angela Burns. And Janet Finch-Saunders is here today substituting. Welcome, Janet. May I explain that this meeting is bilingual? Headsets are available to hear simultaneous translation from Welsh into English on channel 1, or to hear contributions in the original language amplified on channel 2. And also, I just want to remind you that we don't expect a fire alarm this morning, so, should an alarm sound this morning, you should follow the instructions of the ushers.

2. Darparu gofal iechyd a gofal cymdeithasol ar yr ystâd carchardai i oedolion: Sesiwn dystiolaeth gyda Dr Rob Jones
2. Provision of health and social care in the adult prison estate: Evidence session with Dr Robert Jones

Felly, gyda chymaint â hynny o ragymadrodd, dŷn ni'n cyrraedd eitem 2, darparu gofal iechyd a gofal cymdeithasol ar yr ystâd carchardai i oedolion. Dyma sesiwn dystiolaeth gyda Dr Robert Jones. Mwy am Dr Jones yn y funud. Mi fydd Aelodau'n gwybod mai dyma'r sesiwn dystiolaeth gyntaf ar ymchwiliad y pwyllgor yma i ddarparu gofal iechyd a gofal cymdeithasol mewn carchardai i oedolion yng Nghymru, ac felly sesiwn gyflwyno ydy hon. Felly, mi fydd Dr Robert Jones, sy'n gydymaith ymchwil yng Nghanolfan Llywodraethiant Cymru ym Mhrifysgol Caerdydd—bore da i chi, Dr Jones—yn gwneud ei gyflwyniad, a bydd yna gyfle i ni fod yn cwestiynu ar y pryd. Robert, wyt ti'n hapus i dderbyn cwestiynau fel rwyt ti yn traethu?

So, with that much of an introduction, we'll go to item 2, which is provision of health and social care in the adult prison estate. This is an evidence session with Dr Robert Jones. More about him in a moment. Members will know that this is the first evidence session of this inquiry into the provision of health and social care in the adult prison services in Wales, and so, this is an introductory session. So, Dr Robert Jones, who is a research associate at the Wales Governance Centre at Cardiff University—welcome to you, Dr Jones—will give us a presentation, and there will be an opportunity for us to ask him questions. Robert, are you happy to take questions as you go along?

Yes, sure. Diolch.

A hefyd bydd yna gyfle, yn naturiol, ar y diwedd i ateb cwestiynau. Mae gyda ni ryw awr a hanner am hyn, ac felly, gyda chymaint â hynny o ragymadrodd, Dr Jones, mae'r llawr gyda chi. 

And then there'll also be an opportunity at the end to ask any questions. We have around an hour and a half for this, and therefore, with those few words, Dr Jones, the floor is over to you.

Diolch yn fawr. Okay, so, just to start, really, I want to put what I'm about to outline into some kind of context and where this has emerged from. Largely, the bullet points that you can see on the screen—. The points I'm going to raise and discuss here emerged out of this research.

So, beginning in 2013 and 2014, when the UK Government announced its decision to build a 2,100-place prison in north Wales—back then it was unnamed in 2013—we began to do a little bit of work around the existing prison estate in anticipation of what effect a new prison would have on devolved services. So, of course, health is part of that. We looked at education, we looked at housing, we also looked at ambulance services and police services as well. So, as part of that work, we looked at the costs and the funding arrangements for existing prisons in Wales, and I'll talk a little bit about that and you've already probably seen that in some of the evidence.

The second point was my PhD research, so that's the title of it there—'The Hybrid System: Imprisonment and Devolution in Wales'—which is looking at the intersection between the UK and the Welsh Government's responsibilities for justice in Wales. Of course, this is a classic example where you have prisons, which are clearly a reserved area, and prison healthcare, which is, of course, a devolved area.

In June last year, we published our 'Imprisonment in Wales: A Factfile'. The data that we're going to use from that today, but we've got the updated information, which is mainly on self-harm incidences and self-inflicted deaths. And as I say, we've got the latest data from that as well.

In August, we put out 'Imprisonment in Wales: A Breakdown by Local Authority', which provides, as is fairly self-explanatory, a breakdown of how many people are in prison by local authority in Wales. My own view is that that can be very helpful in terms of mapping the health needs of people in prison from across Wales. There's a geography to almost all of this, and I think, bearing in mind all of this has come through freedom of information—. So, we don't actually have this available at our disposal, but the aim of disseminating that is that we do. 

And then our report in January looked at the imprisonment rates in Wales, and I'm going to talk a little bit more about that and what I think it may mean for the committee's inquiry.

And then, finally—I've almost run out of time already—the justice and jurisdiction and project, which is a Wales Governance Centre project that is currently shadowing, if you like, the work of the Commission on Justice in Wales, chaired by Lord Thomas of Cwmgiedd. And we're producing a series of reports that are aimed at feeding into the commission's work, and we have recently just produced a draft—a fairly polished draft, but we're still calling it a draft at this stage—of a report on what we call the 'jagged edge'. So, I talked earlier about those intersecting responsibilities. And, as part of that work, I interviewed health professionals as well as housing and education and substance misuse and the like. So, there are some accounts there that have been used to shape this, and their accounts have helped—that first bullet point there—to raise problems.

So, in terms of the methodology of what I want to do here today, in the work of Nils Christie, who's a very, very famous Norwegian criminologist, he said that there are two things that criminologists—and, I suspect, social researchers—can do: they can problem raise and they can problem solve. They can do both, ideally, but what I intend to do today is to use the research to raise problems, to draw attention to what problems there are, based on the accounts of participants and service providers and practitioners in Wales, mainly because there's no work of this kind to draw upon. That's one of the real problems we have studying criminal justice in Wales: there is no existing theory or body of evidence to draw upon. We have to develop it first and then disseminate that. So, that's going to be my aim today.

So, I'm going to talk, first and foremost about the prison population in Wales. We've got the data from February, which is the latest data, so to give you a snapshot of what that now looks like. I'm going to talk a little bit about complexity. That's an issue that's been raised by participants and is central to this jagged edge theory that we're looking at. Funding, as I've already mentioned. We're currently using last year's data. Of course, when we get into April, a new batch of FOIs will go in—I'm sure they can't wait. A new batch of FOIs will go in and we'll get those up-to-date numbers. I'm going to talk about substance misuse as well, deaths and self-harm incidences. And I've done a little bit of work last night and in the last few days—in fact, since I submitted the evidence—in and around this. I've got a mass of paper here, which I'm happy to leave with you. I'm going to talk briefly about mental health and restricted patients, older prisoners, and then this sense of divergence between England and Wales as well.

So, the figure—although it doesn't say this on the slide, this is from February, so this is the latest data that we have, and this is the prison population in Wales. Now, when we put a report out in January, the headline was, and it was a correct headline, but the headline was that Wales has the highest imprisonment rate in western Europe, and that's correct. But what that headline largely missed is that that statement is supported in two ways: one, based on home address—so, we disaggregated England and Wales on home address, and Wales has a higher rate—but also based on the number of people who are held in prisons in Wales. Now, that, of course, is hugely significant for healthcare, because we're talking about the number of people who receive healthcare within the jurisdiction or within the boundaries of Wales. So, the figure you can see at the bottom there, the rate—. This is, of course, from February. The rate for Wales is 145 per 100,000. The rate in England is 140 per 100,000.

Now, the key point for me to make here is with Berwyn. Berwyn, as you can see, is yet to reach its full expected operational capacity, which is around about 2,100 places. I mean, even if it reaches 2,000 places, with the same rate of imprisonment or numbers in prisons in south Wales, you will be looking at a rate of around about—okay, there will be population changes as well—but around about 165 to 170—in that bracket. So, we're expected to see that rate rise as Berwyn comes on stream.

09:35

Can I just get some clarification on that, if you don't mind?

Of course, sure.

Are we talking about prisoners with a Welsh address, because presumably we've got English prisoners here as well, and there are Welsh prisoners in England, so we're just talking about people incarcerated in Welsh prisons, or Welsh citizens—what are we talking about?

So, the figures here are everybody who's held in a Welsh prison, whether they are English or Welsh. The report did both. So, it showed that, based on home address, Wales had the highest imprisonment rate. But now, when you look at the—. Which, of course, is significant for health, because you may have Welsh prisoners held in Altcourse, but of course Betsi Cadwaladr University Local Health Board are not responsible for those. So, that's the distinction.

Okay. So, I mentioned this issue of complexity and confusion, and that is a real theme that's come through our work, and when that's published there will be opportunities to think about that in a range of different areas. But it was also a theme that came through from health practitioners and providers as well, that this is a particularly unclear set of arrangements. Now, it must be said, if we were sat in England I suspect that health professionals in England would say it's not particularly clear and it's complex and it's problematic, but of course, I haven't done that research in England, so I can't talk about those findings.

One of the things that was raised with me, and that's the second bullet point, is that there isn't currently a national structural framework for prison healthcare in Wales. Now, I've put 'current' in brackets, because it's my understanding that the Welsh Government are currently working on a framework or some kind of strategy—that was about five months ago I was told that, so I don't know where that's at, or how far or close it is to completion, or if indeed they're still working on that. In England, that does exist. So, that was a distinction that was made by participants, particularly participants who had worked in England and come into Wales. That was something that was identified as a potential issue, that there is no national—I make a point about this when I talk about substance misuse—there is no national oversight. What are the priorities and objectives here? It's a very, very health board-level focus. There are almost four different approaches here, and again, that's something I'll talk about as I go through. So, as a consequence, there's this real need for almost a mapping exercise, that anybody who approaches this, whether it's to study or to scrutinise it, there's no document to go to to understand how prisoner healthcare operates or works. As is almost typical of Welsh devolution, things happened, and then there's this kind of post hoc rationalisation of what it means and what it looks like after the event. We're talking a number of years down the line since this responsibility was transferred.

So, in and amongst all of that are the commissioning arrangements. Now, this gives me a huge headache, when we talk about commissioning. Indeed, it gave practitioners a headache, which was comforting, because looking at this, and the distinct and different arrangements, it's quite confusing. Amongst this sea of paper there are some accounts from participants about those arrangements, and about how it's different in Wales, and the general perception was that there are better arrangements in England for commissioning. There is a commissioning structure. Now, I think, significantly, one of the points that they raised, and I'm not going to read these verbatim, but it's something perhaps I can hand over to the committee after—is that there's a sense here that, without that commissioning structure, it's a little concerning, that level of scrutiny; it's almost a point of you marking your own homework. That was an issue that was raised with me. Now, the aim of the research was not to forensically look at healthcare. So, it was one of those where you look at it, you take account of it and you then have to kind of move on. But that strikes me as something that is worthy of further consideration.

In and amongst that is the role of many different sectors and different organisations. That is very, very clear across Wales. There are so many different organisations involved in this, including the private sector. Again, that is something that participants highlighted on a number of occasions. Of course, Parc is the anomaly in all of this, because we're talking about public sector prisons, and Parc is of course a private prison and has its own arrangements. I think it's G4S medical service that provide those arrangements at Parc. Now, when we have the data on funding, Parc is again excluded from that, so what role does that play? What are the differences, if any? Are there things that public sector prisons can learn about in terms of best practice at Parc, or is it the other way round—are there things that Parc can learn from other prisons?

09:40

Can I just get some clarification? When you say Parc is excluded, why is it excluded?

So, the funding comes directly from the UK Government to the prison to provide healthcare, whereas with the public sector prisons, it comes from the UK Government to the Welsh Government, who then give that to the health boards. 

Okay. So it's expected that funding to Parc should include an element of healthcare within it, and we should be able to identify that element.

Yes, you should be. But, I think in terms of where you would get that, it would be from HM Prison and Probation Service, as opposed to where we would go with the health board. 

Another point—also with the role of G4S, G4S, of course, play a role in Dyfodol, which are substance misuse services in the community. And this comes back to this mapping exercise. Who's responsible for what? Who's doing what? Who's accountable for this? It's very, very confused and blurred, and I think that, if the committee's report were able to map that out more clearly, that would be a really helpful outcome. 

The second-to-last bullet point is that there are differences between criminal justice settings as well, just in case this wasn't complex enough. Again, in the report we're doing, there'll be a piece of paper somewhere that has this information. I know that you're looking at police and mental health, or police custody, court custody, and then prison custody, and you've got this passage as people pass through these different systems, and if the aim is a whole-system approach, or continuity of care, are people having repeat assessments, are there different standards—there's a huge amount going on here, and when you then factor in that people are shipped from prisons in Wales to prisons in England, I'm getting a headache just thinking about that. English prisons—I'm going to make a point about this with the funding, but it was recommended to me by a practitioner to compare prisons in Wales and the funding with prisons in England, so, that commissioning structure and how it differs, and I'll talk a bit about that, and there are some FOIs on the costs of healthcare in England here to just essentially give us a bit of a picture of what that looks like.

So, as I've outlined in the written evidence, as we have outlined before, prison healthcare in Wales is underfunded by the UK Government. So, the figure in 2017—these are the figures for 2017-18 that we got. So, £2.544 million is provided by the UK Government, and the Welsh Government actually tops that up. So, I think, in 2014—I don't know if the top-up is on that slide, but it was about £900,000. So, the total is about £3.4 million, but you can see, of course, that the total cost is a fair bit more—

09:45

Could I—? When you say 'underfunded', is that as against need or is that as against how they fund healthcare in the prison system in England?

It's against the cost. So, if the UK Government are providing £2.544 million, but it's £3.879 million, it's on that basis.

Yes. I'll come on to the subject of need and what that need is in a moment when we talk about Berwyn. So, that's the basis of the underfunding. And that fee—I've got it on an FOI somewhere—was agreed in 2003. So, that means a huge amount—well, it's 2003, so the population, of course, has increased and the different needs—so there are all kinds of—inflation. There are all kinds of things there. I think what's concerning is that we raised this in 2014 and the figures have stayed the same.

Is it based on per-head-of-prison population, the cost—is that how it's calculated?

I think, again, it'll be here somewhere. It was based on previous spend, I think. So, the figure that they came to in 2003 was based on what it had cost, presumably, up to 2003. Now, how accurate that was, I don't know, but what we can now definitively say is that, according to the health board's own data, it costs more. Just another point in terms of the confusion, to get this information, we originally went to Welsh Government, who said, 'Well, we don't have the information. Go to the health boards.' So then the process of actually trying to gather this information—you have to go to each health board. And also—I will definitely make a point about this: do they count in the same way? Is there consistency between health boards? I mean, is it double in Cardiff or are they just counting it in a different way? From my point of view, you're obviously glad of the data, but you're not entirely sure how authoritative that is.

You haven't asked them for the methodology behind the calculation.

No, I haven't, no. What I would say, though—in the requests, you can see that the working out is different. So, the Aneurin Bevan health board literally just give a very blank page with a figure, whereas Cardiff provide you with costs. So, there is some difference there that you could maybe make sense of. This is the point, I think, that addresses that. So, the devolved settlement in relation to healthcare was agreed with the UK Government in 2003. Inflation and some additional increases resulted in the need for us, the Welsh Government, to provide additional healthcare resources for the prison estate. But, of course, that still—I think it took it to £3.4 million, and you can see the cost there.

Now, one more point I want to make about Berwyn—and, again, I've got this information with me to provide you. So, the figure for Berwyn during this year—so Berwyn at the moment, because it was brand new, doesn't come through the health board; it doesn't go to Welsh Government who then give it to the health board. It's similar to Parc, where they go straight to the health board. Berwyn was given £10.5 million. Now, we know the population is 1,200. So, it's a huge amount of money. They get £2.544 million for three public sector prisons in south Wales but Berwyn gets £10.5 million. Now, before we rush into, 'Well, that's incredibly high and it should be brought down', what has been put to me is that the figure for Berwyn is correct; that's what it should be. It's that the figure given for prisons in south Wales is incorrect. They need to be brought up as opposed to Berwyn needing to be brought down.

Now, this was where I was then put on to looking at the healthcare costs in England. I think it's—no, it's not there; it's going to be undiscoverable now, isn't it? I've got the costs of—I think it was three prisons in England. I think it was a prison in Leceister, a prison in Liverpool—here we go. To give you an example, HMP Liverpool is an about 1,100-capacity prison, I think it's a category B local, so it's very similar to Cardiff in what job it does. In the same year as this, if you look at Cardiff, the cost of healthcare at Liverpool was £4.6 million compared to £2.1 million. Now, what I was told is that though this is what's put forward as the costs, the costs will be very different. That's what I was told—that the costs are actually downplayed here because the commissioning structure is different. In England, they're told, 'If you want us to provide this, this, this and this, it's going to cost you this.' Whereas, in Wales, it's different; the money is just given to the health board and they provide the service. Whereas, in England, the commissioning structure means that they work out what they're going to provide and it's costed. 

Now, I don't sit here as an authority on this. This is simply what we've been told and there's some data to perhaps back this up, but it's something that might be worth looking at. The argument is that Berwyn is right. The £10 million was based on what Berwyn was going to provide, I think, if it was operating at full capacity, not at 1,200. So, this underfunding is not just based on the existing figure, but actually, there may be a hidden underfunding within that underfunding. Again, just in case your task wasn't big enough.

09:50

Well, those figures make no sense at all, do they, because it's £10,000 per head for Berwyn, £3,500, roughly, for the rest of prisoners in Wales, and about £5,000 to £6,000 for prisoners in Liverpool. So, there's something way adrift somewhere in the system there, in costing.

There is an inconsistency, absolutely. And again, I think that comes down to the lack of a national framework in Wales and what's happening. The point I would make about Berwyn, though, is that the idea of Berwyn was sold as something that would bring the costs down, but that argument only works if it's at full capacity. The economies of scale only take place when it's at full capacity and it's currently only at 1,200. You know, if you run a double-decker bus and only fill the bottom floor, it's not cost efficient. So, I think there's more to be worked out there. Okay, let me check my notes in case there's something glaring I've missed out. No. And, the data for England is there as a comparison.

Okay, so the fact-finding in June was followed by some supplementary evidence to the Welsh Affairs Committee on substance misuse in Welsh prisons. Of course, we see stories regularly in the news about drug finds in prisons, and there was one this week I'm sure you saw, about rats being used to bring drugs into prison. You'll see the debates about the need for body scanners, and I suspect that if you're going into prisons, this is something that you will hear first-hand from staff.

The data on drug finds is publicly available. We can get this by institution. The data showed—. The newest figures will be available in July, but the last figures we have showed that there was a 475 per cent increase in the number of drugs found in Welsh prisons. Now, of course, that could tell us that more people are bringing drugs in or that they're getting better at finding them, but that, of course, is something I suppose for the committee to look at. The highest rate in Wales was at Swansea. You can see that relative to 100 prisoners, followed by Parc, Cardiff and Berwyn, but bear in mind that Berwyn was coming on stream at this time, so we don't really have a fair picture.

In 2017, there were 227 alcohol finds. This is from our FOI; this information isn't publicly available. And Parc really jumped out here. So, despite holding just about half the population in Wales, 84 per cent of all finds were at Parc. Interestingly, whenever you compare prisons in Wales with England, there is a complaint from, maybe, HMPPS and the prison authorities that you can't compare England with Wales—you're comparing apples with pears, it's a different estate, et cetera, et cetera. Well, when you look at all of the G4S prisons, there were more alcohol finds at Parc than all of the G4S prisons put together in 2017. So, why? We don't know, we simply—. You know, getting this information is difficult enough, but trying to explain it as well, of course, is a separate project. But, of course, this has implications for health. That goes without saying.

Can I ask, when you say 'find', is that actually within the prison, or being taken into the prison?

I don't know, actually, that's a good question. I don't know. That might be something I can look at, and what they say. I would have thought it would be in the prison, but without knowing that definitively, I can't say. But I would have suspected it would be in cells and in other parts of the prison.

I want to make a point about this, which ties in with what I've just said about the inconsistency. This is quite remarkable, actually. So, in the process of trying to find further information about this, I wanted to discover how many people arrived at prisons in Wales who were alcohol or drug dependant. Of course, that has huge implications for healthcare services. Again, we had to approach each health board to ask this information, and we have a varied picture on this.

So, we approached Cardiff and Vale University Local Health Board about Cardiff. They said the information isn't available; we have to ask the prison services. But we'd been told by the prison services to ask the health board. So, Cardiff and Vale can't provide us this information. Swansea tell us that over the last three years, thousands of people have arrived at the prison who were alcohol dependant. I'm sure people are moving my pieces of paper. [Laughter.] I think the precise figures are included in the written evidence. For example, in 2017, 2,600 prisoners arrived at Swansea who were classed as alcohol dependant. 

09:55

Could I just ask: is that just alcohol dependant, or perhaps alcohol and drug as well, because the two usually go hand in hand? 

The drug dependant was 1,053, so how many of those people had both is not reflected in the data, but I suspect you're right that there's a combination of both. Interestingly, and I'm scratching my head with this, if you look at prison receptions, it's only Swansea, Cardiff and Parc who take receptions from court—what you would class as a 'reception'. Usk and Berwyn don't; they just take receptions from other prisons. Swansea didn't have 2,600 prisoners received in 2017, so what they must be counting there are those who've come from other prisons. And I was thinking—

Yes, exactly. It took me a while to work that one out, actually—I wondered what the hell was going on. So, Cardiff don't have it, Swansea do have it and tell us there are thousands who are coming in. HMP Berwyn and also Betsi Cadwaladr University Local Health Board, as I say, is a prison that doesn't take prisoners from court, so they don't have any receptions. But they still tell us that as part of their processes, there are 156 prisoners who were offered intervention when they arrived. Aneurin Bevan Local Health Board and HMP Usk/Prescoed have the same situation—they don't take prisoners from court, and as a consequence of that, they tell us this: that no prisoners were identified as alcohol dependant during the reception process, because these prisons don't receive prisoners from court.

'The prisoners received by Usk and Prescoed are transferred from other prisons, usually from a higher category, and will have been assessed for alcohol dependency and treated as required.'

So, you've got Berwyn saying, 'We don't take anybody from court, but there are still people who are alcohol dependant', and you've got Aneurin Bevan health board saying, 'We don't take anyone from court, they've come from other prisons, therefore there are no problems anymore because they've come from these prisons.' 

Might that be, though, that if they're coming from a higher category, they're a lower risk category of prisoner, aren't they, in Prescoed? I don't believe it—it sounds ridiculous—but it may be that if somebody is still presenting with alcohol problems, you wouldn't get sent to a lower category prison. Might that be— 

It would be certainly worth looking at that. 

My hunch would be that it's just an oversight; that would be my hunch. The idea that people's drug and alcohol issues have been kicked as they've been held in prisons—and we know, we've seen the alcohol and drug finds, that alcohol is available in prison and drugs are available in prison—I mean, I think is, you know—

It doesn't sound credible; I was just trying to be kind. 

Yes, I think it's something worth looking at. Here's just another example. Anybody trying to look at the picture in Wales, at what is the national picture of healthcare, you have four completely different responses from the health boards; there's no—. You can't compare, you can't contrast, you can't share best practice, because they're not collected in the same way. Also, obviously, incredibly frustrating for this. It's a classic example of the inconsistency. 

Okay, another issue. I looked at this last night; it would've been helpful if I'd added the totals, so I can resend the slides through with the totals, if that helps. Another point that is worth thinking about and looking at here are deaths in custody. One of the points, I think, that is really worth making here, and I'm going to talk about self-inflicted deaths in a moment, is this issue of natural deaths—assumed natural deaths in custody. The evidence of inquests in the House of Commons Health and Social Care Committee report, I think, raised some really important points about natural deaths. They were 'natural' in inverted commas, because the argument is that rather than these being necessarily natural, to what extent have people died prematurely because of the failings of the healthcare system in that institution? We know the average life expectancy of a prisoner is 56, so to what extent have the state of healthcare arrangements in prison actually contributed to somebody's premature death? So, they use the phrase 'natural death' in inverted commas, but it's not natural; actually, there's something at play here that may have contributed to that.

10:00

So, what it means is that it's neither self-inflicted or a suicide nor death by violence, but that doesn't mean to say that it's a death that would have occurred if that person was in the community.

Exactly—that somehow it's an underlying medical condition or health condition. And it's my hope that they submit evidence, but their evidence to the House of Commons committee was: they used case studies to really illustrate their point there and what they're talking about and how people's health needs were not met.

Just an important point on this: I looked through the data last night, so I'm sorry for kind of shoe-horning this in, but if you look at the data on natural deaths—and we'll come back to this, I think, with older prisoners—at HMP Usk, between 2013 and 2018, there were 11 natural deaths. Between 1978 and 2012—a 34-year period—there were 11 natural deaths. So, there have been as many natural deaths in the last six years at Usk/Prescoed as there have been for the 34 years previous. Now, that might be because of the way it's been recorded. The population at Usk and Prescoed has gone up as well—it's occasionally one of the top-10 overcrowded prisons in England and Wales—but I think the natural deaths is something that often gets overlooked, but it's something that should be reflected here and I think those figures are quite interesting, or worrying, to say the least.

Another point, again, in case you haven't got enough to think about, would be deaths in the community—those who are under community supervision. I appreciate that this is about prison healthcare, but, of course, those who are under the arrangements on release—and I very briefly looked through the figures available last night—and if you look at community rehabilitation companies, the CRCs, there were 179 deaths in Wales from 2014-15 to 2017-18. Now, we need to do work on this to work out the rates and what this goes into, but to give you an example, in London, there were 139. There were 179 in Wales and 139 in London. It goes without saying that I used London because the population is greater. How many of those people were in custody and were under supervision in the community post release? Some of them will have been sentenced to court orders, so won't have been in custody, but, again, that's just another area—just to add that to your list of things to look at.

On self-inflicted deaths in custody, again, 2016 was a record year. I think we can also use the inverted commas here with 'self-inflicted'. This is something that critical academics would point towards again. The words 'self-inflicted' in a sense exonerates the failings of the system here—the idea that it's simply 'self-inflicted' and that institutional failings have somehow played no role in this individual—

This term 'self-inflicted'—is that something you are using or is that an official term that they use?

The Ministry of Justice.

You'd have to ask them.

It may be that it also includes things like accidental drug and alcohol overdoses. So, it may be, I don't know, but we should probably—

Is there any way of knowing? Do they not count the suicide deaths separately?

In terms of the terminology, I think there's an aim to move away from the word 'suicide' towards 'self-inflicted death'. I think it would be worth asking them about that. I can't really tell you.

In your report, which we received, I think there's an error, because in your report, it says it was actually 58.6 per cent higher in 2018 than in 2010. I would have thought that it was 58.6 per cent lower because in 2018, it is two and 2010, it is four. I can't see how it's higher—.

Okay, I'll have a look at that. It could have been 2017 I was referring to, perhaps. I'm not sure. I'll have a look—

10:05

—and make the necessary correction. But, again, this issue of 'self-inflicted' is this idea that it's all about the individual. Well, again, what failings has prisoner healthcare contributed there?

There's a real value judgment there, isn't there, using the term 'self-inflicted'? Even for people who—. Take suicides out, then there's a real value judgment there, I think, personally, anyway.

I agree. It somehow puts the responsibility onto the individual and off the system, doesn't it?

Well, in that case, we should be able to find the answer to that, because if it's accidental death or suicide, that'll be recorded.

And when you look at these figures, another point to consider is that, say for example the 2018 figures, there will be cases that are still yet to be determined—the cause of death. You often go back to data sets and they've changed, because they've been updated because verdicts have come back. So, things can move because of that reason. So, again, that's something worth thinking about.

It begs the question why the Ministry of Justice is using a term that is different from the terms that were used in inquests.

I think the point is, drug overdose is probably included in that answer, and some drug overdoses could be an attempt to kill themselves; some could be accidental. So, it's not even clear, in that sense.

But the system is still responsible either way, isn't it?

I'm sure there will be an explanation, actually, somewhere in the notes of the data, of what this means that will clear that up. I don't have it.

Again, in our report last year, we reflected on self-harm figures. We don't currently have the full data for 2018. That will be available on 26 April. But what we do know is that the number of self-harm incidents recorded at Cardiff, Swansea, Usk and Prescoed were higher as of September 2018 than they had been for the whole of 2017. So, you see the blue line there is where we've got the 2018 figures in, but of course we haven't got the full—. That's just up to September. So, it's gone up in three of those prisons already, before we've even had the final quarter, and of course we await the figures for Parc. I think Parc looks as though it's projected to be the same—just below or just a bit above.

Mental health: I mean, it seems incredible to just have one slide on this, really. This could be the subject of its own presentation.

So, you said you haven't got the figures for Parc. Are those figures including the youth offending unit in Parc, or simply adults?

Yes. They don't disaggregate. To get those figures, you have to go through FOI to find out those figures, and I sent those requests probably more than a month ago now. They've now changed from Youth Justice Board to Youth Custody Service, so the FOIs, I think, have been lost in that process. But, yes, we did have those—. It was my understanding that you weren't looking at the youth estate, but we have got those figures from 2017 if you'd like me to send them through.

So, again, as I say, this is something that, of course, could warrant—should warrant—more than just a slide, but of course this issue about prisons as the default setting now for people with mental health issues. The literature on jurisdictions across the western world, particularly the United States, reflects this, that the absence of community support means that, very often, the only option for people is to put people in the secure estate, the prison estate, and Anne Owers made that point in the introduction to a report in 2007. The information you see there is what we've gathered through FOI. I haven't currently done that request for 2018, but I can. You can see the transfer of people from different settings. Frankly, we don't have any context to this. There are no previous years and none post, but it was just a case of: is this information available? Can we get hold of it? And can we include it? 

So, older prisoners is an area of increasing concern. Of course, our sentencing factfile looked at the sentences being handed out; they're the fastest growing demographic group of people in prison, and that was reflected in the House of Commons Health and Social Care Committee's report as well. The average life expectancy is 56 years; it was the British Medical Association that found that. We got the latest data on Welsh prisoners and prisoners in Wales yesterday. Again, I couldn't include it in these, which were sent over on Friday. You can obviously see that 17 per cent of Welsh prisoners were aged 50 or above at the end of September. One in five of all prisoners—not just Welsh prisoners, actually all prisoners—held at Usk were aged 60 or above, 44 per cent were over the age of 50.

To return to the deaths in custody, 86.4 per cent of all natural deaths in 2018 were prisoners aged 50 or above; 64 per cent were 60 or above, of the natural deaths. So, again, you can see the relationship there between older prisoners and health needs and some of the points I've already raised. One in five of self-inflicted deaths were 50 and above. So, again, there are distinct needs here to think about how they're being met, or not met in some cases, and that's just a breakdown of where prisoners who are 60 and over are being held. That's just Welsh prisoners; we've got the data for prisoners in general.

10:10

Robert, is every death in custody subject to an inquest or only those that are suspicious?

That's a good question. I'm not entirely sure.

Okay. Because, presumably, there will be—. So, there would be the natural deaths, the self-inflicted deaths, but there will be deaths that are neither natural nor self-inflicted—I don't know, fellow prisoner harm or whatever it might be. So, have we got information on that as well?

So, I read I think a couple of reports last year on, let's just say a prisoner, who had a condition in his lungs who had died of what you would call 'natural causes'. So, there are clearly inquiries—I think it's Healthcare Inspectorate Wales that carry that out on behalf of—. And then the other body—. And those reports are available. Again, I think Inquest—the charity Inquest—have raised concerns about the delays in those inquiries, how long they take, the inquests, because, of course, if it's about learning lessons, it's two years after the event: have those mistakes been repeated and reflected?

My hunch would be to say 'yes', but, because I don't know definitively, I'm tentative on that, but I heavily expect anybody that dies in institutional settings will require—

I think it's a matter for the coroner, actually. I think the coroner—there's a report to the coroner and the coroner decides. It's the same if people are on a section or deprivation of liberty safeguards in a hospital. 

Okay. Then the final point, really, is this issue of policy divergence. So, to come back to the point of—. We have a—. There's a distinct set of arrangements in Wales and a distinct set of arrangements in England, but there's obviously a crossover between prisoners in Wales and prisoners in England and Her Majesty’s Inspectorate of Prisons have identified concerns about the differences that exist in consistency in approaches there. A report by HMIP found that prisoners in Wales had—there were poorer outcomes for prisoners in Wales because of the integrated drug treatment system, or the lack of. A piece in The Economist—I think it was in July—found that the system in Wales was 'much harsher' and was putting lives at risk.

These are just a couple of accounts by people that I'd spoken to during my PhD research who worked with people who'd been in custody. So, prisons in England are doing this retoxing, which is what that policy refers to. It complicates matters for us in the community; it makes something that's already complex even more complex; different rules and regulations in England are putting people on different ethoses, different rules. Again, it adds to that.

'You are fighting structures and what people are forgetting in all of this is that the prison population are losing out because they don't know what they are coming out to.'

So, again, this issue about consistency. And it was my understanding that Swansea were going to trial something that would address those issues. How that's going, I don't know, but that's what I was told.

But the point at the bottom, I suspect, is something that will come out through the committee's inquiry. Are there other examples of this inconsistency? We've seen it before with housing, but, again, are there examples of inconsistencies where Wales is doing things better or Wales is not doing things better, and even inconsistencies between health boards? That's something that may appear.

So, look, just to sum this up: I've said about problem raising. I think there are plenty of problems that have been raised here. Lots of different research projects have uncovered this. I can't emphasise the importance of data. I think every single report we put out there there's always this statement that says, 'We struggle to get this data through FOI all of the time', and now we're having to go to each of the different health boards. I should say that when I talk about the alcohol dependency, with England, I sent one FOI to NHS England—I think it was NHS England—and I got the information for every single prison in England in one file, but, in Wales, I had to go to each health board and it comes back differently, as you've seen. So, that's—. I'm not saying that that's the holy grail or that there are no problems with that, but that's an example. And the mapping of these services as well: we really don't know enough—as criminologists, we don't know enough about the system in Wales, we don't know enough about the inconsistencies, examples of good practice, examples of poor practice. And, lastly, and this is key to our research, is the importance of service providers' views on this. You've asked me lots of questions that I can't answer, and that's because I don't have experience of doing this on a day-to-day basis. So, I would always defer to their expertise and experience and would say that, hopefully, many of the gaps that have come out of my presentation can be filled by them.

10:15

Can I just ask one question? And I don't know whether you can answer this. The healthcare system that is provided—because you talked about commissioning earlier on—so, who determines the level of healthcare? Is it determined by the prison system, HMP, or is it determined by the health board or by Welsh Government?

So, I suspect it's health board and Welsh Government. I would imagine there's a relationship there between all three, that they discuss what are the needs and what are the—. But the priorities are ultimately set in the Welsh context. Now, one of the points that was raised about the health board structure and about delivery and about priorities is that, of course, you've got different prisons, different populations, so different priorities, but where prison health sits in the health board, in the structure of the health board, will affect the approach taken. So, in terms of the priorities, it's my understanding that it's a bottom-up approach; the health board will set that approach. But one would imagine—I haven't got any evidence of this, because there is no national structure, but one would imagine that the Welsh Government also have a clear set of priorities for what they want to achieve. At the moment, like I said, there's no document. You couldn't get someone in from the health board here and say, 'Are you meeting this, this and this?' Because, to my knowledge, there isn't that document. They're working on it, is my understanding, but—. So, I think it's a Welsh set of priorities, because, of course, it's devolved.

Sorry. I think that is just the kind of crossover, isn't it, with a UK service as prison but health being devolved and what was the—you know, who is it that is setting the standard? Is it the prison service or is it the health service? That's what I wasn't quite clear on.

Just on that, as well, you've got things like food. Who controls prison food? Well, that's, of course, something for the UK Government, what food there is in that prison. Well, of course, food has a direct relationship to people's health and well-being. How many hours are they allowed to spend out of their cell? Well, the regime is set by the UK Government. But, of course, if you want people to be active and have time for recreation but you don't control those rules—. So, you can have a clear agenda on what you want the healthcare to be, but if you don't actually have responsibility for the regime—. But then, if you're in England, I suspect health providers would say the same there. It's not just about UK/Welsh Government, it's also prison and health, so there are those clashes, I think, that go all the way through it.

Thank you for that, Robert. Obviously, I've been involved—because I'm so old, I've been involved in so many reviews over the years that have come to the conclusion that, really, we should be devolving prisons and stuff to Wales because so much of the jagged edge would be taken care of. But in particular as regards drug and alcohol rehabilitation services, which are devolved, but they're heavily dependent on the sentencing length of the prisoner, aren't they? So, what sort of discussion, shall we say, goes on? Because, obviously, how well somebody is going to do as regards getting off the various opioid regimes, or whatever it is, depends on how long their sentence is. If it's a very short sentence—like Swansea tends to have people in only for a couple of weeks, sometimes—it's best not, actually, to embark on the thing at all, otherwise it further complicates the matter so that they've got half of their treatment regime as a sort of prison-based thing and half an expectation outside, which further complicates things. I don't know if you've got any extra information on that sort of stuff.

Yes. The use of short-term sentences is something that the UK Government are currently looking at, I think. Our fact file in January found—it's a staggering finding—that, over the last eight years, one in four of all women sentenced to custody were sentenced to a month or less.

And so I think that absolutely taps into the point you're making there. The other thing to think about, I think, is: if somebody is in court and has alcohol and drug dependency, the pre-sentence report used to, at least, play a key role in conveying this information to the judge or sentencer. But we've seen a significant reduction in the number of pre-sentence reports that are actually presented. So, again, that might be something—this is anecdotal, but it might be something that practitioners who you speak to can discuss in detail. How has that had a—? Has it had a qualitative effect on the information that's available to sentencers when arriving at a decision that, if this person has an alcohol issue but is currently working on that and is doing really well and is then sentenced to custody and may be sent over the bridge to England or may be sent to a prison far away—does that disrupt that?

10:20

The other point I wanted to raise was: how can we get a handle on Parc prison in Bridgend? Obviously, again, back in the day when I was a young psychiatric senior house officer, there were three psychiatric hospitals in Bridgend: Glanrhyd, Penyfai and Parc hospitals. Parc Hospital then went, and Parc prison is on the exact site, housing much the same population, really. About 70 per cent, I think, of Parc prison's inmates have mental health issues. That was roughly the percentage when it was a hospital. But it is a private hospital—G4S. We're in Wales; health, as your evidence suggests, is inadequately resourced by the Ministry of Justice. But, obviously, we have a problem here. Some years ago, Sarah and I went, professionally, to Parc, I hasten to admit, and bits of it are quite glossy—snooker tables and all that—but, in terms of actually how we manage issues, because I see big figures as regards alcohol and drugs and self-inflicted whatever we want to call it, but obviously it's not in the public estate either that we can get a handle on—. So, what sort of issues are there, would you say?

Well, I think there are quite significant issues about transparency and about accountability more generally. I think, from your perspective, asking for representation from whoever is head of offender health—. I think they've appeared at Assembly committees before and they always seem willing to do so. So, I think the first thing to do is probably to ask them for that.

In terms of the funding, I'll maybe have a little look through my e-mails about what I was told at the time about Parc, but I think that getting a handle on that—there may be work on prisons in England that may help. Parc has a peculiar role in this space in terms of accountability, and of course everyone has a view on the role that private prisons play or private companies play in this space, but my own point is that they should be subjected to the same level of accountability, if not more, than those public sector prisons. They're not at the moment, and I think our work over the last year has done that. It's not gone down well; I think that's fair to say. But we're simply presenting MOJ data and will continue to do so.

And my last question—because we have got a bit of time, team, if you're thinking about it—is in terms of Berwyn. Now, we're going to go there on 9 May as a committee, and we'll be coming back from there, obviously, also on 9 May, which is reassuring in its own way. I was just wondering, have we got—you know, the 1,200 prisoners—. Where previously there was no prison in north Wales, people had to go to Liverpool—and obviously issues with the Welsh language provision and stuff and obviously the whole devolved issue, but, in terms of suddenly now having 1,200 there, how many of those are from Wales and how many are from England?

Under 300 were from Wales, as of December. I can get that latest data to you, and we've got it by local authority as well, so you can—. That's the other thing that's actually been lost in the Berwyn—. Of that 300—I forget which report it was; one of the outputs somewhere—I think almost all local authorities in south Wales are represented at Berwyn. So, this isn't just about—. So, you've got prisoners from Bridgend being held in Wrexham and not in Parc. So, there are all kinds of issues. I mean, we've had bizarre situations over the years where there was an increase in the number of English prisoners held in south Wales and an increase in the number of prisoners from south Wales held in England. So, somewhere along the M4, they're passing. And now we see this with north Wales. So, again, I can send that information before you—

Yes. And just on the point of—. So, the health needs of the 900 non-Welsh residents, then, in Berwyn are paid for by—how?

Yes. Betsi—by the health board.

The health board—. It's irrespective of where they're from; they provide the healthcare for those prisoners.

But they get paid directly by the Ministry of Justice to do that.

Whereas, the other prisons, the money comes through the—

Block grant. Now, one of the issues that's been raised with me is: at what point do they bring Berwyn into the block grant? So, I think, at first, this was a case of just a new prison, because Berwyn went up very, very quickly—very, very quickly. So, it was a case of, I think there's a direct, to make sure the arrangement was there, but that's how it's been put to me—. The key is there: what happens? Does that £10 million figure come down, or what happens there? That's the key point. At what point—? They may already be looking to do that, but I think that's the key: at what point does it come back through the block grant and what effect does it have?

10:25

I would assume, therefore, that Betsi would be able to provide details of its spend on Berwyn, because if they're getting direct funding in, they'd have to report on that direct funding back, and that includes commissioning other services they would use in Berwyn, so it's an interesting question to ask.

What is the capacity there? I know it's not at full capacity, but do you know what it is?

So, the expected capacity: it's been built for 2,106 prisoners—

—but it's been lingering around this figure now for—. They were going up 20 a week, I think, at one point.

And the £10 million funding is based on the 2,106 capacity, is it?

I presume so; I presume so. I think it's fair to say that, two years on, they would have expected to have been fully operational by now. So, I think that it's on that basis. Again, all of this is here and I could leave that with you.

Right. Any other issues, team? No. Everybody's happy. 

Lots of questions and lots of research, and obviously we're at the very start of the process. So, can I thank you very much indeed, Dr Robert Jones? Bendigedig. You'll receive a transcript of the discussions as well, so if you could make sure that everything is factually like you would want them to be—.

Perfect. Thank you.

3. Papurau i’w nodi
3. Paper(s) to note

I'm cyd-Aelodau, awn ni ymlaen i eitem 3 nawr a phapurau i'w nodi. Mi fyddwch wedi darllen y llythyr gan Gadeirydd y Pwyllgor Materion Cyfansoddiadol a Deddfwriaethol ynghylch y cytundeb cysylltiadau rhyng-sefydliadol. Mi fyddwch hefyd wedi gweld y llythyr gan Ymddiriedolaeth Gofalwyr Cymru a'r Rhwydwaith Gwella a Dysgu Swyddogion Gofalwyr ynglŷn ag ymchwiliad y pwyllgor i effaith Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 o ran gofalwyr, ac hefyd y llythyr am y canllawiau a gyhoeddwyd gan Gomisiynydd Pobl Hŷn Cymru ar gartrefi gofal yng Nghymru. Pawb yn hapus i nodi? Grêt, diolch yn fawr.

To my fellow Members, we'll go on to item 3 now and papers to note. You will have read the letter from the Chair of the Constitutional and Legislative Affairs Committee regarding the inter-institutional relations agreement. You will also have seen the letter from Carers Trust Wales and the Carers Officers Learning and Improvement Network on the committee's inquiry into the impact of the Social Services and Well-being (Wales) Act 2014 in terms of carers, and also the letter on the guidance published by the Older People's Commissioner for Wales on care homes in Wales. Everyone happy to note? Great, thank you very much.

4. Cynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod hwn
4. Motion under Standing Order 17.42(vi) to resolve to exclude the public from the remainder of this meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(vi).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(vi).

Cynigiwyd y cynnig.

Motion moved.

Eitem 4, cynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod hwn. Pawb yn gytûn? Pawb yn gytûn. Diolch yn fawr.

Item 4 is a motion under Standing Order 17.42(vi) to resolve to exclude the public from the remainder of this meeting. All content? All agreed. Thank you very much.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:27

Motion agreed.

The public part of the meeting ended at 10:27

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