Cynulliad Cenedlaethol Cymru

Yn ôl i Chwilio

Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Health, Social Care and Sport Committee

09/01/2020

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Angela Burns AC
Dai Lloyd AC Cadeirydd y Pwyllgor
Committee Chair
David Rees AC
Helen Mary Jones AC
Jayne Bryant AC
Lynne Neagle AC

Y rhai eraill a oedd yn bresennol

Others in Attendance

Amanda Corrigan Llywodraethwr Carchar EM Abertawe
Governor of HM Prison Swansea
Chris Jennings Cyfarwyddwr Gweithredol Cymru (Dros Dro), Gwasanaeth Carchardai a Phrawf Ei Mawrhydi
Executive Director Wales (Interim), Her Majesty’s Prison and Probation Service
Janet Wallsgrove Llywodraethwr Carchar EM Parc
Governor of HM Prison Parc

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Lowri Jones Dirprwy Glerc
Deputy Clerk
Sarah Beasley Clerc
Clerk
Sarah Hatherley Ymchwilydd
Researcher

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 09:29.

The meeting began at 09:29.

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

Bore da i chi gyd a chroeso i'r Senedd y bore yma ac i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon—cyfarfod cyntaf y flwyddyn newydd—wel, y ddegawd newydd, i fod yn deg. Felly, croeso i chi gyd. Gallaf i bellach egluro bod y cyfarfod yma yn naturiol ddwyieithog a gellid 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. Dŷn ni ddim yn disgwyl larwm tân y bore yma, felly os bydd y larwm tân yn canu, dylid dilyn cyfarwyddiadau'r tywyswyr. Hefyd, mae'r meicroffonau'n gweithio'n awtomatig, felly does dim angen cyffwrdd â dim byd, yn sylfaenol. Mae pob Aelod yma. Oes unrhyw un angen datgan buddiant o gwbl y bore yma? Nac oes. Diolch yn fawr.

Good morning, everyone, and welcome to the Senedd this morning and to this latest meeting of the Health, Social Care and Sport Committee. This is our first meeting of the new year, and, indeed, the new decade. So, I'd like to welcome you all. May I further explain that this meeting is naturally bilingual? The headphones can be used to hear interpretation from Welsh to English on channel 1, or for amplification on channel 2. We do not expect the fire alarm to sound this morning, so should it do so, please follow the instructions of the ushers. And the microphones work automatically, so there is no need to touch anything. Everyone is here. Does anyone have an interest to declare this morning? I see that no-one does. Thank you very much.

09:30
2. Darparu gofal iechyd a gofal cymdeithasol ar yr ystâd carchardai i oedolion: Sesiwn dystiolaeth gyda Gwasanaeth Carchardai a Phrawf Ei Mawrhydi
2. Provision of health and social care in the adult prison estate: Evidence session with Her Majesty's Prison and Probation Service

Gyda chymaint â hynny o ragymadrodd, felly, gwnawn ni symud ymlaen i eitem 2 ar yr agenda ar ddarparu gofal iechyd a gofal cymdeithasol ar yr ystâd carchardai i oedolion yng Nghymru. Dyma sesiwn dystiolaeth gyda Gwasanaeth Carchardai a Phrawf Ei Mawrhydi. Fel cefndir, wrth gwrs, bydd Aelodau yn cofio mai dyma'r seithfed sesiwn dystiolaeth ar ymchwiliad y pwyllgor yma i ddarparu iechyd a gofal cymdeithasol ar ystâd carchardai i oedolion yng Nghymru. Dŷn ni'n ddiolchgar iawn am y dystiolaeth ysgrifenedig, sydd wedi cael ei chyflwyno ymlaen llaw, felly diolch yn fawr iawn i chi. Dwi'n falch iawn i groesawu i'r bwrdd, felly, Chris Jennings, cyfarwyddwr gweithredol Cymru, Gwasanaeth Carchardai a Phrawf Ei Mawrhydi; Amanda Corrigan, llywodraethwr Carchar Ei Mawrhydi Abertawe; a Janet Wallsgrove, llywodraethwr Carchar Ei Mawrhydi Parc. Croeso i'r tri ohonoch chi.

Yn ôl ein harfer, awn ni'n syth i mewn i gwestiynau. Mae'r Aelodau'n ymwybodol o'r manylion, gan gynnwys y manylion dŷch chi wedi'u gosod gerbron eisoes. Felly, awn ni'n syth i mewn i gwestiynau; mae gyda ni ychydig yn llai nag awr. Helen Mary, i ddechrau.

With those few words, therefore, we'll move on to item 2 on the agenda: provision of health and social care in the adult prison estate in Wales. This is an evidence session with Her Majesty's Prison and Probation Service. Just for background, Members will be aware that this is the seventh evidence session on the committee's inquiry into the provision of health and social care in the adult prison estate in Wales. We're very grateful for the written evidence that we have received beforehand, so thank you, again, for that. I'm very pleased to welcome to the table Chris Jennings, executive director Wales, HM Prison and Probation Service; Amanda Corrigan, governor of HM Prison Swansea; and Janet Wallsgrove, governor of HM Prison Parc. Welcome to the three of you.

As is our custom, we'll dive straight into questions. Members are aware of the details, including those details that you have set out in your evidence. So, we'll move straight to questions; we have a little under an hour. Helen Mary will begin.

Diolch, Gadeirydd. Thank you, Dai. Good morning, everybody. The Welsh Government's stated intention is that prisoners should experience the same level of healthcare as the general population—that they should not be treated any differently in the prison estate than people who are outside. In your view, how effective are the prison healthcare services in meeting those physical and mental health needs and how close are we to getting to delivering the Welsh Government's stated intention that there should be equal treatment?

Thank you. And could I just also thank the committee for bearing with us, because I know we were due to give evidence previously, but through the pre-election period in the UK, we were unable to? So, thank you for having us back at another time.

To answer your question—and colleagues will join in—I think, given that the population that we are talking about in prison, it's a great aim to think about equivalence with the community, but, actually, I would suggest that our needs are probably greater than they are in an average community because of the type of population that we've got coming in to us. So, whether or not we're getting exact equivalence is quite hard to judge, because we don't have a set of key performance indicators to enable us to really judge that in any particular way. But I'm not actually sure that that's necessarily the best place for us to start, because I think what we need is above and beyond what you might expect in the community, as I say, given the nature of the people we have in our care.

I'll invite the other two of you to contribute, but I think my reading of the Government's aspiration—and colleagues will correct me if I'm wrong—is that for each individual prisoner—he should get the same treatment as he would've received if he was in the community. But I think your point about the lack of indicators—I mean, how can you measure that if you don't know what your baseline is? That's something for us to—. Because it's all very well to have the aspiration, but you can't know if you're delivering that if you don't know what it means.

It's quite hard for us to know what 'good' looks like, really, actually, because we're not healthcare professionals, and so, for us to judge whether or not what we're getting is the best possible care is quite difficult for us.

If I could just add to that, to echo what Chris has said, there are some specific areas where prisoner needs are clearly not being met. I think, if you look particularly at men with dementia or Alzheimer's, or people with personality disorder, post-traumatic stress disorder and learning disabilities and difficulties in terms of things like statementing arrangements—for example, a young person may be statemented outside and be receiving additional help, but that wouldn't necessarily continue in the same format when they came into custody. So, I think there are some very, very clear areas where equivalence is not being met.

To echo Chris's point around when men come into custody—. For example, take dentistry—an average person coming into custody, given that 70 per cent of our men are coming in with issues with substance misuse, the state of dental hygiene, oral hygiene, for an average person coming in would be significantly more than you would see for an average member of the community. So, I think our starting position is very difficult, is very complex, and I absolutely appreciate that healthcare needs across a broad spectrum are going to be significantly more challenging, which you would see, in an average member of a prison community. So, I think to answer your question—no, there isn't equivalence. I can't say it any more clearly than that.

09:35

Given some of the problems that are existent in the community—. Obviously, I'm the governor of Swansea and Swansea has the highest rate of drug misuse deaths in Wales, followed by Neath Port Talbot—all the areas that I'm getting my men from—so I think that some of the community services probably could use some examination and possibly improvement. Obviously, I get a distillation of the most complex men from some of those categories accumulated in one place, so I think in some places, the service delivered in the prison is better than that received in the community. Swansea has an opiate pathway, so men who come into prison and demonstrate an opiate addiction will be assessed, and will have a prescription by the second day of their time in custody, whereas if they were in the community, it would be three to four weeks if their case was quite simple, and probably three to four months if the case was more complex. My concern with that would be that there's not the psychosocial support that goes with that. We can medicate quite quickly, we can prescribe quite quickly, but there isn't the medical, the psychosocial support that goes with that, which is a massive concern for me. And in terms of mental health services, I probably don't have a particularly accurate picture of what that looks like in the community, but I know in custody it is grossly inadequate in Swansea.

We'll want to come on to some more detail on those issues in a bit. I want to talk a little bit about the governance and oversight arrangements. So, in your written evidence, you say that you think there is a need for a Wales prison health board, that the Welsh Government should establish this, and that that would enable things like strategic planning for prisoner health. Can you tell us a bit more about what you would see as the function of that board, the structure, what would its role be, how would that then interface with the local health boards who are providing the care?

I'll start—I may be best placed to answer that. I've been having a very constructive conversation, I should say, with Welsh Government around this, and there is a willingness to do something in this space, and, in fact, next week I've got a meeting with a director in Welsh Government who has responsibility for this area to progress this conversation. So, I'm gaining confidence that we will be able to move towards something that will meet our needs. What I think it will do—you may have seen in our evidence as well that we've got a partnership arrangement in place that's looking at four key areas of priority that we've jointly agreed with Welsh Government, and I sort of see that this joint governance board will act as the kind of programme board to make sure that we're actually getting the traction we need to really see the improvements against those four priorities being delivered. In a way, at the moment, we've got lots of joint working going on, and lots of meetings taking place, but there's no real teeth and there's no real place where this comes together to make sure, at the most senior levels in both HMPPS but also in Welsh Government, that we're really driving that kind of work forward. So, I think it would be a really useful body to come forward to drive those four priorities, but I also think that, at the moment, there isn't really a place where local health boards can escalate issues and where we can drive consistency across the health boards, and there is a difference in the provision that we get across Wales. Again, I think by having a national group we've got a better mechanism to try and drive some consistency across those boards, to allow issues to come up. If they're having an issue here with one thing and an issue here, let's have one conversation about it at national level, and try and work out the best way forward—not to dictate to local health boards about how they want to go away and implement things, but to try and set that kind of consistent framework.

So, I think those are two things, and there's a live example that might help bring this to life a little bit, if it's helpful. We've been having a conversation for some time now, both in England and more recently in Wales, about the roll-out of PAVA in our prisons, which is, in layman's terms, a pepper spray that police already carry, but it's something that HMPPS is going to be equipping its workforce with. And because this was a kind of 'rolled out from the centre of Whitehall' type of thing, there was a bit of a delay engaging Public Health Wales and the local health boards and things in Wales, which has not been very helpful, and we're trying very hard to put that right. But this board would be a place where those conversations can happen and where we can get colleagues from HMPPS headquarters, if you like, in England to come and engage early with Welsh Government and the relevant bodies on issues such as that, to give ourselves a better chance of getting the right engagement that we need earlier. I don't know if that's helpful, to give a real-life example—that we've had to go out recently to put a bit of a sticking plaster on. I chaired a meeting just before Christmas, with all of the relevant people around the table, to move that on. I think we're making really good progress with it, but I had to convene a separate thing to get all of the right people around the table because there's not an existing mechanism for us to do it. I think a national board would help us do that.

09:40

Okay, that's helpful. As a committee, we've heard evidence particularly around the governance arrangements about healthcare at Parc, which is, obviously, a different set-up because you're a private prison, and I want to explore that a little bit, if I may, particularly things like the role of Healthcare Inspectorate Wales in being able to regulate and inspect services.

You have contract-management responsibilities for Parc. Can you tell us a bit about what the oversight arrangements are as part of that contract from primary healthcare provision in the prison, which is a concern that's been raised with us? How is that overseen? Is there something specific in the contract about how that works?

If I can just say, we have a partnership-board arrangement, in the same way as the other prisons do. The issue, I think, just to echo what Chris says, is that it's quite difficult when you talk about governance, because until there is a clear set of indicators of what we're measuring, what those measurements should be and what, indeed, we should be looking to aspire to across prisons in Wales, it's actually quite a difficult issue to be looking at—whether or not our services are equivalent to the community, as Chris said, or equivalent to what's going on in the public sector.

I think one of the reasons we need a more strategic board is to look at, 'Should there be a disparity in service between what I might get in Cardiff prison, what I might get in Berwyn prison and what I might get in Parc prison?' So, for example, our secondary mental health services at Parc were put in place when the prison looked after 800 people, and that's never been increased. So, there are some very clear issues where—

We're now at double that number, just for accuracy.

Yes, 1,600 men. I think whilst we have governance, and, obviously, we have an inspectorate and we have the Prisons and Probation Ombudsman arrangements—all of the sort of normal arrangements that we would have in public sector prisons—the difficulty we've got is that we need one strategic board that looks across because there shouldn't be a difference. People should get the same service.

If I can just add, in relation specifically to Parc, that the current contract for Parc will expire in, I think, three years' time. So, there will be an opportunity for us to think about what the future provision at Parc will be and who will provide services there, including healthcare. So, there'll be an opportunity for us to have conversations with the local health board about whether the future for Parc looks exactly the same as it does now. I thought that might be useful to share.

That is useful. Would you accept that, perhaps in the context of that new contract, the healthcare services as Parc ought to be regulated and inspected in the same way as in the public sector prisons—that there ought to be that same level of transparency?

I think, from my perspective, I want to make sure we're getting absolute equivalence, whether you're a man in Parc, a man in Swansea, a man in Berwyn or a man in Cardiff. If a way of achieving that is making sure the inspectorate regime is the same across those, then I'd be very interested to explore that.

Just to go back to the question of Parc and the contracts, you said that the contract is due to be up in three years' time and it's looking to renew it. Is there any provision, therefore, within the contract to actually change or amend that contract, because, as you pointed out, you've doubled the number? Maybe the original contract was for 800, I don't know, but is there any provision available to you to actually amend the contract so you can accommodate the needs of your inmates?

In relation to that specific point—Janet may be able to correct me if I'm going down the wrong track here—that is not within the contract that we've got with G4S to run the prison. That is a provision that's provided by a healthcare provider via the local health board in Wales. So, it's really for them to decide whether or not they can put more resource in. We will be lobbying them to do so, and we have been.

We are—we are having discussions. It's useful to be able to take the opportunity to put on the record that I'm very grateful to the Welsh Government. They did put in an extra £1 million last year to mental health provision across public sector prisons in Wales. I have to say that that didn't go to supporting Janet in Parc, but it did go to supporting the rest of the prisons we've got in Wales. So, through the negotiations we've been having, we have seen some improvements made with some additional funding put in; but it didn't solve Janet's problem. It's one of those things: there's never enough, really. So, we were very grateful for it, but there's always more that we need.

09:45

I'm concerned now because, if you say it didn't solve the problems in Parc because it's a privately run prison, what's the future like? If Welsh Government is going to have responsibility for the other prisons but Parc is still out of scope because it's still a private prison, where do we lie with the future contracts? If the Welsh Government's not putting the money in, where's the money coming from?

Sorry, just to be clear, the example that I gave was in relation to secondary mental health. As the prison has expanded, we have expanded our primary healthcare services. But I think it comes back to the root cause of the problem. Actually, what should healthcare look like within a prison setting? What does 'good' look like? What are the screening arrangements for a whole range of things? The difficulty is that, fundamentally, if those things don't exist, it's actually quite difficult to benchmark what's going on at Parc and what's going on elsewhere.

As Chris said, we didn't receive any additional funding. We are the biggest prison in Wales and, to answer your point, I would welcome whatever kind of additional scrutiny and support could be given to improve healthcare provision. Because, irrespective of whether a man sits in a public or a private sector prison, the expectation should be that they receive the same level of treatment and care. Any help that we can get and any changes we can make in governance arrangements that would help to achieve that would be really gratefully received by me, my staff and the men I look after.

Just to be clear about that, following on from David Rees's questions, you've got twice the number of prisoners that you did have, and you've still got the same secondary mental health care provision. Mr Jennings has said that, obviously, with a new contract you could look at what might be put in that contract about whether it was decided to keep it as a private prison. But as things stand now, whose decision would it be to double that spending? 

One of the things we've heard from other sources is that the governance arrangements appear confusing and that there are different contracts with different health boards to provide different bits of services. Whereas, as we understand it, in the public sector prisons it's one relationship with one health board that's then providing all your services. So, who would have to decide today to double that spending on your mental health provision for your men?

For secondary mental health services, that wouldn't be—

It'd be the local health board, is my understanding. It's a responsibility for local health boards.

For secondary care, yes.

For secondary care, it'd be the responsibility of the local health board.

And who would be paying the local health board to provide for that?

If I've understood where they get their money from correctly—I'm not an expert on that.

No—that's helpful, because there's certainly confusion in my mind as to who's buying the service. Because you might expect that it would be the company that's running the prison, but in fact that's not the case.

No, for secondary services, that's not the case. Therefore, my point about the contract actually wouldn't solve this issue. What we can put into any future contract will not be about that. It might change the way that we get primary care delivered, because at the moment that is provided by G4S. We might, in the future—. An option for us is to consider whether or not—even if Ministers choose that that prison should remain a private prison—we could have a conversation about primary healthcare being delivered by the local health board in a way that it's not currently. That would be an option for us to think through and to talk to the health board about.

Okay, so the health board's providing the secondary mental health care, but it's not providing the primary.

Currently, that is exactly the case, yes.

Yes, that's—I was going to say, 'That's clear.' In fact, it's not very. [Laughter.]

It's important to understand it, because we've been talking about secondary mental health and primary mental health, and clearly there have been a lot of discussions on primary mental health in the wider public anyway. We'll come on to mental health in a short while. What number of patients, or inmates, are we talking about that require secondary mental health care?

That's quite difficult to quantify, because, obviously, there are some services not being provided at the moment. What we do know is, from Her Majesty's Inspectorate of Prisons surveys that go on when we have our independent inspection, that the level of mental health need, the level of distress experienced by men in prisons in Wales, is higher than it is in comparator prisons in England.

09:50

I understand that. My thinking is: if we get the primary mental health agenda better, would that reduce the pressures on secondary mental health as a consequence?

Yes, it would certainly reduce some pressures because, for example, there are services, as Amanda's already said, such as psychosocial services, some of the mental health services, some of the learning disability service provision, dementia—. There's a whole range of things, which makes it quite difficult to answer your question. Because those pathways don't exist, because the assessments don't take place when a man comes into custody, actually it's very difficult to quantify what the need is.

So, you'd have a health needs analysis, but in some ways the health needs analysis doesn't really produce that accurate an assessment. So, it would give you an indicator of the critical areas, but, for example, if you're not providing services for PTSD or there's no proper screening—well, there are screening arrangements for people with learning disabilities, but there's no ability for formal assessment and diagnosis. It's actually quite difficult to answer the question because those things are not there to get you a benchmark and a baseline to say how many people actually do need those services.

If I may, Chair, I'll just add one comment. I think it's worth mentioning that we do have a real opportunity, I think, though. These are men who have had health problems of a variety of nature, be it substance misuse, mental health or any of the other needs they may have. They may have had that for some time; they don't start the day they arrive with us, of course. These are problems that have existed in these men's lives in the community and in the lives they've had prior to entering our system.

But we do have an opportunity to do something about it, because—if you excuse the phrase—we have got a captive audience. So, we do have a real opportunity to work closely with healthcare providers and Public Health Wales and others to really take a chance to do something for the men in our care whilst we've got them. Because many of them do lead chaotic lives—you'll be familiar with that phrase—and actually, when they're in the community, it's a lot harder for them to access some of those services that might help them to fix the underlying cause of their need. So, we have got an opportunity, I think, that is perhaps being missed by the lack of resources that we've got.

Could I just explore that, in terms of the provision of that service, a little bit further? Because we have had the relevant health board in front of the committee and I think it would be fair to say that we were a little bit concerned about how strong the relationship with—because it's a new health board taking you over now. Can I ask how active discussions are with the health board about that secondary mental health care provision, and about the level of what's available, and picking up on everything you've said, really, about not even being able to be sure what the need is because it's not possible to get the need accurately assessed? So, are those discussions ongoing at present, or ought they to be if they're not?

In fairness, I think those conversations have been ongoing for several years. As you say, obviously, we've now got the change in the health board. So, in some ways, we will have to restate our position and just continue to have those conversations again. But they're not new conversations, obviously. When the prison increased its size, it put additional pressure on us, but what we're also seeing in custody is an increased level of complexity as time goes on. We're seeing more elderly people coming into custody, and some of the services are not there at all. So, irrespective of the general secondary mental health provision, things like dementia pathways, psychosocial pathways, personality disorder pathways, they just don't exist. There are old conversations to be re-had and there are probably new conversations about things that really do need to be looked into.

If I may just add? I think this is a really good example of something that needs a bit more teeth at a national level. These are the sorts of issues I would like to be able to see escalated, so I can have a conversation directly with the right people if, at a local health board level, we're unable to get the traction we need. That won't be because of willingness; I'm sure it'll be resource constraints that health boards have. But I need somewhere to be able to take that issue and escalate it to the right level, because it can't go on, that issue, for as long as it's gone on.

So, at the risk of putting words into your mouth, the Welsh Government needs to get a grip with the health boards on that provision.

I think the local health boards would welcome some support nationally from the Welsh Government, probably.

That's one way of putting it. Thank you. If I could just look briefly back again at the arrangements at Parc around complaints, we understand that, following recommendations from the ombudsman, there's a new health complaints procedure and that those complaints can be escalated outside the company, outside G4S, to yourselves. Are you satisfied that the changes that have been made are sufficient to ensure that the healthcare complaints process is clear for prisoners, and that it's equitable between the public and the private sector prison for those prisoners if they have a concern or complaint they want to raise?

09:55

I think it's clear to the men. Again, we would welcome—and personally I would always welcome—the most transparency that you can possibly have in any complaints procedure. So, it would always have been my wish that our complaints would have been dealt with and handled in exactly the same way as if I'd been in the public sector. It's not in anybody's interest—. There absolutely needs to be transparency. It's really, really important that people have the opportunity to raise their concerns with professional people. So, all I've ever really wanted was to have those similar arrangements, but it's better than it's been. But again, as Chris said, I think if we had a more national approach to things some of these issues could perhaps get a little bit more traction. Men should have the same experience. It seems bizarre to me that, if I'm in Cardiff, I would have one process; I'd transfer to Parc in two weeks, I'd have a different process. That doesn't seem sensible. There should be a pathway for all kinds of health provision and complaints provision. That's my personal view.

That's really helpful. Final question from me, then: can you clarify for us what is the role of the independent monitoring board and who they should escalate concerns to if they have concerns about prisoner health or social care?

The independent monitoring board are volunteers who have volunteered to perform that function on behalf of Ministers. So, every year, they write an annual report for each establishment in England and Wales, and that report goes directly to the prisons and probations Minister, who then responds to any concerns that have been raised by the IMB. So, that's the formal recourse they have above the governor and above me, but they obviously have regular conversations with the governor, and the director in Janet's case, about any issues they're finding as they go about their daily business. But the formal reporting process is an annual report directly to the Minister.

To the UK Government Minister.

That report, with regard to the health and care provision, if there were concerns—there's no formal way in which that would go to the Welsh Ministers who are responsible.

No. If they made recommendations in their reports about healthcare, we would then have to liaise with Welsh Government or the local health board to respond to that. The formal response would go from the UK Government Minister, but we would have information provided to us from either Public Health Wales or whoever the right body was to deal with the particular issue.

Okay. So, that might again be something—if you had this national board in Wales for health and social care for prisons, that might be the national forum. If there was a concern that was coming up from different establishments, that might be, again, another place where that could be looked at.

Absolutely. I guess the discussion bit might be something that we'll want to look at with all the IMBs, and HMIP as well of course. Because we have HMIP inspections too that make recommendations about healthcare, and they do make joint recommendations, HMIP, to Welsh Government and UK Government, depending on the issue. So, healthcare would be one, accommodations another. Recently, in an inspection we had published in November for Cardiff, there was a joint recommendation with the Welsh and UK Governments to work more closely together on solving accommodation issues. So, we do get joint recommendations like that too.

Ocê. Symud ymlaen, ac mae amser yn carlamu ymlaen hefyd. Felly, iechyd meddwl. Mae rhai o'r cwestiynau hyn wedi cael eu hateb eisoes, ond, David Rees.

Okay. We'll move on, and time is pressing. So, mental health. Some of these questions have already been answered, but David Rees will ask some more.

Diolch, Cadeirydd. Before I go on to the mental health question, just back to this health board agenda, because my interpretation of what you're saying is not of actually a health board, more of a panel that would actually set national guidelines and national standards. Because our interpretation of what a health board is is slightly different from that, because it actually is delivering as well. But you're more talking about having a body that will have the opportunity to discuss the issues, set guidelines, and give advice to health boards, basically, and Welsh Government.

Yes, I think that accurately describes it.

Yes. The language is probably unhelpful to refer to it as the same thing, yes.

Okay. On mental health, we've already discussed mental health and I think in your evidence you've highlighted a couple of points. One of the big questions, I suppose, that's coming from this is the inconsistency you're experiencing across Wales, particularly referral times and so on. How big a problem is that for you as governors, effectively, when you're trying to address things and you are seeing some of your colleagues perhaps getting a better response than others to address the issues for patients?

10:00

Personally, I find it very frustrating. I've only been at Swansea for 12 months, so I've been asking persistently for a needs analysis so I can understand fully what the needs of my prisoner population are. When I've delved into that, even the needs analyses can be quite inconsistent, so they're not producing the same results and there's not a consistency there to help you work with. But it's to help to understand, then to scope my specification and what I'm providing—gap analysis. What I'm looking for is a service specification and, again, if we had a board across, then I think we could—there would be a more holistic approach. The service specifications—these are the expectations that prison healthcare will deliver in prisons in Wales. These are the specifications that we are working to and we will all work to those and there would be some clarity. There's a great deal of difference from board to board, from prison to prison, in the levels of service.

Will that help you, then, identify the appropriate needs for those prisoners? Because we talked about the secondary mental health. If we can get it correct at a primary care level, then reduction in demand for secondary is another player, then, isn't it?

Yes. And, again, I'm a recipient of the funding from Welsh Government for mental health, and I'm really, really grateful for that, and that will give me a primary mental health service, which I don't have at all at the moment; it hasn't kicked in yet. My expectation—. I share my secondary mental health resource with Parc and, obviously, they're a much larger jail than me, and they're based in Bridgend, so you can see where their bias might lie. So, when I did some digging, again, into that in April, I asked what the caseload was, there were six. I had a population of 450 men with six men on the secondary mental health caseload, which seemed alarming to me when about 70 per cent of my men have got mental health problems. They don't all have profound and enduring and chronic mental health problems, but more than six will. So, I put some pressure on that. I think it went up to 15 in December, but, between April and December, I was asking every month, 'What's the caseload? What's the caseload?', and wasn't receiving that information. So, there's a little bit of trying to—I don't know. That information wasn't easy to receive.

I think, when I get a primary healthcare service, which I'm expecting to get in the early part of this year, my secondary mental health need will escalate dramatically because I will be identifying the need that is currently going undiagnosed, unidentified, and all of that need is being met by discipline staff, prison service staff, who are not experts in this field.

Your paper recognises that, and it also highlights the shortage of beds in secure psychiatric units, which is another issue. Is that putting your staff and therefore the inmates in greater vulnerability as a consequence of that?

Absolutely. It can be very distressing for staff and for other prisoners as well. They're trying to provide a level of care that we're not set up to be able to deliver, really, when you're looking after 550 men, trying to make sure we keep people alive and safe and well.

Is that having an impact—I would expect it to—on your other inmates, in a sense? Because if you have a certain number of inmates who have that need within that environment (a) it demands more time from your staff, but it also has, clearly, an impact upon other inmates.

Absolutely. Some of these men are dangerous and some of these men are just very, very poorly. Yes. And it does—absolutely, it draws a lot of resources. Some of these men have to be on constant observations in order to keep them—.

Have you had discussions with the Welsh Government on this? I know you talked about the money for mental health that's primary, but have you had discussions with Welsh Government on this?

I personally haven't had. Again, I know they're happening at local level, and I think—. Again, I keep coming back to this, but I think with a forum, where we can raise these issues more readily, there will be opportunities to raise those discussions at national level as well. You've correctly identified the potential resource impact, but, of course—and I think you eluded to it as well, the emotional impact it has on our staff but also on other men in our care who will undoubtedly be impacted by their neighbour, who may be severely unwell, causing issues.

Can I ask whether you've had discussions with the health boards, then? Because actually, technically, it's different health boards now, but it used to be the same health board at one stage. What's the health board saying?

Well, I think part of those conversations, as I've said already, have been ongoing for many years. I think the other point to make is that the problem is, if you've got insufficient people dealing with primary mental health, for secondary mental health, a lot of people are not being assessed. So, we've not even got the real scale of the problem. The other thing to fundamentally note is these people are going to be released back into the community, and, if we've not got the correct support, the correct diagnosis, it does, obviously, fundamentally increase the risk both to them as individuals and in what happens when they come out, back into the community. So, the problem is, as Amanda said, that we share a resource, but that resource is very, very low. I think the people who are trying to deliver the service, the staff that we've got in, are excellent—this is not a reflection on those people as individuals—but they are overloaded and they have to triage the cases. So, if you've only got capacity to be dealing with x amount of people, what tends to happen is you're going to prioritise or triage the people with the most pressing need, which means there is a whole range of men who are never really getting into that arena or onto that caseload that should be.

10:05

And I think—you know, there is obviously an extremely difficult job across the whole of the health sector, which I'm not qualified to comment on all the detail of, around balancing priorities, and we're a microcosm of that issue, aren't we? It's just that we have a very severe set of requirements and a very constrained environment within which we work, and so the implications of that tend to be amplified in custody.

Can I ask, in that sense, because clearly that links into the next question, which is that Cardiff and the Vale have given us evidence indicating the lack of response for urgent critical situations—are you also seeing the same problem? Because we're talking about—perhaps, in some sense, we shouldn't—planned types of scenarios, but what about the critical situations that arise and need urgent responses? How are you managing with those situations?

I think there's a perception, because these men are in custody, they're not in the community, they don't represent a danger to the public, that, even if it's urgent and critical, it can wait. So, I think that is the perception. That's not always the case, but I think that is the perception, that the public are protected while they're with us and we are providing a level of care, albeit not the right level of care and not the treatment that is required. So, I think that plays into it. We do raise these things at the health board, and I think that there was a little bit of an acknowledgement from the board that it's the same in the community: 'It is what it is and we can't help you any more than we are.'

And is that consistent across Wales again—the same inconsistency, in one sense, across Wales?

There undoubtedly will be an inconsistency, but there are also some really positive responses that we've seen. Up in Berwyn, we were, at one stage, finding ourselves calling ambulances a lot because there were men who required urgent attention, and, through a conversation with the health board and the ambulance service up there, they have been really flexible in working with us to base people at the prison. It was getting to be such a regular thing, it was a much better use of their resources and a better service for the men in our care to actually have somebody there. So, there is flexibility and give and take on both sides. It's not a completely bleak picture at all, and it's important to recognise that.

Okay. The final question from me, in the sense of—. Clearly, the risk of suicide is higher in the prison population because of the circumstances they face and the mental issue already identified, and that risk prevention is the responsibility, you understand, of the Ministry of Justice, but the mental health care is the responsibility of Welsh Government. Do you think there is good communication between the Ministry of Justice, maybe yourselves, and the Welsh Government to ensure that those who are identified and deemed to be at risk are given that support when they need that support?

I think the issue is that in the prison, obviously, there are set procedures that we need to follow when we identify people who are in crisis and at risk, which we do. As Amanda said, that's, in a lot of cases, opened and dealt with by our discipline staff on a day-to-day basis. But if a more significant, underlying issue is identified, then we're back to the same problem, really. So, at the risk of repeating myself, it is a problem in that you can identify the risk, but, if there's insufficient resource to meet that risk, what we're left with, then, is keeping safe. So many of the people who we look after, probably almost exclusively, are coming in with complex mental health needs. We've got the adverse childhood experience situation, and the more that you look at the needs of the people and the complexities, and when you start to analyse people in the ACE context, it gives you an even more stark reality check, I think, of some of the problems that people are coming in with. These problems don't occur in prison; they're already there when they come to prison and they're there when they go out, back into the community. So, it's a community issue that manifests itself in prison. The problem in prison is that everything is amplified and magnified and the complex range of individuals—. So, if I can give an example, we haven't really talked about young people, but the success of diversion from custody of young people has been fantastic. What we're left with is the most complex cohort. And if you talk about mental health provision and your lack of child and adolescent mental health services provision is—. The inspectorate, obviously, with young people, they inspect every year and we've had repeated concerns raised about the mental health provision.

Similarly, speech and language therapy; there's a whole range of service provision that doesn't exist in the south Wales prisons. So, there is a whole range of things that impact on people's well-being, or may help them to stabilise whilst they're in prison that don't exist. So, it's quite hard. You've got a structure and a process that we follow, but the need is an unmet need in a lot of cases. I know that that's not true for everybody, because there are some issues that can be dealt with by—you know, somebody needs a little bit more support or we need to get them into a different kind of activity and they need to be engaged and—. So, there are some things that we do and we do those very successfully.

But to build on what Amanda said, where you've got significant complexities—. So, people, for example, coming in to us with multiple complex needs who may have been in a secure hospital, may have been under community mental health teams in the community, when they come in to us, actually, that service is provided by our staff on a day-to-day basis—the staff on the landings.

10:10

Thank you very much indeed. Can I just ask you—? I want to talk a little bit about substance misuse and I want to talk about older prisoners, but can I just ask you: do you have a feel, Chris, for the churn rate in Welsh prisons of prisoners who leave to go to a hearing and are re-confined but then go back to another prison?

I'm not quite sure if I know how to answer that in a numerical sense. There is—. I certainly don't think that there would be any difference between Welsh prisons and English prisons, for example, in relation to that, but there is certainly a churn. And in local prisons, particularly for Amanda, that's a daily thing, with large numbers of men going in and out, and the same in Cardiff. And Berwyn has just started, in fact, in December, taking remand prisoners from court hearings as well. So, that is an absolute live part of our business and it's something that we manage on a daily basis. I don't know if that's helpful.

Yes, I think that—. I was talking, over the last few weeks, with people who work within the Ministry of Justice and I don't think I'd really appreciated that one of the reasons that men—and women, I guess, in women's prisons—miss hearings is because they don't want to move. So, they don't want to pack up everything, go to a hearing, find that they've got to go back into prison, but instead of—you know, they've come from your prison and they end up going to another prison.

Absolutely. That absolutely exists.

Because the impact that that would have, then, on treatment programmes must be enormous. So, I was just trying to get a feel for how much churn rate there—

Amanda, would you like to—?

Yes. The average length of stay in my jail is 12 weeks. But it shouldn't impact on treatment too much. In my prison, we do have people coming in and out to court. Once they're sentenced, if the sentence is of a sufficient length or of sufficient seriousness where they need treatment programmes, we would send them somewhere else for treatment. Once they go to a category C, where they're receiving treatments or programmes, they shouldn't any longer need to be going to court. So, there are some isolated incidents, but that shouldn't, in terms of treatment—. We do have—. There are pressures in England in terms of some prisons experiencing significant disruption and loss of accommodation, so they're diverting prisoners who should have been going to, say, the west midlands—they're going to Cardiff. So, Cardiff men returning from court, instead of going to Cardiff, will be coming to me and they're not always happy about that. So, you get—. That's a slightly technical point, but that is happening.

And that only happens, then, with remand prisoners. Once somebody is in sentence, they go to, say, a prison like yours and that's it, that's where they stay.

It would be minimal, yes.

So, you then can initiate, at that point, hopefully, effective treatment programmes.

10:15

But it does point to why one of the four priorities we agreed in our partnership agreement with Welsh Government is around medicines management, because there is an inconsistency at the moment. So, you could arrive in Swansea and you might be given a particular opiate substitute that you might not get if you go to another prison, because they might have a different approach to doing it, and so there is an issue for us, with men moving around the system who don't necessary get the same treatment. But, again, that's not unique to prisons, is it? Because that would be the same in the community, where there are different prescribing approaches in different parts of Wales. So, it's not a unique problem, but it does cause us an issue, and you do hear anecdotes that men might prefer to be sent to a particular prison because they know they can get hold of a particular type of medicine that suits them. So, there is a bit of that going on in the system.

Because, actually, Amanda, I wanted to ask you just to explain a little bit more about your opiate pathways and any other pathways that are in place for substance misuse and what sharing of best practice throughout the Welsh prison system is there. Because if you've got something that's working successfully, and if it's not being shared, what's the blocker? Is it because prisons don't talk to each other, or is it actually because the health boards don't support the pathways that you want to initiate?

So, the opiate pathway's been running for about 18 months. We've just had analysis of the pathway. So, we've just done a written report about that just to have a look at what impact it may or may not have had—quite difficult to evaluate that, because lots of other things have changed as well; we've brought in key workers, et cetera. It may well have saved lives; it's difficult to quantify that, because, obviously, it's difficult to evidence that. So, yes, we have produced a report, and I certainly will be sharing that with Welsh colleagues. There are pressures in terms of, obviously, that levels of prescribing have increased hugely, which puts financial pressure on the health board. So, that's under constant review, and there may come a time when they don't feel that they can support that financial outlay, and whilst there's increased prescribing, something else may well be suffering.

There's also some—. We need to be cautious that we're not encouraging men to come into custody in order to receive a quick prescription and address that need, because obviously that doesn't help the taxpayer or—you know, there's obviously a crime that needs to be committed in order to access. But I think the perception of the men that I look after, and a lot of the staff, is that it has stabilised people quite quickly, people have relaxed, they don't have to chase illicit substances or seek to top-up with illicit substances, that it does provide—. I think there's some concern that we've got a lot of men on maintenance, whereas I would like to see them on decreasing prescriptions. But that's something, again, for analysis, and I've asked for figures on that just so that I can get a handle on where we are. But, clearly, these are clinical decisions. 

It's very, very new, and so we're currently in the process—. After the 12 months, we started doing some analysis of what that looked like and what impact that was having. 

And can I ask—? Because I don't want to—. I'm not trying to tread on prisoners' human rights and what have you, but is it mandatory to go on to these treatment programmes?

—treatment if they want. That stems from—you know, the numbers are very high; 70 per cent of offenders report drug misuse, and I just wondered, if you've got these pathways, how is it explained to them, how are they given that choice, how are they guided to make a choice that, actually, would benefit them in the long term. Because I understand that there's no element—there should never be an element—of compulsion, but I just wasn't quite sure—. I kind of imagined that, if you were used to taking stuff outside of prison, then you go to prison and you can't access it, I think I thought that you would immediately want to go on a pathway, because at least you could access something, but, actually, from what you're saying, a lot of people perhaps might be able to get illicit substances from other methods.

They can certainly try. It is very consultative. You have to declare an opiate dependency, then a urine sample will be taken; that will be tested just to back up that there is, actually—you have some of that substance in your system. And then it is about a consultation, then, with a medical practitioner about, 'Okay, what do we want to do?'

I should say that whilst access to illicit substances remains a problem—that is impossible to deny—we are doing a huge amount, as you would expect and hope, to reduce access to substances in prison, and the Government has announced not too long ago an extra £100 million across England and Wales for additional security investment into prisons. We're hopeful—I may go as far as to say confident—that for Swansea, Cardiff and Berwyn, which are the prisons that really need additional security equipment, such as body scanners, to enable us to see what prisoners may be bringing on their person into establishments, we will be able to get investment to supply all three of those prisons—the remand prisons, essentially—with that equipment at some point during the next financial year, which will be another tool in the security department's armoury to prevent substances coming in.

10:20

We've talked an awful lot about substance misuse, so I've just got, really, one more question that I picked up, which is—. We understand from the evidence that there's a significant difference in the drug treatment services offered in Welsh prisons and English prisons, and, therefore, cross-border transfers can be very problematic. Can you shed any light on that at all?

In England, drug treatment programmes are IDTS, so it's an integrated drug treatment system that they use in England, so there's very much psychosocial support along with that. My experience of Swansea, which is the only jail I've worked in in Wales, is that we have the opiate pathway, we can prescribe and we can medicate that situation, but we're not providing the psychosocial support to the same extent, so we're not treating the entire person, if you like, and influencing the behaviours as much as I would like to see. I think, with the additional money I'm getting for primary mental health, I will utilise some of that to support that function because I think it's really important.

But I do think, to your point earlier, again around best practice, there is absolutely more that we could be doing in Wales to share best practice and promulgate it, and there is more we can do to learn from other jurisdictions, and I don't just refer to England, I refer to other jurisdictions more broadly, to look for ideas of best practice about how we can support men to reduce their addictions.

I'm sure over our evidence sessions we've probably asked this question, but I need to ask it again because I can't remember the answer if we were ever given one. I understand the chaos that the system you work in produces because you're transferring people in and out and it's a tight, tight system. So, I'm imagining that paper files on this prisoner about what he's having, when, and they move around between prisons or come in and out of custody, it probably doesn't travel with them. Are there electronic files on everybody, and are they all shareable amongst all of the prisons?

So, you can put down that, 'Joe Smith is on this opiate pathway. He's had this, this, this and this, but he's not had this and this, and people think he ought to have this.' And then, if he happens to go to Berwyn, Berwyn can read that, pick it up, and go, 'Right, that's where we need to step in.' 

Absolutely. There's a separate medical system called SystmOne, which is accessible in each and would follow that prisoner.

But I would just add that there is always more to be done in terms of information sharing between different parts of the system and different players within the system and it is not a perfect system. Whilst we have an IT system that supports it, it's important for us to know, if I use the example of a prisoner arriving in a reception in custody, what he was like at court, how he was behaving in the court cell before he was there, because if he's displaying mental health signs there, we need to know that when he arrives in reception. And are we getting that perfect information flowing right every single time? Probably not. We're doing a lot about it and we're continuing to try, but you can never do enough to share information about individuals.

No. And there's that realisation throughout the whole of public services. We just can't capture everything, although we do try. I just want to talk particularly now about older people specifically in prisons, because, I think, Janet, you mentioned a lot about people with dementia and so on and so forth. How well are prisons equipped to deal with an older prisoner who's displaying cognitive failure?

Well, the truth is it depends on where somebody would be on that kind of journey. As I've said before, the formal assessment process doesn't exist, and it's quite hard because in prisons sometimes it's really difficult to understand why people are behaving in the way that they are. It could be levels of distress; it could be drug misuse. So, sometimes things are masked. So, it sometimes takes a while for people to realise that there may be something wrong because there is no formal assessment process. So, if somebody's coming into custody aged x or over, there's no formal pathway. I think, where people are diagnosed and supported, it then becomes quite hard—.

We had a particular case at Parc where somebody was in really—. The bottom line is he shouldn't have been in a prison setting, but there's the paucity of beds or places available for somebody in that situation. So, if you can imagine, somebody may be serving a very long sentence for a sexual offence, historic sexual offences, and may be very elderly, there may be issues that have come in, they've become exacerbated, and they've still got quite a long time to serve. What does one do with that type of individual? The level of EMI beds in the community for people is—. The pressure is on those anyway, so what you do with somebody who represents a risk? Because on paper, if I were managing somewhere in the community, you've got to be mindful of people visiting their relatives, children coming to—. So, there are risks, I absolutely understand.

So, I think one of the challenges that we've got, both in terms of assessment, diagnosis, and if there is a pathway, well, what arrangements are there when you have got somebody who is really requiring some specialist support? Prison is not a place to be dealing with somebody who's got advanced dementia. It's absolutely not.

10:25

The prison in Usk is a real microcosm of this. Ten per cent of the prisoners there are over 70, and so they have got the most acute kind of—. Although Janet, I know, also has a large number of elderly men in her care as well, Usk is the place where this really comes alive for us in Wales. There's a huge amount of good work going on in Usk, working in partnership with the Samaritans and the social care team in Usk, to try and improve the offering that we can provide for men who are suffering from conditions such as dementia and similar types of things. It's an issue that's not getting smaller for us; it's getting bigger. We're trying to get better at dealing with it. It's obviously not just a HMPPS issue; it's an issue we've got to work in partnership with health colleagues and social care colleagues to improve. But I think, actually, what I would welcome is some real work to go on to think about what is the correct pathway for people with dementia, and developing a proper pathway so that we have more clarity on how we should provide support to those men. That doesn't really exist at the moment and it's something I'd like to see developed in the future.

Well, I notice that HMIP has consistently recommended a national strategy for older prisoners and, I guess, it's not just dementia cases but people with terminal illnesses, palliative care, end of life. I know this is difficult, isn't it? Because it's the line between—. What are we doing when we lock people up? Punishment; retribution; rehabilitation? And then letting them go. Because how can you have somebody in a prison who's completely demented?

So, my question is, because this is a question I can't answer: at what point is someone transferred to another facility because their crime, actually, now is the lesser of the situation that they face? Because perhaps they've lost all reason or because they are literally about to die. Or do they stay within prison and what we need to do is create a dementia-friendly setting in a prison or whatever?

I think it's quite difficult. The answer to that is it's very difficult to give a generalised response because we have men who have been terminally ill, they've gone into hospital and have elected to come back into the prison setting. They prefer to be in a prison setting because, as Chris said, we have buddy schemes, we have a lot of very, very caring staff. We've a lot of very good structures that we've not really touched upon today. We've talked about some of the challenges rather than some of the good work that we do. So, there are those people who would prefer to be there.

I think the cases about dementia is a specific issue because we do training for people, we do dementia awareness, we have a whole range of things going on. But sometimes, when you are presented with an acute case, which we have been, it is incredibly distressing, not so much for the individual, where clearly they're not really in a position to be aware of their surroundings, but for other men and for the staff, it's incredibly distressing. And in this particular case, I personally felt very ashamed that that was going on in this day and age in a prison. And that's not about blaming anyone, it's because that system and that pathway doesn't exist. There should be something that says that when we have—. Those numbers are few, thankfully. They will increase, but we shouldn't be scrabbling around for, 'What are we going to be doing with person X?' There should be something that means we all know what that pathway is and that there's a facility available that we can use. The problem is going to get worse, and we do need to address it, both as prisons and as a community, and as a society. It's a very real issue.

10:30

Is it possible, do you think, within Welsh prisons, for us to look at the concept of having a prison within a prison, i.e. more like a dementia-friendly home where people who are that bad would actually just be transferred there to all intents and purposes? Because, for many of us who've had experience of people with dementia, it isn't just the person or your trained people, but, of course, it's the other prisoners, and they may not be so aware or so relaxed about what they see as odd behaviour coming from a dementia—

If I may, that's exactly what we're looking at creating in Usk. So, we have created in HMPPS for Wales, an older persons strategy—we do have one, which I'm very happy to share with the committee if that's of interest—

—and it sets out our strategy for how we are intending to look after and support older people specifically in our care, not dementia-specific, but older people. In Usk, we are creating a unit that we believe will be able to provide the best practice and support to those men who really need it, and we would look to, if appropriate, transfer people from other prisons to there in order for them to be looked after properly.

So, of course, if we're going to do that for older people, can I also ask then is there a plan or a thought about doing that for people with severe mental health issues, real psychosis or—?

I think the answer there is secure mental hospitals, rather than, necessarily, the HMPPS being responsible for that.

Yes, okay. Last question, funding reductions in allocations for social care in prisons—this is your opportunity to make a pitch. [Laughter.] I don't blame you.

Can we have some more money, please?

There has been a reduction, and, in fact, the decision taken to spread the social care funding across all the 22 local authorities did have quite a detrimental impact on prisons, rather than it being held centrally. If it were me, although it's clearly not, I would prefer to have seen it held centrally, because we think we have a better chance of getting the support that we need out of a central pot than if it is left down to local authorities that happen to house a prison. Of course, there are only a few of those, and so the drain on those local authorities is very great, and I feel their pain, genuinely, having to support a prison in their constituency, if you like. So, we would like to see something done about that if possible.

We're running out of time now, so we need some agility—thank you, Angela—both in questions and in answers, please, and we've got the leader in agility, Jayne.

Thank you, Chair. There's pressure now. During our visits to prisons, one of the big issues that came up was around missed appointments for healthcare, whether that was in-service or external appointments. In one, we were told that it was around about 50 per cent, according to one clinician, of missed appointments. So, what are the difficulties in getting prisoners to those appointments and is there any good practice that you're looking at, or is there anything where challenges are insurmountable. What are your comments on that?

I monitor those figures weekly. I'm sent those figures weekly, so I keep a close eye, so if they seem to be deteriorating in any particular area—sometimes the dentist drops off and you need to start digging around as to why.

We changed our process, it is slightly boring. Anybody who had a medical appointment wouldn't go to work that day, so we found lots of people making reasons to have medical appointments to avoid going to work and then not attending the medical appointment, so that was a lose-lose situation. So, we addressed that, and then we had the teething problems of physically getting the men from their place of work to their appointment. We've largely cracked that, I'd say. I would say we were at 90 per cent attendance for appointments, but I monitor that weekly. It's not massive at Swansea, but Swansea is a small jail where it's quite easily controlled. Places like Berwyn and Parc, where you're dealing with a much larger scale and free-flow movement, et cetera—that can make it a much more complicated problem.

Sometimes, there are issues of safety, so if you have a communal waiting room where you have men from various wings sitting and waiting for appointments, that can be a hostile environment and people can feel threatened, or sometimes there are assaults in those environments. That can put people off, so sometimes you need to do a piece of work around that. It's a complicated question.

So, is that around staff shortages as well? There's a challenge around—. Because obviously it's quite reliant—. Everybody's aware that it's reliant on prison staff to escort people to their appointments.

10:35

No, that's a resource that is always ring-fenced at Parc. We wouldn't stop that service; that's always something that continues on a daily basis.

There are pressures. It's a big prison logistically, so sometimes that's quite difficult. As Amanda said, sometimes people don't always want to turn up. We've had some success in using peer mentors, peer support, healthcare champions, in following up people and encouraging them to say, 'You've got an appointment tomorrow. Would you like to go?' and if people have not turned up, to try and understand what that's about. We've done that in liaison with our patient liaison champion within the healthcare setting. So that's actually been really, really helpful.

I think dentistry's a little bit more complex, because I think sometimes people have got quite complex dental needs, and sometimes I think at the eleventh hour, people decide that actually a trip to the dentist may not be something that they want to do. So I think there are some specific issues around dentistry, but similar to Amanda, really, we monitor those things very, very carefully. It is one of the things that, with a range of healthcare indicators, would be one of those top-range things that we would be benchmarking across all prisons if we had a national set of indicators, because it's indicative of how well you're doing, because getting people to the appointment—if they don't get them to the appointment then they've not got much hope of getting the treatment that they need.

It can be a challenge, and sometimes it is down to individual choice. If I'm scheduled to see the GP and, for example, I decide that I'm going to prefer to go to the gym or something else, sometimes that does come down to personal choice. It's not always because the staff don't do their jobs. So, as Amanda said, it's quite a complex set of circumstances.

Okay. I think throughout this session you've touched on the transient nature of the prison population and the inconsistencies that that brings with it in terms of healthcare, and some of the examples about information sharing and the access to health records. I don't know if there's anything else that you want to say about that transient nature and the improvements that could be made on information sharing, and perhaps better access to those health records. But, I wondered, perhaps somebody who's been in prison for a short time, come out of prison and gone back in, and perhaps come back—repeat offenders—and those records then, and the relationship you have with other health boards and getting the access to records of those people who might have changed their medication and the delays in that. I wonder if there's any work going on to improve that information sharing.

We recently did a survey of our men and their perception of the healthcare services provided, and a lot of the feedback was that there were some initial prescribing delays, and a lot of that was around getting information from doctors, et cetera. Sometimes, men have been out of an area for a particular time, they're going back to an area and they don't have a GP and they don't qualify to have a GP, and that causes prescribing problems. So I think there's certainly more that could be done in terms of communication, but sometimes there is a delay and that can be quite distressing for men—on pain management medication for example, or all sorts of other medication.

Is there some work going on with health boards, then? Do you have those conversations about how that can be improved?

I know that Cardiff were running a pilot programme where everybody would have access to all the GPs' prescribing information. That had a little bit of a sticky start, is my understanding, but I can't speak for how that's working now. We'll certainly be watching that closely, and if it's paying any dividends then we'll be looking to adopt it.

Great, thank you. And just finally from me, we've heard about prison staff shortages, overcrowding in prisons, and lockdowns, which have repercussions for the provision of healthcare beyond the control of prison health teams. There's a lot of talk around the whole-prison approach in terms of the planning of health and care in Wales. Are you satisfied there's a real focus on that at the moment, looking at the whole prison?

Yes, I think when you sit in our position as governors and directors, you've got to have a whole-prison approach to a whole range of issues—mental health, violence reduction—so I think we're used to doing that. Certainly at Parc, there are no staff shortages that are impacting on the discipline side and getting people to where they need to be. Some of the pressures that you do have are in the demand to take people to secondary services, and what happens—. So, for example, today, I've got four men out in hospital who all require two members of staff on 24-hour cover. So, those things present a challenge. We're not resourced for that level of support and we receive no additional funding. So that would come out of my budget. There have been times where those numbers have been six or seven people, and sometimes those men can be out for considerable lengths of time. So that causes a problem in accessing secondary services, and certainly we're not resourced to be taking people.

We see a large amount of movement into accident and emergency departments, for a whole range of reasons. So that, at Parc, is more of a problem, because we've got a more static population. The longer you tend to have somebody, the more you're attuned to their needs and the more that they're going out for appointments, the more you go for external appointments, the greater chance there is of people requiring more and more treatment. But internally, there's no operational—. From a prison officer point of view, we don't have anything that impacts on delivery. 

10:40

If I may, and conscious of the Chair's steer for brevity, there were a couple of things you mentioned there around staff shortages and overcrowding that I'd just like to offer a quick view on. Staff shortage is not really such an issue for us anymore. A couple of years ago, that absolutely would have been the case, but there's been huge recruitment across Welsh prisons over the last few years, and we're more or less at the number that we need to be at now, so that's not such an issue for us. I think that's important to have on the record. And also, 'overcrowding' is not a term that we use. We don't describe ourselves as 'overcrowded' at all. We are crowded, but we are within the limits that are reasonable for men to be held at. So, again, I just thought it was important to put that on the record as well. 

Thank you, Chair. I just wanted to ask if you could tell us what the healthcare funding per head is in each of your prisons. 

I'm afraid we don't have that information. It's something we can try and provide to you afterwards in writing, if we can come back to you. 

Dyna ddiwedd y cwestiynu. Dyna ddiwedd y sesiwn. Diolch yn fawr iawn ichi am eich presenoldeb y bore yma a hefyd am ateb y cwestiynau mewn ffordd mor drylwyr ac aeddfed. Diolch yn fawr iawn ichi, mae wedi bod yn sesiwn ddiddorol iawn, a dyna ddiwedd yr eitem yna, felly. Diolch yn fawr iawn. 

That brings us to the end of the questions and the end of the session. Thank you very much for your attendance this morning and for answering our questions in such a detailed and mature manner. Thank you very much, it has been a very interesting session, and that brings that item to a close, therefore. Thank you very much. 

Thank you for having us. Thank you. 

3. Cynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod hwn
3. 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.

Symudwn ymlaen i eitem 3 a chynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod. A ydy pawb yn gytûn? Pawb yn gytûn. Gwnawn ni gymryd toriad bach am dair munud i gael y tystion nesaf i mewn. Diolch yn fawr.

We'll move on to item 3 and a motion under Standing Order 17.42(vi) to resolve to exclude the public from the remainder of the meeting. Is everyone content? Everyone is, I see. We'll have a short break of some three minutes to bring the next witnesses in. Thank you. 

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:42.

Motion agreed.

The public part of the meeting ended at 10:42.

Dysgu am Senedd Cymru