Cynulliad Cenedlaethol Cymru

Yn ôl i Chwilio

Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Health, Social Care and Sport Committee

29/01/2020

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Dai Lloyd AC Cadeirydd y Pwyllgor
Committee Chair
David Rees AC
Jayne Bryant AC
Lynne Neagle AC
Rhun ap Iorwerth AC

Y rhai eraill a oedd yn bresennol

Others in Attendance

Alistair Davey Llywodraeth Cymru
Welsh Government
Matt Downton Llywodraeth Cymru
Welsh Government
Vaughan Gething AC Y Gweinidog Iechyd a Gwasanaethau Cymdeithasol
Minister for Health and Social Services

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 09:51.

The meeting began at 09:51.

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

Bore da i chi i gyd a chroeso i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Senedd. 

Good morning, all, and welcome to the latest meeting of the Health, Social Care and Sport Committee here in the Senedd. 

2. Darparu gofal iechyd a gofal cymdeithasol ar yr ystâd carchardai i oedolion: Sesiwn dystiolaeth gyda Chymdeithas y Swyddogion Carchar
2. Provision of health and social care in the adult prison estate: Evidence session with the Prison Officers Association

Yn anffodus, o dan eitem 1 ac eitem 2, nid yw'r tyst a oedd i fod yma am 09:30 wedi ymddangos bellach, felly mae hynny'n rhoi inni ychydig bach o broblem yn ymdrin â'r sesiwn gyntaf. Felly, dwi'n credu does yna ddim dewis gyda ni ond i atal pethau mor fuan ag y maen nhw wedi dechrau, a dweud y gwir, a bydd yn rhaid cael egwyl nawr a dod yn ôl am 10:30. Felly, gydag ymddiheuriadau i'm cyd-Aelodau, fe wnaf i agor y cyfarfod eto'n gyhoeddus am 10:30. Diolch yn fawr. 

Unfortunately, under item 1 and 2, the witness that was supposed to attend at 09:30 hasn't appeared. So, that causes a slight problem in our dealing with the first session. So, we have no choice but to suspend things as soon as they've started, really. We'll have a break now and return at 10:30. So, with apologies to my fellow Members, I'll open the meeting again in public at 10:30. Thank you very much.

Gohiriwyd y cyfarfod rhwng 09:52 a 10:46.

The meeting adjourned between 09:52 and 10:46.

10:45
6. Darparu gofal iechyd a gofal cymdeithasol ar yr ystâd carchardai i oedolion: Sesiwn dystiolaeth gyda'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol
6. Provision of health and social care in the adult prison estate: Evidence session with the Minister for Health and Social Services

Croeso nôl, bawb, i adran ddiweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Senedd. Dŷn ni wedi cyrraedd eitem 6 erbyn nawr, a pharhad efo ein hymchwiliad i mewn i ddarparu gofal iechyd a gofal cymdeithasol ar ystâd carchardai i oedolion. Dyma sesiwn dystiolaeth gyda'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol, ac, wrth gwrs, bydd Aelodau yn ymwybodol dyma'r sesiwn dystiolaeth olaf ar gyfer ymchwiliad y pwyllgor yma i mewn i iechyd a gofal cymdeithasol ar ystâd carchardai i oedolion yma yng Nghymru.

Diolch am y papur ysgrifenedig ymlaen llaw gogyfer y sesiwn yma. Dwi'n falch o groesawu i'r bwrdd Vaughan Gething, y Gweinidog Iechyd a Gwasanaethau Cymdeithasol, Matt Downton, pennaeth iechyd meddwl a grwpiau agored i niwed, a hefyd Alistair Davey, dirprwy gyfarwyddwr galluogi pobl. Yn ôl ein traddodiad, awn ni yn syth i gwestiynau, a dweud y gwir, ar sail eich tystiolaeth chi a hefyd y dystiolaeth mae eraill wedi gosod gerbron. Mae'r cwestiwn cyntaf yn nwylo Lynne Neagle.

Welcome back, all, to the latest session of the Health, Social Care and Sport Committee here in the Senedd. We've now reached item 6, and a continuation of our inquiry into the provision of health and social care on the adult prison estate. This is the evidence session with the Minister for Health and Social Services, and, of course, Members will be aware that this is the final evidence session for this committee's inquiry into health and social care on the adult prison estate.

Thank you for the written paper beforehand. For this session, I'm very pleased to welcome Vaughan Gething, the Minister for Health and Social Services, Matt Downton, head of mental health and vulnerable groups, and also Alistair Davey, deputy director, enabling people. As usual, we'll go straight into questions on the basis of your evidence and also the evidence that others have provided. The first question is from Lynne Neagle.

Thank you, Chair. Good morning, Minister. In your written evidence you say that prison health has been identified as a priority for health boards in 2019-20. What does that actually mean in practice? Can you tell us what your expectations are for health boards, and also how any improvements in health outcomes for prisoners are being assessed and monitored?

We've provided additional funding for health boards around primary healthcare provision in the three public prisons, and part of the challenge is that the prison estate in Wales isn't uniform, so we have a different relationship with Swansea, Cardiff, Usk than we do with Parc, and equally a different relationship than we do with HMP Berwyn as well. So, we've provided recurrent funding to go into Aneurin Bevan, Cardiff and Vale and Swansea Bay to help deal with the primary healthcare, even though it's three prisons, and we also have, in terms of priority policy work, the work we've got with the oversight and partnership arrangements as well. So, we expect that look, and the review that we do, to help to move forward the relationship that we have with the prison service and the health service, but also taking in social care as well. So, the money has gone in there to deal with an identified need. Matt, do you want to talk more about the specifics?

Yes. So, the additional funding that went in for prison health, the health boards were asked to look at prison needs, or the health needs of their population, so whilst the focus was on primary mental health needs, obviously for Usk and Prescoed, where there's an older population, there's been more of a focus on chronic conditions, whilst in Cardiff and Swansea there's more of a focus around the primary mental health needs of individuals in the secure estate there. We'll be monitoring that both through the additional funding that's gone out, and health boards will report on that funding, so they gave us bids with milestones in, so we'll monitoring them on that. But also, as part of the 'Together for Mental Health' delivery plan, it's included within the plan, so it's part of the routine reporting that will come in on a six-monthly basis. So, that will be looking at outcomes and the impact of that funding.

Ocê. I fewn i fwy o fanylion cyllido nawr, ac mae Rhun gyda rhes o gwestiynau.

Okay. We'll go into more funding detail now, and Rhun has a series of questions.

Bore da. Y peth cyntaf ddywedasoch chi fanna oedd rydym ni wedi cael mwy o gyllid—[Anghlywadwy.]—ddim yn bell o 20 mlynedd yn ôl at pan gawsom ni'r setliad datganoli mewn perthynas â gofal iechyd mewn carchardai nôl yn 2003, does yna ddim cynnydd wedi bod ers hynny. I ba raddau, felly, ydyn ni'n gallu ystyried bod Llywodraeth y Deyrnas Unedig yn tangyllido gofal iechyd mewn carchardai yng Nghymru, a pha resymau sy'n cael eu rhoi i chi ynglŷn â'r tangyllido hwnnw?

Good morning. The first thing you said there was that we have received more funding, and coming back to around 20 years ago when we had the devolution settlement in relation to prison healthcare in 2003, there hasn't been an increase since then. To what extent, therefore, can we consider that the UK Government is underfunding prisoner healthcare in prisons in Wales, and what reasons are given to you for that underfunding? 

10:50

Welcome back to the committee, Rhun. It's good to see you in this environment again. On your question, if you look at the end of my evidence paper, you'll note that there was a transfer of funding that took place in the financial year 2004-05, and that block transfer hasn't been uprated. Now, that's a good deal from the UK Government's point of view—not a great deal from Welsh Government's point of view, let's be upfront about that. So, that means that we're essentially made to try and buy out the provision on Swansea, Cardiff and around Usk and Pencoed. Now, the challenge with that is that that would have dealt with the transfer of staff, at the time, who'd come into the health service, but the challenge is it hasn't dealt with the continuing and increasing level of need within the prisoner population or indeed the numbers of the population.

Now, because of the work that is being done, we think there's an opportunity to have a grown-up conversation between ourselves, the prison service and the Ministry of Justice. That's partly because, as I've described, the review work that's been done, and there are conversations about what we want from prisoner health and social care, the sorts of standards that we expect to be provided. But it's also because we need to have a conversation that then takes in the relationships around Parc, which are different, but also because it's a very different deal with Berwyn, where actually in the memorandum of understanding that's been agreed, there's an entirely different and significantly better resource base going into healthcare provision in Berwyn.

Now, from the MOJ point of view, they've agreed to do that. If we had the same conversation with the whole estate, I think we'd end up with a different figure. But I think we do need to acknowledge that it comes back to the deal that was done in 2004-05, and that isn't a great deal because, for whatever reason, there isn't uprating built into that and that is a challenge. So, it just hasn't kept pace with the reality of need and numbers.

So, we need to pin down what the underfunding is and how we address that—between the Governments—

Yes, to understand—. And the work we're doing on the need of the prisoner population will help us to do that, to understand, 'Here's the need and this is what we think we need to do.' 

Looking at a couple of the prisons separately, on Berwyn in particular, you do explain in your written evidence that the funding arrangement is due to change when the prison is up to full capacity. Do you know when that is? Are you able to plan because you have a firm enough timescale from the Ministry of Justice?

Well, no, because the MOJ aren't clear themselves on when that prison will be up to capacity, and in some ways that's fair, because you'd expect them to take account of their ability to manage current capacity before they get to full and to make sure they can properly operate it. The challenge for us is that, obviously, we don't have a specific end date when it absolutely will be at full capacity and what that will mean to the review in healthcare provision and resourcing. But there's been a properly constructive relationship with the MOJ around Berwyn and health services, so I wouldn't want to try and give the impression that there haven't been conversations and we don't feel that that's properly constructive. 

I guess perhaps it's a newer arrangement with the additional funding that came with it. On Parc prison, I know this committee, prior to me joining, has voiced some concerns about the lack of transparency and accountability in terms of what exactly the private provider is contracted to provide in terms of care. Do you share that concern? 

We're looking again at what we provide, how we provide it and how that relationship works, both with the private contractor themselves, but obviously with the prison service in understanding what their expectations are and not just what our legal responsibilities are, but then going into, 'Well, how do we make sure we're providing the right sort of health and care?' Because as everyone on this committee will know, once people come out of prison they're fully into the space of all the devolved services, so it's in our interests to want to try to have the best sort of prison environment for their health and care needs as well. But, again, that's part of the broader, grown-up conversation that I referred to at the start that we need to have, rather than just having individual conversations about individual prisons, but more broadly, 'Well, what's the expectation?' And I think the oversight group for escalating concern is one thing, but actually I think that might lead to a forum to address this broader conversation, which I think would be in everyone's interests.

10:55

Can I ask about the blurred lines between which health boards serve which prisons and who should be liable for what? Can you tell us what the breakdown of funding is for Swansea Bay, Cardiff and Vale and Aneurin Bevan relating to the provision of health at Swansea, Cardiff and Usk?

Okay. With Swansea Bay, we'll need to look again at the provision, but that's just a practical thing given the boundary change. But Swansea prison itself—so the figures are, in-year, they started in October: £265,000 for Aneurin Bevan; £329,300 for Cardiff and Vale; £164,500 for Swansea Bay. And then the recurring full-year amounts would be: £440,000 in Aneurin Bevan; £507,000 in Cardiff and Vale; and £329,000 in Swansea Bay. So, they're the amounts recurring going in for the primary care and the additional priorities that we talked about earlier on. 

How is the accuracy of that breakdown measured or monitored to make sure that the burden does rest in the right place? 

I suppose, to be clear, that breakdown is for the additional £1 million that's gone in, so not the full cost of what health will cost in the prison estate. So, the prison funding will be in the main allocation, so there's a broader amount that goes into the prison. The breakdowns are for the additional £1 million that health boards have received to improve services. They're very specific, those figures, because they're based on bids that the health boards were asked to put together based on a needs assessment of the prison population. 

The difference between the block transfer and what's actually spent, that's work that we're working through and looking to work through with health boards about what the reality of that is, and that's a conversation we then need to have with the prison service and MOJ. Like I said, there's a different model in Berwyn, so there are different comparator points to then work through. The reality of it—and what I don't want is that we get into a position where people throw their hands up and say, 'It's not my responsibility anymore', and we end up with what we recognise is a vulnerable population and even people that are judgmental about the prison population. Well, actually, when those people come out of prison, if their health and care needs have not been met at all, they'll be a bigger problem for the whole population as well. There's some self-interest here as well as what I would say is trying to do the right thing in any event in providing decent health and care for the prisoner population. 

Of course, but some health boards won't have a prison. I'm trying to drill down to: do we know that those that do have a prison in them are bearing too much or not enough responsibility for the provision of healthcare within the prisons that happen to be within their board's area geographically? 

Well, when we have more detail on the reality of what's being spent, I don't have any problem with actually sharing that information when we have it. It'll be part of the conversations we have with others, so I don't think there's any secret about that. So, what I think is, when we have figures that we think properly reflect what's being done, I'm happy to write to the committee to share that, because what I don't want is the ridiculous situation of people making a freedom of information request for that information rather than just understanding what it is—let's provide that in a way that we understand what it looks like, and then you're talking about not just the resource being put in but then some of the challenges about data, with lots of comparability about what's being done within each estate. On this issue, you may see different amounts being spent by health boards that don't have prisons, but, of course, the danger always is that if you want to break things down into every level that may or may not occur, you may find, well, actually, health board X may say, 'Well, actually, we spend lots more on a different issue.' So, I think it's not always a straightforward conversation. It doesn't necessarily lead to lots of light rather than heat, shall we say?

On the £1 million additional funding, just a couple of quick questions. Just to clarify, you referred to it earlier, is that specifically for improving access to primary care mental health services? 

The emphasis in what we asked health boards to do was around primary mental health services, but because we know the needs in the prisons are quite different, they were asked to do a health needs assessment. So, it's only, really, in Usk and Prescoed where the focus isn't so much around primary mental health needs because it's more around chronic conditions because of the older population there. But for Swansea and Cardiff, it's very much a focus on primary mental health services.

11:00

As a private prison, they weren't included in the—

And that's simply contractual because of the way Parc is funded; there was no way that that could've been—

Yes, it's an entirely different contractual relationship. I don't want to have a philosophical argument or discussion about it, but the practical reality is there are different relationships because of the way it's been set up and run.

And in future years, how much flexibility will health boards have if that money is to be recurring? Will they have flexibility on how to use it? Will it be incorporated in their general budgets?

Recurrent moneys are being provided, and then as to the use of it, we'll want to see—. The first question from Lynne was: do you know how it's being used, and what are you going to get for it? And there's going to be monitoring on what happens, we'll then have to look at both what comes from that monitoring as well as the need within the population. And that's part of the point about having assessments on the needs of the prisoner population.

But as you've said, Usk and Prescoed have been told that they can be flexible in the way they use the money. Would the health board have that flexibility as well, then?

Well, if the healthcare needs changed, then we're not going to insist that health boards spend money on an area where they don't have healthcare needs. But there's a lot of hypothetical prejudging, but the money is there to improve a service that is being provided to that population, with the particular needs they have on each of the sites.

Hapus? Symudwn ymlaen rŵan yn benodol at gwestiynau ynglŷn ag ariannu gofal cymdeithasol, ac mae'r cwestiynau gan Lynne Neagle.

Happy? Moving on now, specifically to questions regarding funding social health, and questions from Lynne Neagle.

Thanks, Chair. In the draft budget 2020-21, can you confirm that £0.371 million has been transferred into the RSG for social care? And if so, why is this less than previous years, particularly when the number of older prisoners with social care needs are increasing?

Yes, it's been transferred, and it reflects the reductions in different parts of our budget settlements. So, it's simply about the reduction in resourcing. We did agree, though, with local authorities on the transfer into the RSG. And as you know, local government across the different political leaderships have been looking to have transfers into the RSG and are moving away from areas of specific grants.

We did review that, actually, at the request of one local authority, but the view from local government was that they want the money to come into the RSG because, again, there are winners and losers in different parts where that money comes in, and they thought that was the right way for that money to be presented. And the Government agreed the clear consensus requests from local government.

Because the WLGA told us that they were concerned that the money was going into the RSG, which generally benefits all local authorities when only a few local authorities have got prison populations. I mean, is that something that you're aware of?

Oh, yes, and that was part of the reason why the review took place. So, Alistair, do you want to explain how and why we came to this position? Because it's odd that the WLGA has given that evidence, given that local government then asked us to put the money into the RSG.

Certainly. Well, just to reiterate what the Minister said, we had those discussions, it was reviewed, and they came back that they wanted the money split across all local authorities. So, that was reviewed. It was Bridgend who originally raised that request. And, obviously, at the end of the day, they wanted to keep that as it was.

Diolch, Lynne. Symudwn ymlaen i gysidro llywodraethu a thryloywder, ac mae Jayne Bryant yn mynd i ofyn y cwestiynau yma.

Thank you, Lynne. Moving on to consider governance and transparency, and Jayne Bryant will lead on these questions.

Thank you, Chair. Her Majesty’s Inspectorate of Prisons told us that data collection oversight and evaluation in prison health is needed. To what extent will the new prison health and social care oversight group that you're establishing address the calls that the committee's heard for stronger national leadership on prisoner health?

So, the national oversight group will bring together the prison service and the Welsh Government so there's a point of escalation and contact. I think it will assist with the constructive nature of the conversation, and if there are concerns, they can be escalated up so choices can be made across the system. We're working through some of the terms of reference for that and I think, once the terms of reference are agreed, again, there will be no problem at all in making those publicly available and to the committee. But on the data points, we don't think that we currently have consistent data across the different prisons, and so, part of the work that we're interested in seeing completed is seeing consistent data sets, so you're comparing like with like as far as possible. And, again, I'm happy to keep the committee updated as that work progresses. If you want specific detail, I'm sure that Matt would be happy to give you more now, or we can provide it to you in writing—it's up to you.

11:05

Is there a date set for the first meeting of the oversight group? 

Yes. It's currently being arranged. We expect it to be in the next few weeks, but we can confirm to the committee. 

So, it'll be the first time that it's met formally, and they'll draft up the terms of reference, and I think that'll determine then how information is shared. But we can share all of that information with the committee once it's met and agreed. 

Brilliant, thank you. What role will the oversight group have in overseeing the implementation and recommendations made by HMIP and the Prisons and Probation Ombudsman, specifically in relation to reviews of deaths in custody, and ensuring that they're acted on?

Ultimately, there are already prison health partnership forums in place with each of the partners on—so, the prison, the local authority and the health board—and we'd expect that to be the point at which each partner provides assurance that they're taking forward any recommendations, whether it's in a deaths-in-custody report or in any other inspection report. We would see the oversight group at a point at which an issue could be escalated if there was any concern around how well a partner was or wasn't implementing any of the changes that they needed to take forward. The oversight group would be the point where that would be escalated to ensure that that action does happen. 

Okay. Can you tell us what contractual mechanisms and performance management frameworks are in place to monitor the delivery and quality of health and social care provision, for example at Parc Prison, which, obviously, is a privately run prison? 

Clearly, it's different in Parc. The areas that are contracted directly by HMPPS, which would be the primary healthcare services, we wouldn't be involved in those. We wouldn't be involved in any of the performance or contract management of that. In terms of what the health board provides, they would report on that to their partnership board and they report data to the partnership board, and that's the same relationship for the other prisons, with the exception of Berwyn, because Berwyn have got a memorandum of understanding. They have service level agreements, so they would be reporting on particular specification when they're reporting their data. So, there are probably three different ways in which data is reported. 

Okay, and just going back to data collection really, there have been concerns about the limited data set, and you've said about the difficulties in collecting that sort of data. What steps are you taking to improve data collection so that people don't have to rely on freedom of information requests, like I think some are at the moment? 

Well, the work that's being done, for example, on some of the national standards work, so—[Inaudible.]—national standards on mental health and the work being done on substance misuse, but there's national standard work to be done on medicines management as well—that's work that we're doing with a range of other partners. So, that's for national standards to report against, as well as trying to understand the rest of the performance data. And like I said, we recognise that we've got data that doesn't tell you the same thing about these establishments, so that is work that we're working through with partners. So, I think that you will see, as part of the partnership agreement, we'll end up having a standard set of national indicators and we can then use those to report on for prisoner outcomes. So, that is work that is actively being pursued.  

Okay, thank you. In your written evidence, you've said that the delivery of healthcare and improving outcomes for prisoners can only be delivered in partnership, and the partnership agreement does set out the four key priorities—one of those is the prison environment. Can you tell us what the key outcomes indicators and performance measures are for that work stream and how they'll be used to help you to monitor the progress? 

The work isn't completed yet, so we won't know them. And, of course, that's being led by the prison service, because obviously they're in control of the prison environment. But that environment has a significant impact on the context in which health and social care is delivered, but also, it matters in terms of your ability to do things. We all recognise that there are different healthcare needs for the prisoner population. If you look at not just rates of literacy and numeracy, but mental health, physical health, blood-borne conditions—we're talking about the hep C reservoirs, much more significant within the prisoner population—so there are different healthcare needs within the population. And in some ways, that can make it easier to deliver healthcare, but equally, the context is not the same. And if you think about mental health needs, you're normally trying to improve someone's mental health and keep them locked in a room for 20 hours in a day. 

So, there are challenges about the environment, and the broader regime that we are not in control of. So, that's why it's being led by the prison service, but also we have a direct interest in the outcome of that work, and how that then feeds into our ability, if we're going to have these national indicators and standards, about how we can deliver them. 

Running the prison pharmacy that I visited in Swansea is very different to a high-street one, as you'd expect. The other thing that I was shocked by, and I really noticed it, as a glasses wearer—and I see that there are many of us in the room—was when I went to Swansea, I couldn't believe that I couldn't see any prisoner who was wearing glasses. And that isn't because the prison population have excellent 20/20 vision all through their life. So, there's a challenge there and there's a need there, and yet, you also understand that actually, the glasses might not be used just as items to help people to see. 

So, there's a challenge there about the environment and the regime. But actually, how do you deal with not just the inability to see, and—? I mean, I could get around; I'd just be stumbling around a bit. I can see a metre and a bit clearly, and after that, it starts to get blurry. But, if you're not having regular checks on your eyes, if you're not getting that regular interaction, and you know that you've got challenges with your eyes, there are other conditions that may not be picked up. So, there's a challenge there about that broader health and care provision that you can't disassociate from the environment. So, that's why all of these things need to come back together to see how they impact across each other. 

11:10

And just finally from me, around—. We have heard about gaps in service provision relating to substance misuse in prisons in Wales. When will the draft substance misuse treatment framework for prisons be published and implemented?

So we have got a draft that is being considered and it's being shared. I'm expecting in the autumn of this year to have a final version to publish.

Diolch yn fawr, Jayne. A'r cwestiynau olaf o dan ofal David Rees. David.

Thank you very much, Jayne. And the final questions are from David Rees. David.

Diolch, Cadeirydd. Minister, you have four key priorities in your paper. We've focused on some of them already, but another one is the standards of medicine management in the health service, and you will be publishing those standards. How far have we gone in producing those standards, and when do you expect to be in a position where you can publish those standards?

I'm not sure where we are in terms of the publication of those. Yes. [Inaudible.]—we're doing with the Royal Pharmaceutical Society.

So they're small workstreams, and for this workstream, it's being led by the Royal Pharmaceutical Society. We've only just agreed the contract with them, if you like, to take this work forward. What they won't be doing is, whilst in the delivery plan it says about producing a new set of standards, what they're clear on is that there is a set of standards that should be being achieved in a secure environment, so instead, there'll be going out and appraising health boards on where they are against those standards currently, and then developing improvement plans for each of the prisons or each of the health boards to improve their performance against that.

So you're going to use the existing standards and you're going to assess the progress against those standards and if any action is needed, you'll identify those actions?

Identify the actions and there'll be a separate improvement plan for each of the health boards to do that. They will also identify where they need, or where there is a need, for any national policy guidance in addition to what guidance is already out there.

But the context will differ in each of the prisons, not just with the population, but the physical environment in which the provision will take place.

Okay. All right. Another one of the priorities, obviously, is mental health and clearly, it's an important agenda. Again, you talked about it in your paper: the appropriate work was underway on developing draft standards for mental health in prisons. And as you stated in your written evidence, just again, if you could give us an indication as to what progress has been made, where we are, and when you expect that to be completed.

Well, we're expecting to have draft standards this April. I think that's the expectation. April, May—we expect to have draft standards and then, we'll want to circulate and consider those, to then come back, and that's being led by the Royal College of Psychiatrists. So, there's work being led by different partners, but that's from the draft standards, and I'll happily provide an update to the committee as we're working those through as well.   

11:15

That will be very helpful. Again, let's stick to the mental health, because you talk about an universal mental health standard, as well as specific interventions. Now, I appreciate all that, and we understand the different conditions and different circumstances within the prison environment, but I suppose, in a sense, what we're trying to find is that we have HMP Parc, which is a private prison, it commissions its own, not from health boards necessarily, so how do you intend to monitor perhaps the service provision at Parc, compared to that provided by local health boards? 

Well, that's part of the conversation that we want to have. We've already had a boundary change as well. So, in terms of where, physically, that prison is, it's now in a different health board. But, equally, the opportunity to review and say, 'Well, let's make sure that the provision that the health board does provide', to understand how and why that provision is provided, the basis on which it's provided, not just in terms of financial terms but actually the sort of outcomes we expect to be provided as well—. But that's an odd conversation, because it doesn't take place in the same context as the other prisons, because of its ownership and management arrangements. 

Okay. Because, clearly, one of the things we've heard evidence on, and it is a concern, is the different approach in Parc compared to the other prisons, because they commission the services. And so it is important we, therefore, are able to ensure we are monitoring the provision of all services in Parc, primary services in particular, to ensure that there is consistency for individuals who receive healthcare across the prison estate in Wales. But I've listened to what he's said, that's fine.  

But that is a real challenge, because it's the responsibility of the prison service. So, we're not responsible in the same way as we are for the other public prisons in Wales. Whilst we may want to monitor, actually there's a limit to our ability to do that, because we're not responsible.  

But one of the important aspects on that—. I'm sorry, we'll digress a little bit. But one of the important aspects of this is clearly that as those individuals are released from Parc they move into the service provision, which is under your authority and control. So, it is important we look at how we can ensure that those individuals coming out into the community and using services, which are definitely under the control of the Welsh Government or local health boards or local authorities, are moving smoothly between the two, and I think that's important.  

Well, that's certainly why we're having the conversation, that's what we want. So, we're not directly responsible for the provision in Parc in the same way, but we still have the same interest in those citizens when they leave the prison estate and when they're released. So, there's a very practical conversation to have there. 

Okay. Another question was raised earlier by Lynne about older persons in the prison estate, because we are seeing an increasing number of older individuals in the estate. Do you think that you should actually include that as an additional priority, because there are different demands based upon the system, as a consequence of the older person? Sometimes, they have more complex needs; they may have dementia as a consequence of this. Should you be looking at an additional priority of particularly focusing on the older individual within the prison estate?   

Well, it's the reality of the prisoner population. So, it's not like there's going to be no consideration of the fact that there is an older prisoner population with the challenges that provides for health and social care provision for the entire population. I'm a bit agnostic on why there needs to be a new priority. We've managed to get to agree four to work through and I'd be reticent about wanting to say, 'And we now want a fifth priority' when we haven't actually finished what we started on the four.

But the reality of the changing age demographic of a prisoner population is an integral part of the work that we're considering in each of the areas. If you're thinking about a consistent approach, we'll need to think about what that means for prisoners who are older and who have different needs, we'll need to think about substitutes for older prisoners as well, because that's a double challenge as well. So, within all of those, it's not like it's something that will just be completely out of the minds of people who are actually trying to design and deliver the service, and equally the work that we've been doing on social care and the social care needs of the prisoner population, well, that is definitely driven, at least in part, by the recognition of the fact that there is an older population. 

Okay. Because you did talk about that you would be building upon the HMPSS strategy for managing older persons in custody in the Welsh region, so I'll assume, therefore, you are looking very carefully at that. It would be helpful, perhaps, if you could identify, when you get to that stage, how will you build upon that strategy for the individuals and older people in prisons. That would be helpful to the committee down the line. 

11:20

Well, we can happily forward a copy of the strategy. That's not a problem. Then, obviously, we'll be—. And that does set out how we're then looking to work towards the—[Inaudible.]

Finally from me, again, as I mentioned earlier, you are responsible for many of the services that prisoners face when they leave the prison estate and they come out into the community. Housing is a big issue, and we've seen many occasions where individuals end up homeless as a consequence of coming out of prison. So, how are you working across Government, and across the prison service, to ensure that, as people are released from prison, they will benefit from appropriate and adequate housing so that they don't find themselves homeless and in a situation where they end up returning to prison because of their circumstances?

We know that there are a number of people who have been through the criminal justice system who are homeless. There are two particular projects, one with Cardiff and one with Rhondda Cynon Taf, together with housing colleagues. I don't know if Alistair wants to talk you through what those projects look like. They are projects, but there's the opportunity, obviously, to learn from those and understand if we need a broader approach, because, like I said, they're people we have responsibilities for when they are outside the prison estate, and housing is a key factor as well. We recognise that.  

Certainly, Minister. That's about working with those who are coming out of prison about their needs. We've also got the accommodating offenders in Wales strategic framework now, which has got a number of objectives around demand and a profile for accommodation from prison leavers around improving their access to private rental and registered social housing and increasing the commissioning and provision of specialist accommodation for all types of offenders and that resettlement pathway. So, there's a lot in train, and I think the Minister has already given the example of the good work that's going on in Cardiff. I think it's called the Housing First project. We could send you more details if you would like that. 

When do you expect those projects to be evaluated and, therefore, when will they be considered to be rolled out across Wales?

I'm not sure on the evaluation timescale, but I'm happy to write to the committee. Obviously, this is work that goes across this portfolio and with Julie James as well, but I'm more than happy to provide an update, if you want it, on the work we know has taken place both in Cardiff and RCT and when we expect to have an evaluation outcome for those—[Inaudible.]—about when those come in. 

Another good example would be the older person's unit in Usk prison, because that's very much looking at enabling older prisoners, particularly with mobility issues, to learn to live independently as part of that transition. Obviously, we have the buddy system there within the prison as well to provide that support, to aid that transition out of prison. So, this is an area of real focus for us.

Gorffen? Hapus?

Wel, dyna ni. Dyna ddiwedd y cwestiynu a dyna ddiwedd y sesiwn, felly allaf i ddiolch unwaith eto i'r Gweinidog a'i swyddogion am eu presenoldeb a hefyd am ddarparu'r dystiolaeth ysgrifenedig ymlaen llaw? Yn ôl ein harfer, byddwch chi'n derbyn trawsgrifiad o'r trafodaethau i gadarnhau eu bod nhw'n ffeithiol gywir, ond, gyda gymaint â hynny o ragymadrodd, diolch ichi unwaith eto am eich presenoldeb. Diolch yn fawr. 

Okay, done? Thank you. 

Thank you very much. That is the end of the questions and the end of the session, therefore can I thank the Minister and his officials once again for their presence here at the committee and also for the written evidence submitted beforehand? As usual, you will receive a transcript of the discussions to confirm that they're factually accurate, but, with that much of a summary, thank you very much again for your attendance.

7. Papurau i'w nodi
7. Papers to Note

I fy nghyd-Aelodau, dŷn ni'n symud ymlaen i eitem 7, a phapurau i'w nodi. Mi fydd Aelodau, wrth gwrs, wedi darllen y llythyr gan Fwrdd Iechyd Prifysgol Betsi Cadwaladr gyda gwybodaeth ychwanegol yn dilyn y sesiwn graffu cyffredinol gyda'r Pwyllgor Cyfrifon Cyhoeddus as 3 Hydref 2019, a hefyd byddwch chi wedi gweld y llythyr gan Gomisiynydd y Gymraeg ynghylch y Bil Iechyd a Gofal Cymdeithasol (Ansawdd ac Ymgysylltu) (Cymru). Pawb yn hapus i'w nodi? Diolch yn fawr.

To my fellow Members, I move on to item 7, which is papers to note. Members will, of course, have read the letter from Betsi Cadwaladr University Health Board with additional information following their general scrutiny session with the Public Accounts Committee on 3 October 2019, and also you will have noted the letter from the Welsh Language Commissioner regarding the Health and Social Care (Quality and Engagement) (Wales) Bill. Is everyone happy to note those? Thank you very much. 

8. Cynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod
8. 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.

Rydym ni'n symud ymlaen at eitem 8 a chynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod hwn. A ydy pawb yn gytûn? Diolch yn fawr. Symudwn i gyfarfod preifat, felly. 

We move on to item 8, which is a motion under Standing Order 17.42(vi) to resolve to exclude the public from the remainder of this meeting. Is everyone content? Thank you very much. We'll move to private. 

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 11:24.

Motion agreed.

The public part of the meeting ended at 11:24.

Dysgu am Senedd Cymru