There are a number of indicators in the Public Health Outcomes Framework (PHOF) (see section 5.2.1) related to people in contact with the CJS, one of which is the proportion of people assessed for substance dependence issues when entering prison who then require structured treatment and who had not previously received community treatment. The measure is designed to give local authorities an indication of the scale of treatment need unmet in the community. In 2012/13 the average proportion across England was 46.9% (Public Health England, 2015h).
Up until March 2014 a broad set of indicators, known as the Prison Health Performance and Quality Indicators (PHPQIs), were used to monitor the quality of healthcare in prisons, as well as the performance of other contributing health and prison services. However, the PHPQIs were not outcome-focused and were qualitative measures that largely relied on self-assessment by local healthcare teams. Given this and the recent changes in the commissioning of healthcare services in places of detention, it was widely agreed that the PHPQIs needed reviewing and updating. To replace the PHPQIs a new set of Health and Justice Indicators of Performance (HJIPs) have been developed by NHS England, PHE and the NOMS (National Health Service England, 2014).
The new indicators are largely quantitative measures and include specific measures for drugs and alcohol. NHS England Area Teams will work with their commissioned providers to collect the HJIPs with the aim of:
• supporting effective commissioning of healthcare services in places of detention;
• enabling national and local monitoring of the quality and performance of healthcare in the secure estate;
• providing a tool for providers to review their performance and identify areas that need improvement;
• providing data for local health needs assessments (HNAs);
• providing assurance to commissioners and partners, including NOMS, that healthcare delivery in prisons is fit for purpose; and
• providing information for the Care Quality Commission (CQC) and the HMIP to support their inspection work
The framework has been agreed and is now up and running. Collecting complete and accurate data for 2014/15 has been challenging but an annual report will be published in late 2015. Data quality and completeness are expected to improve in 2015/16.
8.6.2 Wales
Across the public sector prison estate in Wales, standards of treatment provision will be matched against those set out above. In addition, the practice standards issued by the Royal College of Psychiatrists in relation to Mental Health services for prisoners will also be adopted.
8.7 New developments
8.7.1 New psychoactive substances
The presence of NPS within prison establishments is a significant and growing problem. Ten out of 16 prisons who responded to the State of the Sector survey (DrugScope, 2015) reported an increase or significant increase in the use of NPS. Further, 13 prisons reported an increase or significant increase in the number of prisoners accessing treatment for help with the use of synthetic cannabinoids. In 2014/15 the contents of 893 samples of substances thought to be NPS were collected from prisons and analysed by the FEWS. Of these samples 738 contained non-controlled NPS, the most commonly identified substances being 5F-AKB-48 and 5F-PB-22, which are both synthetic cannabinoids (Home Office, 2015a).
The use of NPS has been linked to mental health problems and disturbed behaviour by prisoners, including violence. It is having an increasingly destructive impact on security and order in prisons, and the welfare of individual prisoners. Control and order is a fundamental foundation of prison life. Without it, staff, prisoner and visitor safety cannot be guaranteed and the rehabilitation of prisoners cannot take place.
There is a wide-ranging programme of work being undertaken by NOMS to counteract NPS. This includes joint work with the Home Office on the re-classification of drugs to enable the control of most NPS substances and to make most NPS illegal to supply (see the Psychoactive Substances Bill, section 2.2.3). This will allow prisons to press for the prosecution of those smuggling NPS into prisons or throwing them over walls (see Serious Crime Act 2015 below). Additionally, work is underway to develop new drug tests to detect NPS substances through the MDT programme.
The MoJ work closely with health partners to co-ordinate work on tackling the harm caused by NPS and other substance misuse, and to provide staff with the tools and information to tackle this issue in their work with offenders. There is an ongoing campaign to ensure that all prisoners are aware of the very serious risks that NPS bring. This has included a prison radio campaign, harm reduction posters, leaflets and a DVD, and focus groups and local initiatives in many prisons.
In July 2015, the PPO reported on 19 deaths which occurred in prison between April 2012 and September 2014, where the prisoner was known or strongly suspected to have been using NPS-type drugs before their death (Prisons and Probation Ombudsman, 2015). The PPO called for better education of both prisoners and prison staff regarding the signs that someone may be using NPS and the potentially harmful effects of such substances.
Scotland
The SPS is currently developing a national strategy and action plan to respond to prisoners under the influence of NPS. This includes developing a protocol on the management of prisoners under the influence of NPS who are demonstrating challenging behaviour including ‘excited delirium’, and the roll out of a national NPS staff training programme. SPS is also working collaboratively with NHS Health Boards to support the development of a clinical response in line with the Project NEPTUNE guidance.
During 2015 the SPS in partnership with Crew, a third sector organisation who are experts in the field of NPS misuse delivered an NPS (training the trainers) training package to SPS staff, which will provide staff with the knowledge and skills to deliver awareness sessions to colleagues and prisoners on NPS.
8.7.2 Legislation
In January 2015 the Criminal Justice and Courts Act 2015 (Her Majesty’s Government, 2015a) provided additional powers to prison governors to test for non–controlled drugs, such as NPS, in MDT, and to impose stiffer penalties on those suspected of being involved in smuggling NPS into prisons. New sanctions include
‘closed visits’ (no contact with partners or children), extended or further sentences, solitary confinement, forfeiture of prison wages and/or privileges and being moved to a higher security prison.
Further, in March 2015 the Serious Crime Act 2015 (Her Majesty’s Government, 2015b) was enacted which made it an offence to throw any article or substance in to a prison. Those found guilty could face up to 12 months in jail, or a fine or both for a summary conviction or up to two years in jail, or a fine or both for an indicted conviction.
The Offender Rehabilitation Act 2014 (Her Majesty’s Government, 2014) came into force on 1 February 2015. At this time new providers became responsible for each of the 21 CRCs, who supervise low to medium risk offenders following their release. Throughout 2015 Payment by Results will be rolled out across these services, which will need to reduce both the number of offenders who reoffend and the number of further offences committed by each offender in order to achieve full payment.
The Health Act 2006 (Her Majesty’s Government, 2006) brought in a total smoking ban in enclosed public places in England on 1 July 2007 (similar bans had already been implemented throughout the rest of the UK). Whilst prisons were exempt from this ban and prisoners remained able to smoke inside their cells, in January 2016 a full smoke free policy is to be implemented in all prisons in Wales and at four sites in England (HMPs Exeter, Channing Wood, Dartmoor and Erlestoke). This is part of a phased approach to make all prisons smoke free. E–cigarettes are available to buy in prisons and nicotine replacement therapy (NRT) products can be obtained on prescription through prison health services. Smoking will still be allowed outdoors.
8.7.3 Licence conditions
On 1 November 2014 two new licence conditions and supervision requirements, the Drug Appointment Condition and the Drug Testing Condition, became available to manage offenders in the community following their release through PSI 32/2014. The Drug Appointment condition requires those who have been receiving drug treatment in prison and whose use is associated with dependence to attend an appointment at a community treatment service upon release. Whilst the appointment is mandatory, entering treatment is not. This condition can be applied to any offender with drug misuse issues and is not limited to those misusing class A or B substances.
The Drug Testing Condition should only be applied to offenders whose use of a specified class A or class B drug “caused or contributed to an offence of which the offender has been convicted or is likely to cause or contribute to the commission of further offences by the offender”. The decision of what to test for and how frequently is made by the offender’s case worker. Refusal by the offender to take a test constitutes a breach of the condition, whilst a positive test result should instigate consideration of a breach of the Good Behaviour Condition of their licence.
8.7.4 Guidelines
A new toolkit designed to support prison healthcare and custody staff on tackling the growing NPS problem has been developed by PHE. This was published in January 2016, and will be supported by a training programme.
Guidance on the clinical management of substance misuse in prisons is currently being reviewed and updated to reflect changing patterns of drug use and to keep pace with the learning from recent reviews of unclassified deaths in custody and emerging best practice. This work will pick up issues around opioid substitution therapy, including for example the use of methadone and Subutex® (buprenorphine), and also the use of naloxone, which may be provided by clinicians when someone leaves prison to mitigate the risk of overdose.