Drink and Drugs News February 2017 DDN February 2017 | Page 19

Prison

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A mAtter of conviction

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

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

As part of a group set up by the Royal Society of Arts ( RSA ) I was involved in suggesting some key reforms . A matter of conviction set out to develop a blueprint for a future community-based rehabilitative prison ( DDN , November 2016 , page 4 ). It argued that the potential impact that prisons could have on reducing reoffending and community safety has been undermined by a lack of consistent political leadership and clear purpose and that this has led to reactive policy , which has disempowered the workforce and undermined public confidence . We argued for a national rehabilitation strategy with health and wellbeing as a key component .
So what lessons can recent history on drug policy and practice have to offer in rising to this challenge and how does the Prison safety and reform white paper , published in November , seek to learn from these ? Some of our ideas have found their way into the white paper , including introducing a new duty on the secretary of state to ‘ reform ’, along with additional freedoms for governors and an enhanced inspection regime . But it fails to address wider links to the community or aftercare in detail and has not embraced our proposals for a phased process of devolution and the introduction of local prison boards . This approach leaves the central grip – of the National Offender Management Service – intact , while introducing greater accountability on governors , risking , we believe , a mismatch between local decision-making and central directives .
The additional investment in prison officers and some focus on workforce development is welcome and , alongside a greater emphasis on education and employment , should help to reduce demand ; if people are bored , miserable and locked up for most of the time , drugs

‘ Prison drug treatment has been slower in adapting to changes in drug use than community services .’ have a greater pull . Also welcome were some of the longer-term proposals including attempts to control the supply side of drug taking in prisons . The increased emphasis on local commissioning and decision-making will be accompanied by a target to reduce reoffend - ing , and more governor involvement in health services in custody . Prisons are not healthy places and have always had a high proportion of drug and alcohol users among their population . The provision of treatment has had to balance three considerations – the health of prisoners , reducing reoffending and the good order and running of prisons – which can create conflicts in management .

Back in the real dark past , prisons had the Prison Health Service . This responsibility was then moved to the NHS , and health services were effectively commissioned between Primary Care Trusts with the prison service acting as co-commissioners , often through local partnership boards . The prison service also directly commissioned a drug service in prisons , known as Counselling , Assessment , Referral , Advice and Throughcare , or CARATs , from the turn of this century , provided by trained prison officers in some prisons and by voluntary organisations in others . From around 2006 additional funding was provided via the NHS to commission drug treatment in prison .
In 2013 drug and alcohol treatment became part of prison healthcare and was commissioned through NHS England , reducing the role both of local drug and alcohol commissioners and prison management . Since this happened , I have been concerned that the focus on the treatment of illicit opiates , particularly heroin , in healthcare contracts left prison drug treatment services slow to respond to new patterns of drug use in prisons and did not recognise the significance of alcohol use and dependency . Prison drug treatment has been slower in adapting to changes in drug use than community services , in particular the emergence of novel psychoactive substances in prisons since 2009 , the use of image and performance enhancing drugs ( IPEDs ), particularly anabolic steroids – whose prevalence has greatly increased in both prisons and the community – and the misuse of prescription medicines .
So what can be done ? The RSA report proposed prison and community boards as a way of breaking down barriers between prisons and communities , driving longer-term strategy and enabling a locally accountable approach . It argued for an increased role for local and regional government including city mayors and police and crime commissioners ( PCCs ), in commissioning probation and prison services . This approach would bring services closer to communities , encourage co-commissioning and the pooling of resources and address some of the concerns regarding disinvestment . Despite Theresa May being a champion of PCCs while at the Home Office , the white paper does not go this far and it remains to be seen what the Ministry of Justice review of probation will suggest . The focus on rehabilitation by prisons , and by implication the rest of the criminal justice system , is very welcome . It is to be hoped that we can edge towards good quality , evidence-based drug and alcohol services in prisons , which are linked to the community and are part of a wider package of measures designed to reduce further reoffending . Tony Margetts is the substance misuse manager responsible for commissioning drug and alcohol treatment for the East Riding of Yorkshire
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