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10.19 pm

The Parliamentary Under-Secretary of State for the Home Department (Paul Goggins): I congratulate my hon. Friend the Member for Northampton, North (Ms Keeble) on her success in obtaining this debate. She set out eloquently and powerfully the complaints made by her constituent, Mr. John Tero, about his medical treatment while he was in prison in 2001. He believes that the Prison Service failed to give him proper access to adequate health care and treatment, despite his making repeated complaints about the symptoms, including substantial weight loss, of what turned out to be a serious medical condition. We are, of course, all deeply concerned to hear about his current state of health.

In my reply, I intend to refer to the wider context of health care in prisons, and the general improvements that are taking place under the partnership established in April 2000 between the national health service and the Prison Service. However, I shall begin by responding to the specific points that my hon. Friend made on her constituent's behalf. I know that she will understand if I do not go into the same detail as was possible in the exchange of private correspondence that she has already had with my predecessor and the director general of the Prison Service. Medical confidentiality limits the amount I can divulge in public. I will try to deal with as many of the points that my hon. Friend made as possible, but I will in any event write to her to give a full answer to every question that she has asked me this evening.

Mr. Tero was first received into Woodhill prison on 15 December 2000. He told staff that he had recently seen his GP about a medical problem and he subsequently underwent successful surgery for that problem in May 2001. On his return from surgery on 4 June, he had a full medical examination. He did not at that time report any significant symptoms. He did, however, report symptoms of a different condition on 16 July 2001 when he was seen by a prison doctor. The doctor prescribed medication.

My hon. Friend asked whether it is standard practice for a prisoner to be returned to his cell after surgery. That is a clinical decision in each case. Normally, prisoners are returned to the health care centre on their immediate return from hospital. Health care centres have cells, of course, and I do not know whether it was one of the cells in the medical centre to which Mr. Tero was returned. That is one of the points that I will clarify in the letter I send to my hon. Friend.

Later in July he was seen again. Similar symptoms had persisted and further medication was prescribed. He was seen again in August and September, and at a further appointment with a doctor on 4 October his weight was recorded. It had remained stable since the beginning of June. On 9 October 2001, Mr. Tero was

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transferred to Wymott prison. On reception his continuing health problem was again identified and recorded. On 15 October, he consulted a doctor at Wymott with further symptoms. In view of that development, he was referred to a local NHS hospital for specialist investigation. The first appointment made for him was for 20 November but unfortunately it was cancelled at short notice. A new one was arranged for 12 December.

The investigation revealed a significant condition that merited further attention. The hospital made an appointment for 19 December. As my hon. Friend said, by coincidence that was the same day as Mr. Tero won his appeal and was released from Wymott. Prison staff advised him of the importance of keeping the hospital appointment but he preferred—perhaps understandably—to return home to Northampton and consult his own GP. Staff at Wymott informed the hospital about what had happened and subsequently forwarded details from the hospital to the GP.

My hon. Friend and her constituent are clearly dissatisfied with the responses that they have received to date from the Home Office and the Prison Service. I know that, in addition to bringing this matter to the attention of the House in this debate, my hon. Friend has referred the matter to the prisons and probation ombudsman. Although the clinical aspects of the complaint fall outside his jurisdiction, he has—I understand—agreed to examine the alleged administrative failings in the case. In addition to any other material that has been provided to the ombudsman, I shall ensure that he receives a full copy of the Official Report for this debate, so that all the information that my hon. Friend has provided tonight may be fully considered.

Ms Keeble: I wrote to the ombudsman for the second time on 27 May, and I have not had a reply yet. Is my hon. Friend saying that he has now agreed to take on the case, as he had not done so previously?

Paul Goggins: It is my understanding that the ombudsman has accepted the case, but I undertake to confirm that and to ensure that there is proper communication from the ombudsman to my hon. Friend, as that is the least that should happen in terms of indicating to her whether the case is to be considered. I assure her that I will look closely at the ombudsman's findings and take any remedial action that may be called for in the light of his conclusions.

My hon. Friend raised two specific questions. One was in relation to the payment of compensation, which she says is owing. I have in front of me a copy of a letter that she received from my hon. Friend the Member for Leeds, Central (Hilary Benn) dated 11 February 2003, which refers specifically to an agreement that Mr. Tero would be offered £45 in compensation. I cannot understand why that payment has not been made in the months since, and I intend to follow it up as a matter of urgency, to make sure that all the problems are ironed out and that the payment is properly made.

Ms Keeble: As of today, that money had not been paid to my constituent, and he is very ill.

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Paul Goggins: I assure my hon. Friend that I will follow the matter up first thing in the morning and ensure that any payment that is outstanding is made. I understand the circumstances in which that would happen.

My hon. Friend's second question was whether I would offer an apology to her constituent. Given my undertaking that I will follow up the inquiry with the ombudsman, I need to look at his findings before I make any firm commitment in that area. I also confirm tonight that I have decided to ask the director of prison health to arrange for an independent clinical review of this case and to report the outcome directly to me. I hope that my hon. Friend will therefore be reassured to some extent that I want to deal with this case in as open and honest a manner as possible.

Ms Keeble: I understand that there are always cautions about making an apology, but does my hon. Friend accept that this matter is now six months on? If an ombudsman's inquiry would have sufficed, I would have left it at that. It seems, however, that at the very least my constituent has been given some very shoddy treatment, and it is fair that he should receive recognition of the fact that he has been badly treated—frankly, I would not treat a dog like that. That should be recognised and he should be given some form of apology for the suffering and hardship that he has experienced, which has been needless.

Paul Goggins: Rightly, my hon. Friend argues forcefully and powerfully again on behalf of her constituent. There is at least a possibility in relation to some of the assertions that have been made that that information would not be shared by the Prison Service or the medical staff within it. It is my responsibility as a Minister to weigh all the facts and to make a proper judgment in the light of all that as to whether an apology is owed. I will be the first to offer that apology if I judge that it is merited. I promise my hon. Friend that I will follow this issue through as swiftly as I can.

As I said at the outset, this debate takes place within the context of a major reform in the delivery of health services for prisoners that began in 2000 and has already led to significant improvements as services become mainstreamed within the national health service. With the exception of acute care, prison health services used to operate more or less independently of the NHS. This led to deep concern about growing isolation and the emergence of significant differences in the standards of health care afforded to prisoners compared with those enjoyed by the general public. In response to those concerns, the Government established a formal partnership between the Prison Service and the NHS in April 2000. Two new joint Home Office and Department of Health units—a prison health policy unit and a prison health care taskforce—were appointed to lead and manage a programme that was designed to modernise prison health services, increase NHS engagement with the prison population and introduce much improved performance monitoring arrangements. The organisational changes were accompanied by new investment to tackle substance misuse, mental health problems and communicable diseases.

The Prison Service has committed more than £60 million to improve health care centres and services in the three years since the new approach was adopted. All

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prisons now have health needs assessment and improvement plans. They provide an important focus for prisons and their local health partners when planning and managing change and improving services. Increasingly, the plans are being incorporated in the local health economy, thus giving a clear signal that in future there will be full integration with local NHS planning.

A prison health work force strategy has been developed to broaden the base from which prison health workers are drawn, improve access to training and promote professional development, which was recommended by the report of the working group on doctors working in prisons and an earlier report on prison nursing. The appointment of a head of health care training at the Prison Service training college has also enabled robust and targeted training for health care workers to be developed.

Occupational standards have been introduced that reflect good NHS practice and provide the basis for an NVQ in custodial health care. Work is under way to ensure that prison-based health care staff have access to the same training opportunities as their NHS colleagues and that work force development confederations include prison staff in their planning and development activities.

Many of the worst examples of unsuitable and inflexible health facilities are being replaced or improved as part of a four-year capital investment programme that is worth more than £70 million. New purpose-designed health care centres are being built at Birmingham, Pentonville, Chelmsford, Hull and Feltham, where the quality of the existing health care facilities had frustrated modernisation and the introduction of much needed improvements to the quality of care for prisoners. Eight further substantial improvement schemes are planned for Liverpool, Norwich, Cardiff, Durham, Holloway, Parkhurst, Brixton and Dartmoor prisons. Improving arrangements for information sharing between the Prison Service and the NHS will help to improve the continuity of care for people as they pass between the community and prison.

Our plan for improving primary care in prisons is designed to increase integration with primary care planning through local primary care trusts. The publication of "Developing and Modernising Primary Care in Prisons" in June 2002 provided a framework for the development of primary care in prisons and practical advice on how change could be achieved.

The extent of mental ill health in the prison population is a particular cause of concern. In December 2001, we published a strategy for modernising mental health services in prisons that outlined how the provision of prison mental health care is expected to develop during the next three to five years. The plan included the development of day care provision and—building on the commitments in the NHS plan—of mental health in-reach services for prisoners with severe and enduring mental illness.

The plan stated that, by 2004, the 5,000 or so prisoners who will have a severe mental illness at any one time should receive more comprehensive mental health services in prison. All prisoners with severe mental illness will receive treatment and no prisoner with a serious mental illness will leave prison without a

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proper care plan or a care co-ordinator. In the new partnership between the NHS and prisons, some 300 additional staff will be employed to help to achieve this objective.

Research indicates that current reception screening processes fail to identify up to three quarters of those prisoners who have a severe mental illness. To rectify that, new triage-based reception screening arrangements were developed and piloted at 10 local prisons during 2001–02. They focused on identifying and managing prisoners' immediate and significant health needs on their first reception into prison. The work is closely linked to the development of the Prison Service's suicide prevention strategy. I am pleased to say that the evaluation of the pilot sites shows a substantial improvement to the identification of prisoners with a severe mental illness. The introduction of the system to all local prisons is being phased in over a 12-month period from April 2003.

Prisoners often have to wait too long to obtain both emergency and routine dental care. Fewer than 20 per cent. of prisons are currently meeting NHS waiting times for access to routine and emergency dental services. The recently published "Strategy for Modernising Dental Services for Prisoners in England" sets out how we intend to develop and modernise the provision of dental services within prisons. A three-year investment plan has been put in place to support its implementation, which will enable regional prison health development teams to ensure the implementation of dental service action plans for those prisons currently not meeting access targets.

A new standard for clinical services for substance misusers was issued in December 2000. It is consistent with current Department of Health guidelines and forms the basis for ensuring that substance misuse services are available in all local prisons and remand centres to a level of quality that is at least comparable to those in the general community.

Every prison is now expected to have in place a range of measures aimed at reducing the risk to prisoners, their families and the wider community of the transmission of

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blood-borne viruses. For example, all prisoners should be offered immunisation against hepatitis B on reception in order to increase protection for individuals, reduce the risk of outbreaks of infection in prisons and increase protection for the wider community following a prisoner's release. All NHS organisations now have in place a system of clinical governance. Clinical governance must also become the framework within which health care in prisons is delivered.

On 1 April 2003, financial responsibility for prison health was transferred from the Home Office to the Department of Health in England and the Welsh Assembly. Funding transfers of £117.7 million for England and £2.2 million for Wales took place on that date. That was a logical development of the partnership between the Prison Service and the NHS and will ensure that prisoners can access the same range and quality of health services as the general public.

A development network of prisons and primary care trusts has been established to provide a test-bed for that transfer at operational level and is likely to lead to some PCTs assuming effective commissioning responsibility for prison health services in their localities from April 2004. By April 2006, responsibility for commissioning prison health services in England will be fully devolved to NHS PCTs, thus effectively mainstreaming that activity within the NHS.

The Government have made new money available to support that development. The Department of Health will be making available significant additional resources for prison health in England worth an extra £46 million a year by 2005–06. That is more than a third more than the Prison Service spent last year on health services. It will be targeted on areas of real need, including mental health, drugs and infectious diseases. I assure my hon. Friend and the House that the programme of modernisation and reform of prison health care is very much on track.

Question put and agreed to.


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