Select Committee on Home Affairs Appendices to the Minutes of Evidence


APPENDIX 1

Memorandum by HM Prison Service

DRUGS AND PRISON

1.  INTRODUCTION

  1.1  In April 1998 the Government published "Tackling drugs to build a better Britain"[1]its 10 year strategy for tackling drugs misuse. A month later the Prison Service was the first Government agency to publish a linked strategy. "Tackling drugs in prison"[2] was the product of a review of the 1995 strategy document "Drug misuse in prison", which took place in the context of three key developments:

    —  the work of the UK Anti-Drugs Co-ordinator, at the forefront of a new integrated approach to drugs issues;

    —  new research evidence on the effectiveness of mandatory drug testing—a cornerstone of the old strategy; and

    —  emerging research evidence on the effectiveness of the first wave of pilot drug treatment initiatives.

  1.2  At the same time, certain elements underpinning the existing strategy remained constant:

    —  the Government's commitment to the reduction of illegal drug use in prisons; and

    —  the need to strike an appropriate balance between reducing the supply of and demand for illegal drugs; as well as minimising the harmful effects of drug misuse, for individual prisoners and the community (both inside and outside prison).

  1.3  Accordingly, the new strategy provides a clear blueprint for further progress, building on the foundations of the previous strategy. But the strategy is not just about good intentions. Effective action also requires proper, carefully targeted resourcing and, under the Comprehensive Spending Review, the Government has provided £76 million over the next three years to fund the strategy.

  1.4  This memorandum:

    —  assesses the available information on links between drug use and crime, the relevance of drug misuse to the sentencing process and the scale of the drug problem in prison;

    —  summarises the developments which shaped the new strategic framework;

    —  describes current initiatives and future plans to reduce the supply of drugs into prison;

    —  describes current initiatives and future plans to reduce the demand for drugs, through mandatory and voluntary testing and a range of treatment interventions;

    —  summarises how the strategy is to be taken forward over the next three years and what it is hoped to be achieved.

2.  BACKGROUND: THE SCALE OF THE PROBLEM

Drugs and Crime

  2.1  There has long been speculation about the links between drug use and crime (beyond the fact that use of illicit drugs is a form of criminal behaviour). In 1998, for the first time in this country, research has helped to pinpoint those links.

  2.2  The research was carried out on behalf of the Home Office by the University of Cambridge[3] and was based on an established American programme. It involved interviewing 839 people arrested by the police, in five locations, and then asking them to give urine samples, which could be analysed for the presence of drugs. All of this took place on a voluntary, anonymous and confidential basis and participation was good.

  2.3  The self-report interviews and the urine tests demonstrated much higher levels of recent drug use than the general population. Nearly two-thirds (61 per cent) showed some traces of drugs, which for most drugs means that they had been taken within three days before arrest. By implication, they were probably regular users. 27 per cent tested positive for two or more drugs.

  2.4  Breaking these figures down, the most prevalent drug was cannabis (46 per cent) but 18 per cent tested positive for heroin and 10 per cent tested positive for cocaine/crack. The cost of heroin and cocaine/crack means that they are often thought to be funded by acquisitive crime with heroin the drug which research suggests is most strongly associated with crime. For comparison, the prevalence of heroin in the general population is very low indeed (around 1 per cent of all young people aged 16-29 have tried heroin).

  2.5  The research also pointed to some even clearer indications of drugs-crime links:

    —  property offenders-the largest group of arrestees-had the highest level of drugs in their urine;

    —  nearly half of all arrestees-and especially property offenders-themselves acknowledged a link between their drug use and their offending, emphasising the need to fund drug purchases;

    —  arrestees admitting this link between drugs and offending had illegal incomes far larger than those not admitting such a link;

    —  the more drugs for which an arrestee tested positive, the higher their illegal income, mainly from property crime but also from drug dealing;

    —  levels of illegal income were highest for those arrestees reporting use of heroin or crack in the last few days: £10,000 to £20,000 a year, depending on the combination of these substances;

    —  arrestees had a high level of drug dependency with over one in ten reporting dependency on heroin and even more on cannabis.

  2.6  The "extra" expenditure of the heroin and/or crack users resulted in the total illegal income of all the arrestees being 32 per cent higher. In other words, 32 per cent of all the arrestees' offending behaviour—from acquisitive crime and drug dealing—was geared to the regular purchase of heroin and/or crack. Given that 75 per cent of the illegal income derived from property crime for heroin/crack users and others, the researchers inferred that the level of property crime would have fallen by a third, if their illegal income had been the same as other arrestees. This prompted the tentative conclusion that close to a third of property crime is drug driven.


Drugs misuse and sentencing

  2.7  So far as concerns sentencing for crimes either committed under the influence of drugs or in order to raise funds to buy drugs, there is no legal doctrine that these circumstances should either aggravate or mitigate the sentence which would otherwise have been imposed. Increasingly, however, courts have been able to consider sentencing options aimed at addressing the underlying drug problem. Since 1992 courts have had the power to add a condition of treatment for drug dependence to a probation order. That power was, however, relatively little used, and is now being replaced by a new type of sentence, the Drug Treatment and Testing Order. The Government's overall strategy sees the piloting of the new sentence as a key component of developing sustained and collaborative treatment for those committing drug-related crime.

  2.8  The Drug Treatment and Testing Order was introduced by the Crime and Disorder Act 1998 and came into effect in selected pilot areas on 30 September 1998. The new order aims to strengthen the court's existing powers and to clarify roles and responsibilities. Under the new Act, the court may, with the offender's consent, make an order requiring the offender to undergo treatment for his drug problem, either in parallel with another community order, or as a sentence in its own right.

  2.9  It will be targeted at drug misusers who commit crime to fund their drugs habit and who show a willingness to co-operate with treatment. Effective screening, assessment and inter-agency communication will be vital to the success of the order.

  2.10  There are two crucial differences between this new approach and the previous position: the role of the court in reviewing the offender's progress on the order; and the mandatory drug testing which offenders will undergo.

  2.11  Enforcement of the order will be crucial to its credibility with both courts and offenders. The probation service will provide the link between the treatment provider and the court. In the case of a breach, sentencers will have several options, including continuing or amending the order with an option for imposing an additional penalty; or, in cases of wilful and persistent non-compliance, revoking it and re-sentencing for the original offence.

  2.12  The new Order is being piloted for 18 months, during which it will be rigorously evaluated, with special emphasis on its effects on re-offending. Merseyside, South East London and Gloucestershire Probation Services were designated to manage the pilot, which started on 1 October 1998 and will run until 31 March 2000[4].

  2.13  If the evaluation shows that the Orders have been successful, the Government has undertaken, as part of the outcome of the Comprehensive Spending Review, to introduce the new Order throughout England and Wales, at an annual cost of £40 million. The bulk of this money will, as in the pilot schemes, be disbursed by Probation Services to meet the costs of treatment, which will be provided by both the statutory and non-statutory sectors.


Drug misuse in prison

  2.14  There have been a range of research studies carried out into the level of drug use in prison and two Home Office research studies published in 1998 shed useful light on the scale of problem.

  2.15  A study into levels of HIV/AIDS risk in a sample of about 1,000 male prisoners[5] where the field work was carried out in 1994 and 1995, produced the following findings in relation to drug misuse:

    —  the male prison population has experience of much higher levels of drug use and injecting behaviour than the general population;

    —  62 per cent of the sample reported cannabis use in prison;

    —  18 per cent reported using injectable drugs in prison (compared with 41 per cent in the 12 months before prison);

    —  the impact of imprisonment on the pattern of injectable drug misuse was a sharp fall in the use of stimulants and a much smaller fall in opiate use.

  2.16  An evaluation of the mandatory drug testing programme[6] (which is discussed in more detail later in the memorandum), based on a sample of only 148, produced the following:

    —  76 per cent claimed to have used drugs in prison, of whom virtually all had used cannabis at some time;

    —  the level of current heroin use was 27 per cent, although up to 44 per cent reported its use at some time;

    —  young offenders were regular drug misusers in the community but had little experience of misuse in prison;

    —  current users of heroin and cannabis were much more likely to have experienced custody as a juvenile.

  2.17  However, these figures must be viewed cautiously. The size of samples and variations in emphasis means that individual studies tend to provide only snapshots of drug use at particular times, in this case prior to the introduction of the Prison Service Drug Strategy. While these offer useful insights, they do not provide the kind of systematic analysis of changing patterns of use over time which is necessary for monitoring the success of a wide-ranging drug strategy. This is where Mandatory Drug Testing (MDT) is invaluable, providing information on patterns of drug misuse in every prison over time. Even if some misusers escape detection, the data offers reliable guidance on trends. The MDT data suggests lower rates of heroin use than those above.

  2.18  The levels of positive random drug tests is one of the Prison Service's key performance indicators. Last year, the outturn was 18.9 per cent, a significantly lower level of positive tests than the target of 24.4 per cent. 1998-99 is proving similarly encouraging. Against a target of 20 per cent, the performance for the year to November is 18.9 per cent.

  2.19  It is important to recognise that patterns of drug misuse do vary between different groups in the prison population. For example, research[7] has shown that drug misuse amongst female prisoners is significantly different from men—with different levels of types of misuse; and different motivations and behavioural consequences.

  2.20  This record suggested that two-thirds of women entering prison report misusing drugs and/or alcohol previously. The Chief Inspector of Prisons' Survey in 1996 found that 40 per cent of women had misused one drug and over a quarter had been poly-drug misusers prior to prison. The high rate of women needing detoxification on reception represents a problem. Misuse in prison is at a lower level than for men, (16.8 per cent positive MDT tests in 1997-98), although the misuse of prescribed medication is a particular problem. The Prison Service is to research the nature, scale and extent of this issue as part of the wider research on the needs of female prisoners who misuse drugs. In behavioural terms, although there is less violence and intimidation associated with the supply of drugs, links with histories of personality disorder and self-harm pose problems for staff.

Drug use and criminality

  2.21  While there appears to be a substantial correlation between drug use and other criminal behaviour, the link between drugs and criminality is more complex. Not all drug use causes criminal behaviour and drug use should not be viewed in isolation when identifying the causes of criminal behaviour. Indeed, longitudinal studies suggest that early childhood factors which predispose to drug abuse also predispose to delinquency generally. Consistent with this view, low levels of substance abuse are not particularly predictive of future offending amongst either young offenders or adult prisoners. In contrast, severe drug abuse (in which large quantities of the more addictive drugs are taken, and in which the offender develops a drug problem or dependency) is predictive of future offending.

  2.22  One of the underlying principles of the Government's overall strategy is integration, deriving from the recognition that drug problems do not occur in isolation but are tied in with other social problems. This is certainly true of offenders coming into the prison system. The Cambridge research illustrated that the lives of the arrestees were beset by a range of personal difficulties, ranging from homelessness to previous involvement with the criminal justice system and suggested that their drug use could be seen as a (misplaced) way of coping with other problems. The challenge for the Prison Service, if it is to help prisoners make a successful return to the community, can involve treating a drug problem but often also needs to include addressing offending behaviour, employability, education deficits and maintaining family ties. Progress in these areas will reinforce efforts to tackle drug misuse.


3.  OVERVIEW: THE NEW PRISON SERVICE DRUG STRATEGY

  3.1  "Drug Misuse in Prisons", published in 1995, represented the Prison Service's first attempt to provide a strategic framework for tackling the problem of drug misuse in the prisons of England and Wales. Before that drugs projects had tended to proceed in a piecemeal fashion, as the result of local initiative rather than central direction, and lacking a systematic evidential basis.

  3.2  The strategy balanced control/deterrence measures (notably Mandatory Drug Testing which was launched in Spring 1995) with treatment initiatives (the first tranche of pilot drug treatment programmes was launched in Autumn 1995).

  3.3  A review of the 1995 strategy was commissioned in 1997. This provided an opportunity to review experience to date; review emerging research evidence; consider the common criticisms; and take account of wider developments. The review was carried out by staff in Prison Service Headquarters, in conjunction with colleagues in the Home Office and the Central Drugs Co-ordination Unit and in consultation with other agencies.

  3.4  More specifically, the review covered:

    —  an evaluation of drug treatment programmes;

    —  an assessment of the impact of mandatory drug testing, including the claim that it was causing prisoners to switch from cannabis to heroin;

    —  an assessment of the evidence on voluntary testing, together with planning to provide universal access;

    —  delivery of the strategy: infrastructure and staff training.

  Each of these issues is addressed in more detail in the remainder of the memorandum.

  3.5  The principal conclusions of the review were that:

    —  the basic structure of tackling supply, demand and harm reduction should remain intact; but

    —  there should be new emphasis on the following areas:

  —  voluntary testing

  —  improving the effectiveness of treatment interventions

  —  throughcare and aftercare

  —  more differentiation in disciplinary terms between suppliers and users and between more and less harmful drugs

  —  filling the gaps in existing provision (eg specific strategies for young offenders).

  3.6  The review formed the basis for the new strategy which, at the outset, summarised the legacy of the 1995 strategy:

    "There is now

  —  evidence of progress on reducing the prevalence of illegal drug misuse in prisons; and

  —  emerging evidence that prison can provide an effective environment for interventions with problem drug users. Properly targeted, and with support following release, interventions in prison have the potential to interrupt cycles of abuse and recidivism".[8]

  3.7  As such, the new strategy should be seen as an evolutionary development, retaining and refining the main thrust of the 1995 strategy and taking it into new areas. It also follows the Government's strategic approach to drugs issues by importing the four aims set out in the national strategy, "Tackling Drugs to Build a Better Britain":

    —  help young people to resist drug misuse in order to achieve their full potential in society;

    —  protect our community from drug related anti-social and criminal behaviour;

    —  to enable people with drug problems to overcome them and live healthy and crime free lives; and

    —  to stifle the availability of illegal drugs on our streets.

  3.8  The Prison Service must play a key role in the national strategy because it has in its care a large number of drug misusers. There is therefore the potential for very significant harm reduction both for these individuals and for the families and communities to which they will return. In the long term there is the possibility of having a real impact on the levels of crime associated with drug misuse.

4.  REDUCING THE SUPPLY OF DRUGS

  4.1  The Prison Service and prison staff are committed to tackling the supply of drugs to prisoners. It is a difficult task. Drugs are relatively easy to hide; drug dealing is a potentially lucrative activity; and isolating all prisoners from any contact with the outside world would compromise a great deal of work on maintaining family ties and facilitating resettlement. Prisoners also demonstrate considerable ingenuity in trying to find ways to circumvent security procedures. Staff have to counteract everything from tennis balls containing drugs being thrown over the wall to drugs being hidden under the postage stamps on incoming letters.

  4.2  As a result, without isolating all prisoners from all contact with the outside world, which would be unacceptable in control, care and resettlement terms, it is not a realistic expectation that illegal drugs should be eliminated from prisons. Staff certainly strive to stop drugs being smuggled into establishments and to disrupt the distribution and misuse of drugs within the establishment, but the realistic goal is to reduce the supply of drugs as much as possible.

  4.3  There are a wide range of measures in place to stifle supply. Many of these represent good basic security procedures and so the general emphasis in recent years on improving security procedures has brought real benefits in tackling the problem. However, in this context, feedback from the field indicates that security procedures are most effective when they are properly integrated into the overall establishment drug strategy. Activity falls under the following headings:

Improving perimeter security

  4.4  Establishments have adopted a range of measures to improve perimeter security, including increased patrolling; searching the ground near the perimeter before inmates are allowed access; use of dogs and use of CCTV. Maintaining security against contraband is, inevitably, easier at higher security establishments than open prisons or those with particularly long perimeters.

Searching

  4.5  Effective searching procedures are an essential component of preventing drugs getting into prisons in the first place and ensuring that some of the drugs which do get in are not misused by prisoners.

  4.6  Prison Rules provide for any person or vehicle entering or leaving a prison to be searched and for any officer to be searched at any time within the prison. The frequency and level of search employed at a particular establishment vary according to security category, the scale of the problem and the level of intelligence. It is policy for anyone entering a prison regularly holding Category A prisoners to be searched on every entry to the prison. 100 per cent searching also applies in most category B prisons. For domestic visitors this means a full rub-down search and an x-ray of all property; for staff this means at least a metal scan and an x-ray of property. If there is intelligence that visitors or staff are smuggling in contraband, the level of searching is increased proportionately and, if the intelligence is sufficiently specific, individuals will be targeted.

  4.7  Local searching strategies also include provision for searching prisoners and their cells at regular but unpredictable intervals, and for searching prisoners after any contact with the outside world (visits, release on temporary license, outside work parties or escorts).

  4.8  Measurement of the effectiveness of searching is complicated by the broad range of measures bearing down on drug misuse but from April 1995 to March 1996 9,503 drug finds were reported centrally and this number fell to 7,587 in the following 12 months. Given the sustained emphasis on the importance of searching during that period, the likely explanation is that the overall drugs strategy was having a positive effect.

Supervision of visits

  4.9  It is commonly accepted that domestic visits is the most common route for smuggling drugs into prison[9] 1,174 visitors were arrested in 1997, on suspicion of smuggling contraband, 1,098 of whom were arrested after entry, as a result of careful management and supervision of visits. The provisional figure of arrests for 1998 is 1,090. Many establishments have been making changes to their visits procedures and the layout of their visit rooms in order to make supervision easier. Specific measures include: providing lockers for visitors to deposit luggage before going into the visits area; using furniture which has been designed to make the passage of drugs more difficult (low-level tables, fixed chairs); installing CCTV to aid supervision; searching visitors again if they visit the lavatory during a visit; and imposing closed or non-contact visits on those caught smuggling.

  4.10  CCTV can be costly to install (£25,000 to £50,000 depending on the size of the area to be covered) and live monitoring is staff intensive but carefully planned systems are proving a valuable asset. All category A and B prisons and all but three category C prisons now have CCTV in their visits areas and film from the cameras is providing evidence for subsequent adjudications and criminal proceedings.

  4.11  The Prison Service recognises that some prisoners and their visitors are pressurised into attempting to bring drugs into prisons. Visitors in particular have difficulty in accessing advice and support in dealing with this situation. A number of establishments in partnership with British Telecom have provided a freephone number and information pack which can be used by visitors to provide them with advice or allow them to give information to the prison about drug supply. Fifteen establishments are already committed to this initiative and two more will join the scheme shortly. Five other establishments already operate similar schemes independently. If the scheme proves effective, consideration will be given to extending it more widely.

Use of Dogs

  4.12  The presence of dogs can be a useful aid in both deterring and discovering drug smugglers. There are currently 669 dogs within the Prison Service spread across 70 establishments and there are plans to increase the number. 178 are active drug dogs, trained to seek and find substances and 34 are passive dogs which indicate the presence of drugs on visitors or prisoners.


  4.13  The National Dog Support Group is responsible for managing current resources and providing training. They also have a team of 18 dogs which are available to establishments on request for general searching purposes or to meet an operational need. Until recently the cost of training and deploying dogs was prohibitive but the Service is developing its own training capability which will reduce the costs from around £10,000 to around £3,500.

Intelligence

  4.14  Effective use of accurate intelligence is important in targeting supply routes and identifying drug dealers in establishments. The Prison Service has recently invested in developing improved IT systems for the handling and analysis of intelligence. This will complement a Memorandum of Understanding with the police, signed in August 1997, which focuses on improving co-operation and exchanging information. Discussions are also underway with Customs and Excise about similar improvements in joint working. Although not solely geared towards drug detection, these initiatives should mean better quality information on supply routes.

Contraband detection technology

  4.15  The Prison Service has an ongoing programme of research into technology designed to aid the detection of drugs (and other contraband). This research is carried out by the Home Office's Police Scientific and Development Branch (PSDB). PSDB also co-ordinates a working group in which various agencies shareexperience and assess new technologies. The Service is alive to the potential benefits of new technology but is waiting for the development of reliable and cost effective equipment which offers improvements on existing techniques.

  4.16  Operational trials of two trace detection machines have recently taken place in the Scottish Prison Service and the evaluation report is expected shortly. Customs and Excise have recently piloted a soft tissue image scanner (known as a "backscatter machine") which, in theory, would have detected items hidden in or under clothing but the equipment proved unsatisfactory and the trial was abandoned. We understand that more sophisticated drug detection portals, which would identify the presence of drugs as people pass through, are at an early stage of development.

Control of prescribed medication

  4.17  Measures are in place to prevent the misuse of prescribed medication. Health Care Standard 9.5 covers "in possession" medication generally and Health Care Standard 4.2.1 covers the specific arrangements for prescribing Methadone.

  It requires the prisoner's photograph to be attached to the prescription; adequate security to be maintained during dispensing; and for the Methadone to be taken in the presence of a Health Care worker.

Role of staff

  4.18  The claim is made periodically that staff are involved in the supply of drugs to prisoners but there is very little firm information to support the allegation. Centrally-held records show that, in the period since December 1993, nine staff have been found guilty of drugs-related disciplinary offences (covering personal use as well as breaches of security) and three staff resigned after disciplinary charges were laid against them.

  4.19  However, the Prison Service is aware of the potential for pressure to be applied to members of staff to compromise security, and the corresponding needs to identify those at risk and offer support. In relation to drug smuggling, this pressure may grow as other supply routes are targeted. There is particular concern that staff who misuse drugs themselves may be especially vulnerable to being suborned by prisoners or others. In the light of these and other concerns, and in conjunction with a review of policies in relation to the use of alcohol, the Service has begun an examination of whether any particular steps are needed to counter drug misuse by staff, beyond existing security procedures.

  4.20  Possible options include the introduction of pre-employment testing for drug misuse and the introduction of testing for drug misuse of existing staff, either on a "with cause" or random basis. Any compulsory testing of staff would involve a change in terms and conditions of service and would need to be the subject of full negotiations with the Prison Service trade unions. No decisions have been reached at this stage about whether any of these measures should be pursued.

Future developments

  4.21  The new strategy will seek to ensure that the wide range of existing measures which have been developed are implemented in the most effective manner. This embraces consistent delivery of basic procedures and the promotion of more innovative good practice. The review of the 1995 strategy highlighted some specific examples of the latter, including:

    —  use of posters in visits areas detailing the number of visitors arrested and the outcome of court appearances;

    —  liaison visits from the CPS and magistrates to increase understanding of the problems caused when drugs are brought into prison by visitors;

    —  protocols for co-operation between prisons and the local police covering arrest procedures, sharing of intelligence product and joint training.

  4.22  On 25 January, the Home Secretary announced a new initiative to clamp down on visitors and prisoners involved in drug smuggling. The changes, to be introduced in April, will bring a firmer and more consistent approach to the problem. Sanctions will include:

    —  a new power to ban visitors caught or suspected of smuggling drugs, for a set period to be determined by the quantity and type of drugs involved; the relationship between visitor and prisoner; and the circumstances of the offence. A typical ban would be for three months. (Governors would have discretion to override this if it would cause severe and disproportionate detriment to the rights of the person concerned to a family life);

    —  involvement of the police and the arrest of the visitor (as at present);

    —  all visits for the prisoner to be held in closed conditions for three months (and subject to review thereafter);

    —  prisoners targeted for frequent MDT;

    —  prisoner's status on the incentives and earned privileges scheme to be reconsidered;

    —  prisoner's categorisation and allocation to be reviewed where appropriate; and fresh sentencing guidelines on adjudications to promote greater consistency.

  4.23  The revised arrangements complement the Prison Service's recognition of its duty of care to prisoners and the importance of maintaining family ties. Some prisoners have already made it clear that they welcome this tightening of sanctions on the smuggling of drugs since it will enable them and their families to better resist pressure to bring drugs into prisons. A general review of visiting arrangements will shortly commence, which will look at how to promote the objective of maintaining family ties whilst maintaining security. The drug question will be an important consideration. The Service is keen to work with family ties groups to involve them in communicating positive messages about the drug strategy and in devising new ways of supporting visitors and helping them to resist the emotional pressure to smuggle drugs.

  4.24  Other initiatives planned under the new strategy include:

    —  a project to map the principal routes by which prisoners acquire drugs, drawing on intelligence sources, in order to provide more reliable data;

    —  the disruption of distribution networks in prisons; and

    —  the setting of targets for reduced availability of both opiates and other drugs.

5.  REDUCING THE DEMAND FOR DRUGS

Mandatory Drug Testing

Background

  5.1  Mandatory drug testing (MDT) was a cornerstone of the 1995 strategy. It was introduced in eight first phase establishments from February 1995, in order to test sample collection procedures, and between September 1995 and March 1996 it was extended to all establishments in England and Wales.

  5.2  It has three objectives:

    —  to deter prisoners from misusing drugs through the threat of being caught and punished;

    —  to supply better information on patterns of drug misuse to improve the targeting of treatment services and to measure the effectiveness of the overall strategy; and

    —  to identify individuals in need of treatment.

The Testing Process

  5.3  Mandatory drug tests can be undertaken for the following reasons:

    —  a random test of a proportion of the prison population per month (currently, 10 per cent of the population is tested, this is to be replaced with a minimum 5 per cent level for establishments with populations of 400 or more);

    —  on reasonable suspicion of having used a controlled drug;

    —  as part of a frequent test programme, ordered after the prisoner has been found guilty at adjudication of a drug-related offence;

    —  as part of the risk assessment process, for example in considering granting temporary release or transfer to a lower security establishment; and

    —  on first reception or transfer from another establishment.

  5.4  All MDT samples are sent to the Medscreen laboratory in London for analysis. Establishments are not authorised to test their own samples. Medscreen performs two types of analysis on samples. All samples undergo a screening test for seven drug groups: cannabis, opiates, methadone, cocaine, amphetamines (including ecstasy), benzodiazepines (tranquillisers), and barbiturates. The sample collector has the option of ordering that a sample be tested for an eighth, LSD.

  5.5  The results of screening are reported back to the establishment. A prisoner whose sample screens positive for drugs is normally charged with the disciplinary offence of drug misuse. If the prisoner enters any plea other than an unequivocal guilty, the adjudication must be adjourned and a more accurate confirmation test is requested. If the test results continue to be disputed, the prisoner has the right to obtain an analysis of the sample by an independent laboratory at his or her own expense.

Results

  5.6  The number of tests carried out across the Service per month ranges from 4,500-6,000. After a steady first year (the overall rate of positive random testing (RMDT) for 1996-97 was 24.4 per cent), there has been a welcome and sustained downward trend in the percentage of samples testing positive since the beginning of 1997-98—down from 23.5 per cent to 18.3 per cent in the second quarter of 1998-99.

Evaluation

  5.7  Two major research studies took place in 1998 to evaluate the MDT programme. The National Addiction Centre (NAC) carried out a statistical analysis of the random testing programme[10] and the University of Oxford Centre for Criminological Research assessed the impact of the testing programme on the extent and nature of the drug misuse[11]. The findings of these two studies were integral to the review of the 1995 strategy and helped to shape the new strategy.

MDT as a deterrent

  5.8  52 per cent of the 111 drug misusing prisoners interviewed in the Oxford study said that they had altered their drug misuse in response to MDT: 27 per cent had stopped using drugs, 15 per cent had reduced their misuse, 6 per cent were misusers of both cannabis and heroin who had altered the balance of their misuse towards heroin, and 4 per cent had experimented with heroin for the first time. A third of the prisoners who had stopped or reduced their drug misuse had not wanted to. In summary, MDT caused 42 per cent of drug misusers interviewed to stop or reduce their drug misuse.

  5.9  A conclusion supported by the MDT data and by both pieces of research is that where there has been an impact it has been largely upon cannabis misusers. The table below illustrates this:


RANDOM MANDATORY DRUG TEST POSITIVES 1996 TO 1998

Cannabis Positives
Opiate Positives

1996-97
19.9%
5.4%
1997-98
16.5%
4.2%
April-Sept 1998
14.7%
4.5%


  However, the fall in positive test results cannot be attributed to MDT in isolation. It is likely that the reduction was caused by the cumulative impact of a growing number of treatment programmes and supply control measures, coupled with MDT.

Better information on drug misuse in prisons

  5.10  This is one area where there is little doubt of the effectiveness of MDT. It offers reliable information on changing patterns of drug misuse over time in every prison. The NAC study confirmed that the random testing programme is a robust mechanism for measuring a particular dimension of drug misuse. However, there will be a continuing need for research to identify the behaviour which underlies the figures.

  5.11  Both the NAC and the Oxford researchers pointed out that in any drug testing system some misusers will escape detection. The Oxford study estimated that 31 per cent of current misusers had evaded detection by MDT, based on self-reporting. The solution, though, is not a technological one. To render the MDT figures a true measure of prevalence would require an extremely costly increase in the level of testing, to a point where there could also be serious control implications.

Identifying individuals in need of treatment

  5.12  The Oxford researchers found an eagerness in all the establishments they visited to integrate MDT with treatment services, although the necessary treatment services were not always available.

  5.13  This positive aspect of MDT has been undermined by prisoner hostility to what they perceive as a purely disciplinary initiative. The new strategy will seek to encourage greater integration of establishments' drug strategies, along the lines of good practice at Wandsworth, where MDT is located in the throughcare department, reducing hostility to the tests from prisoners and promoting greater cohesion with the treatment and rehabilitative elements of their strategy.

Switching from cannabis to heroin

  5.14  A common accusation against MDT, based on anecdotal evidence, is that it encourages switching from cannabis to opiates like heroin, in order to reduce the chance of detection. Occasional use of cannabis is detectable in urine for up to ten days, though this rises to 30 days for the chronic user. Opiates can be detected for up to seven days.

  5.15  Data from the MDT database shows no upward trend in opiate positives, to match any downward trend in cannabis positives and neither research study found evidence to suggest that switching was a problem. 4 per cent of the drug misusers in the Oxford study had experimented with heroin for the first time because of MDT, but none had persisted with it.

Future developments: MDT

  5.16  In the light of the research findings, the new strategy will take forward a number of refinements to MDT, which will be introduced early in 1999:

    —  Minimum levels of random testing: establishments with a population of 400 or more will be able to reduce their level of monthly random testing to 5 per cent of population. Smaller establishments will be required to continue to random test 10 per cent of population per month in order to maintain a sufficiently large sample for statistical significance.

    —  Mandatory frequent testing: MDT has made little impact on the levels of misuse of hard drugs, compared with its impact on cannabis use. However, the NAC research suggests that repeated mandatory drug tests can have a significant deterrent effect on hard drug misusers, with reductions in the percentage testing positive for the opiates with each successive test, until by the seventh test there were no positive tests. Although based on a small sample, this conclusion is potentially very important. Mandatory frequent testing of prisoners who test positive for the opiates, cocaine, methadone and LSD will be introduced from 1 April 1999, with its effectiveness reviewed after one year. The average burden on establishments, in terms of additional testing, equates to collecting an extra nine samples per month.

    —  Weekend Testing: at present, weekend testing is limited (around 8 per cent of total tests), the predictability of which detracts from the effectiveness of the programme. The theory that many prisoners confine their drug misuse to Friday nights, to minimise their chances of detection, exaggerates the self-control of most drug misusers. However, a reasonable level of weekend testing is certain to catch some prisoners who would have escaped detection and send a message that there is no safe time to take drugs. The change will require at least 14 per cent of MDT samples to be collected at the weekend.

Treatment

Background

  5.17  Prior to the launch of the 1995 strategy the provision of drug treatment services in prison was limited and usually reliant upon local initiative and funding. To meet the needs of prisoners identified by MDT the Prison Service made available central funding to expand the provision of drug treatment services across the estate, the amounts were:

    1995-6  budget £3.10 million actual expenditure £1.39 million

    1996-7  budget £5.04 million actual expenditure £4.76 million

    1997-8  budget £6.09 million actual expenditure £6.09 million

    1998-9  budget £7.34 million forecast expenditure £7.34 million

Initial Provision

  5.18  From autumn 1995 a range of pilot drug treatment programmes and services were developed and implemented across the Prison Service estate. There are currently 65 establishments in receipt of central funding. The drug treatment services developed include: counselling, advice, education and throughcare services; detoxification units; 12-Step, cognitive behavioural, and relapse prevention treatment programmes; and therapeutic communities.

Evaluation

  5.19  The first tranche of pilot projects have been subject to evaluation by PDM Consulting Ltd as well as ongoing contract management by the Prison Service Drug Strategy Unit (DSU) to help determine the future development of drug treatment provision across the Service.

  5.20  In summary, the key findings were as follows:

    —  an ambitious project of expanding drug treatment in prisons has been achieved at a time when population pressures have reached unprecedented levels;

    —  completion rates and cost of the programmes and services implemented are broadly comparable to those achieved in the community;

    —  residential programmes have demonstrated an impact upon prisoner behaviour: reduced drug use; improved relationships with staff; positive regard for the prison regime; increased knowledge and more positive attitudes;

    —  there needs to be a better match between the needs of individual prisoners and the provision of treatment programmes and services;

    —  the provision of "drug free" or voluntary testing accommodation needs to expand to support prisoners in recovery;

    —  the long term influence of programmes and services is reduced by the poor provision of aftercare and follow-up work.

  5.21  A major recommendation from the PDM evaluation and the review of the 1995 strategy was to establish a drug treatment service framework to provide an equitable provision of basic and enhanced specialist services to meet low level, moderate and severe drug problems.

  5.22  Prison Service and Probation Service have commissioned joint research into the nature and effectiveness of current drugs throughcare procedures. The research is looking at drug treatment programmes in some 17 establishments and studying how these interface with agencies and services outside. The experiences of some 300 offenders will be tracked in this study. A key aim of the research is to establish what constitutes best practice and to disseminate the lessons learned.

  5.23  The research is being carried out by Surrey University in collaboration with Morgan Harris Burrows. An interim report should be available in February 1999 and the final report in mid-1999.

Future Developments

  5.24  The Comprehensive Spending Review funding will enable significant progress in implementing the recommendations from the review of Drug Misuse in Prison. Specifically the Prison Service will:

    —  make significant progress in implementing a drug treatment service framework;

    —  provide voluntary testing accommodation to all prisoners wishing to prove they are drug free;

    —  buy or develop a centrally accredited moderate intensity drug rehabilitation programme;

    —  require all existing rehabilitation programmes to gain KP17 (see paras 5.40-5.41) accreditation by April 2002;

    —  ensure that the provision of services is dynamic and meets the needs of prisoners through monitoring by area drug strategy co-ordinators;

    —  measure effectiveness through continuing independent research against a bench mark of reducing recidivism; safer or reducing drug use; and maintaining contact with treatment and rehabilitation services.

The Prison Service Drug Treatment Service Framework

  5.25  The Prison Service has developed (in conjunction with PDM) a new drug treatment service framework which, once implemented, will provide an equitable distribution of basic and enhanced/specialist services to meet low level, moderate and severe drug problems.

  5.26  Basic drug treatment services will be provided in all establishments, these include:

    —  assessment on first reception;

    —  ongoing monitoring to measure progress throughout custody;

    —  counselling, assessment, referral, advice and throughcare services (CARATS);

    —  detoxification and prescribing services (local prisons & remand centres only);

    —  voluntary drug testing and/or voluntary drug testing units; and

    —  visiting self help fellowship groups eg AA, NA, etc.

  5.27  Enhanced drug treatment services will be available on an area basis, these include:

    —  Drug dependency centres (DDC)—located in key local prisons and remand centres. DDCs are intended to provide specialist and enhanced detoxification, clinical and prescribing services and act as a resource to other establishments within the area.

    —  Day attendance rehabilitation programmes—12-16 weeks in duration with participants provided with voluntary testing unit accommodation. These programmes could be placed in any type of establishment (not normally remand centres or local prisons unless there is a substantial population who remain within the establishment long enough to complete the programme).

    —  Residential rehabilitation programmes—dedicated units offering programmes of 12-16 weeks in length (not normally remand centres or local prisons unless there is a substantial population who remain within the establishment long enough to complete the programme).

  5.28  The enhanced services that will be provided on a national basis are:

    —  Therapeutic communities—dedicated units offering residential, intensive programmes which last a minimum six months, but more normally 9-12 months. These units will normally be provided in training establishments which have a substantial population with greater than 12 months left to serve.

  5.29  The drug treatment service framework will take account of:

    —  timeliness (most appropriate stage in sentence);

    —  intensity (the demands placed on the participant and the period of time spent in therapeutic contact);

    —  threshold (requirements for entry/access into the service/programme);

    —  tolerance (action taken on a positive urine test for drugs); and

    —  supervision (number of staff, degree of segregation, frequency of urine tests).

Carats

  5.30  The needs of the great majority of prisoners will be met through the development of an integrated counselling, assessment, referral, advice and throughcare service (CARATS) within and across Prison Service areas. CARATS must be available in every establishment via local, cluster or area contracts with community agencies working in conjunction with prison and probation staff. The current plan is for all to be in place by October 1999. This is a pivotal development for the new strategy because CARATS will provide the foundation of the drug treatment service framework; linking:

    —  the courts and establishments;

    —  different departments within an individual establishment;

    —  different establishments upon transfer of a prisoner; and

    —  between the Prison Service and agencies within the community.

  5.31  CARATS will need to provide a range of easily accessible interventions, including:

    —  initial assessment upon first reception;

    —  health liaison with community on prisoners reception to prison;

    —  specialist input into pre-sentence reports, bail applications and assessments for home detention curfews;

    —  post detoxification assessment and support;

    —  specialist input into sentence planning;

    —  counselling aimed at addressing drug problems (on individual and group basis);

    —  support and advice on a range of drug, welfare, social and legal issues;

    —  assessment for in-prison rehabilitation programmes;

    —  assessment for post-prison rehabilitation programmes/drug services;

    —  pre-release training;

    —  health liaison with community upon prisoners' release;

    —  liaison with and referral to community agencies to enable effective resettlement.

Rehabilitation Programmes

  5.32  There is currently a range of different programmes available across the Service that can be placed under the umbrella of "rehabilitation programmes", these include relapse prevention, cognitive-behavioural and abstinence based 12-step programmes. These programmes will be further expanded under the drug treatment service framework.

  5.33  These "moderate intensity" programmes are most appropriately targeted at prisoners who have a documented history of drug dependency and drug related offending. Prisoners need to be serving sentences of six months or more to access these programmes.

  5.34  Rehabilitation programmes have two major aims (a) to enable the participant to reduce or stop using drugs and (b) to address their offending behaviour. These programmes will be required to conduct routine and standard monitoring to provide a range of objective measures of the impact of the programme upon prisoner behaviour. These may include adjudication figures, drug testing results, psychometric tests, constructive use of the prison regime, etc. Failure to meet accreditation criteria by April 2001, may result in the withdrawal of funding.

  5.35  The aim is to provide a range of quality rehabilitation programmes across the Service which meet a recognised standard but there are plans to commission a central accredited Prison Service moderate intensity drug rehabilitation programme to be ready for implementation in establishments by April 2000.

Therapeutic Communities (TCs)

  5.36  TCs are intensive treatment programmes targeted at prisoners with histories of severe drug dependency and related offending who have a minimum of 12-15 months of their sentence left to serve.

  5.37  The TC methodology provides a distinctive approach to the treatment of substance misuse as well as other dysfunctional behaviours that often accompany the misuse of drugs and alcohol. TCs are "drug free environments" which operate a total immersion view of treatment that requires 24-hour residential care and comprehensive rehabilitation services. Residents are expected to take between 6-12 months to complete the programme.

  5.38  The Prison Service currently has three TCs dedicated for drug misusers. These are located at Channings Wood, Portland and Holme House. In each case, these TCs provide a programme based on a generic model developed for the Prison Service by Phoenix House (US). The number of TCs will be expanded as a result of the implementation of the drug treatment service framework.

Auricular Acupuncture

  5.39  Auricular acupuncture is becoming increasingly popular in prison as a low cost and popular method of assisting prisoners to detoxify from drug dependency. Acupuncture is used in a range of different types of establishments including: Holloway, Dorchester, Ranby, Feltham, Elmley and Cookham Wood. All staff administering auricular acupuncture are trained to National Acupuncture Detoxification Association (NADA) standards (two days training, five days on-site supervision and trainee has to perform 50 supervised treatments).

  5.40  Auricular acupuncture helps to:

    —  reduce craving for drugs and alcohol;

    —  ease withdrawal symptoms;

    —  reduce tension and stress;

    —  aid relaxation;

    —  promote sleep; and

    —  clear the mind and give a sense of well-being.

  5.41  Auricular acupuncture is widely used by community drug agencies and Drug Dependency Clinics in the UK. Acupuncture is seen as an adjunct treatment rather than a replacement for conventional approaches. West Lambeth Hospital reported that £4,000 per client is saved while reducing the "revolving door syndrome" notorious in detoxification programmes. Research from the USA suggests that acupuncture can reduce "erratic behaviour that accompanies acute withdrawal in the prison population".[12]

  5.42  Individual establishments are also exploring a range of other complementary therapies (including aromatherapy, yoga and relaxation training). This reflects a willingness to learn from the expertise of community drug agencies; and explore innovative solutions with a view to determining their effectiveness. The Prison Service aims to evaluate the effectiveness of all approaches to tackling drug misuse, including the complementary approaches.

Accreditation, Monitoring and Evaluation

  5.43  The implementation of the Prison Service Drug Treatment Service Framework will be monitored centrally and by Area Drug Strategy Co-ordinators against a standard set of output and outcome measures.

  5.44  The Prison Service accredits programmes which can be expected to reduce re-offending (and the number of completions of accredited programmes is measured as one of the Service's Key Performance Indicators). Accreditation standards are rigorous, requiring both a solid basis in research and careful programme implementation. Some substance abuse treatment is eligible for accreditation and a number of programmes are currently being developed to meet accreditation standards, (although none have yet demonstrated the requisite quality).

  5.45  Other programmes and services will be required to meet the general standards for drug abuse treatment programmes being developed by SCODA and Alcohol Concern for the "Quality in Alcohol and Drug Services" (QuADS) project, sponsored by the Department of Health, which forms part of the "Tackling Drugs to Build a Better Britain" strategy. The standards cover the proper management of services which address the health problem of substance misuse; a programme which meets these standards would not necessarily be effective in reducing offending as measured by the KPI7 accreditation criteria.

Harm minimisation

  5.46  While the aim must be to reduce drug misuse by prisoners, it would be unrealistic to expect every prisoner to accept opportunities to tackle their misuse. Drug smuggling, possession or use will not be tolerated but they are unlikely to be eradicated completely. So it is essential to minimise the harm that abusers will do to their health. A particular concern is the potential for communicable diseases, such as HIV and hepatitis, to be spread by the sharing of injecting equipment. Responding to this potential problem requires a difficult balance to be struck between the Prison Service's duty of care and its duty to prevent drug misuse during custody.

  5.47  A number of pieces of work are currently underway:

    —  provision of disinfecting tablets is being explored so that prisoners may clean their injecting equipment between uses. This forms part of a health education approach which is entirely consistent with the Prison Service's duty of care and with the public health approach adopted elsewhere in the community, to reduce the spread of communicable diseases. Disinfecting tablets are now being provided, on a pilot basis, in 11 prisons in England and Wales. If the pilot is a success, the initiative is likely to be introduced to the remainder of the prison estate;

    —  another area which is being assessed is how quickly the Prison Service can meet its aim of vaccinating all prisoners against hepatitis B;

    —  the creation of needle exchange schemes has been ruled out at present but will be reviewed in due course;

    —  the simple provision of good quality drug misuse advice to all prisoners on arrival in custody will form part of the basic level of support to be introduced later this year;

    —  the point of release of a drug misuser is a crucial time. The resumption of drug misuse after a clean period or after the use of diluted substances while in custody can be fatal as the body's tolerance levels will inevitably have been reduced. Again, the basic level of support provided to all prisoners will ensure that information about the risks of drug misuse on release are made clear.

  5.48  The area of harm minimisation is a key component of the drug strategy and will be reviewed constantly as the strategy is implemented.

Voluntary Testing

Background

  5.49  Prisoners who graduate from treatment programmes will often need support and positive reinforcement to minimise the risk of relapse. The purpose of a Voluntary Testing Unit (VTU) is to provide a suitable environment for those who wish to live drug-free. As well as those who have successfully completed a course of treatment, it is also appropriate for those who have never misused drugs and who are seeking to stay clear of pressure from dealers, either to buy drugs or to have them brought into the prison.

  5.50  The 1995 strategy acknowledged that a number of establishments were experimenting with drug free areas or wings to complement treatment programmes and noted the approach as being worthy of further exploration.

  5.51  In 1997 the new Government made a commitment to provide access to voluntary testing for all prisoners. A survey at the time showed that just over a third of establishments had some arrangements for voluntary testing, providing about 3,700 places. Downview and Blantyre House regarded themselves as drug free prisons. Others had units varying in size from 290 at Manchester to 10 places at Long Lartin.

The present position

  5.52  The number of places has continued to grow and is now over 4,000. However, the absence of standard central guidance on setting up and running VTUs has resulted in piecemeal development. Some prisons require agreement to voluntary testing as a condition for entry to a treatment program, but have no facilities for inmates who have never used drugs. Others have sometimes quite substantial numbers of inmates who have signed up for voluntary testing but have insufficient resources to carry out the necessary number of tests.

  5.53  Further work is planned to estimate the demand for voluntary testing and the cost of providing it but, under the new strategy, a consistent framework for the provision of VTUs is being developed and funds will then be allocated from the CSR resources to make a reality of universal access.

Framework for VTUs

  5.54  The consistent framework will cover the following areas:

    —  VTUs will accommodate both graduates of drug treatment programmes and those who have not taken drugs. Mixing helps to stabilise the unit and to promote a positive atmosphere. Residents who have never used drugs can act as role models and provide peer group support. The balance between the groups does not have to be equal and is for local judgement;

    —  all inmates who agree to voluntary testing must sign a compact. The compact must explain the prisoner's obligations, the procedures to be followed, the standards to be applied, the consequences of failing a test (including random MDT), whether the results can be challenged and any other reasons which might result in exclusion;

    —  selection criteria must be clear and consistently applied. Care must be taken to prevent infiltration by non-using dealers;

    —  testing must be random but sufficiently frequent to prevent inmates abusing the system. On average, VTU inmates should be tested at least 18 times a year, it is essential that testing is frequent enough to detect drug misuse quickly so that the users can provide drug free environments;

    —  a positive result can be followed only by administrative sanctions and not disciplinary procedures;

    —  sampling and analysis methods other than MDT can be used;

    —  establishments may want a more flexible approach than excluding an inmate after a single positive test, such as issuing a warning and only expelling after a second or third failure. The bottom-line, across the service, is automatic expulsion in the event of three positive tests in a 6 month period;

    —  visiting prisoners, ie those who are not resident on the unit, must be barred from VTUs, but there is no need for expensive structural alterations to reinforce this. VTUs are not segregation units, and some measures of contact with other prisoners is desirable. They will not be cocooned post-release, and must learn to resist the temptation that will inevitably come from other dealers. An area can be designated within the prison and declared out of bounds to other inmates;

    —  establishments may wish to impose agreement to voluntary testing as a condition of acceptance on drug treatment programmes they are running. However, VTUs are not in themselves treatment units, although continuing counselling may be needed to support ex-users. Some prisons will have sufficient space and demand to set up Relapse Prevention Units alongside VTUs for those who have recently completed a course of treatment.

Costs and Savings

  5.55  Provisional plans are to allocate more than £5.5 million per year for the next three years. This money is to provide accommodation, testing suites and kits. Any associated counselling or treatment is to be funded from CARATS.

  5.56  Against this expenditure must be set the potential savings from reducing the misuse of drugs. Clearly these extend well beyond the Prison Service but there are potential savings for the Service, particularly if the creation of drug-free environments result in improved behaviour and a reduction in drug-related disorder. Since Downview prison became "drug-free" in 1992, improved behaviour has substantially reduced the number of adjudications and the corresponding number of added days awarded. In 1992, they had a monthly average of 60 adjudications; by 1997 this had fallen to 10. This level of adjudications translates into 929 added days. Some caution is required here as there is little doubt that the positive regime at Downview served to attract prisoners motivated to remain drug free.

Sanctions and Incentives

  5.57  A range of firm and effective sanctions for drug offences sends a powerful signal to prisoners that drug misuse will not be tolerated. At the same time it is important to offer positive incentives for remaining drug-free, as well as treatment options for those with a problem.

Disciplinary and Administrative Responses

  5.58  An analysis of punishments for drug offences across 117 establishments in 1997 carried out by the Home Office Research Development and Statistics Directorate revealed that 62 relied almost exclusively on awards of additional days. This is too narrow a focus. There is some evidence that this can be an effective deterrent for young offenders and short term prisoners, for whom an award of 14 days is a significant addition to the time to be served. But, for other prisoners, it may be more effective to impose punishments that have a more immediate impact, such as forfeiture of privileges or stoppage of earnings.

  5.59  Furthermore, at a time of acute population pressures, the award of added days represents a considerable burden on the Prison Service. The Oxford researchers calculated that the additional days given as punishments for drug offences in 1997 amounted to an extra 360 prisoner places per year.

  5.60  Under the new strategy, therefore, Governors will be encouraged to utilise a wider range of responses, including administrative responses (such as closed visits). The choice of sanction should be based on the likely effectiveness and the potential for differentiating between more and less serious offences. This means recognising the greater harm caused by hard drugs compared with soft drugs, and by supply compared with personal use. It does not mean being soft on cannabis, rather it is a more accurate reflection of the pattern of sanctions applied in the community.

  5.61  The Home Secretary's new initiative on tackling drug smuggling, takes the same approach—drawing up a broad but standardised menu of sanctions to be applied with due regard to individual circumstances and the severity of the offence.

Incentives and Earned Privileges

  5.62  The Prison Service's national framework for incentives and earned privileges (IEP) is designed to encourage good behaviour amongst prisoners and co-operation with the regime. The new strategy commits the Service to using the provision of incentives and earned privileges to reward drug-free behaviour.

  5.63  Governors have discretion to devise and operate local schemes (within the local framework) and may use IEP to help create a drug free environment, for example prisoners could be required to remain drug free in order to qualify for admission to the highest (enhanced) privilege level. Conversely, breaking the rules of a drug-free wing could see the prisoner removed from that location and their privilege level reviewed (movement up or down the different privilege levels is determined by regular evaluations of a pattern of behaviour, rather than a single incident; demotion is therefore an administrative rather than a disciplinary sanction).

  5.64  One of the most powerful incentives available to Governors is the provision of in-cell television, which is currently being extended across the prison estate as an earnable (and forfeitable) privilege. As well as the link to the IEP, Governors have discretion to link it to their drug strategy via drug free wings containing enhanced and standard (but not basic) level prisoners. Of those establishments taking delivery of sets during the current financial year 19 have indicated that they are linking the provision of in-cell TV directly to drug free accommodation.

6.  TAKING FORWARD "TACKLING DRUGS IN PRISON"

Infrastructure

  6.1  To take forward a formidable agenda of work, the strategy sets out a revised infrastructure both at headquarters and in the field. A new Drug Strategy Unit has been created at headquarters, drawing together the various policy responsibilities, to lead and support the implementation of the strategy; monitor its effectiveness and continue the evolution of the Prison Service's strategic framework. The DSU will also liaise with the United Kingdom Anti Drugs Co-ordination Unit.

  6.2  Specific tasks for the DSU will include:

    —  co-ordinating implementation of the strategy;

    —  allocating funding to the field;

    —  a progress report to Ministers and the UK Anti-Drugs Co-ordinator in March 1999;

    —  developing new measures of performance to link in with the national strategy indicators, particularly

  —  reducing recidivism amongst drug misusing offenders

  —  increasing referrals for treatment

  —  increasing treatment programme completions

  —  deterring and detecting drug availability in prisons

    —  strengthening links between the Prison Service and other statutory and voluntary agencies;

    —  commissioning research into key elements of the strategy; and

    —  co-ordinating research into the needs of specific groups of offenders.

  6.3  In the field a network of area co-ordinators has been put in place to oversee delivery of the strategy. They will also ensure the consistent application of effective practice and, through an active role in Drug Action Teams, will promote links between establishments and their communities.

Training

  6.4  Well-trained and aware staff will be crucial to the successful operation of the strategy. There has already been a considerable investment in training under the 1995 strategy:

    —  every establishment provided a team for multi-disciplinary drug strategy team training;

    —  a group of staff from every establishment were trained as MDT sample takers;

    —  prison healthcare staff have access to a range of training opportunities in the clinical management of substance misuse; and

    —  all new staff receive a module on substance awareness in their initial training.

  6.5  Nevertheless, in the evaluation of the pilot treatment projects, PDM concluded that some staff running programmes lacked sufficient knowledge and levels of knowledge amongst officers generally were poor.

  6.6  The new strategy includes a commitment to provide a coherent training strategy, for the full range of drugs issues. The first step is to undertake a training needs analysis to review what is currently provided against what training is required. The aim is to have in place a strategic package of training for 2000-01.

Areas for further work

  6.7  The strategy offers a blueprint for further progress, it does not offer a definitive position on every aspect of the problem of drug misuse but, given that the problem is complex, rapidly changing and multi-faceted, this would not be feasible. Acknowledging that there are gaps in our knowledge and policies, the strategy signals some priority areas for further research and policy development, which will be funded and taken forward over the next three years. Principally this means developing specific approaches for different groups in the prison population.

Young offenders

  6.8  Aim (i) of the Government strategy is about helping young people resist drug misuse in order to achieve their full potential in society. Considerable effort is being invested in developing appropriate regimes for young people in custody, starting with the under 18 year olds. This will be closely linked to the work of the local authority based youth offending teams and to other community based drugs initiatives. There is evidence which demonstrates markedly different patterns of drug use amongst young offenders, both in the community and in prison, although further, more specific research is likely to be needed. There are innovative projects in progress—Lancaster Farms run a successful peer-led drug support group—but the good practice both in establishments and in the community will need to be harnessed into a coherent strategy, which has a particular emphasis on high quality drugs education.

Women

  6.9  Work has already begun to examine the specific needs of women and draw up an appropriate response. This work will need to take on the different histories and pattern of misuse of female prisoners, including the provision of programmes for drug importers, as well as the different healthcare concerns of women, such as care for pregnant drug users and the impact on the unborn chid. Again, the aim will be to survey the available good practice and commission research to fill any gaps in our understanding.

Short-term and remand prisoners

  6.10  For short-term and remand prisoners, prison may offer a fleeting opportunity to make contact with drug treatment services but lack of time is likely to disqualify them from many treatment programmes. The priority for this group will be the CARATs which will at least offer some assessment of any drug problems and the chance to link into community drug agencies.

  6.11  We will commission research into the needs of all these groups of offenders.

Throughcare

  6.12  A crucial factor in the success of the Prison Service's approach to tackling drug misuse will be throughcare. By throughcare we mean the quality of care delivered to the offender from initial reception through to preparation for release establishing a smooth transition to community care after release. For the Prison Service Strategy to succeed, tackling drug misuse must be an integral part of the prison system so that, for example, there are direct links with sentence management or with the incentives and earned privileges scheme. Also, while specialised skills are necessary in a number of elements of the Prison Service's Strategy (clinical practice or rehabilitation are two examples) we must ensure that all staff—regardless of whether they are Prison Service staff or are from other agencies—who have contact with prisoners hold a basic understanding of drug misuse and the measures available to tackle it.

  6.13  As reported by the PDM study, the point of release of an offender is vital. At present the good work done by an offender while in prison can be wasted because support in the community may not be immediately available. Prison Service support currently stops when the offender leaves the prison gate. Offenders will then join the back of a queue for community based support which can currently be a long wait. There is no doubt that many drift back into drug misuse while waiting for that support. For those who remain in the queue, the support eventually offered can lack continuity or even compatibility with the work done by the offender while in custody.

  6.14  We are determined to tackle this problem. The CARAT service described earlier will see drugs workers providing treatment and ongoing support for offenders while in custody. As an offender approaches the date of release the drugs worker will identify a suitable community based support programme for the offender. Crucially, the drugs worker will maintain contact with the offender for up to eight weeks after release to ensure that support is continuous. This is a simple but radical step for the Prison Service which should ensure consistency and continuity of support for drug misusers.

  6.15  The drugs worker will also ensure that the offender's drug misuse needs are linked to other, more basic requirements such as housing. He/she will also warn the offender of the dangers of returning to drug misuse on release, in particular the risk of overdosing because of reduced tolerances. The sentence planning process should ensure that offenders' needs are identified and incorporated in a sentence plan. When a prisoner comes to be released on licence, the supervising (home) probation officer will be involved in the planning of any further treatment/support that is necessary in the community and will provide follow-up and monitoring as part of a supervision plan.

  6.16  The Prison Service cannot undertake these tasks alone and over the course of the next three years (the strategy implementation period) will work closely with the UKADCU, Probation Services, Drug Action Teams and drug agencies to ensure the provision of services which are compatible with those offered in the community. There is scope for new approaches here such as joint funding of services on a large scale, joint purchasing arrangements, joint accreditation or the creation of coterminous areas to help consistency. It is early days and the effects are currently directed towards putting in place key services in prisons. But over the next few years radical and innovative approaches will be explored.

Monitoring

  6.17  Implementation of the strategy will be measured rigorously. There are three elements:

    —  measurement of inputs;

    —  monitoring of spending; and

    —  evaluation of effectiveness.

Inputs

  6.18  In the short term, the only two measures that will be available will be inputs and spending. Input measures are currently being developed which will provide a picture of what is being provided. For example, the number of treatment programmes completed successfully or the number of voluntary testing spaces available. None provide a clear answer on effectiveness but they will:

    —  provide a simple measure of how we are spending our funding;

    —  indicate the level of consistency of approach across the prisons estate (and therefore allow us to tackle any inconsistency);

    —  give pointers to the effectiveness of the strategy—we would, for example, expect to see the demand for treatment or voluntary testing increase in the short term if we are getting the strategy right.

  6.19  The exception is the existence of the MDT systems which provides a well established performance measure in the form of a Prison Service Key Performance Indicator. This provides a measure of drug misuse in prisons.

Finance

  6.20  Clearly we must provide value for money. This year Prison Service spending on tackling drug misuse is just over £9 million. This level of funding is expected to continue in future years. In addition, the Prison Service was allocated an extra £76 million over the next three financial years (1999-2002) from the Comprehensive Spending Review. There is a need to identify the spending of all of this funding in order to achieve the best value for money and avoid disparities between different areas of the prison estate. The Prison Service will ensure that the spending of this funding for 1 April 1999 can be identified.

Evaluation of Effectiveness

  6.21  The most important issue about the Prison Service's implementation of its strategy is evaluation of its effectiveness. Some of the CSR funding will be used to conduct independent evaluation of the effectiveness of specific elements of the strategy and of the strategy as a whole.

Next Steps

  6.22  There is an ambitious and comprehensive programme of work to be undertaken by the Prison Service. Since the new strategy was launched last year, the Prison Service has bid for the CSR funding, marketed the strategy and identified the most appropriate allocation of the extra funding. It has of course also continued the existing programme of work emanating from the 1995 strategy. The Prison Service is now moving towards the actual delivery of the new strategy. The programme of work for the next three financial years includes:

Treatment:creation of minimum standards and specifications for the main interventions;
creation of policies and spaces for voluntary testing;
evaluation of equipment for voluntary testing;
a major procurement programme for the provision of more intervention programmes by external providers;
development of accreditation;
reviews of existing contracts;

Supply Reduction:an analysis of the effectiveness of drug detection equipment;
an audit of the use of drug dogs by the Service;
inter-agency work with family support groups to provide advice and support for prisoners' friends and families;
review of visit procedures;
an intelligence project on drug routes into prisons;
Training:review of existing drugs training;
training needs analysis;
design of new courses;
Monitoring:creation of financial and input monitoring systems;
Research:into the needs of specific groups of offenders;
into the effectiveness of the strategy.


Conclusion

  6.23  This not not the tme to judge the new Prison Service strategy "Tackling Drugs in Prisons". One stage to judge it will be in three years time, when the CSR resources have been translated into new treatment structures and further research has been carried out into the remaining gaps in the strategy. However, the real success or failure of the strategy needs to be measured on a longer time-scale, when the impact on re-offending and drug use can be assessed.

  6.24  In the meantime it is possible to say that the new strategy promises to build on the successes of the 1995 strategy and develop further the Prison Service's response to drug misuse. The strategy is balanced, evidence-based, well resourced and promises to spread effective practice in a more consistent and systematic fashion. It also acknowledges where the remaining weaknesses lie and promises to fund further research and analysis to fill these gaps.

PROPOSALS FOR SITE VISITS

  A range of different types of establishments and approaches is proposed in order to achieve a broad picture of the variations in approach, quality, constraints, etc. The Committee must bear in mind that the situation will change significantly once the Drug Strategy is implemented from April 1999 onwards.

HMP Swaleside, Kent (category B adult training prison)

  The focus of this visit should be E-wing, a 52 bed unit which operates a 24 week cognitive behavioural rehabilitation course. The programme is provided under contract by Addaction, a community drug treatment agency, who work in conjunction with prison staff. The establishment also provides peer counselling, liaison and throughcare arrangements for the rest of the population.

  The Kent Prison Service area has a full-time area drug co-ordinator (ADC) who is responsible for the development of the area's drug strategy and contract manager for community drug agencies working within Kent prisons. The Prison Service DSU funds projects in all 11 establishments within Kent. The HAC are advised to spend time with the Kent ADC in order to understand the complexities of meeting the needs of a range of different establishments. The Prison Service has recently recruited an area drug co-ordinator for each of the Prison Service areas and the Directorate of Dispersals.

HMP Holme House, North East (category C adult training establishment)

  The DSU fund a 65 bed therapeutic community (TC) at Holme House which is linked to a 64 bed voluntary testing unit. The TC is aimed at prisoners with a minimum of 12 months left to serve, who have a long history of severe dependency and drug related offending. The TC is delivered by prison officers who work in partnership with Phoenix House, a community drug treatment agency. An application for programme accreditation under KP17 was made last year and the programme achieved a score of 15/20, narrowly missing accreditation by 2 points. It is hoped a re-submission this year will gain full accreditation for the programme.

HMP Wealstun, Yorkshire (category C and D adult male training establishment)

  Funding from the DSU has enabled Wealstun to develop a 33 bed voluntary testing unit which is enhanced by the provision of counselling, support and throughcare services. Wealstun aspire to become the "Downview of the North" by encouraging the population to sign up to voluntary testing compacts. To this end, the DSU have recommended the provision of significant CSR resources to Wealstun in order to expand the provision of voluntary testing and to further develop the rehabilitation programme.

HMP Holloway, London, North & East Anglia (female local)

  The DSU fund a self contained detoxification unit H1 (10 day programme) and a relapse prevention unit A5 (6 week programme) at this busy female local prison. Both of the units have a capacity for 33 prisoners. Contracts with West London NHS Trust and Cranstoun Drug Services respectively are held for the delivery of these services.

  H1 is extremely busy and dealt with over 1,500 women last year, approximately 35 per cent of the women detoxed at Holloway are "repeaters" ie after attending the programme they were released from prison, only to return to Holloway in need of detoxification again. The increase in the proportion of short-term and remand prisoners at Holloway has required the relapse prevention unit on A5 to be continually modified and shortened to ensure that it continues to meet the needs of the population.

HMP Swansea, Wales & West (local prison)

  The DSU provide funds for a detoxification unit at Swansea. The performance of this project has been disappointing. In part this can be explained by the prison using drug specific funds to subsidise delivery of general healthcare. This project is an example of how a new initiative can be stifled by financial and managerial pressures within the establishment.

HMYOI Portland, South Coast (young offender institute)

  A considerable investment has been made by the DSU at Portland to establish a 72 bed therapeutic community (TC) for young offenders. After two years the TC is still struggling to attract sufficient participants. This may be due to: the location of the establishment; the unsuitability of the TC model for young offenders; insufficient marketing of the project.

HMP Liverpool, Mersey & Manchester (local prison)

  The focus of this visit should be for the HAC to gain an understanding of the competing needs of a large, busy local prison located in an area renowned for drug problems. The DSU provide modest funds for a drug treatment liaison officer and two additional health care officers for the development and delivery of a drug treatment clinic in the health care centre. The CSR drug funds have provided an opportunity to improve the provision of services, particularly detoxification and CARATS, to better meet the needs of this large local prison.

HMYOI Feltham, London South (young offender institution and remand centre)

  Feltham, a good example of a large busy YOI and RC, does not currently receive any financial support from the DSU. Feltham has 60,000 movements through reception each year, including 5,000 new receptions. The positivity rate for mandatory drug testing stands at 24 per cent—the vast majority of positive results are for cannabis.

HMP Buckley Hall, Mersey & Manchester (category C, male training establishment)

  A visit to Buckley Hall would provide the HAC the opportunity to see how a private prison is tackling the problems presented by drug misuse. The prison provides a full-time drugs worker, a detoxification and rehabilitation programme and a drug awareness course. Buckley Hall does not receive any DSU funding.

SITE VISITS TO COMMUNITY PROJECTS

  The Committee will also wish to visit some community projects to examine non-custodial options for drug misusing offenders and throughcare for drug misusing ex-offenders. A couple of appropriate projects are listed.

South East London Probation Service (Croydon)

  This is one of the three probation areas which are piloting the drug Treatment and Testing Order. The Order is targeted at serious drug misusing offenders at risk of being sentenced to imprisonment. Those on the Order are subject to frequent random drug testing to ensure they are staying off illegal drugs.

Bridge House Probation and Bail Hostel, Bristol

  This is a drug and alcohol free hostel where residents are regularly tested by way of urine and breath tests for any illicit use of drugs/alcohol. The hostel runs a structured, intensive, six days a week programme for male offenders who are subject to bail assessment, probation and licence, including lifers. Bridge House works closely with Bristol prison and its drug and alcohol free wing. This enables identification of suitable offenders be they for bail assessment/probation or licence. The Hostel also works closely with Bristol Drugs Project, Narcotics Anonymous and Alcoholics Anonymous.

  When residents have completed the 12 week programme they move onto cluster accommodation run by Bridge House. Residents continue to be subject to regular drug and alcohol testing. Their supervision at this point is primarily undertaken by field based probation officers.

1 February 1999





1   Cm3945. Back

2   Tackling Drugs in Prison (The New Prison Service Drug Strategy May 1998). Back

3   Drug Testing Arrestees (Bennett)-Home Office Research Study 183/Research Findings. Back

4   Guidance to practitioners in the pilot areas is available on the Home Office web site: (www.homeoffice.gov.uk/cdact/index.htm). Back

5   HIV/AIDS risk behaviour among adult male prisoners (Strang et al.)-Home Office Research Findings No. 82. Back

6   Mandatory Drug Testing-An Evaluation (Edgar and O'Donnell)-Home Office Research Findings No.75 and Mandatory Drug Testing in Prisons: The Relationship between MDT and The Level of Drug Misuse (Edgar and O'Donnell)-Home Office Research Study No.189. Back

7   Women in Prison: A Thematic Review by HM Chief Inspector of Prisons, Home Office, 1997. Back

8   George Howarth (Parliamentary Under Secretary of State)-Preface to "Tackling Drugs in Prison". Back

9   The Advisory Council on the Misuse of Drugs concluded that "visits are undoubtedly the main supply route of drugs into prisons" in their 1996 report "Drug Misusers and the Prison System-An Integrated Approach". Back

10   An Analysis of the Mandatory Drug Testing Programme: Key Findings (National Addiction Centre, April 1998). Back

11   Mandatory Drug Testing in Prisons (Edgar and O'Donnell)-Home Office Research Findings No. 75. Back

12   Acupuncture as a Foundation for Treatment Services, Addition and Recovery November/December 1993. Back


 
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Prepared 23 November 1999