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Home Affairs Committee - Drugs: Breaking the Cycle - Minutes of EvidenceHC 184-II
house of commons
taken before the
Home Affairs Committee
Tuesday 3 July 2012
Richard Bradshaw and Digby Griffith
RighT HON. KENNETH CLARKE QC MP
Evidence heard in Public Questions 375 - 429
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Taken before the Home Affairs Committee
on Tuesday 3 July 2012
Keith Vaz (Chair)
Mr James Clappison
Dr Julian Huppert
Mr David Winnick
Examination of Witnesses
Witnesses: Richard Bradshaw, Director of Offender Health, National Offender Management Service, and Digby Griffith, Director of National Operational Services, National Offender Management Service, gave evidence.
Q375 Chair: Mr Bradshaw and Mr Griffith, my apologies for keeping you waiting. As it comes to the end of the Session, we have all our witnesses in to try and clear up our inquiries. Perhaps I can start with this question: Committee members have visited both Pentonville and Brixton over the last few weeks and I was struck by the figure that one-fifth of prisoners, who have tried heroin for the first time, tried it in prison. People who go to prison, who have perhaps never had any dealings with drugs, then come out of prison having dealt in drugs. What do you say to that?
Digby Griffith: I think the 19% figure that you refer to came from a sample of people from 2005-06. I think the research was published in 2010. When you look behind those figures, it looks like those people who took heroin for the first time were heroin users in prison, so they were using heroin, but they became heroin users in prison. What is not clear is the extent to which they were using hard drugs before coming to prison.
We know from the figures that we have that 55% of people arrive in prison having used drugs to a significant degree; 64% arrive having used drugs within the last four weeks; 43% arrive having used cocaine or crack cocaine in the last four weeks-
Chair: Yes, we know that-
Digby Griffith: Sorry, I was just going to say it is unlikely that those people who started using heroin had never taken drugs before. It is a worrying figure, however.
Q376 Chair: We want to look at the broad principle here about people going into prison and then coming out having had drugs for the first time. That is what worries this Committee. Is it a worry to you?
Digby Griffith: It is a worry. The context of this is that a lot of people in prison are heavy drug users. The vast majority of people arriving in our custody have used drugs or some will have dealt in drugs. It is no surprise that there is a desire to maintain that habit in prison and to try to make some money from it. What we have is a twin-pronged approach: trying to reduce the supply of drugs while also reducing the demand for drugs, which is Richard’s area of business.
Q377 Chair: Sure, we will come on to the other solutions to this in a moment. In January 2010, a report was published that claimed that the Prison Service had over 1,000 corrupt guards: that is the equivalent to seven per prison. In your evidence you say that you have in place a National Corruption Prevention Unit. How many corrupt guards have you found, for example, in the last 12 months? How many have come to your attention?
Digby Griffith: Can I deal with a slightly longer timescale because we put in place a new approach to tackling corruption in 2007?
Chair: Okay, how many since then?
Digby Griffith: Since then we have had convictions of 84 staff, we have dismissed 51 and we have excluded about 110. The big change before 2010 and then afterwards was that we have started pursuing convictions. We are talking about criminal offences here, not breaches of HR policy, so we have a very close relationship with the police now for them to investigate the material that we send them, to develop that material and to prosecute with the CPS.
Q378 Chair: But that is a very small figure, isn’t it, 84 prosecutions, when the report claimed there were 1,000 corrupt officers?
Digby Griffith: Is this the Policy Exchange report that you are talking about?
Digby Griffith: I think the evidence base for that report is not clear. When I talk to governors in prisons, they talk about a handful of people probably being responsible for some corrupt activity. It is very difficult to know precise figures simply because if you know the precise figure, we prosecute-we take action against people. Knowing with precision exactly how many corrupt staff we have is incredibly difficult. What is clear is that we are now prosecuting and taking action against people to an extent that we never did before.
Q379 Chair: Finally from me, on drug testing, we know that there is testing on arrival, we found it very odd that there isn’t testing on departure. Why is there no mandatory testing of prisoners when they depart from prison?
Digby Griffith: I think it is an interesting approach. The mandatory drug-testing programme that we have was designed as, essentially, an enforcement tool to deter people from taking drugs. It was also designed to give us an idea of the level of drug misuse inside prison and, thirdly, as a pointer towards treatment.
Q380 Chair: We understand why you do it but why don’t you do it on exit?
Digby Griffith: We do not do it on exit for a number of reasons. One is that we take action against people who have taken drugs. If we took a test on exit we would be unable, in most circumstances, to take action against people, they would have left our custody. We also look at the rates of misuse in prison by using the mandatory drug-testing programme in a different way. We know that about 7% of tests are positive in the last year or so, so that gives us an indication that the level of drug misuse has probably fallen throughout the prison time, given that people are entering with a 64% chance of having taken drugs.
Q381 Chair: Yes. I think the purpose of testing when they go out is not necessarily to prosecute them for being involved in drug dealing in the prison, it is to help them be rehabilitated in the community so they are not one of the 63% who go back to prison in Brixton.
Digby Griffith: I understand that.
Chair: It’s not to catch them or the system out, it is to make sure that they are assisted because we don’t want them to come back in, do we?
Digby Griffith: I completely agree with that and we do it in a different way. In our drug-free wings, for example-
Chair: No, we know about that, we will come to that, but you don’t mandatory test on the way out at the moment?
Digby Griffith: Not on the way out, no, we don’t.
Q382 Dr Huppert: One of the figures that I heard at a seminar last week that really shocked me-I presume you are aware of it-was that, of the people who have ever taken heroin, when they are released from prison one in 200 of them are dead within two weeks. Are you aware of that figure and do you think that is acceptable? What could be done about that?
Digby Griffith: I hadn’t come across that figure but the risk that that figure represents is the extent to which we have, I think, done some good things with people in prison, to try to get them off drugs, to try to treat them. What can sometimes happen is that when people leave prison they start using drugs again. The degree of purity that they are using may well be greater on the street and they end up in serious physical harm or dead because their tolerance levels have been reduced.
Our approach to that is that there are certainly many more maintenance programmes inside prison to aid the transition from being a drug misuser to a former drug misuser. But also the treatment programmes that we have, I think, are far more intensive and of greater quality now than they have been in the past, so there is a far greater chance of someone having better quality treatment. Can I just say one final thing about that? <?oasys [pc10p0] ?>The drug treatment that we provide is only one part of a far larger package addressing accommodation needs, education and a large part-
Chair: Yes, we are coming on to that.
Q383 Dr Huppert: I am surprised you are not aware of that figure. It is quite well attested, there is a lot of literature on it. Singleton et al and various others have looked at excess mortality. I think what it really points to is a problem with the transition from prison back into the population, so what you do in prison is not the only issue. Are you aware, for example, of the Medical Research Council’s trial at the moment into Naloxone on release? Is that something you are aware of or looking at?
Richard Bradshaw: Yes, we are aware of that and we are supportive of the idea of looking at the use of Naloxone to prevent deaths in circumstances whereby people have lost tolerance, as Digby has described. I think the point that you made before about continuity is crucial. I think we have been increasingly over the last few years making sure that, in a sense, the journey that started with a prisoner getting into a treatment regime in prison is just the first step on the way to where you really want to end up, in terms of the transition to ongoing treatment in the community.
The proposition you are making supports the idea that it is not enough just, in a sense, to get people off methadone in prison necessarily-that may not be the absolute goal if what we want to do is get them on to a recovery journey that continues; if they are doing a short sentence and they are going on and into the community. That is where drug recovery wings and all that that comes on, that wraps around them, are so crucial to-
Chair: We are coming on to that. Don’t worry, we like your drug recovery wings, so we are coming on to it. Mr Reckless has a very quick supplementary.
Q384 Mark Reckless: Given what you said there, what would you say to a case that was raised with me yesterday of a prisoner released, come off drugs, wanted to continue drug treatment, went to an agency, the only drug treatment agency available in Kent was methadone maintenance, but they weren’t able to treat him because he hadn’t tested positive? It was basically suggested, I understand, to that individual that, in order to get on that programme, he would need to test positive for heroin and therefore he went back on the street to take a fix of heroin as the way of getting on that programme.
Richard Bradshaw: Clearly, that doesn’t sound right in terms of how people would access the services, but clearly the clinician has to take a view in terms of, is the person using at the time in order to put them on a methadone regime? That is important because clearly methadone is a dangerous drug in itself and can cause harm in its own right if people haven’t been taking it before.
I think the issue about the clinician making a decision, based on the clinical presentation of the person that they have been referred to, would be key and testing is a key way to establish what the status of somebody is before they enter treatment. It is what we do in prison. Before we commence treatment in prison, we test to make sure that the story that somebody is telling us is backed up by the actual chemicals or factors in their-
Q385 Mark Reckless: But what is the point of putting all this effort into getting someone off drugs in prison if then, needing treatment on release, that is not available, unless they can, again, test positive for heroin?
Richard Bradshaw: In the future, what we propose to do under the new commissioning arrangements is make sure-after Lord Patel said that there should be "one pot, one purpose" in terms of dealing with issues of people who are either in prison or going to continue in the community-that commissioning those services will be much more joined up. It is joined up to an extent now, but there is more we need to do to make sure that that continuity continues and we do not face the situation that you have described.
Q386 Michael Ellis: Mr Griffith, the supplementary questions were referring to post-prison, but let us go back to in prison. Is the message getting through that supply reduction is a priority, because it is quite clear that there is still a degree of the supply of controlled drugs in prisons? A recent report by the Chief Inspector of Prisons was very critical, so is the message getting through?
Digby Griffith: I think the message is getting through very strongly indeed. It is very clear that drugs are harmful. It is very clear that substance misuse, substance addiction is part of the profile of many offenders. Given that we have-
Q387 Michael Ellis: Yes, well, we know that. We know that, Mr Griffith, but I am just asking you because I was a barrister in criminal practice for some years before I came to this place and I used to visit people in prison on a regular basis. People, including in category A prisons, would be subject to search on entry when going to visit, including lawyers going to see their clients and yet a quantity of controlled drugs are still getting into category A prisons. How are you addressing that, and it goes back to the point the Chairman raised about corruption?
Digby Griffith: Corruption is one angle on this but I think drugs enter prisons by a variety of means. There are sometimes corrupt staff, either directly employed or non-directly employed. For some prisons, throwing over the wall is the way that most drugs get in, especially for city centre prisons with very many people around. There is also smuggling in parcels in post. There are also prisoners who themselves will plug or crutch drugs in order to take them in via court.
There are a variety of methodologies for getting drugs in and we are addressing each of those: netting to stop throwing over the wall; a far greater use of intelligence; we are using the Regulation of Investigatory Powers Act 2000 to use surveillance to a much greater extent, to use covert human intelligence sources to a much greater extent; we are searching <?oasys [pc10p0] ?>staff where there is intelligence that would suggest there might be smuggling. We are using-
Q388 Michael Ellis: Sorry, can I just stop you there? Do you only search staff where there is an intelligent source? Might it not be a possible consideration to search staff routinely on entering prison, as visitors and lawyers are searched when they enter prisons?
Digby Griffith: It will depend on the type of prison. Obviously in the higher category prisons, you will find the searching of staff happening. Like most law enforcement agencies we have an issue of, do we simply blanket search or do we have targeted searching? Now, blanket searching can be extremely wasteful of money. We have an approach where we try to assess the risk, the level of threat and try to target resources based on those things. I think for most law enforcement agencies, that feels like a better way than simply wasting money targeting everybody.
Q389 Chair: Why don’t you just have one of these special dogs that are trained to sniff out cannabis going round to see if someone has thrown some cannabis or drugs over the walls?
Digby Griffith: We have about 400 dogs in the organisation, 200 or so active dogs that go sniffing around cells and workshops, and about 200 passive dogs that sit in front of a visitor or a member of staff who smells of drugs.
Q390 Nicola Blackwood: Given the change of direction in the Government’s new drug strategy, I wonder if you have adjusted the particular drugs treatment strategies that you have in prisons away from maintenance to abstinence-based programmes?
Richard Bradshaw: Well, the simple answer is no because we have NICE-approved guidelines around the treatment with methadone, which has been established since 2006. So the integrated drug treatment system, which combines clinical with psychosocial, is the same as we have been applying since 2006. It is evidence-based in terms of being able to treat the addictions, and also in reducing reoffending. We have not moved away from that, but, with the advent of the idea of drug recovery wings, we have really placed that on a journey towards recovery because I think-
Chair: I think we are coming to it.
Richard Bradshaw: We are coming to it, yes. We continue with the IDTS programme. There is a large amount of international evidence for its effectiveness, both in terms of clinical management and safety. A recent study demonstrated that we were saving lives of prisoners, particularly those who were dying in those first days and weeks that they come into prison, that methadone and the establishment of them on that was-
Chair: Thank you.
Q391 Dr Huppert: The National Treatment Agency has raised its own concerns that transferring funding from prison drug treatment to the NHS national board could cause the problems of integration, which we discussed earlier, between prison and community treatment to become even worse. What are you doing to try to focus on that and how will you monitor what happens?
Richard Bradshaw: Yes, we believe that the advent of the NHS Commissioning Board taking responsibility for all health commissioning for people in prison and other prescribed places of accommodation will be a helpful step forward in making sure that all health services for people in prisons are integrated and thought through in terms of how they are delivered. But we have been very clear and we have been working closely with the NTA to make sure that the way that that is commissioned in the future is part of a journey between what happens in prison and what happens in the community.
We also have outcome measures that will incentivise providers to get people to complete treatment or to continue treatment into the community, so the outcomes are focused on making sure that that journey works. We have a well established partnership working, which has been existence for, as I said, five or six years for IDTS, and we think that is the rock on which we can build future work, which should prove more effective.
Q392 Dr Huppert: Just to follow on from my colleague, Nicola Blackwood’s question. You would want to see any treatment system that was done by the National Commissioning Board to be evidenced-based and following all the best international guidelines?
Richard Bradshaw: Correct, yes.
Q393 Mr Winnick: The whole emphasis obviously of this session is drug recovery in prison and making sure-as far as is possible-that people get off drugs. Now, as I understand it, there is a report due this month, is that right, on an independent study?
Richard Bradshaw: It is the beginning of drug recovery wings1. It is an initial scoping to evaluate how we might evaluate drug recovery wings in the future. I think it is important to remember that the now 10-the five that started in the middle of last year and the additional five drug recovery wings that are being brought on-stream-have been locally owned and locally grown, and I think your experience of visiting both Brixton and Pentonville shows that they are developing in slightly different ways, but all to the good. All enhancing the skills of staff, using peer mentors. So we are developing a methodology whereby we can properly evaluate them as we go forward. We expect to have results from that in about a year from now. That will indicate what the essential features of the recovery wings are, and how we might replicate that across the state.
Q394 Mr Winnick: Is a report due this month?
Richard Bradshaw: It is in August.2
Q395 Chair: We were very impressed with what we saw in the drug-free wings. Why can’t we make sure that all the wings in a prison are drug free?
Richard Bradshaw: Well, I think we have to work on that. We have to make sure that we know what works, and that, in orientating recovery in prisons, we pick the best features of community engagement, of mentors, and I think that could be a longterm vision, but I think we should sensibly wait for an evidence base to emerge about the best way forward.
Digby Griffith: May I just add a comment? I think that the success so far of drug recovery wings and drug-free wings is really based on the ethos with which they are run, and that depends on interviewing prisoners to make sure that they are committed and absolutely sure that they want to do this. I am afraid it will probably remain the case that many prisoners will want to try to continue to take drugs, as opposed to giving them up and being drug free.
Chair: We were very impressed with what we saw at Pentonville and at Brixton, so pass on our thanks to those involved.
Richard Bradshaw: Thank you.
Chair: Mr Griffith, Mr Bradshaw, thank you very much for giving evidence. We might write to you again as part of our inquiry.
Examination of Witness
Witness: Right Hon Kenneth Clarke QC MP, Lord Chancellor and Secretary of State for Justice, gave evidence.
Q396 Chair: Could I call to the dais the Lord Chancellor?
Kenneth Clarke: Thank you for having me along to give evidence on the same subject as my senior officials.
Chair: We thought it was very important to have the boss sitting at the back.
Kenneth Clarke: I have only been sitting at the back for the last five minutes so the divergence between my answers and theirs will be particularly interesting. I was just looking up my briefing on one of the answers they gave, I will not give you a clue as to which one, but it was news to me.
Q397 Chair: Nicola Blackwood has already spotted one so we will leave that question to her.
May I start with one of your own quotes? It must be very nice to have your words quoted at you. On 19 October 2010 you said, "While more than half the people who are admitted to prison are believed to have a serious drug problem when they arrive, some who enter drug free become addicted while they are there". Is this still a worry to you, after two years, that there are people who have never experienced drugs who enter the prison system and then discover drugs?
Kenneth Clarke: Yes, it most definitely is, although I think the Prison Service and NOMS are anxious to demonstrate they think they are getting all this problem down, to counter the anecdotal evidence that the Committee and I hear all the time about these things. There are figures about those who first take heroin in prison, and I think the latest figure I have seems to have dropped to 7%: those who have taken heroin and say they first had it in prison3. I haven’t turned up the relevant page in my briefing. But it is a matter of great concern. It is of course the case that the majority of those who enter the prison will have had a history of drug abuse-over 60% appears to be the latest figure for that.
Chair: Yes, we have those figures.
Kenneth Clarke: Over 70% have at some time abused drugs. That last 10% is perhaps less surprising, but over 60% have, as it were, a drug abuse problem.
Q398 Chair: What do you see as the role of the Prison Service in this? Clearly, we have seen and we have been very impressed with the work that has been done, both in Pentonville and in Brixton.
Kenneth Clarke: You are ahead of me. I have not visited one of these wings yet.
Q399 Chair: We visited the wings. I know that Crispin Blunt has also visited one of the wings. But we are concerned that that does not go far enough, that in fact to make it truly effective, the whole prison should be drug-free rather than particular wings.
Kenneth Clarke: Firstly, what is the object of the prison? The prison is obviously to punish and then, as you know, the additional emphasis-we are putting much more emphasis on this-is to reform the prisoners so that fewer of them go out with the likelihood that they are going to commit more crimes with more victims. One of the things that is most important to that, crucial to that, is to do more about drug rehabilitation. If the majority of our prisoners have drug abuse problems, quite a lot of them probably are only committing crime as one effect of the fact they have become hopelessly addicted to drugs, and if you could deal with the drug abuse, you have some prospect of being able to tackle them in other ways that might induce them to get back to a more regular and straight way of life. Hence the emphasis we are putting on drug rehabilitation wings, drug-free wings, and so on.
<?oasys [pc10p0] ?>Ideally, every prison should be drug free, but I think as I walked in you were cross-examining my colleagues, who I think were explaining the difficulties of coping with this, with the vast traffic of people, and everything else, in and out of prison all the time. But nevertheless it is supposed to be a secure environment, and we are seeking to get on top of what is an unacceptable situation.
Q400 Chair: We are particularly concerned, Lord Chancellor, about the fact that when people left prison, there were not the support structures outside. Good work was being done inside, but as soon as they were out, the prisoners couldn’t find homes, jobs, and so on, and the good work that is being done on these drug-free wings is just dissipated.
Kenneth Clarke: I don’t know what other evidence you have had, but one of the things we are supposed to be placing greatest emphasis on-and I hope when I visit I will find this happening-is a link up with outside, and to get payment-by-results projects going, involving voluntary and charitable bodies and anybody with an expertise outside the Prison Service as well. The whole point is to begin tackling drug abuse by the individual inside the prison and try to get him or her abstinent, but it does need to be followed up afterwards otherwise, within a very short period of time, they will drift back. We are seeking to develop programmes of that kind.
Q401 Chair: We heard today from your officials that only 84 officials in the Prison Service have been prosecuted for drug-related offences. These are prison officers. But we also noted a report that suggested there were 1,000 corrupt officials in prisons.
Kenneth Clarke: Well, I constantly ask questions about what we are doing to make sure the staff themselves are not one of the sources of the illicit drugs. To be fair, the temptation they are open to is obviously enormous, because they can earn very considerable sums if they start providing a way of getting drugs into the prison. My belief is that we have emphasised that staff should be prosecuted. The procedures in the past were more reluctant to prosecute. It is a serious offence, a very serious offence, and I expect them to be prosecuted. I personally have no idea where your estimate of 1,000 corrupt staff comes from. Plainly, if we knew who the corrupt staff were, we would both prosecute and dismiss them. That sounds like somebody’s estimate. But I have always suspected that one of the problems is that we are not totally on top of a few prison officers giving into the temptation to make themselves much wealthier prison officers by helping to take drugs into the prison.
Chair: It came from a Policy Exchange report. We will send you a copy.
Kenneth Clarke: Yes. I will get that looked into. But the security checks on staff, and particularly in these-well, the whole prison, are obviously a very important part of reducing the ability of people to get drugs.
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Q402 Chair: Finally from me, just on mandatory drug testing. We know it happens when prisoners enter the prison. Why doesn’t it happen when prisoners leave?
Kenneth Clarke: I think because it would be just vastly expensive. We get the figures, and we have people telling us what their history of drug abuse is. Obviously, some testing goes on, but the idea you introduce a regime of mandatory drug testing all the time-it certainly is a way of getting statistics-would be pointless because we know we have a problem, so we just don’t need to keep testing what it is. Obviously, once you get into a drug rehabilitation wing, and so on, I am sure they look out for any indication that someone is reverting. But testing does go on now. It is used as a control technique, and we usually produce figures prison by prison, so the Inspectorate discovers what the rates are.
Q403 Chair: Chair: Yes. We felt perhaps if you had it on departure from prison, there would be more ability to help people be rehabilitated into the community.
Kenneth Clarke: I will consider that.
Q404 Bridget Phillipson: As the Chair said, we visited Brixton drug recovery wing just last week, and saw the excellent work that they were doing there. But, given the number of prisoners with drug dependency, will it be possible to offer this kind of facility to every prisoner who wants it, even if it is rolled out, having been deemed to be a success following the pilot?
Kenneth Clarke: We are anxious to roll it out, and we are doing nothing whatever to discourage the schemes that are being run of their own volition by governors in prison by prison. We have our programme of drug recovery wings and variants of this are being established in various prisons by governors and staff, who are enthusiastic to contribute what they can. With our main programme, our intention is to roll it out, but we intend to evaluate it. The whole history of the struggle against drugs shows that an outbreak of enthusiasm occurs among politicians-everybody-for tackling it in a particular way, and it is pursued for a few years, and then you discover that it is producing rather disappointing results. So we will roll it out as resources permit, but that is not the main constraint, but we have to evaluate it carefully and get evidence to reinforce our optimism that we are going about it the right way.
Q405 Bridget Phillipson: We saw when we visited how prisoners were being supported in prison, towards the point of leaving prison and then would be supported in the community to remain drug free. But how can we sustain that? You potentially have someone in prison for six months or a year, they are drug free, but how can we ensure that when they are back in the community they don’t simply lapse into the same reoffending and the same drug use?
<?oasys [pc10p0] ?>Kenneth Clarke: Sadly, you can’t guarantee that you are going to have a 100% success rate with anybody in this programme. However, as I have said, the key thing is to try to make sure that wherever possible there is, through the gate, follow up, a link up with those people outside who will help sustain the released prisoner in his drug free state. One difficulty of course is the short term prisoners, the ones with 12 months or less, who don’t stay in prison long enough to make a dramatic improvement, though we do concentrate on them. We find people who are trying to get off drugs and can be helped get on the way. We don’t at the moment usually give any support to them when they leave the prison, so you have to put in place the programmes that will give them support.
Q406 Bridget Phillipson: The staff at Brixton talked about the important use of mentoring or volunteers in supporting people to reintegrate back into the community and provide that direct contact one-to-one with someone. Is that something you think could be used effectively by prisons?
Kenneth Clarke: I get that advice frequently from people who have more expertise than myself in the practice of these things, and I think that is true. Actually, it is true of prisoners generally when you are trying to reform them-a very large number of successful programmes have to include an element of mentoring, alongside some positive steps that have been taken to get the man to settle down into a regular way of life and to avoid drifting back into whatever was the problem before that was helping get him into crime.
Q407 Nicola Blackwood: I was rather surprised by the response I received from Mr Bradshaw about the implementation of the Government’s new drug strategy in prisons. Could you tell me if you think that the Prison Service should be fully implementing the Government’s drug strategy?
Kenneth Clarke: Well, before we drive a wedge between Mr Bradshaw and myself, I have always found that clinicians disagree. Over the years, I have always thought that-not just in prisons-there is far too much use of methadone, and I always preferred abstinence-based approaches. I have always suspected that just sustaining people on methadone seems easier, but for years, whenever I have had any contact with this subject, I have always thought it was too easy to slip back into just doing that, and what really matters is trying to get change. The health service, the Department of Health has announced a shift in emphasis. Having said that, clinicians don’t all agree. We are moving into this whole area, when it comes to treatment, of Department of Health commissioned services. It obviously makes sense for health professionals to be in charge of this, so it is not for me to start giving amateur views about the benefits. But I believe the Department of Health is going in the direction, and if I may read from my brief on the points suggested that I make on methadone prescribing, it says, "While substitute prescribing will continue to play a role in the treatment of heroin dependence, we are working with health services to move towards a drug treatment system based on recovery, which does not maintain heroin users in prisons indefinitely on prescription alternatives, such as methadone, unless absolutely necessary". That, I believe, to be the policy.
Q408 Nicola Blackwood: What Mr Bradshaw seemed to imply was that there had been no change in policy since 2006, however, and-
Kenneth Clarke: He appeared to imply that to me, based on the advice of NICE as I understand it.
Nicola Blackwood: Yes.
Kenneth Clarke: I was not aware that NICE had not changed their advice. NICE is not an agency of my Department, and I think Andrew Lansley and myself, NICE and the Prison Service perhaps had better touch base afterwards, about whether we are or are not moving more towards a drug treatment system focused on recovery. I am sure everybody has argued that keeping people on heroin substitutes indefinitely is not something anybody should try to do, but I must admit that, in my present office, I have encountered schemes where it is quite obvious that is all that is being done.
Q409 Nicola Blackwood: Would you also agree that this drug strategy, as he seemed to imply, is not evidence-based but is instead based on-
Kenneth Clarke: I think everything we do has to be evidence-based and I think it is the health professionals who have to be in the lead of deciding what actually is effective. There are things that amateurs have done in the Prison Service in the past, like taking heroin addicts straight off heroin as soon as they come in with no substitute. That is positively dangerous and the service had to pay civil damages, civil compensation for that.
Q410 Mark Reckless: Secretary of State, I am concerned that what is happening in drug treatment on the ground may not be quite what Ministers want to be happening. Two issues have been brought to my attention. One is that the pressure to move from methadone maintenance to genuine recovery and abstinence-based treatment, is less than intended and it is not happening to a great degree. Secondly, you say you are very keen to involve the voluntary and charitable sectors through payment-by-results. However, the actual process of bidding for payment-by-results and the European Procurement Rules, and sometimes the need to have national networks for people to follow people up, is actually driving those voluntary and charitable organisations out of the sector. There are also these divisions between Justice and Home Office and Health, and I wonder if you could advise me on how I can bring these people into the process to try and show Ministers what their experience is on the ground.
Kenneth Clarke: On your first and third points, there has always been a history of slight inter-departmental rivalry-"rivalry" is not the right word; a sort of friction over the years, in my experience, and I think it is important to override that. Is it essentially a <?oasys [pc10p0] ?>criminal matter with the Home Office in the lead? Is it a health matter with the Health Department in the lead? Where does the Prison Service fit in? If we are not careful, it all gets reduced to what is really a competition for resources, which does not get you to a policy. We are seeking to tackle that and, as far as I am aware, we are working principally with the Department of Health in prisons-very much with the Department of Health. It seems to me the relationships with the Department of Health are going remarkably smoothly, and that we are moving to commissioning all our clinical services in the prisons through the new Commissioning Board when it is set up, and on this we are we are working closely with the Health Service.
On things like sustaining people on methadone as opposed to going for full recovery treatments, I am never going to override the clinical advice, but the Department of Health and I must ensure we are all getting the same clinical advice, and that we have decided to establish it on a reasonable consensus.
Q411 Dr Huppert: I am encouraged to hear your focus on evidence, and listening to what the health professionals say. I do not know if you are aware of the work by Professor Strang that is in The Lancet, which looks at things like methadone maintenance versus other options, but I think we would all agree that it should be based on the clinical benefits and what we can do to help people and to reduce the crime that they later cause.
On the subject of evidence, I do not know if you are aware of the research that has been done by the Medical Research Council, looking at deaths of heroin users who are released from prison. But the figure I found quite shocking is that, of all the people who have ever used heroin, one in 200 of them die within two weeks of release from prison. You mentioned short sentences and the problems associated with that. First, presumably you would agree that that is an unacceptably high death rate. What should we be doing to try to reduce that and what steps are you taking?
Kenneth Clarke: First, no, I have not. It all sounds very interesting, very relevant and I do not mean to be difficult about the question, but obviously I have not been through all this medical research and medical opinion. I have always found in the past that medical opinion is not always unanimous on practically anything to do with drug abuse. So everybody tends to choose their particular learned article for their particular point of view, on the ground that these things are very difficult. I am not going to say it is not my Department, but it is not my Department; the Health Department has to be in the lead in deciding the most effective way forward, based on the best evidence they have. Yes, obviously the death rate of people leaving prison-how high it is compared with the ordinary death rate of those addicted to heroin, whether they are in prison or not I do not instantly know-but it is all evidence of failure, when you have someone addicted to heroin who goes on to a premature death.
Q412 Dr Huppert: The figures-and I can give you a reference, if you particularly want me to-are about 37 times higher within the first week. I don’t have them over the fortnight, but I think the figures-
Kenneth Clarke: What do you suggest happens in the first week of leaving prison that causes this sudden mortality?
Dr Huppert: I believe that the suggestion is people taking heroin when they come out and the effects of that. I think the death rate is uncontroversial-I agree with you that there is a whole lot of evidence in different areas. Perhaps the most useful thing would be if you can find out what the Department is doing because clearly it is alarming if people are coming out of prison and dying immediately afterwards.
Kenneth Clarke: It may be that they are achieving more success in making the drug difficult to get in quite a lot of our prisons, so people who are addicted are finding heroin as soon as they can when they get out and not realising they can’t take the same dose again straightaway.
Q413 Chair: You don’t think it is a symptom of your success?
Kenneth Clarke: No, I wasn’t putting it in that way but it may be slightly beyond our control. You are probably going to argue that means we should be maintaining them all on methadone when they are inside. You do create a thriving black market in methadone if you develop a love for it and that-
Chair: Dr Huppert, final question.
Q414 Dr Huppert: There are a number of studies looking at Naloxone and various other things. I would hope that we could agree that a death rate of one in 200 is too high for people leaving prison?
Kenneth Clarke: Of course I agree with that, yes. It is self-evident.
Q415 Mr Clappison: Secretary of State, could I ask you about the future of dedicated drug courts, what is going to happen?
Kenneth Clarke: Well, we are interested in them and obviously there are examples of people doing good work in dedicated drug courts with some enthusiasm. At the moment, we don’t have any funding we can put into it to extend this approach. I always press for some evidence, both here or in examples abroad, where it is an American practice as well, of actual improved outcomes. I have attended-actually in America, not here-one of these styles of courts and I was impressed by the general atmosphere and the obvious rapport, as it were, and the close interest the judge was taking, a rather charismatic judge, in the progress of each client and so on. Sadly, it is quite difficult to demonstrate that this has any measurable effect on things like reoffending, but I am open to evidence that would justify putting more resources into it, but there are more enthusiasts than there are evidenced beneficiaries, is my slightly cautious-I hope not too cynical-comment.
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Q416 Mr Clappison: I have another question, perhaps this is a convenient moment to ask it. If I could tempt you into painting on a broader canvas, because you have obviously rightly talked about the need to have an evidence-based approach, but once or twice in your evidence you have given us the benefits of your experience and you have, if I may say, huge and possibly unparalleled experience, certainly in this Government, of various Departments. On the basis of your experience, what wide conclusions have you drawn about the best way to tackle the drugs problem?
Kenneth Clarke: It is very tempting, Mr Clappison, but for me to sit here on behalf of the whole Government and start propounding the best way of tackling drugs would be unwise. I think I would have to try to reach a considered and collective view with my colleagues before doing that. You are very kind about my experience, but I have not reached the stage of that blinding insight about exactly how we are going to improve our record, is the honest truth. We have been engaged in a war against drugs for 30 years. We are plainly losing it. We have not achieved very much progress. The same problems come round and round, but I do not despair. We keep trying every method we can to get on top of one of the worst social problems in the country and the biggest single cause of crime.
Mr Clappison: In the very distant future, I hope that there will still be a House of Lords, that you will be a member of it, and that then you will in a position to give us the benefit of your experience.
Kenneth Clarke: Of course, in my future years on the benches in the House of Commons, I will try. But what has improved is the co-ordination between Departments. I was once given the thankless task of co-ordinating the Government’s whole approach to drugs, and pulling together the work of the different Departments in the late 1980s. It was a complete waste of time. I did not have sufficient seniority in the Government to get anybody to take the faintest notice of me, and they merely thought it was a bid by my Department to muscle in on the territory of either the Home Office or the Health Department or whatever. That has not vanished but it is very, very much less than it used to be.
Q417 Mr Clappison: Without advocating or dismissing the argument, there are those who argue in favour of decriminalisation. Has your view changed at all on that or-
Kenneth Clarke: Speaking on behalf of the Government, the Government has no intention whatever of changing the criminal law on drugs. Now, you ask me my personal opinion. I have never been persuaded by the decriminalisation argument. I have frankly conceded that policy has not been working. We are all disappointed by the fact that, far from making progress, it could be argued we are going backwards at times. But my own purely personal view is that I would be worried about losing the deterrent effect of criminalisation on youngsters who start experimenting. The really key thing is to try to work out what can get fewer young people to start experimenting with drugs. One thing that does put them off is they will get into trouble with the police if they do it. Once you tell them they will not get into trouble with the police, I have always had the fear that rather more people would experiment. But that is just my personal view as a citizen.
Q418 Michael Ellis: Lord Chancellor, community sentencing, I think you and I can agree, can often be more appropriate for drug users who have committed minor offences. But the drug rehabilitation requirement that is imposed by the courts on offenders in certain circumstances, is only placed on offenders where they consent to go on them, or there is a willingness at least for the offender to comply with the requirement of the drug rehabilitation order. Do you think that is a flaw in the system? Do you think there should be some avenue of recourse, whereby courts can say, "Well, you have failed to comply with a rehabilitation order, or you have failed to consent to it and, therefore, your sentence can be higher and non-community based?"
Kenneth Clarke: Again, in previous evidence we have referred to the advice you always get, that you only make progress on drug rehabilitation when the individual concerned is sufficiently motivated to respond and co-operate. If you have somebody who really is not prepared, in every sense of the word, to actually start trying to break dependency on drugs, you are almost certain to fail. I think that is why the drug rehabilitation requirement is usually linked with a willingness-
Q419 Michael Ellis: But is it too easy for people to say, "Well, I don’t want to have the drug rehabilitation requirement"?
Kenneth Clarke: Well, if the person accepts themselves that they are not ready, not able, not capable, not motivated to try to abstain from drugs, the court may take some more severe step in some other aspect of the sentence. It is one of the things available to the courts. The courts do make use of it. I think obviously they get advice on the suitability of an individual case-alcohol dependence is the same-once someone is determined to have a go at breaking their dependency, it has a chance. If they are really not of a mind to do so you are wasting your time, frankly, in giving them treatment.
Q420 Mr Winnick: Recognising, Lord Chancellor, the need to try and ensure that people who go to prison don’t constantly come in and out-and we had some examples of that when we visited Brixton last Thursday-the Probation Service undoubtedly has an important role to play. Why be so determined to drastically change it?
Kenneth Clarke: I think it needs reform. It hasn’t been reformed for very many years. I think the Probation Service is absolutely crucial to the proper delivery of community sentences, and improving the delivery of individual elements in community sentences is equally important. Following the previous Government’s policy on deciding that some market testing gives us greater diversity of suppliers, looking for some outsourcing is what is required. There is no need for the Government to legislate on the subject. It is the 2007 Act of the previous Government that they never quite got around to implementing that we will be implementing.
Q421 Mr Winnick: So your defence is that since the previous Government proposed it, it is okay?
Kenneth Clarke: No, I was just hoping to make it a little less controversial. Hopefully I was pushing at an open door, Mr Winnick.
Q422 Mr Winnick: When it comes to controversy, isn’t it interesting that the former prison inspector, now in the Lords, supported by a former West Midlands Chief Constable, Geoffrey Dear, and the person who is the patron of the Probation Association-although it could be argued she has an interest, but I don’t quite see why-are very much opposed and have said they will do their utmost in the House of Lords to oppose what you are doing?
Kenneth Clarke: Well, I am sorry Lord Ramsbotham is taking that view, and I have seen that he is but I don’t, with the greatest respect, agree with it.
Q423 Mr Winnick: He usually knows his stuff, doesn’t he?
Kenneth Clarke: Yes, he certainly does. I have every respect for Lord Ramsbotham, but there is quite a range of things on which I don’t always agree with him. My right-wing critics always accuse me of being a terribly liberal sort of Justice Secretary, but I am not in the same league as Lord Ramsbotham, is my experience. I just think that the service has had this set pattern for a very long time, it has been contemplating moving to a purchaser/provider split in order to get a wider range of providers, in order to test the quality of what is provided and to do so more effectively. There are people in the Probation Service who are quite keen on that actually, but NAPO is not. The policy has been foreshadowed for some years and we are going into it, I hope, sensibly. The idea is to try to make a more effective delivery of more effective sentences.
Q424 Mr Winnick: You said you are not on the same liberal wing as the former Prison Inspector, you are not on the same wing as Lady Thatcher, but apparently much of the Probation Service is going to be privatised, which would have delighted her no doubt?
Kenneth Clarke: I find the old argument of whether we are privatising something or not, ever so slightly boring. It is an ideological debate of 30, 40 years ago and more. When it comes to the provision of public services, my own view is I am quite indifferent as to whether the management is categorised as private sector or public sector. I don’t mind what trade union staff belong to, and I don’t particularly mind whose payroll they are on. What matters is what the outcomes are of what they are delivering-whether you are getting good value for money and whether the quality of the service they are delivering is the best you can get. So I am generally somewhat blind as to the status of the provider. What I am more interested in is the quality and the cost of what that provider is going to give the Probation Service.
Chair: Thank you. Mark Reckless has a quick supplementary.
Q425 Mark Reckless: To make the Probation Services more locally responsive, would you see scope for giving powers to Police and Crime Commissioners in respect of probation after November?
Kenneth Clarke: Well, not immediately, no. Police and Crime Commissioners, I think we see where we go. I am keen on the Police and Crime Commissioners. We obviously are going to have democratic and local accountability for the police service. We are not quite sure how that is actually going to work, but I think we are crying out for change from the present police authority system, of which the public are quite oblivious and is not really accountable to the public at all. In another area of my Department, I am canvassing putting victim services fairly quickly-although we are keeping an open mind about the precise timing-into the hands of Police and Crime Commissioners, because I think the link between the police and the victims is one of the best ways of making sure we are getting the right victims and then there will be local accountability of the service. Starting to make them responsible for the delivery of sentences or anything of that kind I think is a bigger step. As of now, I think let’s see how we get on as the Commissioners are set up, and let’s see how the probation reform we are proposing gets on before moving to what would be a great leap for them to start commissioning services for the delivery of community sentences.
Q426 Alun Michael: You will be aware of a declaration of interest I made at the beginning of this process, in that I am a candidate for Police and Crime Commissioner in South Wales. Is your Department, and the justice system generally, keeping up with some rather fast developments? I refer to two things: one we have heard a lot during this inquiry about legal highs and things like the need for generic legislation to stop very clever games being played by unscrupulous chemists; and secondly, the sale of legal highs and other drugs via the internet. We have always found it difficult to cope with street corner sales. Perhaps the trackability of the internet might give some opportunities. Do you think the system is keeping up with these changes?
Kenneth Clarke: I hope so, but it is just ever so slightly outside my present sphere of responsibility, so you are probably more up-to-date than I am, Mr Michael. For as long as I can remember, enthusiastic chemists and pharmacists, and just amateurs who have particular skills in this area, have been inventing substances, trying to get themselves one step ahead of the law and producing what you call "legal highs", and it is a bit like the Inland Revenue dealing with tax abuse. There are experts on both sides, each all the time trying steadily to move ahead of each other, and you probably have to rely on the evidence you have taken, and your own opinion, as to who is winning at the moment.
On the second point, the Misuse of Drugs Act applies to the internet as much as to any other way of sale, and again I am not a prosecutor, or responsible for prosecutors, or responsible for the police service, but I trust that we are sophisticated as everybody else in making use of the fact that the technologies you can use to trace people who are dealing on the internet. But there is no different system of law, so far as I am aware, that applies to internet sales, which makes them different, in principle, from any other sale.
Q427 Alun Michael: I think the point being that perhaps the science can be exploited by the enforcement agencies being inventive and innovative. In view of your earlier answer, perhaps I could ask whether you are keen for Police and Crime Commissioners to be innovative in making connections and trying new ways of doing things?
Kenneth Clarke: Yes, I think anybody with that responsibility should try to be innovative, but we have to be quite clear about what powers they have and what powers they haven’t got. I actually think the powers they will start with, as they replace the old police authorities, are quite substantial and there are plenty of parts of the country where a more innovative approach to the responsibilities of the police and how they account to the public is called for. But I wait to see, first, who is elected and, secondly, what they do when they have taken office.
Q428 Chair: Finally, Lord Chancellor, I am not sure whether as Health Secretary, you appointed the first drugs tsar, but somebody did in a previous Administration, and given what you have said to us today, you talked about the different Departments that are involved, is it now time to have a central figure, perhaps a Minister or someone outside ministerial office who can co-ordinate all the various parts of this very, very difficult subject? Because the Governor of Brixton made it very clear to us, for those who arrive at the prison, the problem starts much, much earlier on. Peer pressure, and the way it is dealt with at that level. You are not involved in prevention. You are involved in dealing, in the Ministry of Justice, with what happens at the end of the process. Should we have someone in charge of co-ordination?
Kenneth Clarke: I have no recollection of appointing or being a drugs tsar. The phrase wasn’t fashionable I think at that time. It came in later. I am sure somebody eventually appointed a drugs tsar. We have had a tsar for most things at various stages. I do think the co-ordination is quite important because I am conscious of the fact that, in the Prison Service or in the criminal justice system, we are merely one part of the picture, a very serious part of the picture: schools, education, policing, the effectiveness of policing, and the health care system that provides cures. When I said my appointment in the late 1980s proved to be pretty ineffective, I was not questioning the wisdom of making such an appointment. I was merely saying in those days there was a mountain, which one of the more junior Members of the Cabinet found quite unable to climb. The powers of Whitehall were not going to have anything of this kind. Things have now changed, and I think there is better co-ordination.
Q429 Chair: So you would say favour better co-ordination?
Kenneth Clarke: I can’t speak for the Prime Minister, but I think the Prime Minister would rather that we worked as a Government, not as different Departments on this subject and that we do co-ordinate what we are doing. My Department is having no problem at all working closely with the Department of Health, and they are taking over the commissioning of all health services in prisons. We are talking about diverting people sometimes to more suitable places to be treated, and they are in the lead on the health care system and they work with our people who are responsible for the custody, the security and fitting in with all the other rehabilitative work that has to do with prisons.
Chair: Lord Chancellor, thank you very much for coming today.
 Note by witness: Drug recovery wings are aimed at those in the process of recovery and contain an integrated range of intensive support to meet the needs of drug misusing offenders who are motivated to work towards abstinence and who may be in receipt of substitution treatment. DFWs are aimed at prisoners abstinent from drugs and substitute prescribing. They include those in recovery but also prisoners who have never had a substance misuse problem and want to avoid the temptation to use.
 Note by witness: The report due in August is a NOMS Drug Recovery Wing Implementation Study
 Note by witness: From a survey (Surveying Prisoner Crime Reduction - SPCR) of 1,435 adult prisoners sentenced to between one month and four years in England and Wales in 2005 and 2006, 7.5% of all the prisoners in the sample (drug users and non-drug users) reported that they had first tried heroin during a previous prison sentence. For those prisoners in the survey who reported having ever taken heroin 19% of those first tried it in prison. This question was asked only once; therefore there is no comparison figure for earlier or later time periods."