ANNUAL REPORT 1995-96

6. PROVISION OF SPECIALIST SERVICES

Education

6.1 We have had some concerns over the year about the degree to which the contracting out of educational services to prisons has actually improved the service. Contractors include, among others, Falkirk and Motherwell Colleges of Technology and Stoke on Trent College of Education. Clearly, the initiative is at an early stage, but we have seen a number of significant hiccoughs in the delivery of some contracts which have resulted in a degree of inflexibility which is in danger of limiting the role of education in the wider regime. This is a situation which we propose to monitor closely - especially in view of the fact that the effect of some of the new arrangements has been to lower teachers' morale quite considerably. We are also concerned that although new education contracts contain agreements on the quantity of educational inputs to be provided, there is a distinct lack of qualitative measures. This deficiency needs to be addressed quickly and in order to ensure that Governors are given the best possible advice on the delivery of their education contracts, all education departments within the SPS should be regularly inspected under the auspices of HM Inspectorate of Schools. This does not happen at the present time.

6.2 Overall, we are firmly of the view that education should, where appropriate, link with VT and employment certification. There should also be clear links between Personal Officers and education staff in order to ensure that needs identified in prisoners' Sentence Plans can be addressed. Education is a limited resource and a much needed one in prisons - it is therefore essential that it is utilised effectively and efficiently. We were therefore disappointed to note that educational needs analyses of prisoners were rare and thus that education departments were not always in a good position to determine not only what educational provision prisoners wanted but, more importantly, what they needed. Education units therefore tended to provide a wide range of classes from English and Arithmetic to Languages and Accountancy but with no real strategy in terms of regime fit.

6.3 We also felt that in terms of sentence planning, it would be useful if education departments across the Service were each aware of what the others were providing, in order that long term prisoners in particular, could continue their studies on transfer with minimum detriment to their chances of ultimate success. At local level though, it is essential that education departments are full and active participants in the sentence planning process which means that they must be involved in consultation, planning and decision making at a strategic as well as a casework level. This process will also help them focus their resources on providing classes which clearly meet identified needs.

6.4 In broad educational terms, however, we would also wish to see:-

More evening and weekend classes (when the weekend routine is at its most limited and boredom at its greatest)

The wider adoption of a timetable approach to regime activities in which full time education is dropped in favour of enabling more prisoners access for shorter periods (as at HMP Shotts)

More involvement by prisoners in suggesting items for inclusion in the educational programme (Peterhead's staff/prisoner education committee is a good example of such an activity done well)

Greater concentration on providing basic literacy and social skills for that large part of the prison population whose deficits in these areas may well have contributed significantly to their imprisonment.

Medical

6.5 All prisoners should be able to receive primary medical treatment which is comparable to that available in the outside community and in general we are satisfied that the level and standard of services being offered to those who are physically ill or injured is at least adequate. Meanwhile some progress is being made to reach the primary community medical treatment standard.

6.6 We inspected all treatment rooms and where appropriate, small prison hospitals most of which were adequate for the task, although the facilities at Greenock, for example, were very basic (though scheduled for improvement). Other facilities including those in the larger establishments such as Glenochil and Peterhead, were often drab and rather depressing, although the opposite applied at Polmont. Medical equipment was considered adequate in most locations. It has been suggested to us and we agree, that the contracting out of pharmacy services might be worthy of further consideration. This could potentially reduce costs and more importantly free nursing staff for more direct nursing duties, and time for patients. The scale of this is best illustrated by the Health Centre at Cornton Vale, where in one month, for example, in late 1995 some 5,528 prescriptions had to be prepared.

6.7 MOs were usually part time GPs from local practices, for whom nurses undertook the major screening of all prisoners before they were seen by the Doctor. However, there has been considerable change to nursing arrangements following the 'Needs Assessment Review of Medical and Nursing Services in Scottish Prisons'. This recommended major changes in the role of all Nurse Officers with the reduction in their security and discipline responsibilities. Originally this change had been expected to span the course of several years, with a gradual transition from uniformed officers to NHS recruited nurses. Unfortunately, however, the initiative became bound up with SSR and its timescale was greatly reduced and finally telescoped into 1995-96.

6.8 In some prisons the new system was working well, with a consensus amongst staff that an improvement had taken place. An improvement in nursing qualifications was also noticeable with over 65% being at Level I last year. Nevertheless, in larger establishments such as Barlinnie and Glenochil, we observed considerable teething troubles. For example, there were recruitment difficulties and personal safety concerns among the mainly female nurses because management was not always able to provide Discipline officers for security duties. Many nurses felt overworked and undervalued and a high turnover of staff was leading to greater reliance on Agency Nurses. More pressure was also falling on MOs and other visiting health professionals with one group of GPs, for example, having recently resigned.

6.9 It is important though to see all these changes in context. The hugely complex and varying demands on the prison service's medical and nursing provision should not be underestimated. Busy local prisons for example have the highest daily turnover of prisoners. On admission, each prisoner requires to be medically assessed and it is the nature of remand and short term populations that they will contain the highest percentages of mentally disturbed and drug and alcohol abusers. Prisoners may be suffering from withdrawal symptoms, may be anxious and confused, contemplating self harm or suffering from the effects of an iterant lifestyle including infestation, poor dental hygiene and even poor nutrition. Medical and nursing services must therefore include provision for acute psychiatric emergencies, the care of prisoners on withdrawal, inpatient care for the physically and mentally disordered, the facility to access NHS beds, general health education, suicide prevention and treatment of disease and injury. In those prisons where there are more stable populations, acute care gives way to more sporadic demand but for much the same range of services.

6.10 We recognise that a major and praiseworthy attempt is being made to improve the standards of nursing and patient care, but remain uneasy about their implementation at some establishments. Adjustments to staffing levels and supporting resources will be needed as the changes bed in. Area Directors will have a growing part to play in this changing situation if balance and impetus is to be properly maintained.

Psychiatric Services

6.11 Overall, we were invariably impressed with the quality of psychiatric services provided to the SPS; however, we felt that the level of provision in the larger establishments did not fully meet the need - eg in Glenochil and Barlinnie. Given the fact that it is recognised that there are significant numbers of mentally disordered prisoners finding their way into prisons because of a shortage of appropriate care in the community, there should ideally be a concomitant increase in the level of forensic psychiatry services made available to needy prisons. We found that where prisoners were displaying serious signs of mental disturbance or psychiatric illness, psychiatrists worked very hard to find beds in outside hospitals (eg at the Murray Royal Perth or in the State Hospital, Carstairs) in order that the prisoner could be treated in a more appropriate setting and prisoners often returned to prison after successful treatment in a psychiatric hospital. Unfortunately, however, particularly in the West of Scotland where there are no forensic psychiatry beds whatever, there could be delays in securing appropriate placements for prisoners who had become ill.

6.12 Overall, we would like to see much greater development of throughcare services for mentally disturbed offenders in which community psychiatric nurses play a much more proactive role in linking into prisons as part of a multi-disciplinary team approach to the care of such prisoners. This already happens in a small but very successful way in Barlinnie. Present arrangements for the care of this group of prisoners on release could and should be better coordinated in order to ensure that the good work undertaken by visiting psychiatrists is not lost when the prisoner is released. That said, we recognise that there is a general shortage of forensic psychiatrists which means that most of the time, visiting psychiatrists are only able to treat acute cases or those who are presenting serious management problems as a result of their mental disorder. On the positive side though we were pleased to note that over 40% of the nurses currently employed in the SPS have a qualification in psychiatric or mental health care which is a significant improvement over previous years.

Dental Services

6.13 Our Inspections showed that the quality of dental services was good, though at Glenochil a considerable backlog of patients had built up. With one or two exceptions, surgeries were well equipped and an ongoing equipment replacement programme appeared to be in progress at most locations. Most dental work involved the repair of damage created by neglect and cosmetic dentistry was not on offer at any of the establishments. At Peterhead, Greenock and Glenochil we encountered concern among visiting dental staff about their personal safety, since the changes to nursing arrangements could at times leave them without appropriate Discipline cover in the vicinity of their surgery. We share this concern and are pleased to note that where we have drawn attention to the problem, remedial action has been taken.

Therapies

6.14 HMYOI Polmont is one of the very few establishments to offer speech therapy classes, which assist those YOs who have speech or language difficulties - a reminder that a number of prisoners will always have major communication and reading difficulties (which in some cases have led to difficulties from an early age with the Authorities). Should funds become available, this is a service which we believe is very much worth expanding. Art therapy classes are also run at several establishments and may often play a major part in helping to calm and improve the self esteem of some individuals - especially those who are more vulnerable.

Chaplaincy

6.15 We were impressed with the wide range of spiritual, pastoral and practical support which was unstintingly given and offered to all prisoners and heartened by the unity of purpose which was displayed by the two full time Chaplains and their part-time counterparts. They span all denominations and their activities cross over into almost every aspect of prison life. Many prisoners made considerable efforts to keep in touch with their chaplain, albeit that the number at formal worship rarely matched the frequency of daily contact. We were also encouraged to find that Chaplains were being involved in some senior prison management teams but arguably, the Chaplains remain an underused resource who have much more to offer.

6.16 In the course of the year we noted further improvements to Chaplaincy Centres, recognising that this had been accomplished despite the ever increasing demands on space and resources. The latter had also led to more centres and chapels being used for several purposes, such as recreation, meeting places, information centres or for the overflow of visitors. An appropriate balance between pastoral and practical needs should nevertheless be maintained.

Clinical Psychology Services

6.17 Pending the outcome of an internal review of psychology services to the SPS first commissioned in late 1993, Governors were discouraged from entering long term contractual agreements for the provision of psychology services to their establishments. The inordinate length of time which was taken to complete the review caused a good deal of uncertainty both for Governors and for service providers and the effect was that psychology services were considerably reduced across the board in anticipation of the implementation of new arrangements. Indeed, a number of clinical psychologists were unable to work on the basis of six months limited contracts and their services could not easily be replaced; consequently, all but eight establishments did not have psychology support for most of 1995-96. We were particularly concerned about this in relation to such establishments as Peterhead (sex offenders) and Barlinnie all of which have very real need for psychology services. This was clearly a most unsatisfactory situation and caused significant difficulties in the management of both vulnerable and difficult prisoner groups.

6.18 The outcome of the review was finally announced in February 1996 with implementation expected later in the year. In essence, existing arrangements will be replaced by an in-house psychology service who will provide a broad range of services including the development and evaluation of prisoner programmes, prisoner risk and needs assessments and staff training. We welcome the fact that there is finally a resolution to this protracted review and trust that clinical as well as other psychology specialists will be part of the multi-disciplinary teams who deal with vulnerable and difficult prisoner groups. We also hope that the new arrangements will quickly help to plug the critical gaps which are beginning to show in the provision of psychology services and which are undermining the efforts of staff to take forward many central initiatives such as offending behaviour programmes, prisoner assessment and sentence planning.

Social Work Services

6.19 Social workers are seconded from local authority departments and are based in every Scottish prison. Their aim is to assist prisoners in confronting their offending behaviour to tackle addiction problems and family difficulties and on release, to help resolve problems over housing and work. Over the year we also found an increase in the involvement of social work staff in multi-disciplinary teams delivering treatment initiatives and programmes.

6.20 Overall, we were pleased with the growing contribution made by prison Social Work Departments, although many of their staff continued to consider themselves as being "on the periphery". We believe that this perception could be ameliorated to some extent by increased cross functional cooperation, but prison management also has a responsibility to ensure that social work staff are routinely included in consultation and planning exercises, that they are provided with all the information which they require to undertake their role effectively and that they are integrated into the prison's communications network. Separately, we were encouraged to find that Social Work Managers were being included in the senior management teams of a number of establishments, eg in Barlinnie and Glenochil, which should also help overcome some of these feelings of marginalisation. Another example of excellent integration is the close co-operation between Social Workers and prison staff in the delivery of the STOP programme at Peterhead.

6.21 Finally, it is always difficult to quantify and assess the quality of the work which is carried out by Social Workers. However, we are pleased to note that progress is now being made with the introduction of National Standards in service delivery which is in preparation for the formalisation of the relationship between the SPS and Social Services Departments of the new Unitary Authorities.

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