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Prisons (Drugs)

Volume 960: debated on Friday 15 December 1978

The text on this page has been created from Hansard archive content, it may contain typographical errors.

1.20 p.m.

In raising the subject of the administration of drugs in our prisons, I want at the outset to pay tribute to all those who work in the prison medical service—the doctors and the nursing officers—and to make it clear that my remarks are in no way directed against them. I must also acknowledge quite freely that there is a severe shortage of doctors in the prison medical service, and I hope that my hon. Friend the Under-Secretary of State will be able to say how it is intended to make up for that shortage.

The problem that we face is that there has been a steady and persistent flow of allegations by former prisoners that drugs are used in our prisons not only to cure people and to help them in a medical sense but also for control and disciplinary purposes. The only way that these allegations can be rebutted properly, assuming that they are unfounded, is for the Home Office to be enormously forthcoming in providing information both to this House and to the public about the facts.

As I have had cause to say in this House on many occasions, the record of the Home Office in prisons, as in other areas, is that it is one of the most reluctant Departments to tell anyone anything. One of the difficulties is that it is not at all clear what the scope of the problem is, and it is very difficult to get any facts out of the Home Office.

Next week, an article is to be published in "Mind Out ", the magazine of the National Association for Mental Health, by Dr. Tony Whitehead. It analyses some figures which the Scottish Office, unlike the Home Office, has provided about the quantities and types of drugs prescribed in one prison. I do not intend to make any exact comparisons, but I think that the figures which will be published next week in "Mind Out" indicate that in one women's prison in Scotland at any rate about one in three of the inmates is permanently on psycho-tropic drugs. That is the only conclusion that one can draw from the admitted volume of drugs being consumed in that prison. I shall not go into the details, but they give some indication of what is happening in one prison which I agree at once is outside the responsibility of my hon. Friend the Under-Secretary of State. I ask, first, whether we can have some indication, perhaps from a number of prisons in the United Kingdom, so that we may form a view of the extent of the problem.

I acknowledge readily that the Home Office has been a great deal more helpful in the past six months than it has in the past six years. Recently Lord Harris wrote to me saying that the Government had decided at last to issue information to the public about the amount of drugs dispensed in prisons in categories of psychotropic drugs—drugs which change the personality—and other drugs. I take it from the rather convoluted third paragraph of his letter that he intends to do this not just on a national basis but prison by prison. He writes:
" We have decided that the information should take the form of the number of doses of medication issued at estabilshments divided in broad classifications according to the type of drug."
What it does not say is "establishments respectively" or "establishments collectively ", and I hope that my hon. Friend will make clear which of those the Home Office has decided the letter means or, if the Home Office has not yet decided which it means, when it will decide. I and a number of my hon. Friends who have discussed the matter feel that the figures will not be of use unless they indicate how much of how may drugs is used in each prison.

The basic problem is that the prison medical service alone of public sector medical services in Britain is not amenable to any of the framework of accountability built into the National Health Service. Community health councils, regional health authorities and area health authorities have no access. The prison medical service stands on its own, and it is very difficult for us to get any information about it. For example, it is very difficult to discover to whom doctors in the prison medical service are answerable. I have had some helpful discussions with my hon. Friend's officials, but every time I have raised this matter I have been given one of two answers" No, they are doctors and they are not accountable to anyone ", or "Yes, they are fully accountable to us."

One's fears are increased by a recent article in the Prison Medical Journal. I welcomed the response of my right hon. Friend the Home Secretary to a Question of mine in putting this periodical in the Library of the House of Commons. But that was only after The Sunday Times had got hold of a copy and revealed that what Dr. McCleery called an experiment but which I understand is not acknowledged to be an experiment was taking place in Albany involving the use of a psychotropic drug, Depixol. I agree that it was only a small experiment or whatever it might be called, but I should like to hear from my hon. Friend what is the procedure in the prison medical service when a doctor wishes to conduct an experiment, especially one using these psychotropic drugs which can very severely alter the personality of an individual, sometimes to the enormous distress of his relatives and to the endangerment of his health.

I know that the problem is not entirely one-sided. There are allegations of prisoners being given injections of medication against their will by prison nursing officers. There is also the quite serious problem of prisoners badgering doctors for drugs—sometimes mild drugs such as Valium and Librium—to counter the regime in the prison and that that produces a problem of addiction. It will be interesting to know how my hon. Friend sees the problem of addiction to some of these drugs in our prisons.

I come to the central accusation which is made. It is that a number of psycho-tropic drugs, especially Largactil, are used persistently on prisoners who in no way need hospital treatment, for disciplinary rather than medical objectives.

If any hon. Member had ever seen a patient who had been given a large dose of Largactil, especially before the administration of the counter-effect drug which is meant to be given simultaneously, he would know the appalling state in which it puts people. If the dose is large enough, the head cannot be moved to the right or to the left, and it creates in the individual a zombie-like state which is humiliating to the individual. In the view of an increasing number of doctors, it is injurious to health if given in overlarge doses. Anyone who reads the report of Mr. Inskip, QC, on St. Augustine's hospital, Canterbury, about the effect of the persistent adminstering of large doses of psychotropic drugs will know the danger to people who are subjected to them.

My plea to my hon. Friend is for a complete change in the Home Office attitude towards openness in this context. The flow of information is held up by three things. The first is the traditional reluctance of the Home Office to say anything. The second is the fact that the Official Secrets Act theoretically applies to everything that happens inside our prisons, including the number of drugs administered. Though I willingly agree that there would be no prosecutions under the Act, the Act remains an inhibition. Thirdly, the flow of information is held up by the supposed professional theory that doctors can never say anything to laymen lest they get the wrong end of the stick. The combination of these three inhibitions means that it is very difficult to get any information on this subject from the Home Office.

I welcome the publication of statistics, but there is, and there will continue to be, greater demands to find out more about the true state of affairs. I understand that the BBC is presently making a programme to be transmitted after Christmas and it is finding it enormously difficult to go into prison and to take the kind of shots it considers essential to put this drugs problem before the country.

If one takes an over-secretive attitude towards a matter like this, it only increases the number of accusations and the amount of suspicion that the Home Office has something to hide. It also increases the number of letters that my hon. Friend will have to write to me. So I plead that when newspapers or responsible television authorities such as the BBC want to examine this problem in detail, and to show both sides of the question, the Home Office should respond rather more openly than it has done in the past.

The scope of the problem becomes clear when we consider the very large number of people in prison who ought not to be there but who ought to be in hospital. I am sure that my hon. Friend would agree with that. The Home Office has done the House a service by answering the Question on 20th November—in column 416 of Hansard—when it set out the fact that 581 people are in prison who are considered to be suffering from a mental disorder of a nature or degree warranting detention in hospital. I shall do all I can, and hon. Members on both sides of the House should do what they can, to persuade the people working in the hospital service that they have a responsibility, on grounds of sheer humanity, to get these people suffering in prison into the hospitals where they ought to be, and allow some of the secure units to be built.

The problem we are talking about concerns not the 581 prisoners but four, five, six or seven times that number who are receiving psychotropic drugs. In some cases—which I do not want to go into, though my hon. Friend might want to say a word or two about them—it has never been suggested for one moment that the people concerned need the drugs for mental disorder. There is great controversy, even in the hospital service, about the use of psychotropic drugs. Although they are widely used in the hospital service, and in the community, many doctors feel that these drugs are too widely used and, indeed, abused.

In the community outside prison, consent to treatment means something. The legal right to refuse treatment does not mean very much for a person in prison, with all the pressures that can be put upon him there. I make a strong plea to my hon. Friend to publish more information about this matter and to strengthen safeguards so that prisoners can refuse these drugs if they so wish. I am quite sure that, if such information is published, in a few years the Home Office will emerge with a much better reputation than it has had in the past.

I remind the House that this debate will finish at 10 minutes to 2 o'clock.

1.35 p.m.

Because of that fact, Mr. Speaker, I shall take only a minute or two, though I could go on for a long time on this subject. It is clear that notwithstanding the barrier to which my hon. Friend the Member for Lewisham, West (Mr. Price) referred, put up by the Home Office against anyone finding out anything concerning this delicate subject, there is an enormous amount of evidence that the use of drugs in prisons has increased very rapidly indeed. It might be argued that one reason for that is that people have learned more about the use of drugs. But all the information about the use of drugs in prisons has come from those countries —most of them with very unsavoury regimes—which have been doing this for very many years and doing it in an extremely wicked way.

There is also the fact that on those rare occasions when it is possible to get an independent medical opinion, in my experience almost invariably, that opinion is contrary to that of the prison medical service. One of my constituents, George Ince, whose case I have raised more than once in this House, was given large lumps of Largactil in Gartree prison. When he fell ill they had to call in a distinguished consultant from Leicester Royal infirmary. He took one look at the chap and said "Get him out of here ".

Order. I understand that the case of Mr. Ince is sub judice [SEVERAL HON. MEMBERS: "No."] Well, that is the advice that I have been given. The hon. Member has been in this House as long as I have, so he will know how to get around it.

You must go by the advice that you have been given, Mr. Speaker, but I beg you to believe that it is mistaken, because I have my finger on the pulse of this case very closely indeed. No legal action of any sort is pending. When Mr. Ince fell ill the consultant took him to Leicester Royal infirmary and was horrified by the treatment that he had been given. And in another case which I have had, quite different—

Order. I am sorry to interrupt the hon. Gentleman—I will allow him a minute extra because of it—but I am advised that the case is sub judice, and we had better act on that basis.

I shall, of course, obey your ruling, Mr. Speaker. I will not refer to that case again. However, I shall have to have it out with your advisers afterwards, because I know better than they do what is going on with George Ince—a lot better. May I refer to a quite different case—

On a point of order, Mr. Speaker. This is a question that affects the House and, with great respect, not the hon. Member or the case of Mr. Ince. If it is sub judice we know that we cannot raise the matter. But, as I understand the situation, Mr. Ince is in prison. He has been sentenced and has gone through various legal procedures, and the only question at issue is whether or not he can or cannot be granted parole.

I understand that he wants to come out. I do not think that there is any legal case pending. May we have an authoritative statement on the question whether there is an appeal pending in the courts?

The hon. Gentleman is absolutely correct to raise the matter with me. If the position is as he states and there is no legal action pending, the case would not be sub judice. I am advised that there is a case pending, but if notice has not been given, it is not sub judice.

I have just been advised that no date has been set. I shall therefore follow the precedent of my predecessor in such matters and allow the hon. Member for Bethnal Green and Bow (Mr. Mikardo) to proceed.

I had said all that I wanted to say anyway. Let me refer to another case that cannot be sub judice because the poor young fellow whom it concerns is dead and the independent examination was made by the Parliamentary Commissioner for Administration, whose report is highly critical of the way in which the young man was treated by the prison medical service. Moreover, the distinguished physician who treated the young man all his life before he was taken to prison was utterly horrified at the way he was treated.

It is the secrecy that arouses suspicion. I have visited many prisons and seen sharp, acute, bright, intelligent men turned into near zombies. I have seen one prisoner who, having refused Largactil, was given Mogadon in doses that horrified me. I take Mogadon when I have a restless night. I am a pretty tough old bird, but one tablet knocks me flat for four or five hours. I have known prisoners to be given doses of several Mogadon tablets at a time, at intervals of an hour or so. That is utterly indefensible, in my view, but if there is a defence, let us hear it. The Home Office ought to come clean.

I inform the Minister that the debate can go on until five minutes to two o'clock.

1.42 p.m.

I am glad that my hon. Friend the Member for Lewisham, West (Mr. Price) has initiated this debate and I thank him for giving me notice of some of the points that he raised. I have noted the problems that he mentioned about the administration of drugs to prisoners and his concern to have statistics relating to their use. My hon. Friend has corresponded with my noble Friend on this matter and will know that the Home Office gives full and careful consideration to these questions. Indeed, he has had discussions with the director of the prison medical service.

The call for the introduction of a means of monitoring the use of drugs in prisons is based largely on allegations of their misuse. In the past year or more, criticism has been levelled at the prison medical service. It has been persistently accused of treating prisoners against their will, using them for clinical trials of new drugs, failing to provide them with proper care and treatment, secrecy, and so on.

Criticism based on a rational interpretation of the facts can be helpful and constructive, but much of the criticism has been ill-founded and based on a distortion of the facts. I therefore welcome this opportunity to set out again the principles governing the medical treatment of prisoners.

Drugs are prescribed for prisoners only when, in the clinical judgment of prison medical officers or other registered medical practitioners, such treatment is justified for the restoration of health or the relief of symptoms. All prison medical officers are bound by the same ethical code of practice, as are doctors in the National Health Service, and neither the Home Office nor prison staff tells medical officers how to treat their patients, or what, if any, drugs to prescribe. Those are matters solely for the doctors' clinical judgment. Drugs are not administered without consent, except in emergencies, when treatment without consent is defensible in common law—when, otherwise, life would be endangered, serious harm to the prisoner or others would be likely, or there would be irreversible deterioration in his condition.

It has been suggested again recently that drugs are used without medical justification to control prisoners or as a disciplinary measure. There is, of course, an ambiguity about the word "control ". Obviously drugs have an effect on symptoms and, in that sense, control behaviour. Otherwise there would be no point in prescribing them. I refer, of course, to an article in The Sunday Times which claimed that prison doctors were misusing drugs. Of the two examples quoted in that article, one was based on an article in the Prison Medical Journal, which had been misinterpreted, and the other was based on allegations that were completely without foundation. Prison doctors have not, and would not, practise the use of drugs as an aid to discipline or to control behaviour.

I am also convinced that none of the doctors who work in the prison medical service would respond to being asked by other prison staff to prescribe drugs for these or any other purposes. To do so would not only be contrary to the ethics of the medical profession in this country ; the doctor concerned, who is personally responsible for each of his clinical decisions, would possibly lay himself open to legal action in the courts. As I stated earlier, a prison medical officer will prescribe medication to a prisoner only when, in his clinical judgment, it is necessary for the restoration of health or the relief of symptoms.

There have also been suggestions that prisoners are being used as subjects for the clinical trials of new drugs. These allegations are without foundation. Medical officers do not conduct trials on prisoners, because of the difficulty of being sure that the consent is valid, owing to the constraints of the environment.

My hon. Friend will be aware of a number of newspaper reports that have appeared in recent weeks on the use of hormone treatment on sexual offenders. The stories have suggested that prisoners are receiving that form of treatment without consent and without a full explana- tion of its effects and possible side effects, and that it is being administered on a large scale. There is no question of prisoners being compelled to receive hormone or other drug treatments to help them control their sexual urges.

I have already mentioned the principles that govern the administration of medical treatment to prisoners. Those principles apply to the provision of hormone treatment. The decision whether to offer that type of treatment is one for the clinical judgment of the doctor concerned, who will wish to satisfy himself that the prisoner has a genuine desire to be helped in that way to control his sexual urges and that it is the most appropriate form of treatment in the individual case.

Hormone therapy is by no means the universal panacea for deviant sexual behaviour, as is sometimes suggested. All doctors who practise in prisons know that, and are well aware of the uncertainties about the outcome of such treatment—because much depends on the motivation of the patients—and are also well aware of the possible side effects. For those reasons, doctors are very cautious about the use of such treatment. It has, however, helped some people and has, therefore, been offered by doctors, on that basis, for those who are willing to undergo the treatment.

It is a basic principle that the Secretary of State should not attempt to give the doctor directions on the way in which he should exercise his clinical judgment or interfere with decisions about treatment. We are naturally concerned that before such treatment is given to any prisoner, its effects should be properly explained to him and it should be made clear that acceptance of treatment cannot guarantee his release on licence. That is just one of the many factors that the Parole Board has to consider. Our inquiries suggest that hormone treatment has been used on a very small number of prisoners in a few establishments and that synthetic oestrogens have been used only on a small proportion of those offered treatment.

If any allegation of improper medical treatment is made, it is carefully investigated, but, so far, no evidence has emerged to suggest that prison doctors are behaving improperly in any way. They have a difficult job to do and I think that they deserve a much better press. Far from forcing drugs on unwilling prisoners, they are constantly asked to prescribe drugs of various kinds, including tranquillisers, by prisoners who are used to them outside or are even dependent on them. That is precisely what happened in one of the cases mentioned in the article in The Sunday Times. Medical officers deal with such requests on the basis of their clinical duty towards their patients and not of the convenience of other prison staff.

In case there should be any misunderstanding about consent to treatment, particularly in the case of the mentally disordered, I must make it clear that prison medical staff are in a different position from staff dealing with hospital patients. Hospital staff may treat compulsorily detained patients without consent, and the recent White Paper reviewing the Mental Health Act 1959 proposes certain limitations on their freedom to do so. Prison medical officers are not empowered to treat without consent, and in the case of a person committed to prison, who had previously been subject to a hospital order, the position is no different—as a prison is not a hospital within the meaning of the 1959 Act.

My hon. Friend suggested that there was a need for an independent body to act as inspectors and to deal with complaints from prisoners about their medical treatment. In fact, in some ways prison medical officers are more accountable than are their NHS colleagues. Inmates are able to take up complaints internally with the governor or with the board of visitors, which is an independent body, and, where necessary, by petitioning the Secretary of State. They can then write to their Member of Parliament, have their case taken up by a Parliamentary Commissioner, the European Commission of Human Rights, or even the civil courts. Also, establishments are subject to regular inspection, and a senior member of the pirson medical service is usually on the team. The regional principal medical officer visits all establishments in his region, and there is close supervision of prison doctors by their seniors.

It has also been alleged that prison medical officers are not as good as general practitioners, but I do not know how this assessment is arrived at. The suggestion that NHS doctors have nothing to do with prisons is also unfounded, when there are at present about 100 part-time medical officers, all general practitioners from the local community, holding surgeries in prison. There are also many specialists visiting prisons on a regular basis, most of whom hold appointments in the NHS. Prison doctors are bound by exactly the same code of professional ethics as are their NHS colleagues, and although prison rule 17 provides that the medical officer of a prison shall have regard to the care of the mental and physical health of its prisoners, there is, and could be, no set of instructions to medical officers on how to treat their patients, or what would constitute a reasonable action in an emergency. Nevertheless, it is by no means uncommon for a medical officer to call in an outside consultant to examine a patient and for a course of treatment to be prescribed by the consultant. Also, medical officers are entitled to call another doctor into consultation when this might help to reduce a prisoner's anxiety about his health or medical treatment.

I should also like to make clear that a prison hospital officer administers treatment only on the express instructions of the medical officer. Hospital officers are trained to provide basic nursing care and to assist medical officers in the treatment of patients. As most prison hospitals are used only to provide treatment, which outside would not normally require admission to hospital, they do not need to be more highly qualified. The qualified nursing staff are mainly concentrated in the four establishments with surgical units and in those for women.

It is against this background that the case for the collection of detailed statistics has to be considered. Those who express concern about this matter appear to want sufficient information to enable them to comment, at least in broad terms, on doctors' clinical decisions. Not only would this require elaborate recording arrangements, but it would go beyond the monitoring to which other doctors are subjected.

My hon. Friend the Member for Bethnal Green and Bow (Mr. Mikardo) appears to have disappeared—

On a point of order, Mr. Speaker. My hon. Friend did send a message apologising for his absence.

I thank my hon. Friend for that message, which I had not received.

The fact that the estimated expenditure on medicines and drugs of all kinds, which my hon. Friend mentioned, has risen from £131,000 in 1971–72 to £379,000 in 1977–78 does not support a conclusion that drugs are now being over-prescribed. When one takes account of the effect of inflation on costs, the increase in the prison population as a whole over the period and the increase in the number of offenders entering prison suffering from mental disorder, the rise in this expenditure is quite understandable. However, as my hon. Friend knows, medical supplies are not accounted for in such a way as to be able to single out drugs. This expenditure includes not only drugs of all kinds, such as aspirin and laxatives, as well as medical and psychiatric drugs, but dressings, ointments, disinfectants and medical sundries.

I know that my hon. Friend would like to see the collection of statistics relating to the use of drugs by the prison medical service, but, apart from the practical problems involved in attempting a subdivision of costs by precise type of drug, information about cost would be of little value in monitoring the use of drugs. Price changes, differences in purchasing practices and arrangements under which one establishment purchases on behalf of several others would make interpretation of such information difficult. There would therefore be serious practical difficulties in analysing the cost of drugs, and the result would not be very informative.

Similarly, to analyse quantities of drugs taken into stock at a prison would not only be a formidable administrative task ; as substances taken into stock are not necessarily in the same form as those issued, and most drugs for inmates are presented in a liquid form for security reasons, the resulting information would be of no management significance or practical use.

The collection of statistics on the basis of the number of prescriptions issued would not be practicable, as there are no prescription forms in the prison service. The medical officers' orders for drug treatment are recorded in a number of different forms, depending on the occasion. As in outside hospitals, where there are no prescriptions as such, the doctor sometimes orders medication on an "if required" basis, and the hospital officer or nurse will not issue the medication if the patient does not require it. There would, therefore, be difficulties about counting the number of orders for drug treatments, and apart from the task of the counting needed to be undertaken by the hard-pressed hospital officers, it is not likely to provide information which is meaningful or comparable with the number of prescriptions issued outside prisons.

To attempt any kind of analysis of doctors' clinical decisions would require drugs to be itemised individually, taking account of the strength of doses and the number of patients actually treated in any given period. This would be a formidable task, involving considerable recording of detail at administrative expense. That would not be justified.

We are, of course, aware of the concern to have some data on the use of drugs. As my hon. Friend knows, we have agreed to collect information that would provide an overall picture—I think that this is what my hon. Friend really wants—and possibly provide a comparison between prisons on standards of health and health care. At the same time it would be collected through our pharmacy services, which would avoid some work for the staff directly involved in patient care.

This information will take the form of the number of doses of medication issued at establishments, divided in broad classifications according to the type of drug. There will be a separate classification for psychotropic drugs. Arrangements have been made for this information to be collected from the beginning of next year, and the necessary instructions have been issued. Inevitably, this is something of a pilot study, but the information that it yields should be interesting and useful. We shall see how the arrangements work out before considering an extension of the scheme. We shall then be able to decide whether to provide further resources for a larger examination of drug supplies.