§ 4.32 p.m.
§ The Minister of State, Home Office (Baroness Blatch)
My Lords, with the leave of the House, I shall now repeat a Statement on prisoners in hospital which is being made in another place by my right honourable friend the Home Secretary. The Statement is as follows:
"With permission, Madam Speaker, I should like to make a Statement on the use of restraints on prisoners attending hospital, particularly women who are pregnant.
"The acting Director General of the Prison Service, Richard Tilt, met Caroline Flint, the President of the Royal College of Midwives, on Monday to discuss the use of physical restraints on women prisoners admitted to hospital to give birth. The discussions were constructive and I am very grateful to the Royal College for its help. I should like to make it clear that it has never been the intention of the Prison Service to apply handcuffs or chains to women who are confirmed as being in labour and never to apply restraints contrary to medical advice. That will continue to be the case. But the Royal College has asked for certain modifications to be made to the use of restraints on pregnant women and the Prison Service has accepted its recommendations.
"In future, women taken from prison to hospital to give birth will normally be escorted by two female members of prison staff. In exceptional circumstances, where this is operationally not practicable, at least one will be female. No restraints will be applied to the prisoner from the time at which she arrives at the hospital. No prison staff will be present in the delivery room unless the prisoner requests it. Governors will continue to be encouraged to liaise with hospital managers and midwives on these and all other security measures for women admitted to hospital to give birth.
"The Royal College of Midwives has also expressed concern about the application of physical restraints to pregnant women waiting in public areas in hospitals for antenatal checks. In future, all physical restraints will be removed from a prisoner on her arrival in a hospital waiting room unless she is judged to present a particularly high risk of escape and of course there is no medical objection to restraints being applied.
724 "The Prison Service has a responsibility to balance the need to hold prisoners securely with the duty to treat them with humanity and to maintain their dignity and privacy. The modifications I have announced will, I believe, allow the Prison Service to strike a reasonable balance on behalf of the public. We arc confident that this revised policy provides the correct balance without reducing security to unacceptable levels.
"The Prison Service has also taken this opportunity to review its policy of applying physical restraints to other prisoners. Following a thorough risk assessment, some prisoners already attend hospital appointments without an escort under the temporary licence scheme. This will continue to apply. When a prisoner is escorted to hospital, physical restraints will continue to be used in most cases unless there is a medical objection. But where, following a rigorous risk assessment, the governor comes to the conclusion that restraints are unnecessary, they will no longer be used. In such cases, the prisoner will, however, still be accompanied and supervised by Prison Service staff. This builds on the experience of the Prison Service in using risk assessments under the temporary licence arrangements introduced with great success last year.
"Let me summarise the new arrangements. First, no woman who goes into hospital to give birth will be restrained from the time she arrives at the hospital until she leaves. Secondly, a pregnant woman who goes to hospital for antenatal checks will have her restraints removed on arrival in the waiting room unless there is a particularly high risk of escape. Thirdly, in most other cases physical restraints will continue to be applied. But governors retain the discretion to release prisoners on temporary licence or to send them to hospital under the supervision of staff but without restraints being applied. I am confident that these revised arrangements will strike a better balance between the various considerations which the Prison Service has to take into account.
"The acting Director General of the Prison Service is writing to governors with details of the new arrangements. He will keep these arrangements under review and will monitor their operation."
My Lords, that concludes the Statement.
§ 4.36 p.m.
§ Lord McIntosh of Haringey
My Lords, we are grateful to the Minister for repeating the Statement. It is tempting to say simply that this is a climb-down, indeed a humiliating climb-down, to thank the Minister for the concessions that have been made and to sit down. But I am afraid that my responsibilities go wider than that and I cannot take that easy course.
Of course, this Statement is welcome in so far as it meets the requirements of the Royal College of Midwives and follows the meeting between the acting Director of the Prison Service and Caroline Flint of the Royal College. We are grateful for the recognition that the Royal College was right in its protests and has been so for a number of months.
725 But we cannot allow this climb-down to pass without saying also that the policies which have now been abandoned were introduced deliberately by the Prison Service under the aegis of this Government no longer ago than April 1995. They were introduced presumably because of a panic reaction to the escapes from Parkhurst and Whitemoor which led to the setting up of the Learmont inquiry.
We cannot avoid noting that when the Learmont Report finally appeared it had references in paragraphs 5.38 to 5.40 to the position of women prisoners. But there is no suggestion that any of those physical restraints on women prisoners outside prison are a necessary addition to security or, indeed, that they are justified. Therefore, the action of the Government and the Prison Service in response to those escapes—all, of course, by men—was entirely unjustified and is shown to be unjustified by the inquiry which the Government themselves established.
Having introduced those new rules, which are very precise and rigid, the Prison Service then proceeded to ignore a number of warnings over a period of months that they were intolerable and inhumane. The Royal College of Midwives protested against the rules in July 1995. The particular example which has given rise to this change was the treatment of women prisoners from Holloway in Whittington. The Whittington Hospital wrote to the Prison Service in August 1995 making it clear that there were serious concerns among hospital staff and particularly among the midwifery staff, asking for talks about it and offering a community midwifery service within the walls of Holloway Prison.
So far as I know, no adequate response was given to those requests and the matter was allowed to continue with this inhumane treatment being applied right up until the present time, despite the fact that my noble friend Lady Hayman wrote to the Minister of State in December 1995 asking for a meeting and expressing her concern about the views of her staff regarding the conditions under which such pregnant women and women in labour were being treated.
At the very least, there ought to be an apology to the women and, indeed, to the hospital staff concerned for the way in which the women have been treated and also the way in which the hospitals have been treated in being forced to participate in and observe such inhumane treatment. I see no sign of any apology by the Government as a whole to those concerned, although there was of course an apology by the Minister of State to the House of Commons earlier this week.
As I say, in most respects the Statement reflects an agreement between the Prison Service and the Royal College of Midwives. However, can the Minister say why there is no reference to the demands from the Royal College for reform of the way in which women are treated in the case of post-natal care? The Royal College asked that there should be no restraints and no prison staff present at medical or midwifery examinations; or, indeed, when women were breast feeding. I see no reference to that in the Statement and I should be 726 grateful for an assurance from the Minister that the concerns of the Royal College have also been met in that respect.
The problem is very much wider than just a matter of pregnant women prisoners, as indeed the Statement recognises. The Statement says:When a prisoner is escorted to hospital, physical restraints will continue to be used in most cases unless there is medical objection".There are two different problems in that respect. First, there is the assumption that, apart from exceptional circumstances, physical restraints will still continue to be used. Surely the presupposition must be that, unless there are really exceptional circumstances, women will not be taken to hospital in chains—and I do not mean pregnant women; indeed, I mean any women in need of medical help—or be in chains while in hospital. The recent release of the woman in St. Mary's Hospital who was in chains, despite suffering actively from AIDS, gives us hope that that must really be the intention, even though the Statement does not say so.
The second point is the bland claim in the Statement that "medical objection" is a relevant consideration. The Statement says that,it has never been the intention of the Prison Service to apply handcuffs or chains to women who are confirmed as being in labour"—and that leads me to ask what is meant by the word "confirmed". There has been a suggestion that it means that a form must be filled in stating that the woman concerned is in labour and, therefore, should not be handcuffed—and never to apply restraints contrary to medical advice".However, I am advised that there are many examples of restraints being applied contrary to medical advice. I believe—and the noble Lord, Lord Glenarthur, may wish to comment on this point later—that the staff at St. Mary's Hospital were not happy with the restraints being used on the woman in that hospital and that, certainly medical protests, as we know from the Whittington case, had been overruled by the rigid rules of the Prison Service.
We shall need to study the new rules laid down by the Prison Service to see how they differ from the existing rules, before we can be satisfied that there is a real change here. My understanding is that restraints have been used contrary to medical advice. I believe that it would have been more gracious of the Government to recognise that fact rather than to claim nothing was wrong in that respect.
Of course we welcome the Statement in so far as it goes, but it fails to show an adequate degree of contrition for the inhumane and degrading treatment which has been in place for a number of months now. Moreover, it fails to satisfy the remaining concerns about the civilised treatment of women prisoners leaving prison in order to go to hospital.
§ Lord Harris of Greenwich
My Lords, like the noble Lord, Lord McIntosh of Haringey, I am in the happy position of being able to welcome the Statement. Indeed, it is the first Home Office Statement for some substantial time where one has been in that position. It 727 is a grudging but almost total climbdown. For that all of us who have expressed concern about the matter are profoundly grateful. This has been a lamentable episode which has, undeservedly, done serious damage to the reputation of the Prison Service. I say "undeservedly" because the decision was taken not by officials but by Ministers of the Crown. That is what is so unjust so far as concerns many dedicated and honourable people in the Prison Service.
I wonder whether the Minister is able to comment on one particular point in the Home Secretary's Statement that I noticed with interest. I refer to the point where the Statement says that,where, following a rigorous risk assessment, the Governor comes to the conclusion that restraints are unnecessary they will no longer he used".I am certainly in favour of risk assessment by governors because inevitably, so far as concerns male prisoners, some inmates may indeed represent a serious potential security threat. However, the use of the word "rigorous" is interesting. I understand the concept of risk assessment; on the other hand, I wonder what "rigorous risk assessment" means. I suspect that it probably means that when something goes wrong the governor will of course be attacked and Ministers will, as usual, hide behind that. I do not believe that Ministers have any realisation of the degree of scepticism—I put it as politely as possible—with which they are viewed by the Prison Service at present.
There will be a welcome by many civilised, decent and humane people in the Prison Service for the Statement. However, I must point out that extravagant rhetoric which gets Ministers standing ovations at party conferences is, unfortunately, a rather poor guide to implementing an intelligent policy in the prisons. Those who receive warm applause from the tabloids in October should not be surprised when the same tabloids denounce them in January.
§ Baroness Blatch
My Lords, I must say, first, how grateful I am for the way in which noble Lords have responded, albeit with a number of criticisms. However, notwithstanding that fact, I believe that both noble Lords have accepted and welcomed the Statement. Perhaps I may put one or two things right as regards several points made by the noble Lord, Lord McIntosh. I shall start with some chronology. Until 1994, the presumption was that female prisoners being escorted outside of the establishment were not handcuffed—I believe that the noble Lord is aware of that fact—unless the governor or the head of custody had reason to believe that the inmate would pose security or control problems during the escort.
The noble Lord seemed to think that there was no reason whatever for a review of that policy. However, it was in fact reviewed in April 1994. It has to be said that, in five years, 20 female prisoners escaped from hospital and seven of those women were in fact pregnant or had just given birth. That is no light matter for the Prison Service because not only myself, but certainly my predecessor in this office, have had to come to the Dispatch Box and account to the very noble Lords who are being critical today as to why it was that the Prison 728 Service had relaxed security to the extent that people were escaping from hospitals. Therefore it is proper that the Prison Service should always seek to balance the importance of protection of the public, security as regards the prisoner and the proper medical needs and dignity of the prisoner who may he experiencing some difficulties. The policy was reviewed in April 1994. Handcuffs were made mandatory for Category A female prisoners being escorted outside an establishment. However, for other female prisoners the policy was not changed.
There was indeed a further review in April 1995 and as a result of that all female prisoners are now handcuffed when they go outside an establishment, irrespective of the risk. Handcuffs are removed from female prisoners only at the request of a doctor and only for the shortest possible time. There has been a great deal of confusion, and a good deal of criticism has been bandied around, as regards how that policy has worked in practice. There has been only one serious breach of that policy—this incident was quite unacceptable in the view of both my right honourable friend and subsequently the Prison Service—when a lady was handcuffed throughout the birth of the baby. Apologies were made both to the lady concerned and in a letter to Mr. Alan Howarth back in the summer.
The noble Lord, Lord McIntosh of Haringey, was also quite wrong to say that we have not addressed the whole issue of the post-natal period. I said in the Statement that no woman who goes into hospital to give birth will be restrained from the time she arrives in hospital until she leaves hospital. That includes all of the post-natal attention to the baby, which of course includes feeding the baby and attending to the baby and the mother. Until the female prisoner leaves the hospital she will not be restrained.
§ Lord McIntosh of Haringey
My Lords, I am grateful to the Minister for giving way. I acknowledge that a manuscript amendment to the Statement uses the words "until she leaves". But of course post-natal care does not occur only on the occasion of giving birth. It can be given on later occasions. I would welcome an assurance that the request of the Royal College of Midwives that there should be no restraint or prison officers present during post-natal treatment, will be agreed to, whether or not that occurs on the occasion of the visit to hospital to give birth.
§ Baroness Blatch
My Lords, I have dealt with the period in hospital for the lady giving birth. I shall now refer to the post-natal period—which is just as important—when the female prisoner has returned to prison. We welcome what is contained within the statement of the Royal College of Midwives in that regard because we believe that is a basis not for me to make announcements at the Dispatch Box but for the proper operational liaison and collaborative workings between the hospital establishments and the prison institutions. We expect that situation to be improved. We know that the Royal College has said that it will do what it can to improve its services to female prisoners within prison, both before the baby is born and following the return of the female prisoner to prison. 729 I believe that we can look forward to better working relationships between the establishments because I believe that much of the criticism that has arisen has resulted from the way in which that relationship has worked out in practice in the past.
The noble Lord, Lord Harris of Greenwich, made reference to the word "rigorous". Female prisoners can come from many different parts of the Prison Service. They may come from open prisons where a prisoner may already de facto be trusted in open prison conditions. Therefore that prisoner may be unescorted when attending a hospital appointment outside the prison. Or there may be good reason for escorting that prisoner. However, for other prisoners whose situation may be more serious a more rigorous assessment is essential. There is a distinction between the kind of assessment one would make for a prisoner where there was such a degree of trust that the assessment need not be so rigorous and those prisoners in custody where assessments have to be made about the degree of security that is necessary when they move from prison to hospital. In that case I believe the word "rigorous" is appropriate.
§ 4.55 p.m.
§ Lord Glenarthur
My Lords, I thank my noble friend for the Statement which she has made which I certainly found encouraging. My noble friend will be as aware as anyone of the considerable disquiet, anxiety and deep disgust held generally as regards some of the cases which have come to light of late. That is felt particularly among hospital staff treating prisoner patients and it is felt by other patients who are naturally aware of what is going on on these difficult occasions. I must declare an interest as chairman of St. Mary's NHS Trust. Indeed the noble Lord, Lord McIntosh of Haringey, referred in a sense to my knowledge of a particular case at St. Mary's which has recently been reported in the press. I believe that my noble friend would expect me not to give details of a particular case and I hope that the noble Lord will understand that. However, I can tell the noble Lord that it was certainly true to say that the circumstances of that case gave rise to a considerable amount of professional concern among the staff of St. Mary's. It was proper that that concern should have been raised. I am grateful to those who took note of those concerns when I made them known.
I should inform my noble friend that I am particularly aware, as a former Home Office Minister who 10 years ago had responsibility for prisons for 18 months or so, that this is a difficult matter to deal with. Ensuring that prisoners do not escape at times when they are more vulnerable in that respect is an important matter. However, this particular issue and the circumstances surrounding the cases that have arisen have given a clear impression that somehow procedures have gone rather over the top and have become excessive. I hope my noble friend would agree that the degree of security that is necessary must depend on the individual circumstances prevailing at the time and the clinical condition of the patient. The expert views of hospital staff must be taken seriously by the Prison Service staff 730 who otherwise would have the responsibility for the patient. Does my noble friend also agree that patients, prisoners or others, are entitled to dignity in their treatment? The same quality of care and consideration must apply universally to patients.
Finally, will my noble friend reinforce her assurance that wherever it is humanly possible women prisoners are escorted only by female prison staff when they arc in hospital and that male officers would be used only under exceptional circumstances, and those male officers would not be asked to be present—or think of being present—when certain treatments and procedures are being carried out during which their presence would be wholly inappropriate? That might well apply to female staff too. My noble friend has made an important Statement. Certain events have caused great concern among the hospital community and I am grateful to her for going a large way towards putting matters right.
§ Baroness Blatch
My Lords, I am grateful to my noble friend for his comments. I understand my noble friend's reticence in referring to a particular case. It was nevertheless raised by the noble Lord, Lord McIntosh of Haringey. It was the medical advice in that particular case which was discussed with members of the Prison Service which resulted in what I believe was a positive outcome. I know my noble friend will accept that I believe the process could have been smoother than it was. I believe that some of the contents of the Statement today and the pledges made by the Prison Service, the institutions and the Royal College to work together in a more practical way in the future, will ensure that that will be the case.
I absolutely agree with my noble friend that the degree of security that is necessary for prisoners must be a consideration for the Prison Service. That is an essential consideration as regards making judgments about how a person should be escorted to prison. For some time now it has been a part of the system that the advice of medical staff to the Prison Service should be taken into account. However, we believe it has not always been properly taken into account. Certainly under these new arrangements that advice will be taken into account. I totally agree that dignity in treatment is also an important factor in this regard.
I can reassure my noble friend in relation to his concern about escorts being female prison staff. The intention is that only female prison staff—two prison officers—will escort a female prisoner. However, we had to add the caveat concerning the possibility of not always being in a position to comply with that intention. For example, if a female prisoner became very sick in the middle of the night it might be impossible, without any flexibility, to find two female prison officers. We shall guarantee that one staff member will be female, but for the sake of getting someone to hospital quickly one of the escorts might be a male prison officer. However, neither the male prison officer nor the female prison staff would be present in the treatment room unless that was requested specifically by the female prisoner herself.
§ Baroness Hayman
My Lords, I should also declare an interest as chairman of the Whittington hospital, 731 which provides the majority of maternity care for Holloway Prison. I thank the Minister for her Statement today. Is she aware that the changes she announced will be very much welcomed by medical and midwifery staff? They have had great difficulty reconciling their professional duties to their patients within the rigid strictures imposed recently by the Prison Service. Is she aware that the issues of balance are very well understood within hospitals where the potential danger is felt very strongly at first instance by the staff and other patients within the hospital community and that this is not an issue in respect of which hospital staff are in any way cavalier? Therefore, will she look with some urgency at the proposals that have been made for taking more NHS services within prisons? I speak particularly about community midwifery services, but there are also opportunities for outreach clinics and the use of technology such as telemedicine for improving the medical services at present available within prisons without in any way endangering security?
§ Baroness Blatch
My Lords, I thank the noble Baroness for her welcome of the Statement. She made some important points. The first that she made goes to the heart of why this is a vexed issue, namely reconciling the professional concern of medical staff for the patient with the proper concern of the Prison Service for the security of both the public and of the prisoner when not in custody inside the prison walls. There is a tension there that needs to be reconciled. I do not believe that there is a difference between us. We want to see a reconciliation which is in the best interests of everybody, particularly, in this case, the mother and the baby.
The other point which the noble Baroness raised is equally important. I believe that there is scope for considerable improvement in services provided within prison for female prisoners. We know that the Royal College of Midwives will focus its mind on what can be done. We expect that the Prison Service will co-operate as fully as possible so that the tension in moving female prisoners outside prison for medical services is reduced.
§ Baroness Williams of Crosby
My Lords, in thanking the Minister I echo the remarks of the noble Lord, Lord Glenarthur. The House owes a debt of gratitude to those members of the hospital staff and the midwives who drew attention to their anxiety over this matter. We should not let that go unrecorded.
Will the Minister ask the Prison Service to consider seriously the issue of those female prisoners who go to hospital for medical treatment at times other than when they give birth? The majority of women prisoners are not serving time in prison for any act of violence. Many are in prison for civil debt such as default on poll tax and television licences. They have no violence in their record, and they go to prison at considerable public expense. Physical restraint is a humiliation and a demeaning of human beings, as the noble Lord, Lord Glenarthur, indicated. Therefore, will the Minister consider with the Prison Service looking at the whole issue of whether we should apply physical restraint to prisoners who have no history of violence or previous escapes? I say that in the light of the fact that I believe 732 that I am right in saying that the total number of escapes from escorts by women prisoners in the past two years is six.
§ Baroness Blatch
My Lords, there will always he a need to balance security, the public interest and the medical needs of the prisoner. We have said that if the medical advice is that a prisoner should riot be restrained then we believe that that advice should be heeded in the interests of the patient. The very people described by the noble Baroness, Lady Williams of Crosby—those who are not pregnant and who go to hospital for other reasons—are often more capable of escaping. I said that in five years 20 female prisoners had escaped. Seven of those female prisoners were pregnant. It is very difficult for prison Ministers to account to the other place or the House of Lords for prisoners escaping when security has been relaxed and to find good reasons for saying that they were not restrained because they were females. It will be necessary from time to time to restrain female prisoners. Approximately 50 or 60 children are born to female prisoners in any one year. We have met all the safeguards relating to the medical needs of the female prisoner and we have gone to great lengths to make sure that babies are not born in prison because that would be very undesirable in the interests of the baby.
We believe that risk assessment will go a long way to satisfy the noble Baroness. If the risk assessment indicates that the prisoner should be secured, then, I am afraid, the prisoner should be secured unless that is inconsistent with medical advice.
§ The Earl of Longford
My Lords, I applaud the statements from the Opposition Front Benches. I shall leave my further comments until I raise the matter again in the House on 30th January. Perhaps I may put one question of some importance to the noble Baroness. Do the Government take responsibility for the changes which, so far as they go, are welcome, or was the decision taken by the Prison Service without interference from the Government?
§ Baroness Blatch
My Lords, the decisions were taken by the Prison Service. My honourable friend in another place said in her Statement to the House earlier this week that the Prison Service would be meeting with the Royal College of Midwives. Thai meeting took place. It was a constructive meeting. It was the Prison Service which made the recommendations, and it is the Prison Service which will be responsible for carrying them out.
The noble Earl is being very discourteous, commenting from a sedentary position, especially if I heard him right. I can tell the noble Earl that I, my honourable friend who is responsible for prisons, and my right honourable friend fully support the changes that the Prison Service has agreed with the Royal College of Midwives.
§ Lord Monson
My Lords, in the light of the contention of the noble Lord, Lord McIntosh, that the revised procedures are still excessively strict, does the noble Baroness agree that throughout history, and in countries all over the world, prisoners plotting to escape have more often than not plotted to escape from 733 hospital, whether it be the prison hospital or any other hospital, for obvious reasons? In prisons, security is an overriding consideration; in hospitals it is not and never can be a primary consideration. In view of that fact, I suggest that it will seem to most fair-minded people that the Government have now got it about right.
§ Baroness Blatch
My Lords, I welcome what the noble Lord says. He is right. If one is plotting an escape it is relatively easier to do so from hospital than from prison. I am acutely conscious of the experience of my noble friend Lord Ferrers, who occupied this particular post before me and who was derided in this House when he had to come to the Dispatch Box to account for a prisoner escaping from hospital. On one occasion it was through a toilet window and on another from a wheelchair. Guffaws of laughter went round the Chamber as he tried to defend the Prison Service's role on those occasions.
It is difficult to address the proper considerations for the Prison Service: the security of the public and of other patients in hospitals. In 150 escapes from hospitals in the past five years, guns, sharp instruments and blunt instruments have been used as well as physical violence without instruments. It is a difficult position for prison staff to be in. The balance between the safety of prison staff, of other patients in the hospital, hospital staff and sometimes the safety of the prisoners themselves is difficult. Some prisoners even attempt self harm and restraining them is one way of preventing it. We need a balance in understanding, recognising and respecting the dignity of the prisoner in such circumstances, as well as proper consideration for security in other circumstances.
§ Lord Campbell of Alloway
My Lords, what would the reaction of the Government be if, on conviction, the medical evidence showed that the accused was pregnant but sentence was deferred until after the birth?
§ Lord Monkswell
My Lords, I thank the Minister for her Statement. I wish to make a query about two points which she made in her supplementary answers. In one she said that a doctor may require the removal of handcuffs; in the other she mentioned that restraints might be removed on the basis of medical advice. Can she assure the House that the Government recognise that other professional people work in the National Health Service who may be in charge of patients at a certain time? I am thinking of midwives, nurses, physiotherapists and radiographers which are independent professions. May we have the assurance that any other professionals providing treatment and in charge of patients who require the removal of restraints would have their advice and requests acceded to?
§ Baroness Blatch
My Lords, we would expect the line management in the hospital to operate. The medical person responsible for any patient would be the arbiter as to whether the medical interests were such that the person should not be restrained. That would be the overriding consideration. I do not believe that that could 734 be delegated just to any member of staff in the hospital, but if staff were in any doubt as to whether the restraints should be removed, it would he for them to work through their line manager or whoever was in charge of the patient's medical treatment at the time.