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16 March 2011: speech to the Revolving Doors conference on offender health

  • Last modified date:
    17 March 2011

Check against delivery

It’s great to be here today. My first chance to talk publicly about health and criminal justice – to explain why this issue matters to me and to the Government; and to explore the possibilities and priorities for the future.

It’s now two years since Keith Bradley’s landmark report laid bare the flaws between our health and criminal justice systems.

A real wake-up call, and a catalyst for some major improvements.

It’s always invidious to pick out specific achievements, but let me mention one major landmark we’re about to celebrate.

From this spring, every prison in England will be linked up to a single national clinical IT system for prison health.

An excellent achievement that will allow medical records to follow offenders as they move between prisons.

It gives those caring for them timely access to high quality clinical information.

It provides a foundation for the kind of connected system we need to take offender health forward in a digital age.

It’s a symbol, really, of the advances we’ve seen in recent years.

To put offender health on the agenda and stop prison services being the ‘poor relation’.

We should be heartened by the progress.

But also emboldened.

There is now a level of political consensus that we’ve never seen before.

All three parties now publicly agree the tough talking, rhetoric of the past is neither sustainable nor effective.

The catalogue of statistics tells us why.

Nine in ten prisoners have at least one mental health or drug problem.

A quarter have a longstanding physical disorder or disability.

Nearly two-thirds of male prisoners admit to heavy drinking, and a similar proportion have taken drugs before going inside.

In many cases, the criminal justice system is our big opportunity to help offenders with health problems.

Really, we have a clear and stark choice, as a society.

If we do nothing, fail to reach out and help people then we all suffer. Reoffending remains high. More lives ruined. More human potential lost. More cost to public services. More damage to communities.

If we’re proactive – if we reach out, provide better support for those with illness, addiction or disability, then everyone benefits. Lives are rescued, futures are restored, money is saved.

Financial challenge

The big question is how we do it.

How do we continue to improve standards in offender health, given the huge financial pressures facing the public sector.

Well, let me answer that in a second.

First, let me say this. I do realise that many of you are deeply and personally affected by the need to reduce public spending.

Frankly, as politicians, we don’t say enough about the huge professionalism and commitment those working within, or in support of, the public sector are showing in these difficult times.

I want to say that I do, and I’m extremely appreciative of the work you’re doing in this area.


But tough times don’t mean slamming on the brakes.

They don’t mean that reform stops dead.

In fact, they make change all the more urgent.

Improving offender health isn’t just about spending more, it’s about spending better.

That starts with the “internal wiring”, if you like.

Getting the right processes, structures and relationships in place to bring the system together around the individual.

Starting with commissioning.

I agree with Keith Bradley.

The alphabet soup of protocols and practices must go.

We need a much more stable, consistent and effective approach.

Since 2006, the NHS has held the ring in terms of commissioning health services in prisons.

And some really important steps were taken in building links between health and the National Offender Management Service.

In the future, the NHS responsibility for prison health will remain, but it will be a national NHS commissioning board, rather than Primary Care Trusts, taking the lead.

Let’s be clear about what it does and doesn’t mean.

It does mean a more consistent, national approach.

Clearer expectations around what services should be available.

Stronger national leadership to set standards and draw links across other health policies.

What it doesn’t mean is turning our backs on the strong local relationships built up since 2006.

The title of this conference is quite right: success does mean ‘thinking local’ – and ‘acting local’ too.

So we expect the Commissioning Board to work closely with GP Consortia to understand and respond to local and regional pressures.

Local Authorities have a key role as shapers of community health. They can help us bring together the broad range of agencies and organisations involved in delivering offender care.

The Health and Wellbeing Boards, coupled with strengthened Joint Strategic Needs Assessment, will be a platform for understanding and assessing local needs in a shared way.

Directors of Public Health will play a key role, working with the new Police and Crime Commissioners, for example, to draw agencies together.

In particular, it will be important to have criminal justice representation at the Health & Well Being Boards.

And through appropriate indicators in the NHS Outcomes Framework, all health agencies will have a clear picture of what they’re aiming for – a strong, collective purpose.

This brings me to another of Bradley’s recommendations – that the NHS should commission healthcare in police custody suites as well as in prisons.

Throughout the country, we find examples of the NHS partnering up with their local police force to join up healthcare provision across the criminal justice pathway in this way. 

The benefits are multifold – the detainee has better health and life outcomes, the NHS can spend money more effectively and the police have more time to spend on what they do best –preventing and detecting crime.

We are currently working with the Home Office to consider how we can best support and encourage such partnerships over the coming year. I am thankful to the Association of Chief Police Officers for their firm support on this.

Diversion and liaison

Now at the heart of Keith Bradley’s report was his suggestion of a national diversion and liaison scheme.

You’ll hear later from Danny, who can tell you much more powerfully than I can why this support is important – and why we need more of it in the future.

Today I’m laying out some specific next steps to help us deliver better community-based support.

Firstly, from next month, the Department of Health will take the lead on funding all drugs services for offenders, with the exception of youth offending teams.

This is significant because it will simplify systems and help us to make the transition between community and prison-based support more seamless.

A joint approach to commissioning, involving both the prison and health services, will bring the two systems together.

And prison drug treatment commissioned against an outcomes framework for the first time – offering clear accountability and a clear incentive to raise quality and improve outcomes.

Second, over the course of this year, we will invest up to £3m in around 40 adult diversion sites of which 20 will be diversion pathfinders. 

These pathfinders will take the best practice and local learning from existing diversion services to help build the financial and social business model needed to make these services available nationwide by 2014.

They will also test new ideas and practices across the criminal and youth justice systems alongside various other high profile questions that we will be testing at the same time.

What treatment based alternatives to custody could be provided for drug-users or people with mental health problems.

Whether dedicated recovery wings in prison can help those with drug problems.

And how can we use payment-by-result schemes involving voluntary providers to treat people with drug problems?

Thirdly, we are putting an extra focus on diversion and support for children and young people.

We know that most young people entering the youth justice system have a range of complex needs.

Half of those in custody, for instance, have difficulties with speech, language and communication.

Over the last two years, six pilots exploring different approaches to liaison and diversion for young people have been set up.

Over the course of the next financial year, we’re putting £2 million towards up to 60 youth sites and extending the pilots to other areas of the country.

As a result, last month, we also invited NHS and criminal justice partnerships to become specific ‘point of arrest pathfinders’ for children and young people.

These pathfinders will look at how we can improve the way children are screened when they first come into contact with the police.

To make sure we’re getting the full picture of their lives, and putting them in touch with the right services earlier.

Finally, based on the lessons we learn from all of these pathfinders, we will introduce a national programme of diversion services by 2014, as the Justice Green Paper says.

So the intentions are very clear.

By building up the evidence base and proving these interventions work, we will make diversion services a staple of the health and criminal justice system.

We will extend them to cover all age groups, and a wide range of needs.

And we will open up opportunities for every court and custody suite to choose these alternatives to prison as and when it’s appropriate to do so.

We will of course take this new diversion initiative forward alongside our third sector partners, including Revolving Doors and NACRO and in collaboration with the NHS Confederation and the Royal Colleges, among others. 

The National Clinical Director for health and criminal justice, Louis Appleby, will be convening further discussions on this important programme with our key partners in this sector.


Offender health has never been the most popular of issues. Charities and campaign groups have spent years battling against a tide of public and political antipathy.

I think with a Coalition Government, we have the chance to break down the old orthodoxies around law and order.

It’s time for a new approach. Diversion is key to it. And with your help, I’m sure we can deliver real improvement in the years ahead.

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