Welsh Government
Devolved Administration
Action Taken
Opiate substitution therapy is now offered routinely in HMP Swansea the day following admission, where appropriate and safe; healthcare team in the prison is expanding, and an Early Days Opiate Treatment Pilot was launched. A new Substance Misuse Treatment Framework is being developed. (AI summary)
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Dear Mr Phillips
Regulation 28 Report to Prevent Future Deaths – Dean Gary George Thank you for your letter enclosing the Regulation 28 report following your investigation into the death of Dean Gary George in HMP Swansea in March 2016. I am responding on behalf of Vaughan Gething, Minister for Health and Social Services.
The Regulation 28 report notes that the Integrated Drug Treatment Service (IDTS) which is implemented in England, has not been funded and implemented in Wales. It states that those arriving from the community who are addicted to opiates but not engaged with community treatment are not offered opiate substitution therapy on the day of arrival – giving rise to concerns over inequality of healthcare in prisons in Wales. Prison healthcare (including substance misuse treatment and services) in public sector prisons is delivered by the NHS and overseen by the local health boards. There is a policy of equivalence in place, whereby treatment and services available in the community should also be available in prisons. This principle is central to the Partnership Agreement on Prison Health, which outlines agreed priorities between the Welsh Government, Her Majesty’s Prison and Probation Service (HMPPS), Health Boards and Public Health Wales.1 Although, in Wales, we do not have IDTS, we do offer comparative services, which are set out in the Welsh Government’s Substance misuse: Treatment of offenders (2009) guidance, and in the 2017 UK Guidelines on Clinical Management Drug Misuse and Dependence (the Orange Book).
The Welsh Government’s Substance Misuse Treatment Framework (SMTF 2009) confirms people in prison should have the same treatment options for opioid detoxification as people in the community. There is also Guidance for Evidence Based
1 https://gov.wales/partnership-agreement-prison-health-wales
Community Prescribing in the Treatment of Substance Misuse which sets out that community prescribing is a Tier 3 service that is implemented across a number of settings, and which includes criminal justice programmes, prisons and other offending services. The SMTF does include for opioid substitution treatment to be provided in prisons by Local Health Boards in accordance with NHS clinical governance arrangements and the 2017 UK Guidelines on Clinical Management Drug Misuse and Dependence (the Orange Book). All relevant NHS standards in Wales apply to health care services for prisoners, with exceptions only where the constraints of the custodial environment are over-riding. Prisoners in a Welsh prison may access opiate substitution if they have an existing prescription or if clinically assessed and prescribed opiate substitution following remand. Opiate substitution therapy is now offered routinely in HMP Swansea, the day following admission, where appropriate and safe. In addition, the healthcare team in the prison is expanding to provide a more joined up service (with GPs employed by the Health Board alongside nursing and pharmacy staff) and strengthening the availability of mental health support for primary mental health issues and crisis response.
In 2018, an Early Days Opiate Treatment Pilot was launched in HMP Swansea which provides a pathway for opiate substitution therapy on the day of arrival. The pilot has been formally reviewed by Public Health Wales and will inform future planned improvements to substance misuse services in the prisons in Wales. Through the Partnership Agreement for Prison Health, Welsh Government is working with Public Health Wales to develop a new Substance Misuse Treatment Framework for prisons. The new Substance Misuse Treatment Framework will underpin the provision of services in prisons in Wales, and the draft of the SMTF will be available by Autumn
2020.
Welsh Government has also identified prison health and wellbeing as a priority for health boards, and has allocated an additional £1million per year to improve access to health services in the public prison estate. This includes the provision of an additional £329,026 for 2020/21 (reoccurring) for Swansea Bay University Health Board. This funding is being used to provide a team of mental health practitioners to broadly fulfil the tasks of the Primary Mental Health Service in the community, as well as providing a service to those in mental health crisis. The Substance Misuse Nurse Prescriber (SMNP) in the healthcare team in HMP Swansea works directly with the new mental health team in planning care for those with a dual diagnosis and in continuing to support the Early Days Opiate Treatment Pilot.
Regulation 28 Report to Prevent Future Deaths – Dean Gary George Thank you for your letter enclosing the Regulation 28 report following your investigation into the death of Dean Gary George in HMP Swansea in March 2016. I am responding on behalf of Vaughan Gething, Minister for Health and Social Services.
The Regulation 28 report notes that the Integrated Drug Treatment Service (IDTS) which is implemented in England, has not been funded and implemented in Wales. It states that those arriving from the community who are addicted to opiates but not engaged with community treatment are not offered opiate substitution therapy on the day of arrival – giving rise to concerns over inequality of healthcare in prisons in Wales. Prison healthcare (including substance misuse treatment and services) in public sector prisons is delivered by the NHS and overseen by the local health boards. There is a policy of equivalence in place, whereby treatment and services available in the community should also be available in prisons. This principle is central to the Partnership Agreement on Prison Health, which outlines agreed priorities between the Welsh Government, Her Majesty’s Prison and Probation Service (HMPPS), Health Boards and Public Health Wales.1 Although, in Wales, we do not have IDTS, we do offer comparative services, which are set out in the Welsh Government’s Substance misuse: Treatment of offenders (2009) guidance, and in the 2017 UK Guidelines on Clinical Management Drug Misuse and Dependence (the Orange Book).
The Welsh Government’s Substance Misuse Treatment Framework (SMTF 2009) confirms people in prison should have the same treatment options for opioid detoxification as people in the community. There is also Guidance for Evidence Based
1 https://gov.wales/partnership-agreement-prison-health-wales
Community Prescribing in the Treatment of Substance Misuse which sets out that community prescribing is a Tier 3 service that is implemented across a number of settings, and which includes criminal justice programmes, prisons and other offending services. The SMTF does include for opioid substitution treatment to be provided in prisons by Local Health Boards in accordance with NHS clinical governance arrangements and the 2017 UK Guidelines on Clinical Management Drug Misuse and Dependence (the Orange Book). All relevant NHS standards in Wales apply to health care services for prisoners, with exceptions only where the constraints of the custodial environment are over-riding. Prisoners in a Welsh prison may access opiate substitution if they have an existing prescription or if clinically assessed and prescribed opiate substitution following remand. Opiate substitution therapy is now offered routinely in HMP Swansea, the day following admission, where appropriate and safe. In addition, the healthcare team in the prison is expanding to provide a more joined up service (with GPs employed by the Health Board alongside nursing and pharmacy staff) and strengthening the availability of mental health support for primary mental health issues and crisis response.
In 2018, an Early Days Opiate Treatment Pilot was launched in HMP Swansea which provides a pathway for opiate substitution therapy on the day of arrival. The pilot has been formally reviewed by Public Health Wales and will inform future planned improvements to substance misuse services in the prisons in Wales. Through the Partnership Agreement for Prison Health, Welsh Government is working with Public Health Wales to develop a new Substance Misuse Treatment Framework for prisons. The new Substance Misuse Treatment Framework will underpin the provision of services in prisons in Wales, and the draft of the SMTF will be available by Autumn
2020.
Welsh Government has also identified prison health and wellbeing as a priority for health boards, and has allocated an additional £1million per year to improve access to health services in the public prison estate. This includes the provision of an additional £329,026 for 2020/21 (reoccurring) for Swansea Bay University Health Board. This funding is being used to provide a team of mental health practitioners to broadly fulfil the tasks of the Primary Mental Health Service in the community, as well as providing a service to those in mental health crisis. The Substance Misuse Nurse Prescriber (SMNP) in the healthcare team in HMP Swansea works directly with the new mental health team in planning care for those with a dual diagnosis and in continuing to support the Early Days Opiate Treatment Pilot.