House of Lords – Justice and Home Affairs Select Committee

Cutting Crime: Better Community Sentences

Just after Christmas, the House of Lords Justice and Home Affairs Committee looked forward to a world of better health treatment after custody, with a stronger range of specialised services - a world which, I hope, SONAR can help to deliver.

The Committee published its report “Cutting crime: better community sentences” on 28 December. It argued that community services can succeed in reducing reoffending: “with the right investment, intensive community sentences can succeed where short prison sentences fail”. It also looked at best practice in providing rehabilitation services.

The Committee strongly emphasised the importance of health treatment after custody. As it said, “helping people on probation face their addictions or mental health issues helps reduce crime”. It drew attention to the New Chance programme, an adult diversion programme for women in the West Midlands. In this programme, after treatment, people who had mental health issues had a 37 per cent lower reoffending rate than the control group. Among those who had substance misuse, the results were 55 per cent lower. SONAR’s ability to collect and share health information pre- and post-release is highly relevant here.

The Committee also noted the success of women's centres. As part of its probation reforms in 2021, the Ministry of Justice let contracts worth around £50 million for services tailored to female offenders through women’s centres. These have provided courses, such as confidence-building; tailored support, for example for victims of domestic abuse; and mental health treatment. The Committee called for this kind of service to be expanded to male offenders as well, raising the prospect of a network of rehabilitation centres across the country. Again, SONAR's ability to join up services, and to ensure that all professionals have up-to-date health information, will strongly support initiatives of this kind:

• The SONAR Secure module (holding healthcare information for prisons and other custodial environments) and the SONAR ReSet, (for people transitioning back into the community) share information seamlessly.

• They comply fully with NHS and criminal justice standards on privacy.

• The SONAR ReSet Hub is designed to support probation teams after release - for example, by flagging when an ex-offender has missed a medical or other appointment.

Improving health is a wonderful end in itself but, in the criminal justice system, it has the extra benefit of reducing crime too. I look forward to engaging with the House of Lords Committee as we continue to explain how SONAR can support a modern health and justice agenda.

Better Healthcare in Police Custody – Why a single national system is the safest and best value route to better outcomes.

I would like to bring you up to date with our advocacy campaign for better healthcare in police custody. We have been able to discuss the ideas with leading stakeholders in police, healthcare and in Parliament, and I am very grateful to all those who have met with us. I am delighted to say that there is universal agreement on the need for a better system and the benefits of better sharing of health information. The discussion has turned on the best way to deliver those benefits – I believe the arguments on quality, cost and ease of implementation point towards a single national system.

To recap, the best way to organize healthcare in police custody in England and Wales has been a concern of governments for over a decade. Custody healthcare is currently commissioned by individual police forces, creating the risk that healthcare information will not be shared between forces (and between forces and other parts of the criminal justice system). The Bradley Report (2009) pointed out that “police custody is now the only major stage in the criminal justice system where primary NHS-commissioned care is not available”. It recommended that the NHS should take on responsibility, and the Angiolini Report strongly supported that view in 2017. Improving police custody is still an urgent need: in the last two years, 25 per cent of coroners’ reports of deaths in police custody have referred to difficulties in sharing or collecting health information. In total 23 people died in police custody in 2022-23.

In our meetings, it has been great to see that stakeholders in police and health see real benefit in improving the sharing of healthcare information. They would judge a new system on its quality, its cost-effectiveness, and its ease of implementation. We have discussed three options: the current system; a regional model; and a single national system.

Some have supported the current model on the grounds that it provides a choice of healthcare information systems for the commissioners in the 42 forces. Competition between providers will lead to better products and competition is the main advantage of the current model. Its disadvantages are the difficulty of sharing information between different systems, as described above, and the cost of duplicated competitions and contracting across the 42 forces. It would be very difficult to implement a joined-up service between 42 police forces and the rest of the criminal justice system.

Others have suggested a regional model, with forces sharing data on a regional basis. This would preserve some competition between forces and would be easier to implement. But there would remain difficulties in sharing information between the regional groups, and the rest of the criminal justice system. There would also be duplicated costs of competitions and contracting.

A single national model would still offer the benefits of competition, since companies would compete to provide the national system. It would also deliver information sharing between forces and would be much easier to integrate with the rest of the criminal justice system. It would also save costs in competitions and contracting.

The evidence points to a single national system. For those concerned about the creation of a single national provider, there would still be strong competition between providers, and choice for the commissioner, when the national contract was let and in future competitions. A well-written contract and effective contract management would enable the commissioner to work with the provider to deliver quality improvements. The current prison clinical system has been a proven success over the last ten years in successfully sharing patients’ clinical data between sites.

As I say, it has been fantastic to discover the shared wish for improved outcomes in custody healthcare among senior stakeholders. I look forward to continuing to explore the best way forward this year.

Young People in Secure Estates

One of SONAR’s core objectives is to improve the sharing of information between key stakeholders, enabling seamless care and support. This is highly relevant to the provision of care for young people residing in secure care, given that young people in secure estates may show complex; demanding needs and be confronted with substantial challenges. Multi-modal support mechanisms are crucial for young people in secure care to ensure adequate accessibility for integration back into society with a clear pathway address to address recidivism.

The population of Young People in custody

Young people in custody will be detained in one of three secure estates:

• Secure Training Centres (STCs), young people aged twelve to seventeen.

• Young Offender Institutions (YOIs), young people aged fifteen to twenty-one.

• Secure Children’s Homes (SCHs), young people aged ten to seventeen.

The HM Prison and Probation Service and Youth Custody Service releases monthly statistics on the population in STCs and YOIs and SCHs (United Kingdom), with the latest data recording 418 in November 2023.

In line with this monthly report, the HM Inspectorate of Prisons report (January 2023) demonstrations that the number of young people held in STCs and YOIs has swiftly declined, with research indicating this drop in numbers is linked to the success of local diversion schemes and the pandemic.

Special Educational Needs and/or Disabilities (SEN/D)

The department for Education and Ministry of Justice published information in March 2023, revealing that 80% of young people that had been cautioned or received a sentence for any offence, had recordings of SEN/D prior.

A custodial stay for a young person will present new challenges. It will also, however enable the appropriate multidisciplinary team to gain an understanding of potential SEN/D needs and/or requirements which may not have been identified within a mainstream educational institution.

The Children and Families Act 2014 ensures that special educational provision for a detained young person are adhered to, the duties are as follows:

• Education, Health, and Care Plan (EHC plan) is kept when a young person enters custody.

• Consider the request for a EHC needs assessment, if it is bought to attention that the young person has or may have SEN.

• Arrange Special Educational Needs (SEN) Provision for a young person with a EHC plan.

• Cooperate with a multidisciplinary team and other relevant providers of youth custodial institutions, Youth Offending Teams (YOTs), SEN Teams, Clinical Commissioning Groups and/or the NHS.

Healthcare Support

Young people have access to the appropriate services and support they may need to meet their health and wellbeing needs, this includes physical health, mental health, substance use, speech, and communication needs.

The primary health care provision in secure estates is deemed to be ‘excellent’ by the Royal College of Paediatrics and Child Health, as a result of the multiple vulnerabilities within this group of young people.

Conclusion

The goal of the SONAR team is to make a difference for every population in the justice system.  However, we are acutely aware of the importance to maintain a child centred and trauma informed approach within a young person’s provision and continue to strive to enhance systems to support services in their mission to reduce young people being held in secure or custodial environments.

A final thought is recidivism and supporting community reintegration, both key SONAR objectives. We hope to achieve this through a patient-focused app. For young people, this would support the individual and their support network to attend healthcare, educational, statutory supervision, and legal appointments with the aim to maximise engagement with service providers and ultimately enhance the young person’s reintegration outcomes.

References

• Monthly population Data: Youth Custody Data, HM Prison and Probation Service and Youth Custody Service, November 2023.

• STCs and YOIs Data: Children in custody 2021-22, HM Inspectorate of Prisons, January 2023.

• SEN/D Data: Education, children’s social care and offending, Department for Education and Ministry of Justice, March 2023.

• Special Education Provision: Children and Families Act 2014, HM Government, March 2014.

• Primary Care Provision: Healthcare Standards for Children and Young People in Secure Settings, Royal College of Paediatrics and Child Health, July 2019.