Report on Drugs Strategy; Implementation & the BMEPrison Population (HMP Wormwood Scrubs)

Abd Al-RahmanDrugs and Diversity AdvisorHMPS (London Area)

December 2003

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Contents

Page

1 Introduction 1

2 Objectives 1

3 Key Targets 1 – 2

4 Methodology 2

5 Meetings with key Stakeholders 3

6 Wormwood Scrubs Drug Strategy Meeting 3

7 Healthcare 3

8 CARAT Service – HMP Wormwood Scrubs 4 – 6

9 Turning Point – HMP Wormwood Scrubs 6 – 7

10 Other drug related services 7

11 Detox – The Process 8 –9

12 Voluntary Testing Unit/Detox 9

13 Mapping of treatment pathways at 9 - 10HMP Wormwood Scrubs

14 Wormwood Scrubs Prison Statistics 11And Monitoring System

15 Race Relations and Foreign Nationals 11

16 Security 12

17 Workforce Planning issues in the 12 - 14Substance Misuse sector in London

18 The RRAA 2000 and the BME Prison 14Population in Wormwood Scrubs

19 Conclusion 15 – 16

20 Recommendations 17 – 20

References & Literature Review 21

Appendices 22 – 34

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1. Introduction

1.1 The Federation has been established as a national, membership bodyactively supporting the needs of BME professionals in the drug andalcohol field and their communities. The Federation also acts in aconsultant advisory capacity to central government, informing theUpdated Strategy (2002) from a culturally sensitive standpoint. TheFederation have established regional committees to support regionalgovernment, other strategic partnerships and BME drugs & alcoholprofessionals to address the aforementioned gaps and meet the targetsinformed by the ten year drug strategy and updated strategy 2002, carriedforward through its key drivers (Drug Strategy Directorate, NationalTreatment Agency, HM Prison Service, Drugs Action Teams, CrimeReduction Partnerships etc). The Federation, through its regionalcommittees, will support the aforementioned stakeholders to deliverjoined up and inclusive services which meet the support needs of the‘whole community’.

1.2 The regional structure is based on government models of best practice,which allow for the step-organic model of change management as detailedin the ‘Change Here’ booklet produced by the Audit Commission. TheFederation will ensure the drug and community safety related needs ofBME communities and wider communities are represented locally,regionally and nationally.

2. Objectives

2.1 This report seeks to inform HM Prison Service (London Area) and TheFederation (London) Regional Management Committee (RMC) of thecontractual outcomes achieved to date. This report representsperformance of the Drugs and Diversity Advisor (London Area) inrelation to the contractual outcomes for the period October 2003 –December 2003.

2.2 The Outcomes to date can be measured by the requirements of the KeyTargets agreed with between HMP (London Area) and The Federation, forthe period outlined above. 1

3. Key Targets

3.1 Key Target 2Review Area and DSU data collection on BME use of drugs services.

1 See Key Targets and Work Programme (Appendix 0.01)

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3.2 Key Targets 3.

Review and evaluate service diversity training for service, employed staff.• Visit 6 named establishments; report on findings

3.3 Key Target 4.Offer the contract drug services consultation and support their trainingneeds and operational considerations to assist complying with the prisonservice duties and policies on diversity

• Produce and distribute letter of introduction to Service Managers ofcontract agencies (1) explaining context of prison service work, rationaleand (2) offering Federation consultancy services2

• Make recommendations on any necessary systems improvements.Highlight any indicated service shortfall or trends to be reviewed bysteering group.

• Equality Health Check Process Update3.

• Information gathered during the visit also pertains to the Prison serviceDiversity training. This feedback will be included in a separate documentfocusing on Prison Service Diversity training and training needs ofCARAT service providers after conducting a training needs analysis.

4. Methodology.

4.1 a). Meetings with key stakeholders to consider culturally sensitive serviceprovision4 in order to consider the service provision in relation to BMEprisoners in Wormwood scrubs. b ) . A mapping exercise to establishexisting pathways and services available to drug using inmates (i.e.throughcare). c). Review of HMPS (London Area) prison statistics andmonitoring systems. d). Consideration of workforce planning issues acrossthe substance misuse sector; recruitment, retention and training of BMEprofessionals. e). Consideration of the implications of the Race RelationsAmendment Act (2000) in respect of the BME prison population inWormwood Scrubs. Culminating in a set of recommendations, which aimto assist the process of developing equitable, and quality service provisionfor BME inmates alongside the HMPS (London Area) Equality HealthCheck process and findings from the national CARAT service review. TheCARAT Admin worker Dorothy Yesufu provided quantitative data andsupport throughout this process.

2 See letter of introduction (Appendix 0.02)3 See Equality Health Check Update 4 See list of meetings (Appendix 0.03)

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5. Meetings with Key Stakeholders

5.1 Informal meetings with key stakeholders were held during the 1st - 5th

December 2003. Discussions took place pertaining to the impact of thedrugs strategy and intervention in relation to BME prisoners inWormwood Scrubs. The meetings were made as informal as necessary tofacilitate the exchange of varied perspectives held by those concerned.

6. Wormwood Scrubs Drug Strategy Meeting

6.1 The DDA attended the Wormwood Scrubs Drug Strategy Meeting duringthe initial visit on Thursday 20th November 2003 where the role of theDrugs & Diversity Advisor was explained and findings from the focusgroup conducted earlier in the year was tabled and discussed. DrugStrategy was also discussed during the block visit with the Drug StrategyCo-ordinator.

6.2 The Prison Drug Strategy Principles states that:

“We are committed to providing a range of quality services to assist thoseprisoners who misuse, have misused or are at risk of misusing drugs orsubstances whilst in custody, through training, support and encouragement ofthose prisoners wishing to address their substance misuse problems.”

6.3 The subject of Diversity and how services can work more effectivelytowards equitable service provision was not a tabled agenda item for themeeting. However, minutes of previous meetings had made reference todiversity in relation to the work being carried out by The Federation i.e.Focus groups and action research. The DDA enquired how Wormwoodensures representation of diversity on its agenda. As a consequence, it wasestablished that the Governor of C & E Wing sits on the LAO DiversityGroup and as such he is the lead for Diversity at the Drug StrategyMeeting.

6.4 To date, there is no model that can be referred to in terms the componentsthat make up an effective drug treatment package in a prison setting. As aresult meetings are largely based on numerical data, service updates andmeeting KPT’s. This, coupled with the fact that many of those attendingdrug strategy meetings are not drug treatment specialists means that thereis little in the way of identifying the developmental direction required inorder to establish a matrix of services are based on needs and

7. Healthcare

7.1 The DDA met with the Healthcare Lead to discuss the detox process, carestandards, general service provision and the diversity/race equalityagenda at Wormwood Scrubs.

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7.1 The current Healthcare Lead has been in post for 2 months and isemployed by the NHS to implement the “Dependence - Guidelines onClinical Management” as the framework for proposed changes

7.2 It was stated that at present the Healthcare Lead is in the process ofdeveloping a strategy that considers all areas of need in relation to theprison population; drugs just being one. The plan is to have a credibleaudit trail and care package by this time next year, as at present this doesnot exist.

7.3 A request was made for data on the uptake for BME inmates of thehealthcare services. I have been informed that these do not exist atpresent.

7.4 Healthcare stated that an individually tailored package of care based oninmate needs was required. It was added that there is not, at present aseamless approach to service provision. Healthcare would be moreeffectively supported if all inmates were to have equality of access tostructured, therapeutic groups, underpinned with harm minimisation,that is accredited with quality standards in place for staff and for thetreatment programmes.

7.5 At present Crack users in the prison population do not have access to adetox program but instead are sent directly onto the wings. With such ahigh number of crack users present in the prison population (see point11.4 below) and no specific provision this was considered to presentadditional challenges; particularly in relation to BME inmates.

8. CARAT Service – Wormwood Scrubs

8.1 The DDA spent the equivalent of 1 day with CARAT team members,including the admin worker. The following information is taken frominformal meetings and discussions held with CARAT staff

8.2 It was stated that the CARAT service has been short staffed for a numberof months with 3 staff members servicing the entire establishment. Duringthis period A and B wings have been provided with a “skeletal service”.However, an additional staff member started on the 2nd December and afull team is expected to be in place by January 2004.

8.3 Fig.1 shows the breakdown of 2002 – 2003 CARAT assessments. Thisinformation was gained from the CARAT admin worker. It can be seenthat the team conduct assessments with a significant number of BMEinmates.

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Fig. 1

Ethnic breakdown of CARAT assessments 2002 - 2003Asian (A1, A2, A9) 197 (13.95%)Black (B1, B2, B9) 470 (33.39%)Chinese (O1) 2 (0.12)Mixed (M1, M2, M9) 77 (5.45%)White (W1, W2, W9) 666 (47.16%)Total assessments 1412Total BME assessments 746 (52.8%)

8.3 It was found that the staff compliment at Wormwood Scrubs comprises ofan all female team of which (with the exception of one Asian worker) nonewere from BME communities. This was discussed at length during ameeting with CARAT staff. Anecdotal feedback suggests this was not aconcern to most of the team members as they believed the expectation wasthat ‘inmates would benefit if they were motivated for change’. A CARATworker stated that the current staffing situation results from ‘a lack ofBlack workers coming forward for interviews’.

8.4 The recent development of a Detox unit was said to have generated manyclients for the team. This unit has 1 CARAT worker based within it.Relapse prevention sessions have been on hold for some time due to lowstaff levels. However, plans are in place to re-start these groups in thenew-year.

8.5 Questions put to staff regarding the diversity related needs of the prisonpopulation were not addressed directly. Within discussions it becameevident that the issue of working with BME inmates focused on theperipheral and the wider implications are not well understood. Forexample, religious rights, language issues and the like were addressed butseeking to effectively deal with perceptions from inmates that stoppedthem from accessing services in the first place were not well addressed. Itwas stated that this situation is not helped by an over focus onquantitative requirements (assessment focused work) to the detriment ofthe qualitative (time allocated for counselling, groups, etc).

8.6 It was stated that as a consequence, the number of services conductingassessments was seen as ‘tedious’ by many of its recipients and gave theimpression of ‘workload’ while the quality side of work at times suffered orwas poorly recorded.

8.7 Concerns were expressed for inmates at the exit stage. Housing wasidentified as the number one issue. There was also a difficulty in trackingwhat happened to inmates between when they left and when they cameback to prison, a cycle that many go through.

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8.8 Concerns were expressed with regard to release plans and appointmentsin the community for inmates. This was seen as problematic particular forthose inmates who were involved in violent offences, as many services inthe community would refuse access due to their own access criteria. Thiswas seen as problematic for inmates generally as different localities hadvarying levels and types of service provision. As BME inmates make up65% of Wormwood Scrubs this issue probably impacts on a significant,though unknown, number of them.

9. Turning Point- Wormwood Scrubs

9.1 The DDA met with the Turning Point Manager and in addition gatheredinformation through the Drug Strategy Meeting detailed herein.

9.2 Turning Point provide a training programme that has been described as‘provisionally accredited’. It is described as broader than simply drugawareness. The programme is 10 weeks long and there is provision of 5groups per year. As well as this there is a pre-admission course once aweek for 4 weeks. All pre-admissions go on a compact before access to thecourse. After completing the course there is a 6 weeks after-careprogramme once a week that is run by a mixture of outside agencies suchas Adfam, various rehabs, NA and the like. The 10-week course is a closedgroup that inmates cannot access beyond the 1st week. As a result therecan be a waiting list of up to 10 weeks.

9.3 It was stated that within the last 6 to 8 months there has been an increasein the number of inmates referring themselves to the course. Those thatcome through this route now outnumber those referred from the CARATservice. Although self-referrals are always sent for a CARAT assessment itis done through an informal process without referral forms.

9.4 The course programme structured and is made up of sessions that will befamiliar to anyone who has worked within a therapeutic setting.Observations and taking into account the views of those who have fullyattended the course are crucial in assessing how effective it is in assisting aprocess of self-change. It is also difficult for those on remand or on shortsentences to access the course.

9.5 Complimentary to the training course health specialists run sessions onTai-Chi, Chi-Gong, breathing exercises and so on. Information on take-upof these sessions was not known.

9.6 Turning Point has a KPT of 60 people starting the course per year. Thefigures indicate that Turning Point are particularly successful at attractingand engaging inmates from BME communities. The ethnic breakdown ofthe last course was 2 White, 2 Asian and 8 Black. However, feedbackwithin the Drug Strategy Meeting showed that high attrition rates are

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present on these courses. It was pointed out that next year there will be aKPT added that would track attrition rates.

9.7 Applicants on the course are required to complete a questionnaire,however there is no robust system present to evaluate qualitativeinformation in relation to the work carried out to illustrate the impact ofthe programme upon those who have successfully completed. Thebenefits of post evaluation were discussed and suggestions for inmatefeedback, both verbal and written were given along with staff debriefingat the end of each session to assist the process of continuousimprovement.

9.8 When asked if Turning Point services were sensitive to culturalneeds/differences the answer came after a long silence, “not sure, I hopeso”. Added to was that ‘differences are respected but the overridingemphasis was on working with individuals’. Diversity training was anaspect of Turning Point’s internal staff training package but there was aninability to demonstrate an understanding of diversity in the context of adrug service and to explain how this learning filtered through to practice.Prison service Diversity training facilitated by officers and psychologistswas said to be more theory than practical, focusing on “language andunderstanding diversity”. This training was said to be consideredinadequate and few T.P. staff attended.

9.9 Turning Point identified staffing as an issue. The service has all femalestaff except the Team Leader. One female worker is Asian. The examplewas given by the Team Leader of an all male team working in a Women’sprison and the issues that would be thrown up as a result of this.

10. Other services – Wormwood Scrubs

10.1 Earlier in the year the Blenheim Project supplied a worker, DavidLawrence from June 2002 – January 2003, to provide crack specific groupsbut this came to an end. The Drug Strategy Co-ordinator stated that thework taken forward by the Blenheim Project worker was beneficial toinmates. Anecdotal information suggests that the lack of a crack specificgroup, or other interventions specific to this user group means that crackusers are greatly disadvantaged within Wormwood Scrubs. The workerwas not replaced and to date there are no crack specific groups within aprison where 49% of reception tests show positive for crack use (see point11.4 below). Numbers alone cannot measure the impact of this on inmates.A recent Home Office report (2003) states that:

“Treatment programmes for crack cocaine should be a primary focus for ethnicminority men”. P.6

10.2 These programmes need to be provided by highly skilled facilitators whoare able to gain the respect of inmates and engage with them in an

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effective manner. Alcoholics Anonymous and Narcotics Anonymousmeetings are available. It was suggested that BME inmates don’t accessthese groups in any significant number.

11. Detox – The Process

11.1 It was stated that Healthcare services are provided by the NHS and are thefirst point of contact for all new inmates. All new inmates are given ahealth screen. For some this represents the first check-up for many years ifever. Medical staff within the first night centre conduct this. Those with ahistory of drug use are identified and decisions are made according to thedrug used, the level of use and the state of the inmate. Here they alsoreceive information on various services operating within the prison. Thisis available in various languages. ‘Listeners’ and a number of multi-lingual inmates also provide interpretation wherever necessary in a widevariety of languages. At this point inmates access the detox which is partof Healthcare (Triage system in operation; 11 beds are available), arereferred to the CARAT team or go onto the wings.

11.2 It was stated that DF118’s are often used as treatment for those accessingthe detox. However, due to protocols around the use of DF118’s thismeans that inmates must stay for 21 days and this means that others aredelayed in accessing the service. As a result, changes will be made to useDF118’s less and, instead, utilise Subutex and methadone. Those who usecrack go straight onto the wings and have no specific provision.

11.3 It was stated that, at 8am each morning a P.O. and an S.O. screen newinmates (about 20 per day) for drug use. A one-paged form is used forthis. If they say they use cannabis there is no referral to the CARAT. Ifthey use any other drugs they are asked whether or not they want to see aCARAT worker, if so then a referral is made.

11.4 It was highlighted that a large proportion of Crack users are identified atreception along with a growing number of new inmates with abscessesfrom ‘speedballing’ (injecting heroin and crack). Crack users, identifiedfrom total reception testing, currently stands at 49%. THC and Morphinepositives are at 37% and 45% respectively. A major problem exists due to alack of specific intervention for crack users.

11.5 It was stated that The Blenheim Project, had in the past, supplied aresource to run crack specific groups. However, at present there was not adedicated worker for crack users or the availability of crack specificgroups. The DDA was informed by an officer that African Caribbeaninmates made up the majority of crack users in the prison while most

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Asian drug users used heroin or heroin and crack. It was also stated thatmost of them did not want to engage with drug services and that, “Heroinusers on reception tend to admit use but crack users don’t.”

12. Voluntary testing unit/Detox

12.1 November figures for inmates resident in a VTU show 68% BME inmates.Caribbean constitute 49%.

12.2 That same month in the detox unit (for drug, poly drug and alcohol detox)there were 0 Black, 4 Asian, 2 Mixed (M1, M2) and 50 White inmates (W1,W2, W9).

12.3 Detox on the wings 7 Black, 18 Asian, 7 Mixed and 36 White. There wasalso a large number of ‘not stated’.

12.4 Points 12.1, 12.2 and 12.3 demonstrates that in one month there were10.7% BME inmates in the Detox unit (with zero Black inmates), 47% ofdetox’s on the wings were BME while the VTU had 68% BME inmates.This illustrates the process of crack users being made up of largely BMEinmates and going straight onto the wings (inc. VTU). It also illustrates aninequality in service provision as there is no structured programme on theVTU.

12.5 The above figures suggest various possibilities that cannot be confirmedwithout more extensive work. For example, Detox focuses on other thanusers of Crack alone. So whereas Alcohol/Heroin/Poly-drug users canreceive a detox those who use only crack, reported by an S.O. to be a highnumber of Black inmates who don’t declare their use at reception, arewithout Crack specific intervention. See also the number of Black CARATassessments in 6.6. Also note the number of Asians in detox’s andcompare with the ‘epidemic’ of heroin use in the community amongst thisgroup.

13. Mapping of Treatment Pathways at HMP Wormwood Scrubs

13.1 Figure 2 below was put together from discussions with the Drug StrategyCo-ordinator, CARAT Manager and Turning Point Team Leader.Mapping services and the process in this way allows for ease inunderstanding what is available, to what level, for whom it is availableand for ease in assessing where problems areas occur/are likely to occur.For example, Where in Figure 2 is the structured Relapse Preventionelement?

13.2 Apart from detox drug treatment in the prison is low threshold. If this wasall that was available to drug users in the community it would not beenough to bring about the change desired. The addition of a structuredtreatment programme that incorporates the elements common to a good

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treatment in the community, perhaps run within a VTU will, along withother recommendations, enhance drug treatment in the prison. Crackspecific/Relapse Prevention groups could run for those awaiting entryinto the programme.

13.3

Fig. 2

George Baker – Head of Dave Sherwood – Drug StrategyDrug Strategy Co-ordinator

Referral toservices

Referral toCARAT TeamAssessment/Careplan

Reception

First NightCentre. HealthScreen.Voluntarydrug test.PalliativeCare, i.e.DF118’s etc.

FullAssessment –Detox Team

Detox Unit –Prescribing.

2nd Stage.Connibere

unit

Forward toWings

Turning Point.

Inmate self referral.Still given CARATassessment. Most

inmates now comethrough this route.

Sentenced 1 to 4 yearswith a minimum of

4mths to serve referredto Turning Point

MandatoryDrug Testing

VoluntaryDrug testing

Drug StrategyMeetings

P.O. and S.O.Conduct drug

specificscreening

Visitor ChecksPassive/activeDogs

AA, NA, etc.

Referral toCARAT TeamAssessment/Careplan

Forward toWings

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14. Wormwood Scrubs Prison Statistics and Monitoring Systems

14.1 Wormwood Scrubs utilises ethnic monitoring system codes that are in linewith the last census. The system used, termed the ‘traffic light system’allows disproportional representation in all areas of prison work to behighlighted for action, as such this system is effective.

14.2 Contained in Fig.3 is information gained from the Race Relations LiaisonOfficer and represents figures for one day at the end of November 2003.There is no particular significance of the specific date used for the figuresaside from the fact that the Race Relations Liaison Officer was seen on thatday and it was said that the figures are representative of the usualbreakdown.

Fig.3.

Total Wormwood Scrubs prisonpopulation

1168 inmates

BME prison Population 767BME as a % of the Total population 65%Breakdown Total Black: 47.86%; Total Asian

10.27%; Total White 34.33%; Other7.53%

E wing BME population 81%Asian prisoners accessing a drugservice

Approximately 2%

Jamaican Nationals 25% of all Foreign Nationals.

15. Race Relations and Foreign Nationals

15.1 It was stated that the highest number of foreign nationals are fromJamaica. They make up 41% of the total. There are also increasingnumbers of inmates from Eastern Europe. Most foreign nationals whoimport drugs don’t use but some become users as a coping mechanism.They are spread throughout the prison but E wing has the highestproportion, 81%. The overriding issue for them is immigration and mentalhealth issues brought on by anxiety.

15.2 Wormwood Scrubs has had 207 recorded racial incidents between January2002 and October 2003 (HMP Wormwood Scrubs Race Relations Report).That’s 18.8 per month. This suggests racism in the Prison environmentmay significantly increase, if measures are not put in place to redress thebalance.

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16. Security

16.1 In relation to the implementation of the drugs strategy; the generalperception gathered was that tightening of security = less drugs = generalinstability, fighting and higher prices. 12 – 15% of visitors indicate fordrugs through the use of sniffer dogs.

16.2 It was stated that mandatory drug testing indicates that it is particularlyeffective in identifying cannabis than heroin or crack due to the length oftime the drug stays in the system. It was said that this leads to manyinmates switching to heroin and crack use. Inmates, drug workers and avariety of prison staff have stated these examples and it appears thesefactors are also considered outside of prison within the wider community.

“We conclude that this [relative or actual shift from use of cannabis to harderdrugs] has arisen from a variety of different factors, of which the MDTprogramme is only one5.”

17. Workforce Planning Issues in the Substance Misuse Sector in London

17.1 Much of the information gathered throughout the process of this visitsuggests that workforce developmental issues, present a significantchallenge to Wormwood Scrubs in relation to the successfulimplementation of its drugs strategy. As a consequence of this exercise, ithas been established that HMP Wormwood Scrubs should not considerthe implications of equitable drugs treatment and service provision inisolation, but within the broader context of challenges faced across thesubstance misuse sector as a whole within the capital. Health Works UK’s6

findings regarding the recruitment and retention of staff in the substancemisuse field also supports this view they describe the issue of recruitmentand retention as,

“A national problem, largely due to overall shortages across the health and socialcare professions…the rapid development of the drug treatment sector – with newcriminal justice interventions developing alongside the expansion of drugscommissioning and policy – has exasperated these pressures. Many agenciesreported difficulties retaining staff due to new opportunities elsewhere. Suchpressures are unlikely to diminish… Estimates suggest that the number of drugtreatment specialists will need to increase by up to 50 per cent in the next fiveyears to meet demand7”

5 Drugs and Prisons Report by The Select Committee on Home Affairs stated (2000)6 Health Works (UK) is a National Training Organisation for the health sector. They are currentlydeveloping national occupational standards for people working in the drug and alcohol sector.7 Audit Commission – Changing Habits (2002)

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17.2 It should be noted that London demonstrates consistently higher rates ofdrug use than any other region in the U.K8 The Mayor for Londonestablished the Greater London Drug and Alcohol Alliance (GLADA)9

who in 2001 agreed that the crisis in recruitment, retention, training andworkforce planning faced by the sector in London should be addressed asa matter of priority. As a first step, GLADA commissioned the CranfieldSchool of Management to undertake a systematic assessment of workforcerequirements. The information generated by the assessment is beingutilised to develop a human resource action plan for the specialist drugand alcohol sector in London. The Federation are members of GLADA.

17.3 London and the South East of England have long been “hotspots” forrecruitment difficulties and for pressures on all aspects of employment.Therefore, an important aspect of the research programme was to form anoverall demographic profile of the sector in London. The Training NeedsAnalysis has generated a reliable profile of age, gender and ethnicity fordifferent areas of the workforce population, its findings are as follows.

In the area of service delivery (TNA A) the population breaks downbroadly as:

• 69% White, 16% Black and 7% Asian• For managers (TNA B) the same three broad groups break down as

75% White, 13% Black and 7% Asian• There is a small disparity between the practitioner ratio and

manager ratio that implies ethnic minority workers, particularlyfrom a black background, may have more difficulty progressing tomanagement levels

• Ethnicity profiles for commissioners indicate an entirely Whitesample

• The community care assessors profile is 78% White• Gender profiles for practitioners reveal a majority of Female

workers, the ratio being 61% Female and 39% male• In the managers sample there are 45% Male and 55% Female

17.4 The National Treatment Agency has committed to recruiting an extra 3000practitioners into the drugs treatment workforce, a significant number ofwhich will be recruited from BME communities. Between 1991 and 1993 amuch smaller increase in BME employees in the drugs field led to a 30%increase in disciplinaries involving BME staff. It is generally recognisedthat the majority of services have not developed the polices, processes,

8Changing Habits (p.8)9 GLADA is a London based partnership alliance established to provide a mechanism to tackle Londonwide problems and to promote better co-ordination of policy and commissioning of drug and alcoholservices

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structures and professional competencies to deal with the challenges thatwill come with an increasingly diverse workforce10 and the communitieswithin which they serve.

18. The Race Relations Amendment Act (RRAA2000) & the BME prisonpopulation in Wormwood Scrubs

18.1 ‘Institutional racism consists of the collective failure of an organisation to provideappropriate and professional service to people because of their colour, culture orethnic origin. It can be seen or detected in processes attitudes and behaviourswhich amount to discrimination through unwitting prejudice, ignorance,thoughtlessness and racist stereotyping which disadvantage minority ethnicpeople’. MacPherson

18.2 The Task Force Review Report, NTA HR Strategy; Developing Careers,Updated Drug Strategy (2002), and National Scoping Study11; DeliveringDrug Services to Black and Minority Ethnic Communities (Home Office),state clearly that the drug related needs of BME communities and BMEprofessionals in the drugs field have not been met by drugs servicecommissioners and drug service providers.

18.3 Lack of cultural competence (absence of culturally sensitive treatmentmodalities, lack of competent management support and developmentalopportunities for BME staff), ineffective needs assessment/consultationwith BME communities, inadequate HR/Performance ManagementFrames, inadequate data collection systems (ethnic monitoring isparticularly poor), research gaps in relation to the specific needs of BMEdrug users and inadequately trained staff, particularly in relation todiversity, have been sighted as key areas in need of development if BMEcommunities are to experience equitable access to drugs services andequal opportunity in the appointment to and development in professionalroles within the drugs field12.

18.4 The Federation Equality Health Check currently being carried out onbehalf of London Area will recommend any necessary training, policyand/or procedural development that is required including a full raceequality specific training needs analysis. The EHC uses an assessment toolthat is DANOS and QuADS compliant and designed to compliment theRRAA(2000) related audit tools developed by local authorities, PCT’s andCriminal Justice Services across the country. The findings will beconsolidated in a confidential report to HMP London Area.

10 Federation Equality Health Check (2002)11 Sangster D, Shiner M, Patel K and Sheikh N (2002)12 Ahmun V, 2000

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19. Conclusion

19.1 HMP Wormwood Scrubs has a good basis from which to build a moreeffective drug strategy. There is good work taking place in some areas andone aspect of drug related intervention, Healthcare, is focused on changein regard to standards and clinical management. The CARAT serviceconducts a large number of BME assessments and the team are on trackwith their KPT’s although there have been staff shortages in the past. Aswell as this Turning Point is able to attract a significant number of BMEinmates to their programme. The need for crack specific intervention wasaddressed over a year ago when the Blenheim project commenced group-work. Although these groups are no longer running it shows that someefforts were made to cater for the high number of crack users after theneed was highlighted.

19.2 However, the information gathered suggests that drug treatment serviceswithin Wormwood Scrubs, despite effort, lacks the required culturallysensitive approach to meeting effectively the drug treatment needs of itsBME prison population.

19.3 Findings suggest the nature and level of provision does not provide theBME prison population with an effective response, particularly withregard to stimulant users and remand prisoners. In addition, treatmentstaff was found to not reflect the diverse prison population they seek toserve. Anecdotal information from BME prisoners suggests that this is anissue that seriously hinders effective delivery of the drugs strategy at agrassroots level. These concerns were also echoed by some CARATworkers.

19.4 The HM Prison Service and in particular CARAT providers shouldencourage greater levels of diversity in teams. Diversity is a gateway tobeing more effective. Belbin (1981)13 talks about balance in a team,ensuring that a whole range of individual differences in areas such asskills, attitudes, attributes and personality is taken into account.4 The morediverse the team is in terms of shared interests, attitudes andbackgrounds, the more potential for increased productivity and practice;thus fostering a more cohesive force.

19.5 Recruitment, retention and training of appropriately skilled staff and inparticular professionals from BME communities are workforce challengescurrently reflected in the wider community. For example, the AuditCommission’s review of the sector; Changing Habits (2002) states thatworkers in the sector experiencing problems with delivery of treatmentmay be doing so as a consequence of “low levels of staff training andexpertise…as staff in the sector are drawn from a wide variety ofprofessional backgrounds”.

13 Organisational Behaviour P.96

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19.6 Whilst this report acknowledges it is still early day in the life of the HMPSdrugs strategy more can be achieved by utilising examples of best practiceas they exist within the wider community i.e. Nafas, the Federation,Blenheim Project etc. These can be adapted and tailored to suit thechanging needs of the prison environment. Thus, supporting HMPWormwood Scrub’s aim to more provide more equitable service provisionin relation to drugs treatment and intervention for those from BME andmarginalised communities.

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Recommendations________________________________________________

1 Drugs Strategy

1.1 Mainstreaming of issues specific to BME drug users within the Prisonthrough inclusion on the agenda within Drug Strategy meetings as astanding agenda item &/or within service updates to be evidenced withinminutes.

1.2 The Federation should be consulted in order to develop a strategy thatwould successfully counter the poor expectations that BME inmates havetowards treatment services

1.3 Voluntary Testing Unit needs to incorporate a programme that is able toeffectively engage with BME inmates and which is modelled along thelines of a rehabilitation service/day programme out in the community. AtHMP Wandsworth such a programme already exists run by theRehabilitation for Addicted Prisoners Trust (RAPt) with excellent results.

1.4 Within Drug Strategy Meetings services need to address the question:“How might services evolve in order to meet the needs of BME inmates,Crack users and polydrug users utilising independent consultants whohave expertise in this area to assist the process wherever necessary.

2. Workforce & Cultural Competence

2.1 There is a need for experienced drug workers who have the ability toeffectively engage and relate with BME inmates at the reception stageallowing inmates to familiarise themselves with providers and to becomemotivated to seek further assistance. This earlier contact with drugservices will aim to lower the number of drug users, in particular crackusers, refusing to see the CARAT team. Also, this will help to rectify whatwas highlighted within the focus group earlier in the year re: confusion inregard to how the CARAT team is accessed and the process throughwhich the team accesses inmates.

2.2 There is a need for crack specific workers – 49% of reception tests arepositive for crack. Crack users also benefit from structured talk therapyand groups – this is a gap that needs to be filled if the Prison is to makesignificant progress in treating BME inmates and inmates as a whole andpreparing inmates for life outside.

2.3 Services as a whole would benefit from a survey as well as ongoingfeedback groups that allow inmates to express what they want from adrug service and their perceptions of current services. As well asinforming the evolution of provision this would include inmates in thechange process. The Audit Commission states that:

18

“Without knowing anything about the people who use your service, how canyou begin to understand their needs? Without hearing what they want fromyou, how can you focus on the areas that really matter to them? Without anaccurate picture of their experiences, how can you be sure that you fullyunderstand what works and what needs fixing, especially where yourcontribution is part of an extended process involving other agencies as well asyour own?” p.64

2.4 The Drug Strategy needs to, as part of its vision, map out what constitutesa service matrix that will ensure the most effective equality basedtreatment provision. This could be drawn up on the back of consultationwith inmates and with assistance from specialists in the drug treatmentfield.

2.5 Drug related information (Harm Reduction, Information on dangersassociated with various drugs, changing from one drug to another to tryand avoid MDT positive results, etc.) in various languages would bebeneficial for those at reception and within services on the wings.

3. CARAT Services

3.1 Contingency plans need to be in place to ensure that counselling/groups(the only treatment available to crack users) are not disrupted due to staffshortages.

3.2 Home Office guidance The Development and Practice Report, states, “Furtherdevelopments in CARAT teams should concentrate on (1) increasing thenumber of places on therapeutic programmes and (2) pre-release planningto address employment and housing needs, and (3) to establish ongoingcontact with services outside prison”. p.6. Employment and housing aresaid to be the most pressing issues for inmates, particularly from BMEcommunities, leaving prison. Closer working ties with services outside ofthe prison need to be established in order to work more effectively,realistically and to document the specific areas of difficulty and need.

3.3 CARAT recruitment and retention policies need to be reviewed to ensurerecruitment process and procedures for CARAT’s are designed to appealto a wider audience and therefore are able to successfully attractprofessionals from BME communities. The NTA states that: “There is clearevidence that issues of anti-discriminatory practice in employment andissues of equity in service provision for diverse communities are, andshould be considered as, related and not as separate issues”. p.7

3.4 Steps need to be taken to ensure that the CARAT team along with otherservices within Wormwood Scrubs operate as one service with elementsmanaged by contractors. At present there is no uniformity in terms of carestandards, no equity in service provision for various drug usage and no

19

robust qualitative evaluation process for counselling sessions or group-work.

3.5 The Federation should support HMP Wormwood Scrubs to developspecific means by which the needs of BME inmates can be adequatelyexplored in terms of the way in which services are delivered andcongruence in relation to references used during therapeutic interactions.

3.6 At present assessing the work of CARATs revolves around numbers.These numbers need defining and definitions need to be made clear sothat interpretation can occur accurately. For example, CARAT counsellingsessions in one month can be as high as 140, but how many individuals (asopposed to sessions) does this correspond to and what constitutes a‘counselling session’ in terms of time and setting?

4. Turning Point

4.1 Turning Point should look into the possibility of having a rollingprogramme alongside or instead of the existing closed process as well asbecoming more flexible particularly in light of recent high attrition rates.

4.2 Extensive focus on long-term inmates occurs to the detriment of Short-term/remand inmates who are all too often excluded from provision. Analternative would be to put in place group-work that is specific to theneeds of those who will very soon be out in the community. The Drugsand Prisons Report by The Select Committee on Home Affairs stated backin 2000:

59 “Drug treatment in prisons has focused on longer-term prisoners. Thesame attention needs to be paid to remand and short-term prisoners. Theyare more likely to be in prison for drug-motivated crime and treatment ismore urgent because they will be released sooner. They are the greatestchallenge if the cycle of addiction, crime and imprisonment are to be broken.We recommend that the Prison Service should make more drugrehabilitation programmes available to remand and short-term prisonersbeyond what is currently envisaged under the CARAT service.”

4.3 Turning Point recruitment and retention policies need to be reviewed andmade live to ensure recruitment process and procedures for staff aredesigned to appeal to a wider audience and therefore are able tosuccessfully attract professionals from BME communities. The NTA statesthat:

“There is clear evidence that issues of anti-discriminatory practice inemployment and issues of equity in service provision for diverse communitiesare, and should be considered as, related and not as separate issues”. p.7

20

4.4 Programme evaluation and inmate feedback processes need to be put inplace in order to make better sense of high attrition rates and to assistTurning Point in meeting the diverse needs of inmates.

4.5 The KPT’s need to include information from inmate evaluations as well asattrition rates. This will give some indication of the extent to whichinmates benefit from the programmes. Without this information it will notbe possible to assess in real terms how effective the Turning Pointprogramme is. The NTA states in Models of Care:

“There is an increasing central imperative to monitor the activity, costand outcomes of substance misuse treatment and care services. Structuredcommunity and specialist substance misuse service providers are nowexpected to report at least some information about how effective they are athelping people who present for treatment. This reflects a desire to gaugethe return on natonal investment in treatment services and to ensure thatresources are directed to treatments that are effective.” P.196

5. Other Services

5.1 The Federation, Blenheim project or other organisation with a track recordof working with BME communities needs to be approached with the viewto developing a crack specific programme as part of overall serviceprovision open to those on short and longer sentences as well as onremand.

5.2 Consultation should take place across the board in order to develop aculturally sensitive model of working suited to the prison service.

6. Voluntary Testing Unit/Detox

6.1 Interpretation of figures needs to occur whole-istically on a regular basisto draw out the underlying issues that cannot be seen so readily bylooking at pieces of individual information. see point 12.5 above.

6.2 See also recommendations under 1. Drug Strategy

7. Race Relations and Foreign Nationals

7.1 The lack of drug related information in a variety of languages has been anongoing issue within the substance misuse field in general. Although thiswas not raised within the focus groups and given that the overall prisonpopulation of foreign nationals is over 11% and rising the provision ofdrugs and various other information in languages other than Englishneeds to occur.

21

8. Security

8.1 Leaflets about specific issues raised by inmates, i.e. MDT and movingfrom one drug to another that has less days for detection could beprovided as a way seeking to prevent such cases.

8.2 The relationships between levels of security, drug supply and theavailability of treatment needs to be explored in order to identify the fullnature of interaction.

9. Workforce Planning

9.1 Carry out Equality Health Check to consider implications for PrisonService, BME professionals and Communities.

9.2 Work with the Federation to develop diversity strategy; which defineswhat diversity means for the prison service (particularly in relation to race– common understanding that is flexible enough to accommodate theproviders varying ways of working with BME inmates).

9.3 Work with Federation to develop Diversity Manual – ‘Identity &Difference’ for bespoke diversity training programme for service staff andproviders.

9.4 Provision of leadership and management training for service staff andproviders working with BME communities.

22

References & Literature Review

NTA for Substance Misuse – a) RRAA 2000 – Implementing good practice b) Models of Care (2002)

Home Office - development and practice Report – ‘The Substance misuse treatment needs of minorityprisoner groups: Women, young offenders and ethnic minorities’ (2003)

DOH - ‘Drug Misuse and Dependence – Guidelines on Clinical Management’ (1999)

Audit Commission – ‘Change Here!’ (2001)

Select Committee on Home Affairs Second Special Report - ‘Drugs and Prisons’ (2000)http://www.publication

The MacPherson Report

Belbin – ‘Organisational Behaviour’ p.96 (1981)

1) Home Office – ‘Findings 186. Prisoners’ drug use and treatment: seven studies’2) Home Office – ‘Prison Population Brief’3) Home Office online report 33/03 – ‘Differential substance misuse treatment

needs of women, ethnic minorities and young offenders in prison: prevalence ofsubstance misuse and treatment needs’.

4) Home Office DSD – Updated Drug Strategy 20025) Home Office – ‘Tackling Crack – A National Plan’6) NTA/COCA – ‘Treating crack and cocaine misuse - A resource pack for

treatment providers’7) NTA – ‘Models of Care’.8) CRE – ‘Race equality in prisons’ (2003).9) CRE – ‘The duty to promote race equality. Performance guidelines10) CRE – ‘Public procurement and race equality’.11) CRE/HM Prison Service – ‘Implementing Race Equality in Prisons’.12) HM Prison Service performance rating system. 2nd Quarter 2003/04.

http://www.hmprisonservice.gov.uk/corporate/dynpage.asp?Page=95013) a. Prison Drug Strategy – detailed initial impact assessment (CARATs). b. Prison Service impact assessment (Reception). http://www.hmprisonservice.gov.uk/life/dynpage.asp?Page=80714) Sangster D, Shiner M, Patel K and Sheikh N (2002) – ‘National Scoping Study’

15) Audit Commission – ‘Changing Habits’

23

Appendix 0.01

The Federation

Abd Al-Rahman – Diversity & Drugs Adviser (London Prison Service)Work Program (21st October 03 – March 04)

Key: Area Drugs Coordinator (ADC) Chief Executive Officer (CEO), Head ofConsultancy (HC), Drugs & Diversity Advisor (DDA), National TrainingOfficer (NTO).

Action Target Date Comment

Identify Mentor/Coach for external support and supervision

(1) Support/advise steering group in relation to issuespertaining to diversity and drugs in prisons

• Organise, coordinate and minute meetings,disseminate information

• Produce quarterly reports(December, March)

) Review all existing area and DSU data collectionon BME use of prison drugs services

• Review transcripts of Focus groups and producereport of key findings

• Review findings and responses to ActionResearch questionnaire.

• Visit HMPS London Area Office and accessintranet (1 full day).

• Highlight any indicated service shortfall or trends.Report findings (plus Focus groups, ActionResearch) to ADC, Steering Group, FSC, FCEO

(3) Evaluate Training needs and develop trainingpack for service employed staff

• Develop, disseminate, evaluate training needsquestionnaire.

28th November03

TBA – aftersecond meetingwith Huseyin

17th Dec 03and 29th March

04

31st Oct. 03

31st Oct. 03

Weekcommencing3rd Nov.03

31st October2003/ongoing

January 2004February

.Essentialrequirement

DDA/Prison Service(PA)

DDA

DDA/HC

DDA/HC

DDA

DDA,

24

questionnaire.

• Make recommendations to steering group

(4) Review and evaluate service diversity training for serviceemployed staff

• Organise Federation Diversity Training Session“Identity & Difference” for prison drug servicestaff

• Disseminate Evaluation forms, collate andfeedback

• Make recommendations for further training.

(5) Offer the contract drug services consultation and supporttheir training needs and operational considerations to assist

complying with the prison service duties and policies ondiversity

• Produce and distribute letter of introduction toService Managers of contract agencies (1)explaining context of prison service work,rationale and (2) offering Federation consultancyservices

• Visit 6 named establishments on at least twooccasions each.

• Make recommendations on any necessarysystems improvements. Highlight any indicatedservice shortfall or trends to be reviewed bysteering group

• Follow up letter to Chief Executives of contractagencies in conjunction with ADC to arrangemeetings with Contractors CEO’s & CEO, HCfollowing completion of the Equality HealthCheck Process

• Inform development of audit tool toestablish awareness and practice pertainingto prison service duties and diversity

Notes – Abd Al-Rahman, as discussed -fortnightly supervision is an essential criteria aswell as your identifying an appropriate individualto provide you with professional mentoring andcoaching

February

February 2004

February 2004

February 2004

February/March2004

7th November2003

by 9th January2003

19th January2004

15th January2004

TBA

DDA, HC,NTO

DDA, CEO, HC

DDA, HC

DDA, HC

DDA, CEO, HC

DDA, CEO, HC

DDA

CEO, HC, DDA

DDA, CEO, HC

DDA, CEO, HC

25

coaching

This template will work in conjunction with your LondonHMPS Outcomes.doc and Rationale.doc. In addition to yoursupporting Federation activities as specified by the CEO.This document will be reviewed monthly and anyadjustments made.

26

SAMPLE

(Appendix 0.02)

Dear ,

I am writing to inform you of work that is taking place within the London Area prisonservice in relation to drug strategy/intervention and BME inmates.The Prison Service London Area Office has funded The Federation of Black and AsianDrug and Alcohol Professionals for the post of Drugs and Diversity Adviser. TheFederation is a national organisation established to support the needs of Black andMinority Ethnic (BME) professionals in the drugs, alcohol and related sectors, and theircommunities. The Federation acts in a consultant advisory capacity to centralgovernment; Drug Strategy Directorate (DSD) Drugs Prevention Advisory Service(DPAS), National Treatment Agency (NTA) etc. Informing the updated, National DrugStrategy, from a culturally sensitive standpoint.

The role of Drugs and Diversity Adviser entails the following:

1. Support and advise the Area Drugs Co-ordinator, the Federation and the HMPS(London Area) Diversity steering group in relation to issues pertaining todiversity and drugs within the London area prisons.

2. Review Area and DSU data collection on BME use of drugs services.

3. Review and evaluate diversity training for service employed staff.

4. Evaluate Training needs and develop training pack for service employed staff

5. Offer contract drug services within the London area prisons, consultation andsupport with their training needs and operational considerations to assistcompliance with prison service duties, race equality and diversity policies

In order to carry out these responsibilities I have been visiting HMP’s WormwoodScrubs, Wandsworth, Latchmere House, Pentonville, Brixton and Feltham to meet withservice providers and others to gain insight into what services are available, to whatextent BME inmates access them and how these services work with these inmates. Thetask is one that aims to advise and assist services wherever necessary in order tofurther enhance the quality of practice.

I have already attended after which I had a chance to brieflyintroduce myself to . I am now booked to attend various meetings at

between the .

If you require any further information regarding this work please call me at TheFederation.

Yours Sincerely,

Abd Al-RahmanDrugs and Diversity Adviser

27

(Appendix 0.02i)

The letter overleaf was sent to the following Area Managers/Directors of Drugservices within London area prisons

HMP Brixton

Adrian DaviesArea ManagerCRI1st Floor Lorenzo StreetKings CrossLondonWC1X 9DJ

CARATs Brixton and Wormwood ScrubsPeter O’LoughlinArea ManagerCranstoun Drug Services112 – 134 Broadway HouseThe BroadwayWimbledonSW19 1RL______________________________________________________________________

HMP Feltham/Latchmere house (South Staffordshire – CARATs)

Alistair Sutherland Director of Inclusion, Drug and Alcohol Services20 Mill LaneYatelyHantsGU 46 7TNalistair.sutherland1@ntlworld.com

______________________________________________________________________

HMP Wandsworth

Joe BernadelloDirector of Operations SouthRAPtRiverside House27 – 29 Vauxhall GroveLondonSW8 1SY0207 582 46770207 820 3716 faxinfo@rapt.org.ukwww.rapt.org.uk

28

CARATPeter O’LoughlinCranstoun Drug Services112 – 134 Broadway HouseThe BroadwayWimbledonSW19 1RL______________________________________________________________________

HMP Wormwood Scrubs

Andy HillasArea ManagerTurning Point100 Christian StreetLondonE1 1RS

0207 265 2010andrew.hillas@turning-point.co.uk

HMP Pentonville

Andy HillasArea ManagerTurning Point100 Christian StreetLondonE1 1RS

0207 265 2010Andrew.hillas@turning-point.co.uk

29

(Appendix 0.03)

Name Position Date visited

Hitash Dodhia C & E Wing Governor 2nd December

Roslyn Anderson Foreign Nationals 4th December

Steve Tutty Clinical GovernanceSubstance Misuse (NHS)

5th December

Dave SherwoodDrugs StrategyCoordinator 1stDecember/

open access

Kenny Jarvis Race Relations LiaisonOfficer

5th December

Senior Officer 2nd December

2 x Officers 2nd December

Sapna Dhall CARAT Team(Cranstoun)

1st December

Maureen Sancaster CARAT Team - Detox 4th December

Steve Smith Team leader TurningPoint

4th December

Turning Point Worker 2nd December

Dorothy Yesufu CARAT Admin 1st December

5 x BME Inmates2x ‘Listeners’ ordesignated inmates whoprovide support for thosewith concerns

1st, 4th and 5th

December

30

(Appendix 0.04)

Questions asked during meetings

The following questions acted as a guideline and directional prompt They wereasked within the framework of a semi-structured discussion. Questions askedwere based on relevancy to the staff member and their role.

• What is the nature of the drug treatment offered? (Detox, groups, one-to-one’s,models used, etc.)

• Is there Information in various languages?

• How many BME inmates are referred to the service?

• What is the ethnic breakdown of those referred?

• Are there mechanisms for inmate feedback?

• What are the drug related outcome targets?

• What are the output targets?

• How are inmates assisted at the prison exit stage? (links with outsideagencies,etc).

• What has been done previously to address any BME unmet needs?

• Treatment service policies – On Diversity and Eq. Opps. How are they madelive?

• Can you outline staff training in relation to Diversity?

• Do services feel that provision is sensitive to cultural differences?

• Do services feel that they meet BME inmate diverse needs? If so, how?

• How do they assess how well they are doing in relation to the above?

• How does the Race/Diversity agenda play a role in the Drug Strategy Group?

• Does a Race Relations Officer/Diversity lead attend Drug Strategy meetings?

31

(Appendix 0.05)1. Inmate perspectives

1.1 The BME inmates who were met with have a negative view of drugservices in Wormwood Scrubs. The DDA was allocated a room to speak toone inmate who is a ‘Listener’, someone who is available to give time toother inmates who need someone to talk to about their general concerns.During this discussion the inmate mentioned the RAPt course that heattended in another prison. He spoke highly of the course but said that itwas not available to all inmates due to capacity. He also spoke highly oftwo individual CARAT team members and their efforts to help. He spokeless favourably of the CARAT service feeling that it did not have thecapacity or the expertise to deal effectively with the client group.

1.2 Another inmate said, when asked what he thought of the drug treatmentin the prison, “What drug treatment? There’s no drug treatment here.” Inrelation to the Turning Point course he stated that he had tried to access itafter it was a number of weeks into the sessions. He felt he should havebeen allowed to access it because nearly all had dropped out (two wereleft) but he was refused access. He felt that the course should be moreflexible, “They have 4 workers. Why don’t they run two courses 2 workerseach”? He also said that he waited about 9 weeks for a CARATassessment. As a result of his particular experience he said that nothing ishappening in drug services.

1.3 Two inmates were approached on the landing for an informal discussion.They had a lot to say in regard to inmates switching to heroin and crackdue to MDT’s. They also said that the amount of drugs inside couldn’tcome in over the wall and from visitors alone. They stated that officersand various staff were also bringing it in to “pacify an overcrowdedpopulation” and assist an understaffed workforce. It was also stated thatabout a month previously there were fights on the landings everyday allover drugs because the supply had temporarily gone down. It is widelysaid that some people come in clean and end up drug users in prison.

1.4 Inmates said that Black male staff are needed in drug services – “Whitestaff can be OK but most can’t relate to where we’re coming from”.

1.5 Resettlement was seen as a major issue. An occurrence was related of aninmate who left prison and had nowhere to live so he slept in a car. Helater committed a crime in order to get back to the relative comfort of theprison.

32

(Appendix 0.06)

2 Staff perspectives

2.1 In order to mask identity everyone quoted below is referred to as ‘amember of staff’. The following came out within meetings.

2.2 Within discussion a member of staff admitted that, “Drugs interventiondoes not hit home with inmates”.

2.3 One member of staff felt that everything was being done that could bedone. He also expressed that he was sick of people focusing on whatWhite workers were not doing for BME communities and they should goand sort out their issues themselves. The DDA felt it was necessary at thispoint to give a reminder of the remit and that it ran contrary to hisstatement.

2.4 Resettlement is seen as the number 1 issue. Members of staff see manyinmates leave only to return soon after. A high number also leave with nofixed abode.

2.5 A member of staff said that there are, “Too many fingers are in too manypies” and a more co-ordinated approach is needed to working with drugusers. At times inmates were referred to outside agencies knowing thatthey will not get a place for a variety of reasons.

2.6 Another staff member said that the underlying issues are not beingaddressed and there was no quality time allocated to do this. There needsto be more 1-to-1’s and group-work for all because what is being donenow is surface work.

2.7 During one meeting it was stated that Turning Point were “perpetrating afraud on the prison service” and should be “turned out of WormwoodScrubs” because issue was taken with the credibility of their data and thequality of their work. He had asked for data from them on numerousoccasions but this was not forthcoming. Having questionnaires alone wasseen as not enough to show that work was completed to a high standard.These could be rigged in favour of the service. Experiences with TurningPoint outside of Wormwood Scrubs also informed the position that theywere the weak link in services.

2.8 It was said that there are no anger management courses yet this issomething that is a necessity.

2.9 Intervention was seen by one member of staff as too drug related. Groupsneed to go into the areas of personal experience and being that led to druguse, crime and so on. There was a “lack of substance” to intervention.

33

(Appendix 0.06)

2.10 Many staff members echoed what was said by inmates, “too much drugsare available in prison to be coming over the wall and through visits.

2.11 It was said that not enough emphasis is put on links between DrugStrat/Chaplaincy(who do a lot of unaccounted for counselling, Education,family, etc.

2.12 During one meeting it was stated that basic human rights must to be takeninto account before minority issues. In other words, staff must keep totheir word with inmates, treat all with care and ensure that their basicrequests are respected and dealt with. In relation to quality and calibre ofstaff it was said that, “If staff have integrity and have understandingwithin their lives then they don’t have to refer all the time to policy (inrelation to equalities)”. Doing this will keep down levels of stress amongstinmates and keep up standards. This perspective is a theme runningthrough services. However, issues specific to the variety of BME inmatesmust not be seen as separate from basic human rights, lower down on alist of priorities.

2.13 One officer, spoken to on the landings, informed of one occasion when aninmate was ‘puffing’ outside his cell and was told not to be stupid and getin his cell if he wants to smoke. It was also said that generally this is theunspoken policy as long as inmates are discreet.

34

(Appendix 0.06)

3. General observations

3.1 There is a disjointed approach to dealing with inmates between thevarious health/treatment focused staff and many prison officers. Someofficers do not demonstrate an understanding of the need for interventionthat seeks to rehabilitate inmates and this, at times, impacts upon therelationship between Officers and treatment staff.

3.2 There is a perception that to look at BME specific issues is in some waydiscriminatory, especially as drugs themselves do not discriminate. As aresult, diversity issues are masked behind the phrase “our service is opento all”.

3.3 Treatment staff make-up is female heavy. One inmate viewed most drugtreatment staff working outside of the detox end of the process as tooremoved from knowledge of their reality. Hence a feeling of “what dothey know”.

3.4 Innovation within drug services is stifled in Wormwood Scrubs. Therewas no evidence of innovative ways of working born out of consultationbetween services and with inmates. Innovation is all the more necessarywhen one considers, for example, that E wing is 81% BME.

3.5 There is no data found regarding completion/retention in treatment byethnic group.