11 April 2008 - 13 April 2008

Prisons policy: rehabilitation, health and drugs

Chair: Lord Falconer of Thoroton QC

Ditchley spent a blustery spring weekend looking at prisons policy, analysing what was working and what was not and trying to come up with new, constructive ideas to take policy forward.  Having had a similar attempt four years ago, we were determined this time to make a difference.  We had several countries represented – the UK, Canada, the US, Ireland, Denmark, France and Germany – but the discussion tended to centre on the prison system in England and Wales.  We nevertheless learnt a lot from other countries’ experiences, with the American one tending to act as the back-marker and Canada offering a good example of a more thoughtful approach.

Since we began and ended with the ambition of affecting prison policy, this record will summarise only some of the excellent analysis we heard.  It is more important to focus on where to go next.  There was by no means unanimity on this amongst participants, whose perspectives were constructively varied.  But no-one was averse to a change of either emphasis or approach.

Why prison?

The starting point of the discussion was the purpose of prisons: a mix of retribution, deterrence, rehabilitation, punishment and public protection, with different emphases in different jurisdictions.  Yet participants largely agreed that in practice prisons neither rehabilitate nor deter. They were successful at protecting society by deprivation of liberty but were not a suitable mechanism for preventing re-offending.  This did not mean that a change in strategy and policy could not produce a system in which prisons, together with a range of other services, could prepare prisoners for re-entry into their communities.  But it would require a deliberate effort.

To gather public support for new approaches, the current state of public opinion would need to be taken into account.  There seemed to be a widespread view that prisons were above all a mechanism for punishment.  Participants, however, questioned whether this was really the case.  They thought that most people would accept that incarceration in itself was a marked punishment.  Just as important was that, once prisoners arrived, they should be treated with decency and respect and helped to prepare themselves for a re-entry into law-abiding society.  Managing offenders as individuals was a key component.  To use prison as an institution to deal with people left behind by other services was damaging.  Prisons too often served, for instance, as mental health institutions to fill the gap left by the failure of other community bodies. 


This was part of the explanation for the rise in prisoner numbers in England and Wales since the early 1990s from 45,000 to 82,000 today.  Yet the imprisonment rate compared to the conviction rate was not markedly higher in the UK compared to its European Union peers.  What was different was (a) the number of laws on the statute books that classified crimes as requiring custodial sentences and (b) the length of prison sentences, which had increased markedly since the early 1990s.  While the increase in prisoners was not so great in itself, fewer were being released.

Comparisons with the United States were made at this point, where changes in sentencing policy in the 1970s/80s and the consequential rise in prisoner numbers had produced doubtful long-term benefits.  It was generally agreed that prisoner numbers were not directly linked to crime rates.  What was clear was that the level of welfare in a society was inversely related to the level of imprisonment – Finland was cited as an example of a country in which successful universal education and health programs were part of the reason for the country’s low rate of imprisonment.

A cardinal point was the diversity of the prison population.  It was unrealistic to expect a ‘one size fits all’ model of treatment to succeed, or even for rehabilitation to work at all under the blunt instrument of a prison.  More individualised care was essential; and judges, governors and other leaders with the scope to exercise such care could more adequately prepare prisoners for a life outside. 

Hence a number of participants voiced their support for parsimony in the use of prison.  It should be used to lock up only the “unavoidable minimum”; and all other offences should be dealt with by local services and solutions, including community service.  Others believed that community service in the UK did not currently represent a viable alternative to custodial sentences.  In their opinion, community service provision was in need of reform and improvement.  Staff were often under-trained, under-resourced and poorly managed.  Investment was needed to ensure community services delivered the sentence of the courts in the intended way:  extra funding might come, for instance, from a reduction in prison terms.

Problems inside prisons

The key challenges faced within prisons were identified as drugs, gangs, high rates of suicides, sexual assaults, communicable diseases, mental health issues and a lack of emergency planning for crises such as flu pandemics or natural disasters.  Prisons were “repositories of our social problems” with inadequate resources to address these.  Overcrowding was the fundamental driver.  The physical architecture of prisons also made it difficult to implement ideas such as drug-free wings or constructive inmate activities.

Drug addiction affected 60-75% of prisoners.  Making drug dependency a disciplinary issue was impractical and costly. The supply of illegal drugs needed to be tackled, as well as the addiction.  Drug addiction was described as a chronic condition; the need for continuity with community services after release was underlined.  There was disagreement as to whether resources should be allocated to maintenance or abstinence programmes – the US did not support maintenance programmes within prisons.  Many agreed that both programmes were useful, as abstinence programmes were less likely to be successful for prisoners on short sentences.  The key was for a continuous programme to be applied within both prisons and the community.

Healthcare too should be linked with community services.  Communicable diseases, such as tuberculosis, hepatitis C and HIV, were twenty times more prevalent than in the general community.  There were harm reduction programmes in place, such as screening, needle exchange and other medical treatment.  Yet prisons need not be the only places to send people for treatment if outside facilities were available.  As for mental health, it was important to recognise the broad range and severity of mental disorders.  Prisons often managed severe personality disorders by restrictive interventions, but rarely provided treatment for the long term. 

The role of prison governors was regarded as crucial.  A good governor created a positive environment amongst staff and prisoners and ensured links with outside voluntary agencies.  Their work on treating prisoners as individuals could feed into decisions.  Privatisation of prisons was thought to work well as long as the terms of the contract had been well negotiated and were subsequently well monitored.  It was however important to ensure that prisons did not become victims of their own success.  They should not be seen by judges and the public as places that solved community problems in the short term.


A key recommendation from the conference was to link prisons and local communities.  Health, drug and psychiatric care should be standardised and continuous between the community and prisons.  With the community in the lead on drug treatment programmes, for instance, prisons would not have to deal with problems they were not equipped to address and crime rates would be reduced.  Prevention was a complex area, but needed to be included in any strategy to improve prisons.  Pilot schemes relating prisons to outside society, as in North Liverpool, had shown real potential, but remained too rare.  Scotland had progressed further in this area.

Public opinion

Participants recognised the political and public constraints.  Yet preconceptions of what the majority of the public thought about crime and sentencing policy had to be challenged.  There was scope for politicians, practitioners and journalists to influence public opinion and educate them on the advantages of more strategic approaches.  A change in culture was needed, moving beyond the ‘us’ versus ‘them’ language of society and prisons.

Some participants felt that the evidence showed the public as positively disposed towards reform in the prison and criminal justice system.  Polls showed victims far more interested in crime reduction than punishment.  Convicts valued the paths to a law-abiding life – jobs, relationships, housing and programmes tailored to their needs.  A focus on punishment had a negative impact and made them more likely to re-offend.  If policy-makers and politicians could harness these responses, they might come to see that a changed approach would not necessarily be unpopular.  It was the impact of crime on the community that was the real criterion.  Others wondered whether this was a realistic judgement in the current political circumstances.  But the strength of argument for policies that went beyond managing the numbers was palpable.

Amongst the specific ideas and proposals produced in the discussion the following were especially relevant to a more productive approach:

  • as many offenders as possible must be incarcerated locally; 
  • their outside relationships must be sustained, as well as the prison’s own place in the local community; 
  • jobs and housing (especially) after release need greater attention;
  • judges and governors should be given greater scope to manage individual prisoners’ cases with the primary objective of reducing re-offending (the pilot scheme in North Liverpool was regarded as a significantly positive example);
  • visitor and other community involvement schemes should be enlarged;
  • sentencing policy should aim at whatever numbers ensure prison environments which avoid overcrowding, boredom, poorly trained staff and low-standard services;
  • Titan prisons are not the answer, except possibly for the most dangerous prisoners and to introduce much better designed and constructed complexes;
  • Certain offenders, especially those with mental health, gerontological or drugs-related problems, should not be incarcerated (for as long or at all);
  • judges, magistrates and possibly governors should be given both encouragement and scope to tailor treatment of the individual offender;
  • money saved by shorter sentences should be transferred directly to community and other non-prison programmes;
  • aggressive conditionality in probation programmes should be reconsidered;
  • standards and service targets should apply in prisons as in the wider community;
  • the theme of education in prisons should received sharper focus;
  • drug addiction programmes should connect with those outside;
  • the contribution of NGOs across the whole area should be better coordinated.

While participants recognised this room for improvement, the mood round the table was often positive about what had already been accomplished.  There were dedicated people working in the prison service, aiming gradually to improve on the past.  Yet there was also scope now for a strategic shift.  The advocacy for this from the impressive range of expertise at the conference was strong.  It needed the guiding hand of our experienced Chairman to balance this with the political realities.  But we were all determined, this time, to see the right changes happening faster.

This Note reflects the Director’s personal impressions of the conference.  No participant is in any way committed to its content or expression.


Chairman:  Lord Falconer of Thoroton QC
Life Peer, Labour (1997).  Formerly:  Secretary of State for Constitutional Affairs and Lord Chancellor (2003-2007);  Minister of State for Criminal Justice, Sentencing and Law Reform, Home Office (2002-03);  Minister of State for Housing, Planning and Regeneration (2001-02);   Minister of State, Cabinet Office (1998-2001);  Solicitor General (1997-98).

Dr Eleanor Clitheroe

President and Chief Executive Officer, Prison Fellowship Canada, Toronto;  Counsel, Gauthier and Associates;  Chancellor Emerita, University of Western Ontario.
Mr Keith Coulter
Commissioner, Correctional Service of Canada, Ottawa (2005-).  Formerly:  Chief, Communications Security Establishment (2001-05);  Assistant Secretary, Planning, Performance and Reporting, Treasury Board Secretariat (1999-2001).
Ms Kim Pate
Executive Director, Canadian Association of Elizabeth Fry Societies, Ottawa (1992-).  Formerly:  Visiting Professor and Ontario Law Foundation Fellow, University of Ottawa (2006 07).

Dr Lars Møller

Manager, Health in Prisons Project, World Health Organisation (2002-).

Ms Laurence Fayet

Executive Secretary, National Association of Prison Visitors, France.

Professor Martine Herzog-Evans

Professor of Criminal Law, University of Reims, France;  Member:  editorial committee, Actualité Juridique Pénal;  Observatoire International des Prisons, Paris.  Author.

Dr Caren Weilandt

Deputy Managing Director, Scientific Institute of the German Medical Association, Bonn (1990-);  Researcher and Project Manager of several national and international research and health promotion projects, European Commission (2003-06).

Dr Enda Dooley

Director of Prison Healthcare, Irish Prison Service.

Mr Jonathan Aitken

Director, Prison Fellowship International (2003-);  Vice President, New Bridge Society;  Chairman, Centre for Social Justice’s Prison Reform Policy Group;  Broadcaster, Lecturer and Author.  Formerly:  Prisoner;  Member of Parliament, Conservative, Thanet South (1983-97);  Thanet East (1974-83).
Mr Peter Bottomley MP
Member of Parliament, Conservative, Worthing West (1997-).  Formerly:  Junior government minister (1984-1990);  Trustee of NGOs including National Association for Care and Rehabilitation of Offenders.
Baroness Bottomley of Nettlestone JP DL
Life Peeress (2005-).  Formerly:  Member of Parliament, Conservative, Surrey SW (1984-2005);  Secretary of State for National Heritage (1995-97), for Health (1992-95).  A Governor and Member of the Council of Management, The Ditchley Foundation.
Mr Andrew Bridges
Chief Inspector of Probation, HM Inspectorate of Probation, London (2004-).  Formerly:  Lead Officer, Offender Employment, Association of Chief Officers of Probation.
Mrs Mary Calvert
Advisor, Drug Interventions Programme, The Home Office, London (2004-).  Formerly:  Drug Strategy Advisor, Government Office for the North West (2001-04).  Founder member, EXASSnet group, Council of Europe.
Professor Andrew Coyle CMG
Professor of Prison Studies, International Centre for Prison Studies, Kings College, University of London (2003-);  Prison adviser to:  UN High Commissioner for Human Rights (1992-);  Council of Europe (1992-);  OECD;  Member, Foreign Secretary’s Expert Committee against Torture.
Ms Frances Crook
Director, The Howard League for Penal Reform, London.
Professor David Downes
Professor Emeritus of Social Administration, Mannheim Centre for the Study of Criminology and Criminal Justice London School of Economics.
His Honour Judge David Fletcher
Presiding Judge, Community Justice Centre, North Liverpool (2004-).  Formerly:  District Judge, Sheffield (2003-04).
Professor Roger Graef
Writer, Filmmaker and Broadcaster;  Visiting Fellow, Mannheim Centre for the study of Criminology and Criminal Justice, London School of Economics;  Founding Chair, Youth Advocate Programme, National Youth Justice Board.
Dr Savas Hadjipavlou
Acting Director, Health and Offender Partnerships, Department of Health and Ministry of Justice, London.  Formerly:  Director, Dangerous and Severe Personality Disorder Programme, Home Office, London.
Mr Nick Herbert MP
Member of Parliament, Conservative, Arundel and South Downs (2005-);  Shadow Secretary of State for Justice (2007-).  Formerly:  Shadow Minister for Police Reform (2005-07).
Mr Nigel Ironside
Governor-in-Charge, HM Prison, Edinburgh (2007-).  Formerly:  Assistant Director of Prisons, Scottish Prison Service (2006-2007).
Mr Erwin James
Columnist, The Guardian;  Trustee, Prison Reform Trust;  Patron, CREATE.  Formerly:  Life Sentence Prisoner (1984-2004);  Member, French Foreign Legion.  Author.
Sir Simon Jenkins
Columnist:  The Guardian (2005-);  The Sunday Times (2005-).
The Hon Isabelle Laurent
Deputy Treasurer and Head of Funding, European Bank for Reconstruction and Development, London;  Trustee, The Rehabilitation for Addicted Prisoners Trust.
Mrs Juliet Lyon
Secretary-General, Prison Reform International (2007-);  Director, Prison Reform Trust (2000-);  Professional Advisor, Childline (1996-).
Professor Rodney Morgan
Professor of Criminal Justice, University of Bristol (1990-);  Advisor to the five criminal justice inspectorates for England and Wales (2007-);  ad hoc expert adviser on custodial conditions to the Council of Europe Committee for the Prevention of Torture and Amnesty International (1989-).
Dr Mary Piper
Senior Public Health Adviser, Offender Health, HM Prison Service/Department of Health, London.
Mrs Sue Saunders
Prison Service (1989-):  Governor, HM Prison and Young Offender Institution, Holloway (2007-);  Lead, Partnerships and Alliances to Reduce Re-offending in the SE Region, National Offender Management Service (2006-07).
Baroness Stern of Vauxhall
Senior Research Fellow, International Centre for Prison Studies, King’s College London (1997-);  Member, Joint Committee on Human Rights, House of Lords (2004-);  Convenor, Scottish Consortium on Crime and Criminal Justice (2003-);  Patron:  Prisoners’ Education Trust;  New Bridge Foundation.
Mr Tom Tickell
Member, Pentonville Independent Monitoring Board Mental Health Tribunals.  Formerly:  Member, Mental Health Act Commission.
Ms Elizabeth Tysoe
Head of Health Inspection, HM Inspectorate of Prisons, London.

Mr Rick Lines

Senior Policy Advisor, International Harm Reduction Association, London (2007-);  Board Member, Irish Penal Reform Trust.  Formerly:  Executive Director, Irish Penal Reform Trust, Dublin (2003-07).
Mr Keith McInnis
Inspector, HM Inspectorate of Prisons.

Ms Catherine Hennessy

Director, Revolving Doors Agency, London.

Ms Elizabeth Alexander

Director, ACLU National Prison Project.
Ms Jamie Fellner
Senior Counsel, US Program, Human Rights Watch;  Commissioner, National Prison Rape Elimination Commission.
Dr Robert Greifinger MD
Consultant in prison and jail healthcare (195-);  Professor, Health and Criminal Justice and Distinguished Research Fellow, John Jay College of Criminal Justice (2005-);  Editor, Public Health Behind Bars:  From Prisons to Communities, Springer (2007).
Mr Herbert Hoelter
Co-Founder, Chairman of the Board and Chief Executive Officer, National Center on Institutions and Alternatives, Baltimore.
Hon Martin Horn
Commissioner of Probation, Department of Correction and Probation, New York (2002-).  Formerly:  Secretary of Administration, Office of Administration, State of Pennsylvania (2000-02).
Dr Nancy Merritt
Chief, Justice Systems Research Division, National Institute of Justice.
Hon Frank Sullivan Jr
Justice, Supreme Court of Indiana (1993-).  Member, Board of Directors, The American Ditchley Foundation.
Ms B Diane Williams
President and Chief Executive Officer, Safer Foundation, Chicago (1996-);  Member, National Institute of Corrections Advisory Board.