Supplementary Submission from the Minister for Health

Commission on Justice in Wales: Supplementary evidence from the Minister for Health and Social Services, Welsh Government Contents Introduction 1 Collaboration between devolved and non-devolved services and authorities 1 Examples of collaborative working – and of complexity 2 Conclusion 7 Mae’r ddogfen yma hefyd ar gael yn Gymraeg. This document is also available in Welsh. © Crown copyright 2019 2 | Supplementary evidence from theWG37417 Minister for DigitalHealth ISBN and 978-1-83876-016-8 Social Services, Welsh Government Introduction This supplementary paper focusses specifically on activities to address the many socio-economic the correlation between the health service and the determinants of health, and involves working across justice system1 in Wales. The justice system often sectors in a collaborative and integrated way as draws upon health services to care for prisoners envisaged in the Prosperity for All national strategy. and others, while, used effectively, health services The justice system impacts upon the wider can reduce offending and lessen pressures on the determinants of health such as someone’s justice system. However this requires collaboration employment status, where they live and their between public authorities, including collaboration support network. It has considerable influence across the divide between what is devolved in Wales on efforts to reduce health inequalities. and what is not. In consequence, health care policies and The Welsh Government is very conscious of the operational delivery will often have to straddle risk of poor health being a causal factor in criminal the devolution settlement. behaviour, and of the need to ensure people are There are examples in this field again, therefore, able to access health support whilst in the criminal of the devolution settlement representing what justice system. Offenders, in general, have higher is essentially an arbitrary divide that can hamper needs for health services. Collaborative working public authorities’ efforts to support and care for between health and justice bodies is also, therefore, the people of Wales. Collaboration across multiple an opportunity to engage otherwise hard to reach bodies and agencies is difficult enough when all people by providing them with health services they are ultimately subject to the same direction at the may not otherwise seek or receive. political level. It becomes significantly more difficult This can be an effective way of tackling health when they are not. inequalities. Health inequalities are preventable differences in wellbeing that arise from an unequal Collaboration between devolved distribution of social, environmental and economic and non-devolved services conditions across society. These can affect the level and authorities of risk of people getting ill, their ability to prevent Interactions between the health service and sickness, or opportunities to take action and access the justice system arise in a number of different treatment when ill health occurs. scenarios and examples are provided below of what Addressing the health inequalities which exist is currently being done. But whilst collaboration and between our most and least deprived communities partnership working both at national and regional is a key priority for the Welsh Government. It is level is commonplace, there are tensions in the well understood that many of the root causes of system. Ensuring that public authorities collaborate health inequalities lie outside the health sector. so as to provide a seamless experience for those They arise as a result of the social and economic in need of support is difficult, as is acknowledged inequalities that shape the conditions in which in a Mental Health Crisis Care Concordat2 agreed people are born, grow, live, learn, work and age. between relevant public authorities in England The Welsh Government’s action to tackle health in 2014: inequalities, therefore, includes a broad range of 1 In referring to the justice system in this paper we also include policing unless the context otherwise requires. 2 https://www.crisiscareconcordat.org.uk/ Supplementary evidence from the Minister for Health and Social Services, Welsh Government | 1 As an example, the extent to which the police are “There have long been concerns about the required to deal with problems that arise from a way in which health services, social care person’s mental health is a difficult issue. All of the services and police forces work together police forces in Wales report a steady increase in in response to mental health crises. the number of mental health related calls that they have been required to attend to each year. They have Where there are problems, they are often formally raised concerns about this with NHS Wales as a result of what happens at the points and the Welsh Government, contending that dealing where these services meet, about the with what are essentially medical issues should not support that different professionals be their responsibility. This is of course a reasonable give one another, particularly at those position. However, the term ‘mental health’ is moments when people need to transfer being used by a number of agencies to define a from one service to another. broad spectrum of circumstances, which as well as including those with a diagnosable mental health This is a very serious issue – in the worst disorder can refer to people in distress due to social cases people with mental health problems or domestic issues and people who are intoxicated. who have reached a crisis point have There is a risk, therefore, of responding to what may been injured or have died when responses not necessarily be an increase in cases of mental have been wrong. In other cases, health problems by investing further in mental health patients have had to travel long distances services, instead of developing multi-agency support when acute beds have been unavailable.” tailored to the needs of the individual. Examples of collaborative working – and of complexity In England, this is difficult despite the main public authorities involved all being subject, ultimately, 1 Mental health to the same political direction. In Wales, as referred The Mental Health Crisis Care Concordat developed to above, collaboration is more difficult because for Wales and led by the Welsh Government brings the ultimate political responsibility for the public together the following partners (of which a majority bodies and workers rests with different governments. are devolved but many are not): Collaboration at the operational level can be • The Welsh Government hindered by different approaches to providing services (differences which can be ideological as • Welsh Police forces well as structural, managerial or practical) and by • Police Liaison Unit disputes over who is responsible for what. In creating • NHS Delivery Unit an equivalent Mental Health Care Crisis Concordat • Welsh Ambulance Service NHS Trust for Wales, therefore, the Welsh Government faced these challenges. • Police and Crime Commissioners • Local Health Boards • Powys Teaching Health Board • Royal College of Psychiatrists 2 | Supplementary evidence from the Minister for Health and Social Services, Welsh Government • Royal College of Nursing Whilst collaboration and partnership working both • Third Sector: Wales Alliance for Mental Health at national and regional level is good – there are tensions in the system. Developing an integrated • Public Health Wales response which is ‘owned’ across multiple agencies • College of Policing is complex, particularly when it includes devolved • HM Prison and Probation Service and non-devolved areas and where actions are • Home Office designed by reference to which agency should be responsible as opposed to being focused on the • Association of Directors of Social Services needs of the individual. • Youth Justice Board-Wales The Mental Health Act 1983 and the Mental • Healthcare Inspectorate Wales Capacity Act 2005 provide the legal framework All partners agree to work together to ensure (for Wales and for England) for health and social that front line services most likely to come in to care provision for some of our most vulnerable contact with people in mental health crisis are citizens (including children and young people). supported, either to provide care or to direct people But, as has been demonstrated elsewhere in the to those who can provide the most appropriate Welsh Government’s evidence in relation to many care. The Welsh Concordat was launched in other circumstances, the line between what is December 2015 along with a national multi-agency devolved and what is not in Wales is blurred. task and finish group to guide the development The subject matter of the Mental Capacity Act 2005 of the Concordat and local implementation plans is reserved (as the UK Government considers it to across Wales. be a legal issue connected to the justice system, In September 2017, an evaluation of the Concordat despite the importance of health and social services by Bangor University concluded that the task and to those concerned), though the Welsh Ministers can finish group had achieved its immediate objectives, exercise certain powers under that Act; while apart including reducing the use of police custody from matters relating to the detention of restricted for those detained under section 136 of the patients, the Mental Health Act 1983 (and mental Mental Health Act 1983. Following the evaluation, health more generally) is devolved. As part of these the group

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