Equality and Social Justice Committee

Thank you. So, obviously, I'm here today speaking from the perspective of the UK Health Security Agency, which has quite a defined remit around health security issues in women's prisons. So, speaking from that perspective, and, again, working in an organisation that covers England, and not necessarily Welsh blueprint documents, but speaking from the perspective of health security and where we have moved to and where we have come from, I think it's fair to say that, in terms of health security infectious disease-related issues, we have made good progress in ensuring we have robust systems in place to tackle diseases that we know disproportionately affect people in prison, including women, such as continuing with our opt-out blood borne virus screening programme recommendations, recommendations around tuberculosis screening in prisons, and we've recently been working in partnership with the British Association for Sexual Health and HIV to design standards for prisons, not just for women's prisons, but all prisons, related to sexual health. So, I think there's a lot of work that's gone on in this space to make sure prisons in their entirety, across the estate, are well equipped to keep them, as we say, health secure, acknowledging that's just one remit of the health system.

Okay. Fine. We may want to come back on those statements. Dee or Jo, do either of you want to comment on this? You don't have to comment on every single thing if you agree with previous speakers.

I think, just from our perspective, until we looked into this, until I knew I'd be here today giving evidence, this wasn't something I was particularly familiar with. So, from that point, I think it would be quite interesting to get more disabled people involved with this kind of blueprint, with this legislation, and things like that, so that you can hear and you can get a wider viewpoint from those communities as well.

Very good. Jo Hopkins, obviously, the biggest issues for women in prison are both adverse childhood experiences, mental health and addiction issues. So, do you think that this blueprint starts to address those issues and the way we handle them?

I was actually working in the Home Office when the Corston report came out, so I have a slightly different perspective on all this, and it feels like a long time ago. So, in terms of progress, I think the first thing to say is that the Corston report was absolutely clear that the approach to women in any form of custody needed to be women centred. So, I think, in terms of the way that the blueprint has not only changed its name, it's changed its perspective, I guess, on understanding that point. So, I think, fundamentally, there's a very clear commitment from the blueprint to make sure that it meets that women-centred, integrated approach that was at the forefront of Corston, if I remember rightly.

The other thing is that I think there are really green shoots within the blueprint that address some of the other key aspects of the Corston report. One, in particular, is the experience of mothers. And I think one of the things that is probably a green shoot, I would say, at the moment, is the identification of programmes, projects, initiatives that support better women in prison who have children either at home still or are pregnant or all of that. There's so much more to do, but things like the Visiting Mum programme, which is one of the things that, in my role, in the blueprint itself, as a research and evaluation lead, I'm keen to understand what difference that's making. So, there are significant issues still to overcome, I think.

We're not going to be able to say today—or, I can't—that the blueprint has answered all the questions that Corston raised. But, certainly, there's a recognition within the methodology and within the ethos of things like understanding that trauma is at the root of many of the experiences of women, in particular brain injury as a result of domestic abuse, and the prevalence of that amongst the female population. But also there's that experience of why women offend—what has happened in their lives? Actually it's a very different experience to why men offend, and what we're really keen to understand and continuing to build on, through the blueprint structure, is getting that better evidence base to say, 'This is what the experience of women is in childhood', up to the point where they're often in a position where there's low-level offending, they are criminalised to a higher point than men are, but also that experience and why they do it— things like coercive control, things like trying to support a family, things like, basically, living hand to mouth need to be better understood, and so the prevention of the causes of women entering the criminal justice system needs to be thought about more. But what I'm encouraged about is that the blueprint is taking those steps, has identified those areas, and whilst it's not there yet, I think we can be encouraged by the direction it's taking.

The latest blueprint update was published in May—lots of fine aspirations, not a lot of detail about what's actually been achieved. So, I wonder, Jo, if you can tell us a little bit about how the Cordis Bright and ORS evaluations are actually influencing the work of the blueprint, because those haven't been published.

No, and, as Public Health Wales, I can't really take any responsibility for that decision to publish or not; they are the remit of His Majesty's Prison and Probation Service. As we all understand, that brings its own challenges in terms of what goes into the public domain. I did ask, because I anticipated that the committee would like to probably see those reports, so that is being considered by colleagues at HMPPS, if that's helpful.

From my perspective, I think one of the key questions for me in terms of the blueprint is exactly what you've just said, Chair, in terms of what is it that it's actually doing, and are those things making a difference. So, one of the things that we've just recently done is a workshop with all three blueprints, because there's a third one now—the violence against women, domestic abuse and sexual violence blueprint—to think about that theory of change. Question: why was that not done at a strategic level in the beginning? I wasn't there; I don't know. But I'm very encouraged to hear that people are now thinking, 'Let's be clear what the mission and the vision is, and how we articulate how we've achieved some of the activities and the outcomes that we want to see. So, hopefully, we will get all three blueprints into the same position in terms of understanding that and being able to articulate it.

On the Cordis Bright and ORS work, both would be very important in terms of informing the direction that we move towards in terms of thinking about where in the point of the blueprints are those things that we could measure, that we could understand what the impact is, and we could then create the narrative that you're looking for in terms of what difference it has made. The evaluability assessment, I think, and the Cordis Bright work both will be very important in identifying where the data gaps are, and particularly the data linkages, because in all of this work, because it's multi-agency, because it's cross-Government, there is always that challenge, isn't there, of who's got what data and how we put it together to give us that integrated picture. So, I think there is still some work to do. Those two reports are not the silver bullet in terms of, 'This is how we take things forward', but they are helping us to understand where the emphasis needs to be, what needs to be measured, and now how we go about doing so. I think they will be really important to ongoing discussions around the evaluation and the research element of this, which is where I sit, and thinking more about what it is that we can support the blueprints with from public health, to be able to evidence some of the things that work and the things that aren't working, because it's absolutely important that if something is not achieving what we anticipated or wanted, then we stop doing it and we focus efforts on things that make a difference.

Okay. So, I think my concern is about the pace of change for diverting women from ending up in prison, with all the upheavals that that causes for them and their family, particularly where very short sentences are involved, where it's completely pointless from a public expenditure point of view as there's absolutely no time to do any sort of rehab work if somebody is on a very short sentence. So, is there anything that you can optimistically say very briefly on this point before I ask some of my colleagues to come in? Chantal, have you got anything you're able to tell us about this?

Yes. Obviously, like I said, I'm speaking from the perspective of my organisation, which has, as I said, a very clear, defined remit, and for all organisations, I think, that have a role in the healthcare system within the prisons, it's difficult to deliver when people are revolving quickly through that door. So, from our perspective, again, from health security, you may identify a woman with hepatitis, but can you deliver treatment in that short stage? Possibly not. Will you see that woman again and again come back through the system, each time not with a length of adequate time to ensure that the treatment is completed? I think that does give us issues that are likely, I imagine, to be seen in other aspects of healthcare that's not the health security side. So, there's something about short sentences being problematic in your ability to make a difference for women that you come into contact with in the criminal justice system, because it is an opportunity to offer healthcare when people come through the prisons, and, as you say, the progress towards stopping these short sentences, we as an organisation would be very supportive of that. The organisation that really works in this area is NHS England's side and their role with the treatment requirements, so it's something that I can't comment on specifically, but I know there is work ongoing to try and make better alternatives for women than custody.

Okay. So, you don't have any specific knowledge of how the system works for Welsh women.

No, because, obviously, we're only on England's side.

Okay. Thank you for that. Can I call on Sarah Murphy to ask some questions now on the specifics?

Thank you very much, Chair. I just wanted to ask some questions on the potential of community-based provision, looking particularly for your views on the planned provision of a residential women's centre in Swansea, but also potentially other areas. As you know, the plan is for a pilot scheme, which will be opening in 2024, will have 12 beds, women will be there for up to 12 weeks, and it will be run by probation service staff. So, the question, really, is whether you value or not this model as an alternative to a custodial prison sentence, and for your views on its residential element. Dee, I'm going to come to you first because I can see you nodding along, if that's okay.

I do like to nod along, Sarah. Thank you. I think, from our perspective, this is something that we'd like to see, if it works, across Wales. We know that there's a postcode lottery when it comes to health, so we want to ensure that that doesn't replicate across the board. I will probably sound a little bit like a broken record today in terms of talking about making sure that things are accessible to anyone that needs to access them, and that they're inclusive. We need to ensure, I think, that accessibility is key. We know that disabled women are more marginalised than other women, and, I think, if you look after the most marginalised in society, you're well on the way to looking after everyone.

Yes, I absolutely agree. Thank you very much, Dee. Jo, did you want to come in next?

Thank you. I'll try and keep my answers a bit briefer; I've already started with my long-winded ones. So, from a Public Health Wales perspective, we have been really supportive of the approach to try and do this in Wales. I think we have a strong evidence base from other parts of England, actually, where women's residential centres have been hugely successful. When I say 'successful', how do we measure success? It's in terms of women being able to return to the community and not returning to criminal justice, and getting the help and support that they need, I think, from our perspective, we've been doing a lot of work, particularly in the ACE hub, around trauma and a trauma-informed approach—every time I come to a committee, I have to get that in somewhere—but the trauma framework and the wider understanding of what the community aspect of this is. So, where women return the community, how do we ensure that that integrated model doesn't just sit within the residential centre and that they aren't then facing those same pressures, whether they're environmental, whether they're at home, or whatever is the root cause? So, really keen to look at this as a whole-community response, not just a building and a facility.

And that leads me to—. Our position is to support and to try and help and evaluate, if we can, if that would be helpful, this pilot, but also to really be clear that the conversation with the residents, the conversation with the community in which this centre will sit, is as important, almost, as providing the centre in the first place. And I think, perhaps, a little more thought needs to be given to the understanding of the wider community in which these facilities may be placed, around who these women are, what their experience is, and to take away some of the fear that communities may have. I think we can learn from examples such as Trevi House in Plymouth, where this has been done very successfully and these facilities are just part of the community itself, so that we don't 'other' people, label people or accidentally, without intention, create something that wasn't there before and just keep going with the generation of a lack of understanding of the experience of these women and what supports them most.

Absolutely. And just a follow-up question to you, Jo—sorry, Chantal, before I come to you—but what conversations has Public Health Wales had with the local authority and the cabinet member for health and social care or the local health board about how this provision or any extra provision that they need in terms of health or substance misuse would be provided? And also, crucially, who would be covering the additional cost of that?

So, Public Health Wales is part of the programme board structure of the blueprint, but, as far as I'm aware, we haven't had any direct conversations with the local authority or with the councillor. However, we are part of that overall team. So, when drawn upon for any advice or information, we would be very happy to give it. I think one of the things that we are very clear about, in terms of a commitment to public health and wider health boards, is that we understand that this pilot, if it is successful, will be of real benefit to the women in our community. So, from that perspective, I think that's the overall driving force: to be as helpful as possible. But I can't comment on any direct conversations that may or may not have happened.

Thank you. Sorry, this is just sparking another question for me around this. I absolutely agree with you about being trauma informed and, actually, when we visited Eastwood Park, it was good to see that, really. There has definitely been a kind of switch to that, and it does make a huge difference, I think, to women in these systems. But, that's quite specialist, really, isn't it, to have that training and experience of working in a situation like that and having that trauma-informed training? And do you know what's being put in place or what kinds of jobs, really, would need to be advertised to be able to provide that? Because I don't think it's something that the probation service would necessarily have the expertise in. Is that right?

So, I think there are a number of levels of trauma informed. Here in Wales, what we've advocated, through the framework that was published in July, is that trauma informed is a way of being, and then there are practice levels within that, which I'm sure you're aware of. So, I think there is a lot of work going on at the moment across the criminal justice system and policing to be sure that anybody working in those institutions is at least trauma aware, so at the more societal, universal level, and then going up to the more specialist therapies, which I think is what you're talking about. So, I think there is a need to understand, first of all, what the capacity levels are around this, because most, if not all women who enter the criminal justice system will have had some form of trauma—we can't get away from that—but their particular individual needs may be very different. So, in terms of training, I don't think everybody needs to be trained in everything, but we really need to make sure that the demand is met by the capacity of the system.

There is some work that's been going on at the moment to train staff in trauma-informed approaches and gender sensitivity as well, which has been really important. One of the things that we're doing as Public Health Wales is evaluating that training. It's not specialist specialist, but, I think, no matter if you are psychiatrist or you're the person that sits on the reception, that sort of overall understanding is important for everybody, and then we can layer up the kind of levels as required. I think it does take a whole view across, and I'd like to defend the probation service a little bit here, because they have been part of what we call the Early Action Together programme, a few years ago in Wales, which was thinking about how we equip policing, criminal justice in terms of trauma-informed approaches, and prisons and probation were part of that and continue to be part of that. So, there's more to do, but I think there is a level of understanding that this is important, and that we need to invest in it going forward.

Thank you. And I'll just ask my last question on your views on the provision of women's centres that don't have the residential element to them. So, we've heard recently that Anawim in Birmingham is particularly good, and the Nelson Trust at Gloucestershire is particularly good. They don't have that residential element to them; it's more about the prevention before women would go into the criminal justice system really, and also then to support them when they come out the other side. So, Chantal, if I can come to you first then on this one: your views on that distinction between the two types of women's centres.

Sorry, I missed the very first half of the question; it sort of broke up a little bit.

All right. Just to say about the distinction between the rehabilitation centres, which have the residential element to them, and then the women's centres that are there to help women before they get to the point really where they end up in the criminal justice system, and then, to help them when they come out the other side of it. So, just the distinction between the two really, and, I suppose, your view on both or either of them.

Yes, sure. So, we don't have responsibility for oversight of them within my organisation, although I'm aware that the evidence base, full stop, for women's centres is very supportive, as has been mentioned already. I don't therefore have a view on which is better or what works better for why and what reason, but I would urge the committee to keep an eye out for the publication of the national women's prison health and social care review that has been jointly commissioned by NHS England and His Majesty's Prison and Probation Service. It's due to report in autumn, so we are one of the agencies that have been involved in the work of the review, although it's not our review. And I know from being involved in that work that women's centres is something the review will be considering in the whole. So, there's likely to be more in-depth information on that, when it comes out, about what models work or why.

I just wanted to touch back though on the points you just mentioned around the trauma-informed and the gender responsive. And, I think, again, that's something that all organisations in England are hearing more and more; it's definitely something we consider in our work and our policies—the need to be trauma informed for anyone involved in delivering services we have an interest in or oversight of. And, then, just around the gender side, so, again, in the department I'm in, in health equity and the clinical governance department, we have specific duties and aspirations around health equity inequalities, and the need to make sure that vulnerable groups are considered with targeted information on specific policies.

So, one of the things we're looking at is around prisons and transgender, for example. So, we have a sexual health registrar in our team at the moment who's going to be looking at transgender health standards, thinking potentially with a European-wide lens about people in prison, and, of course, that can go in all directions—you can have trans men in female prisons and vice versa—so, it's really considering that the needs can be quite complex and diverse. So, we are considering that under our health equity lens at UKHSA, and we also have a project, for example, that another registrar is going to be running, looking at what works for sexual health messaging for LGBT groups in inclusion health settings.

So, I know, sorry, that's straying off the question a bit, but, like I said, I don't have in-depth information on the women's centre side, but just going back to those points to say that they are really important to us as well.

Okay. Is there anything you can elaborate on as to why these residential centres have been successful in England, as Jo said?

No, I don't have the reports to hand on those, because they're not something our organisation is responsible for, because we're more about the policy, advice and guidance around the health security issues. So, it's not a topic that I am as familiar with.

Okay. No worries. Okay, thank you. Can I just ask Jane—? Oh, sorry, Sarah, did you want to add to that?

Yes, I'd like to hear from Dee and Jo about their views on the different types of women's centres—the ones where they're in residential and the ones where they're not. Jo, do you want to come in on this?

Yes, very briefly. Similarly, I don't have huge amounts of evidence to weigh one up against the other. However, I think one of the things that's important about taking a public health approach to this, which I think we are, and I hope we continue to do, is that we need to test and we need to test in Wales, because having used an example of Trevi House in Plymouth myself, actually would that work in a particular community in a particular area of Wales? There is a question, I think, around understanding the needs of individuals and whether it would better for them to be in a residential centre, or not. And there also needs to be a question around how that sits within the community and what services are available. So, it's back to the point of what we don't want is for this to become 'either/or'. It's got to be based on the needs of the women and what would support them the most. I'd be keen to test and pilot both approaches and to think about how that might work. So, a residential centre might be much better suited to an area of Wales that is well served with community-based services around it, and close to the health board ,et cetera. How does that work in rural somewhere—? I don't know; I don't want to pick on a county, but west Wales somewhere, where it's a slightly different model. 'How could we adapt and change what we know works in England to make sure that it does the same in Wales?', would be the way I would look at this. I think that's something we could think about, going forward.

Yes, thank you. Dee, did you want to come in on this as well?

What the others said, but also I think there's an aspect here—. Something that we talk about within our work a lot is about a lack of data, and I think that's something that we're probably seeing here as well. It would be amazing to have and to see and to learn from, but I'm with Jo; I think there is a lot that can be adapted to different communities, but also to the needs of the people who need it as well.

Yes. Thank you very much. Okay, thank you, Chair.

Thank you very much. We seem to have lost Jane Dodds. Is that right? So, can I go to you, Ken Skates, to talk about adverse childhood experiences? Hopefully Jane will rejoin us shortly.

Thanks, Chair. Jane's Wi-Fi has dropped out, but she will rejoin us as soon as she can. We've already heard about trauma-informed services, but I was just wondering whether the panel could give some more views on what they think the national trauma practice framework for Wales will have, and what research on experiences of ACEs for women right on the cusp of the criminal justice system is telling them.

I think that's me, then—I'm unmuted. Thanks, Ken. We're now at the point of trying to ascertain how we're going to implement the trauma framework. This is a really, really crucial point in terms of having got a document that sets out the practice levels, as I mentioned, and sets out the overall ethos of what we're trying to do, which is at a whole-society level. It's not just, 'Let's be a bit more trauma informed over here and cross our fingers over there.' It's really about culture change and it's really about thinking about how we instil the values and the principles, not only of the Well-being of Future Generations (Wales) Act 2015, but also looking at what we have excluded prior to this point, intentionally or unintentionally, and I won't comment on that, but things like the experience of racial trauma and discrimination, or the experience of people who are neurodiverse, for example. All of that is vitally important to be included and inclusive.

So, we've got a big job, but the plan is that we continue to implement the framework in the same way as we developed it, so it's co-production, co-delivery. It's not one organisation that's going to take it forward. We're working with Welsh Government colleagues at the moment to identify what funding might be available to support it, but I'm of the view that actually this isn't about money. This is about bringing people together that can make significant change. So, we'll start to see, hopefully, in the next few months, some real traction around taking that framework forward.

But your specific question around women on the cusp of the criminal justice system is really pertinent, because we are literally about to publish a report next week, which we'll make available to the committee, which is looking at exactly that: the experiences of adversity in its broadest sense. So, not just the ACEs that are identified as part of Mark Bellis's research, but a much broader understanding of the experience of women who have entered the criminal justice system but only in terms of the fringes, and really trying to ascertain what could have been done that wasn't done earlier in order to prevent those women even coming into contact, perhaps, with policing or low-level custody experiences.

What we're finding from that—we've already touched on it a little bit today—is that significant prevalence of domestic abuse and violence against women in the lives of women who are ending up undertaking criminal activity, and, again, the significant prevalence of trauma and head injury within that group as well. We've also got experiences of—. Human survival, I think, is the way to describe it—when there is almost no choice. I think some of that is playing into the wider environmental factors of do we understand the financial pressures on women, do we understand the gender inequality that then causes them to be unable to exist without feeling they have to turn to that, and then the link—as Chair pointed out at the beginning—between mental health, substance misuse, all the factors that come into play when people are struggling and aren't able to get the help that they need.

So, hopefully that report will—. I don't think it'll tell you anything you don't already know, but it brings it together in a way that really, I hope, sets forward the argument for prevention, and looking more keenly at preventative services for women in particular and their individual experience, as well as the need to be very inclusive of that as we go forward in the implementation of the framework.

Thanks, Joanne. That's really timely. Will the report highlight any best practice at all, or do you have any views on best practice that you might be able to share with us from elsewhere?

It's doesn't highlight best practice. The experience of the women is more about things that didn't work so well. However, you can infer from that that if there had been someone who had been more understanding of those particular issues of adversity in childhood, the longer term and life-course impact, that sort of thing—. There is, I think, still a need for education and awareness about that universal level and then funnelling to the more specific interventions. Because it seems from the report, the findings and the interviews—. And we're very grateful to the women who participated in that, actually, because they consented to tell their story, and they consented to say—. In some cases, there were individuals, people that they met, that they felt they trusted and made a difference to them, but overall, the system wasn't co-ordinated. You find good people and people in life that really understand, but not everybody does. Where that person is lost, they fall into the system that is less supportive. So, I think, overall, this is about a system-wide approach. It has to be integrated, and those good people that are within it we should support and encourage to spread that word amongst their colleagues and workforce.

Thanks, Chair. Thank you.

Jane Dodds, I don't think you missed too much of the initial question, so please ask what you wanted to ask before we lost you.

I'm so sorry; my Wi-Fi went down. I think you've covered a lot on trauma-informed approaches and ACEs, so I wanted to ask something completely different, if I may, Chair. There are these massive different views on residential centres. The Howard League and the Prison Reform Trust actually don't support residential centres. But I'm also very interested in whether you've got any really good, excellent practice on how women can have a better experience, both of the justice system and of the prison system. Ken has asked specifically on trauma-informed, but is there anything, anywhere we should be looking, where we will see a fantastic Rolls-Royce system that approaches women on the cusp of criminal justice, and also when they're in the criminal justice system? It can be, 'Yes, I've got this' or 'No, I don't know anyone'. Chantal, shall I turn to you as you're in the room? It can be, 'I don't have anything'—that's fine.

Like I said, the centres themselves aren't an area I'm as familiar with; it's not under our responsibility. On the general idea of who does this well, I don't know that we know who does this very well. It doesn't mean some people aren't, but that's something where we would probably need to establish wider contact with other countries. For example, we know Scandinavia tend to do quite well with their prison system, but I don't know what they do specifically for women. On the bit that you said around interacting with women before they hit the criminal justice system, we have very strong acknowledgement that inclusion health groups, as we call them—people who often aren't included in the health response in the way the community is—often tend to have overlapping domains of exclusion. People who come into contact with the criminal justice system may well have experienced homelessness or worked in the sex trade or had substance misuse issues. And so, it's about making sure we don't just target prison specifically, but we think about where we may come into contact with people who are more likely to potentially have contact with the criminal justice system and take those early opportunities in wider sets of services that reach out to these groups that can be quite vulnerable and may not present to health services until things get extreme but may respond to outreach specialist services. So, I think it's just about thinking broadly where those touch points might be and acknowledging there is overlap with other very vulnerable groups.

Thank you. Dee, do you have any—? If you don't, that's fine. Thank you. Jo.

I was going to perhaps suggest that we take the criminal bit off this. I think there are some really, really good examples in Wales of organisations working at community level—again, I have got another report if you'd like to see it that identifies some of these—where we're not looking at families and young people as potentially, 'Let's try and save you from prison.' We're looking at what is going on in their lives and how can we support better some of the things that are those factors that are introduced then and increase the risk and the likelihood of people entering into what we would term health-harming behaviour, but some of that then becomes criminal activity, largely through the coping mechanisms that people go to when they haven't got that support in place.

There are some really fantastic organisations across Wales, but the latest communities report that we've just published highlights a number in Cardiff that might be useful to have a look at. Because I firmly believe that if we are providing the right support for whatever the need is within the community and the family, then we are preventing violence. I think, as well, it's worth looking at the work that the violence prevention unit are doing at the moment. They're doing a youth violence consultation for a framework—another framework. We're very clear that all these things need to join up, so they shouldn't be frameworks out on their own. But that's a consultation that's going on with children and young people at the moment, including them in a co-production. Some of the things that those young people have said are the things that they need support with and things they need help with. That's where we need to be listening, that's where we need to be thinking about how do we do that, because those young people are going to grow up into their adulthood, and if we haven't got things in place that support them now—.

But it's very interesting; the reason I raise that is because I mentioned this morning on a webinar that, as a 45-year-old white woman, I have an idea of what I think children and young people in Wales might need, but it's actually very different to what they say they need. I've had a couple of times now to step away from a conversation and think, 'I've got that completely wrong.' I just think we need to do that more often. We need to engage with people and say, 'What is it?' Because some of these things—. One of the young people said, 'I want to feel valued, I want to feel part of my community. I feel excluded.' There's nothing criminal about that, not yet, there may never be, but if we don't listen, we don't hear and we don't act, I think that's where the problems start. So, there are some fantastic organisations that are doing great work. I can reel off a few, but if I send that report, it might just be quicker.

Thank you, Chair.

Very good. Thank you very much. Can I bring Sioned Williams in now?

Diolch, Gadeirydd. Dwi eisiau edrych yn benodol ar y ddarpariaeth yn y ddalfa i fenywod. Rŷn ni wedi sôn tipyn bach am hyfforddiant ond dwi eisiau gofyn pa gamau sydd angen eu cymryd o fewn y ddalfa i ddeall anghenion menywod amrywiol. Dwi ddim yn gwybod pwy sydd eisiau dod i mewn. Dee, roeddet ti'n nodio yn fanna.

I think, just like elsewhere in society, really, many custodial environments are not really built with female health in mind. This might be a bit strange, bringing this straight in, but if we look at things like menstruation, this is something that most women are going to experience, and it's ensuring that their basic needs are met. For us, we think that if the Welsh Government's period dignity strategy doesn't cover custody then it needs to. Like I say, it's ensuring the basics are met, that there are period products, that there are accessible toilets and things like that. But, there are other issues linked to menstruation, and those issues can become so significant that they can cause impairment—things like endometriosis, heavy bleeding, conditions impacted by hormones, things like PMDD. Those impairments can become such that women will become disabled. That might happen before custody, it might happen during, it might happen after. But, just like elsewhere in society, women can experience belittlement, they can not be believed, and there can be a lack of empathy and a failure to understand and recognise their impairments and the issues that they cause. So, across this spectrum, but in relation to your question as well, Sioned, I think we need a broader understanding of disability and especially impairments that are thought of as invisible or dynamic. Women are typically conditioned to push through things, whether that be trauma, whether that be pain, whether that be physical conditions and impairments. So, I think we just need to have a better understanding and accommodation of those women and the experiences that they face as well.

Diolch. Efallai y gallwn ni ei ehangu fe ychydig yn yr ymatebion eraill hefyd i—. Fe wnaethoch chi grybwyll yn fanna, Dee, efallai fod angen ystyried rhai o'r pethau hyn cyn dedfrydu hefyd, o ran yr adroddiadau cyn dedfrydu. Jo, ydych chi'n moyn dod i mewn?

Just briefly. I'd completely agree with what Dee has said. One of the things that we in Public Health Wales, from a health point of view, in terms of health provision, really want to do is learn from the experiences of prisons in England and custodial arrangements, so that we don't replicate the problems in Wales. It's things like understanding the fact that women in custodial places may still need to have access to pregnancy testing, may still need support around abortion and contraception and things like that. It doesn't stop just because somebody is in a facility. I, likewise, agree with Dee around period dignity. Menopause is the other one that I think really needs to be focused on.

We in Public Health Wales feel that this is an opportunity to do that from the start, but also recognise that—[Inaudible.]—if we're going to really have an integrated service, then, why should it be any different from the experience that women would have in the community? These things are really fundamental rights, aren't they? So, that is where we are hoping to really make a difference in terms of residential centres coming to being, making sure that all these things are thought about from the outset and, as you say, pre-sentencing if we can, looking at those reports, looking at those opportunities to share information, where there is consent to do so, so that the right things are put in place for women from the very beginning. I think there's very little, actually, from the list that I just gave you, that wouldn't necessarily need to be thought about for anyone, because this is about supporting people who are traumatised, as we said, and enabling them to rehabilitate and to come back into the community. So, that's where we would hope this would be achieved.

Diolch. Ydy Chantal yn moyn dod mewn?

Yes, just picking up on that point around the specifics around women and abortions and pregnancies that don't end in live births. As an example of a piece of work that we're doing in support of our partnership with NHS England, I am again supervising a registrar—it's a very specialist area; it's a sexual health registrar who has particular expertise in this area—to work with the national maternity transformation team in England to review the guidance for best practice around the different categories of pregnancies that don't end in live births. That could be through choice to terminate the pregnancy, or it may have been a miscarriage, for example. It will look at what best practice is, full stop, for these in terms of NICE clinical guidelines, plus to go out and consult through lived experience and engagement to understand what women say they need when they are in a prison setting if experiencing these, including the attitudes of staff, or support from staff that we required, with the aspiration, eventually, once this audit tool is formed, as I said, in partnership with NHS England, women's prisons in England will be asked to complete that audit tool, with support from our registrar, if required, so that we can then understand what people are doing and where the gaps are. We've also contacted, for example, the abortion lead at the Office for Health Improvement and Disparities. So, it's always very much a partnership approach to looking at these issues, but I think you have to take community guidance, but then you have to add that prison lens. And as has been reiterated throughout this, that prison lens comes from women who have had experience of being in prison. We can't do these things in isolation. That's just one example, but I think it shows the importance of, yes, getting baseline understandings of what's going on around these very important areas—as you say, they don't stop when women are going into prison—and making sure that we do look at them with a prison lens, because I imagine it's a very different experience going through one of these situations in a prison than going through it at home.

Diolch. Dwi eisiau sôn tipyn bach yn benodol nawr, te, am un peth rŷn ni wedi'i drafod yn barod y mae nifer fawr o fenywod sydd yn y ddalfa yn ei brofi, sef problemau camddefnyddio sylweddau, neu broblemau iechyd meddwl cymhleth ac anodd. Felly, pa gamau sydd angen eu cymryd i wella cymorth i'r menywod yma sydd yn y ddalfa ac yn profi'r problemau hyn? Hoffwn i hefyd ofyn eich barn chi am raglenni adsefydlu preswyl yng Nghymru.

Who would like to go first?

Pwy sydd eisiau mynd yn gyntaf?

Shall we ask Chantal to come in first, then?

I'll just take this off; I'm getting an echo. The residential centres in Wales I don't have knowledge of specifically, because, as I said, we cover England. The responsibility for substance misuse provision is with NHS England in our prisons in England, and the responsibility for assurance and monitoring sits with the Office for Health Improvement and Disparities. So, it's not something that comes directly to us, although we did, in our submission to the committee, include evidence OHID had given to us for the committee to review in relation to substance misuse. I agree that it is an extremely important area in women's prisons to get this right, and, coming back to what we've heard so many times, that these services need to be gender responsive and gender specific, as they do for any other services, we see in women's prisons we too often apply models from the male estate into women's prisons for many things, and that's not the right way to do it. And, again, just to go back on a point I said a minute ago, the real way to know what women need is to ask women. It's not for us to sit and decide what that might be without their input. Again, I know that the women's health and social care review, when that is published, has a standalone chapter on substance misuse for women's prisons. It hasn't been published yet. I was part of the working group, but it is not my chapter or information to share—that sits with NHS England and HMPPS. But there will be a lot of information coming out in that around what works for substance misuse for women, having engaged with women as well.

Diolch. Jo, wyt ti eisiau dod i mewn yn fanna?

Thank you. Yes. I think, as I said before, the mental health, substance misuse, the experience of domestic abuse, all of these things are almost the symptoms of what's gone before, so we need to think about why is it that these women are struggling with their mental health, or taking substances or whatever, and not just treat what's in front, and take the time to understand that experience of trauma and what needs to be put in place. There's a lot of issues around particularly the experience of women in terms of short sentencing, in terms of putting the provision in place and following it through when they return to the community. For me, the biggest risk is that, actually, you might receive a set of services in prison, you might be geared towards a set of services, because you have to reach a certain threshold to be able to access them and, actually, that might not be what you need. There may be a much lower level of support that's required, but, because that's not available, then there's a risk of people being geared towards and labelled as being having a disorder or something, when, actually, it's a normal reaction to a traumatic experience.

So, there's a lot of stuff to work through there, but, for me, the biggest issue, I think, is, when women come out of custodial arrangements into the community again, they're going back to the circumstances that they were in before, and, without anything changing and anything different, even if they've come a long way in terms of perhaps their substance misuse or something like that, there is a real risk of returning to that if there aren't the right things in place in the community. I think, in terms of the rehabilitation model that is required in a residential centre, the same thing applies. You can't have a gold standard and then just rip the carpet out from under people's feet, because that's just—. It's almost like dangling something in front of you and then taking it away again, and I think that can do more harm than good in some cases. So, absolutely, maintaining that gender-sensitive, gender-responsive understanding and what Chantal said about the experience of women informing this, but let's also think more broadly about that community base and what needs to be there.

Do, fe glywon ni—. Rydym ni wedi bod ar ymweliad â charchar Styal ac Eastwood Park, ac fe glywon ni yn Eastwood Park, yn sicr, ynglŷn â'r ffaith bod y ffin yma rhwng Cymru a Lloegr, o ran y gwasanaeth iechyd, yn creu gwahaniaethau ynglŷn â'r hyn sydd ar gael i fenywod o Loegr sydd yn y ddalfa yn Lloegr a menywod o Gymru sydd yn y carchar yn Lloegr o ran hyn yn benodol, o ran camddefnydd cyffuriau, o ran y feddyginiaeth sydd ar gael, y math o substitutes sydd ar gael iddyn nhw, ond hefyd o ran y llefydd ar gyfer adsefydlu a phwy sy'n ariannu hynny. Achos clywon ni yn Lloegr fod y gwasanaeth iechyd yn Lloegr yn ariannu hynny, ond dyw'r gwasanaeth iechyd yng Nghymru ddim yn ariannu'r llefydd preswyl yma ar gyfer menywod sydd yn y carchar yn Lloegr. Felly, beth yw'ch barn chi ynglŷn â beth sydd angen ei newid yn hynny o beth yn benodol?

I think from basis we need to see this as an integrated system and we need to understand how better to share information, how to share data, how to make sure that we are putting the women at the centre of the work. That's easier said than done. We know that this problem around people being located in England and returning to Wales or whatever is not just for women in custodial settings; there are a lot of issues around people getting the right support for their needs. But I think, if we continue to strive towards that more integrated position and using the blueprint methodology—the blueprint gives us the way of working that should help to overcome some of these barriers—it won't be happening overnight, but I think if we maintain that ethos of, actually, this isn't about Westminster and Welsh Government, this isn't about whether somebody has the right to get something if they live here or there, it's about saying, 'What does this woman need? And how do we facilitate that?', I still hold out hope that this way of working will provide us with some of those answers.

Diolch. Dwi ddim yn gwybod, Dee, os ŷch chi moyn dod mewn fanna. Mae gen i un cwestiwn olaf yn benodol i Chantal. Ydych chi moyn dod mewn ar y pwynt mwy eang neu ŷch chi'n hapus gyda beth sydd wedi cael ei ddweud?

Yes, I'll come in. Diolch, Sioned. I think, just from obviously the specific perspective of disabled women—we're talking about substance misuse, mental health, custody—we know that disabled women often will self-medicate, and that may be due to long diagnostic delays and things like that; it may be coping mechanisms that they've picked up through their lives. That can become an issue. Jo had talked about domestic abuse as well, and I just wanted to highlight that as well, that, among disabled women—. So, there's already a very high risk for women to experience domestic abuse, but that doubles for disabled women, and then there are multiple issues there. For a start, many refuges aren't accessible to them, so they don't have that escape route, if you like. But also we're talking about understanding disability here now as well. Across society, there's a commonly held trope for disabled people and their partners—so, the disabled person is a burden; the person caring for them, their relative or whoever that might be, is considered heroic for putting up with that disabled person. Therefore, when disabled women try and access help, they may be dismissed, they may be unheard, and that can come into policing as well. There's often not that understanding of what's going on, and sticking up for the abuser, if you like. So, then that becomes very difficult. That can obviously then impact mental health as well, and, as I said, that self-medicating aspect might be something there as well. But I think, yes, that we just need to look at—again, it's that data, and it's co-production.

I'm really pleased to hear everyone else talk about the need for co-production and really centering that lived experience as part of how we make improvements, because this is what we see in the work that we do, specifically in health, that that is what makes the difference. We can come to these organisations, we can come to the NHS, we can come to Welsh Government and say, 'Look, between us, we have x amount of years of this system and not getting diagnosis, or not getting the support that we need. Here's what we think could make it better.' That, to me, is the key that unlocks all of this and makes it a lot more inclusive and a lot better for people.

Diolch. Un cwestiwn olaf cyflym i Chantal. Rŷch chi wedi sôn tipyn yn eich atebion hyd yma ynglŷn â'r adolygiad yma sydd ar fin dod mas o iechyd a gofal cymdeithasol mewn carchardai. Rŷm ni'n edrych ymlaen at ddarllen yr adroddiad. A gaf i ofyn i chi a yw'r adroddiad yma wedi ystyried anghenion menywod Cymru yn benodol?

Thank you. So, like I said, it's not our review. We are a partner in the review, which has been very multi-disciplinary. I haven't seen, personally, specific information around women from Wales. However, it doesn't mean that it hasn't been considered in other working groups that I was not a member of. So, I wouldn't like to say definitively—. I haven't seen it, but others may well have. So, it's probably something to go back to the review team and enquire about whether it has been considered.

Iawn, diolch. Diolch, Gadeirydd.

Okay, just to clarify, this is the report that you said was due to be published in the autumn. Is that right?

Yes. I haven't been told of any specific dates, but as a team—

Okay. We'll follow it up. The autumn comes to the end of this month, in my book, but it has been known for things to slide. Before we move on, I just want to ask two specifics. One is on why it is that women in Wales who've been using buprenorphine to manage their addiction and hold down jobs—being an injection, you know—. And once they go to prison in England, that's not available. Equally, there's the lack of access to the 12-step programme, which is only available to men from Wales in English prisons. So, I wondered if either Jo or Chantal Edge can just describe to us how it is that such a level of discrimination against Welsh women has been allowed.

I can add—. Again, it's not my organisation. So, NHS England commissions substance misuse services. So, why they do things differently in male or female prisons, you need to enquire directly with NHS England. I do understand, from the wider public health context that I work in, that buprenorphine, in general in England, is not commissioned in every region. So, you have to be careful—if people are released, they will be going back to an area where they may or may not be able to get it. So, I think that it's an evolving landscape, but it's on bigger drug commissioning policies for England that that is dependant. That, again, is something that probably OHID, which has the overview of substance misuse services, can provide you, again, with better information on.

Okay. Jo, anything that you want to add to that?

No, other than to agree that this is something, I think, that we all need to look at. Because, whilst we haven't got the power to make the change in terms of England, I think that we do have a responsibility in Wales to put the case forward. Hopefully, the work that we are doing and continue to do will be able to influence and change that. I do understand what Chantal was saying about needing to be very careful about where things are able to be provided after release and things like that. But I think that there's a slightly different conversation around sending someone to somewhere where they cannot access something that they are able to access in Wales and are, in my view, entitled to.

Sarah Murphy, you wanted to ask a question on this.

Yes. I just wanted to come back, Jo, because thank you so much for highlighting Trevi House in Plymouth. Whilst we've been on here, I've done a bit of quick research myself, and it does, it looks wonderful. But I think this is sometimes where, in this inquiry, things can get a little bit confused, because that is also called a women's rehabilitation residential centre. But for me, it's very much comparing apples with oranges in terms of what is happening there and what is being proposed here in Wales. So, for an example, now called Jasmine mother's recovery detox, there are 10 beds, most of them en suite, and they get to keep their children with them, and they then go on an average stay of 24 weeks while they go through an intense detox and therapeutic and trauma-informed support and therapy, and whilst they're in those therapy sessions, the children go to a creche, which again is very trauma informed, to help those children. And as well as that, it is run by a very experienced charity that comes under the care quality commissioner. Now, if we compare that to what they're proposing there's going to be in Wales, that would be 12 beds, two would have the ability to have children with them, a minimum up to 12 weeks, and run, as I've said, by the probation service. For me, it's so, so different.

And then on top of that, what they have in Trevi House is the wonderful sunflower centre where the women go from one into the next, and the probation service are all there, the DWP is all there, all under one roof, and they continue to get that support so that they don't go back into the system. I've read through it, and there is a wealth of evidence to support that this is a wonderful model. The UK Government gave them £400,000 to continue providing that model, so why, then, I suppose, are we not pushing for something that is exactly like that instead of what is being proposed in Wales as a pilot scheme where there isn't any evidence to support that? And I suppose my question is: is there, at this stage, any more that we can do to try to push this so that we get more of what Trevi House is, rather than what is being proposed for the women of Wales?

I'm not sure that I can answer the first bit in terms of why is there a difference. I do know that there have been a number of visits to Trevi House to be able to take the best bits. The reason I raised it was: is there a Rolls-Royce kind of example? I think there are probably more than Trevi House, but that's the one I'm familiar with, and I know that the director general from HM Prison and Probation Service only recently has visited, and there have been a number of different things.

Why are we not doing the same? I think that question is something that's worth asking and continuing to be asked. I think one of the things is that we're trying here to introduce something that is almost completely new for Wales, and I think from a public health perspective, like I said about let's not make the mistakes of missing out things that we really need to consider to be built in to whatever we're doing—and I listed period dignity and the other things. Actually, is there more that needs to be shaped in the years to come around what this is going to actually deliver? I think we're at the stage at the moment of simply trying to secure a building, aren't we? I think there's a lot more to do in terms of what actually is provided, and I think I would hope and encourage any kind of support in terms of what that might look like based on the evidence and the learning from wider.

Thank you very much. Thank you, Chair.

Thank you. Can we turn now to Altaf Hussain, who's got some questions about the impact on parenting?

Thank you. I know you're looking at the time, and there's a lot of overlap around the questions and answers. My question is: could the panel outline what action is needed to support pregnant women and those who have babies while in prison, including those who are in treatment for substance misuse? And, for Jo especially, it would be interesting to know about the progress in implementing the reform that was, I think, announced by the Ministry of Justice in 2020 after reviewing mother and baby units. Thank you.

Do you want to go first, and then we'll bring in the other two?

I'm not sure I can update you on the progress of reform. I think one of the things that we're very clear about from a public health perspective is that the experience of motherhood in custody, whatever that may look like, whether it's pregnancy, whether it's actually having the child or whether there are children at home who need to maintain access, at the moment, with women being placed in prisons in England, it's not working for women. So, I think we're still some way away from understanding how we sort that out in terms of Welsh women who are in that situation.

The Visiting Mum service, one I mentioned earlier, again, needs to be formally evaluated, but it's certainly showing good signs in terms of the experience of women who have got access to their children, not just for the women—let's not forget the children themselves—. This is an adverse childhood experience, isn't it? And actually, in terms of who they are looked after whilst the women are in custody is a real question as well, and concern. So, this is a broader point, really, than simply saying, 'How do we support women better in custodial arrangements?'

I think, again, it comes back to the fundamental of: do we put pregnant women in prison? I still don't think we've got to the bottom of what we think about that, and how we address it. I think from a public health perspective and from an adverse childhood experience perspective, that's a conversation that needs to continue to happen. I'm not going to come down hard one way or the other, but I think my own personal view is that you are criminalising two people, and you are placing a trauma on a family if we don't consider this more carefully. I think that's all I'll say.

Chantal, some women enter the prison system not knowing they are pregnant, and that only arises afterwards. Is there anything you are able to add on how well we accommodate pregnant women?

So, again, it's a difficult area for me to answer specifically on because, obviously, pregnancy tests, pregnancy care is our NHS England responsibility—not 'our', sorry—it's our NHS England's partner's responsibility as the one that delivers the care that will deliver pregnancy tests and look after women throughout. So, they are the ones that can give you the specifics around that, and I'm aware that they have a perinatal working group that specifically deep-dives on that area. So, NHS England will provide you with the in-depth advice.

In terms of our perspective on the health security side, it is important to know if a woman is pregnant. If we had a case of rubella, for example, in a women's prison, we'd be very concerned about knowing who was pregnant and whose babies were potentially at risk—unborn babies. In terms of the pandemic, we've dealt with outbreaks continuously over the past few years of COVID. Women's prisons were hit just as badly as men's, and we would be very mindful of the effects on pregnant women if we had an outbreak in a unit where there was a mother-and-baby unit, for example. In our outbreak control meetings, we would wrap particular care and caution around the specific circumstances of the outbreak. So, if there were pregnant women there, we made different recommendations depending on the situation.

So, we have a real vested interest ourselves in knowing whether women are pregnant, and making sure that anything in relation to their security or protection from diseases, et cetera, is considered in that round. The more general question is one for NHS England.

Okay. Back to you, Altaf.

All right. Thank you very much. The next question, really, is: is enough being done to mitigate the impact of parental imprisonment on children at both UK and Wales level? And also, I'd be interested to know if there's any data in Wales to help us understand the different impacts of the imprisonment of either mother or father, or both on the children. Will they have any contact with them, knowing that, in Wales, mothers are imprisoned in England in a hostel or somewhere far away? What will be the effect of that?

Lots of research on this, so if you could all be brief in your answers. Who wants to go first? Chantal, do you want to go first?

I don't feel that I'm the expert in the room here with this one.

Fine. Okay. Dee, do you have anything that you want to add on this?

Not specifically on that. I think, well, probably the same answer as before—there probably is a lack of data; I'm making an assumption, but that's something that we see quite a lot.

No, you're making an assumption. Okay.

I just wanted to say, just to reiterate, really, about the impact that pregnancy can have on some women in terms of either exacerbating impairments or bringing in new impairments—things like gestational diabetes, perinatal mental health, things like that. So I would agree with Jo in that, if you are putting somebody in prison with their child, or apart from their child, that's surely—. We talk about breaking the cycle quite a lot in our realm, and I think, yes, it's that risk of traumatising another person as well and causing issues for them as well. So, yes, definitely just wanted to highlight the issues around disability for pregnant women as well.

Okay. Jo.

Very briefly, because you'll be cognisant with this research, but the parental separation and incarceration of a parent is an adverse childhood experience, as set out in the 10 ACEs in Professor Mark Bellis's research and the broader international research on it. So, it's clear that it is an adversity in childhood. What is also clear is that, if a child has experienced that adversity, they are likely to also be experiencing a range of other things. For example, if we move away from the 10 research ACEs, what financial impact does that have on the family? What impact does that have, perhaps, on that child going to school and being called out because they've got a parent in prison? What impact does that have on their friendships, on their relationship with that parent? I think it's hard to say whether or not the impact in terms of an adverse childhood experience is different if it was male or female—I think there's probably a bit more work that needs to be done there—but we know that, when women are put in prison, it's back to that point of who's looking after the children. When men are put in prison, women predominantly carry on that role. When women are put in prison, then it falls, it seems to me—and I think there's some work from the Prison Reform Trust and others on this—that it's less likely to be the father; they're in the wider family circle, perhaps with grandparents, or whatever, or we're talking about care provision.

So, this is wrapped up into a number of different adversities that are more likely to happen if that experience of incarceration happens. And I think it's all back down to what are the protective factors that are around that child, around that family, to help them to overcome what they're facing. It's very, very difficult if you're not able to see that parent, particularly if you're a young child and then you end up into a different system or a different care arrangement because you've lost that relationship. So, things like encouraging visiting, maintaining contact, is probably the best that we can do in an environment where you are separated in that way. I'm not saying that divorce and different kinds of separations are also not impactful—they are. But I do think that, in this particular instance, there is an increased likelihood, because of the circumstances around criminalisation, that there will be wider adversities, and we know the cumulative impact of that for mental health and wider issues.

Fine. Sarah, a brief intervention, before I go back to Altaf.

I'm conscious of the time, Chair. Thank you very much.

Okay. Sarah, did you want to briefly ask something?

Yes, just a really quick question to Chantal, if I may. This is more about the life of the children, and whether they live if they're born in prison. In September 2019, a newborn baby died at HMP Bronzefield; another baby was stillborn in HMP Styal, in June 2020. But the Ministry of Justice does not routinely collect or publish data on miscarriages, stillbirths and neonatal deaths, so the number of deaths of babies born to imprisoned mothers may be higher. So, as the Health Security Agency, how often do you request this data from the UK Government, the Ministry of Justice? And of course, as I understand it, the role is to really try to predict where things may go wrong, so could you give us any information that you have on this data, or lack of, please?

So, I don't think it's data that we would specifically request, because it's probably data we don't need to know actual numbers for in the Health Security Agency. But if you were to try and request this data, the most likely source would be NHS records. So, it would be recorded, if it is known to the NHS, within the health record. So it would be through that route that you would request it if you had a need to know it. I think the thing to bear in mind, the wider context—and we see this whether someone's reporting an infectious disease or, potentially, whether someone's reporting a pregnancy or a miscarriage—is that people have to decide that they want to tell someone, so numbers will only ever be as accurate as confident as women feel to disclose information. So, obviously, a pregnancy may become more apparent if it ends in a stillbirth, but a miscarriage may go unknown, unless a woman reports it. So, the NHS would hold data, but whether that data is complete we don't know, because it will depend on what women tell us.

But obviously with deaths, they're going to be very aware that that happened, so who is recording that? Whose role is it to oversee this?

Anything that has a health-related repercussion will be recorded by NHS England. Again, they have work streams; I would enquire with them direct around deaths in custody. I would imagine they will consider, given, as you said, the very tragic circumstances with the babies, not just adult deaths. But that is something very much in their remit to enquire with them about.

Okay. Wonderful. Thank you very much. That's very helpful. Thank you, Chair.

I'm just going to ask if we can extend the discussion by literally a couple of minutes. For a start, Chantal, you mention in your written evidence that Bronzefield has the highest number completing treatment to become drug free, whereas in contrast HMP Eastwood Park has a very large number of women in treatment. What is it that Eastwood Park is not learning from Bronzefield?

I feel as if I'm being unhelpful when I point towards other organisations, but again, this was the data from the Office for Health Improvement and Disparities that agreed to put in in one submission. It is their data, and they are the ones who oversee the substance misuse treatment, including alcohol dependency, so would have a better understanding of what or why the differences are.

Okay. Thank you. If there's one thing that you would recommend for improving the current situation, what would it be, each of the witnesses? Who'd like to start? Dee.

In addition to the trauma-informed training, we would love to see mandatory disability awareness training that incorporates female health, the social model of disability and unconscious bias, to tackle attitudinal issues. That training must be co-produced and co-delivered with people with lived experience as well.

Thank you. Jo.

In a similar vein, on top of the trauma stuff, I think as well we need to really think about the marginalised groups—obviously disabled people, but also how people like Gypsies, Roma and Travellers are represented within the populations in prisons, and how people of colour are represented. I think we haven't got enough research going on on that at the moment. And really think about how we address the diversity of experience within this group that we haven't touched on that much today. For me, that's the fundamental here. We can't just be trauma informed; we've got to really understand the different trauma that people experience.

Thank you. And Chantal.

The overall preference would be to send fewer women to prison, but if we continue to see women in prison, it's about making the best of the opportunity to engage, and offer what we can in terms of health intervention, when women are within those services. And, as Jo alluded to, coming back to that: to understand whether we're offering the best, and that comes back to having better data a lot of the time. I know in some of our UK Health Security Agency data sets, it can be hard to identify people who are prisoners, because in the past people were not keen to flag someone as a prisoner, but now we understand we made need to look in more detail at these people. So, improving that data, so we can evidence whether we are doing our best when people do come into contact with these services. I think it's all wrapped up into one.

Very good. Thank you very much, all of you, for your evidence and for your time today. Jo, I wondered if you could send us the link to the report you mentioned on looking at this from the whole-family perspective—that would be really helpful. Otherwise, all three of you will get a transcript of your evidence, and this is your opportunity to correct anything that you haven't said but has been misheard. Otherwise, thank you very much indeed for participating in this inquiry. You'll obviously get a copy of the report in due course.

The committee will now take a short break, and we'll resume with our next evidence hearing on this subject at 3 o'clock.