Official Report: Minutes of Evidence

The Chairperson (Mr Ross): I welcome Brendan McGuigan, the chief inspector, and Dr Ian Cameron, who is the inspector with Criminal Justice Inspection (CJI). You will both be aware that Hansard is recording the session, and the transcript will be on the website in due course. When you are ready, please brief us on the report, and we will open up to questions after that.

Mr Brendan McGuigan (Criminal Justice Inspection Northern Ireland): Thank you very much indeed, Chair, Deputy Chair and members of the Committee. Thank you very much for your invitation to speak to you about the recently published report on an unannounced inspection of Maghaberry Prison.

Let me be clear from the start: this was not a report that CJI or our colleagues from Her Majesty's Inspectorate of Prisons, the Regulation and Quality Improvement Authority (RQIA) and the Education and Training Inspectorate (ETI) ever wished to write, but we have a duty and a responsibility to report independently what we find, and that is what we have done. Multi-disciplinary teams have been conducting independent assessments of the performance of prisons and outcomes for prisoners in Northern Ireland for the past 10 years. During that time, we have reflected the positive, as well as the negative, on the basis of the evidence that we have found. The report on the inspection of Maghaberry prison, carried out in May 2015, was undoubtedly the most concerning of all the reports published to date on any local prison.

The inspection was carried out over a two-week period, and the report reflects the issues affecting the operation of the prison at that time. It has been referred to as a snapshot in time, and, to some extent, that is true. Inspectors are not in a position to monitor any prison for 52 weeks of the year. However, we do not believe that the picture that we found would have been any different had the inspection been carried out one month before or one month after. The circumstances that led to Maghaberry becoming unsafe and unstable had built up over time. Our fears and concerns about the unsafe and unstable nature of the prison were real, and we firmly believe that the elements that contributed to the situation in May and to the malicious fire at Erne House, which occurred just a few weeks before the inspection took place, were still present.

We accept that Maghaberry is our most complex prison. It houses approximately 1,000 men, ranging from those on remand and serving short sentences to lifers and separated paramilitary prisoners. Many of the prison population have learning difficulties, mental health issues, addiction problems and personality disorders. We also accept that the context in which our prisons deliver the service has changed. There are now fewer staff and more prisoners, and the focus is now on rehabilitating prisoners and preparing them for release back into society, together with keeping them in a safe, secure and decent environment. Many of those challenges are not unique to the Northern Ireland Prison Service but are faced and addressed daily by other organisations charged with running and delivering custodial facilities in the United Kingdom and beyond.

The prison was assessed in the same way as before against the renowned and comparative healthy prison standards of safety, respect, purposeful activity and rehabilitation. In relation to safety, respect and purposeful activity, performance in the prison had regressed from its position in 2012, when it was assessed as not sufficiently good. In May 2015, it was delivering poor outcomes for prisoners, the lowest score of one out of four in those three key areas. Only in relation to resettlement had the 2012 standards been maintained, and outcomes were assessed as reasonably good for prisoners. It is my considered view and that of my colleagues who participated in the inspection that the collective failures of leadership in the prison had created unacceptable risks for the staff and the prisoners in their care. Maghaberry had become unsafe and unstable and was in a downward spiral that could have led to serious consequences. This was, in our opinion, a prison in crisis.

Leadership is not just about the day-to-day management of a prison but rather the ability of senior managers to provide the conditions where the contextual challenges can be dealt with, including shrinking budgets, staff shortages, absenteeism, the frequent issues emanating from the separated prisoners and the effective management of paid-for services, including healthcare and education. We saw no evidence of the flexibility, innovation, creativity or problem-solving or the calculable risk-taking and cultural change required to provide stability in the face of these challenges. Instead, we saw and heard a management culture that sought to deflect responsibility and blame others for the malaise that the prison was in. The malicious fire at Erne House should have been a wake-up call for prison leadership. During the inspection, we assessed that the elements associated with the potential breakdown of good order and discipline in the prison were still evident.

Last week, my colleague Nick Hardwick described the prison as one of the worst that he had ever inspected and one of the most dangerous that he had been to. He did not say that lightly but to highlight the fact that, in the context of his experience of inspecting over 40 prisons each year in the last five years across England and Wales, the gravity of the situation at Maghaberry becomes very clear. Dangerousness in a prison is not solely defined by deaths in custody; a wide range of risk factors is taken into account when inspecting a prison. We are talking about increases in the number of assaults on staff and prisoners and increases in incidents of self-harm, along with threats against staff and inadequate supervision in exercise areas. Resourcing issues and unpredictable lock-ups, along with reductions in access to purposeful activity and an increase in the availability of illicit drugs and mind-altering medications, contribute to dangerousness. Our concern about healthcare provision, some aspects of which we assessed as unsafe, together with unacceptable behaviour involving a small number of prisoners, combined to create an unstable mix for staff and prisoners that could have resulted in serious injury or death. In our view, this context created unacceptable levels of risk and a dangerous environment.

The location of separated paramilitary prisoners in Maghaberry was also an issue. They take up a disproportionate amount of senior management's attention and resources to deliver an unrestricted regime, often at the expense of the rest of the prison population. This is, in our view, unfair and untenable. We have therefore called for a radical new approach to managing the separated prisoners in order to ensure that the regime in the rest of the prison is less negatively affected.

We also outlined, at the time of publication, the significant challenges presented by the majority of the prison population at Maghaberry, many of whom will have been receiving support and treatment from our health service before being sent to prison. Those healthcare needs become more acute in the prison environment, especially for those with addictions and personality disorders. This presents a concentration of need that, in our view, was not being met by the healthcare services in Maghaberry.

There were shortages of primary care nurses and problems in retaining staff, some of whom had been threatened. Some areas of healthcare, including chronic disease management and substance misuse, were considered by inspectors to be unsafe. We also had serious concerns about how medications were administered, particularly the practice of prisoners holding their own prescribed drugs. That created a risk of medicines being diverted and vulnerable prisoners bullied.

When the inspection report was published last week, I stated that we had provided frank feedback at the end of the inspection to the senior management team at Maghaberry prison, the senior leadership of the Northern Ireland Prison Service and a director of the South Eastern Health and Social Care Trust. We outlined the clear need for urgent action to halt the decline that we had observed and to stabilise the prison. Such was my concern for the safety of prisoners and staff in Maghaberry, that I followed this up by writing to the director general of the Northern Ireland Prison Service, seeking an interim action plan to stabilise the prison. I advised her that the seriousness of the situation demanded the unprecedented step of the inspection team returning in January 2016 to assess progress against the inspection recommendations, which primarily focus on keeping staff and prisoners safe.

We are supportive of the desire to see change in the Northern Ireland Prison Service. We do not underestimate the scale of the challenge or the resources that it will require. Given my personal experience, I do not believe that you can secure transformational and cultural change in any large public-sector organisation without investing time as well as money. Investment in strong, positive leadership is also required. I am committed to working with all those engaged in the process of achieving that objective, and our inspection reports should be seen as one of the tools to enable it to happen. We are not here to criticise for the sake of it. An opportunity exists at this point for stakeholders from Justice, Health, Education, and indeed wider government; the elected representatives from all political parties; and from the voluntary and community sector in Northern Ireland who have a proven track history in adding value in our prison environment. For them to work collaboratively to drive forward prison reform and ensure that Northern Ireland's Prison Service meets the needs of the 21st century, everyone should be equally invested in stabilising Maghaberry and ensuring that the risks highlighted by this inspection are managed effectively and become a thing of the past.

The Chairperson (Mr Ross): Thank you very much. I appreciate that. We have all been able to delve into the detail of the report over the past week. You used at the beginning a word that I have heard both the Minister and the director general use when you said that the report was a "snapshot" of a difficult time at Maghaberry. It almost implies that they had a few bad days in May when you were there, but, other than that, progress had been made. I presume that you would reject the implication that this was just a bad few days.

Mr McGuigan: It is a snapshot in the sense that it was based on a two-week inspection, but the issues at Maghaberry did not appear overnight. Clearly, those issues should have been detected from analysis of the data that we saw as part of the inspection process. There was a very clear indication of a downward spiral.

The Chairperson (Mr Ross): How did you conduct your inspection over the two-week period? Can you give us a bit more detail?

Mr McGuigan: Certainly. The first week is mainly taken up with gathering data and information, conducting surveys of prisoners and of staff, and talking to senior managers — trying to get a sense of what is going on in. An analysis is conducted of the surveys, and on that basis, you have a sense of the areas that you need to look at in the inspection, which takes place in the second week. In the second week a much larger multi-disciplinary team arrives from Her Majesty's Inspectorate of Prisons, our own organisation, the Regulation and Quality Improvement Authority, and from the Education and Training Inspectorate. Those are all organisations with considerable experience of inspecting prisons and of conducting separate inspections of health and educational services in Northern Ireland. The vast majority of team members were from Northern Ireland.

The Chairperson (Mr Ross): On the evening of 5 November the director general appeared on 'BBC Newsline' and, in response to the accusation by the newscaster that she was responsible as the head of the Prison Service for a failure of leadership — in the report there are a number of references to failures of leadership — she said that "he", and I presume by that she means you,

Is that accurate, or is there also criticism of the head of the Prison Service?

Mr McGuigan: I have to be very clear that I am presenting on the findings of the Maghaberry inspection report. This looked at Maghaberry prison; I was not looking at leadership across the whole of the Prison Service. We have done that in the past; it would be a kind of corporate governance review. This was simply looking at Maghaberry. Every prison sits almost as a separate entity. The prison governor has legal status and accountability, and it is on that basis that this type of inspection is conducted. Any comments that I would have to make about the director general would be purely on the basis of what I have seen her doing in the reform programme, and my personal observation is that she brings a lot of energy and experience to a very demanding and challenging role.

The Chairperson (Mr Ross): One of the criticisms laid at her door is that she seems to be washing her hands of it and blaming local management, particularly the governor. The report talks about poor communication between headquarters and governors. Can you elaborate on the communication channels, where the failures were, and how headquarters, governors and staff corresponded? Where were the breakdowns?

Mr McGuigan: That finding was based on a series of conversations with the leadership in Maghaberry and examination of documentation. A relationship suggests trust and confidence: in our view, they were in short supply. There was clear evidence from monitoring visits of issues being outlined to the governor to be addressed, with subsequent visits showing that they had not been addressed. That for me was a performance management issue. The governor of the prison, as I said before, has independent legal status and responsibilities, but they are appointed and managed by the Northern Ireland Prison Service. How to deal with that becomes an issue for the Prison Service.

The Chairperson (Mr Ross): The Committee has raised drugs in the prison with the Prison Service on numerous occasions. We know that both prescription and illegal drugs are a problem. Why is it that, after this issue has been highlighted for a number of years, medication is still given to prisoners who can walk about the prison with it? Is there any rational justification for not moving to a system where drugs have to be taken under the supervision of medical personnel?

Mr McGuigan: There are elements of supervised swallow in the prison; equally, however, prisoners who need medication perhaps three times a day are simply given it all in one go. Sometimes we know that prisoners retain some of the medication. Unfortunately, that becomes a currency in the prison, and it is also the reason that some prisoners, particularly vulnerable prisoners, are bullied into handing over those drugs. There are systems and processes in place in modern prisons whereby medication can be retained in possession in a place where it can be audited, inspected, reviewed and dispensed, in such a way as to give confidence that the process is not being abused.

Illicit drugs in the prison are a challenge; as you can see, they are finding increasing amounts of them. No matter where you go in the United Kingdom that will be an issue, particularly when prisoners struggle to do their time, when there is no purposeful activity and they are just sitting in a cell. When I asked prisoners who are in the segregation unit for possession of drugs why they keep doing this, they told me, "This is what gets me through my time". In many ways, providing alternatives — work, education, out-of-cell time — is the best way of dealing with illicit drugs.

Of course, there are people who have been sentenced to imprisonment for fairly hefty drugs offences, and there is no doubt, in our view, that some maintain that connection. We personally have seen instances of prisoners on home leave being intimidated into carrying drugs back into the prison. Families have informed the prison authorities that their son or daughter has been approached to deliver them, as their failure to do so leaves them open to reprisal attacks. It is a very difficult situation. Unfortunately, it is one that is prevalent in most prisons across the United Kingdom. Prisoners and their families will go to extraordinary lengths to pass illicit substances into a prison.

The Chairperson (Mr Ross): Given that this was an issue in 2009 and in 2012, before getting worse over the past three years, are you satisfied that the prison has taken the issue seriously and put new mechanisms in place to prevent illegal drugs from entering the compound?

Mr McGuigan: I welcome the efforts that they have made and the fact that they are linking up with the Police Service to follow through and to ensure that intelligence gained in the prison is shared with the Police Service so that appropriate action can be taken. The fact that they are seizing increasing amounts of drugs and then following through at a later stage indicates a commitment not to tolerate this. Unfortunately, illegal drugs are a feature of modern society.

Mind-altering drugs are widely prevalent. Many of those who end up in prison are receiving medication outside the prison environment and are then entitled to it when committed to prison. That is a societal issue for us in Northern Ireland. What it reinforces for me is the fact that, very often, what is required is a therapeutic environment to deal with addictions, disorders and mental health issues. It is difficult to recreate that in a prison environment and practically impossible in the environment that we saw in 2015.

The Chairperson (Mr Ross): The report says that prisoners are not engaging in purposeful activity and that the rehabilitation part of their prison sentence is not there. Is that down to prisoners not wanting to engage in purposeful activity, or is it to do with staff shortages and the demand on educational facilities? What is the issue?

Mr McGuigan: It is a combination of issues. We talked about a growing malaise in the prison. It started with leadership, and leadership is right across the prison environment. It is not just about two or three named individuals; lots of people in that prison have responsibility for leadership. What we saw was the inability of the leadership — the governors at that stage — to bring to account the paid-for services. They are paying for education services that are not meeting the needs of the prisoner population. The fact that you cannot release prisoners from their cell to go to classes or to attend healthcare appointments all added to that malaise. We talk about words such as "creativity" and "innovation", and when you get into that sort of situation you have to find solutions. That is what leadership is about. It is not about day-to-day management; it is about understanding the context that you are in and stepping beyond it. It is about providing opportunities for staff at a lower level to problem-solve. It is about understanding that, sometimes, you have to take risks to create stability in the prison and for the good of the needs of the prisoner population, which are considerable.

The Chairperson (Mr Ross): Is there evidence that prison officers at a lower level were unwilling to try to find solutions themselves or that they were nervous about doing that because of the repercussions? What was the issue there?

Mr McGuigan: To be honest with you, we met some really committed staff who were offering solutions to the day-to-day issues, as they saw them, but they were not being listened to. What I was looking for in that scenario was leadership driving down decision-making that enabled the unit managers, the principal officers (POs) and the senior officers (SOs) on the wings to make decisions that could have a positive impact on the prisoners in their care. By doing that, staff would have been kept safe. The more you concentrate those issues and do not deal with them, the more you get a tinderbox effect in the prison environment. For us, Erne House spoke volumes about where we were with a lot of this stuff.

The Chairperson (Mr Ross): I have a couple of final questions before opening it up. You mentioned the segregated prisoners sucking resources — obviously, that is resource, manpower and everything else — away from the rest of the prison and the need for a radical new approach. Do you have any suggestions for that radical new approach? We often talk about Maghaberry being one of the most complex prisons in Europe and unique, but, in Great Britain, Islamic terrorists are kept in prison, so there are, one would imagine, similar challenges there. What sort of radical approach are you talking about?

Mr McGuigan: I understand that it was a political decision to have the separated regime, and I do not think that it is appropriate for me to get into that. However, I will say that, for as long as it remains in Maghaberry, it will disproportionately attract management time. That is what is happening. During our time there, if there was any shortage anywhere, they would simply draw resources from the rest of the prison population to manage the separate regime. To protect and maintain a regime in one area of the prison, you have to take away from the rest of the prison. Our view is that that is simply unfair and untenable, and you need to find another solution. To be honest, I do not know what the ultimate solution is, but my sense is that, for as long as you put that at the heart of Maghaberry it will be really difficult, and it will continue to be really difficult unless you can ring-fence resources, including management resources, to service the needs of the separated population so that you are not taking management time away from the decisions that need to be looked at for the rest of the prison population. It is as simple as that.

The Chairperson (Mr Ross): Finally, as for where we go from here and further inspections, you are going back in January. One of the most alarming things that I read in the report was that, from the 2012 report, only 16 of the 93 recommendations have been achieved. Would it be worthwhile going back not only in January, which I think everybody would support, but at regular periods after that to ensure that progress is being made?

We do not want to be in a position, three years down the line, where there has not been any improvement, despite assurances that perhaps the Prison Service or even the Department would give us.

Mr McGuigan: That certainly has been part of my thinking. I suppose the difficulty for me is that my responsibility lies right across the justice system, and sometimes outside of it. Some of your colleagues will know that we were talking to the Environment Committee this morning about the environmental crime unit. DARD officials will know of their central investigation services. We are a very small organisation. I believe that we deliver real value to our justice system. Tying us down simply into prisons — I understand that that is our area of greatest risk — but there are other areas that need attention across the justice system if we are trying to move the whole system forward.

I am very conscious that I have been doing all the talking. To my right is Dr Ian Cameron, who has been doing all of the heavy lifting, leading on not only the unannounced inspections and the announced inspection in January but on monitoring the prison reform programme and those areas that have been specifically assigned to my organisation in terms of independent assessment, where they are and what progress has been made. I do not know, Ian, if there is anything that you could add to that. He has been doing that full time for the past three years. That is a big commitment for a really small organisation. There are only 14 people in the inspectorate. When you start to spread that out across the system, it gets very thin. That said, if I thought that there was a concerted will and political support for this, we would look to see what we could do to provide reassurance around what was happening at Maghaberry.

Mr McCartney: Thank you very much, both for the report and for the presentation today. Over the past week, we have seen all of the headlines, and headlines can reduce it down, so this is a welcome opportunity to drill down to some of the findings in a very comprehensive report. You mentioned the fact that the prison establishments are nearly separate or autonomous. With that in mind, in terms of the observations that you have made in relation to leadership and what I think you called the lack of it spreading right down, and the ineffective relationship between Maghaberry as a prison and a headquarters, for want of a better word, could you define that and how you think it contributed to the report?

Mr McGuigan: It is worrying that, when we conducted our inspection, we came up with issues that had previously been identified in the monitoring visits by the director of operations within the prison environment. That was worrying. The fire at Erne House also gave us significant concerns because we really felt that that should have been a warning to the system that something was seriously going wrong at Maghaberry.

There should have been a deeper understanding of exactly what was going on, but there was evidence to us that issues were being identified in those monitoring visits but action was not being taken. When we spoke to the governor group, everything was blamed on headquarters not providing something to support what they felt they needed in Maghaberry. That ineffective relationship within the same organisation has to be based on trust and confidence. In our view, those were absent. In the absence of those, you had a deteriorating situation within the prison. The contextual issues that they were constantly faced with were increasing numbers of staff on the sick and increasing shortages in their complement to overall staffing numbers in the prison. That was creating a malaise. In a situation like that, my expectation, and the combined expectation of the inspectorate, was that that is when you expect your leaders within that environment to really get going and to start to try to find some of the solutions to the problems that they were facing. I do not know whether that comprehensively —

Mr McCartney: That leads on to my point, because I am trying to put this into the context of the Owers report as well. You have obviously done reports of other aspects of the prison system but it almost looks as if, where the Owers recommendations were followed, we have seen progress. That has happened at Hydebank Wood, as shown in the type of reports that were done there and were favourable, and in Magilligan. Maybe it is not in your remit, but would you say that there was a culture in Maghaberry of ignoring the Owers report; that they thought that it did not apply to them, so to speak?

Dr Ian Cameron (Criminal Justice Inspection Northern Ireland): Many of the prison review team (PRT) recommendations were very strategic and high-level. I know that one of the ones that you referred to is PRT 5, which concerns the three mini prisons in Maghaberry. Much of that is dependent on funding, so a lot of the PRT recommendations are much longer term and are not in the day-to-day performance management areas that Brendan has been talking about.

Mr McGuigan: In my experience of transformational change and the sort of cultural change that Owers was aiming for, my observation is that trying to do it in three years is unrealistic. I know what it took in policing, and I know the investment that was required there. I know the significant investment that is required in the Northern Ireland Prison Service, and I know what was made available to it to enable this reform programme. I appreciate that, when Owers reported, the fiscal environment was not as it is today and that, when you are competing with health and education, there are no protections for the criminal justice system and the Department of Justice. There are none.

Cultural change in the Prison Service would have been enabled through some of the estate development. The things that you want prison officers to do are in creating dynamic security, talking to prisoners and doing so in an environment where both feel safe, where you do not have dark corners or blind corners in buildings that are open and airy, and where there is a sense that you can really move the rehabilitative programme forward. That is what we were aiming for in the Northern Ireland Prison Service.

I stress to people the fact that we want different things of the Prison Service now than we wanted before. We wanted different things from policing than we wanted before. Cultural and transformational change does not come cheap, and it does not come quickly. Unfortunately, it requires an investment of both time and money to make it happen, and part of that must be capital investment. I have heard some of the reports from Phil Wragg, the newly appointed governor at Maghaberry, about trying to clean it up. Those are basic things and I welcome that. I hope that, when we go back to Maghaberry, we see a changed prison; a prison that has stabilised and that is now safe for prisoners and staff. That is what I am hoping for and that is what the inspection will be trying to achieve.

Mr McCartney: People are in total support of that as a goal and achievement, but I think that it has been said here that, when you go into Maghaberry to visit, you can see that there is no doubt that it is a complex prison to manage. If it continues to be managed in the same way as it always has been — I am not saying that you are going to end up with it being as bad as the observations made in the report. When Anne Owers made her recommendation around the three mini prisons — I have said this to different senior managers in the Prison Service and Maghaberry — I found a resistance to it; I found that they were nearly saying, "It's a great idea but it won't work". I will certainly put this to the Prison Service when it comes in. We might need a capital injection into Maghaberry but, if there is no emphasis on trying to bring about the three mini prisons, I find it difficult to see the way forward. The action plan has the capital for 2019. That is too far away. What you need, in terms of innovation, is for someone to say, "What can we do? Can it be two mini prisons? Can it be a separation of categories so the prison can open up?". The prison closes itself down as a result of the current system.

Mr McGuigan: The Prison Service has appointed Phil Wragg to the role. I can only ever make a judgement on the basis of what happens in January in terms of what can be achieved. It is around governors who understand what can be achieved and what success looks like. We identified a number of years ago that there was not that level of development of skills, particularly leadership skills, about understanding and an experience of working in a different environment and seeing what can be achieved. I do not underestimate the ability of really good positive leadership in an environment like that. That could start to resolve some of these issues. However, it will not come cheap.

There has been significant underinvestment in capital in the Northern Ireland Prison Service. Some of the estate is clearly not fit for purpose. The square houses in particular — Erne House has been mentioned — are inappropriate. It is not where modern prisons are now. I know about Nick Hardwick's comments such as, "Dickens wouldn't have batted an eyelid". What he said to me — he said it privately as well — was, "Modern prisons feel different. They feel as if they have signed up to the focus on rehabilitation and that everything in the prison environment drives towards that". When he came back and looked at square houses, dark corners and high staffing levels to try to manage an estate that is outdated, I think that is what he was talking about. I do not want that for our Prison Service. We have a real opportunity to ensure that the capital investment required in the Prison Service is supported and that we turn places like Maghaberry right around. I think that we can, but I do not underestimate the ability of a good leader to take a look at it and come up with perhaps an innovative solution that none of us has thought of. I would love to see the three mini prisons. I think that that was the basis on which we were signing off on that recommendation. Do you agree, Ian?

Dr I Cameron: Yes. Quoile House has been built, and there are plans for another big residential accommodation block, but those are all down the road. Those are not going to happen in the next year; they are two, three or four years away. You are talking about that length of time before you can get to the stage where we will have the three mini prisons that Owers envisages in her report.

Mr McCartney: Do you not think that it can be done in the current context? Does the system have to be maintained as it is? If you maintain the system as it is, it will be an uphill battle. No matter how good the leadership is, if your structure is not conducive, you are running against the structure.

Mr McGuigan: I hope that I have evidenced today that I will seek to support the Prison Service on initiatives of this nature, in the belief that they are absolutely required if we are to move our Prison Service forward. I can see it being particularly difficult, and I said that about the separated regime. For as long as it remains in Maghaberry, with the complexity of Maghaberry as it sits, and to have at the heart of it a separated regime that you are trying to manage, it will always be like a festering sore or something that is distracting the management away from what needs to happen in the wider prison. Sometimes, the majority of the prison population can lose out in that scenario because you become focused on one area at the cost of the rest of the prisoner population.

Mr McCartney: That is why I talked about innovative thinking or trying to change the structure. We said at the time that the Steele report, which brought in separation, was designed to make it unattractive for prisoners. It made it controlled, restrictive and staff-intensive etc. It has been in place for the last 10 or 12 years and people need to start thinking about it. When you talk to people in the prison, they will tell you that there are far too many staff in it. If there are too many staff in it, that is maybe where the decisions have to be made. Is it necessary to have controlled movement, or the number of staff that are there, even in lock-up periods? On the other side of the prison, managers will tell you that they cannot get someone out because they are short of one person. They have told us that two or three extra prison staff on a block could mean that other prisoners get out of their cells. That is the thinking that I am talking about. I know that is not perhaps for you to give an opinion on.

One of the other aspects is in relation to training. It is about changing the culture. In February 2011, Anne Owers said that she was fearful that there was a fundamental opposition to change. I wonder whether the recommendation that training should be external should be considered again, because the training aspect has not been changed.

Dr I Cameron: We reported on that recently, and those were the concerns that we expressed. The Owers report was clear that training should be externalised. One of the other things in that recommendation was about staff secondments and exchanges, which had been mandatory before promotion. Again, when we reported back to the oversight committee, we said that those two elements had not been progressed sufficiently for us to be able to say that the recommendation was complete.

Mr McCartney: This is my final point, Chair. Thank you for your indulgence. As a result of your report, do you think that the Prison Service has a clear understanding of what should have been done and when, so that when it goes to correct it, it has a very clear view? I have seen the action plan and structurally it is sound. However, should there be more meat on the bones around implementation? For example, something needs to be done on a certain date and, if it is not done by that date, you will start to see slippage in the following recommendations. All the reports that you have carried out, particularly on Maghaberry, seem to indicate an inability to deliver the recommendations, but there never seems to be a step-in to say that a certain recommendation was the responsibility of whoever or whatever. You need to correct that, because that is the weakness.

Mr McGuigan: That may well be something that we would have to consider in terms of more regular monitoring of what exactly is going on in Maghaberry. There are a range of other organisations that are regularly in the prisons, and I welcome that. They include the voluntary and community sector organisations that support prison staff in delivering rehabilitation in the prison. Until recently, the Probation Board would have had a very strong footprint in the prison. They are all there and they are all supporting the move and progression towards achieving the delivery of a rehabilitative regime in the prison environment. Of course, there is also the role of the independent monitoring boards, which we would like to see strengthened, to be honest. If they are doing their job, it takes a bit of the pressure off us. That is about ensuring that the prison is operating to the standards that have been set out in the vision for the Northern Ireland Prison Service and, indeed, the action plans around the prison recommendations that we are making. That is a bit like the Policing Board, but it has been more effective in terms of monitoring recommendations that we might make around the police, where they are asking for updates etc. Maybe we will have to come up with another system. I certainly do not want to produce a report like this again.

Mr McCartney: Earlier, you mentioned that governors have their own legal responsibilities. If a governor does not want a good relationship with headquarters, is it easy for him to take that approach, or is there something that can be done to make sure that there is better harmonisation of authority?

Mr McGuigan: My view on that is that prison governors are appointed by the director general and managed, on a regular basis, by the director of operations. That is the system that has been in place for the last number of years. That would be largely akin to other organisations in the justice family. In policing, although George Hamilton would accept executive responsibility for his organisation, he equally has expectations of both his Assistant Chief Constables and the district commanders who operate and deliver the service to the public. There are some things that you would equate there. If you transfer that out of Justice and into Health etc, what is the role of the Department? What was the role of the Health and Social Care Board? What is the role of the trust? The Health Minister desired to clarify all that, but, within Justice, it is fairly clear, in my view.

Ms McGahan: Thank you for your presentation, Brendan. Earlier, you said that different people want different things from the Prison Service, but I suspect that everybody has the same objective, which is a Prison Service that is fit for purpose. That is where your leadership comes in and, clearly, that has failed. On the provision of healthcare services, have you met the South Eastern Trust regarding its plans and do you believe that a plan would be sufficient to address the major failings in the delivery of a health service to prisoners?

Mr McGuigan: I met the chief executive of the South Eastern Trust and his director who has responsibility for prison healthcare. We agreed that we will meet on a more regular basis. To be fair, he met and briefed us on the actions that have been taken since the inspection. I hope that that level of meetings and conversations will continue. I must say to you that healthcare was largely within the remit of the Regulation and Quality Improvement Authority, which partners us in this work. It takes the primary lead on that. We had significant concerns on this really when it started to impact on safety, particularly around the issues that I have mentioned to you: chronic disease management and the issue of in-possession medication which, in our view, needs to be sorted out because, although it is an issue in every prison, there are better mechanisms in other prisons for managing it and ensuring that we do not get this bullying and intimidation, or the opportunity for people to hoard medication and, perhaps, overdose, self-harm and stuff like that. These are critical issues. I have really only highlighted the issues that impacted on safety, but a much more full piece of work has been delivered by the Regulation and Quality Improvement Authority. I am sure that it would be more than willing to talk to the Committee if it had particular concerns around Maghaberry.

Dr I Cameron: We published a report last year on the safety of prisoners, which we did with the RQIA, and one thing that we tried to bring out in that was that there needs to be much closer joint working between the Prison Service and the trust in order to deliver outcomes for prisoners.

Ms McGahan: Regarding the safety of prisoners, do you believe that there has been medical negligence?

Dr I Cameron: I think that would be a matter for RQIA to comment on, in terms of clinical and medical governance.

Ms McGahan: Have you had any engagements with the public services ombudsman, who has responsibility for maladministration highlighted in complaints made by prisoners? Have complaints been made by prisoners to the public services ombudsman that you are aware of? I know that you cannot go into specifics.

Mr McGuigan: I am not aware of any. I meet Tom Frawley occasionally, and I think that, if there were, he would have pointed them out to me. We also meet the Prisoner Ombudsman regularly, and he keeps us in touch with the issues that he is dealing with, particularly deaths in custody, which are of relevance and would feature in our reports as well.

Ms McGahan: The public services ombudsman has a statutory duty to deal with complaints of maladministration, so I imagine that they would have more of a role in this than the Prisoner Ombudsman in dealing with health complaints.

Mr McGuigan: I am not really aware of that, and I think that the RQIA might be in a better position to provide advice on that. I am not personally aware of any.

Ms McGahan: Has any prisoner ever stated to you that they had made complaints through the available channels?

Dr I Cameron: There is a process for prisoners to complain about their healthcare but, again, that goes through the trust and any comment on that would be for the RQIA as opposed to us.

Ms McGahan: It sounds from your report as though the trust has clearly failed, so the next avenue then is the public services ombudsman.

Mr McGuigan: Again, I would only be speculating. I am sorry but I am not in a position to advise you on that.

The Chairperson (Mr Ross): I know that you cannot go into specifics, and I understand that you do not have the expertise in how healthcare is delivered, but it used to be in-house within prisons. Do you think, from your overarching look at this, that we need to re-examine that model of how healthcare is delivered in prisons?

Mr McGuigan: At a personal level, I found that, when we observed in various prisons, there is almost a degree of standing off from healthcare in the belief that it is the responsibility of the South Eastern Trust. The difficulty for us as we looked at it was that the legal responsibly rests with the governor of the prison into whose care prisoners are committed. What we talk about there is managing those paid-for services. Governors should be intrusive, not about individual packages of care but about how care is being dispensed and whether it meets the needs of the prisoner population. We should not need an independent inspection to have to come in and say, "Listen, you have a problem here". There were clearly problems and problems for the healthcare staff in the prison itself. Some of those concerns were escalated as whistle-blowers' concerns to RQIA, which would progress that as a matter of course, it being the health regulator.

I am talking about the role of governors in ensuring that healthcare services meet the needs of the prisoner population. For instance, there are no inpatient services provided in Maghaberry, so, if a prisoner presents with a problem, they are off to accident and emergency.

That is fine, but the prison officers are not standing and waiting and ambulances are not waiting outside the prison. Sometimes, it can take considerable time. The new governor has shared some information with me on the frequency and cost of transporting prisoners to accident and emergency and returning them to prison. Decisions were made. There are no secondary care services in Maghaberry any longer. It does not deliver that. I do not know whether that was a correct decision and I am not clinically qualified to make a judgement on that, but it strikes me that you need the capacity to do certain things as opposed to continually sending a prisoner population, many of whom self-harm and cause problems, to accident and emergency.

Ms McGahan: Brendan, it concerns me that we have potential medical negligence and that we do not have any clarification around that. You cannot clarify it. It definitely needs further scrutiny. I know that you do not have the expertise and that it is not within your statutory responsibility to ascertain somebody's medication and whatever medical problems they have, but, in this report, there is a suggestion of potential medical negligence. That is deeply concerning to me.

Mr Douglas: Thank you for your presentation so far. Brendan, you mentioned the radical new approach to separated prisoners: what do you mean by "separated prisoners"?

Mr McGuigan: Separated prisoners are the prisoners who are held in Roe House and Bush House in the prison environment. As I said, the agreement goes back to the Steele report, probably about 12 years ago, and regimes that are in place to manage those prisoners.

Mr Douglas: So, you are talking about loyalist and republican prisoners.

Mr McGuigan: Yes.

Mr Douglas: You are not talking about sex offenders.

Mr McGuigan: No. Sorry, I beg your pardon. I am talking about separated paramilitary prisoners.

Mr Douglas: I am aware of some of the stuff. Do you agree that Northern Ireland has a very segregated society? In my constituency of East Belfast, we have walls that divide people, and all the paramilitaries are still there. Maghaberry is, in one sense, a reflection of that. The Chairman asked you about radical new approaches: you were not able to give us those answers. For 20 or 30 years, we have asked those questions and have never got the answers.

Mr McGuigan: I was trying to reinforce the fact that there needs to be some new thinking about this to resolve what appears to be a continual problem. It has featured, to one degree or another, in every one of our reports on Maghaberry, but it was particularly difficult on this occasion because we saw that resources were being diverted to support the separated regime and, in doing that, the rest of the prison population was being disadvantaged and was not getting access to purposeful activity, healthcare and time of out cell. Those are elements that lead to the prison becoming dangerous.

Mr Douglas: In my experience of visiting Maghaberry, in one of the wings that I went into, it seemed to be working, even though it was separated. There seemed to be a surprisingly good relationship between the prison officers, who were doing a great job, and the prisoners. You say that quite a lot of resources were put into that, but it appeared to me, from speaking to some of the prisoners, that it was working and that they had a good relationship.

Mr McGuigan: If you look at the overall functioning of the prison — we mention that — you will see that many of the complaints come from the dissident republican prisoners in Roe House rather than Bush House. There are issues that need to be addressed, and our sense was that, if you are to continue to manage that situation within the Maghaberry environment, you need some radical new thinking about how you do that. I do not have the answers to it, and I hope that the new leadership team in the prison can come up with a set of better working arrangements that will ensure that you have less negative impact on the rest of the prisoner population.

Mr Douglas: You also mentioned that there has been an increase in the problem of drugs. Again, that reflects that there has definitely been an increase in drugs in society. As I said, in my constituency, we recently found over 100 heroin needles in one area. That was unheard of a couple of years ago. Can you tell us a bit about the drugs that we are talking about? Obviously, people are being prescribed drugs, and, sometimes, they can build up for a while.

Mr McGuigan: My understanding is that it is the full range of drugs, which includes heroin, cocaine, cannabis, legal highs and the very strong prescription medications such as tramadol and valium. You name it and it is available in that environment. It becomes a black market currency. Not so much on the Maghaberry inspection, but the last time we inspected Magilligan, it was very clear that some prisoners were being intimidated and bullied while on home leave to bring drugs back into the prison or, indeed, their families were being intimidated to bring drugs, through their visits, and pass them through that way. It is only with the courage of going forward and advising the prison authorities that these approaches have been made.

I know that you might ask why they do not take this to the police, and I understand that. But, sometimes in communities, people are really concerned about reprisals. It is better to stop drugs coming in than perhaps trying to apprehend the people who do it. Sometimes, some of that influence and those directions are coming from within the prison; it is not just somebody on the outside doing it. It could well be that fellow prisoners see an opportunity, know that somebody is on home leave, and somehow get messages out. There is a knock at the door of the family home, where the person is told, "We want you to bring this back in, and, if it does not happen —". We talked to two prisoners at Magilligan who went through the discipline process. Much of that was around keeping them safe so that they could integrate back in the prison population after they had served their time in the segregation unit for trying to bring concealed drugs into the prison.

Mr Douglas: Obviously, we, as a Committee, need reassurance, because this is a major report that has raised a number of issues. There will have been improvements from what you saw six months ago. Is there some sort of checklist that we could get, even monthly, to reassure us on the recommendations? The staff could be saying the things that had been changed on that checklist. There are some very serious issues here, and I imagine that, if you went back into the prison today, you would want to ensure that those things had been achieved.

Mr McGuigan: Absolutely. It may be a regular update to the Committee on progress against recommendations that the Prison Service provides. As I said to you, I understand my responsibilities around this, but I am reluctant to commit the inspection to an ongoing process. If it were felt that this was the only answer, then I might have to consider it. I also think that, when we talk about this culture of innovation and doing things, sometimes it is the small things that start to add up.

As I said to you before, what does success look like? Sometimes, people do not know that. Governors do not know that, and they have no experience of initiatives that other jurisdictions are trying to implement. Sometimes it is that there is a good idea that works for a time, and then you have to come up with another one. That is the reality of it. It is a difficult environment, but that is where leadership really comes in and gives hope to staff in the face of the context that they are dealing with so that morale does not dip to the extent that it had and that staff feel safe and look forward to going in to do their work.

What we saw and heard was that there are a lot of committed staff in that prison. There is no doubt about that. We firmly believe that, with the right leadership and support, they could start to deliver different outcomes. We have already highlighted some areas for reform. Maghaberry needs capital investment. There needs to be a mechanism to allow people who do not feel that they want to belong to the Prison Service any longer to leave with dignity. You need ventilation through bringing new people into the organisation, depending on what it is that you want from a modern Prison Service in the twenty-first century.

Mr Douglas: There was a record in the top 10 a number of years ago, 'Reasons to be Cheerful, Part 2'. What reasons do we have to be cheerful today in the midst of all the difficulties here?

Mr McGlone: Do we not have a part 1? [Laughter.]

Mr McGuigan: Ian and I sit on the oversight group on prison reform. Ian provides reports on progress against the recommendations. We are aware of very good initiatives in the wider Prison Service. Ultimately, the acid test for us in the prison reform programme is changed outcomes for prisoners. Then we will know that the reform programme has worked. Hopefully, there will not be another dip like this, but there will be highs and lows. This is a longer-term project; it is not a three-year flash in the pan. That is not the nature of transformational reform in the public sector. It might be in the private sector, where you just get somebody else to do it, but that is not an option here. We are investing in a public sector organisation to deliver transformational change.

When I use those words, I am not just talking about prisons and the justice system. We know that those are requirements across other areas of the public sector in Northern Ireland, such as our health and education services. They all feel that they have to step up to the mark as a result of the changing fiscal environment in which they find themselves. It is not easy, and I am not underestimating the scale of the challenge here. What I am committing my organisation to is to be part of the support that helps deliver transformational reform in the Northern Ireland Prison Service.

Mr Douglas: Thank you for allowing me some latitude, Chair. Probably the most positive thing you said today was about some of the work done by voluntary organisations. You also paid tribute to the Probation Board for Northern Ireland. Why were you so impressed by them?

Mr McGuigan: Quite simply, these are organisations and institutions that bring social care into a prison environment. Many of our prisoners are in prison as a result of circumstances. I understand that there are very dangerous people in prison who need to be kept there to protect society. Many others, however, have been failed by our education and health systems, and they end up in the prison environment. The kind of social care these organisations provide looks beyond the individual to their family and to what is going to be required to support them back out in the community. The Probation Board and organisations from the voluntary and community sector are powerful in adding real value to our prison environment. I could not overestimate that. These are people from the community, some ex-offenders, who stand alongside people and try to keep them on the right side of the law and guide them towards rehabilitation. Surely it is in all our interests as a society if offenders go through a programme that brings them to a realisation about their offending and how they can contribute to society. It is often the voluntary and community sector organisations that help to give prisoners the skills and support to make the transition from crime to a positive contribution toward our community.

Mr Douglas: Yet some of those organisations have not been immune from cuts. I think that the Probation Board's budget was slashed by about 50%. It is not a good news story when we are slashing our budgets. Thank you very much.

The Chairperson (Mr Ross): I would just like to pick up on something you said. You mentioned the dangerous people in our prisons, and in one of your responses to Sammy you talked about bullying. If there are individuals in prison who are creating a dangerous environment or orchestrating intimidation and other difficulties, what scope is there to move them to other prisons in the UK?

Mr McGuigan: Therein lies a real problem. We do not have that capacity in our prison system here. Normally, prisoners who present less of a risk will be sent to Magilligan; really difficult prisoners do not go to Magilligan. As I said in the report, many of the prisoners in Maghaberry will spend their full time there, because there are no opportunities for different locations or different ways of dealing with them. They have to be managed within that environment, be it in the lifer blocks, the Mourne House complex or, indeed, in the wider prison environment.

The Chairperson (Mr Ross): Is there something prohibiting prisoners in Maghaberry being moved to another high security prison in GB? If a prisoner is causing difficulties for the management of the prison in England, they will be moved to another high security prison. Is there a mechanism to do that here, or is moving someone from Maghaberry to another high security prison prohibited?

Mr Douglas: Chair, may I come in? We asked that question on our visit. A couple of prisoners, who were a danger to everybody, including themselves, were sent to England. That surprised me.

Mr McGuigan: I think that would be right, Chair. If prisoners are seen to be a risk to the rest of the prison population, then there are secure mental health institutions, such as Rampton, that can be considered; and some Northern Ireland prisoners are being detained there. There is a wider issue to do with getting agreement, including that of the prisoners themselves. We know that one of the strongest supports for prisoners is their family. Family support is critical to how they will react on release. Being supported in that way can be such a power for good in enabling prisoners along that path to rehabilitation.

Mr A Maginness: Thank you very much for your contribution today. I am a very enthusiastic supporter of the reform programme, but this report, which reflects very badly on the state of the programme, disappoints me very much. The problems here are very significant, and that is probably putting it mildly. A total of 442 segregations over a period of six months out of a prison population of 997 is very high, even allowing for multiple segregations of the same prisoner. Then adjudications are up by over 100% from 126 to 281. These things are crying out to be addressed.

However, I will leave that all aside. The reform programme is what interests me. The oversight group has been telling us for a couple of years now that the reform programme has been progressing reasonably well, and that a lot of the recommendations have been either fully or partially implemented, with only a few outstanding. To be blunt, how does that square with this damning report on Maghaberry, which is at the very heart of the prison system? Perhaps Dr Cameron is better placed to answer that, Mr McGuigan. Can you reassure us about the state of the reform programme, despite the fact that you have had this awful report?

Mr McGuigan: I know the absolute commitment of the Minister to see the successful completion of —

Mr A Maginness: I do not doubt that and I have always congratulated —

Mr McGuigan: — and, indeed, the commitment of the director general, the change manager, the director of rehabilitation and the director of operations in the past, who have all been driving the reform agenda. Maghaberry was a real setback. As I said to you, this was never the report that I wanted to write. However, we have a wider responsibility here. This is a setback, but it is an opportunity as well.

Hopefully, when we go back in January, we will find that the prison has stabilised. I appreciate that we are not giving them much time but, to be honest with you, if we could have organised to go back in July we would have done so, such was the nature of the circumstances and the condition in which we found the prison. We were genuinely concerned when we left in May that, actually, a critical incident could have occurred. In the prison environment, coming up on the summer leave period, when even fewer staff would be available, we were concerned that prisoners would experience an even more impoverished regime than that which we saw. In those circumstances, we were extremely concerned.

I put my concerns in writing to the director general and sought an interim action plan to respond to the issues we had uncovered in the inspection. She has responded and has kept me fully au fait and up to speed on the decisions and actions that have been taken to stabilise the prison. Unfortunately, organising inspections of this nature takes time and money. I have devoted our organisation's resources to this matter but this is not what I wanted to be doing in January. There are other parts of the justice system that, in our view, need attention as well. Such as the seriousness of the situation that I asked the prisons inspectorate and my partners in RQIA and the Education and Training Inspectorate to indicate when they could give us some time and when we could do this. I asked them whether we were likely to see any signs of a stabilisation of the regime in Maghaberry and the consensus view was that January would be the first available opportunity; and that is when we are doing it.

Dr Cameron: I return to your original point about the prison review team recommendations. In the case of a number of those that we have reported on, we have said very clearly that they are a work in progress and that we will have to come back to them over time to ensure full completion. Many of them are a work in progress and are not complete at the moment.

Mr McGlone: Thank you very much indeed, Mr McGuigan. I was listening very carefully to you earlier, and forgive me for saying that I am a complete novice when it comes to running prisons, but is there nobody who is fit to step up in the prison and look beyond the parapet to see how new things, or maybe not so new things, are done elsewhere in the world? They might only have to cross the sea, or maybe not even have to cross the sea to find out how to go about that. This is a drastic report. It is disastrous, when you see how the situation seems to have developed there. You said that there required to be a therapeutic environment. I hope that I am not paraphrasing you too incorrectly, but you also said that it was impossible to create that with what you saw in the prison.

Let us look at it another way. There is an old Irish saying "Ná lochtaigh gan leasú", which means, literally, do not find faults without presenting solutions. Was it so radically bad that there was nothing that you could have recommended for just that environment to be created in the prison? Was it that impossibly bad?

I have two or three other things that I want to ask you. First of all, you mentioned that — and I presume that you were referring to external services — there was an inability to bring to account the paid-for services. That sounds totally crazy to me. If you are paying for services and you cannot hold people to account for the services that are being delivered, you either no longer pay them and get rid of them or make further complaints to the supply chain or the organisation providing them. I cannot get my head round that.

The other thing was about staff not being listened to. Will you elaborate a bit further on that to explain how or in what way were staff not being listened to, or, more importantly, by whom and at what level if it was not being registered? The final thing was the lack of development and leadership skills and where the responsibility for that lay to ensure that that was happening. That issue seems to be the glaringly obvious. You wonder about the way in which the place was being run.

Mr McGuigan: I will start in reverse order. We reported on the issue of prison officer training and development quite extensively in 2009. My background was in policing. I equated it with the investment of that organisation in developing me through my career. I saw a significant underinvestment by the Prison Service. It was not developing its senior cadre of governors in the way that the Police Service would have invested in me. By that, we talk about an opportunity to work in different environments to understand how other prison services deliver their service against the pressures they might be facing. I use the term "knowing what success looks like" and being able to take calculable risks. We know that you can achieve an awful lot sometimes by doing very little things. However, if you do not have the confidence that those little things will be approved of or supported or whatever, they do not get done. The easy thing is to say, "Well, that's just the way we do things here", so that creativity and innovation does not happen. Unfortunately, that is the one area of the reform programme that we have not signed off on. We do not see the improvement that even Owers was calling for in that area. Some of it is self-directed and about individuals choosing to say what they are going to do. I cannot see inside people's minds regarding this, but, if people are no taking or seeking out opportunities, organisations will sometimes not do it for them.

Mr McGlone: You are a man of experience; you have just outlined some of it. Where did the buck stop for making sure that that was done at a management level? If people are not self-starters, maybe they need a bit of encouragement or nurturing. Sometimes, if they are not self-starters, you just park them and move on with others, but, clearly, from what you have told me, it was not even being done with others. Was that a departmental thing? Was it a Minister's thing to make sure that it was done? I am not looking for people to blame. Why was it not being done?

Mr McGuigan: To be honest, I think there was a cultural weakness in the Northern Ireland Prison Service for a number of years. We identified it in 2009, and Owers reported on it in 2011. We have been monitoring the reform programme. This is one area that has not been developed.

Having said that, I understand that, in the last three months, it has developed its top 50, which looks at people in the Prison Service who are likely to be there for the foreseeable future and have expressed an interest and displayed the skills that say to it that they are the sort of people whom it needs to invest its future leadership in.

Mr McGlone: How many reports have to be produced before the penny drops? You are sitting here with a report — you have just outlined a litany of reports. How many more times will you have to come before us? How many more press conferences will you or your organisation have to have before the penny drops? It is not looking good; in fact, this report shows that it is getting worse.

Mr McGuigan: I never want to produce another report like this. Never. However, I will report what I find; that is what I have to do, and that is the role of the inspectorate. In terms of creativity and innovation, as inspectors, we outline, as we did in this report, the high-level issues that need to be addressed as a matter of urgency to stabilise the prison and make it safe. So there are not 120 recommendations. When we did this, we said, "We can give them a lot to be thinking about, or we can give them some things to be thinking about that, in our view, prioritise the issues at Maghaberry". That is what we have done. It is not really for inspectors to micromanage the prisons. However, we have seen — I have witnessed it personally — where senior leadership in the Northern Ireland Prison Service has intervened and micromanaged, and I say to myself that outcomes for prisoners are improving on that issue. So, fair enough. However, it says to me that there is a deficit here. There are definitely some great people within that Prison Service. They need to be nurtured and supported to provide the future leadership for our Prison Service. That is my view.

Mr McGlone: Well, let me come back to the original point. We have seen a number of reports that you have outlined that say "Bad, bad, bad". The latest one says, "Worse". Now, you say that it has started to improve: does that mean that it has started to improve to come up to bad again? Back to those points that I outlined to you earlier: that inability to bring to account paid-for services; staff were not being listened to; and the issue of the therapeutic environment which you found impossible to create with what you saw there. Can you just take me through those things again, please? Please answer them this time.

Mr McGuigan: Let me address the issue of paid-for services. It is the ultimate and legal responsibility of the governor to ensure that the constituent elements of service delivery are actually being delivered within the prison environment, which include healthcare and education. We did not see any of that. What we saw was that it was left to the healthcare manager or the person in charge of learning and skills. What we are saying is that leadership has a greater responsibility than that. It may well be that, as we found, neither of them was meeting the needs of the prisoner population, yet there was no sense that action was being taken in relation to that. The frustration around that is that these are paid-for services. We understand and support the rationale for moving to the clinical governance model, but the ultimate responsibility around the health and welfare of the prisoner resides with the prison governor, into whose care that prisoner is committed. The buck stops there.

We were frustrated by that, and the Inspectorate of Prisons said that that would not happen in England and Wales. I am sorry, but it would not. There would be a more intrusive questioning of the provision of services, to ensure that, first, we were getting value for money and, secondly, it was meeting the needs of the prisoner population. These are things that are basic, now, in public-sector management; you need to be able to do this. If you are managing a hospital, a police station or a police district, you need to know who is delivering the service, whether it is meeting the needs, what is being paid for it and whether it is the best that we can get. Those questions, we believe, need to be asked and were not being asked.

Mr McGlone: By whom?

Mr McGuigan: The ultimate responsibility resides with the prison governor.

Mr McGlone: On the prison governor not doing his or her job, should an intervention be taken by the wider Prison Service or, ultimately, the Department?

Mr McGuigan: In my view, the governor is appointed by the director general and is managed, on a day-to-day basis, by the director of operations. That is the structure in the Northern Ireland Prison Service. Ultimately, they have management responsibilities for the governor, but the governor has legal responsibilities that they have to discharge. Does that answer your question?

Mr McGlone: No, but you have just prompted me to ask something else. What if that is not being discharged?

Mr McGuigan: I could only honestly say that if I were looking at a further review of corporate governance in the Northern Ireland Prison Service.

Mr McGlone: Let us just stick with your report in front of us.

Mr McGuigan: OK.

Mr McGlone: It is a damning report. Clearly, that was not being discharged. Where is the responsibility for coming in and kicking here and replacing somebody, or for taking them to one side, mentoring them and saying, "This hasn't been done. You are not doing your job right here. Do your job right"? Where does that responsibility lie? I just want to get this into my head. This report is awful; disastrous. It shows a deteriorating situation. We can all make the case, as people have tried to do, that it is a unique situation. However, there are difficult prisons all over the world. So where does the buck stop? Who should have intervened when it was patently obvious from the damning reports all round the place that there had been difficult situations? You then came in and not only verified that but said that it was getting worse.

Mr McGuigan: The ultimate responsibility for the Northern Ireland Prison Service resides with the director general, but this was not an assessment of the director general's performance. I am trying to say that to you. This was an inspection of Maghaberry prison.

Mr McGlone: We will just park it there for a wee minute. I am not asking about the director general's performance. I am asking who is responsible when the management of the prison falls absolutely flat on its face and winds up with a disastrous report like the one that you have just presented us with.

Mr McGuigan: The ultimate responsibility resides with Prison Service headquarters.

Mr McGlone: Right, and what should it do in these circumstances?

Mr McGuigan: What we saw evidence of was —

Mr McGlone: I am not asking you what you saw evidence of. I am asking what it should do in these circumstances.

Mr McGuigan: I am sorry; I am dodging this one because our inspection reports are based on what we find. You are asking me what should have happened in that situation, but I am not there to manage the Northern Ireland Prison Service. What I am trying to do here today is to say what we found in two weeks in May.

Mr McGlone: OK. [Inaudible.]

You are presenting us with the problem. There might be others coming along who are supposed to present us or should have presented us with the solutions.

Mr McGuigan: Yes. What I was saying to you was that there was evidence of those attempts to mentor. That was available in the regular reports being carried out by the director of operations. We saw those, and we saw where there were helpful suggestions and directions about things that could be done to improve.

Mr McGlone: Which were not taken up.

Mr McGuigan: They were not done. It becomes an issue about performance management.

Mr McGlone: Exactly.

Mr McGuigan: That resides with the person responsible for appointing the governor.

Mr McGlone: That is grand. Thanks very much for that.

Mr McGuigan: No problem.

Mr Lynch: I apologise; I had to go out for a few minutes. Just a quick one, Brendan. You have called for an independent inquiry into the fire. What do you think an independent inquiry is necessary?

Mr McGuigan: Because we heard competing accounts of what had happened. The constituent elements around that were, we believed, symptomatic of what was going on in the wider prison environment. In many ways, we struggled to see how a situation that must regularly occur within the prison, in which prisoners refuse to do something and have to be confronted and challenged about their behaviour and, indeed, on occasions, forcibly removed back to their cells — surely that must be a regular occurrence within prison environments, no matter where you are. At some stage, some prisoners will rebel. Sometimes it could be because they are high on drugs or have reached a stage where something is going on in their lives that has not been picked up, and they just lose it. That was not a situation in which prisoner officers had been kidnapped; there was no use of weapons or anything of that nature. We struggled to understand why it took so long to bring a situation like that under control.

In the meantime, a fire — a malicious fire — was set, and trying to unlock 140 men who were trapped in an environment that was fast becoming smoke-filled was a real danger to both staff and prisoners. It was one of those situations that were described to us as a near miss. In medical terms, that would be seen as a serious adverse incident. It needs to be examined in such a way that, if there is learning, it is taken on board by the organisation and that situation is not allowed to occur again. It seemed so dangerous for a situation like that to arise as a result of a small number of prisoners in an open exercise area who were not dealt with in a timely fashion.

Mr Poots: Thanks to Brendan and Ian. It is good to see you both again.

Brendan, I do not think that you covered yourself in glory in your response to Mr McGlone. You danced on the head of a pin for around five minutes before finally admitting that the DG was responsible. I ask you to reflect on your time when you were in R division in Lisburn. Was a report done in Lisburn that stated, "Brendan McGuigan has delivered terribly here, policing is an absolute shambles, and that is no responsibility of the Chief Constable or headquarters team"? Of course it is their responsibility. Let us be very clear, and let you be very clear: this is not the responsibility alone of Maghaberry's governors. It is the responsibility of the Minister and the headquarters team. Is that clear?

Mr McGuigan: Yes, absolutely. I am trying not to dance on the head of a pin but to confine my remarks to a document that I have produced here with a set of findings. I do understand that the director general has responsibility for the appointment and management of governors in the Northern Ireland Prison Service. That is absolutely clear.

Mr Poots: When failure happens, you need to call those people to account. You have appointed someone to do a job. If they are not doing their job, you need to call them in and ask them what is going wrong and how we can help them or tell them that you cannot help them, that they are not doing it to a satisfactory standard and need to go. Is that not what should happen?

Mr McGuigan: To be honest with you, I think you are doing that. That is not for me to do. I have to do an analysis of the prison and how we found it and the roles and responsibilities of the prison's governor. I have been clear enough — I have explained it to people here — that we saw an ineffective relationship between headquarters and the governor group at Maghaberry, in which trust and confidence had clearly been lost. The monitoring reports that were completed by the director of operations, which identified issues that needed to be addressed, were not being addressed. When we came in —

Mr Poots: Was one of those issues staffing? Was there a full complement of staff in the prison throughout that period?

Mr McGuigan: No, there was not.

Mr Poots: Whose responsibility is that?

Mr McGuigan: That is a discussion between, once again, the director general and the prison governor.

Mr Poots: Who is responsible for recruitment?

Mr McGuigan: I imagine that that rests with the Prison Service headquarters.

Mr Poots: You are the inspector.

Mr McGuigan: Yes, absolutely.

Mr Poots: I am not looking for imaginings; I am looking for facts. You are the inspector. Who is responsible for recruiting staff?

Mr McGuigan: Prison Service headquarters.

Mr Poots: OK. So they did not give the governors the staff to do the job. If prisoners were in their cells for too long, as you identified, who was responsible? Was it the prison governor, who did not have the staff to let the prisoners out safely, or Prison Service headquarters?

Mr McGuigan: To be honest with you, it was a combination of both. What was clear to us was that there were increasing sickness levels in the prison. Could and should anything have been done to stem that situation and encourage people back to work? You know —

Mr Poots: Were sickness levels associated with prison staff who were overstretched and overworked as a consequence of there not being enough staff in the first instance, because recruitment was not happening?

Mr McGuigan: Yes, absolutely. Some of that was there. Some of that was the result of threats. Some of that was the result of assaults.

Mr Poots: Was it anything to do with experienced prison officers having received an early payoff and fairly new recruits coming in who were quite inexperienced, and many of them leaving very quickly after arriving in the job? Did that have anything to do with it?

Mr McGuigan: Absolutely. I am sure that it would have had an impact on the confidence of staff to do the job that they have signed up to. Therein lies some of the problems that I identified earlier around the lack of investment in the estate and where you can use fewer officers and have better ways of monitoring exactly what was going on. It is a combination of issues that leads to the current problem.

The Chairperson (Mr Ross): OK. That is everyone. Thank you all very much. I appreciate it.