In care, out of sight
Are patients receiving good forensic care?
It is uncertain whether the forensic care provided to convicts helps their recovery and stops them reoffending. The information available to the Minister for Legal Protection is inadequate to say one way or the other. It therefore cannot be said whether the treatment of convicts actually makes society safer.
Conclusions
The Minister for Legal Protection currently does not know whether forensic care reduces reoffending and therefore makes society safer. In addition, he has only limited insight into the extent to which forensic care is timely, appropriate and of the quality required under the Forensic Care Act. The Ministry of Justice and Security has data that could improve the insight. The minister, however, does not use the data as input for policy-related information. Neither does he inform parliament about the insight provided by the data.
What are our recommendations?
We recommend that the Minister for Legal Protection gain an insight into the progress towards the policy ambitions laid down in the Forensic Care Act. To do so, he will need:
- straightforward forensic care goals,
- good integrated data to steer and account for policy.
Why did we audit implementation of the Forensic Care Act?
The original audit objective was to assess the Custodial Institutions Agency’s achievement of the Forensic Care Act’s goals and the contribution towards them made by the agency’s procurement and contract management. In the course of the audit, however, it became clear that the data on forensic care and its results were so fragmented that the audit question became: Does the Minister for Legal Protection have sufficient insight into achievement of the Forensic Care Act’s goals? The Court of Audit then examined how the available data could be put to better use to determine the achievement of the act’s goals.
What audit methods did we use?
For this audit, we requested and analysed data from the Ministry of Justice and Security, the implementing organisations concerned and the Dutch Health Care Authority. The data related in particular to the patients’ care needs assessments, placement in an institution and care billing. We also studied relevant documents on the quality and procurement of forensic care and held interviews with relevant staff at the ministry and the implementing organisations.
What data did we use in our audit of the implementation of the Forensic Care Act?
We retrieved information from several data files in the forensic care information system (IFZO) and the billing control system (FCS) and from one data file kept by the Dutch Health Care Authority. We used this information to gain an insight into the placement of patients and the available forensic care provision. We combined data on the care location and the active period of the care location in two IFZO data files, Admissions and Care Offer. On the basis of our list of criminal case numbers and placement decision numbers (from the IFZO), the Custodial Institutions Agency retrieved billing data from the FCS. In response to a request similar to the one concerning the IFZO, the Dutch Health Care Authority provided us with a data file with forensic care starters derived from its own systems (Dis and Vektis).
Response of the Minister for Legal Protection
The minister agrees with us about the importance of improving insight into the effectiveness of forensic care. He also agrees that the interim goals of the Forensic Care Act should be properly worked out and the work should be more data driven. The measures he will therefore take include:
- development of a quality framework for forensic care,
- development of treatment assessments,
- study of ways to provide information on the complementarity with regular mental health care in the judicial system.
In addition, a multiyear programme to convert the IFZO into a patient monitoring system is already being carried out. Regarding insight into effectiveness, the minister notes that a direct link between forensic care and reoffending has not been established. Such a study would be difficult to carry out. Interventions with a scientific underpinning regarding the impact on incentives to commit crime, however, are being made. Furthermore, the Research and Documentation Centre will continue its multiyear study programme in the years ahead.
Court of Audit’s afterword
The Court of Audit wonders whether the measures mentioned by the minister will create sufficient insight into the quality and effectiveness of forensic care and the problems concerning the care provided. We agree with the importance of the Research and Documentation Centre’s programme to increase effectiveness. The minister refers in his response to a quality framework for forensic care. We state in our report that the framework was overly concerned with conditionalities at the expense of the 4 goals.