Unlocking care in prisons

There are some facts that lodge in the brain. So, in the interest of sharing interesting facts, did you know the prison service:

• is the largest residential care provider for elderly men in the UK
• classifies anyone over 50 as elderly.

We’re all familiar with the challenges facing us as a country as a result of an ageing population – not least how best to fund a social care system that has been stretched for so long and is now showing signs of almost irreparable damage. It appears this is no different in our prisons.

The number of over-60s in prison is rising faster than any other age group – in 2002, there were just over 1,500 over-60s in prison, by 2020 this had grown to more than 5,000, reflecting longer sentences and the increased focus on identifying and prosecuting sex offenders (42 per cent of male prisoners aged 50 or over have been convicted of a sexual offence).

There is little to suggest that the Government or the population at large, is supportive of a radical change away from punishment towards rehabilitation. Elderly sex offenders are unlikely to galvanise support for reform. However, there are some important reasons why we should be thinking about this.

Our prisons are over-crowded and not suitable for an ageing population

Almost two-thirds of prisons are over-crowded. Despite significant investment going into building new prisons and new accommodation in existing prisons, demand is outpacing supply. Her Majesty’s Prison and Probation Service (HMPPS) expects to deliver 3,566 new prison places by 2023-24 against its target of 10,000 by 2020. Plans to close old, unsuitable facilities have been shelved and the continuing growth in the forecast population means large numbers will continue to be held in old, overcrowded, unsuitable establishments.

Given these pressures facing the prison service, perhaps we should be questioning who we are imprisoning and for how long, and whether there might be better alternatives for securing justice for their crimes. Elderly prisoners are generally compliant and non-violent. Almost 60 per cent have complex health problems and 59 per cent report having a long-standing illness or disability. And 90 per cent have at least one moderate or severe health condition, with more than half having three or more. Is prison the best and only option for them?

The prison environment can make it difficult to meet even the basic needs of older prisoners. Traditional technology enabled care (TEC), widely used in the community, can be a struggle to deliver in prisons. For example, staff constraints limit some TEC. An alarm may alert prison staff if a prisoner has had a fall but, with staffing levels stretched, the speed of response can be slower if prison officers are dealing with another issue, and as traditional call centres can’t monitor alarms within prisons, false alarms could waste a lot of prison staff attention. Even wheelchairs and hoists are difficult to use, particularly in old Victorian jails.

Culture of care

Social workers are responsible for assessing prisoners’ needs but they depend on prison officers making the referrals. The level of engagement with social workers is variable and, anecdotally, the feeling is that prison leadership might drive this as much as the needs of prisoners. Whatever the reason, the fact is that social workers are engaging with very few prisoners. Even when social workers are engaged, the prison routine can be so restrictive that it leads to quite narrow care provision. There also appears to be a lack of parity of care between health and care needs in prisons – established contracts for health services exist, whereas trusted fellow prisoners meet personal care needs in an ad hoc way.

Issues can also extend to the release of prisoners. A recent interview with a social worker suggested that, for many prisoners, the option to be referred to a residential care home is unavailable because of a reluctance by care home providers to take ex-offenders, particularly sex offenders, however infirm they are. As a result, prisons release the elderly into supported housing, but at what cost?

Options for the future

A strategy for elderly prisoners is in development, which is a welcome opportunity to address future social care needs. We see three main priorities this strategy needs to address:

1. Cultural change: Prison staff will be key to unlocking the opportunity to better embed social care in prisons. Determining and prioritising the care needs of prisoners will require a shift in mindset that needs to come from the top. Individual governors set the tone and establish and prioritise social care. Whilst some prisons demonstrate good practice in addressing prisoners care needs, this is inconsistent.

2. Integrate social care: Changes to process and policies will show social care is an important part of responding to prisoners’ needs. Currently, interventions that could better support prisoners’ social care needs can butt up against standard prison procedures. For example, there are epileptic sensory mats that detect fits but the fire safety levels of the prison -issued mattresses inhibit the use of the technology meaning they can’t be used.

3. Rethink the prison estate: Victorian prisons are inherently unsuitable for older prisoners – particularly those with mobility issues. As we start to plan for the prisons of the future an option might be to consider designing specialised care wings along the lines of the eight-bed ward for rehab and end of life care recently announced by HMP Stafford. These could mirror the regime of a care home within a prison setting, including appropriate TEC provision, complementing the hospital wings that already exist for prisoner healthcare needs. Going further, could the open prison estate offer more appropriate settings?

Focusing on these three areas would help prison staff better meet the needs of an ageing prisoner cohort. It would also mean care needs wouldn’t escalate rapidly, resulting in much lower costs to society when these prisoners are eventually released.

We’re moving towards the tipping point at which the ability of prisons to meet the needs of prisoners is so constrained as to be impossible. We have an opportunity to address this, but the window to do so is closing rapidly and the catalyst for change must not be a tragic event that could have been avoided.