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The number of older prisoners in England and Wales has risen from 365 to 1,154 between 1990 and 2000 and looks set to rise still further according to Growing Old in Prison, a report by the Prison Reform Trust.

The report, released late last month, argues that older prisoners are being neglected because the Prison Service is failing to meet their specialist health, social and rehabilitation needs. It predicts that numbers of older prisoners will continue to rise due to measures within the criminal justice bill currently being put before parliament.

Prison Reform Trust director Juliet Lyon says that for older prisoners, and particularly those with a disability, prison is a double punishment. "Jail is experienced by older people as a harsher environment than it is by younger men."

Stuart Ware, an ex-prisoner who is now director of Pacer 50plus, a support network for older prisoners, says:"I know from my own experience that prison life can be twice as difficult for older prisoners. Prisons and their regimes are not designed for people over 60 who have special health and social needs."

The report calls for a national strategy for older prisoners to address:

• Health care.
• Provision of disability services.
• Social care provision.
• The development of education and rehabilitation programmes.
• The specific resettlement needs of older prisoners.

But the government has dismissed the need for any such strategy. In May, the then minister for prisons and probation Hilary Benn told parliament: "There are no plans to put in place a separate national strategy for elderly prisoners that specifies regime requirements. The Prison Service aims to assess prisoner's needs through sentence planning. This takes account of the requirement for appropriate accommodation, health care, regimes and resettlement support for all prisoners."

Growing Old in Prison says more than 80 per cent of older prisoners have a long-standing chronic illness or disability. But it expects their health care to improve because the NHS took responsibility for it in April this year. The report also outlines how prisons are aiming to improve disabled prisoners' access to facilities by 2004, although Ware doubts this target will be met.

The government announced plans for HMP Norwich to build a new health care wing for 15 older and infirm long-term prisoners earlier this month but no building work has begun and there is no date for completion.

The report also says that social care in prisons is failing many older prisoners. Lyon says that social care received by older prisoners is variable around the country but worse than that received by older people in the community. She adds that prison staff receive no specialist training in how to care for older prisoners and that there is a failure to acknowledge that people age faster in prison.

The report states that more than half of older prisoners suffer from a mental disorder, with the most common being depression. Ware says that this is partly caused by the prison regime's failure to cater for older people, leaving them to drift into inactivity. HMP Kingston, in Portsmouth, which holds only life sentence prisoners, is the only prison in England and Wales to have a specialist unit for older prisoners. It has received mixed reports over the past few years.

Crispin Truman, chief executive of Revolving Doors, a charity that works with ex-offenders with mental health problems, says that many older people leave prison with unidentified mental health problems because psychiatric services in prison are too specialised and only focus on those with the highest level of need. Truman explains that this makes them highly vulnerable. "If they are not diagnosed, they are denied a whole range of health, social care and housing services." He adds that those who do not receive services can return to crime and end up back in prison.

Ware says that unless certain health problems such as Parkinson's disease and Alzheimer's are identified in prison, it is unlikely they will be diagnosed on the outside after release because the Probation Service is so overstretched.

Truman says that the Probation Service no longer provides a befriending role, when often this is what many older people require.

The trust's report also highlights the need for improvements in rehabilitation services for older prisoners released back into the community. "The major problem is when they come out," says Ware. Although he was only in prison for just over a year, he estimates that it took him between four and six years to get over it. He adds that he came out with mental health problems and that for those serving long stretches this problem is even more severe.

Lyon says the links between older peoples' charities, councils and prisons need to be strengthened in order to help older prisoners back into the community. Mervyn Eastman, a trustee of the charity Action on Elder Abuse and author of the report Discovering the Older Prisoner, released in 2000, says that many older prisoners receive social care services in prison but after release these do not continue.

He argues that, in order to ensure services carry on, social care provision in prisons should be made the responsibility of the local authority where each prison is located, following in the steps of health services. "If prisons are to be seen as part of the wider community then it makes sense for social care to be social services' responsibility in partnership with the prison service," he says.

Ware says that many older people do not have families to provide them with support, exacerbating their isolation. He says prison overcrowding is adding to this, with older people being sent to stay in prisons far away from where they live. This can make it harder when people are released, he adds, as the social services department whose care they are released into may never have heard of them.

Ware believes that if an older person is coming out of prison it increases the likelihood that they are going to have much greater caring costs and that the government does not take this into account when it imprisons them. "The cost implications for health and social services are not recognised," he says.

He argues that, in order to address this, once an older prisoner has left prison a sum of money needs to be transferred to the receiving social services department to cover the cost of their social care.

With more older people being imprisoned and a lack of specific services for them in jail and when they are released, some are querying whether they should be there in the first place.

Geoff Dobson, deputy director of the Prison Reform Trust, says that there needs to be more research into what types of community service could act as an alternative to imprisonment. He asks whether the current lack of options could be causing some older people to be imprisoned inappropriately.

Ware says he knows of older prisoners who become involved in helping in community care services on a voluntary basis while they are in prison or once they have left and that this should be looked at as an alternative to jail.

He highlights alcohol services as one area where older prisoners could help out, explaining that despite many older people having a history of alcohol abuse, services are becoming ever more focused on the young. "Peer support programmes are often used but not in terms of older people for older people," he explains.

As the levels of older prisoners rise it will become even more pressing for the government to address this problem. The trust raises questions around the extent to which ministers should favour developing age- or disability-specific services, and says that it may have to consider building "nursing home prisons" similar to those in the US.

Regardless of how older people are imprisoned, Lyon questions whether putting them in jail is the answer. "Is locking up more and more prisoners into their old age of any real benefit to society?" she asks.

- Ken Howse, Growing Old in Prison from the Prison Reform Trust, 020 7251 5070.