Caring for older prisoners

(Maurice Dix, project manager of the Older Prisoner’s Project.   Pic Tom Parkes)

While the church-run National Prisoner Week (9-16 November, 2008) asks us to remember those languishing in prisons, Natalie Valios reveals the plight of a forgotten group of inmates – older people

The oldest male prisoner in England and Wales last year was 92 and the oldest female prisoner 78, according to prisons inspectorate statistics. By March 2008, there were almost 7,000 prisoners aged over 50 and prisoners over 60 are the fastest growing incarcerated age group. Longer sentences are resulting in many growing old in prison, while some elderly people are inside for the first time – convicted of sexual offences they committed earlier in life.

Prisoners are deemed older at 50 because their living conditions mean they decline at a more rapid rate than the general population and so are likely to have earlier onset of chronic health and social care needs. Despite this they don’t have access to the plethora of care and support services available to the outside world because local authorities have no legal responsibility to provide them.

To address these problems, Offender Health, a policy branch in the Department of Health, set up the Older Prisoners Action Group (Opag) 18 months ago. Opag is chaired by Offender Health’s primary and social care policy lead Mark Freeman, and has representatives from the prisons inspectorate, the Care Services Improvement Partnership, the Probation Service, the National Offender Management Service, the Prison Service, Age Concern, the Prison Reform Trust, Nacro, the NHS, and the Isle of Wight Council.

Offender Health’s remit to ensure that health-related services provided in prisons are comparable with those in the community was boosted in 2006 when primary care trusts took over responsibility for the provision of healthcare in prisons from the Prison Service. This has led to improvements in healthcare, and now Opag has the task of looking at the social care needs of older prisoners while inside and on their release.

End-of-life care is increasingly becoming an issue in prison, says Freeman, because long sentences mean some prisoners accept jail as their home and choose to die there. “The main aim is to give prisoners compassionate leave when possible so that they can go home to their families if that’s an option, or to a hospice or nursing home,” he says. “It’s all tricky stuff. We are writing a policy that will try to maintain dignity and choice.”

This could be even trickier without councils on board. While PCTs have taken on responsibility for prisoners in their areas, local authorities continue to hide behind the ordinary residence rule – that the prison is not an inmate’s ordinary place of residence and so they are the responsibility of another local authority – to avoid providing or commissioning social care services in prisons.

The Wight way

Step forward the Isle of Wight, which has no such reservations. With DH funding it is running the Older Prisoners Project in its three prisons – Albany, Parkhurst and Camp Hill.

Sarah Mitchell, the island’s director of community services, is the driver behind the project. “We’re probably the only local authority doing this directly because everyone says ‘it’s not our problem’. But they are older people living on our island and they have a right to services, whatever they have done,” Mitchell says. “They are getting older and frailer and they need personal care.”

The project has £40,000 funding from the DH and £17,000 from the council to cover the costs of a senior social worker (who started in September) and research. The aim of the one-year project is to develop an outcome-based assessment framework to identify the health and social care needs of older prisoners.

Project manager Maurice Dix says: “When they go into prison there’s no one with the skills, time or experience to assess their social care needs. Many are spending a lot of time in their cells because they can’t do the same activities as younger prisoners. The potential for depression and suicide is high, particularly for those who go into prison later in life because their children have disclosed abuse as adults.”

Freeman says that once the Isle of Wight’s findings have been analysed “then we have to wrestle with the problem of who’s responsible for delivering these services”. He adds: “It won’t be a black and white answer. Some will belong to the PCT, some to the prison service, for example adaptations, but the raft of stuff in-between that is the difficult bit.”

He says they are seeking to clarify the uncertainties around ordinary residence but in all likelihood local authorities’ reluctance to be involved will only be resolved by legislation or new regulations. Meanwhile, the slack is often taken up by prisoners acting as informal carers to each other.

There are no statistics on how many of these buddy schemes are operating, but the DH has picked up on their potential and is pushing for pilots of informal carers to run in three prisons in south east England.

“These would develop a prisoner profile so we would know the right sort of person to do this. We then want to get them up to an NVQ carer qualification. We also need to define what care can appropriately be provided by prisoners,” Freeman says. “Personal care could present problems and it may be that’s an element they can’t provide. I’m open-minded about it. If all you do is develop a system where prisoners with the right profile provide non-physical services then that’s still better than nothing.”

Stuart Ware became an informal buddy when he was in prison. Now an independent consultant representing the views of older prisoners, he is a member of Opag and involved in the Isle of Wight project. He found himself in prison for fraud and theft in his late fifties and was shocked to find a fellow inmate with dementia: “I had to lead him by his hand to get his meals, he was totally confused.”

Where a year is a lifetime

He saw other prisoners refused walking sticks and hearing aids. On release, he started up Restore 50+, a support network for older prisoners and their partners. “I was only in prison for a year but it felt like a lifetime and I aged.”

In the Isle of Wight, Ware is looking at several options including buddy care, setting up a day centre in prison and developing social care passports detailing care plans that prisoners take with them when they move prisons and on release.

Back at the DH, Freeman believes substantial progress has already been made. Its consultation has recently closed on improving health and social care in prison and the report is expected next spring. He also cites the older prisoner care pathway that is modelled on the national service framework for older people and used by several prisons.

But he admits that he “can’t honestly put a deadline on” knowing when there will be clear responsibilities set out for who provides what when it comes to social care.

“It depends how complicated it is. If you are talking legislation it can take quite a long time. But we will do it as quickly as we can and it isn’t easy.”

What’s going on in National Prisons Week?

About the convention

In June this year, chief inspector of prisons Anne Owers published Older Prisoners in England and Wales, a follow-up report to her 2004 review of the treatment of older prisoners. In the report she said “the lack of adaptation made for those with age-related impairments and disabilities was not only disadvantageous, but dangerous in some cases”.

She said that there was a need for a national strategy for social care in prisons. Currently, there is only Prison Service Order 2855 on prisoners with disabilities with a short section on older prisoners, and PSO 4800 on women, which includes guidance on working with older women.

The Disability Discrimination Act 1995 as amended by the DDA 2005 was extended to prisons in December 2006. But prisons are far from complying with this extension because it is unclear which agency is responsible for services to support prisoners.

Web resources

Home Office, 2004, No Problems – Old and Quiet

Her Majesty’s Inspectorate of Prisons, 2008, Older Prisoners a Follow-up

Prison Reform Trust, 2008, Doing Time

Action for Prisoners’ Families website

Published in the 13 November 2008 edition of Community Care under the headline ‘No Country for Old Lags’

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