Why social care in prisons falls short

Although some prisons appreciate the benefits of social care, many lack care levels that are taken for granted outside, leading to severe hardship for prisoners, reports Vern Pitt

The NHS has only been operating behind the walls of prisons since 2006, but social care is yet to make the leap, meaning many prisoners in need receive little or no care.

A survey by Community Care and the Prison Governors Association this week reveals that 38% of prison governors rate social care in their prison as below average or poor.

While primary care trusts in England now commission healthcare in prisons, local authorities do not do the same for adult social care.

The absence of social care services has made prisons very reliant on prisoners themselves delivering care to each other, with 39% of governors saying inmates provide care in the prison. This trend has led to concerns in the past about levels of prisoner competence and training.

The situation might be less of a problem were the prison population not ageing so rapidly. The number of sentenced prisoners over 50 nearly doubled between 2000 and 2010 from 4,006 to 7,452. Prisoners are considered old at 50 because of the toll incarceration takes on their health. It is one of the fastest growing groups in the prison system.

In 2007, the government tried to tackle the problem by setting up the Older Prisoners Action Group (Opag), made up of stakeholders and designed to co-ordinate improvements to health and care in prisons. But apart from producing guidance on end-of-life care, those in the sector are downbeat on its impact, though the Department of Health says it is developing a longer-term strategy for managing older prisoners.

Mervyn Eastman, a former director of social services who authored a report on social care in prisons in 1999 for the Association of Directors of Social Services, feels there has been little political will to make changes.

“All issues around prisons are politically sensitive,” he says. “Every minister will have their eye on what this will look like in The Sun or Daily Mail. What will the public think about a paedophile ‘enjoying’ robust social care inputs, when they are not deserving of good social care?”

The result of this, Eastman argues, is that despite multiple recommendations and reviews there has never been a clear policy position defining who is responsible for social care in prisons and forcing action.

Others feel that the problem lies with councils not taking responsibility for incarcerated older people in need as they would do for those in the community.

“We would say that statutory services are not fulfilling their obligations for looking after older people,” says Francesca Cooney, advice and information manager at the Prison Reform Trust.

Introducing new practice into prisons is also difficult, says Andrew Neilson, director of campaigns at the Howard League for Penal Reform.

“Prisons are very bureaucratic institutions and they’re run in ways which make it difficult to take initiatives. The emphasis is on security.”

High numbers

This is exacerbated by prison numbers. Neilson paints a picture of a service in crisis, arguing prison governors are always on the back foot trying to manage an increasing population – the total number of prisoners, including those on remand, has grown from 71,218 in 2002 to 85,002 in 2010 – with ever-diminishing resources.

He says progress in improving other specialist areas, such as support for young adults, has also been sluggish.

The age of the prisons themselves is part of the problem, argues Eoin McLennan-Murray, president of the Prison Governors Association. “When most prisons were constructed there weren’t really allowances for people with mobility issues, for instance,” he says. When renovating the prison he governs he says he introduced accessible cells but there was pressure not to do so because, at nearly double the size for each, it reduced the total number of cells being added to the prison.

McLennan-Murray says similar competing priorities have affected staff training in social care. Governors no longer have mandatory training to deliver and must set their own priorities but he says issues such as corporate manslaughter or fire training often rank higher on the list of priorities.

However, he argues that the increasing numbers of older prisoners will serve to push social care for them up the agenda.

It begs the question of what care should be delivered?

Eastman says that more than 10 years after he looked into the problem there is still no shared understanding of what social care in prisons should look like. “Understanding of social care is a bit of a mixed bag in the community, let alone in institutions,” he says.

He says developing specialist prisons or segregating older prisoners in their own wings all carry challenges. Plus, more caring approaches are often interpreted as more lenient by prisoners themselves.

McLennan-Murray adds that when trying to find prison staff to take on specialist roles, be it co-ordinating social care or fire marshalling, governors usually rely on volunteers. These are not always forthcoming for social care, given how different it is from the job of prison officer itself.

With limited resources in the prison service, health and social care for the foreseeable future, McLennan-Murray says only extensive use of prisoners themselves can plug the gaps in provision. “Being a realist the biggest resource we have, which isn’t reducing, is prisoners themselves,” he says.

Prisoner support

“In a community friends and close relatives will help each other out; what is the difference between that and prisoners helping each other out? Sometimes it’s an opportunity for prisoners to develop an aspect of their character which they haven’t before. Helping other people is a very worthwhile activity, it brings a bit of humility and you become less ego-centric,” he adds.

Cooney is cautious about backing this model saying it needs to be supported with the proper investment in training for those inmates who volunteer.

Instead, she calls for social care in prison to mirror provision outside, and, for that, social services will need to be involved. “It has worked really well with the NHS over the past five years. Prison healthcare has really improved and we believe that prisoners should get the same level of health and social care as they would get in the community,” she says.

For that to happen, councils will have to be persuaded – or mandated – to step in, something that seems remote as authorities struggle to fund care for those in the community.

ISLE OF WIGHT LEADS THE WAY

The giant grey walls topped with barbed wire surrounding HMP Isle of Wight’s three sites, Parkhurst, Albany and Camp Hill, do not exactly say “caring environment”. However, once inside visitors are greeted with colourful wings, manicured gardens and even Queen Victoria’s old hunting lodge, immaculately preserved. It is abundantly clear that appearances can be deceptive.

The Isle of Wight has, for some time, been at the forefront of introducing social care into the prison environment. It was the first council to partner with its prison service, providing a social worker to conduct assessments of prisoners’ needs as part of a Department of Health-funded older prisoners project in 2008.

It was a move driven by the prison’s population, which is the oldest in the UK. It currently has 431 prisoners over 50, and 70% are on long sentences.

Following the end of that initiative, in April 2010, the island is now a development site for the DH’s common assessment framework for adults (CAF), which is designed to promote information-sharing between social care and other services and backed by £630,000 funding over two years.

Reablement is the ‘big thing’

Phil Parkinson, head of residence and prison liaison with the project, says it has “opened his eyes” to what can be achieved. “Reablement, to me, is the big thing,” he says. “The more people we can get through from the in-patient health wing and enable them to live on a wing and prepare for release, the better. The cell is their own home. We want to be doing what happens on the outside.”

Cheryl Garrett, the social worker who has been working in the prison since 2008, says her role is much more about developing services than it would in the community. “For instance, there are a lot of dementias which can get hidden within the prison system because it’s very regulated – things are all done at a certain time,” she says. “So, we have been working with the memory service and they are now doing the tests to pick up any dementias or poor cognitive functioning on the part of people in the prison.”

Perhaps the most successful project is the older person’s activity group, run by Mary Wozencroft, disability liaison officer. Wozencroft says that demand for the group, which allows older prisoners to socialise and learn some key living skills, has soared from 15 people to more than 70. She says Garrett’s input and the use of the CAF has helped her develop the support that is really needed but also control demand for the service to ensure it’s reaching those with the highest needs.

One prisoner, whom Community Care finds in the middle of game of dominoes, appears to be in high spirits, but he says it’s only the group that keeps him that way. “I have two budgies in my cell and I used to spend most of my time in the cell just doing paintings and looking after them. I was getting depressed,” he recalls. He says he did have difficulty reaching the group because of his ability to push his own wheelchair but since he has attended he can find any number of people to take him there.

However, Garrett’s influence can only stretch so far. She will take referrals for assessment from any part of the three sites but two prison officers on one older prisoners’ wing have no idea who she is when questioned. Her managers put this down to shift patterns which can mean certain staff have little contact with those that work office hours.

Barriers to integration

The council’s service commissioner, Jackie Raven, says there are other barriers to fully integrating social services with the prison. “We use our IT system, health uses another and the prison uses a third and they don’t necessarily talk to each other. That’s not a local issue it’s a national issue,” she says. It is further complicated by the high levels of IT security necessary in the prison.

It’s clear that Raven, Garrett and project manager Peter Smith all feel that the first step is effectively assessing people and sharing information about their needs. Introducing a common assessment framework has opened that door and enabled targeted development of services, they say.

Meanwhile, Parkinson has his eyes on a bigger prize. He hopes to use the information the CAF generates to argue for further funding from the Prison Service or the local authority to expand its social care provision.

When the final report is published on the project’s success in April 2012, prison governors and council commissioners across the country may also have evidence to finally argue for better partnership work and more funding for social care in prisons, plus how to make it a reality.

Case study: ‘He now has to use a wheelchair’

Jessica Irving* says her husband, who has been in prison since 2006, is close to being “a broken man”.

Harry Irving*, aged 75, has a back injury and diabetes and he and his wife had just moved to a specially adapted bungalow before he was sentenced.

Jessica, herself a retired care worker, says he has received little help since he went into prison. “His condition has deteriorated,” she says

His back injury combined with a loss of sensation in his feet, caused by the diabetes, means he has trouble walking. He has fallen 55 times during his time inside.

“When he did fall down they picked him up but they then started to refuse to pick him up for health and safety reasons. That’s why he uses a wheelchair now,” she says.

There are other complications. “He has not, since he has been in there, had a shower,” she says. “He cannot cope with the showers in there. They are not made for disabled people. Here we have a wet room, which was purpose-built for him.”

She says she doesn’t blame the staff at the prison. She believes they are doing their best in a very restricted system with little training or support.

What adaptations her husband has received, such as grab rails to help him out of bed, have been a result of her constant badgering of the prison authorities, she says. But she has now become frightened to push too hard for improvements to his living conditions because it may result in her husband being transferred to a specialist prison miles away from her home.

“I don’t really want to travel for a visit to the other side of the country; I’m his mainstay,” she says. “If he didn’t have the visits from me he would be a completely broken man.”

Jessica wants to see a more professionalised care system, which mirrors social care outside the prison, but doesn’t hold out much hope.

* Not their real names

(pic: Jackie Raven, commissioner of adult social care, (left) with Cheryl Garrett, senior project officer, and Peter Smith, project manager at HMP Isle of Wight (Camp Hill site, by Robin Crossley/UNP).

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