How social workers and OTs are putting the Care Act into practice in prisons

By Bridget Hollingsworth and Julie Smith

Warrington hosts two prisons, Risley, a category C prison with a sex offenders unit and a population of 1,200, and Thorncross, an open prison with population of about 400. With the Care Act 2014 placing a responsibility on local authorities to assess the needs of adults in prisons within their area, it was no particular surprise that we carried out our first prisoner social care assessment on 1 April, the day the act came into force.

In preparation for the implementation of the act we met with the prison governors and staff on a regular basis and exploited support available regionally. Despite these discussions we were still uncertain as to the predicted levels of assessment and advocacy demand and the subsequent level of new care and support provision that would be required.

On this basis we did not want to make a long term commitment to a particular model or commission a service that may be either unnecessary or of insufficient capacity. One thing we were resolute about was using our staff to undertake the assessments, to provide them with support in their new role and to monitor implementation. We wanted clear information to help us predict future demand, support commissioning and play into workforce plans.

Social workers seconded into prisons

In order to achieve this we offered social workers and occupational therapists the opportunity to be seconded. Both prisons offered ‘taster days’ to interested staff. So significant was the level of interest that interviews had to be held and two social workers and two occupational therapists were recruited on a part-time basis to manage leave and other eventualities. We agreed that that they would remain in their substantive teams but receive supervision from the manager of the criminal justice liaison team, which supports people with mental health problems in contact with the criminal justice system.

We met with a local advocacy provider, Speak Up, and asked if they would be willing to provide this support for year one of implementation. Additional funding would be provided for this time period, but no guarantee of business could be offered for future years. We also agreed that all advocacy interventions would be recorded and, over a twelve-month period, would furnish us with a relatively accurate picture of demand to inform future commissioning arrangements.

Domiciliary care was already in place for a very small number of prisoners and it was agreed that in the short term the same provider would be commissioned. In the longer term we have agreed to work with NHS England and undertake a joint tender for future health and social support.

A very different assessment process

It was very evident from the initial contact phase that the assessment process this would be very different to assessing someone in the community. It had to accommodate the time it takes to access the prison and the routines of the prisoners but also to acknowledge the restrictions imposed on them by virtue of their environment. For example someone in the community might receive support to bathe on a daily basis but in prison, unless there was a clinical need, this might not occur with the same frequency. One of the OTs described an occasion when he proposed observing a prisoner making a cup of tea as he could often establish much about an individual’s sequencing, motor skills and cognitive abilities from this process. He was told that would “never ever” be an option in that environment, which helped him understand new approaches would need to be deployed when completing functional assessments.

Both the social workers and the occupational therapists experienced some anxiety before contact but described receiving a very positive response from prison staff. They also felt a shared commitment to working collaboratively with health staff and the service user to maximise independence and dignity and to aspire to develop a support plan which promoted wellbeing and prevention. Clearance has been somewhat delayed but on completion bespoke training will be made available to staff and advocates to maximise their safety within the prison.

Forensic model of practice

We recognise that work in this area continues to evolve. We intend to participate in research and we intend to develop, as part of this, a forensic model of practice. Most evident though, has been the commitment and enthusiasm of our staff to apply their values to comply with the Care Act and ensure that vulnerable adults in prisons have their needs met and, as a result, can maximise rehabilitation opportunities.

As Mike Glassbrook, OT, said of his assessment at Risley: “This is a very interesting and exciting role. I felt I was able to utilise my skills to aid my practice and think outside the box to creatively address complex physical/psychological and environmental barriers. I was able to work collaboratively with both health and social care colleagues to offer a full and comprehensive assessment. I did not look at the forensic background of the person I assessed as unconditional social regard felt critical to an effective an effective therapeutic relationship.”

Lorraine Wilde, social worker, said of her experience: “It is a unique role that is challenging and exciting; I believe effective communication and working in partnership with other professionals aided my intervention. Furthermore the sharing of knowledge and skills highlights the complex operational and environmental difficulties. Overall it has been a very positive experience and I wait with enthusiasm to see how the role develops.”

Bridget Hollingsworth is programme manager (strategic) for the implementation of the Care Act and Julie Smith head of service for adult social care at Warrington Borough Council