‘Slow start’ to implementation of Care Act duty to support prisoners with care needs

There has been a “slow start” to the implementation of Care Act provisions for councils to assess and respond to the social care needs of prisoners, an Association of Directors of Adult Social Services (Adass) survey has found.

Councils received 10 or fewer referrals each from the vast majority of prisons in the first three months of the implementation of the Care Act 2014.

Section 76 of the act makes clear that most of the other duties on councils under the act – including to provide information and advice and preventive services, and assess need and meet it when eligibility conditions were met – applied to prisoners as they did to local authorities. The Department of Health provided councils that had prisons in their areas with an £11m grant to carry out these responsibilities.

‘Slow start’

Thirty three councils responded providing data for 79 of the 115 prisons in England. During the first three months of the act’s implementation, these councils received 542 referrals from prisons. But 60 prisons generated 10 referrals or fewer, while 41 – more than half – supplied five or fewer.

Adass said this meant there had been a “slow start” to the implementation of the duty. It said councils in areas where there had been 10 or fewer referrals should consider meeting with prison staff to make sure they understood the role of local authorities and the value of social care. It added that Adass hoped that the National Offender Management Service, which oversees prisons, would explore whether some prisons were performing above or below expectations so that the reasons could be explored.

Low referral rate for learning disabled prisoners

The survey also identified particularly low rates of referral for prisoners with learning disabilities or autistic spectrum conditions.

The survey found that 87.8% of referrals to social services from prisons in this period concerned prisoners with physical disabilities but only 4.3% of referrals were for learning disabilities and 0.4% for autistic spectrum conditions.

The report on the survey said the low level of referrals for learning disabilities and autistic spectrum conditions was surprising given that estimates suggest 7% or more of prisoners had such needs.

“With less than 5% of referrals being identified as potentially having a learning disability or autistic spectrum condition the suggestion that there is an under identification of such individuals would appear to have some validity,” the report said.

It added: “There is evidence that people with a learning disability or autistic spectrum condition are often not recognised as having specific needs within the prison system. Local authorities, prisons and healthcare providers are advised to consider how effective local approaches are in respect of this population.”

Assessment threshold concerns

The report also raised concerns about the application of the Care Act’s assessment and eligibility thresholds to prisoners. Overall, 74% of referrals led to a care and support assessment, but this varied significantly by client group and by prison.

Councils have duties to provide information and advice to people who receive an assessment, whether found to be eligible or not, to help them meet or reduce their needs.

“Local authorities need to assure themselves that they understand what this means in the context of prisoners and are providing it and not setting so a high threshold for eligibility for a care and support assessment that it effectively denies prisoners access to this valuable entitlement,” said the Adass report.

Variable eligibility thresholds

Of the 542 prisoners referred to the 33 local authorities surveyed, 45% led to assessments that deemed them eligible for social care. However, the percentage varied wildly from place to place with some reporting 0% to 100% of prisoner referrals leading to eligibility for care.

“Whilst in some cases the numbers of referrals and assessments are too small to be statistically significant the variation of the conversion rates of assessments to eligibility does suggest varying practices across the country with the possibility, as is being identified in the broader community, that there is more work to be done to ensure a consistent interpretation of the national eligibility criteria,” the report said.