HM Prison and Probation Service needs a national strategy to
address the needs of the increasing numbers of elderly prisoners
living – and dying – in jail so that they can be managed and
cared for more appropriately, said Prisons and Probation
Ombudsman (PPO) Nigel Newcomen. Today he published a report on
older prisoners.
One of the most marked changes in prisons in recent years has
been the increase in the number of older prisoners. This shift
has been driven largely by increased sentence length and more
late-in-life prosecutions for historic sex offences. The number
of prisoners over 60 has tripled in 15 years and the projections
are all upwards, with 14,000 prisoners over 50 predicted by June
2020.
The Care Act of 2014 clarified that local authorities are
responsible for assessing the care needs of older prisoners and
providing support. This legislation, along with national and
international expectations that prisoners should be
able to access a level of care equal to that in the community,
are positive developments. However, faced with such a rapid
increase in older prisoners and without a properly resourced and
coordinated strategy for this group, an already stretched prison
system is struggling to meet need.
Today’s report reviews PPO investigations into naturally caused
deaths of prisoners over 50. It examines 314 investigations
between 2013 and 2015 and offers 13 lessons on six areas where
recommendations are frequently made following investigations into
deaths in custody of older prisoners. The six areas are
healthcare and diagnosis, restraints, end of life care, family
involvement, early release and dementia and complex needs. Among
those lessons are:
- prisons should ensure that newly arrived prisoners have an
appropriate health screen that reviews their medical history and
conditions and identifies any outstanding appointments and
relevant conditions;
- use of restraints should be proportionate to the actual risk
posed by the prisoner, given his or her current health
condition;
- prisons should ensure that terminally ill prisoners who
require intensive palliative care are treated in a suitable
environment;
- prisons should ensure that, with the consent of the prisoner
and agreement of the family, trained family liaison officers
involve families in end-of-life care and promptly notify them
when the prisoner is taken to hospital;
- risk assessments associated with applications for
compassionate release should be based on an assessment of actual
risk given the prisoner’s current health condition; and
- prisons should ensure that patients with complex health needs
have personalised care plans in place.
Nigel Newcomen said:
“The challenge to HM
Prison and Probation Service is clear: prisons designed for fit,
young men must adjust to the largely unplanned roles of care home
and even hospice. Increasingly, prison staff are having to manage
not just ageing prisoners and their age-related conditions, but
also the end of prisoners’ lives and death itself – usually with
limited resources and inadequate training.
“There has been little
strategic grip of this sharp demographic change. Prisons and
their healthcare partners have been left to respond in a
piecemeal fashion. The inevitable result, illustrated in my
review, is variable end of life care for prisoners and a
continued inability of many prisons to adjust their security
arrangements appropriately to the needs of the seriously ill. I
still find too many cases of prisons shackling the terminally ill
– even to the point of death.
“I have personally seen
examples of impressively humane care for the dying by individual
staff, as well as glimpses of improved social care and the
development of some excellent palliative care. However, I remain
astonished that there is still no properly resourced older
prisoner strategy. This is something I have called for repeatedly
and without which I fear my office will simply continue to expose
unacceptable examples of poor care.”
- ENDS -
NOTES TO EDITORS
- A copy of the report can be found on our website from 20 June
2017. Visit www.ppo.gov.uk.
- The PPO investigates all deaths in prison, to examine
the circumstances surrounding the death and establish whether
anything can be done to help prevent avoidable deaths in the
future. The PPO investigates complaints made by prisoners to
understand what happened and correct injustices when found.
- The Ministry of Justice’s prison population projections
2016-21 can be found here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/548044/prison-population-projections-2016-2021_FINAL.pdf
- The Care Act 2014, c.23, can be found here: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted
