Written evidence from Wayland Independent Monitoring Board
We are responding, where we can, to the questions raised in the email requesting responses and have italicised them below.
We cannot provide data for this question but our impression is that the older prisoners are usually the ones sentenced to life or very long sentences (many of whom have serious violence in the index offence) or are IPP prisoners often with short tariffs for perhaps minor violence but who are now in their thirteenth year, or more, of incarceration. This prison has very few older sex offenders but this must be an issue which will build in the future as prisoners, already mature, are sentenced for serious historic sex offences.
We have to say that there are no particular services addressed to the needs of older prisoners as a group, services, almost exclusively medical, are based on individual need, of course, but even though medical services in the community are conscious of the interrelationship between medical and social care, this approach has yet to be widely accepted in the prison service. As expected, the major challenge faced by older prisoners is that they are inevitably living cheek by jowl with younger, noisier, more physically and verbally aggressive prisoners who make up the majority population. They cannot escape the constant barrage of noise, from shouted conversations between cells when locked up, loud volume pop/rap/gangsta music from over-powerful ‘boom boxes’ all within the sheer noisy environment of a prison with hard wall, floor and ceiling surfaces reflecting and echoing every sound, from doors and gates being banged shut to loud calls from prisoners and staff. The services older prisoners, by and large, need are those associated with any group of older people (and prisoners age faster than the general population, that is accepted, and their health is usually worse from long-term self-abuse and neglect); to be with others of a similar age for at least a large part of their time, and opportunities for quiet separation, for the acquisition of hobbies and useful skills (such as self-catering) and for the removal of threat from their daily lives. This will usually only be possible in dedicated units or parts of units whereas the dominant philosophy of prison is that there is very little room for anything major against the ‘one size fits all’ approach conditioned by tight budgets and poor prison design.
The short answer is ‘no’ the design of the ‘normal’ prison is far from what is required for the older prisoner. The challenge is to combine security and observation with openness and privacy for a range of prisoners covered by the term ‘older prisoner’. Given that ‘old’ in prisoner terms is over 50 but there are many much older prisoners than that, such a design would need to take into account the different release needs of older prisoners who may not be in a position, or able to, take a full part in economic society but who will have needs for such skills as will enable them to take care of themselves and, where feasible help others. Essentially, of course, this is the same fundamental purpose of prison; to release prisoners able to contribute positively to society and not to re-offend. Such a rehabilitative target would be easier to achieve in suitably-designed structures which emphasise community and cooperation, both issues that are more likely to resonate with the older prisoner. Given the designed longevity of prisons it is unlikely, however, that whole prisons could or should be built for the older prisoner, any more than whole towns should be built round the older citizen; what is needed is a recognition of their particular needs in the design of any prison and, where required, the creation of units within the prison capable of meeting those needs, including, as well, the needs of other vulnerable prisoners, since, in many ways, the older prisoner is a vulnerable prisoner. Within the generality of prison expansion or dedication there could be improvements of a more immediate kind, such as the identification of a unit or wing, preferably separated from other units where a regime focused on the needs of the older prisoner could be more easily instituted than in the main prison population.
As previously noted, the drawback of most prisons, especially perhaps the larger ones, is that the regime is likely to be dominated by the needs of the largest cohort, and that will be the younger prisoner. It is very difficult for the average older prisoner to interact meaningfully with such a regime although most do by just ‘going along’ which satisfies the prison’s output measurements for purposeful hours delivered, enables the older prisoner to benefit from the available pay arrangements for ‘work’ but does little for the quality of their life or to prepare them for their personal circumstances on release as we have argued in the foregoing responses. Efforts to make the PE regime more varied and targeted towards the majority of prisoners often pushed out by the ‘weight-training brigade’ can have some success but the maths is against the needs of this small but growing group outweighing the needs and desires of the younger prisoners. This is another example of the demand for a distinct and separated regime for older prisoners.
The main drawback with prison medical care is not that it denies the medical treatment needs of the older prisoner (although we believe that the long-term treatment needs of older prisoners should be routinely surveyed and acted upon in a local context to a greater extent than they may be currently), but that the older prisoner cannot as easily stand the extended waiting times before GP appointments as attempts to prioritise the older prisoner in this regard could be seen as unfair queue-jumping by the not-old prisoner groups. However, it used to be the case in this prison that a specialist nurse for long-term conditions was available under the previous contract which overcame this difficulty, this specialist care for the older prisoner is no longer available. Without this kind of provision there could be said to be passive discrimination against the older prisoner who is more likely to need a more rapid healthcare response. If a policy of recognition of the particular healthcare needs of the older prisoner were put in place with sufficient consultation/information it could conceivably contribute to the creation of a wider community-consciousness amongst all prisoners of the needs of and the care for the older prisoner. Another example of where the care needs of the older prisoner are not being routinely met is at night-time in prisons with no on-site night medical staff, our suggestions elsewhere of dedicated units for the older prisoner could help alleviate this difficulty through staff awareness and training for night cover even if medical staff were not deployed. In the round, therefore, there is a need to review the healthcare budgets across the Service; the current shibboleth that access to such services should be the equivalent to that in the outside community takes no account, it appears, of the fact that the prison community, especially the older members, is intrinsically a less healthy one, that there are no opportunities for comprehensive self-medication through pharmacy access as there is the open community and that voluntary attendance at an A and E hospital is not possible. While the foregoing suggestions could improve access to medical care for the older prisoner there needs to be a wider acceptance of their social care needs which are not always predicated on medical needs but, as the term implies, their particular human social needs, as we have argued for in other responses to this current questionnaire; we have referred to the need for research in this regard in our response to Question 9, below.
We are aware that the social care responsibilities towards older prisoners are satisfied as far as it goes for the provision of aids such as shower grab rails within the prison, despite the frequent very long delays in their physical provision, but in this context we are not aware of such potentially useful initiatives as detailed Social Care Plans for the older prisoner being built into the prison’s normal induction and rehabilitation management activities. Such plans and their use would be, we believe, a helpful reminder to all staff of the particular needs of this group in the same way as is the arrangement for ACCT management. Social Care Plans would clearly need the integrated involvement of healthcare and local authorities both for treatment within the prison and, importantly, for support on release.
We have to say that the arrangements for the release of prisoners could be classed as ineffective; some prisoners, which must include some older ones, are still being released with instructions to collect a tent and sleeping bag from a charity. It has proved impossible to get hard figures of the actual provision from the CRCs involved in the release of prisoners from Wayland as many of them are ‘out of area’ and there seems little incentive for the CRCs to share information across their operational borders. Although there has been, locally, an improvement through the creation of a ‘discharge board’ 12 weeks before release we remain unconvinced that the release plans for older prisoners are given the attention they deserve. This is important, considering the greater lack of social support likely for older prisoners who may have lost family and other contacts through death or dislike, have been incarcerated for long periods with the subtle, and gross, consequences of institutionalisation including a lack of confidence in confronting authority and who may even be suffering the undiagnosed start of dementia. This situation brings into sharp relief the lack of a national policy for older prisoners, the subject of Question 9.
Is this question general across the Service or particular to this prison? If general it is really folded into Question 9. If particular, yes, as far as we are aware, it does; staff are concerned to treat all prisoners alike in this regard and do not intentionally discriminate against older prisoners in any way. It is the lack of specific requirements for the management and treatment of older prisoners which leads to the difficulties experienced by the group by default, not intent.
For the reasons we have set out in these responses the Wayland board believes it to be absolutely essential that a national strategy indeed be created to address the needs of older prisoners; to expect local governors to be able to address these needs from their own budgets in the face of dwindling resources is not a realistic option.
As to the content of the strategy itself we believe this should be result of an assessment of needs from a time-limited working group with expert representatives from HMPS, the NHS, the Academy (Nottingham University is doing some good research in this area we understand) and the relevant Third Sector bodies with experience of caring for older citizens, both in their own homes and in communal living arrangements, with, finally, representatives from the IMB and from the prisoner community itself.
Such a move would indicate a welcome determination to work openly towards a strategy for the betterment of treatment for the older prisoner and, by extension, for the wider community.