Justice CommitteeWritten submission from the Criminal Justice Alliance The Criminal Justice Alliance (CJA) is a coalition of 70 organisations - including campaigning charities, voluntary sector service providers, research institutions, staff associations and trade unions – involved in policy and practice across the criminal justice system. The CJA works to establish a fairer and more effective criminal justice system. Two CJA members – Nacro and Prison Reform Trust – have undertaken a significant amount of work in the area of older prisoners and this is referenced throughout this response.

Executive Summary

People over the age of 60 are the fastest growing population in prison.

This increase in the ageing prison population is mainly due to the fact that more people are being sent to prison and they are being sent to prison for longer.2

The health and social care needs of older prisoners are not consistently met in custody and upon release, though there are good examples in some prisons.

A cross-government strategy on older prisoners should be published without delay. This strategy should include a commitment to halting the growth of the number of older people in custody. For those older people who must be in custody, responsibility and guidance for addressing their health and social care needs must be defined.

Introduction

1. On 31 December 2012, there were 6,503 prisoners aged 50–59 in England and Wales and 3,377 prisoners aged 60 and over.3 These numbers have steadily increased over the last decade, so that prisoners aged 60 and over are now the fastest growing age group in the prison population. The number of sentenced prisoners aged 60 and over increased by 103% between 2002 and 2011.4

2. In 2004 Her Majesty’s Inspector of Prisons found that the needs of older prisoners were not adequately assessed or provided for.5 Four years later in a follow up review, it was again found that there was still significant room for improvement.6 Since 2004, progress has been made in some prisons. However, there remains no national strategy or mandatory standards for the treatment of older prisoners, and as a result the quality of treatment provided for older prisoners can differ significantly across the prison estate.

3. The CJA acknowledges that the Justice Select Committee has for the purpose of this inquiry, defined older prisoners as those prisoners aged 60 and over. However, many organisations who have undertaken work in this area define older prisoners as those who are aged 50 and over.7 Therefore, unless otherwise stated, the research and statistics referred to in this document relate to prisoners aged 50 and over.

Are responsibilities for the mental and physical health and social care of older prisoners clearly defined?

4. Since 2006, the provision of healthcare in all public sector prisons has been the responsibility of the NHS through Primary Care Trusts. However, the responsibility for the provision of social care has not been clear. In the 2011 report on adult social care, the Law Commission stated that the legal framework did not explicitly exclude prisoners from the social services provided by local authorities. However, in practice, prisoners were excluded on the basis of other provisions in legislation, such as the residency rules.8 The Law Commission recommended that the government’s position on social services involvement in prisons be made clear.

5. Section 29 of the Health and Social Care Act 2012 now creates a duty on local authorities to support public health in prisons. This permits local authorities and prisons to delegate public health functions to each other. The Health and Social Care Act 2012 does not specifically mention social care and older prisoners, and not all reforms have been fully implemented at this stage, so it is not yet clear what effect this legislation will have for this sector of the prison population.

6. There are some examples of governmental willingness to address the particular needs of older prisoners. For example, the Older Prisoners Action Group was established in 2007 and the Department of Health has provided a toolkit for dealing with older prisoners, including assessments for health and social care, and on re-settlement.9 The NOMS Single Equality Scheme requires that all prisons consider age when coordinating their diversity strategies and action plans, and Prison Service Orders 2855 and 4800 provide limited guidance. However, it remains that there is no national strategy or national mandatory standards defining who is responsible for the health and social care of older prisoners or how it should be provided.

Are the particular health and social care needs of older prisoners met?

7. Older prisoners have a range of particular health and social care needs. More than 80% of older male prisoners have a disability or chronic ill health.10 They have a higher prevalence of alcohol and smoking related diseases, cerebrovascular and vascular diseases, respiratory problems and infectious diseases.11 More than 50% of all older prisoners suffer from a mental illness, the most common being depression which may emerge while the prisoner is in custody.12 Incontinence has also been highlighted as a serious problem for many.13

8. The particular health and social care needs of all older prisoners are not effectively met across the prison estate. It has been suggested that this is partly because older prisoners are often a compliant group in the prison population, so there particular needs are easily overlooked.14

9. Many prisons do not have adequate assessment processes to identify and monitor the health and social care needs of older prisoners.15 Research undertaken by Prison Reform Trust found that when some older prisoners entered custody, the medication they were taking in the community was stopped.16 In addition, 93% of prison respondents made no mention of social service involvement in their prisons.17 Some prisons saw social services as only having a role in resettlement, as compared to daily life in prison.18

10. There are very good examples in some prisons of work that is regularly carried out to ensure the health and wellbeing of the older prison population. However, Age UK has highlighted that it is not consistent and depends on the goodwill and motivation of particular individuals in each prison.19 The Age Concern Older Offenders Project (ACOOP) offers social care, advice and support to older prisoners. The project has been recognised as an excellent example of working with older prisoners and was rewarded with an Una Padel award in 2009.

What environment and prison regime is most appropriate for older prisoners and what are the barriers to achieving this?

11. The CJA maintains that prison is not appropriate for many older people, particularly those who do not pose any risk of harm to the public, and those whose health concerns are so serious that their needs would be better met in the community.

12. The reasons for the increase include legislative and policy changes have made sentence lengths longer for certain offences (eg through the introduction of indeterminate sentences for public protection, mandatory minimum sentences and increased maximum sentences) and increased the likelihood of offenders being imprisoned for breach of non-custodial sentences or recalled to custody for failure to comply with licence conditions The drivers for increasing numbers of elderly people in prison should be addressed in any strategy on older prisoners.20

13. Those older people who must be detained in custody are entitled to the same level of health and social care they would receive in the community. The CJA endorses “A Resource Pack for Working with Older Prisoners” published by Nacro, in partnership with the Department of Health.21 This has also been endorsed by Her Majesty’s Chief Inspector of Prisons as a document that should be referred to in every prison’s diversity strategy.22

14. Prison Reform Trust has detailed a series of “good practice recommendations” around several themes including consulting with older prisoners, developing policies and action plans specifically for older people, multi-disciplinary assessment of health and social care needs, involvement of the community and voluntary sector, changes in the prison regime to provide activities targeted at older people, and adequate training for staff.23 Prison Reform Trust has also highlighted the need for prisons to make adaptations for mobility issues to ensure full compliance with the Disability Discrimination Act (DDA) 2005, and enable older prisoners to participate fully in prison life.24

15. Age UK has also published a document with “Ideas for Practice”. This highlights the importance of providing activities to ensure that older prisoners have time outside their cell, as well as providing information and advocacy, supporting health and wellbeing and resettlement.25

16. Overcrowding and stretched resources are issues that have been identified by many prisons as serious concerns in relation to their ability to adequately provide for the health and social care needs of older prisoners. In their survey of 92 prisons in 2009, Prison Reform Trust found that prisons were concerned about budget cuts and their ability to continue providing the services they were already providing.26

How effective is the training given to prison staff to deal with older prisoners, particularly in relation to mental health and palliative care?

17. Age UK has highlighted the lack of adequate training for prison staff in the needs and rights of older prisoners.27 Prison Reform Trust also found in their research that a quarter of the prisons sampled provided no training in working with older or disabled prisoners. Of those that did provide training, many focussed on disabled prisoners and it was not clear that the particular health and social care needs of older prisoners were addressed.28

What is the role of the VCS and private sector in the provision of care for older people leaving prison?

18. In their survey of 92 prisons in 2009, Prison Reform Trust found that the examples of good practice all involved a significant amount of involvement by the community and voluntary sector, particularly Age UK.29

19. There is excellent work undertaken by charitable and voluntary organisations in the provision of care for older people in resettlement. However, the CJA believes it is important that the overall responsibility for these services remain with the public health system to ensure continuity of care upon release.

How effective are the arrangements for resettlement of older prisoners?

20. Like the provision of health and social care in custody, the provision of care in resettlement appears to be dependent on the unique arrangements at any given prison. In their survey of prisons in 2009, Prison Reform Trust found that resettlement was one area where there was significant room for improvement.30

Does the treatment of older offenders comply with equality and human rights legislation?

21. The Disability Discrimination Act (DDA) 2005 requires that prisoners with disabilities should have full access to prison services and be able to participate fully in prison life. Research undertaken by Prison Reform Trust found that staff in many prisons lack an understanding of what qualifies as a disability under the legislation.31

22. Age is a protected characteristic under the Equality Act 2010. Thus, prisons are required to promote age equality and outlaw harmful age discrimination. However, prison programmes and activities are often developed for younger prisoners, excluding older prisoners. In addition, older prisoners may not be able to participate, even if they wanted to, due to health and/or mobility issues.

Should there be a national strategy for the treatment of older offenders?

23. The CJA believes that a national strategy for the treatment of older prisoners should be established and published without delay. Any such strategy should contain measures explicitly targeted at halting the growth of the number of older people in custody. The problems outlined with regard to meeting the needs of older prisoners will continue to increase unless overcrowding and the growth in the older prisoner population are addressed.

24. A review of the guidelines for compassionate release on health and welfare grounds is recommended. The current position that anyone with three months or less to live may be released on compassionate grounds is considered too strict, particularly because it can be very difficult for specialists to predict how long someone has to live. The CJA supports Prison Reform Trust’s view that this should be increased to one year.32

25. Prisons must comply with their requirements under the DDA 2005 and Equalities Act 2010 by promoting activities and specifically targeted at disabled and older prisoners, to allow them to actively participate in prison life.

26. Training guidelines and processes should be developed for all prison staff in the identification and assessment of the particular needs of older prisoners.

February 2013

1 The Criminal Justice Alliance (CJA) is a coalition of 70 organisations - including campaigning charities, voluntary sector service providers, research institutions, staff associations and trade unions – involved in policy and practice across the criminal justice system. The CJA works to establish a fairer and more effective criminal justice system. Two CJA members – Nacro and Prison Reform Trust – have undertaken a significant amount of work in the area of older prisoners and this is referenced throughout this response.

2 Ministry of Justice, (January 2013) Story of the Prison Population, 1993 – 2012, London: Ministry of Justice http://www.justice.gov.uk/downloads/statistics/mojstats/story-prison-population.pdf

3 Table A1.8, Ministry of Justice (2013). Offender Management Caseload Statistics (Quarterly) July to September 2012. London: Ministry of Justice.

4 Table A1.11, Ministry of Justice (2012). Offender Management Caseload Statistics 2011. London: Ministry of Justice.

5 Her Majesty’s Inspectorate of Prisons (2004). “No Problems – Old and Quiet”: Older Prisoners in England and Wales. A Thematic Review by HM Chief Inspector of Prisons. Retrieved 25 January 2013, from www.justice.gov.uk.

6 Her Majesty’s Inspectorate of Prisons (2008). Older Prisoners in England and Wales: A Follow-up to the 2004 Thematic Review by HM Chief Inspector of Prisons. Retrieved 25 January 2013, from www.justice.gov.uk.

7 This is for a number of reasons, including the fact that many prisoners have a physical health status 10 years older than those of the same age in the community. The NHS also use age 50 as the starting age for health care and services for healthy aging: see Cooney, F. & Braggins, J. (2010). Doing Time: Good Practice with Older People in Prison – The Views of Prison Staff. London: Prison Reform Trust.

8 The Law Commission (10 May 2011). Adult Social Care (Law Com No 326). London: The Stationery Office.

9 Department of Health (2007). A Pathway to Care for Older Offenders: A Toolkit for Good Practice.

10 Cooney, F & Braggins, J (2010), above n 6.

11 Docherty, J L (2009). The Healthcare Challenges of Older People in Prisons – a briefing paper. Prison Health Research Network. Retrieved 1 February 2013, from www.ohrn.nhs.uk.

12 See Hayes, A (2010). The Health, Social and Custodial Needs of Older Men in Prison. PhD; University of Manchester, And Her Majesty’s Inspectorate of Prisons (2008). Annual Report 2006-2007. London: The Stationery Office.

13 Hayes, A (2010), above n 11.

14 Le Mesurier, N (2011). Older People in Prison: A Monitoring Guide for IMBs. London: Age UK.

15 Cooney, F & Braggins, J (2010), above n 6.

16 Ibid.

17 Ibid.

18 Ibid.

19 Le Mesurier, N (2011), above n 13.

20 Ministry of Justice, (January 2013) Story of the Prison Population, 1993 – 2012, London: Ministry of Justice http://www.justice.gov.uk/downloads/statistics/mojstats/story-prison-population.pdf

21 Nacro (2009). A Resource Pack for Working with Older Prisoners. London: Nacro.

22 Her Majesty’s Inspectorate of Prisons (2008), above n 5.

23 Cooney, F & Braggins, J (2010), above n 6.

24 Ibid.

25 Age UK. (2011). Supporting Older People in Prison: Ideas for Practice. London: Age UK.

26 Cooney, F & Braggins, J (2010), above n 6.

27 Le Mesurier, N (2011), above n 13.

28 Cooney, F & Braggins, J (2010), above n 6.

29 Ibid.

30 Ibid.

31 Ibid.

32 Cooney, F & Braggins, J (2010), above n 6.

Prepared 11th September 2013