29.As discussed in the previous chapter, rates of disability are high among older prisoners: it has been estimated that 54% have a disability, with 28% having some form of physical disability. Reduced mobility is also common among the cohort. Age and disability are protected characteristics under the Equality Act 2010. Section 20 of the Act imposes a duty on public-service bodies, including prisons, to make adjustments for disabled persons and prevent them being substantially disadvantaged by any provision, criteria or practice. Prisons are required to ensure the equitable treatment of disabled prisoners under HMPPS policy, set out in Prison Service Instruction (PSI) 32/2011.
30.The standard design of many prisons can restrict accessibility for prisoners with disabilities, those who have reduced mobility, or sensory or cognitive decline. In particular, older establishments built during the Victorian era (about a third of the prison estate), were designed for young, able-bodied men and women and without consideration for those with accessibility requirements. Even in fairly modern buildings, adaptations are often required in order to meet the needs of older prisoners, as G4S explained:
Residential units across our establishments have a generic, modern prison design with galleried wings contributing to the majority of our accommodation. Without modification, units such as these do not fully meet the needs of older prisoners as few provide step free access to key facilities such as medication hatches, showers (when not cellular) and multi-purpose rooms.
31.Without provision of reasonable adjustments, it can be difficult for older prisoners to receive care and participate in the prison regime. Adjustments may include grab rails in cells and bathroom facilities; lifts, ramps, and other means of providing step-free access to and within prison buildings; wheelchair-accessible cells; and mobility scooters or other walking aids, particularly on large prison establishments. Evidence received for this inquiry indicates that the provision of adjustments and physical adaptations to meet the needs of disabled or less mobile prisoners is variable across the prison estate. We heard of good practice, particularly in prisons which have a substantial number of older prisoners. However, elsewhere, necessary modifications are lacking; or, where facilities such as lifts are installed, faulty or out of use, with significant delays for repairs. HM Inspectorate of Prisons described how:
We found physical barriers to accessing communal areas at some prisons. For example, the health care department at North Sea Camp was a significant walk up a steep slope. At Dartmoor, the education department and chapel could only be accessed by steps, as was also the case for the exercise yard on F wing (which housed men with mobility problems). Some establishments had installed lifts and stairlifts but we found that these were not always working, as was the case at Swaleside. At Littlehey we found lifts were frequently out of order in 2015, and the situation had not improved by 2019, affecting those wishing to visit the chapel and healthcare unit.
32.In-cell reasonable adjustments, such as grab rails and raised toilet seats are reportedly lacking in some prisons. Problems also exist around older prisoners placed in cells without sanitation. At night, they must either ring a bell and queue to access the toilet or use a pot in their cell. This disproportionately affects older prisoners as their need for night-time access to sanitation is more likely and more frequent. In addition, overcrowding on the prison estate means that older prisoners often share cells with other prisoners. This can be problematic, as the bunk beds used in shared cells are difficult to access for those with limited mobility. For example, a serving prisoner described to us how:
I am not supposed to be in a top bunk because of mobility problems and severe COPD, but I have had to share a cell with a prisoner much less mobile and so I had to use the top bunk. Changing the sheets of a top bunk bed was a particularly perilous task whereby I had to perch on a chair feeling very unsafe and at high risk of a fall which at my age could have been very serious.
33.Shortages of appropriate cells has led to prisoners with accessibility needs being housed in healthcare units in some prisons. This can isolate such prisoners from the wider regime and reduce the number of places in healthcare available for prisoners with medical need.
34.The MoJ stated that accessibility audits have been carried out at several prisons, with more planned, to identify access issues that require action. They acknowledged, however, that ability of prison governors to implement physical adaptations is limited by the amount of capital funding available. HMPPS has a significant backlog of major capital works, estimated to cost £916 million as at November 2019, with more than 60,000 outstanding maintenance jobs as at April of the same year. It has estimated that it needs to spend £194 million annually on maintenance in the public prison estate for each of the next 25 years. In oral evidence, Justice Minister Lucy Frazer highlighted that the MoJ had secured an additional £156 million for maintenance funding for 2020–21, and would look to make further bids to address the backlog in the next spending round.
35.However, some submissions pointed out that necessary physical modifications cannot be made at some prisons as the level of work required is too extensive to be accommodated by the building design or too disruptive for the prison regime. Previous Government plans to close some old prisons in a poor state of repair have been put on hold; in October 2019 Justice Secretary Robert Buckland told the previous Justice Committee that he did not intend to close any prisons in the near future. Lucy Frazer later confirmed that Victorian prisons would need to be kept open to house the expected number of prisoners.
36.The previous Committee was told that the MoJ was developing a long-term estate strategy to address the maintenance backlog and the poor state of repair of many prisons. This would include surveying the estate to improve information on assets and their condition, to enable better decision making and prioritisation of maintenance projects. In its response to our predecessor Committee’s report on prison governance, the Government said it would publish the estates strategy by the end of 2020.
37.The MoJ has also highlighted plans to expand the prison estate. In August 2019, the Government announced that it would create an additional 10,000 prison places, at a cost of up to £2.5 billion. This would be in addition to an extra 3,500 places to be created as part of the Prison Estate Transformation Programme (PETP) announced by the then Government in 2016. As at January 2020, 206 places had been built though the PETP. In the Government’s written submission to this inquiry, the MoJ said that the new build resettlement prisons at Glen Parva and Wellingborough already under construction as part of the PETP will feature design improvements to better accommodate older prisoners. These include level access across the site and the provision of lifts in all buildings, as well as cells appropriate for prisoners with reduced mobility. Consideration of the needs of older prisoners would also be included in the design of future new build prisons. Lucy Frazer reaffirmed this in oral evidence, and told us that the expansion of the prison estate would remain a priority for the MoJ despite the economic difficulties created by the Covid-19 pandemic:
The Ministry of Justice, during the covid crisis, has looked at what work we need to continue as significant, important work to the Department. Our building programme is our top priority, and we have continued to do site visits and investigate additional accommodation where we have existing sites.
38.It is welcome that the new prison places planned as part of the Government’s expansion of the estate will be designed to better accommodate older prisoners and others with disabilities or limited mobility. However, the number of new places delivered under existing expansion projects has been limited. In addition, much of the existing prison estate is unsuited to the needs of older prisoners, and there is a substantial backlog of maintenance works. We recommend that the long-term prison estate strategy in development specifically addresses the provision of reasonable adjustments and physical adaptations necessary to meeting the needs of the ageing population in existing prisons. In its response to this report, the Government should also update the Committee on the timeframe for publishing the long-term estate strategy in light of the Covid-19 pandemic, especially given the greater propensity of older people to contract the disease.
39.We are concerned that HMPPS is not consistently fulfilling its duties towards older and disabled prisoners, as required by the Equality Act 2010. These prisoners should not be housed in establishments where the physical design prevents them receiving equitable treatment. In its response to this report, the Government should set out what processes are in place to ensure that older and disabled prisoners are accommodated in an appropriate setting.
40.Some prisons have developed wings or units for older prisoners and others with complex care needs, typically located on ground floor level to improve accessibility. According to ADASS:
These include some adapted cells that allow for wheelchairs and lifting equipment to be deployed and beds to be located so that, where required, two carers can safely work together on either side of an individual and therefore reduce the risk of injury to either the individual or themselves. Such units also offer the potential to install raised toilets and showers where an individual can sit and be supported to wash themselves with dignity and can facilitate a quieter, gentler regime that the individual may find less distressing.
41.HMIP reported that such wings or units had been developed in several prisons where older prisoners make up 20% or more of the population. The criteria for which prisoners are housed in this type of accommodation vary; for example, at HMP Usk, the older prisoner unit in development is for prisoners aged 67 and over, as well as prisoners with specific social care and other needs. At HMP Frankland, a wing has been designated for prisoners over 55 years old.
42.It was suggested that while these wings or units are more suitable for some individuals, not all older prisoners want to be housed on them. Some prefer to remain in an environment where they can interact with younger prisoners. In addition, other prisoners can associate age-specific accommodation with men convicted for sexual offences, leading to abuse for the residents of such units. Dame Anne Owers, National Chair of IMBs, therefore highlighted the need to manage the question of whether to separate older prisoners within a prison case by case. Adapting existing prison facilities to make them more accessible and age-friendly can be costly and disruptive.
43.We received evidence suggesting that a different form of custody should be considered for very elderly prisoners, particularly those with disabilities or complex health or care needs. It is difficult and potentially costly to house such individuals appropriately on the secure estate, and the health of these prisoners means they may carry a lower risk of escape or harm. Alternative accommodation could involve lower security and be focused on specific needs of elderly prisoners. Peter Clarke, HM Chief Inspector of Prisons, summarised what this form of accommodation could look like:
To put it crudely, it would be a care facility with a wall around it, where there is sufficient security to hold those people safely, securely and decently, while potentially giving a considerable amount of headroom within the more secure estate, where higher levels of security are needed.
44.Prisons Minister Lucy Frazer drew attention to how new prisons planned or under construction will be designed to better accommodate older and more vulnerable prisoners. HMPPS’s Model for Operational Delivery: Older Prisoners, states that there are no plans to separate older prisoners through specific accommodation strategy.
45.It can be very difficult to accommodate some older individuals on the prison estate. Steps taken by some prisons to develop specific wings or units for older prisoners are welcome, though the variability of individual needs should be considered. Good practice around the accommodation of older prisoners should be shared more widely. We recommend that all prisons housing a significant number of older prisoners designate appropriate accommodation for those with more complex health and care needs. We further recommend that the Ministry use the expansion of the prison estate to develop additional accommodation that is specifically adapted for older prisoners. The viability and cost of developing bespoke forms of custody for those with disabilities or nearing the end of their lives should also be explored.
66 Ministry of Justice, (October, 2014), p 5
67 Ministry of Justice, Department of Health and Social Care, Public Health England, NHS England and Improvement ()
68 Ministry of Justice, Department of Health and Social Care, Public Health England, NHS England and Improvement ()
69 Serco Ltd ()
70 Age UK ()
71 The prison estate, Briefing paper number , House of Commons Library, 28 November 2019, page 17
72 G4S ()
73 Independent Monitoring Boards ()
74 HM Inspector of Prisons (); Catholic Bishops’ Conference ()
75 Independent Monitoring Boards (); Prison Reform Trust ()
76 HM Inspector of Prisons ()
77 Independent Monitoring Boards ()
78 Independent Monitoring Boards ()
79 A serving prisoner ()
80 Prison Reform Trust ()
81 Care Quality Commission ()
82 Ministry of Justice, Department of Health and Social Care, Public Health England, NHS England and Improvement ()
83 Ministry of Justice, Department of Health and Social Care, Public Health England, NHS England and Improvement ()
84 National Audit Office, , February 2020
85 National Audit Office, , February 2020, p.7
87 Association of Directors of Adult Social Services (ADASS) (); Care Quality Commission (); Serco Ltd ()
88 Oral evidence taken on 16 October 2019, , Q44
89 Oral evidence taken on 22 October 2019 , Q24
90 Justice Committee, Prison Population 2022: Planning for the future: Government response to the Committee’s Sixteenth Report of 2017−19, , 11 June 2019, p 5–6
91 Justice Committee, First Special Report of Session 2019−2021, Prison Governance: Government Response to the Committee’s First Report of Session 2019, , p 3
92 Ministry of Justice, , accessed 4 June 2020
93 The prison estate, Briefing paper number , House of Commons Library, 28 November 2019, page 15
94 National Audit Office, , February 2020
95 Ministry of Justice, Department of Health and Social Care, Public Health England, NHS England and Improvement ()
98 Association of Directors of Adult Social Services (ADASS) ()
99 HM Inspector of Prisons ()
100 Ministry of Justice, Department of Health and Social Care, Public Health England, NHS England and Improvement ()
101 HM Inspector of Prisons ()
102 Independent Monitoring Boards ()
104 Serco Ltd ()
105 BMA (); NOTA (National Organisation for the Treatment of Abuse) ()
106 NOTA (National Organisation for the Treatment of Abuse) ()
107 Q63 [Peter Clarke]
109 Ministry of Justice, Department of Health and Social Care, Public Health England, NHS England and Improvement ()
Published: 27 July 2020