Older written evidence submissions

OP 2 A OP 3 Prisoner B OP 4 Prisoner C OP 5 Dr Azrini Wahidin, Reader in and Criminal Justice, Queen’s University, Belfast OP 6 Prisoner D OP 8 Prisoner E OP 10 Prisoner F OP 12 Prisoner G OP 13 Prisoner H OP 14 Prisoner I OP 15 Prisoner J OP 16 Prisoner K OP 17 Jen Geary OP 18 Criminal Justice Alliance OP 19 HM Chief Inspector of OP 20 NEPACS OP 21 POA OP 22 Prisons and Probation Ombudsman OP 23 Offender Health Research Network OP 24 The British Psychological Society (BPS) OP 25 Nick Le Mesurier OP 26 RECOOP OP 27 Louise Ridley and Charlotte Bilby, Senior Lecturers in Criminology, Northumbria University. OP 28 Centre for Mental Health and the Mental Health Foundation OP 29 AGE UK OP 30 Dr Elaine Crawley OP 31 The Association of Members of Independent Monitoring Boards OP 32 The Royal College of Psychiatrists OP 33 Solicitor A OP 34 The Prisoners Education Trust OP 35 Restore Support Network (RSN) OP 36 Prisoner spouse A OP 37 Leigh Day OP 38 Reform Trust OP 39 Ministry of Justice OP 40 Prisoner L OP 41 Prisoner M OP 42 Prisoner N OP 43 Prisoner O

OP 02

Written submission from Prisoner A1

Dear Sir,

Instead of closing D’moor – as it should be (having been built to hold Napolean’s men) – this prison is being turned into the V.P. unit (vulnerable person) of the south-west. It is fast filling up with elderly men, due to “Historic Cases”. Perhaps the MoJ hopes that the terrible cold and damp climate here will kill us off. The buildings must cost a Prince’s Ransom (I believe he owns the place) to heat but even so, D’moor plays havoc with your asthma and arthritis. Some sort of headwear would be nice in this freezing weather. Some of us have coats due to “Recoop”. But there are not enough to go round. [...]. For this area says she experiences hostility from some of the staff. One of my fellow inmates, [...], was diagnosed with prostate cancer last July but has received no definitive treatment yet. “Healthcare”, here – as in most British prisons – is an “oxymoron.” I have prostate symptoms: like all sufferers, I need to sit down and RELAX to be able to urinate. Here at D’moor there are no curtains that can be drawn around the toilet. How can one relax when a female officer can look through the spy-flap at anytime? Such degradation would not be tolerated in a women’s prison. At ..., when your door is open, using the toilet is impossible and you must “cross your legs” until lock-up time (there are no communal toilets available).

The showers are not properly screened – with female staff around.

Being in a wheelchair as I am, D’moor is particularly bad: the education bloc van only be accessed via a multi-flight, outside fire escape. When I couldn’t get up it, I was placed on for 10 days for “Refusing to Work”. The other education bloc has steps but no ramp; corridors are very narrow and the toilets inaccessible to me because the doorways are too narrow. All round D’moor, conditions are terrible for a w/chair user: distances are immense; ramps (e.g. library indoor ramp) are ridiculously steep and open areas are not only steep but have ... in all directions.

Yours faithfully,

January 2013

1 Redacted for publication. Redactions are signified thus: “[...]” OP 03

Written submission from Prisoner B

Dear Sir,

I am writing this as a submission to your enquiry into elderly prisoners in custody. I am a 47 year old male prisoner serving a 12 year sentence in HMP Wakefield, a high security prison.

I am not elderly, but am friends with many elderly prisoners, say 70 years plus. These people have an awful time in prison, and I hope through your enquiry you can help their decency and rehabilitation. You could also save the prison service a lot of money.

(a) Elderly prisoners often are carers for their elderly spouses – so when an old man is jailed his elderly wife struggles to run a household, attend hospital appointments and hold a family together. In more enlightened countries such as Sweden elderly prisoners are generally sentenced to a form of tagged house arrest, thus not creating a victim of the spouse. Costs are far less than being in jail. (b) Many elderly people are in Wakefield, a high security prison that is much more expensive than at a cat-c or cat-d prison and is designed to prevent the escape of the most determined prisoners. A lot of the elderly prisoners struggle to walk 10 yards, so the thought of them jumping 30 foot walls and dodging Alsatian guard dogs is farcical. The prison service should take account of an elderly prisoner’s ability to escape when categorising them to a high or low security prison. (c) Medical care ‘in prison’ is only ever obtained by extensive lobbying form filling and extensive advocacy. Elderly prisoners often give up and fall through the cracks. There is no joined up medical care, and especially no specialist elderly professionals. The Prison Service should examine creating specialised residential and medical units for the elderly. (d) The elderly in prison to not get as many visits from their spouses. Family visits are vital to a prisoners mental health, and their successful reintegration to society. But 70 year old spouses find the long journey across country to a remote prison and the intrusive security to get into the visit hall, too intimidating so simply give up visits. There is also the cost of fares etc. Which are rarely refunded by the prison service. I would suggest NOMS needs to come up with a plan to increase family visits for the elderly. (e) Many elderly prisoners are in prison for historic offenses that happened, say, 30 years ago. During that 30 years the prisoner has lived a free life. But the Prison service and Probation service treats the 70 year old prisoner as the same as if they were 30 years old and had committed their rape etc. A few months before. They should look at the whole picture and give credit for not re-offending for 30 years. That must count for something in terms of risk assessment!

This ends my submission. I hope my submission is used, I would very much appreciate a note acknowledging receipt of my submission. If you were able to send me a copy of your report when completed I would be doubly grateful.

January 2013 OP 04

Written submission from Prisoner C

Esteemed and Respected Committee members,

Thank you, I write in response to your article published in “Converse” January 2013 edition. Thank you for this opportunity to voice concerns.

You speak of “mental and physical health and social care of the effectiveness with which the particular needs of older prisoners --- are met, and examples of good practice.”

As regards “examples of good practice” = NIL!

“The effectiveness of training given to prison staff to deal with ---- including mental illness and palliative care.” = NIL!

When I was in Lewes Prison, the terminally ill were looked after, with the prisons authority, but by untrained, unqualified, but good hearted inmates. This included washing and dressing of the patient.

In this prison, Dartmoor, there are men with mental problems that roam on the wings. They are not shunned, but most people try to be kind and helpful. Generally none of us are trained to be of any help or assistance to these poor afflicted souls. The impression we gain from the staff here is “couldn’t care less.”

To my knowledge there are these three if not four men with terminal cancer. Am I qualified to use the term “terminal?” Yes! Why? As none of these folk have any treatment their cancer is bound to grow and increase in its insidious, pernicious, virulent progress. None of these men here with cancer have access to chemotherapy nor radiotherapy. One man with cancer of the prostate gland had a complete blockage or retention. NO help was forthcoming from the authorities here and he had to catheterize Himself. Cancer patient taken to health centre by the education staff. Health centre nurse said “that man is NOT seeing a doctor today!” A fellow prisoner said to the nurse “You know this man has cancer and can see he is agony. Please give him my appointment and I will make application for a fresh appointment for myself.” The nurse snapped her reply “You can cancel your appointment if you wish, but that man is NOT seeing a doctor or having medical attention today.”

My doctor has prescribed me medication for “dangerously high blood pressure” His words, not mine. 29th of January I went for repeat prescription. Nurse snapped at me “Your medication cancelled 19th January!” Many of us older folk here take daily aspirin 25mg. However we are frequently told, “Out of stock!” My doctor has prescribed me olive oil drops. In five months I have only had three 10ml bottles. I am meant to use the drops each morning and evening for four weeks. Not been able to do that cycle once in five months. OP 04

Good Folk, I could easily double the length of this letter but will forbear. Sincere thanks for raising very valid point concerning OA Pensions.

Yours appreciatively, thankfully and sincerely,

January 2013 OP 05

Written evidence from Dr Azrini Wahidin, Reader in Criminology and Criminal Justice, Queen’s University, Belfast

Appropriate age cut-off:

Much of the debate on older offenders is over how to define ‘old’. The definition of ‘elderly’, ‘elder’ or older, can produce information which at first appears contradictory.

An extensive review of the literature reveals that some previous researchers have defined older prisoners as those 65 years of age and older (Grambling and Forsyth 1988; Newman 1984a), some 60 (Kratcoski 1990) and some 55 (Goetting 1992). However, the majority of studies such as Aday, (2003), Wahidin, (2002), Phillips (1996), the American Department of Justice and older units for older prisoners in the UK and in the States have used the age 50–55 as the threshold age to define when one becomes an older offender. Aday (1994), conducted a national survey of State prison departments and found that 50 years of age was the most common criterion for old age that prison officials utilise. Similarly, Wahidin (2002, 2004) found in a national study of men and women who are over 50 in prison in the UK that prison officers, healthcare personnel and governors running older units, defined older offenders as 50 and over.

Furthermore, UK healthcare statistics show that from the 50–80+ age group, the 50– 59 is the most costly age cohort in terms of bed-watches required and medications consumed (Wahidin 2005), underlining the usefulness of a cut-off point which enables this age group to be included within the definition of ‘older’. This definition is further supported by the fact that offenders experience what is known as ‘accelerated’ ageing so that a typical offender in their 50s has the physical appearance and accompanying health problems of someone at least ten years older in the community.

Studies have shown that on average the cost of keeping an elder in prison runs over three times that of a young adult in prison (Dubler 1988). The specialised medical care for elders varies from simple needs such as hearing aids and dentures to more expensive items such as high-cost prescription medication, prosthetic devices and wheelchairs. At the far end of the cost spectrum are the needs of Alzheimer’s sufferers and critically or terminally ill prisoners. For these reasons, Morton (1992), and prison health-care personnel and prison officers in the UK (Wahidin 2004, 2005) stipulate that 50 is the ideal starting point to initiate preventive health care and is the point to take appropriate measures to reduce long-term medical costs for older offenders.

OP 05 2) OLDER PRISONERS IN THE UK

The literature available on older prisoners is still restricted to predominantly American-based research (Aday, 1995; Anderson and Morton, 1989; Newman, 1984). The work of Aday (1979, 1994a, 1994b) in the USA has been of particular importance in addressing the increase in older people committing crime and the challenges the ageing prison population poses to correctional facilities, and is discussed in some detail below.

The majority of the over 50 and over prison population are serving sentences between four years and ‘life’. The 60 plus age group has become the fastest growing age group in the prison population (Ministry of Justice, 2007), with the number of men more than tripling between 1996 (699) and 2008 (2,242) ( Trust, 2009). This compares to a one and a half times increase among the under- sixties prison population. The majority of men in prison aged 60 and over (56 per cent) have committed a sexual offence. Out of all the 60-69 year old prisoners, 52 per cent have been imprisoned for sex-related offences and among the over-seventies it is 73 per cent (, 2009). More than one in 10 male older prisoners who are 60 and over belong to a minority ethnic group, which is far higher than the proportion of the general population (Prison Reform Trust, 2007). At the end of August 2007, the oldest male prisoner was 92, while 454 were over 70 years of age (Prison Reform Trust, 2009).

From 1999 to 2008, the older prison population more than doubled from 3,000 to over 6,000. This increase in the older prison population is not explained by demographic change but is a consequence of harsher sentencing policies which have resulted in courts sending a larger proportion of criminals aged over 50 to prison to serve longer sentences (Howse, 2003b; Wahidin and Aday, 2005, Wahidin, 2006). This has been especially the case in relation to sex-related offences including men in later life charged with ‘historical offences’ (offences committed two/three decades ago) and drug traffickers (Ministry of Justice, 2007). The women’s prison population in and stood at 4,390, representing 5 per cent of the total prison population. Out of the 316 women aged over 50 who are in prison in England and Wales, nearly half are foreign nationals (44 per cent) with many serving sentences for importing drugs (Prison Reform Trust, 2009).

3) SEGREGATION VERSUS INTEGRATION

The USA has been at the forefront of delivering special programmes addressing the needs of older offenders (Krajick, 1979; Aday and Rosenfield, 1992). In this sense, ‘special programmes’ constitutes the distinctive treatment of the elderly prisoner housed in an age-segregated or in an age-sensitive environment. Elder housing placements are typically based on a clinical criteria based on medical need. Rather than relying strictly on age, most states take the length of sentence and physical condition into consideration when prisoners are classified, custody graded, and given work programmes or housing assignments (Flynn, 1992, 2000). The main question for prison administrators concerning ageing offenders in prison is whether to mainstream or segregate this population. One argument is that segregated housing provides a concentration of specialised staff and resources for the elderly, thereby OP 05 reducing costs (Florida Corrections Commission 2001). Previous research supports the notion that participation in a specific group increases self-respect and increases capability to resume community life once released. A choice of age segregation or age integration provides older prisoners with the opportunity for forming peer networks, while at the same time reducing vulnerability and violence they may encounter in the mainstream of prison life.

MANAGEMENT CHALLENGES OF AGEING PRISON POPULATIONS: THE RESPONSE OF THE UK

In the case of the United Kingdom, it is evident from the report ‘ No Problems - Old and Quiet: Older Offenders in England and Wales’ (HMICP, 2004) that people aged 50 plus are a significant group within the prison population. However, the subsequent report (HMCIP, 2008) found that many of the key recommendations made in the earlier document had not been acted upon. For example, one of the key areas identified concerned the extent to which the prison environment was failing to reflect the needs of those with age-related impairments and disabilities. The Inspectorate Team found that in the majority of the prisons there were no separate regimes for older prisoners and that many were excluded from a range of activities and remained locked in their cells during the day. Another key area for concern was the general level of health of older prisoners and healthcare provision. In some cases, centres were being used inappropriately to house older and / or disabled prisoners. Mental health difficulties are also a major issue. Over half of all elderly prisoners have been diagnosed with a mental illness, the most common being depression, which can itself emerge as a result of (Prison Reform Trust, 2009).

3) Resettlement

The reports from the Inspectorate Team also highlight the lack of adequate resettlement programmes for offenders in later life. Prison Service Order 2300 (para.1.12) states inter alia that account must be taken of the diversity of the prisoner population and the differences in resettlement needs, and that specific cohorts of the prison population (e.g., elderly prisoners) may need be catered for in different ways. However, Aday, Dayron, and Wahidin, (2009), and Mann, (2009), have highlighted that older men and women in prison often experience anxiety as release becomes more imminent. Many elderly offenders - especially men who are convicted of sexual offences - feel that they are more vulnerable to assault when released. Many feel that they have nothing to go out to and that for them ‘time is running out’ (Aday, Dayron, and Wahidin, 2009; Wahidin, 2005;Aday, Dayron, and Wahidin (2009) found that some older offenders exhibited a profound sense of fear and despair at the prospect of dying in prison. So the question that must be asked is ‘what sort of life is left for those who know that a life after prison would never be a possibility? Thus for older men and women in prison, release and resettlement is not an unproblematic issue but a highly complex one. The two key issues facing the older offender due for release are: first, the lack of clarity from prison and probation staff as to where they are going to live, with whom they will be living, and how they are going to get there. Secondly, many elderly prisoners have little idea as to what they are supposed to do once released, or what (if anything) has been arranged for them when they get out. The majority of prisons in England and Wales have virtually no resettlement OP 05 schemes geared for the elderly offender, and no account is taken of the need for older prisoners to manage, often by themselves, with disability or illness, or loneliness and isolation (Gallagher, 1990; Howse, 2003b). At the time of writing (2009) there is no national strategy to develop such courses for older prisoners to ensure equality of access for this age group. It is important to note that due to the relative compliant nature of this prisoner group, their specific resettlement needs are being overlooked. In the above studies, the knowledge that time is running out makes both the prison experience and the resettlement process for older men and women different to that of the younger population.

The UK experience suggests continued reliance on the initiative of committed prison officers, with an assumption that the care of older prisoners, including their social care, is a matter for the health services rather than that of the prison service. Since 2004, prisons in England and Wales have been subject to the Disability Discrimination Act (DAA), which requires the prison service to take all reasonable steps to ensure that prisoners with disabilities can access services. In consequence, the Prison Service has issued orders (PSO 2855 and PSO 8010) detailing the steps prisons should take. The National Service Framework (NSF) for Older People (Department of Health, 2001) also identifies the need for prisons to provide for the health and social care needs of prisoners over 60. Yet it is evidence from the official reports in this area that few prisons are reaching the standards required in legislation, though progress could be identified in some cases (HMICP, 2008; Prison Reform Trust, 2009)

FUTURE ISSUES AND RECOMMENDATIONS As the number of older offenders participating in the criminal justice system accelerates, developing social policies to respond effectively to the group will become critical. To alleviate some of the problems associated with imprisonment, the prison authorities should be turning their attention to literature relating to residential homes or assisted living facilities (Aday, 2003; Atherton, 1989; Coleman, 1993; Hockey, 1989). There are many simple measures which could be taken that would allow elders control over their immediate physical environment, for example: installing doors and windows which they could open easily, and radiators which they could adjust themselves; replacing the harshness of the prison corridors with appropriate carpet tiles; use of electricity sockets which would allow all elders the opportunity to listen to the radio; televisions with teletext for the hard of hearing, electric hoists, and replacing the glare of the strip light with something less harsh. Such measures would at once make prison a less hostile and more accessible place. In addition, due to the impairment of sight, hearing, memory, and reflexes, as well as the general slowing of movement and mental responsiveness, elders need to be cared for by staff members who are specifically trained in the needs of elders in prison. Mental and physical assessment, counselling services, and other programming will be necessary. For prisoners who will spend the rest of their lives in prison, managing their health care will become a critical issue. Prison officials will be faced with the problem of finding suitable work and recreational activities so prisoners can pass the time in reasonably good health. Of course, prisoners who have spent a greater portion of their lives incarcerated will need intensive discharge planning and OP 05 community placement orientation. Locating family or community agencies who will accept ageing prisoners eligible for parole will be a challenge. The limited knowledge concerning the elderly, and the absence of relevant policies and planning in this area, lead one to suggest that the criminal justice system should be turning its attention to:

• An examination of existing formal and informal practices regarding older prisoners, as the first step in developing an explicit and integrated set of policies and programmes to address the special needs of this group across jurisdictions. This will enable a national strategy to be implemented and good practice to be identified.

• Developing a comprehensive and gender and age-sensitive programme for elders that fosters personal growth and accountability and value-based actions that lead to successful reintegration into society.

• Preparing all personnel of the criminal justice system to understand and appropriately address elder-specific topics and issues.

• In terms of being able to address the needs of elders in the criminal justice system, prison units should be able to institute the following:

• Adoption of the age of 50 as the chronological starting point in a definition of the older offender.

• Compiling of comprehensive data on the over 50s from arrest to custody, through to re-entry into wider society.

• Introduction or expansion of specific programmes, policies, and facilities geared towards the needs of older people.

• Identification of the costs of long-term incarceration of infirm prisoners and the potential risks of early release or extended medical furlough for this population.

Even as I write this briefing paper the Prison Service in the Uk, is still yet to have a national strategy for this cohort even though the Disability Discrimination Act (2005) now applies to prisons few establishments are compliant. There are big questions to ask in the context of the global recession, not withstanding the notion of ‘invest now for longer term gains’. Thus in order to comply with the European Convention of Human Rights Convention, policy makers must address the needs of the ageing prison population or be accused of discrimination on the basis of age and, at worst, be accused of contravening Article 2 (right to life) and Article 3 (right to be held in conditions that do not amount to inhuman and degrading treatment). As Wahidin (2004, p. 196) pointed out, ‘so many have faded into anonymity’ and are now all but forgotten. It is well known that the proportion of the elderly in the general population has increased. However, research, policy initiatives and programmes targeted at the elderly criminal have not kept pace with this general movement. Age, OP 05 in time, will be considered one of the biggest issues that will continue to affect the criminal justice system and prison health care in the future. February 2013

Further Readings (References for this briefing can be obtained on request) Aday, R. (1994a) ‘Aging in prison: A case Study of new elderly offenders’, International Journal of Offender Therapy and Comparative Criminology, 1(38): 79- 91. Aday, R. H. (1994b) ‘Golden years behind bars: Special programs and facilities for elderly inmates’, Federal Probation’, 58(2): 47-54. Aday, R.H (2003) Ageing Prisoners: Crisis in American Corrections, Westport, CT: Praeger Publishing. Aday, R. H. and Krabill, J. J. (2011) Women Aging in Prison: A Neglected Population in the Correctional System, Boulder, CO: Lynne Rienner Publishers. Aday, R. H., Krabill, J. J., and Wahidin, A. (2004) A Comparative Study of Health Care Needs of the Female Ageing Offender in the USA and the UK, American Society of Criminology Conference 2004, Nashville (Unpublished paper). Deaton, D., Aday, R., Wahidin, A (2009), The effect of health and penal harm on aging female prisoners: views of dying prisoners in the Journal of Omega, Vol 60 91 51-70. Her Majesty Chief Inspectorate of Prisons (HMCIP) (2004) ‘No Problems - Old and Quiet’: Older Prisoners in England and Wales, London: HMSO. Her Majesty Chief Inspectorate of Prisons (HMCIP) (2008) Older prisoners in England and Wales: A follow up to the 2004 Thematic Review, London: HMIP. Howse, K. (2003) Growing Old in Prison: A Scoping Study on Older Prisoners, London: Centre for Policy on Ageing and the Prison Reform Trust. James, M. (1992) ‘Sentencing of elderly criminals’, American Criminal Law Review, 29: 1025-44. Kratcoski, P.C. and Babb, S. (1990) ‘Adjustment for older inmates: An analysis by institutional structure and gender’, Journal of Contemporary Criminal Justice, 6: 139- 56. Mann, N (2011) Doing Harder Time? The Experiences of an Ageing Prison, Unpublished PhD, Essex University. Wahidin, A. (2002) Life in the Shadows: A Qualitative Study of Older Women in Prison, Unpublished PhD.

Wahidin, A. (2004) Older Women in the Criminal Justice System: Running Out of Time, London: Jessica Kingsley. OP 05 Wahidin A. and Aday, R. (2005) ‘The needs of older men and women in the criminal justice system’, Prison Service Journal, 160: 13-23.

Wahidin, A. and Cain, M. (eds) (2006) Ageing, Crime and Society, Cullompton: Willan. Wahidin, A and R. Aday (2011), Later Life and Imprisonment in C. Phillipson (eds) Handbook of Social Gerontology, London, Sage. Pp 65-78.

Wahidin A and Aday R (eds) (2012), Older Female Prisoners in the UK and US: Finding Justice in the Criminal Justice System in M. Malloch and G. McIvor (2012), Women, Punishment and Community Sanctions: Human Rights and Social Justice, London: Routledge. (Pp 65-79).

Wahidin, A, (2005), Older Offenders, Crime and the Criminal Justice System, in C. Hale, K. Hayward, A. Wahidin & E. Wincup (eds) Criminology, Oxford: Oxford University Press. (Pp 402 – 425).

OP 06

Written submission from Prisoner D

Dear Sir

I am writing in regards to the article in the Converse for January 2013. This article is about an Inquiry being launched about elderly prisoners in reference to their treatment while in prison. I am an 85 yr old prisoner and since April of 2010 when I had a severe heart attack and also with one lung not working properly. I have to use a wheelchair to get around this establishment even going any distance. The problem I have is this if I have a visit no officer will push me up any incline or even if I have to go to the health care centre where there is an incline I have to come up after leaving this centre. By the time I reach the top I am breathless. There is one other problem that elderly prisoners has here that is our prison retirement pay up to six years ago we got £5 per week less £1.00 for our in cell television. That leaves us with only £4.00 to spend at our canteen and the canteen prices are dearer than those in the shops outside these prices are set by NOMS. Also for some wheelchair users their cell doors are not wide enough for their chairs to go through also they have a step outside as well. If you are a “Cat A” prisoner you cannot have a cell that has been made for wheelchairs. They are for “Cat B” prisoners only this I believe is wrong. I also believe that when you reach retirement age when not in prison and receive the state pension then when you come into prison it is taken away from you. I strongly believe we should be allowed to our pension as many prisoners has no family to help them out with money being sent into them. We are not treated humanely here. I sincerely hope this information may help you on your Inquiry.

Yours faithfully,

February 2013 OP 08

Written submission from Prisoner E1

Sir, Chairman,

I would like to submit for your committee’s attention some articles, papers I wrote last year when at HMP Pankhurst. They’re self-explanatory and are rooted within the end-of-life-care (palliative) environment/sphere.

Whilst at Parkhurst on the Isle of Wight I was treated with dignity and respect by the health care staff there in that prison. Whilst there, on July 4th 2012 I was diagnosed with cancer. I was offered the full support for that diagnosis within that environment by the end-of-care-life team and seen by doctors within 3 days of presenting with a problem/query. Nurses there would deal with any problem immediately. This was the case right up until I gained C cat status and moved here to HMP Dartmoor. That’s when my ‘nightmare’ began and to date is still being experienced/lived.

The healthcare regime here is nothing short of ‘hell-on-earth’. Even with my diagnosis I’ve not yet seen a McMillan pain-relief nurse to ease my constant pain. Enclosed is a letter dated 22/01/13. This was requested for (the appt.) on the 05/01/13. This is 17 days wait. It showed on that day so my appt was not honoured. I requested a re-booking to get my pain-relief sorted and was given a new one (after specifically pointing out I’d already waited 17 days) that is appointment dated 15th February 2013. That all told to see a doctor is 26 days between the two appointments, plus the original 17 days between booking the first appt and getting the appt of the 22/01/13!! That makes it from the 05/01/13 to 15/02/13 to get to see a doctor (with a diagnosis of cancer and complications of asthma and heart problems not being treated and prev. Diagnosed). 41 days all told! Surely that can’t be right and within equality and human rights legislation?

I have had a ‘care-plan’ written by the deputy manager here called [...] and that’s about it. She has been spoken to by me on several occasions about pain-relief and seeing the McMillan pain-relief nurse but all her answers have never come to fruition. The same goes with certain B wing officers here at HMP Dartmoor. One, an [...] has threatened me with physical violence, and another [...] has seen fit to withdraw my washing facilities. It’s abuse of power and punitive, targeted bullying, which is systemic within a prison that is renowned for ‘brutality’. It’s 2013 but it’s still happening with the governor ‘looking’ the other way condoning it with a truly astounding level of indifference.

To summarise: I have cancer but am not getting proper treatment or pain relief.

1 Redacted for publication. Redactions are signified thus: “[....]” OP 08

If I complain I’m ignored totally. My next-of-kin has been show the exact level of contempt as I have ([...] letter has been enclosed).

*Good dental and eye care here at Dartmoor. No McMillan pain-relief nurse has been near me since I left Parkhurst on [...].

My/The ‘care-plan’ isn’t worth the paper it’s written on.

I have to wait to date for a full doctors surgery a total of 41 days with only a brief doctor/patient/inmate interaction on the 22/01/13 to issue emergency catheters.

My medication last month was 5 days overdue which sent me into ‘urine retention’ in the first instance. This ‘late’ dispatching of monthly medicines is used as a ‘punitive-message’ to stop causing outside agencies to ‘look-in’ at what’s ‘not’ going on for me.

All medication/hospital visits/ healthcare should be covered by PSI’s to set legal levels of standard treatment country wide. I look forward to your recommendations.

January 2013 OP 10

Written submission from Prisoner F1

Dear Sir/Madam,

On the 28th June at 08:00 I had a stroke here in my cell. What happened was, I woke up at almost 8:00am with what I thought was a severe cramp in the calf of my left leg. I got over to my cell door to ring my cell bell when my door was unlocked by the day-staff, a warder [...]. I told her that I thought I had a stroke and to ring the Health Care. She asked if I could get back onto my bed and I said yes so she locked my door and left. At 8:50 am [...] came to my cell. He took my blood-pressure and I told him that I wanted to see the GO. He never gave me my morning meds. I asked him when I was seeing the GP and he said that I did not need to see the GP that he would sort me out. He then left my cell. At 11:50am I again asked landing staff [...] if I could see the GP and she said she would ring Health Care. At 3:30pm [...] came back to my cell. I asked when I was seeing the GP. He said you never asked me to see the GP. You must have asked someone else but not me. I was annoyed at his ... and told me to leave my cell. At about 9:00am the 29th a GP and a nurse came to my cell. After the examination a wheel-chair was wheeled into my cell, I was strapped into it and taken to Health Care and then put into an ambulance and taken to outside hospital. I went through several tests out there and was put on tablets which I’m still on. There are Atorvastatin 80mg once a day and Clopidognel 75mg once a day. I can’t walk without a stick, when I leave the wing I have to go by wheelchair. I’ve been given various aids to help me in my daily life. Needless to say I’m not able to go to work. I’m not allowed to go out on exercise because there is a step out into the exercise yard. I can’t go upstairs at all. I have lost so much since my stroke but my biggest loss was not being allowed to see the GP on the 28th. The “Golden Hour” was denied to me by [...]. I’ve read that if a person is seen by a GP an hour or so after a stroke almost all of the patient will be saved. The longer one is denied medical attention the less you save of them. I was denied seeing a GP for over 24 hours, much too late to save me. I now walk like a crustacean, my left arm/hand does not perform as normal. I will be on medication for the rest of my life just because a medic was too lazy to get me to a GP. That he was negligent is beyond question. Two Physiotherapists came into examine me. They tested me on a stairs and said that I could use them but to go slowly and take my time. They also tested me going out to the exercise yard. Again they said I could use the yard but to go easy. The prison won’t allow me either, they won’t accept responsibility in case I fall. I have to use an ankle brace because I have “Dropped foot”. I am 68 years old and I’m now living with one foot in the grave. I don’t get nor have I ever gotten physiotherapy here in the prison. Maybe it would help, maybe not. Either way I think that I was very badly treated by prison staff here. How long must cases like mine go unanswered. Surely there must be a way to stop the likes of this. [...] is still working as a medic as if nothing happened. He is answerable to no one apparently. Who does a prisoner turn to? I am not seeking revenge but I would like justice.

Yours sincerely,

February 2013

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Written submission Prisoner G1

Sir I am [...]. Long before I came to prison I had existing health problems, rheumatoid arthritis in my knees, hips and now my back. I have plantar f... a condition of painful heels. I have an undiagnosed uncontrollable falling problems of which I was transferred to this prison for as my diagnostic treatment is at a ¾ stage and this is at Stafford General Hospital. I basically came to HMP Stafford to continue my diagnosis. ... month on I’m now further backwards than before ... to prison, I had an MRI booked by E.N.T. dept at S.G.H., Healthcare have cancelled it so many times. Cannock Hospital cancelled it completely, 4 months later I go to have a MRI but on my brain not my ears as order by ENT dept., Healthcare have rebooked it through a neurologist, she said there’s nothing wrong with your brain, quite rightly, but when I go to the ENT Dept the doctor asks where’s my MRI, this is no good, wrong area, wasted appointment. I had a appointment to collect a sleep ... machine from Cannock Chase Hospital in Sep. 12 still not got it. In December 12 I went to rheumatology appointment, Doctor ordered ... on my legs up to now it has not been allowed or mentioned. In December I went to Royal Orthopaedic Hospital in Birmingham with an ongoing problem with my hand, the left one, the doctors ordered MRI on it, scans, ultrasounds and electro conductive tests on it. Last week they took me back before I left HMP Stafford I stated it’s a waste of time as I have not received those tests or MRI, on arrival at R.O.H., Doctors wanted to know why I was back without the tests and MRI, my escort or me could not answer. Only to ask Healthcare at HMP Stafford, no one admits any wrong doing, so I involved I.M.B. Healthcare did admit to them they had cancelled my MRI and tests at R.O.H. in Birmingham because they thought I did not need them. A I had a MRI at Cannock. I will (no) longer go to healthcare as they are ruining my health and am no seeing a mental health nurse because of my depressed state over all my cancelled, delayed and abandoned appointments.

I cannot speak to anyone about it, the healthcare manager, the doctor just don’t listen to anyone ... i have tried to explain what’s gone wrong, they don’t want to know or seem to care. The nurses are complete angels, always helpful and understanding but management and doctor do not care at all. In 5 months I have over 20 episodes of uncontrollable falling and uncontrollable eye movement and balance. I had getting more infirm and losing the will to live because no one cares enough to realise or ask how ill I am.

The prison regime is not made for old people. The nurses here did an assessment on my health and needs and said I must no work in workshops or any place I’m in danger of falling and I should be put in Education. So the next day the wing officers put (me) in a workshop and tld if you don’t go to work, you’ll be ... and lose all privileges, so I go, I don’t want any trouble or problems with staff. 16 weeks ..., I’ve tried two curses but I could(n’t) one because I’m nearly deaf and the other I’m too infirm. I was promised to go to education to find courses I could do with my disabilities but over a week no joy. I’m back in a

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workshop where I started in Sep 12. I’m going round in circles. I have made several app’s to a disability officer, no answers.

Both me and my wife are disabled. On visits she books a disabled visit for extra leg room and because of my poor hearing, but with always have problems as they stick us in the middle where there’s most noise and shortest legroom, some officers will move us to an outside table or the disabled tables but not always as it’s a lot easier to say no then yes.

The health problems of the older prisoners are many folds, stairs are a big problem, not so much walking up and down but add food, ... and..., and their problems because older people need to be able to hold hand rails. Walking distances are a major problem, I’m last in workshops and last back to the wing through infirmity, it’s no fun ... officers dirty looks at my slowness.

In another prison I miss(ed) mealtimes on three occasions because of my deafness, I ... on report for refusing to go on the 4th floor in the top bunk with a smoker. I’m ... flat bottom bunk and NON SMOKING but because your old they try to bully you. I’m a big lad I don’t do bullying either way I would not do it. And I don’t except especially from staff at any level. But some officers, only some officers take pride in bully boy tactics, if only ... conflict and ... amongst weaker, infirm and older prisoners a little understanding would go a long way. Most older prisoners have health problems and to be paraded around a hospital in handcuffs only causes more anguish and its very depressing. And how over 60s would escape anyway. Most of us have been on bail knowing a prison sentence coming but the prison service treats us as A Cat prisoners 3 man escort from a C Cat prison 3 fit and healthy officers for a frail old man unable to walk far, let alone run away, but that’s prison for you. They are quick enough taking handcuffs off if it involves Xrays, MRI, or electro conductive tests. Security goes out the window then, double standards? Ha. I’m a retired, infirm, non violent person, I’m treat(ed) with no respect, no dignity or compassion!! I’m classed as a medium security risk where does that come from.. it must be from another planet as it is not reality. Me a security risk, I’m not new to prison and I’ve never been a security risk. I’ve worked for the ... governor in B cat prisons and in the officers security training wing I’m a B cat prison but here and now I’m a security risk, unbelievable. These old Victorian prisons have not caught up with modern times and they never will.

What’s needed are regional prisons built with old and infirm in mind not multi floor monster prisons run by private money with profit in mind but a single story medically based centres where old, ill or disabled prisoners can live out their sentences with compassion and care not seen as a source of ridicule by uncaring officers and staff. ... numerous small hospital health centres and semi suitable premises lying idle waiting for a new use? Incarceration is not always the answer to non violent prisoners. You’re probably not interested and no one can blame you, we’re prisoners, the scum of the earth, no worth any consideration.

February 2013 OP 13

Written submission from Prisoner H

Dear Sir,

After reading an article in Converse (a prison newspaper) with reference to the treatment of the elderly who are held in prison, I felt I would write to you at the Justice Select Committee with some of my particular issues. My first and major issue with the government is in regard to my state pension. I came in prison aged 68 years and prior to that was in receipt of D.L.A. and state pension plus a small private pension on which I was paying tax. At the age 15 back in 1958 I started work and paid my N.I. contributions on a weekly basis. It was explained to me that the contributions were for social welfare and a contribution toward my state pension. If I made sufficient payments throughout my life I would, when I reached 65 years old be entitled to a state pension as of right.

It was further confirmed to me the contributory nature of the state pension when in the late 60s early 70s the Government of the day introduced what I think was called a graduated pension. This was an additional weekly payment taken over and above tax and NI payments and shown separately on my wage slip. It gave for every £7.00 paid in 6 old pence per week extra on your eventual pension at age 65. I feel that this clearly shows that the pension was a compulsory contribution based separate entity to the benefit system. I have no argument with the loss of my DLA as the prison service to a greater or lesser degree care for me with regard to my health and mobility issues. I do though think that to take away my pension, after me paying the contributions demanded by the state, with me having no right to stop the contributions is nothing short of theft.

Please show me where and how I was informed of the major change in the pension contract (and it was a contract) that informed me of the change that said, you will get the pension you paid in for, unless you go to prison. I was not informed of this, nor given the right to withdraw from the contract if I did not agree with this major change of conditions in the contract. This right to withdraw would be allowed to happen in any normal contract.

With regard to the treatment of the elderly in prison I can only say that here they are treating me properly as a disabled person. Given the circumstances of a prison building they have kept me on the ground floor and ensure I am kept warm and fed. Therefore I have minimal areas of complaint. It is though the way you can be treated by the NHS that raises real questions of concerns especially with regard to dental treatment. Also if you have to visit an NHS hospital then the treatment given falls well below any acceptable standards. I was actually physically abused at the hospital in Dorchester and physically forced to undergo an internal exam despite refusing to allow it to happen.

While conditions for the elderly in prison does require so minor changes, 1. ensuring the elderly are kept on ground floor 2. Finding and keeping some form of work to enable OP 13 them to pay their own way in prison rather than sponging off their elderly wives or partners 3 ensuring that all the facilities required are also on the ground floor 4. Ensuring all officers understand that we are physically slower.

I wish your committee all success in attempting to make OAPs lives a little easier.

Yours sincerely

February 2013 OP 14

Written submission from Prisoner I1

Dear Sirs,

I am a prisoner here at Albany, IOW, I am now seventy years old and I work on the ... cleaning course. I choose to work rather than receive the £4.00 per week unemployment/pension money, as an enhanced prisoner I am paid £15.00 per week for my wage. I have no option but to work if I am to be able to afford the little extras I need, salad cream, pickle, vinegar sauce to make my food more palatable and phone money to ring my other half who is living in Spain. These phone calls alone cost me £5.00 per week on average, there are other things too such as birthday or Christmas cards and stamps to send to my friends and relatives on the outside. As you can see the £15.00 is needed £4.00 per week would just not do it! All this is because my pension for which I paid in contributions all my life has been stolen from me. Besides my normal work, I act as a ‘buddy’ for other prisoners who are disabled, I fetch their meds, stores, canteen and reception, (foods coming in from Argos etc.), I also clean their cells for them once a week on Saturdays. All this ‘...’ is done on a voluntary basis, I am not paid for it at all! There is a recognised community contributor pay of £2.50, a bonus payment which was originally supposed to be paid to the ‘buddys’ on each wing but the requirements for this pay are continually moved to the point now where it is a requirement to do as a level two maths course, a level two literacy course and a peer mentoring course. Three courses to qualify for a £2.50 bonus for work we are doing already!!? This is just a scam to make money for the Education Department. I will continue to do my work on a voluntary basis, I am not doing it for the prison, I am doing it to help my fellow inmates. I have been doing this for two years now. I am the chairman of the Albany prison over 50s forum from which we lobby for ‘extras’ for the older prisoners such as use of the gardens for sitting out in during exercise periods, the use of a different garden and greenhouse for inmates to grow vegetables to supplement the inmates diet. Wheelchair training and free TV for pensioners unable to work etc. All this is done to try to improve the quality of life for the older and disabled prisoners some of whom are kept in cells with no toilet facilities. Here at Albany they operate a ‘...’ system, there are no toilets in the cells and it is necessary to press a button to get let out to use the toilet facilities, there are a number of older prisoners who cannot operate this system because the cannot read the numbers it needs to check back in or in other cases they do not have enough time to get to the toilet and back and do what is needed in the seven minutes allowed.

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For these prisoners it is necessary to urinate or defecate into a bucket. The wings operating this system are A-E. There are two new wings F&G which have toilets and showers but the queue to get onto these wings is too long. The prison is only allowed to have a certain number of disabled prisoners on these wings because of fire regulations, this is some 28 prisoners, all the rest must wait in cells with no facilities. Recently a prisoner with advanced cancer who had trouble standing was found by an officer doing his rounds lying on the floor of his cell having fallen down, [...] who was also suffering from incontinence had been trying to use the porta-potti he had been supplied with, he had fallen, messed himself both ends and was unable to get up off the floor, was not able to reach his medication and had to lie there until an officer came around he had no way of calling for help. I am pleased to say that personal alarms are now being introduced for disabled prisoners. But it is too late for [...] who died later that day, he’d been waiting for months for a move to F&G wing where he would have toilet facilities. Another prisoner who died from emphysema recently had spent years in a cell riddled with damp. [...] did smoke and how much this contributed to his death I don’t know for sure but the damp will not have helped. This damp is caused by a broken gutter which has been that way for 4 years to my knowledge. The prison cannot get the funds it needs to fix the gutter. This renders that particular cell and also the one next to it UNFIT FOR HUMAN HABITATION! The prisoner who is now in this cell is seventy five years old and already has some breathing problems, he has done his very best to dry it out using newspapers to soak up the excess water but this will only last until the next heavy rain. He could insist upon being moved but this would only result in another ‘mug’ inmate being put in there. We have campaigned to have this cell sorted out but were told ‘don’t hold your breath’ a request for this work to be done has been logged on the computer. To sum it up these wings A-E are not suitable for disabled prisoners, work could probably be done on some of the ground floor cells to install toilets and ... pipes but of course there is ‘no money’. This prison is probably a lot quieter than most. The population is over 50% of prisoners aged 50+ the officers are generally good, a few are excellent and [...] the ‘older prisoners lead’ does work constantly to help It is her work that has got the personal alarms, walking sticks, high back chairs, dinner trays and other aids for the elderly prisoners, some of the officers are a bit indifferent to the prisoners, in general their role is more like that of welfare workers than that of ‘wardens’. With the ... style of campaign against people being accused of historic cases of child abuse or rape there is going to be more need to cater for elderly, infirm and disabled prisoners now that there is no need for evidence to confirm these allegations and only an ‘if you believe it may have happened’ asked of the Jury many more allegations are being made, many of these are false but the Justice system is paying huge sums of money to anyone who makes an allegation and obtains a conviction (no evidence required) and no need of a ‘beyond reasonable doubt’ anymore. In conclusion I will point out that other civilised countries have stopped paying compensation ‘rewards’, Germany and Sweden if I recall correctly, and also in civilized OP 14 countries inmates are thrown out of prison at the age of seventy as their government/justice system has decided that ‘Prison is no place for a seventy year old,’ but in this barbaric and vengeful country some people are being thrown into prison at 90 years plus in order for a corrupt justice system to show off. HISTORY WILL SHOW YOU FOR WHAT YOU ARE!! There is unfortunately no interest in Justice, only convictions to the extent that you have changed the laws to cater for your own corruption. The British have reputation in this world for being ‘bullies’ there are only a handful of countries in the world we have not invaded at some stage or the other our massacres of innocents are legion and we are famous for our ‘Witchfinder General’ even we its own citizens are not safe nor have we ever been. You should wake up and take a look at yourselves. If there are any points you would like me to expand on please don’t hesitate to write to me. Yours in eternal hope

February 2013

OP 15

Written submission from Prisoner J

Dear Sirs,

As wing Rep of the Older Persons Unit (OPU) at HMP Parc I write in response to your request in the Inside Times for input into your proposed enquiry of prisoners over the age of 60 yrs.

The OPU at HMP Parc comprise of 30 single cells. Each cell is furnished with WC, shower and sink with constant hot water, TV and in cell telephone. It is staffed by sic specially selected officers on a rota basis, with each officer being given approximate training for the various difficulties of the older inmate.

Healthcare is provided by local GPs supported by trained nursing staff. The GPs care for the older prisoners cannot be faulted. Both excellent and courteous treatment supplied on a daily basis equals the care given to outside patients. The nursing staff are on call 24/7. The only criticism can be when occasionally they find themselves under manned. Other healthcare services such as dentistry, chiropody, optician and psychology regularly attend clinics at this prison albeit the chiropodist, who only attends one day a month for 1400 prisoners retains an inordinate delay with some inmates waiting over 6 months for an appointment. This delay is particularly difficult for the older prisoners whose need for foot care are perhaps more obvious than that of the younger inmate.

The recent death of a terminally ill patient allowed me to observe the palliative care given by medical and wing staff. Everything that could be done, was done, with doctor and nursing staff constantly in attendance. Every courtesy was extended to the family including 24 hour access to this persons bedside, with wing staff, led by the unit manager taking it in turns to remain on the wing overnight to support the family and allow 24 hour access to the inmate.

With regard to activities, there are three part-time teachers who specialise in art and crafts. Every inmate on the OPU is encouraged to participate with items being successfully submitted to the Koestler awards.

All in all there can be no criticism of the way that this unit is run but (and there is always a ‘but’) there is unfortunately a ‘fly in the ointment’!

With regard to hospital visits the protocol of category ‘B’ inmates being double cuffed and category ‘C’ inmates being single cuffed is strictly adhered to with no consideration given to elderly and/or infirm inmates. It is fully accepted that there has to be security issues for inmates visiting hospitals in the community. However the discomfort and indignity of elderly and/or infirm inmates being double cuffed is, in my view, totally unnecessary. I give as an example the instance of one particular OPU resident being double cuffed – he was 84 years old. Another example was an 85 year old resident being discharged OP 15 from hospital after treatment and who is 100% blind, 90% deaf and who used a zimmer frame. Was it really necessary to cuff these residents? On a personal level I have declined cardiologist appointments after my last experience of attending the local hospital after I was made to sit double cuffed in an A&E cubicle for 4 1/2 hours. I have yet to meet anyone who returns from these visits without bearing bruises or pinch marks around their waists. It is to be hoped that the issue of double cuffing elderly or infirm ‘B’ category inmates can be addressed during your enquiry.

I trust the above mentioned issue may assist you and I would be most grateful if you could acknowledge receipt of this letter.

Yours sincerely,

February 2013 OP 16

Written submission from Prisoner K1 Dear Sir

I am a 68 year old prisoner who has been in prison since [...]. Like the increasing majority of prisoners over 60, I have been (falsely) convicted of historic sex offences. With the current witch hunt, the large sums available in compensation and no ‘presumption of innocence’ for sexual offences, I can only see, in the future, prisoners over 60 taking up more than 50% of the prison population in this country.

In addition to my age, I also have a paralysed left arm and suffer severe chronic nerve pain. Generally, I have found there is nothing in place to reflect the needs of elderly and infirm prisoners and often their problems are ignored by the Governor and Officers, who have a duty of care. I am sure that you will have seen a copy of the Prison Reform Trust’s “Doing Time – Good Practice with Older People in Prison – the Views of Prison Staff” 2010, so I will just tell you of a few of my experiences in the 5 prisons I have been in.

My first prison was HMP Bullingdon. I was quickly welcomed by other prisoners as there was a system of carers in place for the elderly and infirm. However, the officers paid no heed to age or disability. I was given an IEP warning for failing to obey a shouted order because of my hearing problems. This was not accepted as a reason why I did not obey the order. Healthcare was initially very bad but improved with a change of GP. All my on-going hospital appointments were ignored. The worst thing this original doctor did concerned a 64 year old man who was on for serious historic sex-offences. Because of his serious mental turmoil this man had been on tranquilisers, vital for his sanity. Upon his arrival in prison, he was immediately denied this essential medication. It was easy to tell that without these pills the prisoner was a serious suicide risk. You could see it in his facial expression. The officers were aware of his state of mind but paid no heed to it. He was placed in a cell with another man. When that man had a visit, he hung himself, I gave a statement to the Ombudsman and the police, but we never heard anymore. Even the investigating Ombudsman was not asked to go to the inquest. Then there was a 78 year old man with terminal cancer. Most of his stomach had been removed. In spite of this, he was put on a SOTP course. Later when he was bedridden, he had no heating for a week, in freezing winter conditions. Despite his terminal condition, no clemency was shown him. He was finally removed to a hospice as he was dying to save the prison a lot of paperwork. He died the next day.

The heating was regularly switched off in mid winter. It failed regularly with no hurry to repair it. Often officers, whose rooms were always heated, would open all the wing skylights. The more they were asked to shut them, the longer they stayed open.

I have toenails that are too thick for the toe clippers available on the canteen, I was refused the clippers that I brought in with me. At HMP Wandsworth they were thrown into a

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bin by a reception officer, still in their original packaging. Despite a stomach condition that requires a wholemeal diet, it took 18 months to get it. In 8 months at HMP Wandsworth, I was never given it. At Maidstone, I have eventually been given it regularly for sometime, if it is not taken by the servery workers. There were single cells at Bullingdon, but they were only given to young troublemakers. The elderly were always twoed-up. Wandsworth was even worse and Brixton worse again. Only HMP Maidstone offers single cells to the elderly, absolutely essential for any quality of life.

I was taken from Bullingdon to an appointment in St Thomas’ Hospital in central London. It was a day trip. The 2 officers ignored me throughout the day. Lunchtime they both ate packed lunches that they’d brought with them. Other patients looked on in surprise when I was given nothing to eat. I should have had a lunch pack too.

Later, I was unexpectedly shipped to Wandsworth with no possessions and denied pain killers for a month. The first night I was denied a pillow and only had one blanket. Later, the pillow I was given was like a slab of concrete and I had to fill the pillow case with clothes instead, This lasted most of my time there. Throughout my 8 months there, I was never given the correct amount of painkillers. I was two-ed up with a lifer who’d already done 27 years. None of my medical records followed me and my possessions left a Bullingdon, as I was told I’d be returning, took 2 ½ months to reach me. Some possessions had been removed by Bullingdon reception officers. When I arrived I was denied my special sleeve and glove for my paralysed left arm/hand. They were finally returned to me sometime later. Then, every time I went to court they would be taken off me by reception. Nurses would have to get them returned. During my 6 weeks at Brixton I was never allowed them. On hospital appointments, my wrists were handcuffed together, causing me great pain. It should have been obvious to officers that my shrivelled up left arm should not be handcuffed. They said there was nothing on my records so they had to apply the handcuffs and were not allowed to use common sense. On my regular court appearances, I was always shut in a cell without heating and denied my pain killers. There was no heating in the buses, either. The day after spending 16 hours like this, I was forced to plead guilty despite my innocence because I couldn’t stand anymore cold and pain. In my whole time at Wandsworth, I was only allowed gym on 4 occasions, despite constant requests. The gym officers would only unlock the younger prisoners whom they could better relate to.

I was only at HMP Brixton for 6 weeks. The regime was 22 hours bang-up. The needs of the elderly were ignored. I did not get wholemeal bread and had to share, for a while, with a prisoner with mental health issues. During my time there, legal mail was lost, delayed or opened, with documents removed.

When I was transferred to Maidstone, the bus left too late for us to get there within the allotted hours. We spent 3 days at Elmley in a freezing cell with only one blanket and no pillow or kettle (for the first night). Once I got the kettle I had to boil it continuously to keep warm. When leaving, a reception officer removed my special safety pin holding my sleeve in place and threw it away. OP 16

At Maidstone there is no system in place to care for elderly or infirm prisoners. There are no social activities for them. Most are unable to join the gym/outside activities for the younger prisoners. We are put downstairs, which is the coldest part of the wing as often doors and windows are left open. The D.L.O. officer is useless and has ignored all my requests to see him. It seems the elderly are regularly subjected to M.D.T.’s though they know we will be negative. I have also been made to put all my possessions in the volumetric control boxes over lunch and unpack them immediately. They were not interested in checking I had all my stuff packed. My letters to friends and family have been passed to the police. My complaints have been ignored. After a cell search, my table was removed as my personal officer said I could use the broken leg as a weapon. It was broken when I moved in. I was then forced to rely on a table that was too small to get close to which made eating and letter writing difficult for a one-armed person. All attempts, including an application to the DLO were ignored.

The worst nightmare of all for us are the regular “transfers” to other prisons, often sprung upon us with little time to pack, phone family, cancel visits or say goodbyes. We are expected to carry all of our bags, despite our physical inability. We are then forced to travel and wait hours in those terrible and claustrophobic ‘bus’ cells with no access to toilets, proper seats or seatbelts. Upon arrival at the new prison we are back to square one, without many of our possessions. None of the needs or achievements at previous prisons follow us; only the bad things. We are back to one (head) pillow, one blanket and few extra clothes. To get back to the gym takes ages; much longer if you tell them about your medical problems. I thought “NOMS” was intended to make transfers easier?

Officers often expect the elderly to remain in their cells and not join into any activities that are available. Access to computers for the elderly to write legal letters is extremely limited and impossible at Maidstone. Copying papers is another impossibility which means all legal letters have to be written twice. Water to drink is often unavailable, even for the elderly and someone like me who needs to drink regularly because of medication side effects. Elderly dementia sufferers are even worse off because they are left living in their own, sad little worlds.

I hope that what I have written will be taken seriously by the reader. I have not written this for my own benefit, but in the slender hope that what I have written may help other elderly prisoners, older and more infirm than me.

Please acknowledge receipt of this letter so that I know my efforts to send you my input have not been in vain.

Yours faithfully,

February 2013

OP 17 Written evidence from Jen Geary, Dr., LLB

Executive Summary

This submission is linked to the treatment of older prisoners and equality and human rights legislation. Currently University based research is being conducted between researchers in Australia and Canada. This research is concerned with understanding the needs and service responses of older people in prison. The participation of professionals from Western nations including those linked to prison, parole, psychology, social work, the clergy, counseling and law are currently being sought for the purposes of this research. The objectives of this research are to: • generate new knowledge about the needs and situations of older prisoners to devise means to enhance their well-being whilst developing the public safety. • expand on existing literature, for example, Aday (2003), Human Rights Watch (2012), Mann (2012), Wahidin (2004). • give information about the legal, pragmatic and ethical challenges faced by corrections professionals who work with or are involved with older prisoners. • provide recommendations to guide corrections professionals in their efforts to meet the legal, treatment, rehabilitative and reintegration needs of older prisoners.

Introduction

1. Older inmates have been identified as the fastest growing segment of federal and state prisons (Abner, 2006), and the costs of incarcerating older prisoners are estimated to be triple that of younger inmates. The American Civil Liberties Union (2012) have argued that “a growing number of life sentences have effectively turned many of our correctional facilities into veritable nursing homes” (p. i) and it has been suggested that “failure to begin addressing the problems and costs associated with older inmates may lead to a corrections crisis similar in proportion to that of the early nineteen nineties concerning the availability of inmate beds” (Florida House of Representatives Criminal Justice and Corrections Council Committee on Corrections, 1999).

2. The research adopts a human rights perspective. An object of the Victorian Charter is to safeguard and to develop human rights by understanding that all people are “free and equal in dignity and rights” (Department of Education and Early Childhood Development, 2012). The OP 17 Charter may lessen incidents of inequalities and promote equal opportunities (Department of Education and Early Childhood Development, 2012). When the State is making decisions it should not do so in a way that offends the Charter [Charter of Human Rights and Responsibilities Act 2006 (Vic)]. The Charter can develop dignity and equality of, for example, disadvantaged and vulnerable individuals.

3. Older prisoners are widely considered to be particularly vulnerable and at risk of victimisation in institutional settings (Abner, 2006; American Civil Liberties Union, 2012; HM Chief Inspector of Prisons, 2004; Human Rights Watch, 2012; Passau, 2008). Human Rights Watch (2012) attests “While human rights law does not preclude imprisonment of older offenders, the incarceration of the elderly nonetheless raises two major human rights concerns” (p. 87). The first is whether or not the imprisonment has conditions that are in keeping with human rights requisites; the second is whether or not the conditions are proportionate or inhumane. According to the Equality and Human Rights Commission (2009) a human rights approach can deliver “real improvements and drive systemic change in public services” (s. 10); with others observing that the approach may assist in the development of quality and consistency in service provision (e.g., Crook, 2001). 4. This research seeks to explore human rights issues as understood by correctional professionals (prison officers, parole officers and Board members, psychologists, social workers, the clergy, counsellors and lawyers). These may be linked, for example, to the safety, dignity, education, privacy and well-being of older prisoners. Safety can be an issue for older prisoners who seek to resist bulling or violence by younger prisoners (Cruise, 2012, p. 3; Davies, 2011, p. 6). 5. The underlying objectives of this research are to generate new knowledge about the needs and situations of older prisoners, understand more about the legal, pragmatic and ethical challenges that are faced by correctional professionals who work with or are involved with older prisoners, and to provide recommendations that can guide correctional professionals in their efforts to meet the legal, treatment, rehabilitative and reintegration needs of older prisoners. There are three research questions: 1) How can correctional professionals address the needs and rights of older prisoners? These needs include: emotional, physical and OP 17 social. Examples of correctional professionals include prison officers, parole officers and Board members, psychologists, social workers, the clergy, counsellors and lawyers. 2) How do correctional professionals understand the rights and needs of older prisoners? 3) How do correctional professionals who have had contact with older prisoners, understand their role with these prisoners?

Definition and Numbers of Older Prisoners

6. A starting point for this research is to understand how older prisoners are defined, and consider how many prisoners might be labelled as elderly under these definitions. In the United States and Australia, for example, individuals over the age of 50 may be considered to be ‘older’ (American Civil Liberties Union, 2012; Grant, 1999), although considerable differences exist between jurisdictions in both policy and practice. For example, Gubler and Petersilia (2006) refer to prisoners over the age of fifty-five as being older. In Canada, inmates who range from fifty to sixty four years may be labelled as being older. In the United Kingdom, prisoners who range from sixty to sixty five years are often classified as being older (see United Nations Office on Drugs and Crime, 2009). 7. What is clear is that the number of older prisoners is increasing in most western jurisdictions (Collins & Bird, 2006; Correctional Service of Canada, 2009; Grant, 1999; United Nations Office on Drugs and Crime, 2009). Abner (2006), for example, has observed that “some estimates suggest that the elder prisoner population has grown by as much as 750 percent in the last two decades” (p.8-9). During the period from 2007 to 2010, “the number of sentenced state and federal prisoners age 65 or older [in the US] increased by 63 percent” (Human Rights Watch, 2012, p. 6). As Howse (2002) notes: “the majority of prisons (90 per cent) have at least one prisoner of pensionable age, though in most cases the numbers are small – between one and five prisoners” (p. 45). 8. The apparent rise in the number of older prisoners is thought to be a result of individuals tending to live longer and thus having more opportunities to commit crime. It may also be because more offenders are being imprisoned and the mechanisms for early release are less available than they were previously (Human Rights Watch, 2012, 25). Retributionist laws, for example, three strikes legislation may also contribute to the influx of older prisoners (Abner, OP 17 2006, American Civil Liberties Union, 2012; Human Rights Watch, 2012; United Nations Office on Drugs and Crime, 2009; Williams, McGuire, Lindsay, Baillargeon, Cenzer, Lee & Kushel, 2010).

Groupings of Older Prisoners

9. Although older prisoners share common concerns and interests with other prisoners including, but not limited to “racial, ethnic, geographic, governmental, regional, social, cultural, partisan, or historic interests; county, municipal, or voting precinct boundaries; and commonality of communications” (Alabama State Legislature, 2011), they do have distinctive needs. It has been suggested, for example, that the loss of social relationships including through the death of family members and associates also takes a toll upon the mental health of some older prisoners. According to Murdoch, Morris and Holmes (2008) one of the most profound negative effects of prison on older prisoners is depression. 10. Needs may, nonetheless, vary between groupings of older prisoners who committed offences at different ages (Tomar, Treasaden & Shah, 2005). For example, those who committed violent at a young age and who have been incarcerated for a lengthy period of time often struggle to preserve and develop social and work-related links. Another example is chronic, or repeat, offenders who have been repeatedly imprisoned throughout their lives and have diminished communal and work-related supports. Finally, those who have been found culpable of having committed offences, including sex crimes, later in life. The American Civil Liberties Union (2012) identify four groupings of older prisoners:

1. those who were first imprisoned when they reached 50 or older for such crimes as homicide and sex-related crimes. 2. those who were first imprisoned before they reached the age of 50 and have remained in prison for 20 years for offences such as petty crimes or drugs. 3. chronic offenders who have served manifold periods of imprisonment and who were imprisoned under the age of 50 for offences including unlawful entry into premises, robbery or drugs. OP 17 4. those who were imprisoned for a sole offence prior to the age of 50 and who have not yet served 20 unbroken years for an offence including unlawful entry into premises, robbery or drugs.

Human Rights

11. In this research, particular attention is given to those aspects of human rights that are linked to dignity, privacy, education and equality (Manitoba Law Reform Commission, 1999; Madrid International Plan of Action on Ageing, 2002). These provide a useful lens through which to view the current way in which services respond to the needs of older prisoners. For example, Principle 12 of the United Nations Principles for Older Persons (1991) recognises the rights of older persons to be autonomous, and members of staff are responsible not to act in an arbitrary manner and to respect the autonomy of prisoners (Human Rights Watch, 2012, p. 62). Thus, at all times correctional professionals and prisoners should be treated with respect for their personhood (Human Rights Watch, 2012; United Nations Office on Drugs and Crime, 2009). 12. There are, of course, competing rights including those linked to individual and community rights. There are tensions between the rights of the community to be protected and personal ones (HM Chief Inspector of Prisons, 2004; Vess, 2010). The risk to the public in releasing some older prisoners may, however, be negligible. In their 2012 report, The American Civil Liberties Union recommend the use of conditional release for older prisoners who constitute minimum risk to the public, including the use of what has been termed ‘medical parole’ for those who may not be expected to live longer than twelve weeks (HM Chief Inspector of Prisons, 2004).

Dignity and Privacy

13. The dignity of older persons may be negatively impacted in prison (Strupp & Wilmott, 2005, p. 56). Respect for the inherent dignity and privacy of persons are key human rights principles (Article 8 of the European Convention on Human Rights, 1950; United Nations Principles for Older Persons, Principle 17; United Nations Office on Drugs and Crime, 2009). Older prisoners may not always enjoy the benefits of these rights. For example, prisoners who age in institutional care are likely to lose privacy. OP 17 Social and Political Liberties

14. The right to education is recognised by the United Nations (Basic Principles for the Treatment of Prisoners UN Doc A/RES/45/111 (1990) s 6; Office of the High Commissioner for Human Rights, 2009, [4]-[6]). The United Nations Office on Drugs and Crime (2009) has suggested that “staff bias against the participation of older prisoners in prisoner programs has been noted in some research… …factors that are associated with this bias include misconceptions that older prisoners are not likely to progress and resources to assist them are likely to be wasted” (p.125). On release in the community the educational and employment prospects of success are limited. Older prisoners may be too sick or disabled to find gainful employment or may not be eligible for work-related assistance because they have inadequate employment histories. Statistics suggest that “75% of ageing parolees will not have a high school diploma upon release and that 100% of ageing parolees will be unemployed due to illness (65%) or lack of work (35%)” (American Civil Liberties Union, 2012, p. xv).

Equality

15. Often human rights are linked to equality. Ward and Birgden (2007) refer to “equality before the law, and freedom from discrimination on the grounds of religion, gender, disability, or some other feature considered to be irrelevant for the ascription of individuals' moral status” (p. 631). Each individual without being subject to discriminatory practices should enjoy liberty, security of person, confidentiality, a satisfactory living standard, health maintenance and instruction (Council on Social Work Education, 2008, s 2.1.5). Both older and younger prisoners should enjoy security of person. The State has a duty of care to safeguard older prisoners from attacks from younger prisoners (Abner, 2006; Human Rights Watch, 2012; United Nations Office on Drugs and Crime, 2009). Older prisoners may not have the physical, cognitive and emotional strength to defend them against bullying and could be victimised by younger and other prisoners and staff (Human Rights Watch, 2012). Care also needs to be taken in the allocation of older prisoners to provide for their safety (United Nations Office on Drugs and Crime, 2009; Wilson, 2005). For example, older prisoners may become isolated, be unable to contact staff through a call system in their cells or hear staff call their names (HM Chief Inspector of Prisons, 2004). Adequate clothing should also be provided to give opportunities for older prisoners to participate in exercise programs (HM Chief Inspector of Prisons, 2004). OP 17 Safety and Wellbeing.

16. Broadly human rights include the right to life, not to be subject to violence, torture, degrading or discriminatory treatment (Brooke, 2001; Human Rights Watch, 2012; Kindred Saunders, Brunnee, Currie, McDorman, deMestral, Mickelson, Provost, Reif, Toope, & Williams, 2006; Singh, 2001; United Nations Office on Drugs and Crime, 2009). Prisoners, staff and the public have the right to be safe (HM Inspectorate of Prisons, 2004; Human Rights Watch, 2012; Scott & Ward, 2001; United Nations Office on Drugs and Crime, 2009; Wilson, 2005). 17. In conclusion, in this submission rights including dignity and privacy, social and political liberties linked to older prisoners have been outlined. This submission is an excerpt from University based research that joins researchers in Australia and Canada.

February 2013

OP 17

References

Abner, C. (2006). States Face Challenges of an Aging Inmate Population. USA: The Council of State Governments. Aday, R.H. (2003). Aging Prisoners Crisis in American Corrections. USA: Praeger Publishers The Alabama State Legislature (2011). Reapportionment Committee Guidelines for Congressional, Legislative, and State Board of Education Redistricting. Retrieved August 29, 2012, from Alabama Legislature web site: http://www.legislature.state.al.us/reapportionment/Guidelines.html American Civil Liberties Union (2012). At America’s Expense. The Mass Incarceration of the Elderly. USA: American Civil Liberties Union. Basic Principles for the Treatment of Prisoners UN Doc A/RES/45/111 (1990). Brooke, (2001). The European Convention on Human Rights: A Judge’s Perspective. In The Howard League for Penal Reform (ed), Human Rights and Penal Issues. London: The Howard League for Penal Reform, 4-8.

Charter of Human Rights and Responsibilities Act 2006 (Vic).

Collins, Rónán & Bird, Rachael (2007). The Penitentiary visit—a new role for geriatricians? Retrieved August 29, 2012 from Oxford Journals web site: http://ageing.oxfordjournals.org/content/36/1/11.full > Correctional Service Canada (2009). Forum on Corrections Research 6 (2). Ottawa: Correctional Service Canada. Retrieved August 29, 2012 from Correctional Service of Canada web site: http://www.csc-scc.gc.ca/text/pblct/forum/e062/e062j-eng.shtml

Council on Social Work Education (2008). Educational Policy and Accreditation Standards. USA: Council on Social Work Education. Crook, F. (2001). Foreword. In The Howard League for Penal Reform (ed), Human Rights and Penal Issues. London: The Howard League for Penal Reform, 2-3. OP 17 Cruise, C. (2012). In the Voice of America (ed), Longer Prison Terms Mean More Seniors Behind Bars. Retrieved November 14, 2012 from Voice of America web site: http://learningenglish.voanews.com/content/meeting-the-needs-of-elderly-prisoners- 148505265/611101.html

Davies, M. (2011). The Reintegration of Elderly Prisoners: An Exploration of Services Provided in England and Wales. Internet Journal of Criminology. Retrieved November 14, 2012, from Internet Journal of Criminology web site: http://www.internetjournalofcriminology.com/Davies_The_Reintegration_of_Elderly_Prisoners. pdf

Department of Education and Early Childhood Development, The Victorian Charter of Human Rights and Responsibilities, Implications and advice for schools. Retrieved October 12, 2012, from The Department of Education and Early Childhood Development web site: http://www.education.vic.gov.au/studentlearning/programs/multicultural/tchhrcharter.htm

Equality and Human Rights Commission (2009). Report of the Equality and Human Rights Commission. UK: Equality and Human Rights Commission. European Convention on Human Rights (1950) opened for signature on 4 November 1950 (enacted into force 3 September 1953). Florida House of Representatives Criminal Justice & Corrections Council Committee on Corrections (1999). An Examination of Elder Inmates Services An Aging Crisis. Florida: Florida House of Representatives. Retrieved August 29, 2012 from University of Illinois College of Law web site: http://www.law.illinois.edu/elderlaw/issues/vol_11/num_2/pdf/Burrow.web.pdf Grant, A. (1999). Elderly Inmates: Issues for Australia. Canberra: Australian Institute of Criminology. Gubler, T. and Petersilia, J. (2006). Elderly Prisoners are Literally Dying for Reform. CA: Stanford University HM Chief Inspector of Prisons (2004). No problems – old and quiet. Older prisoners in England and Wales. London Home Office. OP 17 Howse, K. (2002). Growing Older in Prison A Scoping Study on Older Prisoners. UK: Centre for Policy and Ageing and Prison Reform Trust. Human Rights Watch (2012). Old Behind Bars. The Aging Prison Population in the United States. USA: Human Rights Watch. Kindred, HM, Saunders, PM, Brunnee, J, Currie, RJ, McDorman, TL, deMestral, ALC, Mickelson, K, Provost, R, Reif, LC, Toope, SJ & Williams, SA (2006). International Law Chiefly as Interpreted and Applied in Canada (7th ed). Canada: Emond Montogomery. Madrid International Plan of Action on Ageing 2002. Retrieved October 14, 2012, from United Nations web site: http://social.un.org/index/Ageing/Resources/MadridInternationalPlanofActiononAgeing.aspx Mann, N. (2012). Doing Harder Time? The Experiences of an Ageing Male Prison Population in England and Wales. England: Ashgate Publishing Company Manitoba Law Reform Commission (1999). Informal Assessment of Competence. Manitoba: Manitoba Law Reform Commission. Murdoch, N., Morris, P. & Holmes, C. (2008). Depression in elderly life sentence prisoners. International Journal of Geriatric Psychiatry 23, 957-962. Office of the High Commissioner for Human Rights (2009). Prisoners’ Right to Education > Retrieved August 29, 2012 from United Nations web site: http://www.ohchr.org/EN/NewsEvents/Pages/Prisonersrighttoeducation.aspx Passau, C.K. (2008). Germany: Prison Specializes in Older Prisoners. Retrieved August 29, 2012 from Seniors World Chronicle web site: http://www.seniorsworldchronicle.com/2008/03/germany-prison-specializes-in-older.html Scott, J. & Ward, D. (2001). Human Rights and the Probation Service. In The Howard League for Penal Reform (ed), Human Rights and Penal Issues. London: The Howard League for Penal Reform, 31-36.

Wahidin, A. (2004). Older Women in the Criminal Justice System Running Out of Time. England: Jessica Kingsley Publishers

Singh, G. (2001). Criminal Justice, or Criminal Injustice. In The Howard League for Penal Reform (ed), Human Rights and Penal Issues. London: The Howard League for Penal Reform, 19-23. OP 17 Strupp, H. & Wilmott, D. (2005). Dignity Denied. The Price of Imprisoning Older Women in California. Retrieved November 14, 2012 from California Endowment web site: http://www.calendow.org/uploadedFiles/dignity_denied.pdf Tomar, R., Treasaden, I.H. & Shah, A.K. (2005). Is there a case for a specialist forensic psychiatry service for the elderly? International Journal of Geriatric Psychiatry 20, 51-56. United Nations Office on Drugs and Crime (2009). Handbook on Prisoners with special needs. New York: United Nations. United Nations Principles for Older Persons (1991). Resolution 46/91. Vess, J. (2010). Risk Assessment and Risk Management with Sex Offenders. Community Protection v’s Offender Rights. Vic: Deakin University Centre for Offender Reintegration. Ward, T. & Birgden, A. (2007). ‘Human rights and correctional clinical practice’, Aggression and Violent Behaviour, 12 (207) 628-643. Williams, B.A., McGuire, J., Lindsay, R.G., Baillargeon, J., Cenzer, I.S., Lee, S.J, & Kushel, M. (2010). Coming Home: Health Status and Homelessness Risk of Older Pre-Release Prisoners. Wilson, D. (2005), Death at the Hands of the State. London: The Howard League for Penal Reform. OP 18 Written evidence from the Criminal Justice Alliance1

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,

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. OP 18 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

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. OP 18 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 (e.g. through the introduction of indeterminate sentences for public protection, mandatory minimum sentences and

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. OP 18 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

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. OP 18 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.

28 Cooney, F. & Braggins, J. (2010), above n 6. 29 Ibid. 30 Ibid. 31 Ibid. OP 18

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

32 Cooney, F. & Braggins, J. (2010), above n 6. OP 19

Written submission by HM Chief Inspector of Prisons

SUMMARY

• HMI Prisons is an independent inspectorate and every prison inspection assesses whether older prisoners are treated equitably according to their individual needs. HMI Prisons has found that the needs of older prisoners are too often neglected. Our submission is based on individual inspections and two thematic inspections on the treatment and conditions of older prisoners. • Our inspection evidence suggests that because older prisoners are a largely compliant population, their specific needs may be overlooked in a system geared towards managing the much larger proportion of younger men. This remains a central issue today. • The needs of older prisoners and a supporting framework to meet these needs have not been clearly defined by a national NOMS strategy. This has resulted in significant variation across the prison estate in service provision for older prisoners. • A national NOMS strategy on older prisoners should set out a clear framework for delivery, define the responsibilities of the prisons and other agencies involved and include a common system for assessing the needs of older prisoners.

1. We welcome the opportunity to submit information to the Justice Committee’s inquiry into older prisoners. The needs of older prisoners are neglected too often and the lack of a clear strategy and defined responsibilities mean their treatment and conditions are frequently inadequate.

2. Her Majesty’s Inspectorate of Prisons (HMI Prisons) is an independent inspectorate whose duties are primarily set out in section 5A of the Prison Act 1952. HMI Prisons has a statutory duty to report on conditions for and treatment of those in prisons, young offender institutions and immigration facilities. HMI Prisons also inspects court custody; police custody and customs custody (jointly with HM Inspectorate of Constabulary); and secure training centres (with Ofsted).

3. HMI Prisons is one of the organisations that deliver the UK government’s obligations arising from its status as a party to the UN Optional Protocol to the Convention Against Torture. OPCAT requires state parties to implement a system of independent, preventative inspection of all place of detention.

4. All inspections are carried out against independent criteria based on relevant international human rights standards and norms which are known as Expectations. Expectations are brigaded under four healthy prison tests: Safety, Respect, Purposeful Activity and Resettlement. Our Expectation for older OP 19 prisoners is that they are ‘treated equitably and according to their individual needs’1.

5. In addition to individual inspections, we carry out thematic inspections into cross- cutting themes. We have carried out two thematic inspections into the treatment and conditions of older prisoners. The first, ‘No problems - old and quiet’ was published in 20042 and a follow up inspection which assessed progress was published in 20083. Our evidence is primarily based on individual establishment and thematic inspection findings.

Background

6. As of 30 September 2012, there were 9,913 prisoners aged 50 or over in England and Wales. This number included 3,333 aged 60 and over. Prisoners aged over 50 make up 11% of the prison population and this has risen from 7% in 2002. Prisoners aged 60 and over have almost doubled since 20024 and are the fastest growing age group in the prison estate.

7. The title of our 2004 thematic report ‘No problems – old and quiet’ came from an entry into a prisoner’s wing file. It reflected the reality that because older prisoners are a largely compliant population, their specific needs may be overlooked in a system geared towards managing the much larger proportion of younger men. This remains a central issue today. Now as then, older prisoners are not to be stereotyped. We find many that are active and determined to be as independent as possible. However, our inspection findings support the conclusions of much other research. In general:

• older prisoners are more likely to have health problems than the rest of the population and may have restricted mobility; • the effects of crime and victimisation against them are more serious because of the frailties that may be associated with their age; and • they are unlikely to be in work and training, have less income and may be isolated from friends and family.

8. For the purposes of inspection we consider older prisoners to be those aged fifty and above. This is because research5 suggests that using 50 years of age as a cut-off recognises that people age quicker while in prison; by up to 10 years more than their biological age prisoners age.

1 http://www.justice.gov.uk/downloads/about/hmipris/adult-expectations-2012.pdf?type=Finjan- Download&slot=00000123&id=00000522&location=0A64420E 2 http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmipris/thematic-reports-and-research- publications/hmp-thematic-older-04-rps.pdf?type=Finjan- Download&slot=0000012B&id=0000052A&location=0A64420E 3 http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmipris/thematic-reports-and-research- publications/older_prisoners_thematic-rps.pdf 4 Table A1.11, Ministry of Justice (2012) Offender Management Caseload Statistics 2011, London: Ministry of Justice 5 Wahidin, A. & Cain, M (Eds.) (2006) Ageing, crime and society. Willan Publishing: Devon. OP 19 Whether responsibilities for the mental and physical health and social care of older prisoners are clearly defined

9. The needs of older prisoners and a supporting framework to meet these needs have not been clearly defined by a national NOMS strategy. This has resulted in significant variation across the prison estate in service provision for older prisoners. Strategy appears to be developing at a local level, but there is no direction or coordination. During our most recent inspection of HMP Wandsworth6 we found that although there was an extremely diverse population, there was no strategy to ensure that the various needs of prisoners with protected characteristics were being identified and met. As a consequence for example, we found older prisoners who had not been able to access a shower for some weeks. In comparison, our most recent inspection of HMP Kirklevington Grange7 found a whole-prison needs assessment had been carried out within the previous 12 months and there was an effective single equality scheme with good promotion of each diversity area. Older men could request to be placed on quieter wings and there were designated activities such as gym sessions.

10. The needs of older prisoners not only encompass mental, physical, spiritual and social care needs but also wider practical, social and resettlement needs. Currently, prison responsibility appears shared between healthcare departments and equalities officers but the approach is often unsystematic and disjointed.

11. Service provision to address the health and social care requirements of older adults has been defined in the National Service Framework for Older People (DoH, 2001) (NSF)8. It highlights the importance of good liaison between prison healthcare staff and their colleagues in health and social care organisations in the community, to ensure that prisoners who are being released are assessed for and receive services which meet their continuing health and social care needs. However, adoption of the framework in prisons has been patchy.

12. Safeguarding has been included within HMIP expectations since January 2012. The expectation specifically states that:

• Prisoners, particularly adults at risk, are provided with a safe and secure environment which protects them from harm and neglect. They receive safe and effective care and support.

13. Safeguarding is an area which the prison service is beginning to address. However, our inspections have found little evidence that prisons are meeting their obligations in this regard. For example, in our most recent inspections of HMP

6 http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmipris/prison-and-yoi- inspections/wandsworth/wandsworth-2011.pdf?type=Finjan- Download&slot=0000012D&id=0000092C&location=0A644211 7 http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmipris/prison-and-yoi- inspections/kirklevington-grange/sept-2011-kirklevington-grange.pdf 8http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4071283. pdf OP 19 Gloucester9 and HMP Bullingdon10, there were no formal safeguarding procedures or strategy for prisoners at risk.

Whether the treatment of older prisoners complies with equality and human rights legislation

14. HMI Prisons Expectations are based on international human rights standards and norms. Each expectation is underpinned by a set of indicators that inspectors would expect to find if the expectation has been met.

15. The Expectation and indicators for older prisoners are as follows:

Expectation

Older prisoners are treated equitably and according to their individual needs.11

Indicators

• Following initial assessment on arrival, older prisoners have a care plan that involves the required range of staff and is reviewed regularly. • Any special accommodation for older prisoners has been designed based on advice from the NHS, social services and relevant voluntary agencies. • All staff working with older prisoners know how to recognise the signs of mental health problems and the onset of dementia. • Older prisoners who are retired or unfit to work are unlocked during the day and provided with access to appropriate and sufficient regime activities. • Minimum retirement pay is set at a level that is sufficient for those who do not have another source of income. • Prisoners over retirement age do not have to pay for their TV.

9 http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmipris/prison-and-yoi- inspections/gloucester/gloucester-2012.pdf 10 http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmipris/prison-and-yoi- inspections/bullingdon/bullingdon-2012.pdf 11 Relevant human rights standards from HMIP Expectations: Criteria for assessing the treatment of prisoners and conditions in prisons: • Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment (principle number 5) • Basic Principles for the Treatment of Prisoners (principal number 2) • Recommendation Rec (2006) 2 of the Committee of Ministers to member states on the European Prison Rules (principle numbers 13, 15.1, 16, 25, 74 and 81.3) • United Nations Principles for Older Persons (principle numbers 4, 5, 11, 12, 14 and 17) • Standard Minimum Rules for the Treatment of Prisoners (principle numbers 6, 24, 25 and 69)

OP 19 16. Age is a protected characteristic under the Equality Act and the prison service has issued PSI 32/2011 which describes the duties that prison staff have under the Act. Despite this, there is no guidance to staff about working with older people in their care.

17. Since October 2004, prisons have been subject to the Disability Discrimination Act which requires them to take all reasonable steps to ensure that prisoners with disabilities can access services. Prison Service Order 2855, Prisoners with Physical, Sensory and Mental Disabilities, contained a chapter on older prisoners, but it was largely focused on their health and mobility needs in the prison environment, rather than their general welfare. However, this PSO has now been replaced by PSI 32/2011, which does not refer to older prisoners.

18. With regard to female offenders, PSO 4800 contains a section which details how to work with older, female prisoners. It addresses the fact that older women will have different needs to that of other female prisoners, and that these needs should be addressed.

19. The lack of clearly defined responsibilities means that these fundamental rights are not consistently met. At its most basic level, too many older prisoners tell us they do not feel safe and are not treated with respect. In 20011/12 our inspections found:

• About two out of five older prisoners report12 that they had felt unsafe in the prison at some time and 15% stated they felt unsafe at the time of the inspection. • One in five older prisoners state they have been victimised by other prisoners. • 85% of older prisoners state that staff treat them with respect and 84% state they have a member of staff they can turn to with a problem. • We have found examples of older prisoners with mobility problems unable to use the showers and being required to access top bunk beds with associated risks to their health and safety. In some cases, prisoners had been unable to shower for some months and relied on other prisoners for assistance, exposing them to bullying. Some prisons have a formal system of using prisoners acting as carers for older prisoners who have difficulty in caring for all their own needs and provided carers are properly trained and supervised we welcome this.

The effectiveness with which the particular needs of older prisoners including health and social care, are met; and examples of good practice

20. The NSF recommended that a senior nurse has responsibility for older persons care within each area. However, within prison healthcare few establishments have a lead nurse for older prisoners in place. Most prisons have special clinics for older prisoners, but the service provided varies significantly concerning: quality; the age of prisoners targeted; the assessment tools used; and the support services available.

12 Survey results from prison inspections 2011/12 OP 19

21. There are few discrete services for older prisoners with complex needs who require greater supervision and support. This is compounded by restrictions that are placed on prisoners with mobility issues through, unsuitable prison environments and a reduction in prison inpatient beds.

22. Older prisoners are disadvantaged by limited access to community screening programmes including bowel and Abdominal Aortic Aneurysm (AAA) screening. This is despite the fact that AAA is more likely to be found in males over the age of 65 and bowel screening in the community is specifically offered to those people over the age of 60.

23. Since our original thematic report on older prisoners, we have found that palliative care has generally improved. However, we endorse the concerns raised by the Prison and Probation Ombudsman Annual Report 2011/2012 about the use of restraints on seriously ill, older prisoners, in hospital and his view that they should be able to ‘die with dignity’.

24. 70% of older prisoners report that they are taking medication compared with 44% of the prison population as a whole. Prescribing and medicines administration practice is often weak and this may make older prisoners a target for bullying.

25. Our 2012 annual report noted that although older prisoners in some establishments may be unlocked during the day, there was often little activity available for them. Some prisons provide day centres but this is not typical.

26. Older prisoners may receive retirement ‘pay’ of £2.50 a week. They will often have to pay 50p/week for a television and this leaves very little for other necessities.

27. Although some prison gyms provide sessions for older prisoners, overall older prisoners are significantly less likely to use the gym or take other healthy exercise than other prisoners.

28. Examples of good practice we have found include HMP Leyhill, an holding men serving long sentences, included:

• ‘The Lobster Pot’, a day care centre run by the Resettlement and Care for Older Ex-offenders and Prisoners for the over 50s population, which was an excellent resource. The various activities on offer, which attracted approximately two thirds of over 50s, included training and allowed staff to conduct a dynamic assessment of needs. As a result, the provision was evolving accordingly. • Many, but not all, older men were located on B wing, and some benefited from the prisoner carers who worked there. There was a shortage of trained and paid prisoner carers, and a number of men helped out on a volunteer basis. • Retirement pay was £8 a week in contrast with a working wage of around £12.50, so this was comparatively low, but better than we often see. Men over 65 could apply for a free television. OP 19

29. In our last inspection of HMP Kingston in 2010, older prisoners made up one third of the prisoner population. Many of these were men who had served long sentences. Work was progressing in this area. For example a popular wallet card system had been introduced for older prisoners, to remind them to attend healthcare appointments and the overarching policy document contained information on the prison’s legal obligations for all strands of diversity, with sub- sections on disability, older prisoners and sexual orientation. The closure of HMP Kingston was announced in January 2013.

30. Other examples of good practice include: • HMP Wakefield – excellent gym and activities available for older prisoners; • HMP Northumberland – older prisoner meetings; and • HMP Whatton – excellent palliative care and lead nurse in place.

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

31. Older prisoners may have widely variable physical, mental and social needs. However, older prisoners require first what all prisoners require:

• Safety. • To be treated with respect for their human dignity. • To be able to be able to take part activity likely to benefit them. • To be helped to resettle successfully and reduce the risk that they will reoffend.

32. Specifically, older prisoners should have:

• A care plan based on an individual assessment of their needs that is regularly reviewed; • Reasonable adjustments to the prison’s physical environment and regime so that they can access all services and facilities; • Healthcare equivalent to that offered in the community; • Activity tailored to their needs and interests – which may often be best provided, at least in part, by a day care facility; • Income sufficient to maintain a reasonable standard of prison life; • Access where required and wished to a support group and advocates; • Help to resettle successfully after release and access relevant entitlements in the community; • Reintegration support for older prisoners who are being released after long sentences; and • Support from all staff who are aware of the needs of older prisoners and specialist support where required.

33. The barriers to achieving an effective regime and environment include the lack of a cohesive, national strategy which recognises the individual needs of older prisoners and clearly defines responsibility; a lack training to help staff understand and meet the needs of older prisoners; a limit in the number of appropriate activity OP 19 places for older prisoners; and a lack of resources in order to overcome environmental challenges.

The effectiveness of training given to prison staff to deal with the particular needs of older prisoners, including mental illness and palliative care

34. With regard to mental health, statistics suggest13 that over half of all elderly prisoners suffer from a mental disorder. Insufficient staff are being trained in mental health awareness and therefore few have the ability to identify the early onset of mental health problems, including dementia.

35. The Mental Health Foundation has recently published ‘Losing track of time’14 - research on dementia among the increasing number of older prisoners. This research concentrates on existing evidence as well as new research on managing and treating male offenders with cognitive impairment and dementia. It identifies the challenges and shares examples of good practice used in 14 prisons worldwide, including eight English prisons.

36. Although our inspections have found that palliative care has generally improved, this needs to be consolidated. There is no PSO or service provision relating to it. The study “Dying behind bars: an evaluation of end of life care in prisons in Cumbria and Lancashire”15 found many prison staff had little experience of caring for prisoners with palliative needs and many specialist community staff have little experience of prisons. The study identified a range of barriers to good end of life care.

37. Some prisoners who have served long sentences and for whom the prison is effectively their home, wish to die there. This requires greater co-ordination between health commissioners and prisons. At HMP Leyhill for instance, inspectors found in 2012 that an excellent palliative care suite had been developed – but the funds had not been identified to run it.

The effectiveness of arrangements for resettlement of older prisoners

38. There are challenges linked to post-release risk management needs, as the late identification of release addresses may hamper effective discharge planning.

39. In our 2008 follow-up report to the older prisoner thematic, we had grave concerns that the social care needs, in particular, of older and disabled prisoners were not planned or provided for, after release. Overall, we found that there was little in the way of specific resettlement help for the older population. We believe that this is still an issue.

13 HM Chief Inspector of Prisons for England and Wales (2008) Annual Report 2006-07, London: The Stationary Office 14 http://www.mentalhealth.org.uk/content/site/publications/losing-track-of-time 15 http://www.lancs.ac.uk/shm/research/ioelc/groups/media/mturner_150410.pdf OP 19 40. Many older prisoners will in turn have older visitors – an older spouse for instance. It is particularly important that older prisoners are held close to their homes and that visit facilities are accessible to visitors with mobility difficulties.

Whether a national strategy for the treatment of older prisoners should be established; and if so what it should contain

41. Within the 2008 follow up report to our older prisoners thematic16, we called for a NOMS national strategy for older prisoners. NOMS and the Department of Health are assessing the possibility of a national allocations strategy for people with significant care needs.

42. A national strategy should ensure that prisons are able and expected to meet the needs identified above and set out minimum standards.

43. It should set out a clear framework for delivery, define the responsibilities of the prisons and other agencies involved and include a common system for assessing the needs of older prisoners.

Nick Hardwick HM Chief Inspector of Prisons March 2013

16 http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmipris/thematic-reports-and-research- publications/older_prisoners_thematic-rps.pdf OP 20 Written submission from NEPACS

Introduction

NEPACS and its forerunners have been working in the north east of England to 'Build bridges for prisoners, their families and the community' for 130 years. During this time, the structure of the organisation and the activities we undertake have changed, but our commitment to helping people affected by imprisonment remains constant.

• NEPACS works in prisons across the north east of England and we welcome over 100,000 visits through our centres each year. • NEPACS provides tea bars and staffs play areas within the prison visits rooms and organises special visits for children so they can spend quality time with their parent, learning through organised play activities. • NEPACS helps about 500 offenders and/or their families each year with a small grant to help them through financial difficulties and get their lives straight. • NEPACS provides free caravan holiday breaks for up to 40 families with a relative in prison each year. • NEPACS promotes good practice in resettlement through our Annual Awards and raises awareness through public lectures and events.

Much of our work is delivered by volunteers, who bring energy, warmth and friendship and ensure a warm welcome to all.

Summary

• NEPACS organised a national conference on ‘The Isolated Prisoner’ in April 2009 (see report on our website www.nepacs.co.uk) which recognized this as a growing issue in our prisons. • The age profile for prisoners has increased, partly due to the conviction of sex offenders who may have committed their offences many years ago. Those prisoners who lose or perhaps never have had contact with family of friends can face years of incarceration with no visits and no support outside the prison, and this makes release a daunting prospect. • Prisoners can ‘retire’ from work at 55, and subsequently have little ‘purposeful activity’ • Some excellent initiatives have been recognised through NEPACS’ awards scheme. • Good practice exists in pockets – for example, lifer days and adult only visits – but a reliance on charity (e.g. NEPACS grants) for basic needs is not good enough. A policy decision must be made on whether the duty of care for frail and elderly prisoners falls on the prison, social services or healthcare providers. • There is scope to develop schemes which address social isolation and help advocate for appropriate support on resettlement – but will resources be forthcoming if this isn’t a ‘reducing reoffending’ priority?

1). Examples from NEPACS’ work in prisons in the north east OP 20 Many prisoners find it hard to cope with the noise on main locations and in the gym with loud music etc. HMP Frankland and Northumberland have developed “older” (over 55) wings, specific times for going to the gym and now special / quieter visits sessions including ‘Lifer Days’ at which prisoners without any family visitors can enjoy relaxed time out of their cell with social activities like quizzes and bingo etc.

One prisoner who attended the more relaxed "older visit" said ‘I just want to be able to choose a nice cake.’ (For my Mam).

HMP Frankland has a ‘nostalgia group’ for older prisoners.

There is a significant issue with health/ disability / personal care. Many prisons rely on fellow prisoners / Buddies performing tasks such as getting meals, laundry, pushing wheel chairs etc. for their peers. One example is of prisoner with a colostomy bag who is taken down to health care once a week to have a shower and clean change of clothes. Whose job is this? It is not within a job description but it is part of daily care ‐ the prisoner should not and would not want to spend the rest of his life on the health care unit.

2). North East Offender Health report

North East Offender Health have produced a report on the Social Care Project at HMP Frankland (Angela Craggs June 2012).

Recommendations included:

Occupation/Activity

• There is a clear need to develop occupation and activity for those with identified needs who are excluded from current provisions. This should also be available to those of retirement age to ensure they are socially included and mentally stimulated. The development of sessions which is accessible to all including those with mobility issues, which is meaningful, purposeful and rewarding. A joined up approach from services could deliver such a service. • Development of an Activities coordinator for over 55's and those with specific needs, who are excluded from any other activity, who could develop and implement an activity program

Equipment

• The DLO currently provides the majority of equipment; they have no formal training in this area. The securing of an Occupational Therapist to undertake assessments of daily living, who could also to support with equipment provision and location on wings of items such as grab rails, access, appropriate chairs, stairs assessment. This could provide a prompt service OP 20 • Disability Equipment budget is limited and some items provided are accessible through Home Loans, having a specialist assessment could be cost effective to the Prison service and equipment can be returned when no longer required. • It was identified that in the event of a fall either on the wing or in the cell, there is no current mobile lifting equipment to assist a prisoner up. This could have implications for Health and Safety if staff were expected to assist someone following a fall. One solution would be to purchase a Mangar, which is portable inflatable lifting device. • Consideration needs to be given in the event of a prisoner requiring access to minicom or Braille, at present there is no provision for this.

Prison

• It appeared that there was a general lack of awareness and understanding by disciplined staff regarding disability and old age, and the impact this has on daily living. Development of a training session to raise awareness on disability and age related issues would be advantageous; this could be undertaken as part of the induction program which every staff member undertakes upon entering the prison. • Currently there is no training program for those taking on the Buddy role, this could be developed to enhance the role and reduce risk. Currently the Buddy scheme is undertaken by a member of disciplined staff on a voluntary basis, support in developing this role further would be advantageous to staff, prisoners and those undertaking the role of Buddy’s • Ideally an environment which is specifically for older prisoners and those with disability which is functional and capable of meeting identified needs. Ideally a progressive wing which would enable a pathway to accessing specific needs unit if and when disability or needs require. Alternatively adapt all bottom one landings to allow for developing older and disabled population with disabled access on the wing and into the exercise areas.

Social Care

• Generally prisoners did not feel that disability was assessed and supported upon entering the prison, nor did they feel that needs were addressed through care planning or shared with appropriate agencies within the prison service. Development of a Social Care Pathway would ensure that needs are assessed at point of entry and supported throughout the duration of time spent in Frankland Prison. • There is also clear anxiety regarding moving on from prison into the community, The social care pathway would allow for joined up working to address needs prior to release and liaison with the local authority to ensure provision is in place. It could also assist in the securing of benefits to ensure financial stability upon release. Social care would also be able to act in an advisory role when specialist care/environments are required to support individuals on release. • Further concerns are when prisoners are transferred to different prisons and they are fearful that their needs will not be acknowledged or addressed. The Social Care OP 20 Pathway would provide the opportunity for information in relation to their assessed needs being shared with the receiving prison. • There is limited support for families whilst they have a relative in prison and on progression to the community. A role specifically to deal with disability and older prisoner issues and liaison for family, this role could link in with NEPACS or take referrals from them when issues arise.

3).What happens on release?

There was a time when older prisoners were released to approved accommodation where they would get the necessary support and assistance, but now the criteria for approved premises is high risk only.

A recent example of an application to the NEPACS grant scheme was from a Probation Officer on behalf of a 74 year old gentleman on life license. He was recalled to HMP Durham from his home in Preston. When due for release in December 2012 he owned no coat or winter clothing since the prison only supply T shirt and jeans.

He suffers from severe arthritis in both hands and feet and also has problems with his memory. As he has been unable to work within the prison he has no savings, nor has he any family support. NEPACS were able to supply winter clothing, but prison staff expressed their anxiety as to his ability to reach a hostel in the north west without assistance. Eventually it was agreed to transfer him to HMP Preston and organise transport from there, but the concern is that he may offend again with a view to returning to the security of a prison environment.

Another example is a 61 year old gentleman who has been in custody since 1974 – 39 years. He suffers from emphysema and has thus been unable to work in custody.

He is currently at HMP Kirklevington and is due for home leave. However, having no family support he will spend this time in St Cuthbert’s bail hostel in Gateshead. NEPACS have agree to support him with a small grant for each leave. He remains very vulnerable, with no contacts in the community.

4). Dealing with (natural) deaths in custody

A nationally acknowledged example of best practice (which was honoured with a NEPACS award) is the partnership between HMP Frankland, Care UK and MacMillan nurses, who have developed an ‘end of life’ care pathway for long‐term prisoners who will never be released.

The aim of the pathway is to provide:

• Timely assessment of need, care planning and review OP 20 • Seamless patient pathways of care

• Excellent palliative and End Of Life Care

• Equity of access to services

• Standards that include effective systems and processes

• Workforce development appropriate to all staff and patient need

The learning from this project is now being applied at other prisons in the north east.

5). Ideas for future developments

Social care needs of prisoners should be picked up by local authorities as they would be in the community, however, there is a disconnected ‘host and home’ issue to deal with. This is analogous to the experience NEPACS has with engaging with local authority Children’s services to support children of prisoners.

The voluntary sector could provide a greater role in befriending older prisoners and providing social support. This could happen via developing and supporting peer support / buddying schemes within the prison; Official Prison Visitors maintaining contact with individuals, and agencies such as NEPACS recognising the diversity of family structures (e.g. developing adult only visits sessions) and replicating the special sessions which families can enjoy for those without family to enable some social stimulation and connection with the outside world.

The key question is whether there will be a policy commitment to address these issues and invest the resources required.

March 2013 OP 21

Written submission from POA, The Professional Trades Union for Prison, Correctional and Secure Psychiatric Workers

Introduction

The number of elderly prisoners has increased within our prisons. Prisoners grow old in prison, having received lengthy sentences while others receive custodial sentences late in life. These prisoner groups have difficult and challenging needs.

Predictions on the size of the prison population are difficult to predict but the policy of the current Government and the effect on the prison regime will do little to improve the conditions of older prisoners.

THE OPERATIONAL ENVIRONMENT

1. The budget cuts reduce staffing levels and impoverish regimes to create a negative impact on safety, decency, purposeful and appropriate activity, rehabilitation and maintenance of family and community ties. These cuts in our opinion impact the aged prison population.

2. Government have pressed ahead with privatisation and prison closures to the detriment of the aging prison population. The new, for old policy in respect of accommodation and facilities, has not addressed the needs of the aging prison population.

3. Prisons are designed to hold and control offenders with little thought for their physical requirements or their health needs.

4. Prisoners with moderate levels of physical infirmity find it difficult, sometimes impossible, to access all areas of the prison.

5. Prisoners with chronic health problems find themselves being accommodated in the prison hospitals as this is the only suitable accommodation (potentially indirect discrimination).

6. Often the programmes and services provided by the prison are inappropriate for aged prisoners with the result that aged prisoners have little, if any access to purposeful activity.

7. Prisoners with disabilities or special needs are often transferred out of their local prison or to a prison which can accommodate their needs. This is a problem that has existed for many years and results in poor family relationships and ties.

8. The POA accepts that many organisations are involved in prisoner’s welfare but it is the responsibility of frontline uniformed professional Prison Staff to manage their daily needs.

OP 21 9. If it is accepted that people are living longer, there has to be a correlation between the numbers of older offenders being convicted of criminal offences which receive custodial sentences.

10. As more prisoners receive longer custodial sentences, more prisoners will age and die in prison.

11. 10 years ago, former Chief Inspector of Prisons Lord Ramsbotham stated that the Prison Service should have “a fully developed strategy for the growing number of elderly prisoners”

12. In 2002 the Department of Health and the Home Office announced that, as from April 2003, the NHS would begin to take responsibility for prison healthcare and hold full operational responsibility for it from 2008.

13. Some of the implications of the proposed changes for older prisoners (as well as the published National Service Framework for Older People) were made explicit in the joint Prison Service and Department of Health ‘Report of a Working Group on Doctors Working in Prisons’, which recommended that:

14. “As part of the health needs assessment process, prisons, health authorities and primary care groups/trusts review the needs of older prisoners and those with a disability and take steps to ensure that they have access to the same range of professionals and services that are available to these groups in the community. There needs to be a greater emphasis placed on providing both groups with a healthy and suitable regime”.

15. Following this report changes were introduced. However further cost cutting have meant that these changes have not proven to be effective whilst the numbers of older prisoners has increased.

16. Do aged prisoners have different needs than younger prisoners and if so, are the current policies and practices fit for purpose?

17. In our opinion many older prisoners are facing not just the effects of incarceration, but the unintended consequences that institutions are unable to provide for their particular needs. (Indirect Discrimination.)

GENERAL HEALTH ISSUES

Health problems from mild aches and pains to the most devastating illnesses do not go away when offenders are sent to prison. Prisoners may be loath to admit to illnesses for fear of being bullied and staff may not have the time or skills to identify the problem.

Alzheimer's & Dementia Alzheimer's disease is the most common form of dementia. There are OP 21 other types of dementias, memory loss and impaired cognitive function that impact seniors.

Parkinson's disease Parkinson's disease is a chronic, neurological disorder that affects nerve cells in the part of the brain that controls muscle movement.

Incontinence Incontinence, or loss of bladder control, can happen for a number of reasons. Whether it's temporary or chronic, it's unpleasant. It also can lead to emotional distress.

Cancer Cancer is a group of more than 100 diseases in which abnormal cells grow out of control, thereby invading other parts of the body. There were more than 1.5 million new cases of cancer reported every year.

Heart Disease Heart disease—whether it's a heart attack, stroke, cardiac arrest, high blood pressure, peripheral artery disease, or another cardiovascular condition.

Arthritis Arthritis is a painful condition that can strike the spine, neck, back, shoulder, hands and wrists, hip, knee, ankle, and feet. It can be immobilizing, and it comes in many forms.

Vision & Eye Diseases Macular degeneration, cataracts, glaucoma, presbyopia, and retinal disorders are just some eye diseases that can reduce a senior's ability to see well.

Diabetes Having high blood glucose levels is the hallmark of diabetes, a group of diseases that affects the body's ability to produce or use insulin correctly.

Sleep Disorders Sleep disorders—whether insomnia, sleep apnoea, or movement disorders—all can rob elderly people of needed sleep. Disruption in sleep patterns can lead to more problems than just making the elderly feel more fatigued.

Depression Depression is a serious medical illness. It’s more than just feeling "down in the dumps" or "blue" for a few days. It can be mild or so major that it's disabling and it can also be hard to recognize.

Hearing Loss It is accepted that between the ages of 65 and 74 hearing problems occur. That statistic increases with age. Yet only one in five people OP 21 who could benefit from a hearing aid actually wears one how this compares in prison is not known.

Osteoporosis Osteoporosis is a condition that causes bones to break more easily and take longer to heal. As a result, even minor falls can land elderly people in hospital.

Lung Disease Lung diseases can diminish an elderly persons ability to breathe well. While many types of lung problems can be treated or prevented, they can be serious, with major complications.

The POA accepts that the vast majority of these illnesses would be picked up by the Healthcare profession in the community. Some may not have been in prison and if left untreated they can lead to violence, bullying and or serious acts of self-harm or self-inflicted deaths as older prisoners come to terms with prison life and change.

The cost of looking after an ageing prison population as a result of associated health problems needs to be considered as part of any proposals.

PHYSICAL BARRIERS

A physical barrier is when a person can’t access the care they want or need because of a physical problem like a walking difficulty or a wheelchair access. In prisons these are often exacerbated due to the design of the building and structure of the regime.

A simple activity like collecting a meal in some prisons can be extremely difficult for an elderly prisoner. Some elderly prisoners may need the use of a walking stick so simple tasks become difficult and pride often prevents help for other prisoners no matter how well intentioned.

The vast majority of elderly prisoners are located on the lower landings to assist them in their daily movements but due to the pace of the regime they can often find themselves in the way or holding up the routine which often causes them to lose self-esteem for example.

CONCLUSION The care and wellbeing of the ageing prison population is a serious issue that if left unaddressed will create long term operational difficulties for the service. We currently have female, juvenile and young offender and a high security estate but no estate to deal with the older population perhaps this is something that should be considered as part of the process.

March 2013

OP 22 Written submission from Prisons and Probation Ombudsman

Background

1. When I appeared before the Justice Select Committee for confirmation of my appointment, I indicated that a key part of my vision for my new office was increasingly to identify and disseminate lessons from investigations which deserved to be learned by the services in remit. This occurs routinely in individual investigations, where recommendations may be made for improvement, but it should also be possible to contribute more generally to improvement in custody by identifying broader lessons from a number of cases. To this end, I have created a new series of learning lessons bulletins, as well as continuing to produce thematic studies. Some of these touch on the Committee’s interest in exploring the effectiveness with which the particular needs of older prisoners are met and good practice.

2. I am conscious that the Committee has guidelines on the submission of written evidence which are transgressed by attaching documents which together constitute more than 3000 words. I therefore briefly identify key issues below and leave it to the Committee as to whether the full documents (published in PDF format but provided here in Word version) are required for reference.

Learning lessons about older prisoners from death in custody investigations

3. The majority of deaths investigated by my office are from natural causes. Last year we investigated 142 deaths from natural causes (a rise of 16% on the year before)1, of whom 132 were serving prisoners, three were immigration detainees and seven were living in approved premises. Older prisoners made up a high proportion of these deaths, with nearly half (70) having been aged over 60.

4. These deaths reflect an ageing prison population; a changing demographic linked to conviction of offenders later in life and increasing sentence length. While prisoners of all ages can suffer serious health issues, health problems increase with age. It is remarkable that, although still a small proportion (4%) of the total prison population, those over 60 are now the fastest growing age group in custody. The number of sentenced prisoners aged 60 and over more than doubled over the past ten years, from 1,376 in 2002 to 3,333 in 20122. This poses a significant challenge to a prison system originally more geared to a younger population.

5. A brief description is provided below of findings from three recent publications which present collective learning from investigations into deaths in custody undertaken by my office and which may be of interest to the

1 Prisons and Probation Ombudsman Annual Report 2011-12, statistical tables, p45 2 Table A1.11, Ministry of Justice (2012) Offender Management Caseload Statistics 2011, London, Ministry of Justice OP 22 Committee. In summary, the reports suggest some commendable progress in the treatment of older prisoners by the Prison Service, in conjunction with the department of Health and various charities. Thus at a time of competing pressures, much has been done to improve end of life care for many prisoners dying in prison. However, the improvements are not uniform and in some areas, for example the use of restraints on terminally ill prisoners, my investigations too often found that the Prison Service got the balance wrong between care and decency.

• Learning from PPO investigations: Natural cause deaths in prison custody 2007-2010 (March 2012). This thematic report provides summary data on 402 deaths during this period. The report looked at equivalence of care with the community (as judged by the independent clinical reviewers’ commissioned to contribute to my investigations). Equivalence of care was found to increase with age, with nearly 85% of those who died aged over 55 being judged to have had care equivalent to that they might have expected in the community, compared to only 72% of those under 55. Those whose deaths were reasonably foreseeable, either due to a terminal illness or multiple chronic conditions and old age, were also more likely to be judged as having received equivalent care.

• Learning Lessons Bulletin 2: Use of restraints in fatal incidents (February 2013). This short bulletin noted that the care of increasing numbers of seriously ill and dying prisoners poses a growing challenge for the Prison Service, particularly as the population ages. Improvements, for example better palliative care were noted but investigations too frequently identified inappropriate use of restraints on seriously ill prisoners being taken to hospital or hospice for treatment. The principal responsibility of the Prison Service is to protect the public but too many prisons struggled to balance appropriately security with humane treatment for the increasing numbers of prisoners dying in their care. Suggested lessons included the need to adjust risk assessments to take account of the current health and mobility of prisoners, and the need to consider medical opinion.

• Learning from PPO investigations: End of life care (publication due 27 March 2013). Currently in draft form, this thematic report presents a review of 214 fatal incident investigations into foreseeable natural cause deaths, of which 58 per cent were of prisoners aged over 60. Commendably, the majority of prisoners (85%) received care which was assessed by our clinical reviewers as being equivalent to what they might have expected in the community, but there was still a good deal of variation between prisons. For example, a third of these prisoners did not have a palliative care plan in place. Learning points for prisons focussed on full implementation of end of life care plans, better involvement of prisoners’ families and, once again, avoiding inappropriate use of restraints. OP 22

I and my office are at the Committee’s disposal should you require further information or clarification.

Yours sincerely

Nigel Newcomen CBE Prisons and Probation Ombudsman March 2013

OP 23 Written evidence from Offender Health Research Network

Summary

• Senior et al. (2012) conducted a large scale research study regarding health and social care services for older adult men in prison. • This project was commissioned by the NIHR Service Delivery and Organisation (NIHR SDO) programme under the management of the National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre (NETSCC) based at the University of Southampton. From January 2012, the NIHR SDO programme merged with the NIHR Health Services Research (NIHR HSR) programme to establish the new NIHR Health Services and Delivery Research (NIHR HS&DR) programme. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR HS&DR programme, NIHR, NHS or the Department of Health. • The research was funded by the National Institute for Health Research and took place over three and a half years, concluding August 2012. • The research programme was a mixed‐methods study divided into the following four parts. 1. A study of all prisons in England and Wales housing adult men, establishing the current availability and degree of integration of health and social care services for older adults; 2. Establishing the health and social care needs of older men entering prison, including their experiences of reception into custody; 3. The development, implementation and evaluation of an intervention to identify and manage the health, social care and custodial needs of older men entering prison; and 4. Exploring the health and social care needs of older men released from prison into the community. • Key findings pertinent to this inquiry into older prisoners include: o A lack of accountability and clarity regarding the responsibility for addressing the social care needs of older prisoners; o That, on entry into prison, older prisoners’ highest proportions of unmet needs were in the domains of information about their care and treatment, psychological distress and daytime activities; o The Older prisoner Health and Social Care Assessment and Plan (OHSCAP) was developed through action learning as part of the research. It is a structured approach for identifying and managing older prisoners’ needs. We concluded it was possible for a Prison Officer to deliver the intervention successfully. It was considered to be acceptable, feasible and of value to staff and prisoners; and o Release planning for older prisoners is generally inadequate.

OP 23 Whether responsibilities for the mental and physical health and social care of older prisoners are clearly defined.

• Interviews were held with 32 staff members including prison, healthcare and external agency staff (such as community‐based social care services and specialist older age organisations). • The findings identified a lack of integration between health and social care services due to ambiguity regarding responsibility for meeting older prisoners’ social care needs. • A prominent theme that emerged was the ambiguity staff felt around whom, or which disciplines/agencies were, properly responsible for providing social care to prisoners. Problems around the integration between the prison and community‐based services were a recurring theme and were, in the majority of cases, felt to be non‐existent. Even when integration existed, relationships between prisons and social services were generally considered to be strained. One interviewee described how prison staff often considered the social care of older prisoners to be the responsibility of other prisoners rather than staff and therefore other prisoners would often be left to assist older prisoners with their social care needs without adequate training to undertake such tasks. • Geographical limitations were highlighted as a significant barrier to effective integrative working. Many prisoners, particularly those serving long sentences, do not reside in prisons in their home area. Additionally, people are often transferred routinely between a number of establishments during their sentence and ongoing care from outside, or prison‐based, agencies is often considered to be insufficient a priority to keep an older person in one particular establishment. This can create tension between the prison and local social care services. A Social Worker in the mental health in‐reach team illustrated this by detailing an experience of contacting a local authority on behalf of a prisoner, outside of the area in which their current prison was situated. He described a laborious process of trying to get staff in the person’s home local authority area to accept that the prisoner was originally from their area. The local authority instead stated that the prisoner should be released to the area in which the prison was located, an area to which the prisoner had no home or family ties to help with successful community reintegration.

The effectiveness with which the particular needs of older prisoners including health and social care, are met; and examples of good practice.

• Our study assessed the unmet needs of recently incarcerated older prisoners, as well as capturing their experiences of being received into prison custody. Results from the Camberwell Assessment of Need – Short Forensic Version (CANFOR‐S, Thomas et al., 2003) showed that the highest proportions of unmet needs were in the domains of information about condition and treatment (38%); psychological distress (34%); daytime activities (29%); benefits (28%) and physical health (21%). Full results are given in table in Appendix 1. • Analysis of Geriatric Depression Scale (GDS; Sheikh & Yesavage, 1986) found that nearly one third of our sample (31.4%;n=27) reached the cut‐off score for mild depression and nearly one quarter (23.3%; n = 20) reached the cut‐off for severe depression. • Only eight (17%) of those showing signs of depression were receiving anti‐depressant medication and five (12%) had contact with a Mental Health Nurse during their initial four weeks of custody.

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

OP 23 N/A

2. The effectiveness of training given to prison staff to deal with the particular needs of older prisoners, including mental illness and palliative care.

• Example of good practice – The Older Prisoner Health and Social Care Assessment and Plan (OHSCAP) was developed by an Action Learning Group including older prisoners, healthcare staff and prison staff. The group decided that the Older Prisoner Lead (OPL), usually a prison officer, was the most appropriate person to deliver the OHSCAP. The OPL successfully delivered the OHSCAP and older prisoners found him to be helpful, professional and felt at ease talking to him. A copy of the OHSCAP is included in appendix 2.

3. The role of the voluntary and community sector and private sector in the provision of care for older people in leaving prison.

N/A

4. The effectiveness of arrangements for resettlement of older prisoners.

• Qualitative interviews were carried out with prisoners in custody who had four weeks left to serve, with follow‐up interviews in the community within four weeks of release. Sixty two prisoners were interviewed in prison and 45 (73%) were successfully followed up on release (73%). • Release planning for older prisoners was frequently non‐existent. When asked about the plans for release, prior to their discharge, the majority of prisoners simply stated that no plans had been made. It was their perception that their release was not being planned at all. They described that this caused high level of anxiety in the months, weeks and days prior to release. • A number of participants were unaware of where they were going to be living until a few days prior to their discharge from prison. A lack of information about where older prisoners would be housed was a key contributor to these high levels of anxiety and provided a key barrier for the older prisoner to plan their release. In particular, older prisoners were particularly anxious about the prospect of residing in probation approved premises. The provision of pre‐release courses was ad hoc and where such courses were provided, information was not tailored to the needs of older prisoners. There was a perception that there had been minimal or no contact with Probation Workers and Offender Managers in preparation for release. • Once released, anxiety levels were generally reduced, largely as a result of people being generally satisfied with their placement in approved premises, despite their foreboding about it whilst still in custody. Those in approved premises tended to report that their immediate health and social care needs were largely well met. Those residing in approved premises generally considered themselves to be in a transitional period, where they had not been fully released into the community. • Those who were residing in probation approved premises had fewer unmet needs on release than those who were not. Such participants were more likely to perceive their health and social care needs to be unmet on release, even though they did not always anticipate

OP 23 that they would require support on release. Their unmet needs varied but included a lack of support with finance and employment, and being inappropriately housed.

5. Whether the treatment of older prisoners complies with equality and human rights legislation.

N/A

6. Whether a national strategy for the treatment of older prisoners should be established; and if so what it should contain.

The evidence from the current study suggests the following:

1. Fundamental adaptations to prison buildings are still required to allow older prisoners with mobility difficulties physical access to services and facilities fully in accordance with The Equality Act.

2. There has been an increase in the number of assigned Older Prisoner Leads in healthcare departments, however they are still not present in all establishments and a large proportion are not active in their role. Each prison should identify an Older Prisoner Lead within their healthcare department who should lead on the development of specialist services such as older prisoner/buddy schemes and designated older adult clinics.

3. A large proportion of establishments are failing to adhere to the Department of Health’s recommendation that they should have an older prisoner policy in place. Each establishment should develop such a policy.

4. Establishments and their partners are, in the main, failing to meet the Department of Health’s recommendation that there should be effective inter‐agency co‐operation between healthcare and social services. An identified social care lead may well assist with these difficulties and help to actively support and address older prisoners’ social care needs.

5. The ambiguity regarding the responsibility of social care for older prisoners requires clarification to improve integrative working.

6. An increase in face‐to‐face networking opportunities would improve effective integrative working between health and social care staff.

7. It would be beneficial to house older prisoners in close proximity to their planned release location in order to improve the co‐ordination of their care.

8. Comprehensive local agreements between prisons and social services should ensure that local social services effectively coordinate care for all prisoners.

9. The Department of Health’s recommendation for providing an older person specific health and social care assessment on entry is largely unmet. Evidence suggests that such specialised

OP 23 assessments are required because older prisoners have more complex health and social care needs than their younger counterparts and those of a similar age living in the community.

10. The tool developed in our study, the OHSCAP, is feasible, acceptable and of value to older prisoners and staff.

11. It would be beneficial for Older prisoner Leads to receive training in the use of the OHSCAP and case management.

12. Release planning for older prisoners requires improvement and needs to start earlier in a person’s sentence than it does at present. Furthermore, older prisoners and healthcare, social care and prison staff do not presently routinely work co‐operatively to plan discharge, causing high levels of anxiety for older prisoners.

13. The Department of Health’s recommendation that prisons provide pre‐release courses specifically designed for older prisoners is often not adhered to. Each establishment should regularly provide such courses.

References

Senior, J., Forsyth, K. J., Walsh, E., O’Hara, K., Stevenson, C., Hayes, A. J., Short, V., et al. (2012). Health and Social Care Services for Older Male Adults in Prison.

Sheikh, R. L., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS). Recent Evidence and Development of a Shorter Version. Clinical Gerontologist, 5, 165–173.

Thomas, S., Harty, M. A., Parrott J, McCrone, P., Slade, M., Thornicroft, G., & Gaskell. (2003). The Forensic CAN(CANFOR). A Needs Assessment for Forensic Mental Health Service Users. London: Gaskell.

OP 23 Appendix 1: Table 1 ‐ Results from the Camberwell Assessment of Need – Short Forensic Version

Need on entry into prison (CANFOR‐S domains ) Cases analysed older prisoner with unmet need n (%) Information about condition and treatment 100 38 (38%) Psychological distress 100 34 (34%) Daytime activities 100 29 (29%)

Benefits 100 28 (28%)

Food 100 22 (22%) Physical health 100 21 (21%) Telephone 100 13 (13%) Money 100 13 (13%) Company 100 10 (10%) Accommodation* 57 9 (16%) Looking after the living environment 100 8 (8%)

Treatment 100 8 (8%) Alcohol 100 7 (7%) Self care 100 6 (6%) Intimate relationships 100 6 (6%) Basic education 100 5 (5%) Transport* 57 5 (9%) Childcare* 4 0 (0%) Psychotic symptoms 100 2 (2%)

Safety to self 100 2 (2%) Sexual expression 100 1 (1%) Sexual offending* 74 1 (1%) Drugs 100 0 (0%) Arson* 2 0 (0%)

* Denotes item can be scored as ‘not applicable’

OP 23 Appendix 2: Older prisoner Health and Social Care Assessment and Plan (OHSCAP)

General information

• This assessment tool is divided into three areas: wellbeing, social care and discharge from prison. It revisits information that may already have been provided on initial reception, and identifies new information that has come to light following a few days in custody. It then explores any issues relevant to ensuring appropriate discharge from prison. • It is to be completed 7‐10 days after the prisoner has arrived in the prison. • Ideally it will be completed by both health care and discipline staff together, jointly interviewing the prisoner. This is provided he is happy to discuss his health issues in front of the discipline officer. However, it may be more appropriate for the discipline officer to take the lead and refer to health care if necessary. • The assessment will be reviewed at a time deemed appropriate by staff completing it, and the prisoner. • A care plan must be completed by the staff conducting the assessment, and agreed with the prisoner. The prisoner may retain a copy of the care plan if they want to. Social assessment

The aim of this part of the assessment is to discuss any issues with the prisoner that might be affecting his ability to settle into prison life and feel safe. The questions are divided into three sections: relationships; activities and mobility. There is space in the assessment to record discussion on any other areas that might be important to the prisoner.

Wellbeing assessment

This part of the assessment revisits the information gathered during medical reception a week earlier to see if there have been any changes, and to identify if the prisoner requires further health/wellbeing assessment following the first week of settling into custody.

Discharge from prison

This part of the assessment explores the issues that require addressing prior to the prisoner being discharged from prison.

© 2012 The University of Manchester and University of Leeds all rights reserved. V3, 28.02.2013

OP 23 Section One: Social Assessment

Name Date of Birth

Age NOMS Number

A: Relationships

Ask the person if they have been able to maintain their social and family relationships whilst they have been in prison. Is anyone looking after their finances/benefits etc? How are they getting along with other prisoners? Do they feel safe?

B: Activities

What is the prisoner doing with their time? What are their interests/hobbies? Are they aware of what is available to them e.g. gym, over 60’s club, library? Do they want to work? Are they going out on exercise? If not, why not?

© 2012 The University of Manchester and University of Leeds all rights reserved. V3, 28.02.2013

OP 23 C: Mobility

Is the prisoner managing to get around safely? Can they collect their own meals; get in/out of bed, get to/from their cell to association, and in/out of shower. Can they walk to visits/healthcare/treatment room etc?

Section Two: Wellbeing Assessment

D. Emotional wellbeing

Is the prisoner coping OK with being in prison? How are they feeling in general? Are they feeling supported? Are they getting on with other prisoners – feeling safe? Are they sleeping? Do they have any concerns?

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OP 23 E. Physical wellbeing

Are there any physical problems that have arisen since first reception in to prison? Can they think of anything they might have forgotten to mention when they first arrived? For example, have they got their reading glasses/contact lens solution etc? Does the prisoner know how to access health care? Are they able to attend to their own personal hygiene needs effectively?

F. Medications and treatment

Does the prisoner take any medication? If so, have they been getting it at the right times? Are there any problems with getting their medication e.g. ability to attend treatment room, pressured into giving it to other prisoners?

© 2012 The University of Manchester and University of Leeds all rights reserved. V3, 28.02.2013

OP 23 G. Any other concerns that have not already been mentioned?

SECTION 3: Discharge from Prison

H. Discharge from prison

When is the person being discharged from prison? Where do they plan to go? Will they be welcome there? Do they have finances in place to support themselves? Are there any health care/social care needs that need to be considered?

© 2012 The University of Manchester and University of Leeds all rights reserved. V3, 28.02.2013

OP 23 Healthcare staff (sign) (IF PRESENT) (Print Name) Date

Discipline staff (sign) (Print Name) Date

Prisoner (sign) (Print Name) Date

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OP 23 Care Plan

To be completed in conjunction with prisoner

Number Issue raised from Aim of Action (including by whom Date to be Status of action

assessment action and when) reviewed and rationale

1

2

3

4

5

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OP 23 Review

Date:

Reviewer(s):

Number Progress since last review Action planned Next review with rationale

1

2

3

4

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OP 23 Review

Date:

Reviewer(s):

Number Progress since last review Action planned Next review with rationale

© 2012 The University of Manchester and University of Leeds all rights reserved. V3, 28.02.2013

OP 24

Written evidence from The British Psychological Society (BPS)

Introduction

The proportion of older prisoners in England and Wales doubled in the decade from 1994 to 2004 (Home Office, 2005). This trend can be seen in Western Europe and the United States. The increase is seen in both men and women, the number of older women prisoners rising by 48% in the 4 year period from 1996 to 2000. (Wahadin, 2003). Older prisoners have poorer physical and mental health; Fazal et al. (2001) found that 83% of older prisoners reported at least one chronic illness at interview. Older prisoners are also more prone to vascular disease than the general population. Psychiatric morbidity is high with a third having potentially treatable mental health problems with depression being the most common. Fazal et al. (2001) found that 53% of older prisoners had at least one diagnosable psychiatric condition, and 30% had depression, including 17% who had experienced a major depressive episode. These figures are much higher than those found in comparable populations in the community. It is against these demographics that the responses to the questions are framed.

Fazel and colleagues surveyed the health records and self-reported health status of 203 men in prison aged 60 and over. They found that 85% of older prisoners had at least one chronic illness recorded in the medical notes and 83% reported at least one long standing illness in interview. The most common complaints were psychiatric, cardiovascular, musculoskeletal and respiratory disorders (Fazel et al., 2001a). Three quarters were prescribed a range of medications, but only 18% of those with psychiatric illnesses received any psychiatric treatment (Fazel, et al., 2004). Mental disorders are particularly common amongst prisoners of all ages (Birmingham, 2003; Rickford & Edgar, 2005), and there is some evidence this may be especially so amongst older prisoners. Fazel and colleagues’ survey found that 53% had at least one diagnosable psychiatric condition, and 30% had depression, including 17% who had experienced a major depressive episode (Fazel et al., 2001b). These figures are much higher than those found in comparable populations in the community (Fazel, 2001a).

1. Questions

Whether responsibilities for the mental and physical health and social care of older prisoners are clearly defined.

Comments:

The Society believes that there is lack of clarity of responsibility regarding the mental health needs of older prisoners. This is primarily due to:

• The high demand on prison in-reach teams, few of which contain practitioner psychologist as an integral member; • The absence of older adult specialists within those teams; • That these teams are normally based outside the prison estate; The generally poor liaison between prison psychologists and in-reach psychologists, with some notable exceptions; • The significant cultural differences between the prison service and the NHS which leads to frequent misunderstanding and poor or non-existent liaison.

It is essential that links are made between practitioner psychologists working with older people in the community and prison psychologists to ensure greater awareness of the health and social care and third sector support available when people are discharged.

Since 2000, a number of reports and papers have drawn attention to these needs of this population and argue for their better recognition. Perhaps the most significant of these reports was, No Problems, Old and Quiet: Older prisoners in England and Wales: a thematic review, published in 2004 by Her Majesty’s Inspector of Prisons. In October 2007 a toolkit for good practice in the care of older offenders was published by the Department of Health (DH, 2007), and in June 2008 HMIP published a follow up to the 2004 review (HMIP, 2008). From a very low level of awareness there is an increasing understanding of the high levels of mental and physical health problems experienced by older prisoners. Nevertheless, many prisons remain poorly equipped to meet the health and social care needs of older prisoners, most of whom will be released after many years of institutional living, often with very little in the way of community support. As more people enter prison in old age with long sentences, increasing numbers of older prisoners may be expected to die in prison of natural causes, some of whom will require palliative care in the last stages of their lives.(Le Mesurier, N. et al., 2010)

2. The effectiveness with which the particular needs of older prisoners including health and social care, are met; and examples of good practice.

Comments:

The NHS has had responsibility for prison health care since 2001 but prison mental health in-reach teams seem to have generally a low priority for commissioners particularly in the current economic climate. Increasingly posts are lost or reduced, therefore making the application of NICE approved psychological treatment for those in need increasingly problematical. Many teams do not have a practitioner psychologist as an integral member. There is also a lack of expertise in the teams concerning the psychological and neuropsychological problems of older prisoners. The prison culture of containment rather than treatment means that prisoners with psychological problems are often never referred for assessment. Physical illness is better understood but psychological problems among older prisoners remain hidden or marginalized.

The Society believes that teams should include practitioners with the best knowledge base and therapeutic skills for working with older prisoners as well as the neuropsychological skills to assess people with stroke, Parkinson’s disease and dementia. Teams should also be made aware of community psychology initiative e.g. bibliotherapy and stepped care which might offer support in early stages of distress. They should also work in a systemic way to involve families in possible discharge plans and support whilst in prison.

As part of their investigation into older prisoners, the Prison Reform Trust (Cooney & Braggins, 2010) conducted a survey of prisons throughout England and Wales and found that although gyms can be physically inaccessible (i.e. reached by stairs) or intimidating for older people, when reporting social activities that were organised specifically for older prisoners, more than two thirds of the prisons surveyed reported that they ran gym sessions adapted for older people, which were met with enthusiasm and were often the aspect of their work that staff were most proud of. Areas of good practice that were identified in the report included instances of gym staff working in tandem with physical and mental health care professionals, and the development of groups specifically targeting older prisoners (for example, a ‘nifty over fifty’ group).

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

Comments:

Many prisons are now setting aside special units on the estate for older prisoners where their health and social needs can, potentially, be addressed holistically. This is consistent with the report of HM Inspector of Prisons (2004). Further guidelines have been published since then including a useful toolkit by the Department of Health (2007). This is to be welcomed as it permits a focus on those needs both within the estate and in preparation for discharge. However much more needs to be done especially in the area of palliative care as many older prisoners may live out their lives and die in prison.

Older prisoners might be best served in family type support units where they can develop self care skills and make contact with family and friend who might support them on discharge. The combination of mental and physical health problems and poor literacy/numeracy/financial management will make them vulnerable in the community unless they build skills when inside. Older men are particularly at risk of suicide if unsupported. Single cells and punitive/custodial regimes and mind sets are not best suited to

enabling people to develop the social skills they might need on release.

4. The effectiveness of training given to prison staff to deal with the particular needs of older prisoners, including mental illness and palliative care.

Comments:

Prison staff require training in psychological mindedness and the recognition of changes in mood and behaviour which may be indicative of psychological problems. Regular supervision would be required. E.g. withdrawn behaviour – depression; panic in anxiety disorder; challenging behaviour in dementia – not to be seen as attention seeking or acting out behaviours.

Discussions about end of life needs and palliative care are difficult if staff don’t have the psychological mindedness or regular supervision to cope with the challenges this raises for their own fears about mortality.

5. The role of the voluntary and community sector and private sector in the provision of care for older people in leaving prison.

Comments:

Development of the “through the gate” rehabilitation and mentoring services provided by the private and voluntary sector, and currently being piloted in Doncaster and Peterborough prisons could, if successful, be extended to older adult prisoners.

The Society believes that it could be successful to train people to understand both the forensic and clinical facets of this. There are risks to workers with limited skills and training who might become over involved with vulnerable people who may then exploit them/ or even physically harm them., Again, specialist training and ongoing supervision and support are needed.

6. The effectiveness of arrangements for resettlement of older prisoners.

Comments:

Resettlement is a major problem and is particularly difficult for prisoners who may have served long sentences and so have lost contact with family and friends and whose home environment will have completely changed. Ideally a seamless service with care-planning and a formal hand-over should occur but this can be difficult or impossible if the prisoner is not near his or her home. A released older long- term prisoner will need a lot of support. Those on license will regularly see their probation officer but others may simply disappear from sight. Perhaps the Probation Service or its successor(s) could be given responsibility for the over-sight of all released older prisoners and be able to access or ‘buy-in’ services for them. All released prisoners could be banned from moving around the country until their rehabilitation programmes are completed as suggested by Chris Grayling, the Justice Secretary, this could have some benefit for older released prisoners as it would ensure continuity.

7. Whether the treatment of older prisoners complies with equality and human rights legislation.

Comments:

The Society has concerns about this area and, in particular, has concerns that the mental capacity of older prisoners is often not assessed when it should be and as a consequence may be denied access to processes to establish best interests.

8. Whether a national strategy for the treatment of older prisoners should be established; and if so what it should contain.

Comments:

The Society believes that a national strategy for England and Wales does need to be developed. This may seem straight forward but is actually quite difficult. A balance will need to be struck between recognising and safeguarding their human rights and recognising that they are a ‘special’ group within the estate who probably will require closer supervision due to their relatively poorer mental and physical health. It has been suggested that if the Mental Health Act applied to prisons this would ensure that older prisoners can receive timely and appropriate treatment. The setting up and development of units within the estate for older adult prisoners seems to be a good way forward and will allow for the recruitment of specialist staff, including specialist psychologists, and for their efficient and effective utilization.

Such a plan needs to extend beyond the prison gates with good pre-release planning including liaison with local services at the prisoner’s ultimate destination in order to provide a seamless aftercare service tailored to the prisoner’s physical and psychological needs. The development of an accurate data base to record mental and physical conditions of older prisoners is needed. Data that includes information about whether people have a known mental health condition and what that is, whether they have a learning disability and or literacy/numeracy problems; previous abuse history; whether they have cognitive problems in relation to dementia, head injury, stroke or other neurological conditions needs to be recorded. The database should also record physical health conditions and what the impact of these are on the older prisoner’s mental health; whether they have any family and social support and what form that takes; whether they have sensory disabilities and whether they have gender/race/spirituality considerations that need to be taken into account. A strategy should contain information about the best forms of psychological/neuropsychological assessment and intervention/therapy for this age group to be available and run by appropriately trained and supervised staff and offered at the relevant steps of a stepped car model.

Good pre discharge planning and liaison with community and voluntary services; good care planning good and ongoing post discharge support.

References

Birmingham , L. (2003). The mental health of prisoners. Advances in Psychiatric Treatment, 9, 191-199.

Grayling, C. Rt. Hon. MP, Lord Chancellor and Secretary of State for Justice, Oral Evidence to House of Commons Justice Committee, 27th February 2013 from 9.31am-11.09am - http://www.parliamentlive.tv/Main/Player.aspx?meetingId=12683

Cumming, I. and Wilson, S. (Eds). (2009). Psychiatry in Prisons: A Comprehensive Handbook.

Department of Health. (2007). A Pathway to Care for Older Offenders: A toolkit for good practice. www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications Policy and Guidance/DH_079928

Fazel S, Hope T, O'Donnell I, et al. (2001). Hidden psychiatric morbidity in elderly prisoners. British Journal of Psychiatry, 179, 535–9.

Fazel, S. et al. (2001). Health of Elderly Male Prisoners Worse than the General Population, Worse than Younger Prisoners. Age and Ageing, 30, 403–407

HMIP. (2008). Older Prisoners in England and Wales: A follow-up to the 2004 thematic review by HM Chief Inspector of Prisons

HMIP. (2007).Time Out of Cell: A short thematic review. www.justice.gov.uk/inspectorates/hmi- prisons/docs/time-out-of-cell-rps.pdf

Home Office. (2005). Offender management caseload statistics 2004. Home Office Statistics

Bulletin,17/05. London, Home Office

HM Inspector of Prisons. (2004). No Problems, Old and Quiet: Older prisoners in England and Wales: A Thematic Review, identifying older prisoners.

Le Mesurier, N. et al. (2010). A Critical Analysis of the Mental Health Needs of Older Prisoners, Staffordshire University & South Staffordshire Primary Care Trust. www.nicklemesurier.org/old-age- inprison.html

Rickford, R. and Edgar, K. (2005). Troubled Inside: Responding to the Mental Health Needs of Men in Prison. London: Prison Reform Trust

Wahidin, A. (2004).Older Women in the Criminal Justice System: Running Out of Time. Jessica Kingsley Publishers

Wahidin, A. (2003). Doing Hard Time: Older Women in Prison. Prison Service Journal, 145, 25-29

March 2013

OP 25 Written submission from Nick Le Mesurier

Summary of evidence

• Many older prisoners are serving long sentences, during which some may become institutionalised and lose touch with changes in society and lose crucial self‐help skills. • Resettlement involves engaging with a number of complex systems, such as banking, benefits or pensions, housing, and personal finance. Many older prisoners are released on licence, which also requires them to manage a range of restrictions and obligations. • Preparation for release is often poor. Resources do exist in prisons to help older prisoners prepare for a new life in the community, but it is unclear why these are not consistently and effectively applied. • Many older prisoners leave prison on licence or at the end of their sentence without family, friends or community to return to or help them. They need to have arrangements made in advance of release to ensure they have access to financial and housing facilities. • Very little primary research has been done into the experience of older prisoners. • Though it is well known that almost 10% of the prison population is aged 50 and over, there is a lack of essential quantitative information on the process and experience of release. We need to know how many older prisoners are released each year, under what conditions, where to, and with what consequences, including rates of recidivism, life expectancy after prison, and presentation of serious health needs.

1. In order to improve its services I am assisting RECOOP in an exploratory study of the experiences of older prisoners released to hostels and other locations in Devon. To date nine offenders (in three bail hostels) released on licence, and ten ex‐offenders who have completed their sentences and were living in supported housing have been interviewed. In addition, hostel managers, staff and community voluntary sector care providers have also been interviewed.

2. I have encountered the following descriptions of problems relating to resettlement: I. If a prisoner is to access the help that might be available he has to understand when and where to ask for it. Some older prisoners are not good at being proactive or are unaware of what they have to do to prepare for release. For some the thought of release is so frightening they prefer to ignore the prospect. Others simply don’t know or understand how to ask for help. II. Every prisoner has a personal officer to whom they can bring problems and raise queries, but many prison officers are not trained in resettlement or the needs of older prisoners and are perceived as unable or unwilling to help. III. Some prisoners are released to No Fixed Abode (NFA). The reasons are unclear, but may include late or no referral to housing agencies. IV. I have heard stories of wheel chair users being released without a wheelchair, and of older prisoners being released without adequate clothing for the time of year. Many seem to lack information or understanding of what support might be available in their new location. Information or guidance on how to cope with being homeless appears to be lacking. V. I have heard many stories of prisoners being released without photo ID, without benefit application in place or knowledge how to access their pension. They thus risk having no OP 25 income for weeks or months. Some have said they had no bank account or post office account and didn’t know how to get one. Many said they didn’t know how to use basic IT. Some are prevented from using the internet as a condition of their licence VI. There appears to be no obligation to refer a prisoner to a community doctor or dentist. Some lack the knowledge or necessary documentation to help them make their own arrangements. VII. Some older ex‐offenders are vulnerable to exploitation by private landlords. I have heard accounts of poor housing conditions, and of some landlords charging a premium for coins or tokens for electricity meters. VIII. Private accommodation is usually sought through letting agencies which can charge high fees. For example we heard of one man who had moved to private accommodation at short notice who said he had just paid £120 agency fees from his fortnight benefits payment. (£140). This left him just £20 and no food or furniture or heating for the following 2 weeks. I understand that £140 is a modest fee for a letting agent and charges can be a lot higher. IX. A minority of older offenders have described positive experiences of release in which resources and information were appropriately available. Those who have family or friends willing and able to help are more likely to have a positive experience.

3. I have heard suggestions for improvements. These have included: I. It should be recognised that individual prisoners’ needs and abilities vary considerably, and that resettlement cannot be effectively provided on a ‘one size fits all’ basis. The opportunity to discuss personal needs is valuable II. The sorts of preparation for release should include a. The nature and implications of licence conditions b. Self‐help skills training, including basic cooking, managing finance, keeping well c. Benefits and pensions rights and obligations d. Information on how to access medical and other help, e. Information on volunteering and other opportunities , particularly those that are open to people released on licence, f. Information on how to manage disclosure. III. Such preparation can be affectively applied in group sessions, though 1:1 support may be needed in some cases IV. Some sort of screening process should be in place in prison to identify obstacles that are likely to affect older prisoners’ resettlement plans. As some individuals are not confident in presenting their needs, or may not realise they have them, it should not be left to the individual to speak up for himself. V. Suitably approved, trained and supervised mentors in prison can be an effective way of sharing information and advice VI. There needs to be better access to housing facilities including short term housing with a planned move onto supported housing VII. There should be reliable mechanisms in place to ensure that appropriate photo ID is provided for every prisoner before release. It should not be left to the prisoner to realise that he needs an ID VIII. Arrangements should be made to ensure that benefits and pensions are available within a week of release, and bank accounts set up in advance OP 25 IX. Telephone help support line should be available X. Accommodation should be arranged in advance of release. No Fixed Abode should be a very last resort, only after all other avenues have been followed up. In such cases the offender should be registered as NFA before release. XI. There are long waiting lists for local authority housing. Those leaving prison to NFA need letters of support produced in advance of release. XII. Unless otherwise prohibited offenders should have Release on Temporary Licence (ROTL) for visiting and settling into hostel and housing placements, and for arranging access to volunteering placements XIII. There should be more opportunities for effective community sentencing

3. These findings suggest that: I. There is clearly no universal standard of quality or quantity in preparation for release. Some respondents described positive experiences, but others described experiences that suggest serious shortfalls in preparation. It is not clear why such variations occur or what factors cause people to be released in a vulnerable state. There is a need for more research into the reasons why the system appears to fail some older prisoners on release. II. Those particularly vulnerable include those who are released after having served their full term in prison. They are thus ‘free’ citizens, but this does not mean they are capable of coping with the demands of living in society after having been removed from it, in some cases for many years. Those who are released on licence and / or are in contact with hostel, probation or with drug and alcohol support, mental health or other support services seem at least to have the advantage of being visible to some degree and to have some sort of structure provided for them, though this does not in itself confer adequate resources for living independently. III. Some older prisoners are extremely vulnerable to exploitation from private sector landlords and agencies. IV. We do not know how many older people are in positions of vulnerability, but comments from hostel managers and other service providers suggest that the number is likely to be higher than might be expected. One hostel manager commented that about a third of the people using her service are aged over 50. V. Payment of benefits at fortnightly intervals is likely to end in April 2013. Some people will find managing a monthly income very difficult. VI. Providing the sorts of support that can help older prisoners resettle into the community is not ‘soft’ treatment. A prison sentence is itself a punishment, but it would seem that for many a penalty has to be paid in suffering long after the sentence is over. We do not know the impact of poor resettlement provision on reoffending, but it would not stretch the imagination to suppose that if some people find themselves unprepared and ill‐equipped to live in the community they might consider re‐offending as a way to ensure their own well‐ being.

March 2013 OP 26 Written submission from RECOOP

RECOOP is an independent charity delivering support services and resettlement programmes for older prisoners in the South West of England. We also carry out capacity-building work on behalf of NOMS with prisons, probation trusts and third sector organisations across England and Wales to improve the range and quality of interventions, support and services available for older offenders and ex-offenders.

Summary of recommendations: • The threshold for an ‘older prisoner’ to be lowered to 50, due to the more rapid onset of physical symptoms of aging amongst prisoners than in general population; • Older prisoners’ forums to be established in all prisons; • Older prisoners’ accommodation units/wings to be established where possible; • Age-relevant resettlement programmes and support services to be made available in all prisons, particularly for retired prisoners who do not take part in education or work. In many cases these could be delivered by prisoners themselves using resources available on the “virtual campus” (online prison learning environment); • “Buddying” to be established in prisons, where older and disabled prisoners with mobility issues are supported by another prisoner to carry out every-day tasks; • Older prisoners to complete a tailored resettlement course for older people prior to release (e.g. RECOOP/Media For Development’s “Getting ready to go” course) and to develop personal release plans with the support of a dedicated officer; • Retirement for prisoners to be made optional, and retired prisoners to have continued access to work and education opportunities; • Legislation put in place so that older prisoners are not released to “no fixed abode”; • Through-the-gate mentoring support available for older offenders on release; • A national strategy for older offenders to be developed.

Definition of ‘Older prisoners’

1. ‘Older prisoners’ should be defined as prisoners over the age of 50, not 60 as set out in the terms of the Inquiry. This is due to the evidence that, in prison, older people can have health symptoms of people ten years older in the community. In “Doing Time: Good practice with older people in prison - 2010”, the Prison Reform Trust defines ‘older’ people as anyone aged 50 or over for the following reasons: • Some older prisoners will have a physical health status of 10 years older than their contemporaries in the community. This can be due to a previous chaotic lifestyle, sometimes involving addictions and/or homelessness. • Fifty is used in NHS healthcare and services for healthy ageing start at this age; • Age UK and organisations working with older people start their services at 50;

2. The former Offender Health Commissioner for Devon said in her 2011/2012 health needs assessment: “An ‘older prisoner’ is deemed to be aged over 50 to account for the potential impact of [his] lifestyle choices on his physical health… Clearly not all individuals older than 50 in the prisons will have complex and complicated health and social care needs but there will be many who do. Chronic and long-standing conditions will be greater amongst this age group.”

Whether responsibilities for the mental and physical health and social care of older prisoners are clearly defined

3. Following our engagement with over 60 prisons across the estate [see Appendix 1], it would appear that most are relatively happy with the standard of healthcare for older prisoners but do not delve too deeply into what is actually in place. This suggests OP 26 responsibility sits with prison healthcare services, who will respond to physical health issues but mental well-being and social care are a ‘grey’ area.

4. An example: a prisoner needed special footwear due to his diabetes, but no-one was sure who should take responsibility for paying. It took nine months to resolve with the prison finally buying the item, but the prisoner was unable to engage in regime activities during this time as his mobility was restricted. The prison still feels unclear as to who should have taken responsibility.

5. Mental health is difficult to measure though there are concerns around under- diagnosis due to difficulties in identification. For example, older people suffering from depression may be perceived as just being “quiet” [No Problem – Old and Quiet, HMIP 2004], and their lack of motivation will not be challenged as there is often little expectation of them to do anything anyway.

6. Dementia sufferers often function well in a structured environment. A prison regime might increase the chance of symptoms going undetected for longer. “The prevalence of dementia among older prisoners remains largely undetermined. Combining rates in the community with the theory of accelerated ageing in prison would suggest it affects approximately 5% of detainees over 55.” [Losing track of time: Dementia and the aging prison population, Mental Health Foundation, 2012.] However, official diagnosis in prisoners is thought to be much lower than this.

7. Social care tends to be the biggest emerging issue reported by prisons. Even when prisons have developed links with their local Social Services and have arranged for carers to visit prisoners, the Local Authority uses agency staff and the procedures for getting them security cleared are unworkable for most prisons. Meeting the needs of prisoners with social care issues tends to be based on goodwill (predominantly from fellow prisoners), which can work well with prisoners collecting meals for each other and helping to clean cells etc. but is more complex when, for example, a prisoner develops continence issues or is unable to dress themselves.

8. There are reported cases of prisoners being permanently located in 24 hour healthcare facilities due to social care needs. This is a far from satisfactory solution for all concerned and raises the question of how long this system will be viable as the number of older prisoners continues to increase.

The effectiveness with which the particular needs of older prisoners including health and social care, are met; and examples of good practice

9. No-one would challenge the benefits of mental and physical stimulation for older people and for them to engage in age-specific activities to benefit both mental and physical health, yet prisons seem to focus on responding to immediate age-related problems as they emerge such as depression, early-onset dementia and poor levels of fitness, rather than considering preventative measures.

10. Examples of good practice in RECOOP’s work in prisons in the South West, and in work undertaken by prisons we support through our capacity building work: • RECOOP runs a mental wellbeing programme in three Devon prisons. This involves weekly ‘brain gyms’ for older prisoners and group sessions of Shibashi Qi Gong, an adapted form of Tai Chi for older people and people with mobility issues. • RECOOP supports the delivery of older prisoners’ forums. These promote skills and confidence to help older prisoners cope better on release and are recognised in prison governance structures as a legitimate means by which prisoners' concerns can be addressed. OP 26 • RECOOP works with older prisoners at HMP Leyhill to produce personal release plans covering appropriate support services and arrangements for key transitional stages, including preparing for release and/or preparing for end-of-life in custody. • RECOOP works with older women prisoners at HMP Eastwood Park to provide a quiet space and relevant activities for the older women twice a week. Work here is shorter term and based around individual activities as the average length of stay is short (c.6 weeks). Equality Officer: “For the first time in my prison career I have witnessed this unique group of prisoners happily serving their sentences whereas in the past they would be quite vulnerable and of a concern to staff.” • HMP Stafford allows older prisoners not engaged in education or work to meet up during the core day in a portacabin, but they were struggling to fill the time productively. They’ve recently begun making breakfast packs, which has had a significant positive impact on the men. One representative reported that this simple activity had provided those taking part with a sense of worth, achievement and usefulness alongside fostering a sense of camaraderie in working towards a common goal. HMP Stafford prioritise their work with older prisoners due to the high population they accommodate (18.6% of the population are over 50 yrs old. National average is 11.5% - NOMS 2012) • HMP Whatton contracts in Age UK services to run a support group for older prisoners where age-specific activities similar to those delivered by RECOOP are undertaken. Sustainability is currently under threat due to cost. HMP Whatton has demonstrated a commitment to palliative care services, again due to the relatively high numbers of older prisoners there (91 over 60 and 55 over 70 on 30.9.12).

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

11. Establishing dedicated older prisoner accommodation units or wings:

Advantages • Older prisoners feel safer amongst their peers, reducing stress and anxiety; • It would be a quieter and more peaceful environment free from loud music, often reported to be a source of anxiety for older people; • Older prisoners are more likely to engage in age-specific activities if they are carried out on their wing and they don’t have to negotiate free flow or route movement restrictions in order to attend. Particularly pertinent for those with sight, hearing, mobility issues; • Older prisoners can instigate activities during association periods. Forums [see para. 10] could meet and prisoner volunteer “peer-educators” could print RECOOP session plans from the virtual campus to deliver relevant activities with their peers on the unit, increasing purposeful activity and out of cell time; • The unit could be adapted for disabled people, reducing the need to adapt all areas of the prison; • Buddying schemes could be developed where physically fit prisoners assist disabled prisoners with simple tasks such as collecting meals and cleaning cells; • May require less staffing as older prisoners are generally more settled and do not require as much supervision or intervention as their younger counterparts. It may be appropriate for the unit to be an enhanced prisoner unit only; • Healthcare can target certain resources to one single area.

Disadvantages • Some older prisoners may not wish to live there or may have concerns about perceptions relating to offence type. Residence on the unit could be optional. This may mean, however, that prisoners who chose not to live there would miss out on attending relevant, age-specific activities. In such cases effort would still need to be made to encourage and enable prisoners not living on the unit to attend. OP 26 • Young prisoners may feel it is unfair for older prisoners to have a dedicated unit. • Older prisoners are often seen to provide a valuable ‘steadying’ influence on the younger population, and prisons may be reluctant to risk losing this. However, if older prisoners are not forced to retire in a prison and have continued access education, then they will continue to exert this influence on a regular basis.

12. There are very few disadvantages to dedicated older prisoners’ accommodation areas. Prison policies on retirement age and access to education should be considered, and situations where older prisoners are forced to retire and are no longer allowed access to education should be addressed.

The effectiveness of training given to prison staff to deal with the particular needs of older prisoners, including mental illness and palliative care

13. The only training in this area that we are aware of is that which we (RECOOP) have sourced and delivered ourselves for the prisons we work with in the South West. Our service delivery team in prisons has arranged ad hoc training for prison staff in issues such as Mental Health and Dementia awareness. Although course feedback was positive, the longer-term effectiveness has not been measured.

14. Feedback from older prisoners we work with: Officers need further specialist training in ‘spotting the signs’ of mental and physical health needs in older prisoners.

15. In our experience, key training areas for consideration are: • supporting people with serious health decline and at end of life • recognising symptoms of age-related illnesses • planning resettlement for older people • recognising that many older prisoners will not be expected or expecting to access training or employment on release, and building awareness and confidence around accessing other appropriate positive activities on release

The role of the voluntary and community sector (VCS) and private sector in the provision of care for older people in leaving prison

16. There are many community resources for prison leavers, particularly services targeting young people. It’s generally accepted that young people have specific needs and services have been developed in the community to meet those needs, (e.g. young people’s accommodation and training facilities). We have, however, identified no community resources aiming to meet the needs of older people leaving prison, although it could be argued that older people are in more need of specialist support due to the complex issues they face, such as:

• Deteriorating health, age-related illnesses and feelings of vulnerability; • Issues around institutionalisation where a lengthy prison term has been served; • Lack of social networks and support structures; • Retirement; • Potential exclusion from activities for older people due to offence type; • Difficulties accessing sheltered/supported housing due to offence type; • Older people do not tend to embrace change as readily as younger people; • Increased social isolation due to being a) an older person and b) an ex prisoner.

17. Providers of ex-offender mentoring services tend to focus on training and employment opportunities. These are often not relevant to older people.

18. The VCS and private sector specialising in services for older people are in a favourable place to develop services to meet the needs of older prisoners on release, OP 26 but there appears to be a reluctance due to lack of funding and concerns regarding risk factors around working with offenders.

19. A housing provider which provides ex-offender accommodation at projects in and around Birmingham is currently exploring the possibility of setting up an older ex- offender supported housing project. They report that when they’ve worked with older offenders released to their generic projects for adults in the past they’ve recognised the need to tailor their approach to meet the needs of the older person. The biggest factor reported was the slower pace at which older people adapt to life in the community and a general reluctance to engage in activities or even leave the building during the first few weeks. They also report that older ex-offenders often need more staff support initially, but that long-term results were very positive.

20. There are useful services in most communities – walking groups, coffee mornings, befriending services – and most facilitating agencies have no objection to ex-offenders accessing them. However, there seems to be an issue in getting the offender to the point where they feel motivated, confident and willing to go along.

The effectiveness of arrangements for resettlement of older prisoners

21. Davies, The reintegration of elderly prisoners, 2011: “Older inmates disproportionately struggle with resettlement as a result of distinct psychological adjustments they have made in prison, a reduced support network in the community and an increased likelihood of health and mobility concerns. These problems are exacerbated by a system oriented on a stereotypical understanding of the young male criminal. In England and Wales, this has restricted the usefulness of prison programmes and activities for older prisoners who are less likely to re-offend and who are less likely to be a threat to society upon release. With the prioritisation of reducing re-offending and protecting the public, the National Offender Management Strategy (NOMS) fundamentally conflicts with the characteristics of elderly prisoners and fails to consider their re-integrative needs”

22. In the 60+ prisons we work (Appendix A) with, little specific resettlement support s being provided for older prisoners. Funded to develop collaborative working between the 3rd sector and prisons/probation services, we are in an ideal position to comment on the void outside the prison gate in terms of services or support for older offenders. There is a strong need to develop specialist pre- and post-release services for older ex-offenders. There is a lack of communication and joint working in the transition for older prisoners from prison to the community; statutory agencies appear to work mainly in isolation, only communicating effectively when managing the transfer of an offender’s risk between services. Care/resettlement plans or assessments with a social care element would provide a good starting point to prepare for an older offender’s transition into the community. Older offenders may leave prison with a licence requirement to have a confirmed address or place within an Approved Premises by a set time, when they are on walking sticks or struggling with mobility problems and thus will not be able to do this as quickly as a younger prisoner. Furthermore, the practicalities of achieving this are more difficult for someone who has been incarcerated for a long period of time.

23. Approved Premises (APs) are the most likely destination for long-term prisoners, who’ve effectively grown old in prison, but they report a lack of information on the health and social care needs of older offenders. There should be an assessment prior to release, to ensure a smooth transition into the community. There is a free older prisoners’ resettlement assessment tool available on the RECOOP website, though prison resettlement staff have demonstrated a reluctance to use it due to the additional OP 26 workload it may create. There is also confusion regarding whose responsibility it is in the prison to instigate Social Services support.

24. Not all older offenders will face accommodation issues on release, but many long- term prisoners will have lost contact with friends and family. For many, hostel accommodation is not appropriate as they are often challenging environments where older people are particularly vulnerable and are seen as “easy targets“ Most hostel staff do not have the required knowledge or expertise to effectively support older people. Hostel accommodation can only be avoided if an older prisoner has significant health and/or social care needs, or has served an extended period in custody (4 years or more); here, there is a duty on the Local Authority to source housing in accordance with the Homelessness Act 2002.

25. Successful resettlement is a significant factor in reducing re-offending, though resources are minimal in most prisons and there are significant difficulties in sourcing appropriate accommodation for prisoners on release. Whilst age-related needs are recognised by most Local Authority Supporting People budget holders for young offenders, the same does not apply for older offenders. Ideally, resettlement planning for older prisoners should include: • Courses where older prisoners can mentally prepare for release such as RECOOP/Media For Development’s “Getting ready to go”; • Thorough needs assessment and further assessment by Social Services if necessary to ensure that support services are in place at the point of release; • Financial planning with pensions being applied for prior to release; • Through-the-gate mentoring support delivered by agencies that understand the needs of older offenders and are specialists in age-related issues.

26. Older prisoners are frequently released to “no fixed abode” (NFA). This effectively “sets them up to fail” – any positive work carried out pre-release (e.g. survival cooking in a hostel) is redundant. [NB Welsh system has legislation in place preventing prisoners being released to NFA.] There is little to no pre-release planning for individuals, e.g. a wheelchair user might be released without a wheelchair, with totally inadequate clothing for the time of year, with no information about what support is available on the other side and no guide to being homeless.

27. There is a significant danger that an older offender may perceive that their basic needs (access to healthcare, gym, meals provided, laundry done, friendships etc.) were met in prison and that these needs are no longer met when they are released, resulting in a desire to return to prison where life is easier and safer. This is why specialist support after release is so important with this age group.

28. Better preparation for release should include: benefits and pensions organised beforehand so they are accessible within a week of being released; photo ID arranged before release; bank/post office account in place; housing address confirmed so no- one is released to NFA; practical and social skills release courses; volunteering placements arranged (for prisoners on ROTL before release where possible); through- the-gate mentors to support resettlement process; more opportunities for community sentencing for older prisoners who do not pose a serious risk to society. Offender accommodation management: “It would be enormously helpful if offenders were registered with a GP and dentist prior to release”; “Not having benefits set up prior to release can mean that it can be up to three months before someone will receive benefits. This can encourage petty theft and recall measures being taken.”

OP 26 Whether the treatment of older prisoners complies with equality and human rights legislation

29. The prison regime is designed with the younger majority – and their preparation for education and employment on release – in mind. Outsourced education contracts have restricted the availability of programmes and courses for those who are not eligible for release until retirement age. Alternative meaningful and purposeful activity for this group is poor. Few resources are available to develop these services, with low-level activities such as games (carpet bowls and dominoes) being the norm.

30. Some prisons have written their own policy for older prisoners and some have established older prisoners’ forums to encourage dialogue and open communication so issues can be raised, but this isn’t consistent. Some induction procedures are robust whilst others would prove difficult for some older people. Not all areas of some prisons are accessible for people with disabilities which is case for concern. Not all prisons offer age-specific activities, though most have some type of gym provision designed for older prisoners. Not all prisons can offer offending behaviour programmes for people with mobility, sight or hearing issues. The rate of pay for prisoners of pensionable age who are not working varies significantly from prison to prison and is open to litigation.

31. We believe this leads to potential for litigation to be brought where the treatment of older prisoners does not comply with Equality and Human Rights legislation.

Whether a national strategy for the treatment of older prisoners should be established; and if so what it should contain

32. Davies, The reintegration of elderly prisoners, 2011: “there is an absence of a cohesive strategy in England and Wales to manage [older prisoners’] needs.”

33. A national strategy should be established to ensure equality and fairness in the treatment of older prisoners and to make the most of resources available. The strategy should include:

• A requirement for all prisons to provide an older prisoners’ forum, which link directly to the prison’s equality management; • A nationally consistent rate of retirement pay; • Dedicated older prisoners’ accommodation areas; • Training for prison staff on issues affecting older prisoners (ageing, behaviour, health); • Resettlement services for older prisoners incorporating assessment of health and social care needs; • Defined ‘older prisoner’ responsibilities within the Equality Officer role description; • An information sharing protocol to be agreed between prisons and healthcare providers for all older prisoners; • A monthly multi-disciplinary meeting in prisons to discuss older prisoners as a group and individual case plans where there is an increase in need; • Improved links to be developed between prisons and local Social Services; • Increased use of ROTL (Release on Temporary Licence) for eligible older offenders prior to release to help prepare for life outside prison; • A commitment to review the management of end of life care and natural age- related deaths in custody;

OP 26 Appendix 1 A list of the prisons working with RECOOP

HMP Dartmoor HMP Exeter

HMP Channings Wood HMP Guy’s Marsh

HMP Erlestoke HMP Dorchester

HMP Verne HMP Shepton Mallet

HMP Leyhill HMP Swansea

HMP Parc HMP Kingston

HMP Usk HMP Isle of Wight

HMP Bullingdon HMP Coldingley

HMP Holloway HMP Eastwood Park

HMP Bure HMP Chelmsford

HMP Sheppy Group HMP Highpoint

HMP Whitemoor HMP Bedford

HMP Bullwood Hall HMP Blundestone

HMP Wayland HMP Hollesley Bay

HMP Littlehey HMP Peterborough

HMP Leeds HMP Manchester

HMP Buckley Hall HMP Askham Grange

HMP Wymott HMP Liverpool

HMP Haverigg HMP Kirkham

HMP Low Newton HMP Holme House

HMP Lowdhan Grange HMP Garth

HMP Featherstone HMP Stafford

HMP Shrewsbury HMP Dovegate

HMP Drake Hall HMP Leicester

HMP Whatton HMP Gartree

HMP Stocken HMP Stoke Heath

HMP Oakwood HMP Nottingham

HMP Long Lartin HMP Kennett

HMP Newhall HMP Norwich

HMP Everthorpe HMP Risley

OP 26 HMP Kennett OP 27

Written evidence from Louise Ridley and Charlotte Bilby, Senior Lecturers in Criminology, Northumbria University.

Summary

• This submission is based upon work we have carried out, and work we are currently undertaking, with professionals in HM Prison Service North East, the National Offender Management Service and associated professionals from healthcare and elder care organisations. • The aim of the work is to share information about the punishment, management and needs of the older prison population. • The work is focusing on the activities in the North East of England, but the information will draw on national and international practice and be disseminated nationally. • Both statutory and third sectors agencies are involved in the work, with the goal that the needs of older prisoners are outlined and ultimately met. • To date we have both data and information that can be used in order to inform a national response to the needs of older prisoners.

1. Our current work is focusing on North East regional prisons. However, the nature of the prison estate in the region is such that findings developed as part of this current project could be applied to other locations. The geography of the region sometimes makes practice for stakeholder organisation difficult, which is an element that will be missing elsewhere. The positive working relationships that the applicants have with staff from each of the region’s prisons, and NOMS, means that both a breadth and depth of support to the working partnership is guaranteed. 2. There are seven prisons situated within the North East region, holding 4500 prisoners, with 70% of this number being discharged into the local community. Although this is a relatively small number, the North East holds a wide variety of prison types. There are two large male category B prisons (holding over 1000 prisoners each): HMP Holme House and HMP Durham. Within the North East region there is also a women’s prison (HMP/YOI Low Newton), a semi-open resettlement prison (HMP Kirklevington Grange), a young offenders’ institution (HMYOI Deerbolt) and a high security prison (HMP Frankland). Within HMP Frankland is the Westgate Unit: holding dangerous and severe personality disordered offenders. This unit is self-contained and has its’ own separate regime. Similarly, HMP Low Newton also runs the Primrose Project; a programme for dangerous and severe personality disordered women offenders. In addition to these five prisons there is a large category C training prison, HMP Northumberland. This prison was recently created by amalgamating HMPs Acklington and Castington, giving it an operational capacity of 1,348 prisoners.

OP 27 3. Both Bilby and Ridley are established criminologists with many years experience of both teaching and research. Ridley has worked for the past five years developing a well-regarded student placement scheme in the region, with support from all prison governors and business managers. There are currently students engaged in research work with the older prisoner population at HMP Northumberland. Bilby and Ridley curated an exhibition of prisoners’ art work in Summer 2011 and Autumn 2012 hosted at Northumbria University’s Gallery North. This meant working closely with the region’s Offender Learning and Skills Service (OLASS), the service who implements all training and education programmes in prisons. Art is an area that many older prisoners find they can engage with during their prison sentence. Other areas of education offer little interest to the older age group who feel that there is little to be gained from the more formal education courses on offer. The success of the event has meant that the University will host annual exhibitions until 2014. Ridley is also a member of the PORSCH (Prison and Offender Health Research in Social Care and Health) management team. 4. The prison population in England and Wales is not only increasing, but it is ageing. During the past 15 years the up-tariffing of sentences, increased use of life sentences, and the creation under the 2003 Criminal Justice Act of indeterminate sentences of Imprisonment for Public Protection (IPPs) means that the number of older prisoners is growing. Ten percent of the prison population is over the age of 50 and the over 60s are the fastest increasing group within the prison estate. Between 2000 and 2010 this age group grew by 128% (Prison Reform Trust, 2011). It is generally accepted that the experience of imprisonment speeds the ageing process in terms of physical and mental health. High security and category C prisons that hold longer term and life sentence prisoners at different stages of their sentence have, of course, a higher percentage of older prisoners. In some cases up to 15% of inmates are 60 and over (HMIoP, 2008). 5. Just as with an ageing general population the ageing prison population brings with it challenges for support and medical services. Within prisons these pressures and problems might be said to be more acute. Prisons are not only built for men, they are built with young, able men in mind, and are not always able to cope with chronic illness, mobility needs, emotional support and the recreational requirements of an older male or female prison population (PRT, 2008). The most recent report from HM Chief Inspector of Prisons (2011: 7-8) notes that the manner in which older prisoners are held and treated is lacking: ‘work on diversity strands other than race and religion was limited... The sight of frail, older prisoners shoved aside in the meal queues or prisoners in wheelchairs struggling to move up a slope because, we were told, prison officers had not had the necessary health and safety training to push them, was disturbing’. Only five prisons were identified as working positively with groups of older prisoners; providing them with activities during periods that younger prisoners were working, or developing mentoring programmes to encourage pro-social behaviour on wings. 6. Where prisons identify older prisoners in their diversity documentation, it is normally in association with the needs of disabled prisoners (HMCIP, 2011), which may be seen as a rational decision given that 80% of older prisoners have long term illness or are

OP 27 disabled (RECOOP, nd). While ageing may mean an increase in the number of episodes of ill health and an increased likelihood of living with the impact of a disability, the needs of older prisoners may differ significantly from younger ill and disabled prisoners. It is also worth noting here that there must be an agreement on what constitutes an older prisoner, as at the moment there are different ages used to define the ‘older prisoner’. We note that the Committee is suggesting 60 and over. Most prisons now work on the basis that 55 and over constitutes an older prisoner. Whilst an acknowledgement here to the impact on resources must be made should the age of an older prisoner remain at 55, any inquiry must consider if 60 is the appropriate point at which to start addressing the needs of the older prisoner. 7. HM Prison Service does not have a national strategy which addresses the experiences or needs of older prisoners, and it is possibly this which contributes to the ‘institutionalised thoughtlessness’ (Crawley and Sparks, 2005) in some local practice. Where policies are developed, there are often not the human resources to manage work, and where capital is spent, there are often not the on-going funding arrangements to keep activities running. For example, Mann (2010) notes that many of those involved in the running of education, training and skills programmes could identify ways in which activities could be improved for older men, but were not asked to implement any change. The ageing prison population, and the resultant social and healthcare needs, must be addressed so that all offenders continue to be managed with humanity and respect. 8. Despite research and practice that addresses the specific needs of older prisoners, it must also be acknowledged that older prisoners may not identify themselves as a homogenous group and may not feel that they have a collective identity which is different from younger prisoners. It is our observation, from the work that we have carried out to date, that the vulnerable prisoner group age more rapidly and are more comfortable with the label ‘older prisoner’ at an earlier stage of their incarceration than the prisoners held in main conditions. This raises the question of physical health resource provision for this group during their incarceration. Activities which aim to research or map the needs of an identifiable group of people need to ensure that they themselves have input into any changes in policy or practice. It is also true that practice may differ between the types of prison and the category of prisoner. 9. In the current political and economic climate, with cuts being made to services provided in prisons, the number of staff being reduced, and the proposed ‘rehabilitation revolution’ how HMPS works with older offenders will be tested once again. This current research will consider how prisons in the North East of England manage and deal with the impact of punishing, rehabilitating and looking after older prisoners, and will enable good practice to be shared outside of the region for potential national impact on policy and practice. More broadly these proposals will contribute to the Government’s aim of reducing crime, tackling re-offending, tackling poverty, reducing worklessness, promoting growth and opportunity and will help to deliver the objectives and targets of NOMS. 10. Current activities include two planned workshops (April and July 2013) on sharing best practice and identifying knowledge, policy and operational gaps from within and

OP 27 outside of the region, and a review of the academic and policy and practice literature. Each workshop has a key note speaker, the first is Mary Piper (Offender Health Team, Department of Health) and the second is Nigel Newcomen (PPO). In addition to this, there are a number of other current activities exploring the views of the older prisoners themselves (looking at social care and wellbeing, provision of care for those leaving prison) taking place in HMP Northumberland. 11. The scheduled workshops will share information on a number of topics relating to the social and health well-being and care of older prisoners. They will consider how HMPS and partner organisations such as health care trusts and organisations, such as Care UK, local authorities and third sector organisations, including the Samaritans and Age UK, address issues associated with older prisoners and will share this knowledge within the North East prison region. 12. These extensive activities will, through a variety of events, develop and maintain an informational infrastructure between academic researchers, HMPS staff with strategic and operational responsibility for older prisoners, and other public and third sector staff with responsibility for older people. By ensuring that HMPS activities to address the needs of the NE region’s older prisoners, are informed by both the latest academic understanding of issues and the practice of professionals with expertise in older people, lifestyles may be altered. Older prisoners will experience their incarceration without the added pain (Sykes, 1958) of old age. 13. Our current activities will address four main areas of concern; punishment and rehabilitation; health, social care and well-being; strategic and partnership objectives; operational issues, practices and concerns. It is clear that these categories overlap, but the following broad breakdown outlines the areas of concern to which we seek responses: a. Punishment and rehabilitation • Within a regime where the rehabilitation revolution is of paramount importance, how do ideas of resettlement function for older prisoners? • If prisoners are not to be released, what is the role of resettlement and rehabilitation? Is it simply to address their behaviour so that the number of adjudications is kept low? • Are there differences between older and young prisoners in terms of educational and recreational needs and if so, how are these being addressed? • Are there differences between older and young prisoners in terms of addressing offending behaviour and thinking patterns about offending, and if so, how is this being addressed?

b. Health, social care and well-being • Are there differences are there between the older and younger prisoners in terms of medical (physical and psychological) needs? If so, how are these being addressed? • Are there differences between older and younger prisoners in terms of social and well-being support? If so, how are these being addressed? • How are older offenders supported with mobility, visual and hearing issues?

OP 27 • How are chronic and long-term illnesses associated with ageing managed and addressed? • Are there any specific issues associated with diets for older prisoners? • How are issues of dying and death dealt with in prisons? • How do prisons regimes identify the support that they need to address these needs for older prisoners?

c. Strategic and partnership objectives • How do prisons identify and allocate resources to older prisoners? • How do prisons identify, develop and maintain strategic relationships with outside organisations with expertise in the needs and identities of older people? • Are there differences in meeting the needs of older offenders based on prison categorisation or is it based on individual offender risk? • How much staff time is taken strategically to address the needs of older prisoners? • What sort of physical resources are needed to meet the needs of older prisoners? • Are these resources only used by the older prison population? • Are there physical changes that need to be made to the prisons estate? Do cells or health care areas need to be altered? • How are older prisoners’ concerns and needs raised between partner organisations? • How is information shared between partner organisations?

d. Operational issues, practices and concerns • How do prisons identify, develop and maintain operational relationships with outside organisations with expertise in the needs and identities of older people? • How much operational staff time is taken to address the needs of older prisoners? • Are older prisoners housed in separately from younger prisoners? If so, are they housed within vulnerable prisoner units? • If older prisoners are housed all together, what impact does this have on managing the wings? • Are staff specifically allocated to older prisoner wings? • If older prisoners are housed with other prisoners, what impact does this have on managing the wings?

March 2013

OP 28

Written submission from the Centre for Mental Health and the Mental Health Foundation1

Background

Mental ill health is the norm among prisoners in England and Wales. The most reliable prevalence data (Singleton et al, 1998) suggest that 8% of prisoners have a psychosis, 66% personality disorder and 45% have depression or anxiety. Rates of drug and alcohol dependency are also very high, at 45% and 30% respectively. Overall, recent estimates suggest that about a quarter of prisoners have a serious enough mental illness to require specialist treatment (Centre for Mental Health, 2011)

There are no reliable data about the age distribution of these mental health problems. There is, however, no reason to suppose that prevalence rates among older prisoners are very different. The main additional concern for older prisoners is dementia. The prevalence of dementia among prisoners is, however, undetermined (Moll, 2013).

In the UK as a whole, some 800,000 people have dementia, of whom 30% also have depression. The prison population tends to age more quickly than average, as a result of which it is estimated that five per cent of prisoners aged over 55 would have dementia (Moll, 2013).

Responses to specific questions

Whether responsibilities for the mental and physical health and social care of older prisoners are clearly defined.

Responsibility for mental health care in prison was transferred to the NHS in 2006. Since that time the number of mental health teams has risen sharply. All English prisons now have an ‘inreach’ team. These are designed mostly to support prisoners with severe and enduring mental illnesses though an increasing number are diversifying the support they offer. This does not typically extend to supporting older prisoners with dementia, however.

The biggest gap in the provision of mental health support within most prisons is in primary care. Depression and anxiety are common among prisoners of all ages yet provision of psychological support is limited (Durcan, 2008).

1 Centre for Mental Health and the Mental Health Foundation are two independent national charities. We have provided evidence jointly from our different perspectives about the mental health needs of older prisoners. Our evidence responds to the questions the Committee has set for the inquiry where our charities have relevant evidence from our research work. OP 28 The social care needs of prisoners of all ages are currently not well met. The Care and Support Bill affords an opportunity to define more clearly how these needs should be met and who is responsible for ensuring that this occurs.

The effectiveness with which the particular needs of older prisoners including health and social care, are met; and examples of good practice.

The Mental Health Foundation report Losing Track of Time (Moll, 2013) identified a number of shortcomings in the provision of support to prisoners with dementia. Identification of prisoners with age-related impairments was poor because of:

• A lack of screening for prisoners with age-related difficulties, including cognitive impairment; • A lack of awareness of dementia among prison staff, including healthcare workers; • Deficiencies in communication between prison officers and healthcare staff.

The report also identified examples of prisons taking positive steps to overcome these barriers, including:

• HMP Isle of Wight has a clear ‘pathway’ for prisoners having difficulties with memory including assessments and specialist services. It also provides a ‘buddy’ service for older prisoners. • HMP Stafford provides assessments for care services in the community two months prior to older prisoners’ release dates to ensure continuity of care when they leave. • HMP Whatton has appointed a lead nurse to coordinate the care of older prisoners. • HMPs Exeter and Dartmoor provide dementia awareness training to both staff and prisoners, delivered by the Alzheimer’s Society.

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

Many older or disabled prisoners require alterations to the standard prison regime in order to participate fully in rehabilitative activities. A number of studies have evidenced the intimidation felt by older inmates around their younger peers and the risk of isolation such an environment creates. Initiatives launched by several prisons to counter it have included:

• Alternative times to attend the gym (HMP Stafford) • Alternative exercise classes (e.g. Tai Chi at HMPs Dartmoor and Exeter) • Older prisoner clubs offering alternative activities and a safer environment (HMPs Leyhill, Whatton and Shepton Mallet) • Forums for older prisoners to have a voice at governance level (HMPs Isle of Wight and Wakefield) • Physical adaptations to counter mobility issues (HMP Exeter) OP 28 • Activities for older prisoners with cognitive impairment (HMPs Dartmoor, Exeter and Channings Wood).

The majority of the listed alterations are low in cost but have required the initiative of individual prisons to implement. A national strategy on older offenders should offer clear guidance and instruction on how each establishment, regardless of size or security classification, can make their regime more accessible for older prisoners. Utilising the expertise of relevant voluntary sector agencies could be critical in transforming both the provisions available and attitudes towards ageing in prisons.

The effectiveness of training given to prison staff to deal with the particular needs of older prisoners, including mental illness and palliative care.

While Moll (2013) identified a number of promising examples of training being provided and developed, particularly by specialist charities, awareness of dementia among prison staff is poor. The report identified a fatalistic attitude to the cognitive abilities of older prisoners.

Prison officers now receive training in mental health as part of their initial training but many existing staff report feeling under-equipped to support prisoners’ mental health needs.

The role of the voluntary and community sector and private sector in the provision of care for older people in leaving prison.

The voluntary sector is well positioned to share its expertise on issues around ageing. Most establishments highlighted as examples of good practice in working with older prisoners had forged strong partnerships with local and national charities, including RECOOP, Age UK and the Alzheimer’s Society (Moll, 2013). With appropriate support, such organisations could play a major role in addressing relevant resettlement issues in partnership with statutory services or private providers.

The effectiveness of arrangements for resettlement of older prisoners.

Resettlement is a major concern for prisoners with mental health needs. Research by Centre for Mental Health (Durcan, 2008) found that apprehension about release was widespread but that prisoners in contact with ‘inreach’ teams were less anxious than those who did not receive this support. Many inreach teams, however, have found it difficult to make arrangements for prisoners to receive continued health and care support after release. Accommodation was also an issue that aroused considerable anxiety for older prisoners without an address to return to, as many felt hostels were a threatening environment where their chances of victimisation from younger occupants were high (Prison Reform Trust, 2008).

Whether a national strategy for the treatment of older prisoners should be established; and if so what it should contain.

OP 28 We believe that a strategy to meet the needs of older prisoners would be beneficial. Older prisoners have distinctive needs from a range of different organisations that are being met inconsistently and with wide variations from one prison to another.

March 2013

References

Centre for Mental Health 2011, Mental health care and the criminal justice system. London: Centre for Mental Health Durcan G 2008, From the Inside. London: Centre for Mental Health Moll A 2013, Losing Track of Time. London: Mental Health Foundation Prison Reform Trust 2008, Doing Time: The experience and needs of older people in prison. London: PRT Singleton et al 1998 Psychiatric morbidity among prisoners in England and Wales. London: Office for National Statistics OP 29 Written submission from Age UK

Introduction

1. As at June 2011, there were 8,125 prisoners aged 50 and over in England and Wales, including 2,811 aged 60 and over. This group makes up 11 per cent of the total prison population. Older prisoners are the fastest-growing section of the prison population. The number of sentenced prisoners aged 60 and over rose, for example, by 119 per cent between 1999 and 2009, yet none of the systems within the prison service are designed with older prisoners in mind.

2. There are a number of reasons for this growth, but a significant cause is the increase in the proportion of the sentenced prison population serving indeterminate sentences (life sentences and indeterminate public protection sentences) from 9% in 1995 to 18% in 2010. It follows that the majority of these will have been imprisoned for serious offences and no one should be in any doubt about the need to protect the public from those convicted of such crimes where appropriate. For example, 40% of men in prison aged over 50 have been convicted of sex offences. The next highest offence among older prisoners is violence against the person (26%) followed by drug offences (12%) (PRT Bromley Briefing December 2010).

3. Estimates of future prison numbers vary widely. By the end of June 2017 the demand for prison spaces is projected to be between 83,100 and 94,800. We can expect a significant proportion of these to be older prisoners, since there is no indication that the trend will be anything other than upwards.

4. Age UK supports a national body, the Older People in Prison Forum, to bring together interested parties from the statutory and voluntary sector. Some local Age UKs work closely with the prison service in partnership with health and social services and other voluntary organisations, including the Prison Reform Trust, Nacro, Action for Prisoners’ Families, FaithAction, Independent Monitoring Boards, Restore 50plus, RECOOP, the Royal British Legion, SSAFA, and Combat Stress.

5. Through Older Prisoners’ Forums, local Age UKs can help older people in prison to play an active role in improving the quality of the prison regime, to the benefit of the Prison Service as well as older prisoners themselves, and in support of successful rehabilitation and resettlement post release. Age UK has published a document advising commissioners on the services for older prisoners and older ex-offenders available from Age UK and local Age UKsi.

Definition of older prisoners

6. According to its terms of reference, the Justice Select Committee, for the purposes of this inquiry, proposes to define older prisoners as those aged 60 and over. This may on the face of it, seem logical, but it fails to take into account evidence that many prisoners in their 50s and over have a physical health status ten years greater than their contemporaries in the communityii. OP 29

Age UK, among other organisations working in this area use 50+ as the definition of an older prisoner. We therefore think that the Committee should widen its remit to ensure important evidence is not excluded.

The mental and physical health and social care of older prisoners

7. There is no explicit Prison Service Instruction (PSI) or Order (PSO) that supports effective commissioning for older people in prison. Older people in prison commonly suffer poor mental and physical health, but prison staff in general lack training in the rights and needs of older people. Only a few prisons (e.g. HMP Downview) have developed their own older offenders policy and the recent Green Paper, Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders, made no mention of older prisoners.

The effectiveness with which the health and social care needs of older prisoners are met

8. Older people in prison should receive the same level of basic social and health care support as those not in prison and guidance should be developed and disseminated to Resettlement Teams outlining best practice and responsibilities in resettling older prisoners, including pensions advice, housing, and accessing healthcare. A report by Her Majesty’s Inspectorate of prisons in 2008iii raised grave concerns that the social care needs, in particular, of older and disabled prisoners were not planned or provided for after release. Legislation clearly states there is a duty to provide healthcare to prisoners, but it is ambiguous when it comes to social care provision. Prisoners are not explicitly included or excluded from a local authority’s duty of care, but in practice this ambiguity means many authorities do not extend their services to older people in prison. Statutory responsibilities should be clarified so that local authorities have a clear duty to provide in-prison social care.

9. Prison and health care professionals also need support to deliver high quality end of life care to prisoners, particularly if those approaching death are to be able to make genuine choices about how they are cared for in the last months of their life. Being in prison should not negate the right to a dignified death, both for the individual and their families. As the average age of the prison population rises - it is inevitable that the number of natural deaths in custody will also increase; a strategy to ensure these deaths are properly managed is urgently needed.

10. Older women prisoners may have quite specific needs, particularly around health care issues. It is important that women do not avoid seeking treatment in prison because of anxiety about how their request will be met, or possible indignities that they may suffer in diagnosis. Studies have shown that the potential humiliation of being handcuffed and of being strip-searched when moving to and from hospital prevented many women from seeking vital medical treatmentiv. The lack of facilities and inadequate care can lead to a lack of understanding about age-related illnesses so that they are not catered for or even acknowledged. The discontinuation of medication is problematic for women, having unforeseen and unacknowledged side effects.

OP 29

The most appropriate environment and regime for older prisoners.

11. Older prisoners have different needs that should be reflected in their prison accommodation. According to NACRO, many older prisoners wish to remain in a mainstream wing environment, with access to all the available resources, and they should be supported in doing this, but with the option of having quiet spaces, wings and cellsv. Simple environmental adaptations should also be considered and the creation of facilities with enhanced resources for accommodating older prisoners who may have mobility or other support needs. Resource mapping should be carried out at local and regional level to support moves to a more flexible regime for older prisoners.

12. With recent changes in UK legislation affecting the statutory retirement age, it is likely to be the case that many older prisoners will still choose to work, but others may not be able to do so (perhaps because of a health condition) and prison authorities will need to provide the opportunity for older inmates to take up alternative activities.

The effectiveness of training given to prison staff to deal with older prisoners

13. Specific training for prison staff members in how to care for older people in prison is essential. Many of those for whom they are responsible will have impairment of sight, hearing, memory and the slowing of movement and mental responsiveness, all of which can make their needs quite distinct from those in the general prison population.

14. The 2008 HMIP also reported that there was a ‘complete lack of staff training in identifying the signs of mental health problems among the elderly.’ This is especially worrying, as evidence of the health needs of older prisoners has been available for more than ten yearsvi. Recent research by Staffordshire Universityvii, for example, revealed that 48% of older people in four prisons had at least one diagnosable mental health condition, excluding personality disorder. Most had some kind of physical health problem. Finally, the HMIP Annual Report 2007-08 revealed few prisons have a designated nurse for older prisoners. ‘Older prisoners in England and Wales’ HM Inspectorate of Prisons (2008),

The role of the voluntary and community sector and private sector

15. Voluntary sector agencies have a key role to play in improving the lives of older prisoners both inside and outside prison; there are excellent examples of the third sector providing support services, advocacy, information and advice and signposting to prisoners, amongst others. But greater opportunities need to be given to the third sector to provide these and other services to older prisoners. For example, they could be brought in to advise on developing plans for special accommodation for older prisoners, setting up forums for

OP 29

older prisoners, and ensuring that older prisoners receive information and advice about the issues that are of concern to them.

Effectiveness of arrangements for resettlement of older prisoners

16. Resettlement programmes tend to be designed to meet the needs of younger people, which means that older prisoners suffer age discrimination. Many older prisoners experience problems related to housing and pensions/income on release from prison. These problems are often closely linked- and self- perpetuating. A significant number will have lost their homes- or will find it difficult to find affordable accommodation; resettlement grants are not adequate to pay for housing. In addition, many prisoners will not previously have been able to claim a pension.

17. It is therefore vital that older prisoners are able to access effective advice, support and signposting services both inside and outside of prison. Ensuring that older prisoners have access to appropriate accommodation on release should be a priority for prison resettlement/probation teams and local authority/housing association housing officers.

18. Many older prisoners find the resettlement process unsatisfactory in terms of the support and guidance they are given and the blame for this tends to fall on the probation service. They in turn admit that the service, particularly inside jails can be patchyviii, but suggest this is due to insufficient resources and those that are available being allocated according to the perceived risk to the public. Most older prisoners are deemed to be a low risk while still locked up and only as their release date nears are their needs addressed. They are also generally less assertive than their younger counterparts and do not request information, or at least do not do so repeatedly if it is not forthcoming.ix

19. Therefore probation staff need to take account of the particular needs of older prisoners in terms of their resettlement and support prior to release and ensure they are not overlooked. They should ensure all the relevant information is made available and that it is fully understood.

Equality and human rights legislation

20. The Equality Act 2010 is a comprehensive unification of previous strands of discrimination law and new provisions. It prohibits various types of unlawful discrimination where that discrimination is “because of” a protected characteristic. Protected characteristics include disability and age.

21. The Public Sector Equality Duty sets out how a public authority must in the exercise of its functions have ‘due regard’ to the need to:

• eliminate conduct prohibited under the Act; • advance equality of opportunity between those with a protected characteristic and others; • foster good relations between those with a protected characteristic and others.

OP 29

22. There are many aspects of prison life to which the Act and the Duty might be applied, including reception and induction, employment and education and skills, healthcare, adjudications, complaints, visits and correspondence, transfers and resettlement. For example, often little or no attempt is made to obtain a prisoner’s GP, hospital, social services or previous medical records. Similarly, the initial assessment on arrival is still occasionally not done at all, or where it is, the standard is variable.x

23. The area of most concern however is older prisoners with disabilities. In its 2009 thematic report, HMIP concluded that provision for disabled prisoners remained variable across the prison estate and that disabled prisoners considered that they had a worse prison experience across all areas of prison life. It suggested that HM Prison Service still had “a considerable amount of work” to ensure that they fulfilled their duties towards disabled prisoners under the Disability Discrimination Act/Equality Act 2010.

24. The two main areas of practical concern for disabled prisoners are the identification and reporting of disabilities and the assessment and addressing of disability needs. There is a Prison Service Instruction covering this: PSI 32/2011, states “Governors must consider whether prison policies and practices, the built environment, or lack of auxiliary aids and services could put a disabled prisoner at a substantial disadvantage and if so must make reasonable adjustments to avoid the disadvantage” (paragraph 8.2)

25. Despite this the thematic report concluded that prisons have struggled to provide disabled prisoners with full access to facilities and activities, as disability needs are not adequately assessed/addressed. The two key barriers to meeting the needs of disabled people are lack of coordination between healthcare and social care in prisons and confusion over responsibility for and funding of, social care in prisons.

A national strategy for the treatment of older prisoners

26. It is important that the needs of older prisoners are recognised by those employed to care and rehabilitate them; at the same time, support for those who are released is equally as important, particularly if we are to prevent reoffending. It is hard to understand, even in a time of austerity, why a minimum level of resource has not been made available for this purpose and in particular why there remains no national strategy for older prisoners, supported by mandatory national and local standards.

27. A national strategy, while necessary, must also reflect the diversity of older prisoners and their different needs. As set out above, the definition of an older prisoner should be anyone who is 50 or over, which covers a significant age demographic. Many, but not all older prisoners will have health issues, either mainstream conditions or ones resulting from lifestyle choices or substance abuse that commenced in prison itself. There are many organisations representing prisoners who could contribute to the development of such a strategy and we hope that Government consults widely as part of the process.

An example of good practice

OP 29

28. HMP Norwich is a category-B local prison for men aged 18 and over, which serves the courts of Norwich and Suffolk. Ten per cent of the prison’s population are over the age of 50. The prison’s most recent health needs assessment has identified that this small but significant older prisoners’ population is in danger of being ‘lost’ within the younger prisoners’ needs.

29. To address the needs of older prisoners, HMP Norwich has established a partnership with NHS Norfolk, and Age UK Norwich. This aims to: • improve social contact and mutual support between and with older prisoners by using volunteers as well as Age UK Norwich staff to run social engagement sessions and regular forums; • contribute to improving and maintaining good mental health among prisoners, and especially older prisoners; • provide information, advice and liaison support to older prisoners concerning life and opportunities after release; • provide onward referral to appropriate specialist support services to enable ex-prisoners to maintain wellbeing and to reduce further contact with the criminal justice system.

30. Age UK Norwich, together with the then staff at the older lifers’ Nelson unit (L Wing), had been running a pilot project to support less able older prisoners with volunteer visitors. Unlike a normal befriending service, the volunteers visited in a small group. This was both to provide support to each other and also to encourage the development of social interaction between clients.

31. The first year evaluation, after the visits had been going for a few months, indicated that the majority of prisoners had benefitted in some way from the project. Staff and volunteers believed the visits to be beneficial in a number of ways. Indicators of improved wellbeing included improvements in older prisoners’ welcome and willingness to chat, their contribution in suggesting activities and their engagement in activities.

March 2013

i Supporting older people in prison: Ideas for practice ii Kratcoski and Pownall (1989) iii Older prisoners in England and Wales’ HM Inspectorate of Prisons (2008) iv Carlen (1998) v Working with older prisoners (2009) vi S. Fazel et al. (2001) vii N. Le Mesurier et al. (2010)

OP 29

viii Crawley (2004) ix ‘Release and Resettlement: the perspectives of older prisoners’ Crawley CJM no.56 (2004) x Evidence from Leigh Day and Co Solicitors given to Age UK (June 2012)

OP 30

Written submission from: Dr Elaine Crawley

1. The evidence presented here draws directly on the findings of research I have conducted since 2002 on the experiences, perceptions, and needs of older male prisoners (ie prisoners of retirement age and above), in particularly the impacts that their imprisonment has on their physical health, and on the psychological and emotional impacts of their imprisonment. The research began from a recognition that the number of older men in prison in England and Wales had risen sharply over the course of the last decade. This increase has been a sustained one and has significantly outpaced the general rise in the prison population over the same period. My colleague (Professor Richard Sparks) and I set out to grasp the prison‐level consequences of this hitherto relatively un‐remarked development through a systematic programme of observation and interviews with staff and prisoners with the following objectives:

• To explore the social and emotional impacts of imprisonment on the older prisoner and to examine the coping and survival strategies which older prisoners adopt in coming to terms with custody and with the cultures, routines, rules and practices of the prison. • To explore how physical ageing (and the decline in physiological effectiveness that accompanies it) is experienced in prisons, and the implications of the ageing process for prison management (including health and social care). • To explore how the older prisoner (especially the long‐term prisoner) views his eventual re‐entry into the community, and to examine current practice in preparing older prisoners for re‐settlement and social integration. • To explore how uniformed staff who work with older prisoners see their role, given that they work with a group of prisoners who, by virtue of their age, are likely to have markedly different attitudes, needs, problems and experiences from the general the prison population. • To illuminate the resource, regime and policy implications of the confinement of older people.

2. The first achievement of this study was to have gathered new data that informed each of these points. Second, it was possible to develop analytic frameworks that productively link these discoveries with extant traditions of inquiry in the social analysis of imprisonment and with other social scientific resources. OP 30

I feel it is important to emphasise that I encountered exceptionally high levels of distress amongst the prisoners throughout this study, and have subsequently been able to pose questions about how the generic `pains of imprisonment' may be amplified by advancing age.

Unexpected Findings

• I did not expect to find so many elderly men serving relatively long sentences for ‘historic’ offences (usually – but not in every case – sexual offences allegedly carried out up to five decades ago). • Bearing in mind the requirements of current and forthcoming Disability legislation, I did not expect such a ‘patchy’ approach to meeting the health and social needs of elderly prisoners, many of whom are immobile and chronically ill. • I did not anticipate such a contrast between national policy (virtually non‐existent) and local practice (often innovative and sensitively carried out). • I did not anticipate the divergence of elderly prisoner preferences as to whether older men should be ‘mixed’ in with, or ‘segregated’ from younger, fitter prisoners.

3. There is disagreement about who constitutes the ‘older prisoner’. Some countries, and some authors, define prisoners over 50 years as ‘older’, and when compared to the general population they are indeed older. In my own view, however, our retirement age for men (65 years) is the age at which most people, both within and outside the prison community are starting to ‘feel old’. I do not accept the generally held view that prisoners are generally 10 years older, both physically and mentally, than his counterpart in wider society. This was not borne out during my research: rather people from all walks of life age differently. The ‘older’ prisoners I have interviewed in the period 2002 to the present have been aged between sixty‐five years and eighty‐four years.

4. I am in agreement, however, with the numerous agencies which have striven, for over a decade, to press for a National Strategy for the proper management of older prisoners. Of the prisons selected for the project (the range was selected precisely because they held relatively large concentrations of older men), the differences in the extent to which prisoners’ age‐specific needs were being addressed (or not) was OP 30

quite striking. In HMP Wymott, for example, prison officers were generally more aware of these needs, and had put in place, with the support of the Governor‐in‐ Charge, various ‘local’ innovations such as more comfortable chairs, anti‐slip mats and grab grails in the showers, and had engaged a very friendly husband and wife team (both Captains in the Liverpool branch of the Salvation Army) who, once a month, held the CAMEO (Come Along and Meet Each Other) Club. This club, set up and run by the couple, was extremely well‐attended, giving upwards of forty older men the opportunity to play dominoes, listen to an outside speaker, take part in a quiz or just sit and talk. With a mug of tea in one hand and three biscuits in the other, one man told me that “When you come here, for a couple of hours you can forget you’re in a prison.” Despite the kindness and resourcefulness of many officers, it remained the case that a number of the more elderly men, especially those suffering from health problems such as poor mobility, incontinence, hyper‐tension, lung diseases, arthritis and Parkinson’s were still not able to engage in the activities available to their much younger counterparts. While most prisoners of pension age do not wish to go to the gym to lift weights, they very often do wish to visit the chapel, or the library, or to simply go out for a little fresh air. Unfortunately, for a number of older prisoners, this was simply impossible, even at Wymott. In each of the four prisons in the study, older and infirm prisoners were, formally at least, subject to the same regime (same time‐tables, same physical layout, same practices, same rules and same activities) as younger men in the same establishment, most of whom were in their twenties and thirties. When I asked my interviewees whether officers generally made any concessions (in the regime/time‐table) for the ageing and less mobile, they overwhelmingly said that this was not the case. For example, one man in his seventies remarked that:

“..they still expect us to do things within the same time frame as younger men, such as get to the gate in time for the exercise period….things like that. If we’re too slow, the gate’s shut and we’re sent back to the wing. Others that can manage to get there alright don’t go either, because there’s no toilet in the yard so if want to go you’re stuck. “

OP 30

5. Neither were ‘cell‐bound’ prisoners in other prisons able to relax, even in their own cells, since hard, wooden schoolroom chairs were the only type available to sit on. It was alarming to see that one man in his late seventies spent all day sitting on the edge of his bed with his back unsupported and his legs dangling while doing his ‘in‐ cell work’ (an embroidered cushion cover). When I asked if he was “comfortable like that?” he said that he hadn’t much choice because “when I sit on that chair it makes my bottom hurt”. Not only was the lack of support to his back likely to cause back pain, the lack of support for his legs was likely to lead to thrombosis.

6. Moreover, unlike (however problematically) women, young offenders or psychiatric patients, older prisoners are still scarcely recognized at the policy level as a distinctive or special group. No imperative exists therefore to vary the regime or timetable to meet their needs or abilities, if it is inconvenient to do so. My research colleague and I termed the resulting acts and omissions that impinge negatively on the older prisoner ‘institutional thoughtlessness.’ Ten years on, while there have been some developments and improvements (eg a 20 bed unit was established at HMP Norwich, and most of the prisoners I had interviewed in HMP Kingston’s ‘Elderly Unit’ were transferred there when the Unit was deemed unfit for purpose by an incoming Governor‐in‐Charge. It is arguable, however, that seen in the bigger picture of the less‐than‐legitimate treatment of older prisoners, these changes are relatively modest, both in their character and their scope.

7. The participant observational work which was central to this study allowed me to understand how older prisoners negotiated their way through and around the requirements of everyday life under the prevailing regimes ‐ their daily tactics, innovations and tricks for survival, and their methods of coping with the challenges of (largely inappropriate) buildings and the exigencies of the prison timetable. At HMP Kingston I regularly observed elderly men unsteadily negotiating a stair‐lift whilst balancing plates of food and a walking stick. At prisons without stair‐lifts we saw elderly prisoners struggling up stairs or remaining in their cells during the exercise period as they were too immobile to walk to and from the yard in the time OP 30

allowed. Importantly, my observations also allowed me to recognise the heterogeneity of this elderly prisoner group; while many in their late‐seventies were largely immobile, forgetful and depressed, others enthusiastically took computing classes, wrote essays or went to the ‘Seniors’ exercise class.

8. A one‐size‐fits‐all regime for older and elderly prisoners would also be inappropriate. Asked if they would like to move to a wing dedicated to older prisoners, a large number of the men I have spoken to said words to the effect that it would “be my idea of hell.” Although they were old and frail in their bodies, in their minds they remained in their thirties and forties, and liked to chat with younger prisoners, liked their company, their wit, and their music. They felt that it kept them young. In stark contrast, other older men said that a dedicated wing for older men would be “bliss” because they could get away from noisy prisoners and the possibility of personal possessions being taken from them by much younger, stronger men, who found it easy to bully the more frail and compliant prisoners out of goods such as their tobacco, biscuits and tea. It was interesting that a large numbers of older male prisoners have, over the years, suggested a compromise in terms of their living environment. This entailed being able to go and visit younger prisoners in different parts of the prison if they wished, but being able to “return to a safe haven at night.”

Release and Resettlement 9. Most prisoners are eventually released, and so they must make preparations for resettlement. Prison Service Order 2300 (para.1.12) states inter alia that account must be taken of the diversity of the prisoner population and the consequent differences in resettlement needs, and that specific sections of the prison population (e.g. elderly prisoners) may need to be catered for in different ways. However, I found that elderly prisoners due for release often have intense anxieties about, and an inadequate understanding of the resettlement process. Two issues seem to give elderly prisoners the most concern; first, the lack of clarity from prison and probation staff as to where they are going to live, how they are going to get there (with limited money and poor mobility) and whom they will be living with. We were OP 30

also struck by prisoners’ fears (by no means always fanciful) for their personal safety once in the community.

10. Anxieties about what release would bring were especially strong for those serving sentences for sexual offences against children. Several of our interviewees said that they had had to flee their homes, leaving all personal possessions behind, because of threats from neighbours to kill them or burn their houses down. In cases where offenders had expected to return home after the court hearing but had, instead, received a prison sentence, they had to rely on relatives or friends to retrieve personal possessions and this was not always possible. In numerous cases where the prisoner had been living in council‐owned accommodation, it transpired that the housing office, upon hearing of the prisoner’s conviction, had entered the property and thrown everything out, including personal papers and family photographs. A key recommendation to be made here would be for arrangements to be made for those elderly prisoners with few friends (many prisoners find that their friends have died or moved to a care home whilst they had been in prisons) and no family (or a family who had no interest in them) to make arrangements for the safe‐keeping of sentimental items and important paperwork. Otherwise, released elderly prisoners feel they have lost their past, and as such see no future.

11. Sadly, many prisoners who have grown old in the prison most have lost touch with the outside world, lost touch with family and friends, doubt their ability to make independent decisions and, in many respects, view the prison as home Some of these men can barely remember how long they have been in prison; one of my interviewees thought it was ‘about thirty years’ while another thought he had come into prison when he was ‘about forty’ (at the time of my interview he was sixty‐two). A third, an Alzheimer sufferer, neither knew where he was, how long he had been there or what he was there for. Fellow prisoners had the idea of sticking a large picture of a frog to the door of his room so that he could find his way back ‘home’. Amongst long‐serving prisoners, the claim that there is ‘nothing and no one to go out to’ is not uncommon. I was also struck by the number of elderly men who, although not particularly wishing to stay in prison, were, nonetheless, anxious about release. OP 30

In some cases this was hardly surprising, given that, although only two or three weeks away from their release date, they had still not received confirmation from Probation as to where they were going to live or who would support them once they were out. For elderly, relatively frail men, fears of hostel life were intense. They were unsure if they could cope with the nature of hostel life or with the behaviour and attitudes of other (mostly younger) ex‐prisoners already living there. Reflecting the prison population as a whole, those who are released from prison to hostels are usually relatively young men. Many have histories of violence and problems of alcohol and drug abuse and, as such, are seen by elderly men as threatening. 12. Blurring Role Boundaries: What many officers feel about working with elderly prisoners

The content and duration of training given to prison officers who work with elderly prisoners, particularly those who have diseases such as dementia or who are particularly frail is grossly insufficient. Officers tell me that when a prisoner falls down or ignores an instruction, they simply do not know what to do, For this reason, many officers, perhaps especially younger men, do not want to work with elderly prisoners. They do not regard them as ‘proper’ prisoners because they are in the most part unchallenging and compliant ie not ‘proper’ prisoners. By extension, they believe such work is not ‘proper’ prison officer work. This attitude needs addressing: it relates to a long-standing and enduring macho culture. That is why I would argue for a a drive toward greater professionalization within the Service, ie something akin to the Norwegian model (KRUS) where prison officer training, which includes modules on penal philosophy and the ethics of imprisonment is completed in 2 years and not 6 weeks as in England and Wales.

Concluding Remarks

Presently, the treatment of older prisoners does not comply with equality and human rights legislation. At present, the focus is often equality (everyone gets the same) but all too often equality = unfairness and the breaching of human rights. A national strategy for the treatment of older prisoners should certainly be established. It should define the minimum expectations for how to care for elderly prisoners appropriately; effective training for officers and the OP 30 effective monitoring of health and social care need. Such a strategy does not leave the proper treatment of older prisoners to chance.

March 2013 OP 31 Written submission from The Association of Members of Independent Monitoring Boards

AMIMB submission to the Justice Select Committee’s Inquiry into elderly prisoners

WHO WE ARE: By law, every prison and immigration removal centre must have an Independent Monitoring Board (IMB). IMB members are volunteers from the local community, appointed by the Secretary of State and have a duty, established by acts of parliament, to: satisfy themselves as to the humane and just treatment of those held in custody and (in prisons) the range and adequacy of the programmes preparing them for release

IMBs monitor to ensure that people in custody are treated fairly and humanely and that they are offered adequate preparation for return to society. They are the independent eyes and ears of the community and offer a totally unbiased view of what is really happening in our secure establishments

AMIMB, the Association of Members of Independent Monitoring Boards is a membership organisation that was founded in 1980 to introduce consistent standards and reinforce the independent nature of the role of prison monitoring. Our members have unfettered access to their designated establishment and the right to talk to those in custody out of sight and hearing of staff.

This submission is a summary based upon 33 annual reports (all but 2 from 2011/12) of IMBs who have raised issues regarding elderly prisoners and does not necessarily represent the views of individual AMIMB members.

Summary • There is a very mixed picture of how elderly prisoners are treated across the prison estate, with inconsistencies in healthcare screenings, regime activities, how their physical needs are being met. • Most prison buildings and sites are not suitable for an aging population; the cells in the Victorian jails are not wide enough for wheelchair access. Many adaptations are having to be made across the prison estate including stairlifts, grab rails, end of life cells. • Growth in this group of prisoners is placing extra pressure on prison resources (people and budgets) when each prison is having to set its own local policy as part of conforming to the equality policy and ‘re-invent’ the wheel each time • Social Services, NOMS (prisons and probation), Healthcare, Parole Board, Local Authorities need to work together to establish a national strategy for the management of older prisoners during imprisonment and on release so they may receive the most appropriate treatment delivered by appropriately trained staff.

1. Buildings – fit for purpose?

1.1 Concerns have been expressed about the unsuitable conditions to locate elderly prisoners, this relates to the buildings as well as cells.

“Like many prisons Frankland was designed for fit young men, making life difficult for the rising population of older prisoners. There are 132 prisoners who are over the age of 55 and this number will invariably continue to increase as sentences for those in a high security prison tend to be lengthy.” IMB Frankland OP 31 “As the prison population ages there is an increasing need for specialised units for older prisoners. This has been addressed in the case of male prisoners. Is there any hope of such placements for the elderly female prisoner?” IMB Holloway

“Additionally, bunk beds are considered by the Board to be totally unsuitable for elderly, and often, infirm or weak prisoners and present a potentially serious health and safety issue. Some bunk beds have no access ladder. One prisoner stated that he accesses his top bunk “by standing on a chair”; a poor state of affairs for very elderly prisoners.” IMB Wymott

“As highlighted in last two years reports the number of elderly and disabled offenders raise concerns that the in-cell and other facilities for such offenders continues to be inappropriate in many cases” IMB Bure

“We welcome the increased attention being given at Coldingley to the needs of older prisoners, taking account of the fact that many prisoners have led a life which has caused them to age more quickly than the general population. Coldingley’s industrial role is likely to limit its ability to accommodate many older prisoners, and 80% of its accommodation – in the four original wings – cannot readily be adapted to the needs of older prisoners.” IMB Coldingley.

1.2 Some prison governors have recognised the need of the aging population and have converted wings to address the need, but with budgetary constraints not all governors/directors are able to do anything about this. Spending money on conversions does not appear to be based upon any specific criteria like the number of prisoners over 60, average length of sentence or type of offence.

“L Wing, the elderly lifers unit, now appears to be housing more elderly prisoners from the local region, rather than nationally as before. It has the ‘feel’ of a rather sad old people’s home with fewer visitors and little to do. The rather cheerless large sitting room with a games table and big TV is often nearly empty. E Wing is to be re-rolled as a quieter, ‘mature unit’ following the re-roll in March 2012, aiming to provide prisoners with a peaceful environment away from the hubbub of the other wings.” IMB Norwich

“Discussions about developing a dedicated Older Prisoners unit are ongoing and prisoner representatives express some frustration at what they perceive to be the slow pace of implementing this initiative.” IMB Altcourse

“The Board is very pleased to report the conversion of J Wing to use as the Older Prisoner and Social Care Wing unit. It is undoubtedly the case that this could serve as a model for other prisons. The dedication of Wing staff towards the success of this initiative is exemplary. Unfortunately, however, some cells still have no access to hot water. Although a pump has been installed, some cells need an individual pumping system.” IMB Birmingham

1.3 There is a recognition by IMB members of the pressure on resources especially when delivering adaptations to meet the needs of the aging population.

“We also acknowledge that the Governor and her team are doing all they can to mitigate the issues faced by the elderly and disabled where they can [purchasing aids to help those with mobility problems and opening flat access showers on each of OP 31 the six wings]. However with the growing elderly population it is essential that better provision is made for these offenders.” IMB Bure

“There are a limited number of cells adapted to meet specific needs and conversion of a standard cell is problematic. As a consequence wheelchair users are sometimes held on healthcare, taking up ‘beds’ for prisoners with more urgent healthcare needs. Wheelchair dependent prisoners therefore have difficulties in accessing a standard regime of activities, employment and association whilst on healthcare.” IMB Altcourse

“Recognition of increased prisoner numbers over the age of fifty has been responded to by the prison where cost is not a major implication. However, investment in updating facilities is urgently required, The Board has requested the prison to consider various facilities for disabled prisoners over the last year. When marginal cost has been involved the Governor has responded positively to our request. The availability of wheelchairs has been noted. However, the more pressing needs require investment. The most urgent, outstanding needs are: i) An accessible shower for disabled prisoners on each wing (with seat and ramp) ii) Provision of at least one cell providing wheel chair access.

Due to the increasing number of older and disabled prisoners throughout the Establishment it is the view of the Board that more funding is required without delay. Respect and dignity are lacking when disabled prisoners are unable to shower and move in and out of cells in a wheelchair if required. Installation of more disability aids are urgently needed.” IMB Channings Wood

“Showers on the wings are usually cleaned to an acceptable standard and there has been an improvement and increase in facilities for prisoners with disabilities. Most also have some privacy screening, with the notable exception of Down Tor which has no screening, grab rails or seats.” IMB Dartmoor

“Only one cell in the main prison has an adequately wide door for wheelchair access. For these men access to daily showers was not a reality and getting to other areas of the prison such as the chapel, visits or workshops was difficult or limited. It was decided that these prisoners should be lodged in the prison’s inpatient facility, or the drugs unit, while places were sought elsewhere. It was disappointing that accommodation for these wheelchair users was not sought at the earliest opportunity. It was a failure at Area level that no accommodation could be found for them at any other establishment.” IMB Wandsworth

“Lifts and stair lifts are positioned in the prison so that there is access to all areas” IMB Swaleside

“The equality team is very aware of the increasing number of older residents and hence the probability of more residents with disabilities. It is noticeable when walking round the prison the additional facilities to cater for these people which includes, ramps for wheel chairs, grab rails in showers and toilets and the presence and usage of wheel chairs which at one time was a very rare sight.” IMB New Hall

2. Regimes for the Older Prisoner 2.1 Whilst there is evidence of some excellent practice of activities for the retired and disabled prisoners in some establishments there is also some very sad evidence where this group of prisoners can be locked up in cell for 22 hours a day. Many of the activities are delivered through third party agencies and charities.

OP 31 “The prison is beginning to recognise the needs of the older prisoners and to address the lack of activities specifically targeted at this group of prisoners. The older prisoners ‘Out and About’ group on the Reception site is well attended each Thursday afternoon, providing an opportunity for older prisoners throughout the Reception Site to meet together and participate in general activities. L wing continues to have limited activities, although Age Concern and members of the Official Prison Visitors (OPVs) visit the wing regularly.” IMB Norwich

“The Diversity Centre The development and organisation of this centre with its own day accommodation offering occupation and activities for older prisoners continues to extend the opportunities on offer. It is also now open to prisoners under 50 who have physical, mental or psychological difficulties. Activities have expanded and there are now workshops: - Making wooden boxes which are sold for charity. - Repairing old garden tools for inner city gardens and allotments. - Mending and cleaning clothing for prisoners on release. Servicing wheel chairs for the Red Cross. A garden has been created outside the Diversity Centre and grants obtained to provide low-impact exercise machines. A pilot pre-release course was run for those who have served many years in prison.” IMB Dartmoor

IMB Forest Bank asked the Minister: “With the increase in numbers of prisoners aged 65 and over being given significant custodial sentences, what measures are being taken to find and fund purposeful activities for them as they are not required to work in the prison”.

“Retired prisoners were offered a social room each day” IMB Stafford

“Older Persons - It is disappointing to note that the Fifty Plus ‘Time Out’ Community Centre, which the King’s Fund initially pledged funding for in August 2009, still was not completed in this reporting year, although advances were made with completion due in 2012.” IMB The Verne

“A new protocol has been put in place for those residents aged sixty or over who do not have to work, having reached ‘retirement’ age. This allows them, subject to risk assessment and IEP status (Incentive and Earnings Privileges) to be allowed out of their rooms on the wings during working hours.” IMB New Hall

“The Prisoner Representatives hold an ‘Over 50’s Club’ twice a week which has proved to be very successful and is well attended, if only for its recreational value.” IMB North Sea Camp

“For those prisoners who do not go to work, either because they are medically unfit or because they are over the age of 65, far too much time is spent behind their doors, typically 22 hours per day.” IMB Risley

2.2 The gym staff are praised for the activities on offer specifically to cater for the needs of the elderly and infirm and are in evidence in a large number of prisons

2.3 The use of prisoner forums is in evidence at a large number of prisons, however in some instances there does not appear to be a distinction between the elderly and the disabled.

3. Prison staff 3.1 Disability Liaison Officer. The lead for older prisoners in the prison tends to be given to the Disability Liaison officer who combines the overseeing of the elderly with OP 31 those with disabilities. However given the budgetary cuts there are many instances where this officer has been re-deployed.

“The DLO has a busy role in healthcare and unfortunately does not have sufficient time available to do justice to the needs of the disabled and older prisoners There have been some problems during the reporting year caused by cross-deployment of the Race Equality Officer and the Disabled and Older Prisoner Liaison Officer. Attendance at Forums and other meetings by Staff Diversity Officers has been poor.” IMB Woodhill

The Board was informed last year that priority would be given to providing more time to the DLO post which is 100% funded by Care UK. This has not happened and the Board repeats once again that the DLO role should be reviewed with the objective of providing sufficient time and support to carry out all duties effectively.” IMB Frankland

“The Board is concerned regarding the provision of a part time disability officer who is frequently required to perform other duties during his shift. The Board considers that only a full-time officer or equivalent should be in place” IMB Wymott

3.2 Training. Many IMBs acknowledge the care and dedication of many prison staff, who are proactive in ‘caring ‘ for the needs of the elderly, but it is also acknowledged that they have received no training to carry out these tasks.

“In the main prison officers are neither trained nor qualified to act as “carers of the elderly.” IMB Bure

“Given the further reductions on budgets locally, will NOMS be introducing centrally driven initiatives to ensure appropriate input from social services and specialist training to staff who will be dealing with prisoners’ needs ranging from Parkinsons Disease to dementia?” IMB Littlehey

4. Healthcare

The healthcare provision for the aging prison population is inconsistent with some fabulous examples of best practice. Healthcare provision for prisoners has to replicate the provision anyone would receive outside, the question has to be asked as to why healthcare has to pay for the prisoner escort to access specialist services, is this how the healthcare provider justifies the cost of some of the services put in place to meet the needs of the elderly in one establishment. For example the basic cost of putting in place an end of life provision is £100,000 not including staff training, drugs, nursing care etc. At Whatton the end of life suite was used 3 times last year for the last 36 hours of three prisoners lives. Examples of good practice include: “The Health Care Manager has been able to obtain £2,000 from the Kings Fund to re-furbish two side wards into one unit which will accommodate seriously sick patients who need extra care. Four Nurses have been trained in the area of nursing, which is in line with the Liverpool End of Life Pathway which is accepted as “Best Practice”. This year, to date, three prisoners have died in custody from natural causes and there have been 36 bed watches totalling 305 days. “IMB Forest Bank

“HMP Whatton has one of the highest rates of death by natural causes of any prison in England and Wales and the need to provide accommodation for terminally ill prisoners to die with dignity and in surroundings catering for their needs is crucial”

The role of specialist nurse for older prisoners (aged 55 and over) which began two years ago continues and is applauded by the board. Prisoners who would not make OP 31 the effort to visit the Healthcare centre are seen approximately once a month by the specialist nurse who can assess their needs within their own environment. Any medical needs she finds can then be addressed. The nurse involved has told us that she feels that it is an important service to the older prisoner as their needs could be so easily overlooked in a busy and bustling high security environment. The scheme is very popular with older prisoners.”

“Elderly prisoners are now given a certificate upon release detailing any medical condition and treatment given. This can then be handed to their General Practitioner (GP) so that he/she is fully aware of any health issues.” IMB Manchester

“The range of clinics regularly provided: diabetes, acupuncture, smoking cessation, alcohol awareness, epilepsy, coronary heart disease, asthma, ENT (Ear, Nose and Throat) and GUM (Genitourinary Medicine)” IMB Northallerton

“A cell on I wing is being prepared for prisoners with dementia, HMP Stocken held four such prisoners. All new arrivals are offered cardiovascular risk assessment, and all older residents have now been processed. If a s’ risk is assessed at 30% or more, the matter is pursued. Clinics specifically designed for older prisoners are now held at regular intervals.” IMB Stocken

“Abdominal Aortic Screening for the over 65 has commenced.” IMB Swaleside

“There are a number of regular clinics dealing with conditions such as diabetes and heart disease. The diabetes clinic has just completed 12 months and is reported to have made a ‘huge difference’. There is a recently recruited Chronic Heart Care Nurse. This facility has been made available by the British Heart Care Foundation which is providing the funding for three years” IMB Wakefield

“Screening for cardio-vascular disease covers a broader age-range than in the community (30 to 74) because of lifestyle differences in the prison population. The Healthcare team have also now introduced wing-based group sessions aimed at supporting prisoners who want to make a lifestyle change. Screening for bowel cancer has also been introduced although that has proved more difficult to set up in a prison context because of the way in which standard NHS screening procedures are carried out. Healthcare staff are addressing the problem but the Board is concerned that the lack of privacy in double cells contributes to the difficulty in following standard procedures.” IMB Wymott

5. Other areas 5.1 – The role of social services is not clearly identified with very few IMB reports mentioning that there is any representation in the prison at all.

5.2 - RECOOP and Age UK have been mentioned in providing some services but it appears to be locally negotiated.

5.3 - Only one report mentions preparing prisoners for release and how to look after themselves in basic needs like cooking, washing. (IMB Littlehey)

5.4 - Care plans are mentioned when talking about prisoners with disabilities (but not in all cases) and not for elderly prisoners.

5.5 - It is evident that parole boards do not currently take into account age, mobility, disability when assessing risk. How often are compassionate and medical reasons taken into account for release? (For example prisoner X is an IPP prisoner over tariff who now OP 31 has memory problems which make him unsuitable to complete his offending behaviour programme. The parole board will not release him until he has completed his programme.)

5.6 - It is clear from the above that if older prisoners are continued to be located in the existing prisons a national strategy for the management of them is required which can identify the most appropriate locations, given the constraints of many prisons; deliver consistent standards across the prison estate; it will provide clear lines of accountability between healthcare , the prison, social services and other providers; it will deliver specific guidance on mobility aids; healthcare screenings; end of life requirements; staff training; care plans; regime activities and resettlement needs.

March 2013 OP 32 Written evidence from the Royal College of Psychiatrists

This submission is from the Forensic Faculty of the Royal College of Psychiatrists.

1. Introduction

1.1 The Royal College of Psychiatrists (RCPsych) is the leading medical authority on mental health in the United Kingdom and is the professional and educational organisation for doctors specialising in psychiatry.

1.2 Forensic psychiatry is a specialty which helps mentally disordered people who are a risk to the public. It covers such areas as: the assessment and treatment of mentally disordered offenders; investigation of complex relationships between mental disorder and criminal behavior and working with criminal justice agencies to support patients and protection of the public. Forensic psychiatrists work side by side with others including the police, probation service, courts, Crown Prosecution Service and prisons.

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

2.1 The mental health of older prisoners is currently managed by a combination of primary care and mental health in-reach teams, who work across all ages in the prison estate. These are relatively under-resourced in absolute terms (approximately £20M) and also in relative terms (as a proportion of the total health spend in prisons compared to the situation in the community). As there are rarely more than a few older prisoners in any particular prison and their mental health problems are mostly the same as younger prisoners (i.e. alcohol, depression and anxiety disorders), current in-reach teams should be able deal with such mental health problems if they are identified. Dementia remains rare in prisons, but in such cases, mental health teams should liaise with local old age psychiatry services for advice on management of cases.

2.2 The social care of older prisoners is problematic, however, as prison health staff will have very little knowledge or experience of liaising with community old age services. An older prisoner lead for each prison is one such solution to this, and many prisons have adopted this strategy. If a national strategy is adopted (see below), then delineating the possible roles of such a lead will be a dramatic improvement on the current ad hoc arrangements that exist in each prison.

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

3.1 It is currently uncertain if specialist units are the most appropriate ones for older prisoners. There are reasons that would suggest that they might be, including a more suitable physical environment (for example for those who lack full mobility), OP 32 better specialisation, and the potential to offer age-appropriate activities, groups and other forms of rehabilitation.

3.2 However, some research suggests that some older prisoners do not want to be in wings for older people and would rather associate with younger prisoners, for whom they may act as a positive influence. Furthermore, family support may be more available, as sometimes specialist units are far away from the families of such prisoners, and such support is important for post-release health care. One possible solution that we recommend is that individually tailored care plans are agreed for each older prisoner to meet their particular combination of health, social, and family needs. An older prisoner lead could act on such a care plan, and arrange for transfer to a specialist older prison wing if deemed appropriate. However, more research needs to be conducted to investigate outcomes for older prisoners, and this needs to be done in the form of a randomised trial. Otherwise, the prisoners who choose specialist units will not be comparable to those who do not.

4. The effectiveness with which the particular needs of older prisoners are met

4.1 The evidence to date suggests that older prisoners’ mental health needs are often not identified, and even when they are, treatment does not follow best practice. Part of this is a consequence of the prison environment, where prisoners who are disruptive and come to the attention of prison staff will receive most attention. There are potentially important training issues involved, as the presentation of depression and other mental health problems in older people is different to that in younger prisoners. The fact that these needs have been overlooked was highlighted in a 2004 report into older prisoners by Her Majesty’s Inspectorate of Prisons: “No problems – old and quiet”: old prisoners in England and Wales following extensive fieldwork around the country. Few prisons have regular input from a consultant old age psychiatrist or other members of an older adult multidisciplinary team, but this should considered for those prisons with higher numbers of older prisoners.

4.2 In the social care of older prisoners, there are wide variations in practice, with examples of good practice in the prisons included in the Isle of Wight Project. However, some prisons, particularly those with small numbers of older inmates, have little understanding of the issues involved in providing social care for social prisoners with the result that local ad hoc arrangements emerge that may be inadequate.

5. The effectiveness of training given to prison staff

5.1 We are not aware of any evidence that speaks to this, and research evaluating current training is necessary. The case for specialist training is strong as older prisoners present unique health needs that we know are not currently identified. To remain effective, training programmes and materials need to be regularly updated OP 32 and refreshed and there needs to be a mechanism for this to be co-ordinated with input from professionals both from within the prison system and from those used to dealing with late-life issues in the community.

6. The role of the voluntary and community sector and private sector in the provision of care for older people leaving prison

6.1 Different models of provision of aftercare need to be examined, and information on successful pilots shared with the prison estate. However, we know that meeting the large burden of health problems in older prisoners means that close liaison with existing health services is necessary, and the voluntary and community sector cannot replace this. We are aware that a randomised trial is currently starting at the University of Manchester examining one model of aftercare, and the findings from this trial need to inform and be incorporated into any national strategy.

7. The effectiveness of arrangements for resettlement of older prisoners

7.1 There is robust international evidence that the older you are, the less likely you are to offend, particularly in sexual offenders, where international studies have pooled information to demonstrate this. The extent to which parole boards are aware of this, and the capacity of current instruments to assess dangerousness, is unclear. Nevertheless, it occasionally means, from our experience, that older men spend longer in prison that their risk of serious reoffending would suggest.

8. Should a national strategy for the treatment of older prisoners should be established?

8.1 There is an urgent and pressing need for a national strategy for the treatment of older prisoners; we note that researchers have been calling for this for many years. The Forensic Faculty of the Royal College of Psychiatrists would welcome a national strategy for older prisoners and would be willing to support and assist in the development of such a strategy, which would benefit from the participation of a wide range of stakeholders, including primary care, specialist old age medicine and psychiatric input, probation, and the third sector. It should include: identification of the training required for prison staff to better identify older prisoners’ health needs; the development of minimum standards for improving the health outcomes of older prisoners; good practice guidelines, and thresholds for referral to specialist psychiatric and old age medicine for further assessment.

March 2013

OP 33 Written evidence from Solicitor A1

Preface

I am an individual and make these submissions as such. I do not represent any body or organization. I am a 59 year old solicitor who is not practising at present due to disability. I am also the ex wife of an elderly prisoner. Briefly, his was an Historic Sexual Abuse case for which he was found guilty in 2010 and sentenced to 9 years 9 months in prison. He has always protested his innocence and his case is under Appeal.

I wish to make it clear at the outset that this submission is not a complaint about the way my ex husband is treated in prison nor is it to be treated as such. It is intended to be treated as a “case study” which illustrates the kind of problems older people in prison face and which need to be addressed.

1. Effect of prison upon offenders

Any attempt to assess the needs of offenders (of any age) must take into account the ways they are damaged by imprisonment

I attach a link to the Prison Reform Trusts paper “Prisons can seriously damage your health” which I urge the committee to read. http://www.prisonreformtrust.org.uk/uploads/documents/Mentalhealthsmall.pdf I am unable to copy the article here The facts in this paper are compelling and indisputable.

2. Older prisoners suffer age discrimination. Case Study

1. Isolated.

Because of his age, (65) and his ill health (diabetes and angina) Mr T is refused permission to work. He has worked all of his life, been a good, hard worker. He is a qualified commercial electrician and it is totally alien to him to be sitting around for 24 hours out of every 24 in a cell, with nothing to do but watch tv or read. He is often locked up for 23 hours per day. In a small cell on his own. He is isolated, bored and lonely. He is unable to go out for exercise because he has to go to Health Care each morning at the same time as prisoners are let out for exercise. He is not allowed to do both, He is given a stark choice “Health Care, or exercise.” Of course he has to choose Health Care because he cannot survive without his heart medication and insulin for his diabetes. This continual locking up is having a serious effect upon his already poor mental health. He is beginning to forget thing and showing early signs of dementia.

2. Health Care

It is very unclear who has actual responsibility for health care in prisons.

“Health Care “ is an inappropriate description for what actually happens. Mr T has suffered repeated urinary infections and continues to do so, yet the Health Care staff cannot seem to get antibiotics to him for nearly a week, by which time his kidneys are being damaged and he is suffering severe pain. This is worsening his diabetes.

1 Redacted for publication. Redactions are signified thus: “[....]” OP 33 Prior to prison he was under the care of a consultant heart Cardiologist at Oxford John Radcliffe Hospital […]. He eventually got an appointment to see him at 11 am on ……… and was taken by prison staff to the appointment. He was double handcuffed and chained to 2 officers and taken in a prison van to the hospital. He was made to wait in reception with other members of the public, 2 of whom verbally insulted him. By 11 am the doctor was running 10 minutes late. When the officers were told this, they refused to wait further and took him back to the prison without being seen. He is still, to this day, waiting for another appointment. `these are just 2 examples of problems with health care and there are many many more. I understood the Oxford health Trust were responsible for health care at the prison. However, when I contacted them, they did nothing. They did not return my calls.

There is a 93 year old man in Mr T’s prison. He needs nursing care. He cannot wash himself, is forgetful and cannot remember to eat. He needs prompting with that. He needs assistance with toileting and medication. In short, he needs to be in a care home or nursing home not in a . It makes no difference to him at this age. But it does make a difference to the other prisoners. They are locked up for longer on the wing whilst the prison officers have to spend their time caring for this elderly man. It is a drain on their resources. There ought be a maximum age at which persons can be sent prison, men or women. There is a minimum age, and we all know that with incidence of Alzheimer’s is increasing amongst the elderly, those people are unable to understand the purposes of prison or participate in courses, work, rehabilitation etc. It is a total waste of money and inhumane and degrading treatment to put such people in prison and this country should be ashamed of itself for doing so.

3.. Statutory Limitation on Historical Abuse allegations

I hope that the Committee will look at the possibility of legislation to introduce a Statutory Limitation Period on claims of Historical Sexual Abuse. These cases are on the increase. These cases affect elderly men, many of whom are being accused of abusing children many years ago, in some cases 30/40 years ago. These are hard cases because memories fade or become distorted and the truth is impossible to find. Documents are no longer available such as work records, school records, medical evidence forensics, etc.. Laws have been changed over the last decade or so, so that corroboration is not necessary, hearsay evidence is admitted, and in fact it is not now necessary to prove the offence occurred. It is simply down to who the jury believes. This is the briefest of précis. The arguments for a statutory limitation period are too lengthy to deal with here. I urge the Justice Select Committee to hold a separate enquiry into cases of historical sexual abuse and into the numbers of men who have been wrongfully convicted of such crimes. The present and the previous governments seem to believe that it is better for one innocent man to go to prison than to allow a guilty man go free. No innocent man should go to prison. Prison affects not just the prisoner, but his wife, children, nieces, nephews, sisters, brothers, parents & friends. They all suffer.

4. Pension

We are out of step with Europe.

Most elderly prisoners have worked all of their lives and fully paid their taxes and National Insurance Contributions. Yet when they are sent to prison they lose their State Pension. This has a knock on effect. It means they have little money for phone calls to family and their wives suffer the loss too. They lose their rights to Pension Credits. They come out of prison with nothing. This is doubly punishing them. They have already lost their freedom. The wife of an elderly prisoner also suffers the loss of the pension, through no fault of her own. I quote an article (See Annex 1) which argues for pensions to be available to elderly OP 33 prisoners, which I urge the committee to take into account.

It would make sense to pay such prisoners at least the minimum pension. If that is , say £60 per week the over one year, they would save £3120. That would pay for a deposit on a rented home and rent for a few weeks until they get back on their feet again. Over 10 years it would be £31,200. They would have to live on that money as it would take them out of benefits until reduced to the allowed amount of savings , which money would cover the cost of their funeral and could leave a small sum to their next of kin. I would urge the Committee to commission a study and report into a costs/benefits excercise of paying prisoners their state pensions. But please put time limit on it and treat it as a matter of urgency.

Yet nothing appears to have been done to address the issues that are identified here. Select Committee after Committee have looked at these issues and paid lip service to them. Nothing ever appears to be properly put in motion to eliminate the damaging effects of prison upon a persons mental health, which in turn, leads to recidivism. I firmly believe that the people who are sent back to prison time after time are so damaged by prison that they become institutionalized and dependent upon it to survive at all. They are completely unable to live a normal life outside of prison.

It is not difficult to break these cycles, it simply needs someone with a good understanding the prison system who has common sense, who is independent of any political party

5. National Strategy

There ought to be a national strategy for the treatment of older prisoners. I start with the suggestion that the Justice Select Committee looks at the Prison Reform Trust’s work and recommendations relating to elderly prisoners and puts them into effect. There is no point them doing all this work to reform prisons, just to be ignored

There ought to be a maximum age at which a person can be sent to prison. I would suggest 70 years of age. I appreciate there will people who could argue it should be younger or older than that, but we should set a precedent here.

I would argue that the government should set up secure Care Homes for elderly prisoners who have or who develop dementia. Somewhere where care is available but escape impossible. These people will need extra help upon release, to ensure they have a home to go to.

March 2013

Annex 1

Pensions for prisoners By Paul Sullivan, from insidetime issue February 2009 The denial of prisoners’ pension rights is an issue about which we are increasingly out of step with the rest of Europe. Former prisoner Paul Sullivan reports on the support of the National Pensioners Convention.

There are now over 2,400 prisoners aged over 60 in England and Wales, including 493 over 70 (as at August 2008). Most of these prisoners would have paid enough National Insurance contributions to enable them to receive a full State Pension; however under section 113 of the Contributions and Benefits Act 1992 these people are refused their pension. The Act says that anyone in ‘lawful custody’ loses their pension right. The only other exception used to be pensioners in hospital, but that has now been removed - leaving prisoners as the only OP 33 section of society that has their pension right removed.

The National Pensioners’ Convention (NPC), Britain’s biggest pensioner organisation representing over 1,000 local, regional and national pensioner groups, with one and a half million members, believes prisoners should not lose their pension rights. In a statement to Inside Time, Neil Duncan-Jordan, National Officer of the NPC stated: “The NPC considers the state pension to be a right rather than a benefit and as it is currently based on a contributory principle, should be paid to prisoners according to their contribution record in the same way as to any other contributor. The NPC would go further and argue that the disqualification provision in section 113 of the Contributions and Benefits Act should be withdrawn from the statute book. We have been arguing for some time that persons living outside the UK should receive the state pension based on their contributions and up-rated annually in the same way as those living in the UK. This is the first category for disqualification. The second category for disqualification is imprisonment or detention in legal custody. We can see no argument for withholding the state pension on these grounds as; It is based on contributions made to the NI scheme and payments withheld by the state are lost to the individual concerned forever; If the argument is that the state is recouping some of the money spent on detaining someone in prison then why are older prisoners the only category subjected to this ‘charge’? This is discriminatory; Occupational pensions are paid to prisoners whilst in prison; The withholding of state pension to people in hospital is being stopped (this is the only other example of the state withholding the pension that we know of); Prisoners have now won the right to vote (removal of a disqualification in another Act); This leaves the withholding of the pension as a very antiquated and anomalous form of punishment. Therefore we urge the removal of the whole of the disqualification provision in section 113 of the Contributions and Benefits Act.” Elderly prisoners have little provision made for them by the Prison Service, as set out by Charles Hanson in the January issue of Inside Time. In some prisons, if they refuse to work past retirement age they are classed as ‘unemployed’. Similarly, in certain prisons they may get a ‘retired rate’ but remain locked up twenty or more hours a day. The rate of pay for prisoners who are long-term sick or of retirement age who are not working is £3-25p per week. PSO 4460, which covers prisoners’ earnings, states in Para 5 that: “Prisoners of state retirement age are not normally required to work. They may work for standard rates of pay if they choose, provided there are suitable activities available in the establishment”. “Prisoners of state retirement age can, however, be required to participate in other purposeful activity as identified by the sentence / training plan or learning plan. They should be paid at the standard rate for these sessions. Unreasonable refusal renders them liable to be classified as ‘unwilling to work’ and therefore not to receive any pay”. One of the crazy situations elderly prisoners may find themselves in is that, according to Para 2.8 of PSO 4460, if the retired prisoner ‘earned over the tax threshold’ (maybe with work pension, investments etc) he would be liable for National Insurance contributions whilst, at the same time, being barred from receiving the benefits paid for by the contributions. It is now exactly 100 years since the first ‘Old Age Pension’ was drawn under the Old Age Pensions Act of January 1909. In those days, the pension was five shillings (25p) and recipients had to be over 70 years old: anyone who had been in prison during the preceding ten years was barred from receiving it. We live in a more enlightened age and now, a century later, it is time for the issue of elderly prisoners’ pensions to be remedied and due respect shown to those who may not only have contributed to their pension throughout their lives, but may also have fought for the country in conflicts in order to keep us free from OP 33 repression and allow power to the very politicians who now seek to impose further financial on them. Both the Prison Reform Trust and Age Concern have expressed dismay at the continual denial of prisoners’ pension rights. It is not only the prisoner himself who may suffer. Many women of this age have no entitlement to a state pension in their own right and so, if their husbands in prison have pension rights removed, wives at home, guilty of no crime, also suffer. As Gordon Lishman, director general of Age Concern England points out; ‘England, which has a higher number of elderly prisoners than most European countries, is increasingly out of step with Europe on this issue and the continued denial of pension rights can only harm reintegration on release’. How much would it cost? Based on a minimum pension of £54.35 per week, the total cost would be under £7 million each year. The cost per prisoner would be just £2,800 – equivalent to the cost of keeping them in prison for three weeks. The Prison Service might huff and puff about how it would be paid, but that is simple; either into the prisoner’s own bank account or monthly into the prisoner’s Private Cash account and transferred into ‘spends’ at the prevailing rate; dependent upon IEP.

OP 34

Written submission from the Prisoners Education Trust

Introduction to our inquiry response

In responding to this inquiry, we draw on our expertise in the field of and prisoner feedback to make comments relating to the learning needs of older prisoners and how they should be met.

People aged 60 and over are now the fastest growing age group in the prison estate. Yet, there is no national strategy for the education provision of older prisoners1, as a result older prisoners’ experience of prison education policy and provision can vary greatly. This inquiry response is primarily informed by our recent survey of 31 older prisoners2 from our learner voice panel. The survey asked these older learners about their experience of learning in prison, how their learning needs might differ from the general population, and whether these needs were being met by the current provision. We received much interest in the surveys, with one prisoner even distributing copies to other older men at his prison, indicating that many have strong opinions on this subject. The quotes that you find throughout our evidence are from older prisoner learners themselves.

Overview: One-size does not fit older prisoners

Older prisoners’ voices must be listened to in order to understand what their needs are and allow them an opportunity to shape prison education policy and practice.

As can be seen from our evidence, provision for older prisoners must take full account of their individual learning needs and provide facilities to meet them. Older prisoners have told us that, whilst the current focus and investment in basic numeracy and literacy skills under the current learning and skills contracts (OLASS 4) may be appropriate for some prisoner learners, this provision does not provide for the many amongst this age group that have progressed beyond this level.

We stress the importance of recognising that older prisoners are not a homogenous group. While it is sensible to understand that they may have particular needs as a distinct demographic within the prison, older prisoners should not be dismissed as quiet or incapable. Many are highly skilled and capable of pursuing learning with little assistance.

1 Her Majesty’s Chief Inspectorate of Prisons thematic review of older prisoners in England and Wales calls for a ‘NOMS national strategy for older prisoners supported by national and local standards.’ Prisoners Education Trust echoes this call, with the additional requirement that this national strategy includes specific guidance for the provision of education to older prisoners, such as the implementation of older prisoner learner forums across the estate. 2 While we appreciate that, for the purposes of this inquiry, older prisoners are defined as those over the age of 60, we echo other organisations in suggesting that 50 is a more suitable age by which to define this stratum. Research suggests that older prisoners possess a physiological age of ten years in excess of their chronological age.2 Therefore many prisoners over the age of 50 may face similar issues as 60 year olds on the outside. For this reason, we include the voices of prisoners over the age of 50 in our response. The unanimity of views expressed between this sub-section (50 – 60) and those properly defined as older prisoners (over 60) further re-enforces the claim that these age brackets should be defined as one group. OP 34

‘All types of learning benefit older prisoners. Older people face a lot of prejudice and discrimination. People say ‘let’s have a few art classes’- why not mountaineering!! (Age not given)

‘This all depends on individual needs and wants, many older prisoners would like to achieve – they don’t want to be pushed aside.’ (Age 65)

Distance learning, peer mentoring and prisoner carers can play a vital role in meeting the needs of older prisoners, ensuring that they can engage with a wide variety of learning, both formal and informal.

Desistance theory suggests that all forms of learning are key in encouraging older prisoners to desist from offending by offering them a hook to change and allowing them the chance to shape a new identity distinct from their label of ‘offender’. Therefore learning must be allowed to play a fundamental part in the desistance of older prisoners.

Summary of evidence and recommendations

• Listening to older prisoner learners – Section 1.0 Older prisoners should be properly consulted as a distinct group within the estate to ensure that their voices are heard and their needs are properly met. We recommend a national implementation of older prisoners’ councils, and older prisoner reps.

• Learning is of real benefit to older prisoners – Section 2.0 Older prisoners perceive a wide range of benefits including improving mental and physical health, developing family relationships and providing activity that helps them to stay positive through their prison sentence. Despite this, support for distance learning has significantly reduced across the prison estate under recent learning and skills contracts. We recommend that distance learning is supported in prisons.

In their response to our survey, older prisoners highlighted the following issues regarding their learning needs and learning provision across the estate:

• Access to learning – Section 3.0 Older prisoners are more likely to struggle to access learning facilities inside prison due to physical barriers, staff perception of their learning needs and emphasis on providing places to younger prisoners, and the focus on learning for employment at a national policy level. We call for all estates to ensure that learning facilities are accessible to older prisoners and that staff are properly trained to support their access.

• Higher levels of learning – Section 4.0 OP 34 Whilst basic literacy and numeracy skills are appropriate for some older prisoners, most are likely to have progressed beyond this level of learning, either during their sentence or before custody. A broader provision of high levels of learning is necessary to allow prisoners from this age group to progress.

• Peer mentoring – Section 5.0 Older prisoners are a huge resource of knowledge, experience and skills that should be properly utilised. They often act as mentors or classroom assistants, helping others with learning. We recommend a more formalised process of utilising this resource towards peer mentoring and learning assistance, with proper accredited qualifications and embedded learning and support for mentors.

• Prisoner carers – Section 6.0 The increase of older persons in prison requires a greater provision of age-specific care and support. We recommend a formalised system of trained prisoner carers, to support care professionals within the prison and ensure that older prisoners are given the necessary assistance to fully engage in formal and informal learning.

• Arts-based learning – Section 7.0 Older prisoners are approaching retirement, with some having retired before release. For this reason, an employment focused approach to learning does not meet their needs, and proper arrangements should be made to ensure they have greater access to informal and arts-based learning.

• ICT & digital inclusion – Section 8.0 Many older prisoners told us that they need further IT training. They see learning in this area as essential in giving them the best opportunity to re-integrate into society once released. We recommend that age-specific ICT training is implemented across the estate to ensure that older prisoners can up-skill in an appropriate learning environment. We also believe that mentoring is an effective way for prisoners to support others to develop their ICT skills.

Evidence and recommendations

1.0 Listening to older prisoners

Prisoners Education Trust works to enable prisoner learners’ voices to influence prison education policy and practice. Learner voice refers to ‘developing a culture and processes whereby learners are consulted and proactively engaged with shaping their own educational experiences.’3

Our Brain Cells 2 report demonstrates that prisoner learners want the opportunity to engage in a more participatory way in shaping their learning provision.4 28% of those who

3 Rudd, Colligan & Nalik, ‘Learner Voice: a handbook from Futurelab’, 2006 4 Champion, N. ‘Brain Cells Second Edition: Listening to prisoner learners ’, Prisoners Education Trust, November 2012 OP 34 responded to our survey wanted to take part in a learner forum, 56% wanted the chance to meet with policy makers directly, and 27% wanted to receive training in participation skills to help them to better communicate their views.5

Some good practice is already taking place across the estate; more than 30% of prison staff asked in a 2010 survey by Prison Reform Trust indicated that a forum, focus group or consultation for older prisoners was running in their establishment.6

‘We have an excellent older prisoner forum that gives great benefit.’ (Age 63)

However, given the ageing prison population, these pockets of good practice should be replicated across the prison estate, fully engaging older prisoners to ensure their views are heard and they can influence prison policy and practice.

‘Older prisoners are quiet and therefore systematically forgotten.’ (Age not given)

Recommendations

1. All prisons with older prisoner populations should implement age-specific prisoner councils that give older prisoners an opportunity to voice their needs and influence their learning provision.

2. Older prisoner representatives should be enrolled across the estate and invited on to other forums and consultations in the prison to ensure that they can feed the perspectives of their cohort into broader prison practice.

2.0 Benefits of learning for older prisoners

Through our service provision supporting prisoners into distance learning, and by listening to the voices of learners themselves, we continue to believe in, and gather evidence of, the benefits of learning for older prisoners.

These benefits were also recently recognised by the Minister of State for Universities and Science when, referring to older people and education, he said ‘Education is such a good thing – it is not reserved for younger people. There will be people of all ages who will want to study. There is great value in lifelong learning.’7

5 Idem 6 Cooney, F. & Braggins, J. ‘Doing Time: Good practice with older people in prison – the views of prison staff’ Prison Reform Trust, 2010 7 http://www.guardian.co.uk/society/2013/feb/21/david‐willetts‐old‐people‐university OP 34 Research that we undertook in 2011 showed that of a sample of prisoners of all ages who had recently completed distance learning supported by PET;

• 81% were confident that distance learning had a positive impact on them as individuals • 75% were applying to do further study as a follow up to their learning • 58% had become involved in volunteering roles in prison as a result of their learning experience • 33% had applied for prison work as a result of their learning experience

11% of those prisoners we supported last year were over the age of 50, showing a clear will to engage with learning at high levels and in a variety of subjects.

Those older prisoners that have applied to us for distance learning have emphasised that learning in prison can have a wide range of other benefits for older people including improving their mental and physical health, developing family relationships and providing them with an activity that helps them to stay positive through their prison sentence.

‘It (education) helps to create a calmer environment. I hope that with time it will enable me to reduce my medication, to the extent that I will be able to cope without it.’ (Applicant for art materials)

‘When I leave prison I will be sixty-five years old and will be retired. Continuing with the Open University will give me a positive purpose in life and will occupy me.’ (Applicant for Making Sense of the Arts Open University course)

‘I am diabetic and my eye-sight is deteriorating. I am unable to read for more than ten minutes. I enjoy painting, it will keep me from vegetating and I do not need glasses to do it.’ (Applicant for art materials)

Despite this wide range of positive effects, support for distance learning has been significantly reduced across the prison estate under OLASS 4, with many learners who were being supported now no longer able to continue.

Recommendations

3. We recommend that distance learning, as a means to obtaining level three and above qualifications, is supported in prisons. 3.0 Access to learning for older prisoners

Older prisoners told us that there are a number of issues relating to their access to learning;

3.1 Physical environment

The National Offender Management Service is subject to the requirements of the Disability Discrimination Act. It is required to promote disability, equality and eliminate unlawful discrimination in all the prisons in England and Wales. Disability, as defined in the Act, covers a range of impairments, both physical and mental, including learning disability.8

8 Howse, K (2003) ‘Growing Old in Prison: A scoping study on older prisoners,’ Centre for Policy and Ageing & Prison Reform Trust Centre for Policy and Ageing & Prison Reform Trust OP 34

Research indicates that 83% per cent of older prisoners have a serious illness or disability.9 As the Chief Inspector of Prisons recognised;

‘Given an ageing prison population, disability is an increasingly important issue for prisons.’10

Physical disabilities may prevent older prisoners from attending learning facilities without assistance from staff or other prisoners, respondents told us that this can often act as a barrier to learning.

‘Not all needs of the older prisoners are met. This is mainly due to access problems as the older prisoners quite often suffer from mobility problems. With the education department located on two floors with no lift it is not possible for some to take part in some classes.’ (Age 67)

‘I feel that older prisoners differ in many ways, first I believe that health is an issue, more time if any should be spent in identifying individual needs - hearing, manual dexterity.’ (Age 65) ‘One barrier at this prison to access learning in the education department is the amount of steep stairs that have to be climbed; for some senior people this is impossible.’ (Age 63)

‘I only go to the over-50s when I can get there, as I am disabled and on crutches all the time.’(Age 75)

A survey of prison staff by the Prison Reform Trust supported these prisoners’ comments, finding that the Education department was the area that was most likely to be inaccessible to prisoners with mobility difficulties.11

These finding were also confirmed in the thematic report on disability by Her Majesty’s Inspectorate of Prisons, which noted that;

‘Prisoners who said that they had a disability reported less access to activities and association than those who did not, and were less likely to say that they had been involved in work, education and vocational or skills training.’ 12

In the research that we undertook for our report Brain Cells 2, 20% of prisoners self- identified as having a learning difficulty or disability. The report questioned whether ‘sufficient measures are being taken to enable these prisoners to take part in learning activities. For example, those with back problems may find it uncomfortable to sit for long periods of time and may require equipment such as back rests. Given that people

9 Idem 10 Her Majesty’s Inspectorate of Prisons, ‘No problems – old and quiet’: Older prisoners in England and Wales, a thematic review by HM Chief Inspector of Prisons’ September 2004 11 Cooney, F. & Braggins, J. ‘Doing Time: Good practice with older people in prison – the views of prison staff’ Prison Reform Trust, 2010 12 Her Majesty’s Inspectorate of Prisons, ‘Disabled prisoners: A short thematic review on the care and support of prisoners with a disability’ March 2009 OP 34 over 60 are the fastest growing age group in the prison estate, this barrier to learning may well be an area that needs some attention.’13

As prisoners with disabilities, including 83% of older prisoners, may be unable to work or may have retired, education offers a vital form of purposeful activity, and acts as an important rehabilitative tool. The physical environment of prisons should allow these prisoners to access a full range of learning facilities.

Recommendations

4. Education facilities should be adapted so as to be accessible to older prisoners with disabilities, both to ensure compliance with the Disability Discrimination Act and equality legislation, and to maximise access to this important pathway of desistance from crime.

5. Staff should be fully trained to ensure that older prisoners with disabilities can access education and learning facilities e.g. libraries

6. A formal system of trained prisoner carers should be implemented nationally to provide support to care professionals working in the prison and ensure that older prisoners have maximum access to learning (see below).

3.2 Employment-focused learning

Many older prisoners felt that the current focus on employment under OLASS 4 encouraged prisons and learning providers to enrol younger prisoners in to education at their expense. They often felt that they were denied access to learning due to their age.

‘Younger prisoners get priority; I was automatically put on the retired list when I entered this prison.’ (Age 70)

‘There seems to be an ideology in place that says ‘push the younger guys into education and training to keep them occupied and out of trouble, the old blokes can play chess, dominoes or do jigsaw and stay out of the way.’ (Age 68)

‘The new education contract actively works against older prisoners.’ (Age not given)

‘Older prisoners are often looking for recreational learning to keep their mind stimulated, not to enhance their chance of employment when released.’ (Age 67)

‘The focus on employability impacts negatively on older prisoners, programmes are ‘lower-skill’ based and nothing is provided for those who already have employment experience and qualifications.’ (Age not given)

Furthermore, many older prisoners told us that they wanted to learn for reasons other than to gain employment, as they were due to retire either before, or shortly after, release.

13 Champion, N. ‘Brain Cells Second Edition: Listening to prisoner learners’ Prisoners Education Trust, November 2012 OP 34

‘The primary benefit of education is not the awards and skills per se, but more the personal improvements in maturation and psychological self-belief that serve to push offenders away from criminal impulses.’ (Age 58)

‘The needs of older prisoners differ from those of the general prison population in that [prison] education is directed at helping prisoners back into the world of work. Older prisoners require courses or hobbies that keep their faculties stimulated and occupy their time productively, both in prison and on their release.’ (Age 64)

Our experience suggests that learning in itself can be vital in encouraging prisoners to desist from crime, by acting as a hook for change14 and encouraging learners to form a new ‘pro-social’ identity15 - a prisoner becomes a student, a plumber, or an artist. Therefore we strongly support those older prisoners who tell us that they want to pursue learning for its own sake, regardless of whether it will strengthen their employment options.

Recommendations

7. We recommend that specific provision is made for older prisoners to engage in the full range of learning provision, regardless of their employment prospects.

3.3 Age-specific learning environments

Some prisons have provided clubs for older prisoners, where they can engage in activities and arts-based or informal learning. Those prisoners that are in establishments running older prisoners’ clubs tend to speak highly of them, valuing a space away from younger prisoners in which they could interact with others their age and learn.

‘We have a club for people over 60. We play dominoes, cards, bowling and do light chair exercises.’ (Age 70)

‘Here the learning needs of older prisoners I feel are not met as everybody is usually put in the same class, where many older prisoners find it difficult to concentrate in what is usually a noisy environment.’ (Age 65)

Case Study – The Rubies Project

‘The Rubies project for women prisoners who are over 50 has been running in HMP

14 Giordano et al ‘Gender, crime and desistance: Toward a theory of cognitive transformation’, American Journal of Sociology, 107, 990-1064, (2002)

15 Maruna, S. ‘ Making good: How ex-convicts reform and rebuild their lives’, American Psychological Association Books, (2001)

OP 34 Eastwood Park since the summer of 2010. Run by a Project Worker from Resettlement and Care for Older Ex-Offenders and Prisoners (Recoop), a national project working with older offenders in prison, there are two group meetings every week devoted to an enormous range of discussions and activities.

Topics have included: love, being in prison, being an older woman, overcoming difficulties, food, humour, different cultures, Christmas, Valentines Day and Chinese New Year. They also read poems, short stories, articles and reviews with the support of an additional volunteer from Prison Reading Group (PRG), embedding literacy skills and soft skills such as concentration and communication.

One prisoner ‘L’ learnt to knit, crochet and read English with the group.’16

Recommendations

8. We recommend an increased provision of age-specific classes, both for formal and informal learning (such as reading groups). However, there should also be opportunities for those wishing to use their knowledge and skills for the benefit of younger prisoners, through mentoring or classroom assisting (see section 4 below).

4.0 Older prisoners need higher levels of learning

The older prisoners that sent us responses to this inquiry expressed frustration at the lack of opportunities for progression on to higher levels of qualifications and learning.

‘In my experience the educational needs of older prisoners differ greatly from younger illiterate prisoners. For this reason I have to say learning in prison is far from fulfilling or rewarding.’ (Age 61)

‘Generally I would expect [older prisoners’] learning requirements to exceed the level taught in prisons.’ (Age 61)

‘What job awaits an ex-prisoner with Level 2 Maths and English in this present day climate? None.’ (Age 65)

The need for higher levels of learning was recognised by the House of Commons Education and Skills Committee in their 2005 report on prison education;

‘An over-emphasis on basic skills driven by key performance targets has narrowed the curriculum too far. Whilst aiming to meet the basic skills needs of prisoners, the government must endeavour to broaden the prison education curriculum and increase flexibility of provision to meet the much wider range of educational needs that exist within the prison system.’ 17

16 http://www.recoop.org.uk/pages/home/news.php?story=154 17 House of Commons Education and Skills Committee ‘Prison education: Seventh Report of Session 2004-05’ March 2005 OP 34 This issue was also confirmed by our report Brain Cells 2, which highlighted both a lack of accurate data regarding prisoners’ educational profiles, and the need to include higher level qualifications in the prison learning offer, 18

The government should use OLASS 4 as a timely opportunity to collect, collate and analyse up-to-date data on the educational profile of prisoners, including their qualifications… [this] should then be used to establish the appropriate spectrum of further education qualifications…The use of distance learning, modules and e-learning should be explored to enable prisons to offer wider provision and enable progression.’

Recommendations

9. We repeat our recommendation that more research and data gathering should be done to attain better data on the educational profiles of older prisoners, to ensure their learning needs are being met.

10. Distance learning can meet older prisoners’ learning needs once they have progressed beyond the basic literacy and numeracy available in prison. We recommend that all older prisoners that have achieved basic literacy and numeracy be offered and supported to undertake this form of learning.

5.0 Peer Mentoring

Older prisoners tell us that they have a wealth of experience, knowledge and skills that they are keen to utilise to support younger prisoners to learn, providing both parties with purposeful activity and new skills. A significant minority of those who contributed to this response were already enrolled in peer mentoring learning, or acting as classroom assistants to support younger students, and many more expressed their desire to use their knowledge to support others in learning.

‘It always suited me to share my learning, to help and encourage others and to be a good example of what may be achieved in all of us. Older people can be more patient and understanding, and having the ‘lived experience’ are prime candidates to be the most positive, effective, communicative mentors.’ (Age 58)

‘Older prisoners have, usually, a wealth of experience, which needs to be first identified then channelled in a positive direction.’ (Age 65)

‘You are never too old to learn. It has enabled me to be a better mentor and co-ordinator for Diversity & Equality, and given me a lot more confidence. It is good to have the opportunity to interact with people of various ages and learn about their perspective on things. It has enabled me to help other women, especially working with foreign national prisoners – and by this, you learn about their culture.’ (Age 63)

‘Older prisoners benefit from mental stimulation, keeping the mind active and not going into stagnation. It gives them a purpose in life and a goal to aim for. A classroom environment gives them association with others. I found my course enjoyable. I had to push myself, and I was encouraged through the course. I am now able to pass onto others what I have learnt.’ (Age 67)

18 Champion, N. ‘Brain Cells Second Edition: Listening to prisoner learners ’, Prisoners Education Trust, November 2012 OP 34

As well as broadening the training and enrolment of older prisoner peer mentors, prisons should look to identify those that are highly skilled in a specific field, who should then be encouraged to share their expertise with younger prisoners. This would increase the diversity of the prison learning offer and further make use of older prisoners’ experience in assisting other inmates.

‘Older prisoners could benefit the younger generation in prison as most of us have years of knowledge. For instance, I am a landscape and garden designer with two RHS diplomas and over 35 years of experience in all aspects of gardens, plants and soils. This could help the younger generation to look at another job when released.’ (Age 63)

The need to utilise the knowledge, skills and experience of older prisoners and ex- prisoners as mentors was recognised by the Justice Secretary in the debate in the House of Commons on 9th January 2013;

‘In my view the former offender turned good – the former gang member gone straight- is the best way of making sure that a young person coming out of jail does not go back to the same ways.

This is about getting a mix of high qualifications, of the kind we find in our public probation service, in people who have turned away from crime and who are helping others.’

Recommendations

11. We recommend the implementation of a national, formalised system of older prisoner mentor training, with accredited qualifications and embedded learning

6.0 Prisoner carers

The increase of older persons in prison requires a greater provision of age-specific care and support. In their thematic review of disability in prison, the Chief Inspector of Prisons proposed ‘a formal system of prisoner carers, to risk assess, train, support and formalise peer support’ 19 for older prisoners and those with disabilities. As the thematic review of disability also recognises that

‘Over 40% of disability liaison officers said that they did not have the time to discharge their responsibilities, many also reporting a lack of training and support. Crucial social care support was difficult to secure in prisons, and to plan for after release.’20

19 Her Majesty’s Inspectorate of Prisons, ‘Disabled prisoners: A short thematic review on the care and support of prisoners with a disability’ March 2009 20 Idem OP 34

These carers could provide additional support to professional care staff to ensure that they have the time to properly discharge their duties.

Age UK also supports such a scheme in their report ‘Supporting older people in prison: ideas for practice’ where they state;

‘Buddy schemes recruit, train and monitor selected prisoners to offer one to one help to disabled older people in prison, thus enabling to take on a responsible role under supervised conditions and to enable older disabled prisoners to take a fuller part in the regime.’21

A formal system of accredited prisoner carer training could provide a further learning pathway for younger and able-bodied prisoners looking to train as carers, ensuring that additional provision of care is in place to support care professionals while enabling older prisoners with disabilities to access learning facilities. However, it is vital that prisoner carers do not replace professional staff, but act as a support to them in the discharge of their duties.

Recommendations

12. We echo the Chief Inspector of Prisons’ call for a formalised, national system of prisoner carers. While supporting older prisoners to access formal and informal learning, prisoner carers should be able to achieve accredited qualifications in the field of health and social care under the guidance of professional staff.

A system of trained older prisoner mentors, coupled with a formal system of trained prisoner carers for older and disabled prisoners could provide a mutually re-enforcing environment of intergenerational learning. This would increase both groups’ access and engagement with learning and provide vocational opportunities upon release, while also improving the quality of service to older prisoners and ensuring that they have maximum access to activities and learning opportunities. Training programmes could also include embedded literacy and numeracy for those developing their basic skills.

7.0 Importance of arts-based learning

Of the prisoners over the age of 60 that have been supported by Prisoners Education Trust in the last year, 64.5% have been for arts-based courses or materials. This strong interest in art amongst older prisoners across the estate is also reflected in the responses that we have received from them; which highlighted the importance of arts-based learning in meeting their learning needs in prison.

‘Yes, there isn’t enough learning for older prisoners, to keep our mind and brains active, such as art and crafts. Even the gardening is given to the younger prisoners.’ (Age not disclosed)

‘As I was retired due to disability at the time I went into prison, I could see no benefit from doing studies that I would not use or feel comfortable with the level I had. Art

21 Age UK ‘Supporting older people in prison: ideas for practice,’ June 2011 OP 34 based learning was an area I wanted to improve and it was something I could carry on with and progress even on release from prison.’ (Age 67)

Art was considered by these learners to play an important role in keeping their minds active, providing a social space to spend their time, and offering them an opportunity to learn skills that were not primarily employment focused – as many older prisoners do not expect to find outside employment before retirement.

This significance of arts-based learning was also acknowledged in the ‘Review of Offender Learning’ by the Department of Business, Innovation and Skills;

‘We recognise the important role that the arts can play in the rehabilitation process through encouraging self-esteem and improving communication skills as a means to the end of reducing re-offending…. Engagement in the arts with the possibility of fresh vision, or at least a glimpse of a different life, often provokes, inspires and delights.’22

Recommendations

13. We recommend that age-specific provision of arts-based learning be made available to older prisoners, particularly those who are unable or unlikely to find employment once released due to their age.

14. We know that distance learning is a valuable medium through which older prisoners can gain access to arts-based learning and strongly recommend that support for distance learning is maintained across the estate, to provide older prisoners with this valuable opportunity.

‘Distance learning, with correct support, is by far the best.’ (Age 63)

8.0 ICT and digital inclusion of older prisoners

Prisoners Education Trust believe that there is a the digital inclusion of prisoners of all ages is an issue that needs to be addressed across the estate. We are working with the Prison Reform Trust to publish a report on the digital inclusion of prisoners later in the year.

There are also issues regarding the digital inclusion of older prisoners which need to be addressed. On a recent prison visit, one prisoner learner told us;

‘Here we have an aged population – so they have particular IT needs and skills. For some, IT is a new world and it’s very intimidating. People who have spent years inside aren’t familiar with computers at all. Some of us have expertise, why can’t we share it with

22 Department of Business, Innovation and Skills, ‘Making Prisons Work: Skills for Rehabilitation - Review of Offender Learning’ May 2011 OP 34 others? There’s loads of scope for mentoring in PC skills.’ (Prisoner learner, HMP Kingston)

In their response to this inquiry, many older prisoners also referred to ICT training as a vital part of their learning that would help them to integrate into society once released.

‘One subject older people would benefit from is IT, as everything is going that way. Older people, myself included, are afraid of computers.’ (Age 70)

‘I have learnt how to use a computer, which will be a great help to me on release.’ (Age 66)

‘At 81 years of age, I started a Level 1 IT course; I possess neither a computer nor a mobile phone at home, but I wished to bring myself into line with the thinking of younger folk. I am the oldest in the IT class’ (Age 81)

Many of the older prisoners that we spoke with had been able to access basic ICT training appropriate to their needs. However, some felt that they needed longer to learn these skills than younger prisoners in their class. For this reason we recommend age-specific ICT learning, and ICT mentoring between prisoners.

Recommendations

15. Age-specific ICT classes should be implemented across the estate, to allow older prisoners to learn these skills, which they see as vital to their progression both inside and out, at an appropriate pace.

16. Prisoner mentors with good IT skills should be trained and enrolled to help older prisoners to develop their skills.

March 2013

OP 35 Written submission from Restore Support Network

1.0 Introduction 1.1 Formerly known as Restore 50plus, Restore Support Network was established as an older prisoners users group in 1996 by Stuart Ware and six others serving custodial sentences in Bedford, Lincoln and The Mount prisons. The network has grown so rapidly that it became a Limited Company ‘not having a share capital’ in 2011 and has just submitted an application to the Charity Commission for charity status.

1.2 After his release from prison in 1996, its Director (Stuart Ware) has continued to lead a volunteer team of reformed older offenders to offer peer support to network members. Stuart obtained his PhD at University of Sheffield (2007) that focused on the care and resettlement needs of older people in prison.

1.3 In 2001, it approached Age Concern South West regarding establishing a pilot for older prisoners in the region. Consequently Restore worked in partnership with ACOOP in delivering social care programmes in Dartmoor, Exeter, Channings Wood, Shepton Mallet and Leyhill prisons. It is now an established as charity and known as RECOOP.

1.4 Restore was a co-founder of Footprints in Dorset. Footprints has achieved the MBF Approved Provider Status. In 2010-2012, RSN delivered the OPAC (Older Prisoners After Care) programme within Footprints (See attached Final Report on OPAC Pilot, as evidence of voluntary sector collaboration in the provision of care and resettlement).

1.5 As service users group representing the needs of older prisoners and older reformed offenders in the community, it has been a founder member of Age UK Older People in Prison Forum (See Age UK’s submission to the Justice Select Committee). Restore also represented service user interests on the Dept of Health, Offender Health Unit’s Older Prisoners Action Group (OPAG) to ensure the needs of older prisoners health and social care were met in the prison environment. As an example of good practice, this resulted in the publication of the Dept of Health ‘Pathways to care for older offenders: a toolkit for good practice’ in 2007 (See page 29 – Restore as good practice example).

1.6 The CAF Final Evaluation Report (See attached) identified hindrances to the delivery and implementation of CAF in HMP IOW, duplication of assessment tools (1.0), lack of understanding CAF (2.0) no integrated needs assessments prior to CAF (3.0), no previous social care assessment (4.0), lack of transfer of information between service providers, including transfer to other prisons or release (5.0), and restrictive IT practices in sharing of information (6.0). Feedback from Restore service user confirms these issue applied to many other prisons and were not peculiar to HMP IOW.

OP 35

1.7 The CAF Evaluation report identified good practice influences by the CAF initiative and produced good practice examples. Of specific interest is the evidence produced of the cost effectiveness of CAF interventions, especially three examples where the quality of life and was maintained on release that had a knock-on effect of reducing recall (See 5.2 and 4.7/8).

2.0 The CAF IOW Health and Social Care Project (2010-2013) 2.1 In order to capture the service users perspective, Dr Ware was commissioned by the Dept of Health CAF Unit to evaluate the only Common Assessment Framework pilot in the prison estate in HMP IOW. He has already submitted the IOW Council submission to the Select Committee, together with its report – which used information provided by the evaluator in his final report.

2.2 As an example of partnership initiatives, the IOW CAF developed an integrated common assessment service within HMP IOW that ensured prisoners would have access to a range of adult social care facilities. This included the carrying out of care assessments, referrals to other agencies, provision of social care equipment (i.e. disability aids in cells and showers, personal alarms etc) and the running of social care ‘surgeries’. In the words of the latest Chief Inspector of Prisons Report on HMP IOW it was noted that ‘The common assessment framework project was a good example of inter-agency working to meet prisoners’ care needs’. CAF is now scheduled to close on 31st March 2013 leaving a legacy of social care improvements throughout the prison estate.

3.0 Responses to questions raised by Justice Select Committee 3.1 RSN would suggest that the Committee follows research evidence that the older prisoner population ages 10 years biologically in comparison with the same age group in the community (Wahadin, A., ‘Reconfiguring Older Bodies in the Prison Time Machine’, Journal of Aging and Identity, 7/3: 117-93, 2002) and Aday, R., Aging Prisoners: Crisis in American Corrections. Westport, CT: Praeger Publishers, 2003). Hence evidence provided by Restore commences with age 50.

3.2 We confirm the findings from HM Chief Inspector of Prisons in its Thematic Review of older prisoners (2008) that there should be a national strategy for the treatment of older prisoners. It is our view that there is a greater need for such a strategy now than ever before, due to radical overhaul of the NHS, prison and probation services that include the opening up of these services to private and voluntary involvement. Commissioning of these services should take into account a national strategy for care and resettlement of older prisoners.

3.3 The Law Commission and subsequent Health and Social Care White Paper acknowledges the need for the Government to decide whether or not social care should the responsibility of local authorities or prisons and that this may require further legislation. This is a grey area and Restore has identified case stories where older prisoners have been let down by local authorities and the releasing prison.

OP 35

Example:

72 year-old ‘Harry’ with multiple disabilities released from prison with no papers. It was known before his release that he had no accommodation on the day of his release when he returned to his home area. The prison resettlement officer contacted Restore Director, who in turn got in touch with Restores’ voluntary area co-ordinator for Devon and Cornwall (Steve Trelease). Steve contacted the local Salvation Army hostel and arranged emergency accommodation and set up appointment with local housing. Housing accepted ‘Harry’ was its responsibility and agreed to provide supported housing. This should have been arranged prior to release as part of a ‘through the gate’ programme.

3.4 While most older prisoners would prefer to remain part of the prison population and can have a stabilising effect on younger inmates, feedback from Restore members confirms a growing concern for separate wings/units where those with care and disability needs can have their needs met.

3.5 The Justice Select Committee should find further examples of good practice and background information in the CAF Final Evaluation Report (attached).

4.0 Restore filling a much needed gap during a period of rapid changes 4.1 Based upon evidence provided with this submission, Restore has agreed, subject to funding, to work collaboratively with other agencies to provide a ‘through the gate’ care and resettlement service for older prisoners. This will be a follow-up to the Footprints/Restore OPAC (2008-2010) pilot and the CAF IOW (2010-2013) initiative. This will be in the South and South West regions but with the intention of rolling it out nationally. It will be called Opening Doors: through the gate mentoring and is aimed to start September 2013. Subject to approval by respective bodies, it will involve the following collaborations with Restore in Devon, Dorset, Hants and IOW Prisons and Probation Area Trusts: ¾ Pre-release care and resettlement assessment ¾ Personalised pre-released care and resettlement through the gate ‘passport’ ¾ CRB vetted mentor from pilot areas to deliver pre-release programme and meet older person at prison gate and commence resettlement mentoring ¾ Footprints to train and accredit mentors ¾ Prison Education to run peer mentoring accredited courses that link with community peer mentoring courses (accredited NVQ etc).

4.2 In delivering the above proposed Opening Doors initiative, in co-operation with other agencies, such as Age UK and Footprints, Restore believes much of the previous achievements and lessons learned will not be lost. The evidence already produced for the Justice Select Committee can be built upon and that further good practice will continue to inform the committee.

Stuart R Ware PhD March 2013 OP 36

Written submission from prisoner spouse A1

Dear Sir,

I have read in Inside Time, the newspaper for prisoners, that the Justice Select Committee has asked for written evidence for its enquiry into the treatment of older prisoners. My husband is 73 years old and has been in the Category A (high security) HMP Long Lartin for 4 years, even though he is classified as Category B. This is his first ever conviction of any offence whatsoever, and he continues to maintain his innocence. We have both been appalled to discover the lack of common courtesy and basic needs in prison, particularly for the elderly, and I hope my description of the following examples will be of help to you in your investigation.

Sanitation

As reported by the IMB, the practice of ‘slopping out’ is still daily routine for around 2,000 prisoners. My husband is located on a VP (vulnerable prisoner) wing where, unlike the wings for mainstream prisoners, there is no in-cell toilet or even a sink to wash their hands after using the bucket. A fair proportion of prisoners on VP wings are elderly and/or infirm, and access to a toilet is often a matter of great importance.

Prison governors will tell you that adequate provision is made for access to toilets, but this is not so. There is a system called ‘nightsan’ for access after lockdown but it is unreliable, and pressing the button for your turn in the queue can still mean a wait of several hours. In a parliamentary discussion a couple of years ago, Lord McNally said ‘Prison authorities redeploy guards so that ... when, occasionally, the system breaks down, it can be operated manually’. That has never happened in my husband’s experience, though he tells me the guards can be heard chatting and laughing together, well away from the landings.

Lack of access to toilets is also a problem during long periods of lock-down, as ‘nightsan’ is never turned on during the day. The only way to ask for access to the toilets then is by ringing the all-purpose in-cell alarm button. The officers did not take kindly to this, and threatened my husband with an IEP if he did it again. There have been instances of 5 days or more (sometimes in hot weather) when there has been no access to toilets other than for the daily slopping out routine, and no time allowed for washing hands before collecting the meal and returning to the cell to eat it. On at least one occasion, the long queue of prisoners emptying buckets resulted in blockage of the sluice, and the area was awash with raw sewage. It was these conditions my husband returned to

1 Redacted for publication. Redactions are signified thus: “[....]” OP 36 following a facial operation, to find he was not allowed out to wash his hands before applying ointment to the unhealed wound on his face.

Earlier this week, due to staff shortages, some prisoners were allowed out while others (including my husband) were kept locked in their cells. Suffering from a bladder infection, after some hours he rang the bell and asked the young female prison officer if he could be unlocked to go to the toilet as he was in some discomfort. It is, for a man of his age, humiliating to have to ask permission from a girl 40 or 50 years younger. Her refusal, accompanied by the comment ‘just because you’re 73 it doesn’t make you special’ is a classic example of the attitude of prison staff to older prisoners.

Staff attitude

The attitude I have just described is rife amongst both male and female officers, who appear to delight in treating elderly prisoners with contempt.

My husband was recently called to Healthcare for a blood test, and the officer in charge called out ‘Here’s [...] for his voluntary castration’ to the great delight of the other officers.

On another occasion, he went to collect his daily dose of warfarin but his name had been omitted from the list. The officer in charge expected him to just go away meekly, but when my husband explained politely that it was essential he had his tablet immediately due to a heart condition, he was again refused entry. He was subsequently given an IEP warning because the officer falsely claimed he had been argumentative and refused to follow orders. Anyone who knows my husband recognises that he is always polite and well-behaved. He has never been otherwise.

Similar examples are common, and appear to satisfy the officers’ need to humiliate and degrade the elderly prisoners in their ‘care’. This is their job satisfaction, and they will continue to do it as long as they can get away with it. Creating training courses or putting up notices about discrimination is a waste of time if no-one takes any notice. It is a failure of prison management, because they do nothing to stop it.

Healthcare

There is no efficient healthcare in prison for the elderly, whose need is often more urgent than for younger prisoners. The instances I’ve described above are just a few examples. OP 36

My husband is known to suffer from a skin condition, and soon after he arrived at HMP Long Lartin in 2009 he sought help for a persistent ulcer on his face and after much delay, it was eventually agreed that he needed to have a simple operation at the local hospital to remove it. There followed a long period of enquiries by my husband, and complaints from me via prisoner-focused organisations and even our MP before the operation was eventually carried out more than a year later, in July 2010. The delay was apparently the result of hospital appointments having been cancelled by Prison Security, and then not re-booked. By the time the operation was carried out, the affected area had increased so much that a skin graft was necessary, needing 19 stitches instead of the original estimate of 2, and his face is now permanently disfigured.

He is currently awaiting a six-month follow-up appointment at the same hospital, also for a dermatology problem. This was due before the end of 2012 and, at the time of writing, he is still waiting to be seen in spite of having made the proper enquiries at healthcare.

He has experienced numerous other instances of inefficiency and lack of care.

Nutrition

Decent food properly prepared is essential to the health of the elderly, wherever they are. In prison, food is largely inedible and a great deal is thrown away. Yesterday, my husband’s lunch consisted of half a bowl of ‘soup’ which was little more than flavoured water with some pieces of carrot. Fresh fruit is scarce, salad is limp, potatoes are inedible, vegetables are overcooked and pies contain nothing resembling meat. Most of the food he eats he buys himself from the prison supplier, at extortionate prices, with money which I (a pensioner myself) send to him regularly.

The elderly remain the only group of prisoners expected to pay for the privilege of enduring such an appalling standard of living. It is funded by confiscation of the state pension, this being classified as a ‘benefit’ notwithstanding 50 years of continuous compulsory contributions.

I hope you will find this information helpful to your enquiry.

Yours faithfully,

[...] OP 37

Written submission from Leigh Day

Introduction

Leigh Day has a dedicated Prison Law Team, which forms part of the Human Rights Department of the firm. The team, headed by Sean Humber, are recognised as leading experts in prison law in all of the legal directories.

The team’s areas of specific expertise relates to healthcare, discrimination and human rights within a prison context. Over the last decade, the team has successfully acted for prisoners in a wide range of cases, including: personal injury and clinical negligence claims, unlawful discrimination claims, breach of human rights claims, judicial reviews, European Court of Human Rights claims and Inquests. Many of these cases have been on behalf of older prisoners.

In recent years, the team are being approached by an increasing number of older prisoners with concerns over their treatment and care in prison. The common issues running through those concerns are:

• A failure to allow them to fully and fairly participate in the prison regime;

• A failure to provide adequate health and social care; and

• A failure to adequately assess and address their disability needs.

The aim of these submissions is to explore these issues further, and draw upon our experiences, and those of our clients, to assist the Inquiry in identifying some of the more common problems faced by older prisoners.

Summary

• Prisons and prison regimes are not designed for, and do not adequately cater for, the needs of older prisoners.

• The provision of health care to older prisoners is variable and the provision of social care for older prisoners is virtually non‐existent.

• The disability needs of older prisoners are routinely not being adequately assessed and addressed. OP 37

• The various responsible bodies within prisons are failing to comply with their obligations under the Equality Act 2010 (“EQA”) and the Human Rights Act 1998 (“HRA”). Both of these Acts offer older prisoners legal redress. The age discrimination provisions of EQA 2010, which only came into force in October 2012, may offer a particular avenue of legal redress for older prisoners.

• However, given the fundamental nature and extent of these failings, older prisoners should be given a greater opportunity for early release either on compassionate grounds or on home detention curfew.

Submissions

1. Regrettably, the starting point of our submissions is that older prisoners have a worse experience in prison in almost all aspects of prison life than younger prisoners.

2. Prisoners aged 60 or over are the fastest growing age group in prison.1 Nonetheless, prisons and prison regimes are not designed for, and do not adequately cater for, the needs of older prisoners.

3. Therefore, older prisoners are already in a vulnerable position. However, they are also more likely to have chronic health problems and disabilities than younger prisoners and people in the same age group outside of prison.2

4. All prisoners face problems in accessing adequate health and social care, and in having their disability needs adequately assessed and addressed. However, the problems faced by older prisoners and the impact upon them are more acute.

1 Prison Reform Trust, Doing Time: The Experiences and Needs of Older People in Prison (issued March 2008). The population of male prisoners over 60 in 2008 was more than three times the number it was in 1996 (ie 2,242 to 699, respectively).

2 Prison Reform Trust, Doing Time: The Experiences and Needs of Older People in Prison (issued March 2008). More than 80% of male prisoners over 60 suffer from a chronic health problems or disabilities. OP 37

5. Therefore, greater provision should be given for older prisoners. However, if such provision cannot be given, there should be greater opportunity for early release for older prisoners either on compassionate grounds or on home detention curfew.

6. These submissions are divided into five sections: First, the prison regime. Second, health care. Third, social care. Fourth, disability needs. Fifth, early release.

1. Prison Regime

7. Older prisoners should have the same access to prison facilities and activities as younger prisoners. Although they are not specifically excluded from any prison facilities or activities, in practice, older prisoners are more likely to be excluded.

8. The common problems faced by our older prisoner clients include:

• The inability to get to and from activities;

• The inability to participate fully in activities; or

• Intimidation or bullying whilst participating in activities.3

9. This means that younger prisoners are allowed to dominate the prison regime whilst older prisoners can often become isolated, spending the majority of their time in their prison cells. This situation appears to be tacitly accepted by prison staff who, all too often, turn a blind eye to it preferring a “quiet life”.

10. However, in many cases, the situation could be simply remedied. Assistance to older prisoners or adjustments to activities could mean that older prisoners do not have to be excluded. For example, assisting an older prisoner to exercise, allowing an older prisoner to sit down during

3 Prison Reform Trust, Doing Time: The Experiences and Needs of Older People in Prison (March 2008). Almost half (ie 48%) of the male prisoners over 60 interviewed stated they had experienced bullying or intimation either by prison staff or prisoners. Over 60% of those interviewed stated that they felt unsafe in prison. OP 37

employment, or allowing an older prisoner to take regular toilet breaks during education.

11. Structures should be put into place to coordinate this assistance and these adjustments. For example, good practice could include an older prisoner lead amongst prison staff, and an older prisoner committee with older prisoner representatives.4

12. Furthermore, if this assistance or these adjustments cannot be made, alternatives should be considered, such as an older prisoner day room where older prisoners could spend time during the day whilst others are participating in activities, rather than spending it in their prison cells.

2. Health Care

13. Prisoners are entitled to the same standard of health care as those in the wider community.5 However, all too often, this standard is not met.

14. Despite the responsibility for the commissioning of healthcare passing from the HM Prison Service to local Primary Care Trusts in a rolling programme from 2003 to 2006, the provision of health care across the prison estate remains variable.

15. The common problems faced by our older prisoner clients include:

• The failure to adequately assess their health problems upon their arrival at prison;

• The failure to contact their community GP and to obtain copies of their medical records to confirm their health problems and medications;

4 It should be noted that Prison Service Order 2855, Prisoners with Disabilities (April 2008), which was replaced by Prison Service Instruction 32/2011, Ensuring Equality (April 2011), had a section for older prisoners (ie Chapter 7), which made recommendations such as older prisoner leads and older prisoner committees. However, PSI 32/2011 has no such section and makes no such recommendations.

5 Prison Standard 22, Health Services for Prisoners (May 2004) OP 37

• Significant delays and practical difficulties in them seeing a nurse or a GP;

• A reluctance to prescribe them certain pain relief medications even if they were prescribed them before imprisonment, and a reluctance to prescribe them certain pain relief medications in possession or to dispense at certain times (which means that the medications are not taken at the correct times);

• A reluctance to refer them to hospital for investigation or treatment even if they were under the care of a consultant before imprisonment;

• Delays in attending the hospital appointment either because it has been cancelled or missed (which means that average waiting times are much longer than those in the community);

• Handcuffing during consultations or tests and examinations despite suffering chronic health problems or disabilities (which means they are denied dignity and privacy during treatment);

• Transfers to other prison whilst waiting to be seen by or under the care of a consultant (which means they are often put back to the bottom of the waiting list or their treatment is disrupted).

16. It seems to us that there are three possible reasons for these problems.

17. First, with regard to older prisoners in particular, not all Healthcare Departments have specialist healthcare services for older prisoners. Older prisoners have very different health care needs in their nature and extent from younger prisoners. Therefore, those needs will often need to be assessed and managed differently (eg more time needs to be spent contacting their community GP and obtaining their medical records to confirm their health problems and medications, they need more regular appointments with nurse or GP or they need more regular hospital appointments). OP 37

18. Second, the fragmentation of health care services in prisons. The local Primary Care Trusts commission others to provide health care services in prisons. Those contracted to provide the healthcare services then often subcontract the different services (ie nursing, GP, substance misuses, mental health etc) to different providers. This fragmentation, leads to more gaps in the health care services, and makes it more complicated for prisoners to find out who is responsible for providing what service.

19. Third, the lack of cooperation between Healthcare Departments and Prisons. The effective delivery of healthcare services cannot happen without Healthcare Departments and Prisons cooperating effectively with each other6, but there are often tensions in delivering these services.

20. Hospital appointments are good example of these tensions. The Healthcare Department is responsible for arranging a hospital appointment, and the Prison is responsible for escorting a prisoner to a hospital appointment. However, many hospital appointments are cancelled or missed because of lack a lack of cooperation between the two (eg the scheduling of hospital appointments during lunch time hours when there are not sufficient prison staff to provide an escort).

21. Older prisoners are in a particularly vulnerable position due to this lack of cooperation as they generally have more chronic health problems, such as diabetes, cardiovascular diseases and cancers, and, therefore, require more hospital appointments for monitoring and treatment.

3. Social Care

22. The provision of social care across the prison estate is virtually non‐ existent.

23. It is the experience of our older prisoner clients that:

6 Department of Health and Home Office, National Partnership Agreement between the Department of Health and the Home Office for the Accountability and Commissioning of Healthcare Services for Prisoners in Public Sector Prisons (January 2007). Chapter 2 states that the partnership is underpinned by a shared responsibility between the NHS and HM Prison Service for the development of health services for prisoners on the basis of assessed need. OP 37

• Local Authorities do not have any involvement with older prisoners.7 Prior to their imprisonment, our clients are often assessed for and provided with social care in their homes by Local Authorities. However, upon their imprisonment, our clients have had little or no contact with Local Authorities;

• Prisons do not have the expertise, or effective systems, in place to provide social care to older prisoners;

• Healthcare Departments are reluctant to refer for assessments and to provide social care to older prisoners because they do not consider that it is their legal responsibility to do so and, consequently, because they do not have funding to do so.

24. It seems to us that the main reason for this social care void within prisons is a confusion as to who is responsible for its provision (ie Local Authorities, HM Prison Service and/or local Primary Care Trusts).

25. Under the National Health Service and Community Care Act 1990, a Local Authority has a statutory responsibility for social care services to persons who are “ordinarily resident” in their local area. As such, a Local Authority are required to assess a person’s need for social care services and this assessment then determines whether or not any services should be provided. However, it is not at all clear if a Local Authority’s statutory responsibility includes prisons.

26. A report by the University of Birmingham into adult social care in prisons found that prisoners with social care needs were not receiving the same level of assessment and provision of social care services in prison that they would receive in the wider community.8 The report found that this was because of a confusion as to who was responsible for social care services in prisons, caused mainly by a lack of clarity in the law.

7 HM Chief Inspector of Prisons, “No Problems: Old and Quiet”: Older Prisoners in England and Wales (September 2004). The HM Chief Inspector of Prisons also found that, of those older prisoners interviewed, none had had any involvement with a Local Authority.

8 University of Birmingham, Adult Social Care in Prisons (published June 2007) OP 37

27. The Law Commission’s consultation and report into adult social care found, whilst the legal framework for social care does not exclude prisons, this was by oversight, rather than by design.9 However, notwithstanding this, the consultation and report found that, in practice, the legal framework does provides “barriers” to the provision of social care services by Local Authorities to prisoners. These barriers include:

• The assumption that the Prison and the Healthcare Department are already providing social care services to prisoners;

• A lack of clarity as to which Local Authority would be responsible for the assessment and provision of social care under the “ordinary residence” criteria (ie would it be the Local Authority where the prisoner lived before they were imprisoned or the Local Authority where the prisoner was now imprisoned);

• A lack of clarity as to whether or not the eligibility criteria can be applied to a prison context, and, if so, whether or not it would unfairly discriminate against prisoners (ie would a prisoner be eligible for social care before imprisonment but not during imprisonment).

28. Therefore, the consultation and report found that any reform of adult social care must expressly state whether or not prisoners should be excluded.

Case Study

29. These barriers to social care have been borne out in a recent case that we have conducted on behalf of a female older prisoner client.

30. Since her imprisonment, she has been assessed by an Occupational Therapist as requiring assistance with her showering. This assistance was subsequently provided by Healthcare. However, she was only being provided with this assistance by Healthcare twice a week, and wished for assistance at least three times a week.

9 Law Commission, Adult Social Care Review (published February 2010) and Adult Social Care Report (published May 2011) OP 37

31. When we raised these concerns on her behalf, Healthcare's eventual position was that, whilst they were providing assistance, it was not their legal responsibility to do so as showering assistance was a social care rather than a health care need (although they did not state whose legal responsibility it was to meet he social care needs).

32. We subsequently wrote to the Prison, her "old" Local Authority (ie the Local Authority where she lived prior being imprisoned) and her "new" Local Authority (ie the Local Authority where she was imprisoned), asking them whose legally responsibility it was to provide her with showering assistance. In reply, they all denied legal responsibility.

33. However, whilst at the same time as denying that it was their legal responsibility to do so, her new Local Authority agreed to exercise their power, as distinct from their duty, to carry‐out a social care assessment. Her new Local Authority also denied that, should the assessment find that she did have social care needs, it was their legal responsibility to address those needs.

34. Her new Local Authority subsequently sent a social worker to assess her on two occasions in December 2012. These assessments took place in the visits hall of the prison.

35. Her new Local Authority have subsequently been in correspondence with the Prison requesting that they also be able to assess her in her prison cell and wing (not least so they could see the showering facilities). However, in their most recent correspondence the Prison have refused her new Local Authority permission to assess her in her prison cell or her wing.

36. This recent case emphasises the confusion over who is responsible for social care provision in prisons. Furthermore, if the Local Authority (either old or new) does retain a legal responsibility when a person goes into prison, there is a lack of clarity as to the exact nature and extent of their powers (ie can the Local Authority make the Prison allow them access to her prison cell and her wing for the assessment).

OP 37

4. Disability Needs

37. Disabled prisoners should be able to participate as fully and fairly in prison life as non‐disabled prisoners.10

38. The HM Inspectorate of Prisons published a thematic report on disabled prisoners in March 2009.11 The report found that:

• The needs of many disabled prisoners remain unmet;

• Disabled prisoners still consider that they have a worse prison experience across all areas of prison life than non‐disabled prisoners;

• HM Prison Service still have a considerable amount of work to do to ensure they fulfil their legal duties to disabled prisoners.

39. Regrettably, these findings very much echo the experiences of our older prisoner clients, whose own experiences are that:

• There is a failure to adequately assess their disability needs, commonly the reasons for this are:

o Local disability policies are either not in place or, if they are in place, do not sufficiently identify who is responsible for assessing their disability needs;

o Disability questionnaires are not completed and, if they are completed, are not adequately completed;

o Disability Liaison Officers do not have adequate training or time to complete an adequate assessment of their disability needs.

• There is a failure to adequately address their disability needs, commonly the reasons for this are:

10 Prison Standard 8, Prisoners with Disabilities (issued April 2008), states “the Prison Service ensures that all prisoners are able, with reasonable adjustment, to participate equally and without discrimination in all aspects of prison life”.

11 HM Inspectorate of Prisons, Thematic Report, Disabled Prisoners (March 2009) OP 37

o There is a dispute as to the nature and extent of their disability needs (usually, caused by the failure to adequately assess and address them);

o There are no disabled prison cells or, if there are disabled prison cells, they are already occupied by another disabled prisoner with greater disability needs or by two non‐disabled prisoners who are sharing;

o The necessary aids and services are not provided because it is not clear who is responsible for providing them, there are no funds to provide them or they are considered a security risk.

40. It seems to us that there are three possible reasons for these problems.

41. First, the introduction of PSI 32/2011. As stated above, in April 2011, PSI 32/2011, Ensuring Equality, replaced PSO 2855, Prisoners with Disabilities. Along with removing the section on older prisoners specifically, PSI 32/2011 also removed the mandatory requirements for local disability policies, disability assessments and Disability Liaison Officers, which were previously required by PSO 2855. This was very much a backward step. Systems for assessing and addressing a disabled prisoners needs now vary from prison to prison, with some prisons not having any systems at all.

42. Second, disability needs are wrongly conflated with health problems. Although many disabled prisoners also have health problems, their health problems do not require their admission to the Healthcare Department. Nonetheless, many disabled prisoners are still admitted and over half of disabled prison cells are located in the Healthcare Department.12 In the event that Healthcare are not willing and/or able to assist, then a disabled prisoners needs often remain unmet as the Prison do not have the expertise or efficient systems in place to meet them.

43. Third, there is no strategic approach to meeting the needs of disabled prisoners. There is no overarching system, which is managed at a national level by the HM Prison Service and which is able to match the needs of a

12 Prison Reform Trust, Doing Time: The Experiences and Needs of Older People in Prison (March 2008) OP 37

disabled prisoner with the facilities of a prison which is able to adequately cater for those needs.

44. The reason for this is twofold. First, due to the lack of identification and reporting of disabilities, the numbers of disabled prisoners and the type of disabilities they have is unknown.13 Second, the number and type of disabled facilities within the prison estate (and whether or not these facilities are in use) is also unknown. Therefore, HM Prison Service neither know the nature and extent of the disabled prisoner population nor whether or not they have the facilities to cater for it.

45. Typically, transfer decisions are made at a local level between governors, not knowing if a prisoner is disabled and, if so, whether or not the receiving prison has the facilities to cater for their needs.

5. Early Release

46. Given the fundamental nature and extent of the above failings, the question must be asked whether or not those older prisoners with chronic health problems and disabilities which are currently not being catered for in prison, should be in prison at all.

47. The Secretary of State for Justice and the Governors of prisons both have powers to direct the early release of prisoners, either on compassionate grounds or on home detention curfew. However, at present, the criteria for both of these powers do not sufficiently take into account the needs of older prisoners.

48. First, the criteria for early release on compassionate grounds includes a provision for those prisoners who are incapacitated or bedridden.14 However, we are not aware of any older prisoner released on such grounds.

13 HM Inspectorate of Prisons, Thematic Report, Disabled Prisoners (March 2009). The HM Chief Inspector of Prison found that the Prisons LIDS system only recorded 5% of prisoners as disabled, but that, from her own review, 15% of prisoners surveyed identified themselves as suffering from some form of disability.

14 Chapter 12 of Prison Service Order 6000, Parole, Release and Recall (March 2005) OP 37

49. Second, the criteria for early release on Home Detention Curfew in exceptional circumstances includes a provision for prisoners who are infirm either by age or disability.15 Again, we are not aware of any prisoner being released on such grounds.

50. It would seem to us that, if the various responsible bodies within prisons are not able to adequately cater for the needs of older prisoners, and are failing to comply with their obligations under the EQA and the HRA, older prisoners should be given a greater opportunity for early release.

March 2013

15 Prison Service Instruction 31/2006, Impact of the CJA 2003 on HDC (July 2003) OP 38 Written submission from the Prison Reform Trust

1) The Prison Reform Trust, established in 1981, is a registered charity that works to create a just, humane and effective prison system. The Prison Reform Trust aims to improve prison regimes and conditions, defend and promote prisoners’ human rights, address the needs of prisoners’ families, and promote alternatives to custody. The Prison Reform Trust’s activities include applied research, advice and information for people in prison, education, parliamentary lobbying and the provision of the secretariat to the all party parliamentary penal affairs group.

2) Background. The number of sentenced prisoners aged 60 and over rose by 103% between 2002 and 2011. There are around 3,300 people in prison aged 60 or over. This rise is not matched by a rise in convictions. The increase in the elderly prison population is due in part to an ageing population and in part to harsher sentencing polities and risk averse early release (e.g. parole) decisions that mean people stay in prison longer. This has led to a stacking effect with long-term and life sentenced prisoners accumulating in prisons, particularly those with vulnerable prisoner units or these in the high security estate.

3) The definition of an older prisoner varies but 50 and over is more often used by the department of health and NOMS because some prisoners age prematurely as a result of chaotic lifestyles and poor health. We are aware that the Justice Select Committee is looking at people over 60 in prison. Please note that the PRT research quoted in this submission refers to the age group of 50 and over. Unless otherwise stated, the information in this submission is from queries received to our advice and information service, conversations with prison staff and prisoners during visits and our publications: Doing Time: the needs and experiences of older people in prison Doing Time: Good practice with older people in prison- the views of prison staff and Bromley Briefings Prison Factfile November 2012. http://www.prisonreformtrust.org.uk/ProjectsResearch/Olderpeopleinprison

Responsibility for mental health care in prisons

4) The responsibility is clearly defined, as from 2006, the NHS has had a duty to provide health care equivalent to that in the community. However, the practice of assessing and provision of care for all prisoners with mental health needs is more complicated and often somewhat patchy. The findings of the prison inspectorate about the mental health care of older prisoners are troubling. The acknowledged levels of mental health disorder do not appear to be picked up in clinical records. The inspectorate report ‘No Problems: Old and Quiet’ found that mental health issues were mentioned in only 23% of male prisoners’ records and in the great majority (43%) of cases, this referred to depression or reactive depression as a result of trial or imprisonment.

5) There is a lack of awareness of the need to conduct mental health checks regularly to detect symptoms that may vary. Many prison officers do not have the expertise needed to identify specific conditions and refer someone to health care. When referred to healthcare, few health care teams have specialists in mental health OP 38 of older people or dementia. The reception assessments for mental health focus on immediate risk and not long-term conditions. In addition, there is little research or understanding, particularly amongst prison staff, of the impact of long-term or indefinite imprisonment on mental health needs.

Responsibility for physical health care in prisons

6) Again, the responsibility for physical health is clearly defined as the NHS having the statutory duty to provide care equivalent to that in the community. Formerly, the Department of Health (Offender Health Unit) used to resource OPAG, the Older Prisoner Action Group, which supported and developed health care for older prisoners. Following resource cuts in 2011 this no longer operates and there is now no national oversight of the health of older people in prison. It is not yet clear how the new commissioning arrangements for prison health care will work in relation to groups needing specialist care. Currently, prisoners can find it hard to access specialist health care and the clinics that exist in the community.

7) There may be aspects of the prison regime that mitigate against older people being able to maintain health. Being locked up for a long time and not receiving much natural daylight, lack of access to exercise outside and poor diet may have an impact. Sometimes security decisions do not take account of medical needs. A recent Prisons and Probation Ombudsman report demonstrates that restraints and handcuffs are used too often for people going into hospital who are fragile or are terminally ill. A few prisons are developing end of life care suites but there is no national coordination or standards for this work. Compassionate release is not used often enough for people who are chronically ill and deteriorating and cannot have their health needs fully met in prison.

8) In addition, the nature of the social environment in prison makes it even harder to grow old in prison rather than in the community (Wilson and Vito 1986). In prison there is a premium on physical strength and endurance and older prisoners may have an increased sense of vulnerability in prison. When imprisonment becomes a ‘double punishment’ for an older man or woman, a system of secure care for the elderly in the community could be developed. The prison service’s inability to cater for the complex personal physical and mental needs of the 83% of older prisoners with chronic or disability conditions (OCPS 1994, Fazel et al, 2001) are likely to cause additional psychological distress and vulnerability.

Social care responsibility in prisons

9) The statutory responsibly for social care for prisons is unclear. Legislation does not specifically include or exclude people in prison under the local authorities duty to provide social care. The Law Commission (Adult Social Care, 2011) and the University of Birmingham (in a report for the Care Services Improvement Partnership: Adult Social Care in Prisons: A strategic framework, 2007) have identified major shortcomings in the provision of social care in prison. These reports rightly identified a lack of clarity on who is responsible for assessing and providing social care support to prisoners. The reality of this is confusion over provision of daily living aids, personal care and occupational therapy. We were told ‘I could only OP 38 obtain one small walking stick to help me get around. It took healthcare staff over six weeks to find me two longer sticks to support myself’.

10) The Prison Reform Trust would like to see clarification of the relative responsibilities of local authorities and the prison service. We would also like to see assessments being shared between prisons as prisoners move around the prison estate, and shared from community into prison; and from prison back into the community. Currently, there is no equivalence of social care for prisoners and for people in the community with similar care and support needs. The Prison Reform Trust would like to see a statutory duty placed on local authorities to commission/provide social care in prisons, and a regulatory framework that would hold them to account. We would like the local authority in which the prisoner is located to hold responsibility for commissioning social care in that prison, as currently happens with health care. One prisoner told us’ I’m a lifer and I have disabilities. The social services where I should be resettling don’t want to know and say they can’t do an assessment.’

11) We believe there needs to be a clear workable definition explaining when care and support is to be provided by the prison service under ‘duty of care’ and ‘reasonable adjustment’, and where social care becomes the duty of the local authority. Prison Reform Trust would also welcome a statutory duty on local authorities to cooperate with prisons and probation staff to ensure continuity of social care.

12) We understand that the draft Social Care Bill will include a commitment to equivalent provision in social care for people in prison. However, this legislation is not expected until after the next election and we remain concerned about provision for people with social care needs in the mean time. One older prisoner explained that ‘I have bladder trouble especially at night and I often wet my clothes and bedding. I am very embarrassed and don’t want to be a nuisance. When I mentioned this to my officer he laughed and said that we all have problems like that as we get older. But now I’m wetting myself in the daytime too and can’t get to the toilet…. because it is locked. Some of the younger men and officers are teasing me’.

Environment and regime

13) Although we do not have prisons for older people, in the male estate many older prisoners have accumulated in the high security prisons and in prisons holding people convicted of sex offences. There are many examples of wings or units specifically adapted for older people. However, there is no national guidance about what constitutes an ‘older prisoners unit’ and what conditions, environmental changes or services could be provided on such a unit. These are set up by individual prison establishments to meet the need of their population. Some older people would prefer to be in a separate unit but many wouldn’t. The ideal is allocations based on individual need and wherever possible, preference.

14) It is also important that there is provision for people with a disability/social care need at all levels of the prison estate. At the moment, women who have a disability cannot be located in open prison conditions, even if they have been categorised as appropriate for the open estate. This clearly disadvantaged them as they are held in OP 38 a more secure regime with fewer opportunities to have more autonomy. It is clear that dedicated provision for people with mobility and care needs is necessary but prisons do not always have the resources needed to adapt and maintain these units. National oversight of this, following an analysis of the needs of the current population and possible future needs for accommodation, could ensure that resources were utilised more effectively.

15) People who are deemed too elderly or unfit to work, or who choose not to work because they are past pension age may find they are locked in their cell during the day. In some prisons, people will be unlocked during working hours. These changes to the daily regime can make a massive difference to quality of life.

16) Education and work are not always adapted so that people can attend part time or do lighter duties. Very few education departments have specific classes course or activities for older people. Some prisons have in-cell education or work provision. Although this can mean people are occupied, it can also reinforce isolation and desocialisation. The day centre model is acknowledged good practice by the prison inspectorate and others. Some prisons, often in conjunction with a voluntary organisation attempt to replicate day centres in the community that offer a range of activities for older people.

Sentence planning and offending behaviour programmes.

17) Many older prisoners are long or indefinitely sentenced and experience difficulties making progress through their sentence. Active and appropriate sentence planning is necessary. Our research has shown that no specific arrangements are in place for older prisoners. Risk assessments do not often take about of health and social care needs or reduced risk due to frailty or age. Offending behaviour programmes are not adapted for those with disabilities or age related frailties such as dementia, memory loss or visual impairment.

The effectiveness of arrangements for resettlement of older prisoners

18) Our research showed that two thirds of prisons have no age appropriate resettlement services for the older prisoner population. Programmes preparing people for outside life may focus on employment and training opportunities that are not suitable for older people. The Pension Agency will support people applying for pension before leaving prison but this is not widely known or systematically used. Social services have the duty to assess people leaving prison who are returning to their area, if it is believed they may have social care needs but this does not happen in practice. It is anomalous and arguably unfair that people with private prisons often receive this whilst in custody whilst those on state pensions cannot receive this once in prison.

19) In additional, housing is scarce, many former prisoners do not qualify for priority social housing and it can be particularly difficult to place people convicted of sex offences. Some people are required to live in approve accommodation managed by the probation service. It is difficult to find sheltered accommodation for people who have convictions for serious offences. Most of this accommodation is inappropriate for people with care and mobility needs. The likelihood of having accommodation on OP 38 release from custody decreases the older a prisoner is. In 2010-2011 the proportion of positive accommodation outcomes were lower for those aged 50-59% (81%) and 60 and over 79% than the average of 86%.

Compliance with equality and human rights legislation

20) Although the Equality Act applies to all aspects of prison life and service provision, conditions and regime, the prison service is currently unable to fulfil its duties to older people. The legislation regarding disability and age discrimination pose huge challenges for the Prison Service and it is struggling to meet its obligation. All prisoners should be enabled to participate fully in all areas of prison life and access all services provided by the prison. It is particularly difficult for prison staff to identify hidden disability, long-term conditions, and serious enduring mental health difficulties. There is not equality of access and care, regime or activities.

21) The longer sentences mean that older people are systematically discriminated against in allocation polices. Most older prisoners are held more than 50 miles from the home and a third are more than 100 miles from their home. This means that they are experiencing a disproportionate punishment. One prisoner told us ‘I started my sentenced before my grandchildren were born and because I’ve been moved around so much I have not seen them or my daughter for over six years’.

Staff training

22) The basic level training for staff takes six weeks. Previously, this had included an hour specifically on older people. From this year, a pilot is running that integrates all diversity training so there is no focused training on the needs of older people. Our research shows that training for working with older people is sporadic and often based on staff taking a personal initiative. Prison staff are more likely to undertake local training often via a voluntary sector partner. There are no national minimums or standards concerning the training an officer should have when working with older people. The challenge for the prison service is that officers could be sent to different prisoners where the needs of the population vary massively.

Voluntary sector involvement

23) Our 2010 research showed that over a third of prison had voluntary sector organisations providing services to their older prison population. The organisation most commonly cited were local branches of Age UK and RECOOP (Resettlement and Care of Older Ex-offenders). NOMS funds RECOOP to build capacity in this area. The contribution of these organisations is clearly appreciated and valued by prison staff. In some situations, it appears that the prisons and voluntary sector are picking up work that other statutory services, particularly social services, but also housing pensions and benefits agencies, could provide.

National strategy

24) There is a clear need for guidance and direction from the centre. Current prison Service policy, Prison Service Instruction 32/2011 Ensuring Equalities, describes general duties but does not contain significant mandatory requirements or minimum OP 38 standards. Staff are struggling to manage the complex needs of this group. This work has been given insufficient priority. Adaptations for mobility and access have to be adequately resourced so that all prisoners can participate fully and prisons can become compliant with equalities legislation.

25) A national strategy could include:

• Standard allocation policy and a national allocation strategy, that includes units that are a national resource for people with mobility/care needs and end of life care units

• Mandatory regime requirements that set basic standards for the care of older people such as core day unlock, adapted work and education opportunities and appropriate activities

• Clear unified processes for individual prisoner needs assessments, needs analyses when developing services and information sharing between departments in prison, other agencies such as health and social care and when people move prisons as appropriate

• Clear standards and conditions that include rates of pay,

• Individual establishments have action plans that consult regularly with prisoners

• Named lead on work with older prisoners in each prison

• Extension to compassionate release provisions

• Commitment to explore the options for an intermediate estate e.g. supervised accommodation, secure care homes, half way homes and other supported living options and end of life care in the community

26) Examples of good practice:

Forums and older prisoner groups

The Retreat, HMP Whatton

End of life care suite providing palliative care to meet expected health and social care standards in the community. Prisoners can receive support from other prisoners and visits from their families.

The Lobster Pot, HMP Leyhill

RECOOP run a day centre for older prisoners. This work is fully integrated into the prison. Various activities take place in the centre, including poetry, gardening, and memory groups. These are organised and chosen by the prisoners. RECOOP also lead on social care assessments for HMP Leyhill.

OP 38 Single Assessment Project HMP Isle of Wight

The Isle of Wight has had a social worker based in the health care unit covering the three prisons. They have developed a formal integrated health and social are assessment process, mirroring the social care model used by social services in the community.

Dignity Tool HMP Wakefield

Elderly and disabled prisoner team encourage people to undergo individual needs assessments, which are updated regularly. The prison has worked with Age UK on a dignity tool that details the social concerns and needs of older prisoners.

Resettlement work HMP Norwich

Age UK provide advice and support on resettlement, including finance benefits and accommodation.

Gym provision

PRT research from 2010 showed that two thirds of prisons ran gym sessions that were suitably adapted for older prisoners. We found much enthusiasm and appreciation of these sessions both amongst staff and prisoners.

Core Day Unlock

Many prisons have ‘core day unlock’ for their prisoners who are too elderly, ill or have disabilities that means they are unable to work. We are told by prisoners that the opportunity to be out on the wing, rather than locked in their cell during the time other prisoners are at work, is incredibly valuable.

March 2013 OP 39 Written submission from the Ministry of Justice

Executive Summary

1. On 30 June 2012 the prison population included 3,267 prisoners aged 60 or over, including 818 aged 70 or over. It is frequently argued that, because of the earlier onset of a range of health problems amongst the offender population, the term older prisoners should be used to refer to those aged 50 and over. If that definition is applied, there were 9,727 prisoners (over 11% of the total population) in the category. Each of these figures has increased considerably in recent years: since June 2003 the numbers aged 50 and over, and 60 and over have roughly doubled, and the rate of increase for those aged 70 has been even steeper.

2. The Ministry of Justice is committed to meeting the needs of the growing older prisoner population. The National Offender Management Service equality policy statement sets out a commitment to fairness for all, and this is supported by Prison Service Instruction 32/2011 Ensuring Equality that sets out the framework for the management of equalities issues in prison establishments. Prison Service Instruction 75/2011 Residential Services describes a commitment to ensuring that prisoners are supported and that their daily needs are met, and explains that this will be delivered by residential staff, who, through their engagement with individual prisoners, are expected to identify prisoners with any particular needs (including age- related issues) and make reasonable adjustments to their daily routine.

3. NOMS is committed to working with partners to address the issues presented by the older prisoner population. Most notably we are working with colleagues from Department of Health on health and social care issues. We also support the Older People in Prisons Forum that is co-ordinated by Age UK, which provides an excellent opportunity for us to engage with key stakeholders in this area, and grant fund RECOOP to build capacity for joint working across the voluntary sector.

Whether responsibilities for the mental and physical health and social care of older prisoners are clearly defined.

4. The responsibilities for the mental and physical health care for all prisoners, including older prisoners, are clearly defined.

5. In England, until 31 March 2013 Primary Care Trusts have responsibility for primary healthcare, mental health and substance misuse services in public sector prisons and in four contracted prisons. The Ministry of Justice directly commissions primary healthcare in nine contracted prisons, with OP 39 clinical oversight from PCTs, and these services are supplemented by PCT commissioned services.

6. From 1 April 2013 as PCTs are abolished the NHS Commissioning Board assumes responsibility for all health services, including substance misuse services, but excluding emergency and 111 services, for people in prison in England. Emergency and 111 services will become the responsibility of the Clinical Commissioning Group local to the prison.

7. For prisoners in Wales, Local Health Boards have continuing responsibility for health services in three prisons while the Ministry of Justice directly commissions primary healthcare at a single contracted prison.

8. Statutory responsibilities for social care of older prisoners are less well defined.

9. In May 2011 the Law Commission report on Adult Social Care found that although people in prison in England and Wales are not excluded from the provision of social care services, in practice a number of barriers exist to the provision of local authority funded social care services in prison. As a consequence there is a need to clarify eligibility - the Law Commission recommended:

“Recommendation 69: If the policy decision is that prisoners should not be excluded from adult social care, then the legal framework must facilitate this policy, for example through the ordinary residence rules and eligibility framework. If the policy decision is that prisoners should be excluded, then the statute must make this position clear.”

In July 2012 the Government White Paper ‘Caring for our future: reforming care and support’ made a commitment to resolve this issue positively in England, and the Department of Health will shortly bring forward for parliamentary scrutiny proposals to clarify the framework for social care services for prisoners. The proposed approach is that in general people in prison should have their care and support needs assessed and, if required, services provided, by local authorities. This would provide consistency of approach and ensure prisoners are treated in an equivalent way to people in the community, in line with the approach to the provision of health services.

10. In the interim, while statutory responsibility is being clarified, prison governors and directors have a clear duty of care to prisoners and make local arrangements to meet the needs of older prisoners. Where prisons have successfully engaged Local Authorities for assistance with social care issues, the support provided is usually limited to the professional assessment of individuals’ social care need and advice to the prison on OP 39 meeting needs. Not all prisons have such a relationship with their Local Authority. Currently if social care needs are identified by the prison, such care is unlikely to be funded by a local authority. Some prisoners who receive a package of social care in the community have found this care is discontinued or difficult to access in custody. There are some examples of good practice including the Isle of Wight, Exeter and Manchester.

The effectiveness with which the particular needs of older prisoners including health and social care, are met; and examples of good practice.

11. As explained above, the majority of prisoners are NHS patients, and from 1 April 2013 there will be NHS oversight of all health services delivered to prisoners. Health services are commissioned for prisoners to the same standard and effectiveness as those available to older people in the community.

12. Prison Health Performance and Quality Indicators enable assessment of how well the needs of prisoners are met, and include a specific measure of services for people with physical disabilities and older adults. This indicator covers assessment, joint working between the healthcare provider and the prison, health promotion, aids and adjustments and physical disability.

13. Amongst a range of examples of good practice is HMP Wakefield, where a Registered General Nurse has specific responsibility for the provision of care to the older population. All older prisoners, receive an annual assessment, and are referred as necessary to services such as podiatry, physiotherapy, optical and dental care (including a specialist provider for dentures) and the Mental Heath Inreach Team. This service is in addition to the primary care medical services that are available to the general population.

14. In the absence of clarity about statutory responsibility for social care provision, there is less assurance that the particular needs of older prisoners are consistently met.

15. Prisons have developed a range of responses to coping with prisoners with higher levels of care and support needs, including:

• support from healthcare services;

• support from voluntary sector agencies;

• provision of social care by prison officers;

• directly funding agency-provided social care; OP 39 • providing various forms of mobility assistance including wheelchairs;

• facilitating care and support provision by other prisoners.

16. Whilst governors and directors work hard to ensure that they discharge their duty of care, there are cases in which prisons have found it very difficult to cope with the needs of individuals. The work described above to clarify responsibility and put in place a new framework for provision is designed to address this.

17. Amongst a number of good practice examples is HMP Hull, where Age UK Hull has supported a “buddy” scheme for older prisoners for several years. This has involved the recruitment and selection of peer helpers who provide basic care such as collecting meals, cleaning cells, assisting with bedding changes etc, whilst working also to empower and encourage those receiving the service to help themselves. Representatives of older prisoners and their buddies attend monthly prisoner forums where they can raise issues which impact on their quality of life in custody.

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

18. We are committed to providing a safe and decent environment for older prisoners. Many of our older buildings provide barriers to achieving this, and we are working to adapt them to meet the needs of the growing older prisoner population. These include a range of adaptations to cells, showers and other facilities for people with mobility difficulties, as well as devising personal evacuation plans to ensure their safety. Peer support schemes of the kind described above can also assist in mitigating the impact of environments that were not designed with older prisoners’ needs in mind.

19. In general, newer prison buildings offer better facilities than older parts of the estate for prisoners with mobility or disability needs, and we are committed to ensuring that any further new build units and prisons are more flexibly designed to provide appropriate environments, for example by providing cells that can be adapted for use by older and/or disabled prisoners. Work is at an early stage to consider how a strategic approach to the use of the prison estate can best ensure that older offenders are accommodated where their needs can best be met, and the where the built environment can facilitate this.

20. Ensuring that older prisoners feel safe has caused some prisons to develop accommodation areas specifically for them, and whilst this works in some places, it is not always the right solution. For instance Swaleside prison OP 39 recently surveyed all prisoners over 55 about their preferences and the overwhelming view was that they preferred integration, rather than a special older prisoners’ wing. This is a good example of the importance of consulting prisoners, rather than making assumptions about their needs and preferences.

21. We are committed to providing a varied regime which includes age appropriate activities. Older prisoners are subject to the same offender management arrangements, and required to engage with activities to address their offending behaviour and resettlement needs. The main difference is for prisoners who have passed the state pension age, who are no longer required to work. Many of these prisoners choose to continue to work, but some will either be unable to or choose to “retire”, and we are committed to ensuring that we provide suitable activity for them. For example, at Wakefield, where there are large numbers of such prisoners, the regime has been adapted to offer ‘core day unlock’ to older prisoners who do not wish to attend off wing activities or paid work. This facility enables prisoners to remain active and to interact with their peer group.

22. More specific regime provision for older prisoners has been developed in conjunction with RECOOP, a charity based in the South West of England. For example, working in partnership with the Red Cross in Dartmoor prison, they support a wheelchair repair workshop and day centre for older prisoners. This improves the health and wellbeing of the prisoners, while teaching them new skills, including first aid, getting them involved in purposeful activity and making reparation to the community.

23. There is evidence that the level of compliance with the prison regime amongst older prisoners is better than that of their younger counterparts. In March 2012, 43.8% of all prisoners were on the enhanced level of the incentives and earned privilege scheme, compared to 58.6% of those aged 50-59 and 54.3% of those aged 60 and over.

The effectiveness of training given to prison staff to deal with the particular needs of older prisoners, including mental illness and palliative care.

24. Mental health awareness training and diversity and equality training are included in the initial training of prison officers, and the needs of older prisoners are discussed in these contexts. In addition to this, a range of training and awareness interventions specifically about older prisoners are provided for use in prisons. For example, Nacro and DH have produced guidance and materials for an awareness session that has been delivered in a number of prisons, and RECOOP are delivering awareness sessions for staff as part of the capacity-building work described below. OP 39 25. We think that the availability of guidance and information for staff is more important than the delivery of awareness training. The NACRO and DH materials described above include a ‘Resource Pack for Working with Older Prisoners’ that can be used by staff and prisoner peer supporters, providing a useful reference guide to the various statutory and voluntary and community sector organisations available to provide information, advice and guidance services for older prisoners. Age UK has produced ‘Supporting Older People in Prison: ideas for practice’ which presents evidence, lessons from experience and practical solutions. These and other materials are now available via the RECOOP website, developed as part of the capacity- building project described below.

26. Prison discipline and healthcare staff work jointly and co-operate to support positive mental health outcomes for prisoners. For example both prison instructions and the prison health performance arrangements support collaborative working and information sharing to support suicide prevention, and partnership working is encouraged for people with learning disabilities.

27. ‘The route to success in end of life care – achieving quality in prisons and for prisoners’ was published by DH in 2011 and aims to provide a practical guide to support both prison and health and social care professionals in delivering high quality end of life care to prisoners. The guide showcases good practice examples from across the health and prison communities in supporting prisoners at their end of life. Macmillan Cancer Support has also worked with prisons to develop a series of prison standards and associated tools so that more people can die in prison, where this is their choice, and fewer will be admitted to hospital unnecessarily. It is also hoped to reduce hospital and hospice lengths of stay, to increase the number of key staff with accredited end of life care and to raise the profile of palliative and end of life care within the prison community.

The role of the voluntary and community sector and private sector in the provision of care for older people in leaving prison.

28. The recently published consultation document ‘Transforming Rehabilitation’ sets out the Government’s proposals for reforming the delivery of offender services in the community. One of the core features of these plans is integration with local partnerships: we are committed to designing a system to make use of local expertise and to integrate into existing local structures. We will align rehabilitative services with the role played by Police and Crime Commissioners so that our new market model will facilitate co- commissioning with them and other commissioners of public services, including health and social care commissioners. Potential providers will have to evidence how they would sustain local partnerships as part of the bidding process. There will also be significant scope for the VCS to deliver front-line rehabilitation services and to form genuine partnerships to enter the competition process. OP 39 29. Examples of good practice in involving the voluntary and community sector in the provision of resettlement and through the gate services include the work of RECOOP mentioned above. For example at HMP Leyhill they have developed the Lobster Pot, a centre for men over 50 in the prison, providing a ‘one stop shop’ for information and advice on a range of subjects relevant to the release and resettlement of older offenders.

30. Following an open competition in 2011, NOMS awarded a grant to RECOOP to build on their work in the South West by improving the capacity of prisons, probation trusts and voluntary sector organisations across England and Wales in working with older offenders. The grant funding runs until March 2014 and has allowed RECOOP to employ a number of regional consultants who are helping to set up interventions and build the capacity and skills necessary to meet the needs of older offenders in custody and the community. They are engaging prisons and probation trusts to identify the needs of both service providers and offenders, to raise awareness of the issues and begin to form lasting partnerships between NOMS providers and the voluntary sector. This will facilitate a range of interventions at local level, including information and advice; low level social care and advocacy; health and wellbeing promotion; staff awareness; and older prisoner forums. As part of this project RECOOP has developed their website to include a members' area that provides a range of resources for professionals working with older offenders.

The effectiveness of arrangements for resettlement of older prisoners.

31. There are no specific arrangements for the resettlement of older prisoners: as with all prisoners, we respond to individual needs on a case-by-case basis.

32. We monitor outcomes to ensure fairness and work to understand and address any differential outcomes that are revealed by the data. The data presented in the NOMS Equalities Annual Report 2011-12 suggests a mixed picture in terms of resettlement outcomes for older offenders when compared with those for younger offenders.

33. In terms of total successful order and licence completions, the picture is a positive one. Whilst 76.3% of all offenders achieve a successful termination, this rises to 90.1% for those aged 50-59 and 88.6% for those aged 60 and over.

34. This is not repeated, however when we look at successful outcomes for accommodation, which were recorded for 88.1% of all offenders, compared to 83.1% of those aged 50-59 and 84.8% of those aged 60 and over. Similarly, successful employment outcomes were recorded for 25.4% of all offenders, compared to 23.8% of those aged 50-59 and 12.7% of those OP 39 aged 60 and over (although in view of the state pension age it is perhaps no surprise that this last figure is so much lower).

35. By contrast, HDC is granted to 27.4% of all eligible prisoners, but 37.4% of those aged 50-59 and 34.1% of those aged 60 and over.

36. More work is needed to understand these figures: the offence type and sentence length profiles of the older prisoner population are very different from that of the population in general, and is likely to explain at least some of the differences.

37. RECOOP are working to build capacity across custody and the community, and their work is helping us better to understand the specific resettlement needs of older prisoners and to provide relevant materials for prisoners themselves and for the staff working with them.

38. The ‘Transforming Rehabilitation’ consultation referred to above describes the Government’s proposals to improve resettlement provision more generally by competing services in the community, incentivising providers to reduce reoffending and extending rehabilitative services to offenders released from short custodial sentences. We believe that these proposals will improve outcomes for all, including for older offenders.

Whether the treatment of older prisoners complies with equality and human rights legislation.

39. As described above, PSI 32/2011, Ensuring Equality sets out the framework for the management of equalities issues in prison establishments. It sets out the policy approach and lists some key mandatory actions designed to ensure legal compliance. It is accompanied by guidance that sets out the characteristics of a person that are protected by the Equality Act 2010 and the conduct that is not allowed in relation to these characteristics, and explains the duties which the Act imposes on staff, including those relating to age.

40. Governors are required to ensure that a full range of management information on equalities issues is analysed and used to produce a local equality action plan. Progress must be tracked and an update report must be submitted regularly for discussion by the Senior Management Team, copied to the Deputy Director of Custody, and published to stakeholders including prisoners.

41. Governors must ensure that prisoners and other stakeholders, particularly those from minority groups, are consulted and involved appropriately in the management of equalities issues. In many prisons this includes the use of older prisoner representatives, and in some there are older prisoner forums, facilitated in a range of ways, including by staff, prisoners and voluntary sector groups such as RECOOP and Age UK. OP 39 42. The NOMS Equalities Annual Report provides data on a number of outcomes for older offenders (some of which has been used elsewhere in this evidence), and we are continuing to broaden the range of reporting, in line with our equalities objective around equalities monitoring data.

Whether a national strategy for the treatment of older prisoners should be established; and if so what it should contain.

43. The Government does not consider the establishment of a national strategy for older prisoners to be the best way of proceeding. The equalities policy described above already makes clear that the particular needs of individual offenders must be identified and addressed. The differences within the group of older offenders (across the other protected characteristics in the equalities legislation, as well as in terms of offence type, sentence length and other factors) are wide and it is not possible to generalise about what their needs are as a group.

44. The various guidance and good practice documents described above are available to ensure that the needs of individuals are addressed, and we are monitoring key outcomes to ensure that any differences for older prisoners are identified, explored, and where necessary addressed.

45. The Department of Health proposals described above will bring significant improvements in the provision of social care for prisoners that will be of benefit to many older prisoners and the Transforming Rehabilitation proposals will provide more flexible and efficient services for them on release. We are committed also to continuing work specifically on older prisoner issues through the partnership with RECOOP that we are using to build capacity across the system, and through ongoing work with stakeholders through the Older People in Prisons Forum. We are, however, not convinced that a national strategy is necessary or would be the most effective way of taking this work forward.

March 2013

OP 40 Written submission from Prisoner L1

13-26.02.13

Written Evidence to the Justice Select Committee

Biographical Detail: Admitted to HMP Manchester [...]. First time in prison for historical crimes. Seeking leave to appeal. [...]

Formerly local councillor, head teacher, Chair of Governors at [...] University College. Disabled prisoner with poly-... poly-arthritis with rheumatoid factor, asthmatic, suffers from tri-geminal neuralgia, eczema, hiatus hernia. Aged 66 on entry to prison. Member of Prison Racial Equality Group, attends Equality Action team the Governor, attends Wing meetings, mentor for Shannon Trust ‘Toe by Toe’ reading programme.

Personal Prison Mantra: Understand, Accept, Embrace.

Introduction: It is my intent in offering this written evidence to the Select Committee to concentrate on areas that might prove helpful to your deliberations.

a. The mental and physical health care needs of older prisoners b. Identifying and meeting need c. The prison environment and regime

Additionally there is a reading list and 2 appendices.

The observations that form the basis of this evidence have been developed from my personal experiences, those of prisoners that I have listened to, discussions with officers (formal and informal) and my reading of reports, policies and other material available in the library at HMP Manchester. I am also indebted to Judith Caie MSc for sight of her MSc dissertation ‘Biopsychosocial Risk Factors for Common Mental Health Problems in Older Male Prisoners’ (i) I quote from this 2012 dissertation with the permission of Ms Caie.

Section a) The Mental and Physical Health Care Needs of Older Prisoners

Because of the pernicious nature of Jack Straw’s 2003 Act more and more older prisoners are entering the prison estate, often condemned by evidence from a complainant without corroborating police evidence. Many of these prisoners have no experience of prison life and have to develop coping strategies in old age for a life regime that runs counter to their previous experiences. The current pattern of extremely harsh sentences means that many will anticipate that they will die in prison. Many of the prisoners are either innocent or have not committed an offence for twenty or thirty years. The element of shock must not be understated. In (i) above Judith Caie notes that the research indicates that there is a link

1 Redacted for publication. Redactions are signified thus: “[....]” OP 40 between entering prison and a worsening of physical health complaints. Often on admission to custody older prisoners are already experiencing poor physical health and the conditions within prison worsen this.’ Caie draws connections between problems of physical health and significant mental health issues. She finds that ‘risk of developing primary mental health problems may be increased by chronic physical ill-health.

Additionally she draws attention to Crawley’s (2010) ‘notion of “ institutional thoughtlessness” (that) can be potentially damaging to the mental health of older prisoners.’ Thirdly, she finds that ‘depression can go largely undetected in the older male prison population.’ If this depression is largely undetected she finds that older male prisoners are unlikely to have their depression diagnosed or treated whilst in custody.

At this point it might prove valuable for me to offer my personal observations on the physical and mental health condition of prisoners of age on E-wing at HMP Manchester. The vast majority of prisoners of 50+ on E wing have regular physical health problems-some have chronic conditions and require ongoing medication; others have short-term illnesses that require an immediate response. Prison is a partially closed community and thus once a virus enters the wing it has an immediate impact, particularly on those prisoners with damaged immune systems and those prone to chest infection. The prisons initial response is always ‘drink plenty of water and take paracetemol.’ I shall have much more to say on identifying problems and responding to them in Section b. A significantly high proportion of older prisoners have mental health issues. Many regularly see members of the Mental Health In- Reach Team and it has been brought to my attention that many receive medication to help them with their problems. Mental health issues are discussed less frequently which may reflect a situation in the wider community. There are disabled older prisoners on the wing; disabilities such as deafness are easily recognised whilst chronic conditions such as arthritis are generally ignored. Because E Wing has a significant number of motivated and highly professional prison officers inmates with problems receive a supportive and sympathetic response. From discussions with prisoner representatives on other wings this situation appears to be unique to E-Wing. This wing has the highest proportion of elderly prisoners in HMP Manchester, probably running at over 50% of the wing population.

In this part of my evidence I have attempted to reflect my observations and how they fit into the wider research carried out by Caie and others. The proportion of older prisoners is rising and so is the length of sentences; there is also an increased number of innocent inmates ant those have committed ‘historical’ offences. Older prisoners are more likely to have physical health issues and prisoners, particularly older prisoners, with such issues are more likely to suffer from depression and mental illness. In the next section I will look at the identification of needs of older prisoners hand how HMP Manchester deals with those needs.

Section b) Identifying and Meeting the Needs of Older Prisoners

OP 40 The Ministry of Justice through PS1 32/2011 requires that the prison estate carries out the provisions of the Equality Act 2010. The Act recognised a number of protected characteristics. Annex A describes the characteristics and those include ‘Age’, thus:

Age

A.5 ‘This refers to a particular age group, whether this is a particular age or a range of ages.’

Annex D gives prisons the responsibility to collect and monitor on the protected characteristic groups including ‘Age’.

D. 6 ‘The general principle is that prisoners should be asked for this information where information is already available to staff with responsibility for collecting it, prisoners should be asked to check that it is accurate.’

The collection of age data at HMP Manchester is both simple and automatic as prisoners are asked to confirm their date of birth at entry in Reception. Other information such as disability and chronic ill-health are also collected at that point. Many prisoners, particularly older prisoners, arrive at Reception in a state of shock. HMP Manchester recognise this and in its Prisoner Disability Policy (June 2010) it points out that ‘data is collected from Declaration of Disability forms done at reception as well as routine wing census and responses to request forms. An ‘Excel’ database is managed by the Disability Liaison Officer (DLO) and data is shared across functions.’ Information and recognition of age and disability are collected and recorded at prisoner reception. Some prisoners may have chronic health conditions including those with pain as a significant factor. It is not clear that those conditions are recognised and recorded. Discussions with wing officers appear to indicate that whilst they are made aware of older prisoners that come on to the wing the only action that is required is to ensure that an OAP sticker is placed above the door to ensure that older prisoners are ‘opened up’ for additional association time that is offered mornings and afternoons (Monday to Friday lunchtime) to older prisoners.

In December 2012 the prison established an Elderly Prisoner Forum with links to Healthcare and to include the DLO. The forum has not met since its initial meeting. Some elderly prisoners are keen to have another forum meeting so that matters can be raised that they consider both important and urgent. In its HMCIP Action Plan the prison is developing an elderly prisoner community with appropriate facilities on A wing. The target date for completion is March 2013. A risk assessment has been carried out on the showers on level 3 at E Wing; grab rails for older prisoners have been ordered.

HMP Manchester is starting to take the first faltering steps in recognising that older prisoners are part of a protected characteristic and have special needs that need to be met. At this point it might prove valuable to identify those matters that prisoners have raised as serious concerns in discussion. Undoubtedly the issue that is mentioned most frequently by older prisoners is the recognition and treatment of physical health conditions and illnesses.

The first and most frequent point of contact with the health care system is the nurse(s) who come on the wing to administer medication that prisoners are not allowed to hold in their OP 40 cells and to give to prisoners the medication that has been ordered on (repeat) prescription. Older prisoners are unanimous in their praise for the vast majority of nurses; not only are they totally professional but most of them show kindness and concern for their patients, regularly calling them by their first names. Older prisoners are treated with dignity by the nursing team. Since September 2012 I have only seen poor quality behaviour by nurses on two occasions. Nurses also assist doctors at the Health Care Centre. The nursing team are unable to prescribe except for soluble paracetamol at the wing health room. It would be truthful to say that when most elderly prisoners tell the nursing staff that they have a chest infection they are given paracetamol and told “drink large amounts of water”. Some nurses advise prisoners to apply to see a doctor. It often takes a week or more before prisoners receive their appointments. Emergency appointments, whilst available, are fairly rare.

Doctors see patients in the treatment rooms located in the Health Care Centre. The procedure applies to all prisoners but the negative impact of the process falls more heavily older prisoners. The notice of an appointment is short. Usually, but not always, a notification is posting into a cell during the night, often quite late, before the appointment. The appointments give details of which service is to be seen but not the name of the doctor or health care specialist involved. For morning appointments prisoners are told to be ready by 9am and are usually collected by an officer between then and 10am.

Vulnerable prisoners (E wing and A wing) have their own waiting room. It has recently been decorated to a high standard and has a flat-screen TV that shows DVDs. ‘Porridge’ is particularly popular with older prisoners. Unfortunately the waiting room has no heating. The adjacent toilet has a small radiator but this is ineffective in heating the waiting room which has an external door that lets in cold air in winter. The waiting room has about a dozen chairs, but there are regularly more than twelve visitors awaiting appointments. Prisoners wait until everyone from their wing has been seen and are then returned to their cells. The time spent in the waiting room is often two hours. It should be noted that many elderly prisoners forgo a visit to the Health Care Centre in winter as they feel that sitting in a cold waiting room is likely to lend to a deterioration in their health.

Most prisoners who attend for a GP appointment see a locum. The overwhelming view of older inmates is that they are treated by the locum as a prisoner, not a patient. The Health Care medical provision is provided by the local NHS Primary Trust. The Trust has the responsibility to treat everyone as a patient. Older prisoners have expressed concern that they are not believed and have had to draw the locum to their detailed NHS records which are held on the computer on the desk in the treatment room. Locum doctors seem very reluctant to take executive decisions and some have, or appear to have, a fear of prescribing. The sole exception to the culture described above is the NHS Prison Head of Medicine, [...]. His reputation is exceptionally high among older prisoners; he treats everyone as a patient and does so with respect, dignity and humour and this is much appreciated by his patients. Serious medical cases are treated as in-patent on the ward in the Health Centre; some are transferred to outside hospitals. Most elderly prisoners that I have listened to have said that in-patient care is good. They say that they feel safe and secure and are treated with respect. OP 40 The Health Care Centre provides a number of other medical services and I shall deal with these in turn. Dental services have an excellent reputation; the waiting times for an appointment are reasonable and the quality of service is excellent. All elderly prisoners that I have spoken to about the service claim that the outcomes are comparable with NHS dental services outside prison. Optician services are also considered to be good; whilst there is a delay in receiving appointments once the optician has been seen there is only a brief delay, a matter of a few days, before prescription glasses arrive on the wing. Most prisoners agree that prescription is accurate but concerns have been expressed at the quality of the frames. Spectacles are not individually fitted on arrival. The general quality of Podiatry Services available in the Health Centre is recognised by older prisoners as good; however there are significant delays in managing appointments. Prisoner M has been waiting from the middle of November for an appointment and Prisoner C since the early part of December. Worryingly both prisoners still have not seen the podiatrist. The physiotherapy service offered by the Primary Trust is dire. The physiotherapist is a private practitioner. It is almost impossible to find an older patient who has had a satisfactory service or reasonable experience. The reputation of the service is so poor that many older prisoners would rather remain in significant pain than see the physiotherapist. A number of prisoners have complained that advice given runs contrary to that they have received from long-term physiotherapists on the outside. Many prisoners have complained to me about the abrupt, almost brutal, response given by the physiotherapist. It has been noted by many that she does not discuss with patients but delivers monologues. When challenged she appears to lose her temper and raise her voice . Older prisoners are most dismissive of the physiotherapy service. The Health Centre also offers ‘Stop Smoking’ and ‘Sexual Health Clinics’. I have not met an elderly prisoner who has made use of the services.

Sometimes prisoners attend outpatient clinic appointments at local hospitals. I think it might be valuable for me to describe my recent outpatient appointment at [...] Hospital. I am due to have a cataract operation on my left eye. This kind of surgery is likely to become more frequent as the prison population ages. Without any advance warning an officer arrived at my cell at 9am on Wednesday February 6th. I was told that advance warning is not given for security reasons. I was taken to the prison reception were I was strip-searched. I was then double-handcuffed. This means that my hands were handcuffed together and then with a second pair of handcuffs I was handcuffed to an officer. The handcuffs caused some considerable pain and I did not get back the feeling or use of the thumb on my left hand (the double-handcuffed hand) until Tuesday February 12th. Three officers and a driver took me to [...] Hospital in a minibus. At this point I need to stress the professionalism and pleasantness of the officers. They were only following security procedures. However, I remained in handcuffs throughout the four and a half hours that I was with the security team. My hand- to-hand handcuffs had to be removed during parts of the pre-operation examinations, so that the nurses and technicians could carry out their work. The staff at the hospital were excellent; they treated me with respect and dignity throughout. A nurse carried out a medical history interview. She asked me if I had visited a hospital in the previous six months; this question related to my being a possible carrier of MRSA. Whilst I explained to her that I hadn’t been in hospital that I shared a cell with another prisoner. She seemed quite shocked OP 40 when I told her that we ate in our cells which also contained our shared toilet. The nurse asked me to repeat the facts again. I did so. She then explained that I would have to be tested for MRSA on the day of my operation. A brief word on the security set-up: I am a 66 year-old man in poor health; I have asthma and rheumatoid arthritis with particular pain in my hips, knees and wrists; I would find it hard to run to save my life; I had three young, fit officers accompany me the whole time; I have not committed an offence for almost 22 years; I am embracing my time in prison to do all that I can to improve and reform for the benefit of officers and prisoners. The security provision was ridiculously overblown for an unwell, elderly prisoner. I was given a leaflet by the nursing staff at [...] Hospital relating to the cataract operation. I have already had a cataract removed my right eye so I have experience in dealing with pre-and post-operative risk. I have written to [...] to ask how the Primary Care Trust intend to manage the risks, particularly the post-operative risk of infection from open eye surgery.

The Mental Health Care service in the prison appears to elicit variable responses from elderly prisoners. The Prison has a Day Care Centre and on Wednesday mornings elderly prisoners (in this case 50+ years) spend a two hour session with two mental health nurses. The session is not limited to prisoners with mental health records but all 50+ prisoners can attend on application; the Wednesday sessions are specifically for vulnerable prisoners from A&E wings. This facility is considered to be valuable for and by attendees.

The Mental Health Nurses act as facilitators for wide-ranging discussions; they are excellent in maintaining a warm and relaxed atmosphere. Many of the older prisoners that attend describe the Wednesday morning experience as the highlight of their week. Clinics are also held for one-to-one sessions with prisoners who have registered mental health issues. No elderly prisoner has ever discussed the value of such sessions.

At this point I wish to deal with the issue of the recognition of their needs by the elderly prisoners themselves. Provision is currently triggered by applications written by prisoners. Cell furniture is very basic. Older prisoners may find the wooden or plastic seats to be extremely uncomfortable for sitting for long periods. There seems to be little understanding how decisions for requests for padded seating are considered. In an attempt to formalise the process I spoke to the DLO. He told me to put in (an) application to see a GP. I saw a locum who explained that as it was an ‘executive decision’ she would have to refer the matter to [...], Head of Medicine. [...] told me that he was not qualified to make such a decision and made and appointment for me to see the physiotherapist. The physiotherapist told me that there was no medical reason for me to have padded furniture as an aid to easing pain. She told me to stand up and stretch every twenty minutes. Amusingly every seat in her waiting room was padded. Many older prisoners take the opportunity to work full-time or part-time. The general view is that there are three advantages to working: there is a small wage which contributes to purchases made from the ‘Canteen’, effectively the prison shop; workshops are located a considerable distance from the wing and some prisoners ‘enjoy getting off the wing twice a day’. – a quote from prisoner G; the issue of boredom is significant for many older prisoners and whilst for most their work is not intrinsically interesting however many prefer it to being ‘banged up’. Older prisoners’ association time is regular on E-wing but the actual OP 40 amounts are variable. I have enclosed and analysis of association time (my cell door opening) for the month of February 2013. During association time prisoners may remain in the cells should they wish, they can chat with colleagues and officers or play cards, pool, board games etc.

Some older prisoners choose to attend education classes taking qualifications or certain classes, such as art, for relaxation. The wing ‘Read and Relax’ weekly sessions have a significant number of older prisoners in attendance. Older prisoners tend to make good use of the .

Older prisoners on E-wing undoubtedly play an important role in setting the tone on the wing. I have seen wonderful examples of older prisoners regularly talking to young men about their situations and listening to concerns and worries. This is vital for the younger prisoners in that they can speak to older men with confidence and in confidence, rather than to raise similar issues with officers. It is obvious that this is appreciated by members of staff. In contrast, many (not too many) older prisoners have younger prisoners as their dedicated carers. This normally means that the younger men collect the older prisoner’s meals. It is HMP Manchester policy that they can make beds if necessary, and carry out other minor tasks. This reciprocity works well and recognises the symbiotic nature of prison life.

My impression is that there are a significant number of older prisoners who choose not to consider themselves ‘older’. Perhaps it would be more accurate to say that they are only prepared to consider themselves older when they have problems that need solutions. When problems are solved and frustrations reduce they move from the older category to being just prisoners.

Much of the work, indeed I would probably say most of the work, in recognising, assessing and meeting the needs of older prisoners fall on the broad and professional shoulders of the wing staff. On E Wing at HMP Manchester the wing staff are of the highest quality. They are constantly observing the prison population; they are normally the drivers of the ‘Carer’ programme and will approach older prisoners to ask them if they need carer assistance; if the response is positive then arrangements are swiftly put into to place to address the need. The best officers ensure that older prisoners are called by their Christian name, their nickname or they use the form of address ‘Mister’. I am certain that this regime delivers dignity and adds to prisoner self-esteem.

As a member of both the [...] Team and the [...] Group I have the opportunity to assess the attitudes and ethos of the governorship of the prison. Whilst my experience in limited there is no doubt that I have found governors and other senior managers are focussed on problem- solving and reforming practices that will maintain and improve standards; their attitudes to achieving more equal outcomes for protected characteristic groups is focused and excellent use is made of risk assessment; actions follow assessments.

The most obvious flaw in the management process is the difficulty in communicating information and policy changes to P.Os, S.Os and wing officers. I am regularly told that I have more information than the officers; my fellow prisoner Committee members and wing OP 40 officers confirm that they have the same impression. Large organisations are regularly criticised for communication failures; but with new electronic technology there should be no reasons why critical information could be steered on i-pads or similar pieces of hardware. Officers complain that office walls are well papered with memos and notices; just to replace this with e-technology would be pointless, however a thoughtful analysis of the targeting of information on a need to know bases. The prison might agree that targeting is their aim however observed outcomes suggest that improvements can, and need, to be made. For the prison to react swiftly to the needs of elderly prisoners communication methodology needs to be reviewed. A final comment: as we get older we look for sameness and consistency in our lives; newness is often regarded as a threat and is deeply uncomfortable for older prisoners. Constant changes of S.O and Prison Officers on the wing does not help. Older prisoners would prefer that shift patterns would enable a core officer group to be available so that consistent relationships develop a broader and deeper understanding of the needs and concerns of those prisoners. Movement between wings is seen as disruptive and prisoners, particularly older prisoners, are put in the position of rehearsing their needs and concerns again and again. Movement between prisons needs to be well-prepared and older prisoners should be given an indication of the regime and facilities available at the receiving prison. Prison R was informed that he was to be transferred to Buckley Fall Prison in Rochdale. Prison R is over 80; HMP Buckley Fall specifically stated that it is unsuitable for older prisoners as it has a hilly environment. Fortunately this dispersion decision was changed before a move could be made.

Section C) The Prison Environment and Regime.

The evidence submitted is purely based on my stay in the Vulnerable Prisoner section of a Category A wing in a shared local / Category A prison. I shall divide this section into a number of sub-sections.

Inclusiveness or Isolation; the most common view that has been expressed by older prisoners is that they prefer to be housed on a wing that includes middle-aged and younger alongside older prisoners. The reasoning behind this widely-held view is that older prisoners can perform useful mentoring roles with younger prisoners, and even with some middle-aged men. The view is also expressed that a wing of mixed ages has a more natural feel to it; some older prisoners have said that having some of the ‘lads around keeps me young’ – a quote from Prisoner M. However concerns are expressed when the balance of ages is altered particularly when too many younger prisoners are allocated to the wing. As E-wing at Manchester is tightly managed and incidents are few and far between no concerns are expressed by older prisoners about their safety or security. Interestingly, and perhaps obviously, older prisoners then to associate with older prisoners in card games but mix with younger middle-aged prisoner to chat and play pool. Many of the relationships between the older population and the twenty-somethings are based on mentoring, advice sessions and banter about football and other shared interests. Older prisoners on E-wing who are due to be transferred to HMP Wymott generally show an interest in moving into the older persons’ accommodation at the prison (here I am referring to prisoners aged 70+). OP 40 It follows from the above observations that thoughts has to be given as to the amount of influence that prisoners have in whether they are placed on an age-specific wing or are housed on a mixed age wing. I am certain that in the best run establishments officers ask prisoners their opinions on placement and do their best to respond compassionately. As mental health and physical health affects each other it can be presumed that the placement of older prisoners is crucial to their time in prison.

Cell allocation would appear to be particularly important. E-wing as Manchester has a shared cell arrangements with an in-cell toilet with a vanity curtain. The majority of the prison population in the Estate will be in simple cells. It is my intention to comment on the shared cell situation. My impression is that older prisoners value their dignity greatly. Many find toilet-sharing to be Victorian in nature and a thoroughly unpleasant experience. There are also health considerations; older prisoners are susceptible to infection and this should be taken into account when cell allocations are made. Older prisoners often prefer to share cells with other older prisoners. Whilst this may have social benefit it also raises the issue of upper and lower bunk arrangements. It is my view that prison establishments should carry out risk assessments when cell-sharing is considered. On E-wing HMP Manchester I have neither seen nor heard of evidence of bullying of older prisoners by younger cell-mates. Sometimes the pairing of prisoners of different generations can offer positives; a number of them have been referred to above.

I now wish to deal with the controversial subject of furniture and furnishings. As members of the Select Committee will be aware prison cells contain the most basic of furniture. Prison bunk-beds, mattresses, pillows are of a standard design. Whilst some older prisoners might be given an additional mattress by sympathetic wing officer the system appears to have little tolerance of older prisoners with sleep-related pain problems; older prisoners are expected to use beds designed for young fit offenders. Whilst it appears that cupboards and table have slight variety (apparently due to their age) chairs come in two forms; the white plastic moulded chairs have a low-seat base and the majority of older prisoners consider them to be viable only for short-term seating. The wood and metal upright chairs are hard and uncomfortable; the prisoner psychiatrists advises that they should be used with pillows and blankets as softeners; the padded chairs in her consulting room are exceptionally comfortable but don’t appear to be available for use on the wing or in cells. It is my view that prisoners over 50 should be offered a choice from a variety of chairs to allow them to be pain-free the same should apply to disabled prisoners and those with long-term painful conditions.

HMP Manchester has a clear policy to provide aids to living for disabled and older prisoners. No cells on E-wing have been offered to meet the needs of prisoners with protected characteristics. However, it would appear that no prisoners currently housed on the wing are in need of cell adaptations. Following concerns expressed by older prisoners and a carer the showers on level 3 are to be fitted with grab rails and a specialist shower seat is to be provided. This follows similar programmes on other wings. The number of wheel-chair users at HMP Manchester is small; the prison building is poorly suited to wheel-chairs and whilst there are plenty of ramps much of the prison is 11-storey and thus internal movement between floors is challenging. It would take substantial finances to rectify that current OP 40 situation and in the current climate that is hardly feasible. A more pragmatic solution might be to move severely disable prisoners and wheel-chair users to nearby prisons which clearly cater for their needs.

The prison has a number of aids for partially hearing prisoners, particularly for use in making telephone calls. The DHO responds swiftly to meet those needs. Prisoners requiring hearing aids are tested and fitted outside the prison.

Prisons have the responsibility of achieving the maximum amount of ‘Purposeful Activity’ for the prison population; this applies to older prisoners as well. Firstly, a comment on the concept of purposeful activity. Prisons are a semi-closed environment and offer, or should offer, real opportunities to prepare prisoners for their release into society. However the mix on offer is limited and the amount of ‘bang-up’ (behind locked doors) time is excessive. Prisoners claim that boredom is a significant factor in their concerns about their personal mental health. Huge amounts of time are wasted. If government is serious about re-offending rates then it needs to put real resources into the prison estate. The current menu for vulnerable prisons at HMP Manchester is limited: the prison print shop, the laundry, wing cleaning, education. These activities are open to applications for all prisoners, including older prisoners. There are semi-skilled posts in the print shop, however most prisoners are employed in repetitive menial tasks. Older prisoners are encouraged to take education classes if they rejected work. Older prisoners (65+) do not have to take work of sign up for education classes. They have the opportunity for part-time work and many will work several mornings in a week. Some develop a time-table of mixed economy.

Some older prisoners are able to develop a whole week of purposeful activity but much of it was / is based on informal and yet most valuable activity. It might be helpful if i spent a paragraph on the activities in which i engage in prison. Quite a lot of this activity take place behind locked doors. On arrival in prison i chose not to work and the principle reason for this was the state of my health. I was determined to embrace my time in prison and chose as one of my principle objectives was to help prisoners and staff in any way that I can. I write letters and applications for prisoners who lack writing skills, read letters for those with reading difficulties. I am regularly asked for advice; sometimes on prison matters, again on legal issues ( I always pass these questions on to those with more appropriate skills) on family matters; indeed and listen to prisoners who wish to talk about a plethora of matters. I am also involved in the format representation on prison committees where I am able to use my skills developed over a lifetime to present to the administration the hopes and fears of prisoners on E Wing. Visits are among the most purposeful activities in which prisoners engage. As an enhance prisoner I am entitled to six visits per calendar month. Maintaining relationships with family and friends is an aid to mental and physical health and is essential for the success of the post-prison experience. I telephone my family daily, even though this is expensive. Some older prisoners do not receive money from the outside. On entry into prison the old age pension is stopped. In lieu of this OAPs are given £4.40 per week to spend; sadly most OAPs who are new are not automatically paid this amount and have to apply for it. OP 40 Older prisoners are in a special position when it comes to allocation of prison at dispersement. The partners of older prisoners tend to be within the same age band and thus will experience difficulties in travelling to visit. Along with course required within sentence planning the issue of easeness of visiting should be a major priority when dispersement takes place. Prisoner R was offered a place, if ‘offer’ is the right word as HMP Buckley Hall. However Prisoner R is over eighty years old and HMP Buckley described itself as unsuitable for older prisoners. Prisoner R was most concerned about this but was told that it was an error in the system and that he would be dispersed to a more suitable prison. It is essential that the prison estate would quickly towards providing places for elderly prisoners in establishments that have been redesigned to meet their needs. Newly designated elderly prisoner units need to embrace regimes that area suitable for older people and place dignity towards the top of their priorities. It is awful to hear officers call elderly people by their surname. HMP Manchester had a policy whereby prisoners may choose name designatories. The majority of staff on E-wing adhere to this policy however a small number of officers do not take the trouble to the courteons. Being in the right place (properly adapted) prison with the right regime in the right geographical location would greatly help the resettlement and physical and psychological health of elderly prisoners. I would like to make one final point on this matter. Dispersement is a traumatic experience for all prisoners but especially those who are older. Minimum dispersement will allow prisoners to understand their environment and to feel at ease, knowing that they will have a period without major change. Re-categorisation of prisoners is an important precursor to dispersement; elderly prisoners, particularly those who are disabled and / or historical offenders should have the opportunity for swift re- categorisation so that they can be settled for the major part of their sentence in a prison that is appropriate to their needs. Whenever possible older prisoners and their families should be engaged in all discussions relating to dispersement; this should include geographical location, category, choice of course and the regime of the receiving prison.

There at HMP older prisoners have the opportunity to help and support others. We are currently attempting to formalise such mechanisms. The Prison Reform Trust’s Time Well Spent (2011) provides an excellent template for the prisoner led process there is no doubt that many older prisoners have the experience and skills to play a full role in the development of such a scheme. These opportunities need to be recorded as purposeful activity and the underlying trust in prisoners that is essential to the success of such programmes needs to be celebrated by prison regimes. Active citizenship needs to be transferable between prisons and will provide a firm foundation for older prisoners when they are released. Active citizenship can become the basis for older prisoners when they move on and out into the ‘free’ world. Prisoners that have allowed voluntary work to become part of their prison experience are likely to take up such opportunities when they leave prison. It is fundamental to such an approval that the prison authorities, probation and the voluntary sector work together to develop active citizenship plans for older prisoners as they reach sentence end.

Whilst I am firmly of the opinion that a national strategy is needed to meet the needs of older prisoners as there will be far reaching financial consequences, i am also certain that the drivers need to be regionally-based and the thrust needs to come within individual prison OP 40 establishment. Prisoners must play a full role in these plans and that role must be embraced by all stakeholders. HM Inspectorate of prison needs to take an active part in monitoring the success of such a strategy and I also believe that the Justice Select Committee needs to continue with its excellent work in shining a light onto current practice. I could have based my evidence on theoretical publications and whilst I have under-pinned this evidence with the opportunity to read widely, it was always my intention to offer practical evidence from the point of view of a new prisoner entering the world of prison from the first time. However I am including below the seminal publications that have offered me background knowledge against which to present my personal experience and opinions.

I am more than happy to respond to written questions from the Select Committee or to discuss any matter by video-link. The Committee would need to seek the permission of the Governor of HMP Manchester if a follow-up would be useful. I am most grateful for the opportunity to give written evidence to the Justice Select Committee and would like pay tribute to our Governor for responding so positively to my request:

Support Reading List:

i) Report on an unannounced full follow-up inspection of HMP Manchester 1–9 September 2011: HM Chief Inspector of Prisons ii) Ministry of Justice P51/ 32/2011 Ensuring Equality: NOMS Agency Board iii) Prisoner Disability Policy, HMP Manchester, Updated July 2010, HMP Manchester iv) The Equality Act 2010. Securing Equality for all in Britain July 2010; Equality and Human Rights Commission v) Prisoner Wheel Chair Policy, HMP Manchester, Issued November 2009, Review Date: December 2010 vi) Biopsycholosocial Risk Factors for Common Mental Health Problems in Older Male Prisoners. 2012 Judith Caie vii) Thematic Report: Disabled Prisoners, March 2009. HM Inspectorate of Prisons viii) Doing Time; Good Practice with Older People in Prison the Views of Prison Staff: Prison Reform Trust 2010 ix) Time well Spent: A practical guide to active citizenship and volunteering in prison. Prison Reform Trust 2011 x) Locked Up Potential: A strategy for reforming prisons and rehabilitating prisoners: A report by the Prison Reform Working Group: The Centre for Social Justice 2009.

Appendix 1: Data Extraction Table from vi) Thesis above.

February 2013

OP 40 Appendix : Data Extraction Table

TIME Day Association Elderly Prisoner Total hours min 1 Friday G.A 2 16 OAP 1.53 4.09 2 Saturday G.A 5 52 5.52 3 Sunday G.A 6 13 6.13 4 Monday G.A 2 08 OAP 2.14 4.22 5 Tuesday G.A 2 02 OAP 2.43 HC 4.45 6 Wednesday G.A 2 15 OAP 6.31 HA R.R 8.46 7 thursday G.A 0 00 OAP 3.40 3.40 8 Friday G.A 2 02 OAP 1.16 3.18 9 Saturday Not Recorded = = 10 Sunday G.A 2 34 4.49 2 15 11 Monday G.A 2 09 OAP 3.19 5.28 12 Tuesday G.A 1 58 OAP 2.38 4.36 13 Wednesday G.A 2 06 OAP 4.05 HC 6.11 14 Thursday G.A 0 00 OAP 1.52 1.52 15 Friday G.A 2 28 OAP 2.11 4.39 16 Saturday G.A 6 12 6.12 17 Sunday G.A 6 06 6.06 18 Monday G.A 2 10 OAP 2.05 4.15 19 Tuesday G.A 2 07 OAP 3.14 5.21 20 Wednesday G.A 1 58 OAP 4.09 DCC RIR 6.07 21 Thursday G.A 0 00 OAP 0.00 0.00 22 Friday G.A 3 18 OAP 0.00 3.18 LL 23 Saturday G.A 4 36 OAP 4.36 24 Sunday G.A 4 47 OAP 4.47 25 Monday G.A 2 01 OAP 3.46 5.47 26 Tuesday G.A 1 57 OAP 4.54 6.51 27 Wednesday G.A 1 47 OAP 3.59 DCCRIR 5.48 28 Thursday G.A 0 00 OAP 3.16 MOAPF 3.16 Appendix

Key OAP = Elderly prisoner GA = General Association HC = Health Care Appointment MOAPF = Meeting OAP Forum HA = Hospital Appointment R.R = Read & Relax V = Visit DCC = Day Care Centre LL = Library Legal

OP 40 Explanation of key

OAP- Association for Elderly prisoners not in workshop or Education.

G.A - General Association time for all prisoners.

H.C - Health care visit – normally waiting in HC room for up to 2 hours.

H A- Hospital Appointment at Withington hospital referred to in main text.

V - Visit I take my visits at 3.45pm which means that I return after OAP or GA bang-up.

LL - Library legal visit for prisoners who are studying for appeals etc.

R&R – Read and relax- a charity programme for a small group (8 prisoners) to read and discuss short stories and poetry.

DCC – Day care centre (8–10 prisoners) specifically for older prisoners. Facilitated by Mental Health workers where prisoners can talk and have tea, coffee and toast. Part of the prison Mental Health programme.

MOAPF –Meeting of OAP Forum—mostly to discuss matters relating to the needs of older prisoners.

Association time

The daily figures show the time that one elderly prisoner spends out of his cell each day.

Taking Monday 18th February association with all prisoners 2.10 Association with OAPs including one hour visit 2.05 total associations 4.15 times locked up in cell 19.45.

Further Note

On Thursday February 28th 2013 a meeting was convened of the OAP Forum for vulnerable prisoners. Vulnerable prisoners must be kept away from general location prisoners and have their own forum meetings. Eight prisoners from E wing, two prisoners from a wing and three members of the prisoner’s staff attended including the Disability liaison officer. The OAP Forum also deals with matters relating to disabled prisoners.

Matters discussed included

• Provision of wheelchair. • Carer job descriptions and rates of pay. • Carer responsibilities. • Duvets for purchase by OAP and Disabled prisoners. • Elderly prisoner room on A wing. • Toilet for VP prisoners at visits. • Shower adaptations on E wing. • Designated Disabled cells. • Advanced notice of meeting with offender., management unit, Job Centre Plus etc. • Automatic payment system for 65+ prisoners who choose not to work. OP 40 • Activity and employment of elderly and disabled prisoners.

77.5% of prisoners at 65+ years are in purposeful activity – work or education.

Of that figure 40% are employed in workshops

80.6% of declared disabled prisoners are in purposeful activity.

OP 41 Written evidence from Prisoner M1

Dear Sir Alan

I will answer the questions you ask for your Select Committee that are in the Inside Times as best I can.

1. The responsibilities for mental/physical health and Social Care could be defined a lot better. One has long waits for the amenities: Doctor and others but the doctor is a long wait. Social Care we never hear of that in here.

2. The needs of older prisoners could be met a lot better. If disabled as I am and many more on my landing we have a long time to wait for any aids such as shaped pillows, walking sticks etc. Wheelchairs some are broken and when told about this nothing done we also have a large wheel chair that has to be shut when brought onto wing. As a wheelchair user one has to get out and in it to get through the wing door even on wing. Staff told nothing done.

3.The environment and regime.

We have to follow same regime as anyone else. The environment is just normal prison environment our doors are left open for most of the day which gives one contact with other OAPs. There is gym for OAPs if one can make it. There is dominoes cards etc twice a week but time seems to be getting shorter each session.

So there is not much for OAP to achieve in the High Security Estate. The wing staff do not get any training here that is effective. They won’t push wheelchairs. I’m maybe lucky that I have an inmate carer who fetches my food (meals) as I can’t do stairs as the wings in here are upside down. One come is upstairs and comes into wing upstairs if one lives downstairs down they go. All OAP who are disabled live upstairs as easier to get to healthcare. As for staff although I still have my wits about me I have been called a senile Bas—rd. As the rest of us have. Some officers helpful.

4.I’m leaving prison in ten months and I haven’t heard anything from the voluntary and community and sector in what’s going to happen to me care wise when released. I do know i’m going into a hostel for a bit beside druggies and bullies which OAPs can do without.

5. This one I don’t know if it complies with Human Rights more could be done.

6. Yes a National Strategy should be made. It should contain reasonable places to live not HOSTELS. That aids are needed are sorted out e.g. I need a nebuliser. Pensions and Disability Living Allowances should be ready for one on release not

1 Redacted for publication OP 41 waiting for cash Housing Benefits council tax as the prison gets to know where ones going a Doctor and Hospital should all be arranged for us OAPs.

There is quite a lot prison could do for OAPs. For instance re-categorisation. I waited here just over three years for my C cat to move on to a prison a C cat prison for rehabilitation for release. Nothing like that here.

I finished all my courses on 14 Dec 09 and have had no more interventions to do. At my sentence plan the last 3 years it’s been consolidate consolidate consolidate.

Why can’t OAPs like me although there are many here get their C cat and moved on to a better prison for rehabilitation and release instead of kept in high security?

My C cat is not any benefit to me now as it takes up to a year to get a move. One is supposed to go to a prison near their home town for release it doesn’t happen.

So you see there is a lot that can be done for OAPs especially disabled ones.

I hope this helps you and you and can do something to make things better for OAPs in prison and help them on a better road to recovery.

Thank you

March 2013

OP 42

Written submission from Prisoner N1

I am the […] orderly at HMP Stafford and I have a good insight into the daily regime into the lives and problems faced by older prisoner here at HMP Stafford. The fact that older prisoners are coming into the system is due to many factors but the main one seems to be the bringing of historical charges and the Justice system of removal of section 23 of the criminal justices act has made convicting people with no prosecution corroborating evidence other than the complainant's statement much easier and in fact since this change the conviction rate of rape has gone from 6% to 60%. This makes the government's conviction rate more acceptable to a public who think that the police and CPS are doing a better job. In fact the prison population of older prisoners since 1996 has in reality trebled in size.

HMP Stafford is an old prison and the part of the prison where the largest group of older prisoners are housed (VP wing) is nearly 200 years old. This brings its own problems with there being no lifts and no access other than staircases to reach the three upper levels. There are also no cells in the entire prison designed for disabled prisoners. I will expand on these problems in answer to the bullet points in your mandate. Cellular confinement on the ground floor is exceedingly limited.

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

The mental health care of older prisoners can vary from individual prisoners due to their needs. Why are prisoners with mental health care needs kept in prisons in the first place? Prisons and prison officers are not equipped to deal with these problems. I have completed the mental health course that prison staff attends and it is extremely limited in its content. You cannot expect prison staff to be health care professionals. With limited mental health care staff in the healthcare department, help is somewhat narrow, although the help that is available is best practice.

Physical care is also extremely limited for those who have mobility problems, which is probably around 75% of older prisoners. The gymnasium is only available once a week on a Saturday but is a long way from the wing. "Chairobics," are not available or practiced. For prisoners who do not work, long periods of cell confinement are all that is available. When I arrived at HMP Stafford in 2011 there were only one wheel chair, worn tips on crutches and walking sticks and when glasses went for repair inmates could have no reading glasses for weeks. Since 2012 with the help of the Equality Group there are now new wheel chairs, boxes of tips for walking aids and glasses are exchanged for temporary fixed focal length glasses until repairs are carried out. Social Care is non existent. In society the focus is upon the individual within a social framework, rather than the framework within which the individual is operating. Its concern is with the cognitive and affective processes by which individuals interpret information. In prison the opposite is true. The framework determines, and dominates individuals and a non-thinking regime occurs. This is unhealthy and reverses the process of social interaction.

1 Redacted for publication. Redactions are signified thus: “[....]”

OP 42 The effectiveness with which the particular needs of older prisoners, including health and social care are met and examples of good practice!

The difficulty in older prisons to meet the demands of older prisoners is insurmountable due to the infrastructure of the prison and the problems with the structure of older buildings! The fact that no wheel chair access in cellular confinement is possible is due to walls not being able to be moved due to cost, and building work access and building construction plays a major part in where older prisoners can be housed. Showers are not available until association times and many older prisoners do not like, or feel safe showering with younger prisoners and the fact that only one disabled shower per landing is available. Roads within the prison are not conducive to wheel chair access and no training is available to people helping wheel chair users by pushing them. Prison officers will not do this due to health and safety issues. Health care itself is approached by 6 steps and the wheel chair access is through a wing on the main population of the prison and is not viable to vulnerable prisoners. Work tends not to be available to older prisoners due to health and safety and access. A lot of older prisoners do not have the mobility of their hands to do manual work.

HMP Stafford has a Senior Support group who meet daily in a Portacabin that has good facilities and a work ethic that allows inmates to make up packs for the kitchens. This has advantages as it gives the prison economic relief and allows older prisoners to be a part of a working environment, increasing their self worth and forming a community within the group. I have seen a great change in the mental health of some prisoners who are working in this environment and they get paid for their labours. There is down time for these inmates when they can play pool and communicate with each other and the health champion (an inmate who is trained in taking blood pressure, weight, and dietary needs, trained by the prison) comes over weekly to note and deal with any problems. This group is definitely best practice and well supported. More work/activity is planned for the near future and is supported by the Senior Management Team.

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

Low level units and over 60's wings are best practice in some prisons. Lots of older prisoners do not come out on association due to feeling intimidated by the exuberance of younger prisoners plus the high volume noise levels. Over half of all older prisoners suffer from some form of mental illness and a proportion of older prisoners have a physical health status of ten years older than their contemporaries on the outside. Healthcare is limited by the amount of prisoners and only one doctor available at any one time. There is no health care cover at night. Access to healthcare in a physical manner is dealt with at HMP Stafford by staff trying to deal with older prisoner's needs on the wing rather than them having to walk to healthcare. Discrimination does exist within the service as the amount of older prisoners who have an IEP status of standard as they find it difficult to get overachieves, which is the only way to get enhanced status here at HMP Stafford. Isolation is an obvious feature

OP 42 of the older prison due to having few family members who support them due to only having few family members still alive or the cost of the crimes that they have committed. Older prisoners tend to be model prisoners but receive no recognition for this. The arrangement of some prisons to have older prisoners accommodated together is definitely best practice and should be the way forward. Counselling is virtually impossible due to funding. Older prisoners in prisons far from their homes are facing loneliness and isolation due to the distance from family who may not be able to travel far.

The effectiveness of training given to prison staff to deal with the particular needs of older prisoners, including mental illness and palliative care.

The training for prison officer is limited and only covers a one day course on mental health and first aid. No palliative care or older prisoner strategies are taught or discussed. It seems to be down to whichever officers have a humanitarian belief or previous training in another working environment. Officers are already stretched to breaking point and the future reduction in staffing levels will obviously have a detrimental effect as fewer officers will be having to deal with the more needy or disruptive elements of a wing.

The role of the voluntary and community sector and private sector in the provision of care for older people in leaving prison.

The communities and voluntary sector play very little part in the resettlement here at HMP Stafford and we do not have visits from these sectors to communicate their opportunities that they can offer nor do they seem to know the needs of older prisoners, including convicted sex' offenders whereby communities shun them or the "not in our backyard" mentalities. It is difficult to get hold of lists of housing associations or direct contact with housing officers from local councils. Some older men do not know where they are going to live until the day of their release. If they are on recall and their licence has finished then no help is available and they can be returned to the community homeless.

The effectiveness of arrangements for resettlement for older prisoners.

As in the previous paragraph resettlement seems to be only looked at close to release dates. This can be extremely worrying for some older prisoners due to disability needs. Pensions on release can take up to six weeks to re-instate and no help was available. The government have now started an advanced state benefits loan which covers pensions. The resettlement officer here at HMP Stafford seems to be pro- active and very helpful but is limited due to staffing. The removal of the community care grant has left long term older prisoners with difficulties of obtaining clothing as the clothing that they originally came in with no longer fits. The Department of Works and Pensions seem to have no prior notice of prisoners being released to their area and a "fast track" information leaflet with release papers from the prison should allow the staff at these departments to re-instate pensions without the long delays that are causing some concern.

OP 42 Whether the treatment of older prisoners complies with equality and human rights legislation.

The most alarming of the legislative shortfalls is the Disability Disadvantages Act omissions. We have men 70 plus being accommodated on upper landings and on top bunks. There was numerous complaints put in about a partially sighted visitor

(registered blind) being seated in visits rows back from the, refreshments area and he had to go and get hot drinks for his son. This has now been sorted but it shows the lack of this type of care. It is an offence under the DDA to give an advantage to an able bodied person over a disabled person. Who does the culpability lie with? Very few jobs are available to older prisoners and Enhanced status is also difficult to obtain. There seems to be no guide lines as to who the legal responsibility lies with. There is absolutely no reason why inmates could not be trained to help prisoners with disabilities, under supervision. The ECHR is a minefield and needs legal representation but funding is almost impossible and there is no help from within the prison. The PEEPs system (Personal Emergency Evacuation Procedure), is in place but no training of the handling of older prisoners is available. Access to the prison chapel is not available to disabled prisoners due to there only being a Stannah stairlift, but that is in the education department and works sometimes or the key is not available.

Whether a national strategy for the treatment of older prisoners should be established; and if so what should it contain.

A national strategy should be established as the humane treatment of older prisoners should be paramount. We have strategies for most other strands and as the older prisoner strand is the fastest growing strand. If the prison has no national strategy then they do not have to comply or make special needs adjustments to conform to it. Cellular accommodation should house like for like inmates. The accommodating of men who are retired with younger prisoners can have a serious detrimental mental health effect on them and the bullying of older men, whether it is something as simple as the manipulation of a remote control of a television set, to serious bullying of canteen goods.

Noise pollution by younger prisoners can also be a problem for older prisoners as the younger prisoners play loud music in their cells. This seems to be ignored here at HMP Stafford and night staff seem to be blasé about the problem. A policy whereby older or infirm prisoners are located on ground floors although this has proved not the case in the past. Prison staff should on categorisation and allocation record relevant health problems or disability factors. There are no wheel chair accessible cells and there should be, where possible accommodation wings for older/disabled prisoners. Prison staff should have minimum training to deal with older prisoners and made aware of the needs of older prisoners.

Enhanced status should be made easier for older prisoners to achieve as it prevents them from advancing in the system. There is a wing here at HMP Stafford (G Wing), where Enhanced status prisoners can apply to be housed. There are only 40 spaces

OP 42 and only 4 older prisoners which is 10 per cent filling the available spaces. A set standard pay grade for older prisoners should be set. These prisoners cost the government less than any other prisoner as their pension are stopped when they come to prison. The government are saving approximately £1,500,000 per week, calculating £150 per week per prisoner and approximately ten per cent of the prison population is accurate. This is around £78,000,000 per annum. This equates to approximately the cost of running 2.5 prisons. The physical and mental health and social needs should be paramount for the humane care of older prisoners.

Access and equality should be accomplished to avoid discriminatory practices. Staff should monitor more closely the activities or lack of activities of older prisoners. There should be more integration with the community based organisations for the elderly and some of the funding available in the community should be directed to the welfare and resettlement of these older prisoners. These prisoners are amongst the men who served in our Armed Forces and are the financial backbone of the country's pension fund due to the years of contributions that they have made. Risk assessments should take account of health and social care needs. Sentence planning should include appropriate requirements so that older prisoners with learning difficulties or mental illness such as dementia are supported if asked to do offending behaviour courses. Older prisoners should not be prevented from moving to lower category prisons due to adjustments for mobility or health problems not being made.

I hope that you find this an honest and fair view of this establishment.

March 2013 OP 43 Written submission from Prisoner O1

I am giving this statement via my MP Rt Hon Edward Vaizey MP in the hope that despite its being handwritten and received at the end of the consultation period, the Committee will accept it as the honest personal views of someone who, at the age of 62, found himself in prison for the first time in his life. The information and experiences recounted herein are personal in that they relate either to my own experiences or to things I witnessed: prisons are, inevitable, full or rumour and hearsay but this statement excludes all of those. I have attempted to address the points as I understand the Committee to be addressing them, and apologise again that my understanding of this may not be totally correct as it is based on recently-read newspaper articles.

1. Are the requirements regarding mental / physical health & social care of older prisoners clearly defined?

As is often the case, they are reasonably well defined, but that is not the same as them being consistently applied. As other have stated, there is a complete separate rule book of provisions for Young Offenders but not a single provision regarding over 60s. The main provision that covers health care is Prison Rule 20 which provides a direction to prison governors to provide all prisoners with service generally commensurate what that provided to the public by NHS. The Rule is very rarely applied in principle or practice. The Committee may care to examine the 2013 edition of the Prison Handbook, in particular the frequent references in individual prison entries and IMB and inspection reports to failings in those area. I have been on medication for clinical depression since prior to imprisonment, but have not managed to be see anyone specialising in mental illness at any level. Waiting times for opticians (10 months) and dentists (4 plus 6 months) in my case but not atypical.

2. Are needs of older prisoners being met, especially for health and social care, what examples are there of good practice?

On a positive note, Bullingdon’s Edgcutt wing had an officer designated as having responsibility for older and disabled prisoners, and he discharged that responsibility very well, sometimes in the face of internal opposition. If the Committee wishes to interview someone, they could not do better than speak to [...].

At Parc there is a dedicated ground floor wing for Older Prisoners, but it is woefully inadequate in size but from what I have seen provides good day to day service to the older prisoners who have limited mobility. There was a sad unfortunate death there before Christmas: I knew [...] quite well being on an interventions course with him; I know there is an investigation into his death but can only say that in his last few days he was increasingly frustrated at the prison’s inability to get him to hospital to have a plaster cast removed from his ankle.

In general, prisons are expected to do the same physical work at age 60, 70, or 80, as at 25 unless they have a defined condition that designates them as unfit for manual work. There are gym facilitates and in particular a “rehab gym” class with a physiotherapist in attendance, but it has been my personal experience since October that less than half of the scheduled two half hour sessions each week actually take place – reasons given centre, as so often, around staffing shortages, operational

1 Redacted for publication. Redactions are signified thus: “[...]” OP 43 difficulties, of the weather. This class is for all prisoners designated as needing ‘rehab’ but, as with other points in my statement, affect older prisoners disproportionately.

At Bullingdon there was an outreach team dealing with Mental Health Issues; I did approach them and had two interviews. I found them completely ineffective in securing any assistance or support.

3. What is the most appropriate environment / regime for older prisoners, and what are the barriers to achieving it?

I can only comment on this, as other, aspects from the viewpoint of a VP (Vulnerable Prisoner); it is my perception that a much higher proportion of VPs are over 60 than are other ‘mains’ prisoners; this of course can be confirmed from national statistics.

The most appropriate arrangements are of course ones which combine the defined purposes of imprisonment (AS a punishment, not FOR punishment, to quite well-worn expression) with decent, humane, appropriate care of older prisoners. Once the points I have made elsewhere about how over – 60s are treated are taken into account, there remains one huge barrier to achieving that aim that may lie out with the remit of this enquiry but I feel needs to be addressed alongside any attempts to improve the situation: that is the sheer number of older VPs in custody.

First, there is the bail question. This may seem an unfair observation, but it seems that one can be granted bail as a 48 year old actor facing multiple charges over many years, but not as an ordinary male in his 60s or 70s facing a single, historical set of allegations, viz a recent case of a man of my own age recently acquitted after well over a year on remand and after a second re-trial.

That brings me to the difficult question of historic offences. I have no personal axe to grind here, my own offences were not historic, but it is inevitable that if people are to be imprisoned for offences that took place 20, 30, 40 or more years ago, the chance of those prisoners being over 60 increases rapidly and extensively. I do suggest that when people are to be sentenced for this type of crime particularly, a lore more should be done to consider that mush used word “Risk”. What is the risk of a 70 year old who has surrendered his passport fleeing bail? Greater than that for the actor, presumably.

If we are to be imprisoned, what of “risk” then? What is the chance of a 60 year old heart bypass patient assaulting an officer of a fellow prisoner, or of him attempting to escape en route to hospital? Much is made of the rehabilitative purpose of prison, but where is the rehabilitation in a prison regime that prevents older prisoners receiving gifts, however innocuous, from friends / family on their birthdays / religious festivals? If imposing visiting regimes that assume that we all have supporters who can help on a bus to visit us for one at a time? Of expecting a man in his 80s, imprisoned for offences 40 years ago that he can barely remember, to undertake intensive psychologically based group therapy interventions that even younger group members find emotionally draining? How does that reduce the risk of that person re-offending?

Separate from issues around whether or not the present (or under the proposals announced today, more) older VPs will need places, what can be done to improve conditions and treatment? A very few prisons have separate VP older wings or landings, and ever fewer take advantage of the prison IEP system to separate out older, better-behaved, less combative ‘enhanced’ VPs. It is positively dreadful that the only prison doing this successfully is one of the six scheduled to close, to be replaced by more places here at Parc where only a small percentage of the families advertised as being available in the prison (see the glowing picture painted in the multi-page entry in the Prison Handbook) are available at all to the approx 25% of the prison population are VPs. What is worse, only a small percentage of OP 43 that small actually happen with any regularity. I know that the MQPL inspectors who visited last month had this pointed out to them, and I hope their report will reflect this. Older prisoners, whether VP or “mains” need more contact with family, friends, the outside world, and reality, not less.

4. Effectiveness of prison staff training, re: older prisoners’ needs.

With the exception of the good practice at Bullingdon detailed elsewhere, I have seen very little evidence of such training, let alone its effectiveness. There is no evidence here that, with the exception of the staff of the special unit for older / disabled prisoners who seem dedicated and caring, no one seems to recognised any difference in the needs of prisoners as we get older. I have had experience of rules being broken though alleged misunderstanding leading to the removal of items I needed for recuperation following a fall, a fellow prisoner who had a heart attack just before Christmas was only able to occupy a cell on the ground floor special unit for a few weeks before having to return to the first floor. The often-quoted maxim of “I don’t make the rules” is used to justify any action whether it is in accordance with or defiance of the rules.

5. Role of the voluntary, community, and private sectors in the care of older prisoners on release 6. The effectiveness of arrangements for resettlement of older prisoners

I can only comment briefly on these two points as I have never been released from prison and do not see direct examples of it in practice. What I have seen is worrying levels of recidivism and institutionalization with older men released on licence finding no chance of effective resettlement and deliberately flout their licence conditions to regain imprisonment without committing and provisions that released older prisoners know they can access reliably. If someone is fortunate enough to have a safe haven to which they can return or take up, and can meet their reporting etc, requirements, why should they be compelled to live in a hostel first? The present arrangements appear to reflect an attitude towards older ex prisoners that are more towards fear or blame if s/he does go on to re-offend than it does to the actual rates of re-offending amongst older ex-VPs.

7. Treatment of older prisoners: compliant with equality and human rights legislation

I cannot comment significantly on human rights legislation since I am unaware of provisions that outlaw particular treatment on age grounds.

Equality is a different matter. As a former Human Resource Management professional and Chartered MCIPD, I believe that current practice represents indirect discrimination against older prisoners; older male VPs in particular. Current policies that increase the incidence of prosecution for historic offences with or without corroborative evidence will inevitably lead to a greater proportion of older people in prison, and staying there well into their 70s and 80s. If conditions in prison are unsuitable for people of that age range, is this not indirect discrimination?

8. Need of a national strategy; contents thereof.

There has to be a national strategy and, more importantly, national standards for dealing with older prisoners that meets the legitimate need for offenders to be punished however ancient their offences, provided of course they are guilty, without acting in an inhuman way. Before setting out some thoughts, I will make it clear that I have of course some degree of personal interest. I am due to be released on licence in my late 60s and remain under supervision for a lengthy period thereafter. However, I firmly believe that these views are unchanged from those I held prior to my imprisonment. It is difficult to avoid supervision that this is “just another sex offender leading off about how unfair it OP 43 all is”; all I can say is that it is irrelevant to my feelings that a greater percentage of VPs will be affected; that is down to factors outside prison walls.

Bail: it should be the exception for anyone over 60 to be refused bail, and there should be a need for clear defined reasons for this to be the case. Risk (see below) needs to be clearly identified.

Historic Offences: if an offender has lived a blameless life for a lengthy period between offence and conviction, much more account should be taken of the effect of imprisonment on current family members, and an over 60 offender should only be given a custodial sentence in truly exceptional cases. The arguments I have heard put forward that s/he “might just not have been caught” is an outrageous contravention of all the principles of justice.

Risk: one of the facets of prison life that has surprised me, and continues to confuse me, is the way the word “risk” is bandied about with a dangerous lack of definition. In particular there is confusion between risk in prison (of escape, of violence, of self-harm) and the risk of re-offending after release. Both need better definition and perhaps a different word could be found for one, to create separation? What is crystal clear is that the blame culture has taken over so much from common sense and fairness that judgement has largely been abandoned. I really hope that this can be addressed not only for older prisoners, not only for VPs, but for the whole prison population.

IPPs: finally, the practice of setting indeterminate sentences for public protection has been widely criticised and extensively condemned, and should be terminated. I am aware of the recent statements that seek to limit it use, but I am also aware that IPPs are still handed down, and that there are many hundreds of prisoners still behind bars years over their ‘tariffs’ through no fault of their own. This harmful, hateful policy needs to be stopped, entirely, and quickly. I will finish this submission by quoting a desolate, dispirited IPP prisoner at my former prison, a man in his 70s. He asked me what I considered to be the worst thing that prison took away from someone on an IPP. We went through the more obvious options = freedom, family, career, reputation etc, all of which he rejected. In his view, the answer is simply Hope. The absence of a target date, a goal at which to aim an objective, is destructive enough at any age – for an older prisoner, it is the like a life sentence without parole. USA has found that with the harmful effect of the 99 years sentences: I hope we can learn from that.

April 2013