UK:'PPO's learning lessons bulletin: Older Prisoners'

June 26, 2017

“The challenge to the Prison and Probation Service is clear: prisons designed for fit, young men must adjust to the largely unexpected and unplanned roles of care home and even hospice.” – Nigel Newcomen.

Background to the Report:

The numbers of prisoners in the UK over the age of 50 has nearly trebled, from more than 4,800 in 2002, to nearly 12,600 in 2016.This can be attributed to various causes, such as longer sentencing, and prosecution of historic crimes, such as sex offences.

As the number of older people in prison increases, the number of deaths in prison will inevitably increase also. In the last decade, the number of naturally-caused deaths of prisoners over 50 has more than doubled, and this new demographic of older prisoners brings with it new specific challenges for the prison service.

Overall, the report aims to assist prisons to better cope with the changes ahead, and provide an evidence base that will contribute to an effective older prisoners’ strategy.

Key Findings:

The findings of this report fall under three overarching themes:

• Prisons staff should make proportionate decisions in context: This finding is particularly relevant to the issue of restraints risk assessments, determining when or how to involve families, or to assessing applications for compassionate leave.
• Prisons should have a coordinated approach to the care and management of older prisoners: Where a prisoner’s condition is complex, or where multiple organisations, teams or individuals are involved in the prisoner’s care or management, there is a strong need for coordination between parties.
• Prison and healthcare staff should be aware of and ensure their actions conform to local and national policies: Prison and healthcare staff must be aware of, understand fully, and follow their own instructions and policies, for instance, adhering to Prison Service Orders (PSO) and being aware of National Institute for Health and Care Excellence (NICE) guidelines is a necessity.

Recommendation:

The learning lessons bulletin reviews 314 investigations over 2013-2015 and offers 13 lessons, on six key areas, that need to be learned in order to deal appropriately and humanely with older prisoners and their unique needs.

These lessons/recommendations come as a response to the growing demographic of older prisoners. The six areas it examines in depth are: healthcare and diagnosis; restraints; end of life care; family involvement; early release; and dementia and complex needs.

• Healthcare and Diagnosis: Lesson 1 relates to screening of newly arrived prisoners, and Lesson 2 relates to guidelines for diagnosis and treatment of conditions, and continuity of care for those with ongoing health conditions.
• Restraints: Lesson 3 relates to the proportionate use of restraints. Lesson 4 relates to the use of restraints on seriously or terminally ill prisoners. And Lesson 5, discusses the use of restraints during longer hospital stays.
• Palliative and End of Life Care: Lesson 6 relates to the suitable environment for terminally ill prisoners who require palliative care. Lessons 7 discusses all necessary supports for end of life care plans, including the potential to involve the prisoner’s family.
• Family Involvement: Lesson 8 relates to situations where it is appropriate to involve the prisoner’s family and the appropriate step that should be taken when the prisoner is taken to hospital. Lesson 9 relates to next of kin being informed as soon as possible, where appropriate, and that a trained family liaison officer (FLO) is appointed to keep families informed about their condition.
• Early Release: Lesson 10 relates to early release on compassionate grounds, that all applications should be timely and given appropriate priority. Lesson 11 relates to the fact that risks associated with applications for compassionate release should be contextualised given the prisoner’s current health condition.
• Dementia and Complex Needs: Lesson 12 relates to personalised care plans, and coordination between healthcare professionals, for prisoner’s with complex health needs. Lesson 13 relates to risk assessments for in-possession medication, regarding prisoner’s history, and the necessity to have regular reviews.

Read the report here.

IPRT: "In here, time stands still": Rights, Needs and Experiences of Older People in Prison

The Guardian: Buried Alive: The Old Men Stuck in Britain’s Prisons

The Guardian: Prisons Taking the Role of Care Homes and Hospices as Older Population Soars