Prisons or care homes? “The new geriatric penal reality”

23 September 2015

Earlier this month the Prison and Probation Ombudsman, Nigel Newcomen, published his annual report. His findings, much like those of the Inspectorate, suggest that to ensure inmate wellbeing the prison service is in desperate need of reform.

In addition to the well-documented issues of increasing violence and the rising use of “legal highs”, the report highlights the huge demographic challenge facing the prison estate.

In 2014-15 the fastest growing segment of the prison population was prisoners over 60, closely followed by the over 50s. It is important to note that the 2014 prison population data shows that these two groups still only equate to around 11,000 prisoners. The largest group, representing nearly 25,000 remains prisoners between 30-39 years old. The Ombudsman’s report, however, argues that this trend is likely to accelerate – in part due to ongoing increases in the number of older offenders convicted for historical sexual offences. The prison system will, therefore, become increasingly unfit for purpose.

The current penal estate, much of it built several hundred years ago, was designed to house young, healthy men. The Victorian buildings are simply not designed to provide accommodation for the elderly. The case of a 94 year old inmate, removed from a care home to serve his sentence, who fell out of his bed and died is just one example of the mis-match between contemporary need and legacy designs. Crash mats and electronic beds, like those used in care settings, have now been purchased by the prison to prevent further incidents. The report rightly highlights this is simply one “way that prisons, designed for fit young men, have had to adjust to the largely unplanned roles of care home and even hospice”.

It is not just the physical building that is important, but also the skills required to manage ageing prisoners. In an already challenging environment, staff are increasingly dealing with those needing end of life care. Additional training and support – something which the Ombudsman found is often not currently provided – must be prioritised.

Elderly prisoners also pose a huge financial challenge. Cell adaptations are expensive and the cost of transporting elderly prisoners to and from hospitals should not be overlooked. For prison governors, with stringent budgetary restraints, an older population represents an immense financial burden.

Improvements have been made to the end-of-life care provided in prisons, with it now often reaching the standard available in the community. However, with demand rising the report argues there is a danger that these standards may fall. The continuing overuse of restraint on seriously ill prisoners is also a concern for the Ombudsman. An elderly prisoner with chronic health problems who died chained to an officer provides just one worrying example. As the report argues, “protecting the public is fundamental, but this is not achieved by inappropriately chaining the infirm and dying”.

Overall, it is clear that the prison service is facing new challenges. An ageing population is creating an estate which is not fit for purpose. Building specialised prison wings provides one option for Government, however with a tough financial settlement expected for the Ministry of Justice in the upcoming Spending Review this could prove difficult. Additionally, in the long term, adapting the estate may not be sufficient. Tackling the underlying demographic shift in the population through reforming sentencing practices and community alternatives must be a priority for policymakers.

Elizabeth Crowhurst, Researcher, Reform

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