We need a national strategy for older prisoners

Work with offenders examines a new Justice Committee report.

A big rise in the number of older people in prison

Yesterday the House of Commons Justice Committee published a new report with recommendations from their inquiry into the challenges of managing an ageing inmate population.

Older prisoners are the fastest growing group in the prison population. The number of prisoners aged 60 or over has increased by 82% in the last decade and by a staggering 243% since 2002. This rise has primarily been driven by an increase in the number of older adults sentenced for sexual offences. In addition, increases to the length of sentences has meant that more people grow old in prison. It is likely that the older prisoner population will continue to increase. Though the Ministry of Justice’s most recent prison population projections show the over-60 population remaining broadly stable over the next four years, these do not factor in key Government policies, such as increasing police numbers and sentencing reform.

An ageing prison population creates challenges for the prison system as older prisoners often have distinct needs. In particular, older prisoners inevitably carry a greater burden of health conditions compared to their younger peers. There is a greater prevalence of chronic diseases, disability, decreased mobility, and sensory impairment among the cohort. As many as 85% of prisoners over 60 may have some form of major illness. Though the needs of individuals vary, collectively, older prisoners obviously have a much greater level of need for health and social care.

Not wheelchair accessible

Many prisons, particularly some of our largest and most famous institutions built in the Victorian era, were not designed to accommodate individuals with accessibility requirements. Often, therefore, older prisoners and others with disabilities or reduce mobility need reasonable adjustments to be made for them to receive equitable treatment within a prison. The inquiry found that the provision of reasonable adjustments is highly inconsistent across the prison estate and is often constrained by limited funding.

Some prisons have developed activities and forums tailored to older prisoners. But at others a lack of age-appropriate activities and the limited physical accessibility of the estate can make it difficult for older prisoners to participate in the regime. Those who no longer or are unable to work in particular can spend extensive amounts of time confined to their cells. This form of “accidental” solitary confinement negatively effects both their wellbeing and rehabilitation.

Given the greater health-related needs of the cohort, older prisoners are disproportionately impacted by problems in prison healthcare. A particular issue is the cancellation of external medical appointments due to shortages of staff to escort prisoners to hospital or surgeries. This situation has, unsurprisingly, worsened considerably during lockdown when almost no prisoners have been able to attend hospital appointments in the community.

Dementia

Awareness among prison staff of age-related health conditions, particularly dementia, and the availability of screening for such conditions, is not always sufficient. Holding individuals with severe dementia or other complex health and care needs on the prison estate is particularly challenging. The Committee recommends that in some circumstances an alternative form of custody should be considered for these prisoners, although it acknowledges that victims of older adults sentenced for sexual offences may be opposed to the idea, feeling that any such alternatives might well add to the suffering that they have already endured.

The ageing prison population has increased demand for social care. Despite improvements following the Care Act 2014, standards of social care are, again, highly inconsistent across the prison estate. The inquiry found there is often a lack of coordination between prisons, local authorities, and social care providers.

The Committee did acknowledge some improvements in end-of-life and palliative care on the prison estate, though, again, this varies considerably between prisons.

The inquiry found that at some prisons, resettlement approaches are focused towards younger cohorts and do not consider the specific needs of older prisoners. In particular, older prisoners who have served long sentences and experience institutionalisation can require additional guidance and support before re-joining society. There can be challenges finding suitable post-release accommodation for those with disabilities, reduced mobility, or complex health conditions and support adjusting to a more digital world – simple things such as not being able to get on a bus and pay with cash may cause serious problems in navigating every-day life. MPs found that continuity of health and social care is not always well-coordinated among responsible organisations.

Conclusion

The Committee’s overall conclusion is that the greater needs of older prisoners and the challenges many prisons face in meeting these warrants a specific policy. It argues that  HM Prison and Probation Service’s new  operational guidance on managing older prisoners for prison governors does not carry enough authority and that the government should produce a national strategy for older prisoners.

While careful not to commit to an agreement to such a strategy, the Prison Minister Lucy Frazer responded to the Committee’s recommendation favourably, saying:

“[It] is something we need to seriously think about. I am in favour of having an over-arching strategy, particularly on things like accommodation. We have an opportunity now to build 10,000 additional places, which is going to include a number of new prisons. This is a good opportunity to think about how we configure that accommodation, particularly having in mind that we have an older cohort.”

We must wait and see whether these positive words translate into action.