Serving Time: Prisoner Diet and Exercise

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1 HM Priso Service Servig Time: Prisoer Diet ad Exercise LONDON: The Statioery Office Ordered by the House of Commos to be prited o 6 March 2006 REPORT BY THE COMPTROLLER AND AUDITOR GENERAL HC 939 Sessio March 2006

2 executive summary

3 1 Food, commeted oe priso goveror, is oe of the four thigs you must get right if you like havig a roof o your priso 1. Food i priso is a key issue i cotrol, improves prisoers health ad ca help i resettlemet through traiig ad work opportuities. Although the Home Office does ot have a specific Public Service Agreemet target relatig to prisoer diet ad exercise, the Priso Service aims to esure that prisoers live i safe ad decet coditios ad that prisos are well-ordered ad cotrolled. We examied improvemets made by the Priso Service to prisoers diet ad exercise sice we last reported o priso caterig i Mai Fidigs The Priso Service has made fiacial savigs from caterig but scope for more savigs exists 2 I , the Priso Service spet 94 millio o caterig, the largest compoets of which were food ( 43 millio) ad caterig staff ( 32 millio). Sigificat improvemets have bee made to the Priso Service s caterig arragemets resultig i fiacial savigs ad improved quality of service. Sice , savigs have bee made from expediture o food (up to 2.5 millio each year or about six per cet of expediture o food) ad o caterig staff ( 1.7 millio a year or about five per cet of expediture o staff) maily through the civiliaisatio of caterig staff posts. Savigs have also arise from more efficiet procuremet (up to 1.2 millio a year) ad reduced stockholdigs of food (a oe-off savig of some 2 millio). 3 Expediture o food is determied by each priso goveror who sets the budget i terms of a daily food allowace per prisoer. The average daily food allowace for prisoers is 1.87, but there are wide variatios ragig from 1.20 at a ope priso to 3.41 at a youg offeders istitutio. Variatios betwee differet types of priso ca be partly explaied. Youg offeders istitutios, for example, have some of the highest daily food allowaces because growig juveiles ted to eat more tha adults ad they receive extra moey for food from the Youth Justice Board. Ope prisos ted to have lower daily food allowaces because some prisoers eat some meals outside the prisos. Variatios betwee the same types of prisos are due to a umber of factors icludig some goverors choosig to give food a higher priority tha others or differeces i the quality ad rage of foods purchased. Compared with the cost of other public sector orgaisatios, the Priso Service lies i the middle of the rage. The Scottish Priso Service, for example, speds 1.57 o its daily food allowace but hospitals sped up to a average of 2.50 per cosumer. 4 Our aalysis of caterig costs shows scope for further savigs; for example, by bechmarkig prisos expediture o food across the service ad with other orgaisatios. There is potetial for fiacial savigs if prisos with particularly high daily food allowaces ( outliers ) were to reduce their daily food allowace ad coform closer to the average. As a illustratio, if te prisos with some of the highest daily food allowaces were to reduce their allowace by 0.10 there would be savigs of 133,000 a year. Other savigs could arise from adoptig joit purchasig arragemets with other public sector orgaisatios. 1 Iterview with a goveror at a Eglish priso. The other three factors importat to maitaiig good order iclude mail, hot water ad visits. 2 HM Priso Service: Priso Caterig (HC 277, ). Servig Time: Prisoer Diet ad Exercise

4 The quality of caterig has improved, although some stadards are ot beig met 5 Overall, the Priso Service has improved the quality, rage ad choice of meals over the last seve years. Priso caterers provide a professioal service ad prisoers complaits about food have falle. Prisoers are asked for their views about food likes ad dislikes ad they are respoded to where affordable ad practicable. Followig the Committee of Public Accout s report i , the Service itroduced key caterig stadards settig out the legal ad practical requiremets to deliver good caterig practice, food safety ad to provide advice o meu maagemet. The last check o performace by the Stadards Audit Uit of the Priso Service showed that over 80 per cet of prisos met 80 per cet of the stadards. 6 However, there is still more progress to be made. Some prisos are ot meetig recommeded levels of service. I particular: Food is ofte ot served withi 45 miutes of its preparatio which meas that it risks losig some of its palatability ad utritioal cotet. There are, however, practical difficulties i meetig this target, such as the log distaces betwee kitches ad the poits where prisoers are served their meals; kitches havig to cope with larger populatios tha they were desiged for; ad prisoers havig to queue for up to 45 miutes. Mai meals are sometimes served very early. At Chaigs Wood Priso luch was served at 11:15 am ad the eveig meal at 4 pm at weekeds. There are also log itervals betwee meals half of the prisos we visited did ot meet a 14 hour iterval stadard betwee meals overight. Overall stadards for the preparatio, cookig ad servig of religious ad ethic food are beig met, but the equipmet for the productio of Muslim food is ot always separately labelled. There is also a issue about prisoer perceptio. Caterers may well be meetig all of the required stadards for religious ad ethic food but some caterers foud it difficult to covice prisoers that this was the case. The Stadards Audit Uit foud that i prisos were fully compliat with 66 per cet of stadards, partially compliat with 32 per cet of stadards ad o-compliat with two per cet. 7 Area caterig advisers provide advice to the Priso Service s area maagers o kitche caterig. The advisers have played a key part i the itroductio of improvemets i priso caterig over the years. Caterig maagers at prisos act upo their advice. Although two thirds of caterig maagers at prisos told us that they foud area caterig advisers helpful, oe third did ot. Of the maagers who were ot satisfied, their mai cocers were that they added little value at well-maaged kitches. Prisoers have the opportuity to eat healthily but there are some cocers 8 O the whole, food offered to prisoers is i lie with the govermet s recommedatios o healthy eatig. 4 Prisoers are offered a variety of foods, differet dietary requiremets are catered for ad there is a variety of choice such that prisoers who wished to eat vegetaria oe day, halal the ext, ad a stadard diet the ext could do so. At least oe meal optio labelled as healthy, is offered at luch ad i the eveig. 9 Our cosultats, Bouremouth Uiversity, carried out research o the utritioal cotet of food offered to prisoers. They foud that although prisoers were offered meals that cotaied recommeded quatities of most vitamis ad mierals, there were some otable exceptios which could affect prisoers health. Average levels of salt, for example, were far above the govermet s recommeded levels up to 93 per cet more i the case of the adult male stadard meals, maily due to the use of processed ad pre-prepared dishes ad high cosumptio of bread. Dietary fibre, which could be provided by fresh fruit ad vegetables ad wholegrai products, such as bread ad cereals was low. The amout of eergy (calories) provided by some meals over the day exceeded the govermet s recommedatios ad, although the recommedatio for average eergy cosumptio for wome is lower tha for me, most meals offered to wome provided similar eergy levels. 10 Prisoers are provided with meals which rely heavily o coveiece foods, such as pies ad burgers ad tied food ad froze vegetables with little use made of seasoal produce. The researchers also foud that although prisoers were offered the opportuity to eat healthily may did ot choose to do so ad they cosidered that prisoers did ot uderstad what costituted a healthy balaced diet. Prisoers were provided with little iformatio about healthy eatig apart from whe they first etered priso. Some meals with a 3 Committee of Public Accouts 30th Report of (The Priso Service: Priso Caterig, HC 419). 4 Balace of Good Health, Food Stadards Agecy, Servig Time: Prisoer Diet ad Exercise

5 high salt cotet ad salads with a high fat cotet were icorrectly labelled as healthy. To improve the diet of prisoers we recogise that there would be a additioal cost to the Priso Service. Most prisoers have the opportuity to exercise regularly but participatio i orgaised physical educatio at some prisos is low 11 Physical activity is as importat as food i maitaiig ad improvig prisoers health. Accordig to Priso Rules, 5 adult prisoers should have the opportuity to exercise for a miimum of at least oe hour a week ad youg offeders for a miimum of two hours a week. I additio, all prisoers are give time i the ope air each day, which they ca use to exercise if they so choose. Prisos also offer programmes of orgaised physical educatio activities. Prisoers do ot have to atted physical educatio activities but are ecouraged to do so. 12 We foud that prisoers are give the opportuity to exercise accordig to Priso Rules. While 43 per cet of prisoers participate i some form of orgaised physical educatio activities, there are wide variatios ragig from eleve per cet of prisoers i Bristol Priso to 87 per cet i Hutercombe Priso. Low take up rates are affected by the rage of activities ad facilities available (may older prisos have gyms with restricted capacity ad o outside sports pitches); whether prisoers are give equality of access to activities (vulerable prisoers, for example, do ot always have the same level of access as others); limitatios o the availability of staff (especially at eveigs ad weekeds whe prisoers who work or atted educatio classes durig the week could exercise); ad the emphasis give to some activities at some prisos, such as weightliftig ad persoal fitess, which perhaps diverts attetio from activities which might attract wider participatio. The cost of physical educatio istructors varies disproportioately betwee prisos 13 The Priso Service speds some 29 millio o physical educatio istructors. From the sample of prisos we examied, we foud wide variatios i the ratios of prisoers to physical educatio staff ragig from 38:1 at Aylesbury Youg Offeders Istitutio to 165:1 at Chaigs Wood Priso ad commesurately wide variatios i cost. Youg offeders (at Aylesbury for example) are etitled to ad receive more hours of exercise, which is reflected i the costs. Elsewhere the umbers of istructors did ot bear a strog relatioship to the umber of prisoers or the type of priso. For example, the cost each year of providig physical educatio per prisoer, icludig staff, facilities ad maagemet, at Chaigs Wood Priso is 520 compared with 930 at Ashwell Priso. Priso goverors do ot have up to date guidace o stadard ratios of staff to prisoers. The Priso Service told us that there are difficulties i establishig baselies for physical educatio provisio. Very few prisos hold idetical prisoer populatios with similar facilities ad direct comparisos may ot be meaigful. I additio some prisos have deficiecies i the provisio of other activities, such as educatio ad workshops, ad if they icur higher levels of expediture o physical educatio they might be coverig for regime deficiecies elsewhere. Reducig physical educatio provisio i these prisos would oly impoverish regimes further. 14 Priso goverors prefer to employ officers as fully traied istructors because of their leadership skills ad the assistace they ca provide i cotrollig aggressive behaviour. However, cost effectiveess should be a cosideratio as to whether officers should be employed as istructors. There is scope for employig civilias i prisos where the risks to security are less, such as ope prisos. If by employig a civilia istead of a officer a savig of 5,000 could be made, the the replacemet of 20 officers with 20 civilias would save the Priso Service some 100,000 a year. Overall value for moey 15 O the whole the Priso Service provides a well maaged ad professioal caterig service. There have bee cost savigs from ratioalisatio of food cotracts ad civiliaisatio of kitche staff. Much of the food offered to prisoers meets govermet healthy eatig recommedatios. However, there is scope for improvemet: some caterig stadards are ot beig met; food cotais high levels of salt; ad some further fiacial savigs could be achieved. Prisoers have access to some high quality physical educatio activities. Istructors are highly motivated ad respected. Better value for moey could, however, be achieved. Participatio levels i physical educatio activities i some prisos are low. The Priso Service eeds to establish appropriate ratios of istructors to prisoers ad cosider the fiacial savigs that would arise by employig civilias istead of officers. 5 The Priso Act 1952 gives the Secretary of State for the Home Departmet legal powers to make rules for the regulatio ad maagemet of prisos. These are set out i the Priso Rules 1999 which were last ameded i May Servig Time: Prisoer Diet ad Exercise 3

recommedatios 16 We recommed that: O caterig a b c d Priso goverors ad caterers should improve performace agaist those caterig stadards which have cosistetly ot bee met icludig keepig kitche

6 recommedatios 16 We recommed that: O caterig a b c d Priso goverors ad caterers should improve performace agaist those caterig stadards which have cosistetly ot bee met icludig keepig kitche facilities well-maitaied, servig meals at recommeded times, puttig temperature cotrols i place ad traiig food hadlers at servig poits. Goverors should eforce compliace with those stadards, such as traiig, which are ot wholly maaged by caterig departmets. It is vital that prisoers, particularly those from miorities, believe that their food is stored, prepared ad served i the appropriate way. Good practices we recommed iclude appropriate labellig of all equipmet; caterers ivitig local religious leaders ito their kitches; observig religious festivals by preparig special meals; ad ivolvig religious ad ethic miority prisoers i kitche work. The Priso Service should explore the scope for further fiacial savigs i their caterig operatios by: comparig food costs betwee prisos ad other orgaisatios ad reducig the costs of high speders; ad improvig its purchasig power by adoptig joit purchasig arragemets with other public sector bodies. Risk based assessmets are used to determie the umber of visits to prisos by area caterig advisers. Well-ru prisos which comply with stadards eed visitig less frequetly tha others. O prisoers diet e f g Priso caterers should improve the diet of prisoers, especially those aspects of diet which could adversely affect health, by, for example, reducig the high eergy cotet of some meals takig ito accout the differet requiremets of prisoers beig catered for (accordig to age ad geder); settig specificatios for suppliers to offer healthier products; ot offerig fried foods too frequetly; offerig plety of fruit ad vegetables, icludig more wholegrai products; servig fish regularly icludig oily fish at least oce a week; ad icreasig dietary fibre. The Priso Service should provide practical guidace ad traiig to all priso caterers o healthy caterig practices ad utritio, icludig stadard healthy optio recipes, ad the correct labellig of healthy food. The Priso Service should raise the level of awareess of healthy eatig amog the priso populatio through educatig prisoers o the importace of healthy eatig, posters, ad by actively promotig it o a regular basis. Servig Time: Prisoer Diet ad Exercise

O exercise h i j k l Each priso should icrease participatio i physical educatio activities to the highest proportio of prisoers as is practicable give the priso s facilities.

participatio; ad target specific groups who would otherwise be reluctat to participate such as the over 50 s ad foreig atioals.

Prisoers should have equality of opportuity to access physical educatio activities i each priso, icludig vulerable prisoers, as far as is commesurate with maitaiig good order ad the

Goverors could be helped i determiig how may istructors they require ad their level of traiig if up to date guidelies o stadard ratios of staff to prisoers were i place.

7 O exercise h i j k l Each priso should icrease participatio i physical educatio activities to the highest proportio of prisoers as is practicable give the priso s facilities. All physical educatio departmets should cosult prisoers over which activities they would like to take part i ad the offerig them if suitable; promote activities which ivolve greater participatio; ad target specific groups who would otherwise be reluctat to participate such as the over 50 s ad foreig atioals. All prisos should provide exercise opportuities i the eveigs ad at weekeds to icrease participatio of prisoers who work or atted educatioal classes full time durig the week. Prisoers should have equality of opportuity to access physical educatio activities i each priso, icludig vulerable prisoers, as far as is commesurate with maitaiig good order ad the privileges system i place i each priso. The Priso Service eeds to take a strategic view of staffig for physical educatio istructio across the whole estate. Goverors could be helped i determiig how may istructors they require ad their level of traiig if up to date guidelies o stadard ratios of staff to prisoers were i place. The Priso Service should cosider whether all physical educatio istructors i a priso eed to be officers. There is scope for cost savigs i some prisos by employig civilias as istructors where the risks to security ad cotrol are less, such as ope prisos. Servig Time: Prisoer Diet ad Exercise 5

Summary: The state of medical education and practice in the UK: 2012

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