Alcatraz Care Home for Frail Elderly Prisoners? Currently more prisoners are serving longer sentences and more are being sentenced later in life. Those aged 60 and over have become the fastest growing segment of the prison population with the number imprisoned increasing by 142 per cent in the last ten years. UK prisons face the prospect of having to care for ever increasing numbers of prisoners dying in places originally designed for younger men. Is it time for purpose built prison care homes? Matthew Jones, BCom (hons), MCIPS
Speaker introduction What is the problem? What is the current impact? What are some of the solutions for the UK? What next? Presentation Agenda: mattguyjones@gmail.com 2
Commerce and psychology graduate, with post graduate qualifications in procurement, management and care Speaker Introduction Matthew Jones 20 years business and professional services experience in the charity, private and public sectors Experienced in service creation, commissioning and operational management Owner of a management consultancy business - The Daniel Jones Consultancy ltd. mattguyjones@gmail.com 3
Porridge & HMP Maidstone mattguyjones@gmail.com 4
Introduction Prisons are now the largest providers of residential care for frail and elderly men in England and Wales They are increasingly turning into hospices, providing end-of-life care for older prisoners and even managing their deaths. The number of prisoners over 60 has tripled in 15 years. There will be 14,000 prisoners aged over 50 by 2020, amounting to 17% of the total prison population, up from 13% in 2014. The situation is so serious that Peter Clarke, the chief inspector of prisons in England and Wales, believes the time has come to introduce purpose-built older prisoner jails: essentially, residential care homes surrounded by a wall. mattguyjones@gmail.com 5
Older prisoners need health and care and an environment that can meet their needs mattguyjones@gmail.com 6
What is the problem? Emergency response, there can be a difficulty responding to medical emergencies in custodial settings. In 63 cases, there were 27 cases (43 per cent) where the response could have been improved Non compliance with the law. DDA, Care Act, Human Rights, etc Pressure on prison officers and other inmates to do the care Lack of meaningful occupation, leading to a deterioration of mental health Premature ageing/ death from missed, late treatment, lack of care or equipment Increased vulnerability, increased safeguarding issues Lack of rehabilitation and reintegration into society mattguyjones@gmail.com 7
For example HMP Winchester: Two older, severely disabled men who shared a small cell, built by the Victorians for one, were not untypical. [...] Neither man was able to work so they spent 23.5 hours a day in their cell. Although there was a shower on the landing, it had not been adapted for use by people with disabilities and so they were unable to use it. Neither had had a shower for months but did their best to wash in their cell. They relied on other prisoners for help with tasks such as collecting meals. Wing staff were unaware of these problems mattguyjones@gmail.com 8
Which type of prison? High security and category C working prisons are the most likely setting in which older prisoners are held; many older prisoners who are sex offenders are considered to be high risk and so are categorised accordingly. Are they? Moreover many older prisoners are considered to be vulnerable and are therefore co-located. High security and category C prisons that hold longer term and life sentence prisoners at different stages of their sentence have a higher percentage of older prisoners. In some cases up to 15% of inmates are 60 and over. mattguyjones@gmail.com 9
Problems can be grouped into Built Environment Older prisons space, stairs, corridor width, listed, access to toilets, work and other vocations, lots of doors and keys Newer prisons not enough cells designed for old prisoners, stairs, access to meaningful occupations Location - away from response teams Operational Issues Coordination with health professionals, both on preventative care, monitoring and access to treatment Reliance upon staff Staff training Staff numbers Attitude to risk and safety Equipment provision, use mattguyjones@gmail.com 10
Operational Issues not the design of the built estate Lack of escorts to take prisoner to health appointments Reliance on another to spot and act Protocols between prison and health service Complicated by prevalence of mental health issues Concerns over care-planning and secondary-care arrangements more often in deaths amongst the older group of prisoners, particularly those with multiple care needs and various chronic conditions Culture, eg, reluctance to dispense pain relief medication mattguyjones@gmail.com 11
Solutions Operational NOMS should set out the minimum standards of care that it expects and consider placing social workers in prisons to work with older prisoners. Nurses in prisons with case loads Some prisons have developed effective palliative care suites which allow prisoners to die with dignity, while others chose to die in their cells or in hospital. There should be new guidelines on the use of restraint in end of life care. Release on compassionate grounds? Conduct a comprehensive analysis of prisons physical compliance with disability discrimination and age equality laws. No release without a destination mattguyjones@gmail.com 12
Solutions - UK Prison estate? Have a national strategy and ways to ensure consistent minimum standards All major works and new builds have specifications that comply with the needs of the intended population Work with health and care organisations to plug the gaps Keep, adapt or dispose of the existing prison estate and build newer, fit for purpose prisons Build, or adapt a care home that provides incarceration. A secure setting, not a hospital, not a prison, but a care home segregated and safely away from the general public? Specialise ( or is this segregation)? mattguyjones@gmail.com 13
Solutions - Future Designs Gove's think-tank Policy Exchange's 2013 report Future Prisons, which proposed a programme of high-tech hub prisons deploying cutting-edge architecture, each housing up to 3,000 inmates in campus-style units around centralised services. They'd have resettlement aspects built in, wider community and share sites [eg, courts] with other parts of the criminal justice system, said the report I am not sure whether they have considered the demographic changes going on and advent of an ageing prison population? mattguyjones@gmail.com 14
Solutions - Future Designs Karin Beijersbergen of the Netherlands Institute for the Study of Crime and Law Enforcement, writing in the Crime & Delinquency journal, established the existence of six broad jail-design styles, from the late 19th to the 21st century: panoptical, radial, rectangular, courtyard, high-rise and campus; more or less in that historical order. Her study argued for more openness and, like Lyon, she believes that better staff-prisoner relations are a significant factor in preventing recidivism. More open layouts can improve inmate-guard relations and support a culture of progress rather than fear. Closeness to family is also important, another reason for concern about the out-oftown jails, where travel times will be greater. mattguyjones@gmail.com 15
Best new prisons? Norway's Bastoy prison, on Bastoy Island is not for high category prisoners but even so, the recidivism rate, claimed at a low 16 per cent. Austria's Leoben Prison by Josef Hohensinn near Graz, of 2004, has a high-tech look and de-stressing acoustic performance. The Mas d'enric Penitentiary near Tarragona, Spain, by AiB Estudi d'arquitectes in 2013, is a low-rise campus of buildings with green rooftops and courtyards. mattguyjones@gmail.com 16
Next Steps... Start the debate to influence the specification of the new prisons proposed for the UK Build an online think tank, for interested parties to collaborate on prison design for older prisoners Explore with the international community on innovation around prison design that incorporates health and social care for old age Flip the idea around and explore whether other types of built environment can become modern prisons mattguyjones@gmail.com 17
The degree of civilization in a society can be judged by entering its prisons. - Fyodor Dostoyevsky Thank you for listening. mattguyjones@gmail.com 18