2014 - scottish prison service evaluation of high care needs prisoners - sps page 1 of 62 chapter 1:...
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Figure 8 Consultancy Services Ltd
First Floor
30 Whitehall Street
Dundee
DD1 4AF
01382 224846
www.figure8consultancy.co.uk
2010
EVIDENCE INTO PRACTICE
Figure 8 Consultancy Services Ltd
First Floor
30 Whitehall Street
Dundee
DD1 4AF
01382 224846
www.f8c.co.uk
EVIDENCE INTO PRACTICE
EVALUATION OF HIGH CARE NEEDS WITHIN THE SCOTTISH
PRISONER POPULATION
Report prepared for the Scottish Prison Service
2014
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LEAD CONTACT
Andy Perkins
Managing Director (Figure 8 Consultancy Services Ltd.)
First Floor, 30 Whitehall Street,
Dundee. DD1 4AF.
01382 224846 (office) – 07949 775026 (mobile)
[email protected] www.f8c.co.uk
RESEARCH & EVALUATION TEAM
Andy Perkins (Managing Director)
David McCue (Senior Researcher/Associate Consultant)
Dougie Paterson (Researcher/Associate Consultant)
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TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION .............................................................................. 1
1.1 Background ............................................................................................... 1
1.2 Purpose of the study .................................................................................. 2
1.3 Objectives ................................................................................................. 2
1.4 Specific issues to address ............................................................................ 3
1.5 Summary of study methods......................................................................... 3
1.5.1 Stage 1 – Systematic review of the literature ........................................ 4
1.5.2 Stage 2 – Qualitative interviews .......................................................... 4
1.6 Limitations and Assumptions ....................................................................... 6
CHAPTER 2: REVIEW OF RELEVANT LITERATURE ................................................ 7
2.1 Aims ......................................................................................................... 7
2.2 Method of Data Collection ........................................................................... 7
2.2.1 Summarising the findings ................................................................... 7
2.3.1 General Guiding Principles and Policy Drivers ........................................ 8
2.3.2 Older Prisoners ................................................................................. 8
2.3.3 Women ...........................................................................................10
2.3.4 Young Offenders ..............................................................................11
2.3.5 Mental Health ..................................................................................11
2.3.6 Disabilities .......................................................................................12
2.3.7 Social Care Needs ............................................................................13
2.3.8 Long-Term Conditions and Terminal Illness ..........................................13
CHAPTER 3: DEFINITION AND SCOPE OF HIGH CARE NEEDS ............................ 15
3.1 Introduction .............................................................................................15
3.2 Definition of High Care Needs .....................................................................15
3.3 Scope of High Care Needs ..........................................................................18
3.3.1 Older prisoners ................................................................................18
3.3.2 Women ...........................................................................................19
3.3.3 Young offenders ...............................................................................19
3.3.4 Mental health ...................................................................................19
3.3.5 Disabilities .......................................................................................20
3.3.6 Social care needs .............................................................................20
3.3.7 Long terms conditions and terminal illness...........................................21
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CHAPTER 4: THE NATURE AND SCALE OF HIGH CARE NEEDS IN SCOTTISH
PRISONS .......................................................................................................... 23
4.1 The Nature of High Care Needs in Scottish Prisons ........................................23
4.2 The Scale of High Care Needs in Scottish Prisons ..........................................26
CHAPTER 5: CURRENT SCOTTISH PRISON SERVICE RESPONSE ........................ 29
5.1 National Measures .....................................................................................29
5.2 Local Measures .........................................................................................29
CHAPTER 6: EFFECTIVENESS OF CURRENT RESPONSES .................................... 31
6.1 Prisoner Views ..........................................................................................31
6.1.1 Prisoner views - positive examples .....................................................31
6.1.2 Prisoner views - slightly positive examples ..........................................32
6.1.3 Prisoner views - negative examples ....................................................32
6.2 Family Members’ Views ..............................................................................32
6.3 Prison Staff Views .....................................................................................33
6.3.1 Prison staff views - positive examples .................................................33
6.3.2 Prison staff views - slightly positive examples ......................................34
6.3.3 Prison staff views - negative examples ................................................34
6.4 Prison-Based Healthcare Staff Views ............................................................35
6.4.1 Prison-based Healthcare staff views - positive examples ........................35
6.4.2 Prison-based Healthcare staff views - slightly positive examples .............35
6.5 Key Findings .............................................................................................36
CHAPTER 7: AREAS FOR IMPROVEMENT ........................................................... 37
7.1 Definition and scope ..................................................................................37
7.2 Care plans ................................................................................................37
7.3 Built environment .....................................................................................37
7.4 Hall and wider prison regime ......................................................................38
7.5 Wheelchair policy ......................................................................................38
7.6 Early release on license on compassionate grounds .......................................39
7.7 Other issues .............................................................................................39
7.7.1 National Social Care Short Life Working Group .....................................39
7.7.2 Prison based hospital facility with overnight beds .................................40
CHAPTER 8: SUCCESSES AND AREAS FOR EXPLORATION ................................. 41
8.1 General ....................................................................................................41
8.1.1 Multi-disciplinary working ..................................................................41
8.1.2 Staff attitudes ..................................................................................41
8.2 Specific ....................................................................................................41
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8.2.1 HMP Barlinnie High Dependency Unit ..................................................42
8.2.2 HMP Barlinnie Structured Social Care Service .......................................42
8.2.3 HMP&YOI Cornton Vale Social Care roles .............................................43
8.2.4 HMP Dumfries’ flexibility and specific management of a prisoner with high
care needs ...............................................................................................43
8.2.5 HMP Glenochil social care model .........................................................43
8.2.6 HMP Glenochil cell refurbishment programme ......................................44
CHAPTER 9: PRINCIPLES OF CARE AND GUIDELINES FOR GOOD PRACTICE IN
INSTANCES WHERE TERMINAL CARE IS APPROPRIATELY PROVIDED WITHIN
PRISONS .......................................................................................................... 45
9.1 Introduction .............................................................................................45
9.2 World Health Organisation definition ............................................................45
9.3 Scottish Government National Indicator .......................................................45
9.4 National Institute for Clinical Excellence (NICE) End of Life Care Quality Standard
Advice ...........................................................................................................45
9.5 The Scottish Partnership for Palliative Care (SPPC) ........................................46
CHAPTER 10: POLICY AND PRACTICE OPTIONS FOR CONSIDERATION ............. 47
APPENDICES ..................................................................................................... 49
APPENDIX I: Literature Review – Summaries of papers .......................................49
APPENDIX II: References .................................................................................57
APPENDIX III: Interview Schedule ....................................................................59
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TABLES AND FIGURES
Table 1.1: Summary of Fieldwork Study Methods .................................................................... 4
Table 4.1: Potential high care needs assessment criteria ......................................................... 23
Table AIII.1 Interview Schedule – by category ....................................................................... 59
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CHAPTER 1: INTRODUCTION
1.1 Background
The 2012 High Care Needs Assessment1 conducted for the Scottish Prison Service
(SPS) indicated that a small proportion of the prisoner population have high care
needs, including severe physical disabilities, some of whom may not be able to cope
with the prison regime and require assistance with activities of daily living (ADLs).
In terms of the evolving appreciation of what is meant by ‘High Care Needs’
Prisoners the 2012 report was limited in its scope of ‘describing the size of the
population who find the prison regime difficult due to disability’. The report did not
consider a broader base of high care needs such as those arising from: cognitive
impairment; post-traumatic stress disorder; mental health issues; and conditions
associated with aging.
However, the report did rightly acknowledge that the challenges associated with
high care needs are likely to increase in future years due to: the trend for
increasingly longer sentences; people surviving longer into old age; and the older
age at which some sexual offenders are sentenced.
A proportion of prisoners with high care needs are eligible and wish to seek release
on compassionate grounds when the end of life is anticipated and when they fit the
criteria in respect of health, social and public safety grounds. Other prisoners in
this predicament are: ineligible for compassionate release; not willing to
contemplate release; or prefer to die in prison.
Since November 2011, there has been a separation of duties of care which were
previously held by the prison. Since December 2012, arrangements are now
underpinned by a memorandum of understanding between the Scottish Ministers,
acting through the Scottish Prison Service and NHS Scotland2. The general duty of
care remains with prisons, whereas the duty of healthcare has transferred to local
NHS boards. The issue of social care and support in prisons is an emerging issue,
which has recently been debated at the National Prisoner Healthcare Network
(NPHN) and the SPS Offender Outcome Delivery Group (OODG).
Whilst SPS does not currently have a large number of prisoners across Scotland
who require assistance with daily living, numbers are on the increase and there is a
need to address the emerging social care issues. The lines of responsibility for
social care are presently unclear with assistance currently provided by healthcare
staff, prison staff and other prisoners. One particular prison in Scotland (HMP
Glenochil) has procured, at their own financial cost, a social care service through a
private national specialist provider. Prison models vary according to the assessed
need and the prison.
1 Couper, S. (2012). Is SPS optimally configured for prisoners who require assistance with Activities of Daily Living?
A Needs Assessment. Edinburgh: Scottish Prison Service.
2 Memorandum of understanding between the Scottish Ministers, acting through the Scottish Prison Service and
NHS Scotland (December 2012).
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Against this backdrop of inconsistent practice, a number of legislative changes are
being introduced in England with the introduction of new commissioning structures
for prison health and relationships within regions under the Health and Social Care
Act 2012. Responsibility for the social care of prisoners is to be placed with the
Local Authority of residence under the Care Bill 2013 which is currently going
through parliament. This will be supported by the National Offender Management
Service (NOMS).
At the same time, Scotland is planning the integration of health and social care
through the Public Bodies (Joint Working) (Scotland) Bill 2013. The Bill provides the
framework which will support the improvement of the quality and consistency of
health and social care services in Scotland. However, as this Bill is not specific to
offenders in custody, SPS is working in collaboration with the Scottish Government
to seek an alternative policy approach to the management of prisoners with high
care needs in prisons.
The SPS has set up a Working Group to consider the future management of
offenders with high care needs, including social care issues, across Scottish prisons.
The remit of the group is to develop an agreed pathway for offenders with high care
needs across the Criminal Justice System to include throughcare services between
the community and prison, taking cognisance of legislative changes.
1.2 Purpose of the study
Figure 8 Consultancy Services Ltd. was commissioned in February 2014 by SPS to
conduct an Evaluation of High Care Needs Prisoners within the Scottish Prisoner
Population. The aim of the study is to explore the options available to the SPS in
respect of the future management of high care need prisoners within the general
prisoner population, to ensure that SPS meets its duty of care. The study also seeks
to update and build upon previous research undertaken in the English penal system
and to develop the knowledge base obtained from the 2012 review of prisoners who
require assistance with activities of daily living3.
1.3 Objectives
The specific objectives of this project, as indicated by the project brief, were as
follows:
Systematically review national and international literature on the
management of prisoners with high care needs, including financial
implications and effects of care and support interventions on health,
wellbeing, independence and reoffending;
Describe the current range of arrangements in place for the management of
prisoners with high care needs across the SPS estate and assess strengths
and weaknesses in implementation;
3 Ibid.
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Consider approaches to the care of high care needs prisoners found in SPS
and in other jurisdictions and outline one or more models of care suitable for
pilot site testing, identifying potential issues for implementation and
sustainability and taking into account the prison estate configuration;
Suggest principles of care and guidelines for good practice in those instances
where terminal care is appropriately provided within the prison;
Review the financial implications and summarise evidence of cost for different
models of care and project likely cost consequences in the context of a
predicted rise in the general prison population with a proportionally greater
number of high care needs prisoners requiring support; and
Identify roles and responsibilities of partner agencies in responding to the
management of prisoners with high care needs across Scotland to support
the development of an agreed pathway of services for offenders with high
care needs across the Criminal Justice System (including throughcare
services between the community and prison).
1.4 Specific issues to address
SPS is working in partnership with MacMillan Cancer Support and NHS Scotland to
scope the services and support required for prisoners with palliative care needs.
Part of this study (Chapter 9) examines principles of care and guidelines for good
practice in the occasional instances where terminal care is appropriately provided
within the prison. The work aims to support the Scottish Government’s indicators
for end of life care.
1.5 Summary of study methods
In order to conduct a thorough and meaningful review of the current and future
arrangements regarding prisoners with high care needs, a three phase, mixed
methods approach was utilised: (1) Preparatory, (2) Fieldwork, and (3) Analysis
and Reporting.
The fieldwork (Phase 2) was conducted in two key stages with each stage being
tailored to the needs of the study as set out in Table 1.1 below. The interview
schedules were approved in advance by the study commissioner. Copies of
interview consent forms and questionnaires are available upon request.
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Table 1.1: Summary of Fieldwork Study Methods
Stage 1 Method
Systematic review
of literature
Desk-based review and analysis of relevant national and
international literature surrounding the management of prisoners
with high care needs.
Stage 2 Method Sample
Qualitative
Interviews
Semi-structured
interviews
SPS Staff (n=25)
Prison Officer Association Scotland (n=1)
Sodexo Staff (n=2)
NHS staff, prison based (n=10)
NHS staff, non-prison based (n=8)
External agencies (n=6)
Prisoners (n=20)
Families (n=1)
1.5.1 Stage 1 – Systematic review of the literature
Review and analysis of relevant national and international literature was
undertaken to gain a picture of the arrangements surrounding the management of
prisoners with high care needs across Scotland and other jurisdictions.
The review also sought to identify any models of care from other jurisdictions which
might be suitable for pilot testing within the SPS.
Data was collected from a range of sources available including key policy strategies,
appropriate legislation and guidance issued at Scottish, UK and international
organisation level as well as key reports and other documentation which were
relevant to the management of high care needs prisoners.
The subsequent review provides a background and context against which to place
the rest of the report findings. The key elements of the review of literature are
presented in Chapter 2; with summaries of the 6 key papers identified as most
relevant and meaningful to this review presented in Appendix I. A full reference
list is provided as Appendix II.
1.5.2 Stage 2 – Qualitative interviews
The primary methodology used for the study was qualitative in nature. This
consisted of one-to-one interviews using semi-structured questionnaires which were
used to collect all the necessary information for the fieldwork. Bespoke, but similar
questionnaires were used for prisoner, family and staff stakeholder groups.
The first stage of interviews was conducted with all available members of the
current SPS High Care Needs Working Group (HCNWG), excluding the six
Governors-in-Charge on the group, four of whom were consulted prior to
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identification of agreement of appropriate prison-based staff, prisoners and family
members.
Where possible, interview schedules were approved in advance by the study
commissioner, supported by prison site coordinators. Site coordinators were
identified by local Governors-in-Charge following liaison with the study
commissioner. Site coordinators used local intelligence to identify eligible prisoners
with high care needs and family members who satisfied defined criteria outlined in
the study scope.
In total, 10 prisons (including the Open Estate) were identified as appropriate for
inclusion in the study, through discussions with the study commissioner and
members of the HCNWG. The study also targeted contributions from
representatives of SPS’ HCNWG, SPS’ Women Offenders Project and the former
Governor of HMP Aberdeen who is now working at HMP Grampian; as well as
external (non-SPS) agencies. Targeted sites and forums were:
SPS High Care Needs Working Group
HMP Addiewell
HMP Barlinnie
HMP&YOI Cornton Vale
HMP Dumfries
HMP Edinburgh
HMP Glenochil
HMP Low Moss
HMP Open Estate
HMYOI Polmont
HMP Shotts
SPS Women Offenders Project
Former Governor of HMP Aberdeen (now working in HMP Grampian)
External (non-SPS) agencies
Contact was made with all 14 targeted sites and personnel. Interviews took place
with site representatives, except the former Governor of HMP Aberdeen and HMP
Peterhead. In total, 73 individuals were interviewed, 56 of which were conducted
face-to-face and in person, with the remaining 17 via the telephone. The
breakdown of interviews is, as follows:
25 SPS staff
1 representative of Prison Officer Association Scotland
2 Sodexo staff (HMP Addiewell)
10 NHS staff (prison based)
8 NHS staff (non-prison based)
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6 External agency staff (including Local Authority and Scottish
Government)
20 Prisoners with high care needs
1 Family member
In addition to the 73 interviews undertaken, a brief face to face meeting also took
place involving a prisoner with severe high care needs in HMP Addiewell; however,
it was not possible to conduct a formal interview due to operational reasons.
Additionally, a discussion took place with a Health and Well Being Co-
Commissioning Senior Manager (Custody) at the London based National Offender
Management Service (NOMS).
The full interview schedule is outlined at Appendix III.
The key themes of the qualitative interviews are presented and discussed in
Chapters 3-8 of the report.
1.6 Limitations and Assumptions
The following factor should be taken into account when reading this report:
The opinions of individuals/stakeholders are given in good faith and are
representative of their own/their organisation’s views.
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CHAPTER 2: REVIEW OF RELEVANT LITERATURE
2.1 Aims
The aim of this element of the project is to review systematically relevant national
and international literature surrounding the management of prisoners with high
care needs, highlighting key themes and potential models of care (suitable for pilot
testing) to which the Scottish Prison Service (SPS) needs to give most
consideration.
2.2 Method of Data Collection
Data was collected from a range of sources available including key policy strategies,
appropriate legislation and guidance issued at Scottish, UK and international
organisation level as well as key reports and other documentation which were
relevant to the management of high care needs prisoners.
The terms of reference were kept as wide as possible and a variety of terms were
searched for in recognition of the diversity which exists in this topic area. Examples
of the terms searched for included combinations of: management of high care
needs prisoners; social care; health care; prisoners; offenders; illness; disability;
mental health; long-term illness; and other associated terms and specific
conditions.
Sources which were found to be the most relevant were identified by how closely
they related to the topic of the management of high care needs prisoners. Those
which were included in the final review of the literature were identified as having
the greatest relevance to the Scottish Prison Service, whilst maintaining a balance
across the topic.
2.2.1 Summarising the findings
Data was extracted from each of the 29 relevant papers identified and summarised.
Of these, 6 papers were identified as being of most meaning to the current study
and a summary of each paper appears in tabular form in Appendix I. These
summaries were used to form a Narrative Summary (see 2.3 below) which
synthesised the findings arising from the review of papers.
2.3 Narrative Summary
This section discusses the relevant literature in a broadly thematic manner,
highlighting key themes and applicable findings.
The review highlights the following eight key, sometimes interconnected, areas
relating to high care needs:
General guiding principles and policy drivers
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Older prisoners
Women
Young offenders
Mental health
Disabilities
Social care needs
Long terms conditions and terminal illness
2.3.1 General Guiding Principles and Policy Drivers
According to principle nine of the United Nations Basic Principles for the
Treatment of Prisoners4, the guiding principles and related policy drivers centre
on health care in prison being equivalent to that delivered in the community. The
World Health Organisation5 also outlines in the Moscow Declaration 2003 that
prison health should also be viewed as part of public health. Additionally, the
Ottawa Charter further identifies that the prison setting is potentially an opportunity
for health promotion (WHO, 1986)6.
There are nine National Offender Outcomes7, two of which pertain to the health
and wellbeing of the prisoner: firstly, sustained or improved physical and mental
wellbeing; and secondly, reduced or stabilised substance misuse.
2.3.2 Older Prisoners
The review found that a substantial volume of the available literature focused
specifically on the needs of older prisoners and this commonly related to male
sentenced prisoners. An SPS commissioned needs assessment (Couper, 2012)8
between 2001 and 2011 identifies the growth in the number and proportion of
prisoners in older age groups (aged over 50) has increased more rapidly than any
other. Moreover, a greater number of this older prison population require assistance
with ‘activities of daily living’ and this trend is set to increase significantly in the
future.
4 United Nations Office of the High Commissioner for Human Rights (1990). Basic Principles for the Treatment of
Prisoners. Available at:
http://www.ohchr.org/EN/ProfessionalInterest/Pages/BasicPrinciplesTreatmentOfPrisoners.aspx [accessed 10
March 2014].
5 World Health Organisation (2003). Declaration on Prisoner Health as Part of Public Health. Available at:
www.euro.who.int/__data/assets/pdf_file/0007/98971/E94242.pdf [accessed 10 March 2014].
6 World Health Organisation (1986). Ottawa Charter for Health Promotion. Available at:
www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf?ua=1, [accessed 10 March 2014].
7 Scottish Executive (2006). Reducing Reoffending: National Strategy for the Management of Offenders. Edinburgh:
Scottish Executive.
8 Couper, S. (2012). Is SPS optimally configured for prisoners who require assistance with Activities of Daily Living?
A Needs Assessment. Edinburgh: Scottish Prison Service.
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The care needs of older prisoners represent a significant challenge as prisoners may
have a health status about 10 years greater than their age peers in the community
(Howse, 2003)9. The Prison Reform Trust (2008)10 and Fazel et al. (2001a)11
found that more than 80% of male prisoners over the age of 60 had some sort of
chronic illness or disability, many of whom were likely to have more than one
condition.
Kingston et al. (2011)12 examined the occurrence of psychiatric and physical
disabilities, including dementia, in prisoners in Staffordshire over 50 years of age.
Results found 50% had a diagnosable mental disorder with depression being the
most common, whilst 12% of prisoners showed signs of cognitive impairment.
Physical problems were also common in this population with an average self-report
of 2.26 problems per prisoner. Hayes et al. (2012)13 found over 90% of prisoners
having a physical disorder with 61% having a mental disorder which were most
likely to be a depressive disorder or alcohol misuse.
Older prisoners care needs can often mean that they have a cost factor three times
higher than that of younger prisoners (Reimer, 2008)14. Strategies adopted in the
United States identified by Reimer involved special units within the prison to house
older prisoners and where particularly vulnerable prisoners could be monitored by
staff who specialise in gerontological conditions.
Prison can be a daunting prospect for older prisoners. Moll (2013)15 identifies
good practices linked to additional staff training in order to recognise cognitive
difficulties that may be associated with dementia in older prisoners. Furthermore,
utilising voluntary sector and charity organisations is suggested as cost effective
means of delivering additional support as well as staff and prisoner awareness
training.
More than 75% of elderly male prisoners are also receiving prescribed medication
and in some cases this did not correspond with recorded medical requirements;
particularly so for mental health conditions (Fazel et al., 2004) 16. Allied to that,
9 Howse, K. (2003) Growing Old in Prison: A Scoping Study on Older Prisoners. London: Prison Reform Trust.
10 Prison Reform Trust (2008). Doing Time: the Experiences and Needs of Older People in Prison. London: Prison
Reform Trust.
11 Fazel, S., Hope, T., O’Donnell, I., Piper, M. and Jacoby, R. (2001a). ‘Health of Elderly Male Prisoners: Worse than
the General Population, Worse than Younger Prisoners’, Age and Ageing, 30: 403-407.
12 Kingston, P., Le Mesurier, N., Yorston, G., Wardle, S. and Heath, L. (2011). ‘Psychiatric Morbidity in Older
Prisoners: Unrecognized and Untreated’, International Psychogeriatrics, 23 (8): 1354-1360.
13 Hayes, A.J., Burns, A., Turnbull, P. and Shaw, J.J. (2012). ‘The Health and Social Needs of Older Male Prisoners’,
International Journal of Geriatric Psychiatry, 27: 1155-1162.
14 Reimer, G. (2008). ‘The Greying of the U.S. Prisoner Population’ Journal of Correctional Health Care’, 14: 202-
208.
15 Moll, A. (2013). Losing Track of Time. London: Mental Health Foundation.
16 Fazel, S., Hope, T., O’Donnell, I. and Jacoby, R. (2004). ‘Unmet Treatment Needs of Older Prisoners: A Primary
Care Survey’, Age and Ageing, 33: 396-398.
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Fazel et al. (2001b)17 found that depression in the older inmate population is up
to five times more prevalent than in the community.
Current specific health programmes operational across the SPS estate, determined
by age, include: bowel cancer; abdominal aortic aneurysm (AAA); and breast
screening. In principle Keep Well health checks are delivered to all prisoners aged
35-64; however, in practice, the availability across the SPS estate is variable. They
focus on assessing cardiovascular risk and supporting people to reduce their
modifiable cardiovascular disease risk factors such as hypertension, raised
cholesterol and diabetes. Keep Well also allows some assessment of mental
wellbeing.
2.3.3 Women
In The Prison Reform Trust’s Bromley’s Briefings Prison Factfile: Autumn
201318, authors reported that women prisoners account for 28% of self-harm
incidents, despite only representing 5% of the overall population. Furthermore, it
states that women in prison are five times more likely to experience a mental
health disorder than women in the community. 83% of the women prison
population also stated having a long-standing illness, compared with 32% in the
community.
The Kyiv Declaration on Women’s Health in Prison (UNODC, 2009)19 sets out key
principles in relation to the health needs and treatment of female prisoners. The
Declaration particularly notes as areas of concern that female offenders’ frequently
have high histories of physical and sexual abuse, additional health needs related to
mental illness (including post-traumatic stress disorder related to abuse) and
substance misuse.
The Commission on Women Offenders (2012)20 specifically notes trauma and
psychological distress in relation to abuse. This is endorsed and prioritised in the
SPS Strategy Framework for the Management of Female Offenders across Scotland.
UNODC (2009)21 noted that the special needs of older women in prison are rarely
considered separately. For example, in addition to possibly needing more specific
health care than younger prisoners, for some older women, the effects of
menopause may particularly affect their healthcare needs. They may also have
different personal care needs.
17 Fazel S., Hope T., O'Donnell I., and Jacoby R. (2001b). ‘Hidden Psychiatric Morbidity in Elderly Prisoners’, British
Journal of Psychiatry, 179: 535–539.
18 Prison Reform Trust (2013). Bromley Briefings Prison Factfile: Autumn 2013. London: Prison Reform Trust.
19 United Nations Office on Drugs and Crime (2009). Women’s Health in Prison: Correcting Gender Inequality in
Prison Health. Copenhagen: World Health Organisation.
20 Commission on Women Offenders (2012). Commission on Women Offenders: Final Report 2012. Edinburgh:
Scottish Government. http://www.scotland.gov.uk/About/Review/commissiononwomenoffenders/finalreport-2012
[accessed 12 March 2014].
21 UNODC, op.cit.
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2.3.4 Young Offenders
The SPS Health Care Needs Assessment (2012)22 also highlights that the
younger prison population require assistance due to poorer health in comparison to
the general population. Marshall, Simpson and Stevens (2000)23 found that
young prisoners have a much higher incidence of mental health problems,
particularly neurotic disorders in comparison to the general population. In a report
for the Prison Reform Trust, Farrant (2001)24 states that 50% of young men on
remand and 30% of sentenced young men have a diagnosable mental health
disorder and that imprisonment has a negative impact on the mental health of
young offenders.
2.3.5 Mental Health
Prisoner Healthcare in the NHS in Scotland – 1 year on (Miller, Nov 2012)25 by the
National Prisoner Healthcare Network (NPHN) established in November 2011
supports the delivery of high quality, safe and consistent services to prisoners.
Current priorities include mental health (particularly including the use of telehealth
and considering the needs of special health groups such as dementia and those
with co-morbidities), education & training.
Mental health needs among prisoners represent a significant challenge within the
prison estate. Singleton, Meltzer and Gatward’s (1998)26 study of the
prevalence of mental health conditions in the prison population is one of the most
important contributions available on this topic in the literature. In a sample of over
3100 prisoners, personality disorders were found to be especially high among male
remand prisoners with 78% of participants displaying symptoms with antisocial
personality disorders the most common. For female prisoners, prevalence rates
were lower at 50%.
Moreover, Young et al. (2009)27 investigated the link between attention deficit
hyperactivity disorder (ADHD) and critical incidents at HMP Aberdeen and found
that 24% of prisoners screened met the criteria for childhood ADHD, of which a
22 Couper, op.cit.
23 Marshall, T., Simpson, S. and Stevens, A. (2000). Health Care in Prisons. Available at:
www.birmingham.ac.uk/Documents/college-mds/.../11HCNA3D3.pdf [accessed 12 March 2014].
24 Farrant, F. (2001). Troubled Inside: Responding to the Mental Health Needs of Children and Young People in
Prison. London: Prison Reform Trust.
25 Miller, J. (2012). Prison Healthcare in the NHS in Scotland – 1 year on: A Report from the National Prisoner
Healthcare Network. Available at:
http://www.scottish.parliament.uk/S4_JusticeCommittee/Inquiries/Prisoner_Healthcare_-
_Annual_Report_to_CEOs_-_November_2012.pdf [accessed 11 March 2014].
26 Singleton, N., Meltzer, H. & Gatward, R. (1998). Psychiatric Morbidity among Prisoners in England and Wales.
London: Stationery Office.
27 Young, S., Gudjonsson, G.H., Wells, J., Asherson, P., Theobald, D., Oliver, B., Scott, C. and Mooney, A. (2009).
‘Attention Deficit Hyperactivity Disorder and Critical Incidents in a Scottish Prison Population’, Personality and
Individual Differences, 46: 265-269.
Evaluation of High Care Needs Prisoners - SPS
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quarter were still fully symptomatic in adulthood and a further third were in partial
remission.
Young et al. also identified those who were not in full remission as having
significantly higher rates of aggressive incidents within the prison and that high
rates of unmet needs were also commonplace. Both of these examples of mental
health conditions show that with high occurrence rates and the link with aggressive
incidents in Young et al.’s case, mental health issues represent a significant
challenge for both the individual and for the wider prison environment where these
needs are unmet.
2.3.6 Disabilities
In 2004, the Disability Discrimination Act (DDA) came into force, with
disabilities defined within this Act encompassing a range of impairments; both
physical and mental and including learning difficulties (this has subsequently been
replaced by the Equality Act, 2010). Prisons must now guarantee that all
prisoners with disabilities have the opportunity to gain access to services.
Additionally, in England and Wales the Department of Health’s National Service
Framework (NSF) for elderly people necessitates the need to provide for the
health and social care needs of older people in the community, including prisoners
over the age of 60. Furthermore, the UNODC (2009)28 outlines that imprisonment
represents a disproportionately harsh punishment for offenders with disabilities,
often worsening their situation and placing a significant burden on the prison
system’s resources.
In a review of disabled prisoners in England and Wales by
HM Inspectorate of Prisons (HMIP, 2009)29, it was found that provision for
disabled prisoners was variable with the needs of many disabled prisoners
remaining unmet. The review also found that approximately 1 in 3 prisoners with a
disability had been identified by the prison service, with self-reported rates at 15%.
In Scotland, prisoners self-reported similar levels of disability, with 19% saying
they had a disability in the Scottish Prison Service Prisoner Survey 2011 (Carnie
and Broderick, 2011)30.
HMIP (2009)31 also found that dedicated cells for disabled prisoners were only
available in two-thirds of prisons - 50% of which were located within the health
centre. This raises the issue whereby disabled prisoners are often segregated as a
result of their condition and HMIP advocate more work to be done in order to
ensure that disabled prisoners remain on the main location as far as possible.
28 UNODC, op.cit.
29 HM Inspectorate of Prisons (2009). Disabled Prisoners: A Short Thematic Review on the Care and Support of
Prisoners with a Disability. London: HM Inspectorate of Prisons.
30 Carnie, J. and Broderick, R. (2011). Scottish Prison Service Prisoner Survey 2011. Edinburgh: Scottish Prison
Service. Available at: www.sps.gov.uk/nmsruntime/saveasdialog.aspx?fileName=Prisoner%20Survey%20-
%20Bulletin%2020113696_724.pdf [accessed 13 March 2014].
31 HMIP, op.cit.
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The HMIP (2009)32 report also identifies some examples of good practice for those
with visual and hearing impairments. In one example, information was provided in
Braille for a blind prisoner due to be transferred and this was facilitated in
conjunction with Royal National Institute of Blind People (RNIB). Similarly, there
was also an example of a deaf prisoner who was aided with a signing assistant in
order to complete a sentence plan course. These examples of using outside
agencies highlight some low cost examples of the ways in which engaging in
partnership working can help to meet some of the fundamental needs of prisoners.
2.3.7 Social Care Needs
The Prison Reform Trust (2008)33 assessed the experiences of recently released
older prisoners and found that social care needs were often unmet in prison. A lack
of service provision and confusion over who should provide care in many cases
resulted in incidents of needs being unmet. One example is where they found one
prisoner who required the use of a walking stick for mobility having to wait 6 weeks
to receive one of an adequate length due to his height. The report also found other
issues such as the length of time taken to answer call bells could be a cause for
concern in meeting social care needs as only 36% of locations were answering calls
within five minutes.
Senior et al’s (2013)34 investigation of the health and social care needs of older
male prisoners found that: in general, social care needs were frequently unmet and
poorly understood, often being treated on an ad-hoc basis through healthcare
rather than a coherent multi-agency approach. Senior et al. also found that 19% of
prisoners required the use of a Zimmer frame or tripod for mobility, whilst there
were also challenges for many older prisoners in washing and dressing themselves.
Some of these needs were met by a partner prior to sentencing and this was a
particular concern for prisoners as many were uncomfortable asking for assistance
from a cell mate. Buddy schemes are highlighted as an increasingly popular way of
assisting prisoners with reduced mobility for tasks such as tidying cells and fetching
meals. The report also summarises that there is a lack of a coherent approach
towards meeting the social care needs of prisoners.
2.3.8 Long-Term Conditions and Terminal Illness
With the aging of the prison population and health statuses which are often as
much as 10 years older than counterparts in the community, long-term and
terminal illnesses represent a significant challenge in the management of prisoners
with high care needs. One of the pillars around which the Better Health, Better
32 Ibid.
33 Prison Reform Trust (2008), op.cit.
34 Senior J., Forsyth K., Walsh E., O'Hara K., Stevenson C., Hayes A., Short V., Webb R., Challis D., Fazel S., Burns
A. and Shaw J. (2013). ‘Health and Social Care Services for Older Male Adults in Prison: the Identification of
Current Service Provision and Piloting of an Assessment and Care Planning Model’, Health Services and Delivery
Research, 1, (5).
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Lives for Prisoners: A Framework for Improving the Health of Scotland’s Prisoners
(Brutus et al, 2012)35 is built in the ‘Management & prevention of long-term
conditions’.
Emerging issues identified in Prisoner Healthcare in the NHS in Scotland – 1 year on
(Miller, 2012)36 were:
Social Care – e.g. In general there is no overnight nursing service in prisons
and therefore no service available for what could be termed as “social care”
e.g. assistance getting in and out of bed, catheter bag changes etc.
Palliative Care - A pilot is planned within HMP Glenochil in partnership with
Macmillan Cancer Relief to develop a best practice model which the Network
is keeping a close link with. This involves the development of the Palliative
Care Champion Role and a specially fitted cell for those nearing the end of
life.
The scheme being piloted at HMP Glenochil is also one which the Prison and
Probation Ombudsman for England and Wales (PPO) reported on in 201337 as a
particularly good example of ensuring that care provided within the prison matched
the level which could be expected within the community. HMP Whatton is
highlighted as having an older than average prisoner profile and where specific
nursing staff were assigned to lead on palliative care. Involving families in end of
life care plans at the earliest opportunity, as well as providing additional facilities
for visiting where the prisoner is too ill to attend the main visiting centre are also
offered as an additional means of ensuring that care needs are met.
35 Brutus, L., Mackie, P., Millard, A., Fraser, A., Conacher, A., Hardie, S., McDowall, L. and Meechin, H. (2012).
Better health, better lives for prisoners: A framework for improving the health of Scotland’s prisoners. Available at:
www.scotphn.net/pdf/2012_06_08_Health_improvement_for_prisoners_vol_1_Final_(Web_version)1.pdf [accessed
08 March 2014].
36 Miller, op.cit.
37 Prisons and Probation Ombudsman (2013). Learning from PPO Investigations: End of Life Care. London: COI.
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CHAPTER 3: DEFINITION AND SCOPE OF HIGH CARE
NEEDS
3.1 Introduction
This section outlines the definition and scope of high care needs as reported by the
range of study informants; and attempts to highlight the nature and scale of the
problem.
3.2 Definition of High Care Needs
There is no common or accepted definition of high care needs in respect of
prisoners; or indeed other classifications of groups of people. Stakeholder views
vary enormously and are influenced by the specific group consulted. Significantly,
there is little consensus of views across key stakeholder groups such as prison
management, prison staff, healthcare staff, prisoners and other (non SPS and NHS)
staff.
For the most part, prisoners consulted define high care needs in respect of their
personal physical or mental health status which is often poor and complex. This is
illustrated in the following quotation examples:
“I certainly ‘fit the bill’ as someone with high care needs. I require daily care and assistance to
function including getting up, washing and showering, dressing and moving around, although I am
able to eat and go the toilet without assistance.”
“I have a mental illness, am on anti-psychotic medication, and have multiple physical health
problems. I am also getting old, infirm and incapable.”
“I am severely disabled, paralysed from the neck down; and virtually cell bound. I also get
depressed. A disabled cell in a main prison wing is not the best place for me.”
“I am a young man with testicular cancer and I don’t know what the future holds for me.”
“I am waiting to be sectioned to a secure mental hospital because they say I am too ill to stay in
prison.”
“I cannot cope with a mainstream hall or crowds of people. I need to be alone or with just one or
two people around; otherwise I will harm myself and others like I have done before.”
“The regime in here is busy, noisy and sometimes manic; most due to younger men - there is no
peace or quiet area to sit and reflect with my friends.”
Views of prison staff views also vary a great deal, as illustrated in the following
quotation examples:
“There are 75 prisoners in this hall alone who have PEEPS (Personal Emergency Evacuation Plans) in
the case of an emergency. About 6 of these are in wheelchairs, some of whom are severely disabled
and many others have complex physical and mental health problems.”
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“The hall employs 8 passmen (prisoners) full time to help look after the needs of peers with high care
needs which highlights the scale of the problem we are facing.”
“The number of prisoners in this jail on ACT, Rule 4138, Rule 9539, detox and maintenance programmes
is astounding – whoever said prisons reflect communities is wrong as healthcare related problems are
severely exacerbated in the prison system.”
“Most prisoners in here have had hard lives, are physically and mentally unwell and are getting old;
but the system keeps churning and we all get on with managing and overcoming problem as best we
can.”
“This place feels like a combination of a prison, a psychiatric hospital, a nursing home and a care
home with Prison Officers holding the fort.”
“I waited desperately for my annual leave to come around as I didn’t want to be the Officer who
opened the cell door and find the prisoner dead due to his terminal health condition.”
“Learning disabilities are a big problem in here and discipline staff don’t really know how to deal with
this.”
Views of prison management also vary but not as predominantly as prison staff
views, as illustrated in the following quotation examples:
“We manage prisoners sent to the prison by the Court, regardless of the number, conditions or scale
problems they present – some have high care needs, some have medium needs, some have low
needs but all have needs which we serve to meet these.”
“I don’t know how many prisoners there are here with high care needs as there is no definition – it
could be 5, 50 or 500 depending on who you speak with – my own view is that are about 60 which is
about 5% of the prison population.”
“We don’t have any prisoners with high care needs in this prison, although we have been asked to
consider taking a prisoner and are looking at what adaptations would be required.”
“The prison has an integrated model and practice which combines prison, healthcare, external staff,
families and prisoner peers to support prisoners, whatever their care and other needs.”
“Our workforce is very skilled and experienced at managing prisoners with moderate needs;
however, we should do more and develop a strategy and conditions for managing prisoners with high
care needs as some needs are unmet; often due to the limited physical estate and regime
constraints.”
“We section prisoners under the Mental Health Act who should never have been sent to prison in the
first place - we deal with terminal illness with humanity and respect including early release on
compassionate grounds - we treat disproportionately high levels of physical and mental health
38 Rule 41 (Prisons & Young Offenders Institutions (Scotland) Rules 2011
- Where a healthcare professional advises the Governor that it is appropriate to accommodate a prisoner in specified conditions to protect the health and welfare of the prisoner or any other prisoners.
39 Rule 95 (Prisons & Young Offenders Institutions (Scotland) Rules 2011
- Where the Governor may order that a prisoner must be removed from association with other prisoners when it is appropriate for one of the following reasons: (a) Maintaining good order and discipline; (b) Protecting the interests of any prisoner; (c) Ensuring the safety of other persons
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problems - we control prisoners in a safe and therapeutic environment who present risk of harm to
themselves or other prisoners or staff - I don’t know how many prisoners we deal with who have
high care needs but there are quite a few and we manage this challenge well.”
“There are well documented research findings about the complex problems posed by the female
prisoner population – as a national facility, we have implemented a number of positive measures
such as Social Care staffing resources to successfully address the challenges associated with
prisoners with high care needs.”
Views of prison and community based healthcare staff are the most consistent
views expressed, as illustrated in the following quotation examples:
“High care needs patients in prisons are those who require an intervention over and above what is
routinely available in the prison; for example surgery or cancer treatment.”
“I am not familiar with the term and don’t think the term, ‘high care needs’ is used in the prison but
there are people in custody who require intensive support for severe psychiatric illnesses whom I
would classify as high care needs – I currently have six such cases on my caseload and the prison
has transferred prisoners to hospital for psychiatric treatment following integrated assessment.”
“A particular prisoner requires personal care to function daily and there are health and social care
resources in place to support this gentleman.”
“We have a blind prisoner, a deaf prisoner, prisoners in wheelchairs, one of whom is severely
disabled and requires intensive daily healthcare support to function daily.”
“There is a severely disabled prisoner we transferred to another prison as we could not meet his
needs in the local prison due to the fabric of the buildings.”
“SPS healthcare is operated in an integrated, responsive and effective manner with SPS partners to
deliver a full range of health and wellbeing services to everyone in custody. Some patients clearly
have high care needs which require interventions outwith the normal scope of provision such as
emergency and overnight intervention for physical health problems; however, numbers are low and
patients are well catered for.”
“We have a dedicated unit in the prison for about fifty people with high dependency related needs.
We also operate a structured day service for prisoners with high care needs and this population has
access to an independent living service. However, not everyone in the HDU (High Dependency Unit)
has high care needs and other prisoners with high care needs are not located in the HDU.”
Views of non-prison and healthcare staff are also illustrated in the following
quotation examples:
“We need to establish who ‘who pushes the wheelchair in prisons.”
“Prisons are responsible for social care with support from NHS and Local Authority partners.”
“Some people in custody have social care needs and, simply put, an integrated approach is required
to meet those needs.”
“The solution for social care in prisons appears to rest on extending healthcare contracts, as it seems
impractical for Local Authorities to provide this when thousands are prisoners are housed away from
their local area.”
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3.3 Scope of High Care Needs
The qualitative fieldwork for this study highlighted a diverse range and number of
views regarding the scope of high care needs in respect of prisoners. When
collectively analysed, the scope is fully consistent with the study’s literature review
findings which highlights 7 discrete types of high care needs, which are commonly
inter-related; namely:
Older prisoners
Women
Young offenders
Mental health
Disabilities
Social care needs
Long terms conditions and terminal illness
3.3.1 Older prisoners
The SPS is bracing itself for an increase in older prisoners in line with societal
trends. The increase in the prevalence of convicted sexual offenders appears to be
already impacting upon the age profile of Scotland’s prisoners. Several older
prisoners (over 50 years) were interviewed for this study, all of whom described
themselves as having high care needs. Self-reported conditions are:
Physical health problems commonly compounded by aging including:
o Alzheimer's disease and other forms of dementia
o Arthritis
o Osteoporosis
o Blood pressure
o Heart problems and attack
o Stroke
o Aneurysm (brain)
o Cancer (various)
o Diabetes
o Kidney disease
o Other diseases such as Parkinson’s, Multiple sclerosis and Huntington’s
o Prostate enlargement
o Eye disease
o Obesity
o Alcohol misuse
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Mental illnesses including:
o Anxiety
o Depression
o Schizophrenia
Learning difficulty
3.3.2 Women
The study engaged with two female prisoners as part of this study and common
presenting issues included:
Mental Illnesses including:
o Anxiety
o Stress
o Bi-polar disorder
o Borderline Personality Disorder
Learning difficulty
Addictive behaviour (drugs and alcohol)
3.3.3 Young offenders
The study consulted with a young offender who is suffering from a severe condition
of testicular cancer.
3.3.4 Mental health
Many of the study prisoner informants of all ages who participated in the study self-
reported mental health problems or illnesses:
Schizophrenia
Bi-polar disorder
Borderline personality disorder
Schizotypal personality disorder
Paranoid personality disorder
Anxiety
Stress
Depression
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3.3.5 Disabilities
The study engaged with many prisoners who self-reported physical, mental,
learning and other types of disabilities:
Physical including non-visible disabilities such as epilepsy
Mental and emotional
Cognitive deficit
Sensory (vision and hearing)
Learning difficulty including intellectual
Physical disabilities appear more prevalent among the older population of prisoners
consulted. At the time of the fieldwork, there were 6 prisoners in wheelchairs in a
particular hall in HMP Glenochil. This is the same hall which has 75 prisoners on
Personal Emergency Evacuation Plans (PEEPs).
Mental and emotional health disabilities were particularly prevalent among the
female prisoners who engaged in the study, as were learning difficulties. It is
perceived by the authors that the level of self-reporting for learning disabilities,
disorders and difficulties is not truly representative of the scale of this problem due
to associated stigma and lack of diagnostic tools and resources in prisons for
identifying this specific type of disability.
None of the disabilities reported to the research team were reported as being
present at birth, but occurred in later life. In almost every case, the disabilities
highlighted were reported in combinations, as opposed to standalone.
3.3.6 Social care needs
Two particular prisoners located in HMP Glenochil and HMP Addiewell require daily
personal care. In the case of Glenochil prison, this is provided by NursePlus, a
national private company which provides domiciliary care services throughout the
UK. In the case of Addiewell prison, social care is provided via the in-house NHS
Lothian healthcare service as part of their standard practice. At the time the study
fieldwork was undertaken, the research team was unaware of any other prisoners
in Scottish prisons who require social care in respect of assistance with activities of
daily living; apart from the two prisoners highlighted above.
However, a severely physically disabled prisoner (double amputee) in HMP
Dumfries reported that he would receive social care in the community, as did
another prisoner in HMP Glenochil. It is possible that a few other prisoners
interviewed in the study (or outwith the study) might be eligible for social care,
although the research team did not explore this potential due to the reliance on
local intelligence to select eligle prisoners for the study.
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3.3.7 Long terms conditions and terminal illness
The research team engaged a number of prisoners who self-reported long terms
conditions such as cancer, heart disease, Parkinson’s disease, Multiple sclerosis and
Huntington’s disease. None of the subjects reported that their illnesses are
terminal, although two prisoners stated ‘they would die in prison’ due to a
combination of their illnesses, age and sentence lengths. A young prisoner from
YOI Polmont expressed concern about his health and future as a consequence of a
recent cancer diagnosis for which he is receiving hospital based treatment.
A prisoner from HMP Edinburgh had died the week before the scheduled study visit
through a long term condition thought to be cancer. The prisoner was released
under license on compassionate grounds the day before he passed away in a
hospice in the presence of his family. The prison arranged the hospice and had
attempted to release the person earlier; however, license conditions were not to
the individual’s satisfaction and he initially decided to return to the prison before
latterly changing his mind when his health further deteriorated.
This particular episode highlights the challenge faced by prisons and the SPS in
striking the balance between custody, order, care and opportunity; especially when
dealing with in such tragic circumstances pertaining to terminal illnesses and
palliative care. The research team understands that the recent Edinburgh prison
incident is not an isolated case; therefore it is important to review relevant
experiences and promote learning across the prison service in Scotland.
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CHAPTER 4: THE NATURE AND SCALE OF HIGH CARE NEEDS
IN SCOTTISH PRISONS
4.1 The Nature of High Care Needs in Scottish Prisons
Due the lack of definition of high care needs and lack of associated measures, it is not
possible for the authors to determine accurately the nature of prisoners with high care
needs in Scottish prisons. Accordingly, the authors suggest that the SPS considers
creating a definition of high care needs; and disseminating this appropriately to key
stakeholders. Reference should be made to practical measures and questions, such as
those outlined in this section which can support developing the definition’s scope.
Finally, the SPS should consider carrying out a comprehensive social care needs
assessment once a definition for high care needs and its related scope has been
agreed. Table 4.1 below has been created, utilising the intelligence gained through the
breadth of interviews, to illustrate the types of data and information that would be
useful.
Table 4.1: Potential high care needs assessment criteria
TN Theme QN Question
1 Personal
Care Needs
A How many prisoners need assistance with getting in/out of bed?
B How many prisoners need assistance with
washing/showering/bathing?
C How many prisoners need assistance with going to the toilet?
D How many prisoners need assistance with dressing?
E How many prisoners need assistance eating and drinking?
F How many prisoners need assistance with moving in and out of
cells?
G How many prisoners need assistance with moving around the
prison?
H How many prisoners need assistance with night time routines?
2 Wider social
care needs
A How many prisoners remember sufficiently well to function
without assistance?
B How many prisoners participate in the regular prison regime?
C How many prisoners manage their own medication, if applicable?
D How many prisoners carry out day to day problem solving?
E How many prisoners manage their own money?
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3 Social care
providers
Who provides social care to prisoners with high care needs:
A Prison officers?
B Other SPS staff?
C Healthcare staff?
D Social care staff from the LA?
E Social care staff from a private provider?
F Social care staff from a charitable organisation?
G Social care volunteers from a voluntary organisation?
H Other prisoners?
I Other individuals (specify)?
4 Local
Authority
involvement
in social care
A Is the LA involved in assessing the needs of prisoners with social
care needs?
B Is the LA involved in delivering social care services to prisoners?
C Is the LA involved in meeting the needs of prisoners with social
care needs by attending multi-disciplinary case conference
meetings?
D Is the LA involved in social care strategy or practice affecting
prisoners by attending business meetings with SPS and NHS staff?
5 Cost of social
care
A What is the cost of providing social care in the prison?
B Who pays the cost of social care in the prison?
6 The built
environment
A Are prisoners able to move in and out; and around their cell
without restriction?
B Are prisoners able to move around their hall without restriction?
C Are prisoners able to move around the prison without restriction?
D How many cells in the prison are wheelchair accessible?
E How many wheelchair accessible cells have en-suite shower
facilities?
F How many wheelchair accessible cells have en-suite toilet and
wash facilities?
G How many cells have emergency call alarms?
H Are cell emergency alarms accessible in terms of location and
height?
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I Are cell call buttons accessible in terms of height?
J How many cells have hoists?
K How many cells have adjustable hospital type beds?
L How many cells have access to both sides to assist getting in and
out of bed?
M How many cells have been specially adapted for a high care needs
prisoner?
N How many cells have been adapted for prisoners with low
mobility; e.g. those with walking aids, arthritis, etc.
O Are hall call buttons and other electrical items installed at
accessible heights and in appropriate places for prisoners with
high care needs?
P Are there visual indications to assist in orientation e.g. blue level,
red level, etc.?
Q Are stair and floor nosings a contrasting colour to the rest of the
tread?
7 Aids and
equipment
How many of the following aids and equipment does the prison
provide:
A Adapted cutlery?
B Suitable seating e.g. raised seats, raised shower seats, seats that
propel?
C Walking aids e.g. sticks, frames, crutches?
D Wheelchairs?
E Mattresses and cushions for pressure care?
F Incontinence pads and other appropriate appliances?
8 Hall regime A Are there suitable hall regime activities for prisoners with severe
mobility issues or other physical conditions?
B Are there suitable hall regime activities for prisoners with severe
mental illness difficulties?
C Are there suitable hall regime activities for prisoners with severe
learning difficulties?
D If the hall regime is unsuitable for prisoners with high care needs,
what are the alternatives?
9 Access to
education,
Does the prison offer education, programmes, gym, work, hobbies
and other activities for prisoners with the following disabilities or
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programme,
gym, work,
hobbies, etc.
conditions:
A Severe physical disability?
B Moderate physical disability?
C Blindness?
D Colour blindness?
E Deafness?
F Dyslexia?
G ADHD?
H Limited manual dexterity?
I Learning disability?
J Brain damage?
K Dementia?
L Mental illness?
4.2 The Scale of High Care Needs in Scottish Prisons
Due to the lack of definition surrounding ‘high care needs’ and the lack of associated
measures, it has not been possible for the authors to accurately determine or even
gauge the scale of prisoners with high care needs in Scottish prisons. It is clear that 2
prisoners with high care needs are currently receiving personal care in Scottish
prisons. One of these prisoners receives social care through an externally contracted
agency (NursePlus at HMP Glenochil), outwith the Local Authority spectrum. The other
prisoner with high care needs receives social care via the in-house NHS healthcare
team (NHS Lothian at HMP Addiewell).
When attempting to ascertain the scale of prisoners with high care needs in Scottish
prisons, the following list can be used as a baseline of measures which should not
prove too difficult in collating statistics on. This list is equally beneficial in identifying
the true nature of prisoners with high care needs; notwithstanding the potential high
care needs assessment criteria outlined above in Table 4.1.
Number of prisoners with a NHS Care Plan / Stepped up Plan / Extended Care
Plan, / Special Care Plan/ Rehab Care Plan ;
Number of prisoners with a Personal Emergency Evaluation Plan (PEEP);
Number of prisoners on Rule 41;
Number of prisoners awaiting or being considered for transfer to hospital for
treatment under the Mental Health Act;
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Number of prisoners in contact with prison mental health services displaying
psychosis as a sign of a psychiatric disorder, but not currently being considered
for transfer to hospital for treatment under the Mental Health Act;
Number of prisoners with long term conditions and terminal illness including
those receiving or being considered for palliative type care;
Number of prisoners eligible or being considered for early release on license on
compassionate grounds;
Number of prisoners with severe physical health problems;
Number of prisoners who require regular general hospital treatment or
extended stays in hospital;
Number of prisoners requiring assistance with activities of daily living (eating
and drinking; washing/showering/bathing; going to the toilet; getting dressed;
getting in/out of bed; moving in and out of cells and around the prison);
Number of prisoners with severe sensory conditions such as blindness and
deafness;
Number of prisoners with a range of complex problems such as physical health,
mental health and learning difficulties;
Number of prisoners receiving social care via an externally contracted (non NHS
or Local Authority) service provider;
Number of prisoners receiving social care via the NHS through the existing
healthcare memorandum (in terms of extended practice); and
Number of prisoners receiving social care via the Local Authority [NB No such
cases were reported during the fieldwork for this study].
These figures do not take account of the following measures which may also have a
bearing on the assessment of prisoners with high care needs:
Number of prisoners with moderate to severe physical disabilities who are not
highlighted in the bulleted list immediately above, including prisoners in
wheelchairs and prisoners with moderate (or lesser) sensory impairments;
Number of prisoners with moderate to severe mental health disabilities who are
not highlighted in the bulleted list immediately above;
Number of prisoners with moderate to severe learning disabilities who are not
highlighted in the bulleted list immediately above;
Number of prisoners on Rule 95;
Number of prisoners on ACT;
Number of prisoners on a high level of observation;
Number of prisoners on anti-psychotic or anti-depressant medication, who are
not highlighted in the bulleted list immediately above;
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Number of prisoners on a detoxification programme due to dependency on
alcohol/drugs; and
Age of prisoners such as older prisoners over 50 years or elderly prisoners over
65 years.
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CHAPTER 5: CURRENT SCOTTISH PRISON SERVICE
RESPONSE
The SPS has implemented a number of measures to meet the aggregated needs of
prisoners with high care needs. Some responses are national and others are local but
involve national liaison with SPS Headquarters. The following list outlines examples,
some of which are explored further:
5.1 National Measures
Conducting and commissioning research related to prisoners with high care
needs including those who require assistance with daily living activities.
Creation of a national High Care Needs Working Group.
Mental health interventions to transfer prisoners to hospital for required
psychiatric interventions.
NHS Care plans/Stepped Up Care Plans/Rehab Care Plans/Special Care Plans.
Personal Emergency Evacuation Plans (PEEPs).
Implementation of Rule 41 and Rule 95, as appropriate.
ACT and other forms of observations for vulnerable prisoners.
Implementation of Early release on license on compassionate grounds for
prisoners who experience the most severe levels of health problems or
incapacity; or tragic family circumstances.
Disabled cells.
Aids and equipment in cell, hall, shower/bathing/washing areas, throughout the
prison.
Deployment of passmen as peer carers (including pushing wheelchairs).
Family engagement and visit initiatives.
SPS Women Offenders Project emphasis on vulnerable women in designing and
planning the regime for the new HMP Inverclyde.
5.2 Local Measures
Adaption of a cell in HMP Addiewell to meet the needs of a prisoner with the
most severe levels of high care needs.
Provision of a 50-bed capacity High Dependency Unit in HMP Barlinnie to meet
the needs of prisoners with high and moderate care needs.
Provision of a structured social care day service to support prisoners with high
care needs in HMP Barlinnie.
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Access to an Independent Living service by prisoners with high care needs in
HMP Barlinnie.
Partial adaption of a cell in HMP Dumfries to partially meet the needs of a
prisoner with high care needs.
Housing of a prisoner with particularly complex problems in a peaceful but safe
environment in HMP Dumfries.
Deployment of SPS Social Care Manager and Social Care Officer in HMP&YOI
Cornton Vale to meet the needs of prisoners with high (and others levels of)
care needs.
Adaption of a cell in HMP Edinburgh to meet the needs of prisoners with high
care needs.
Provision of specialist social care services procured via an external private
provider in HMP Glenochil to meet the needs of a physically disabled prisoner
with high care needs.
Provision of specialist Rehab Worker via the NHS Forth Valley prison based
healthcare team to work with prisoners with high care needs.
Adaption of cells in HMP Glenochil to meet the needs of prisoners with high care
needs.
Provision of larger disabled cells in HMP Low Moss.
Use of NHS Care Plans, Stepped Up Care Plans, Extended Care Plans, Special
Care Plans and Rehab Care Plans [names vary according to establishment and
informant].
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CHAPTER 6: EFFECTIVENESS OF CURRENT RESPONSES
6.1 Prisoner Views
An important determinant in gauging the effectiveness of the Prison Service’s
response for meeting the needs of prisoners with high care needs must be based on
the views of prisoners themselves. To this end, from the 20 prisoners interviewed in
this study, 14 (70%) reported that their needs were being fully met by the prison. A
further 2 (10%) prisoners reported that their needs were being partially. Three
prisoners reported that their high care needs were not been met (15%). One prisoner
(5%) who seemed particularly agitated and unwell during the interview, was unsure
to what extent their needs were being met by the prison.
A brief meeting took place in HMP Addiewell with a prisoner with the highest levels of
high care needs; possibly in the Scottish prison estate. As previously highlighted in
this report, it was not possible to conduct a full interview with this man due to
operational restrictions. However, this gentleman reported that his needs were being
partially met.40
These views are illustrated in the following quotation examples:
6.1.1 Prisoner views - positive examples
“The prison has done everything to help me by bring me down here and giving me the peace and quiet
I need to cope.”
“Some Prison Officers are really helpful in making sure my everyday needs are met.”
“The prison has made modifications to my cell which fully meet my needs.”
“The prison has arranged for two social care workers to help me twice a day – they have also kitted
out my cell with aids and a hoist.”
“The Social Care Officer is always there for me and my Social Worker helps too, although I’m quite
glad I’m being moved out the Vale to Greenock.”
“It is hardly home in here but the prison and everyone in here pulls together to make the best of a bad
situation.”
“I have a full time passman dedicated to help me which is a God send as I can’t get around on my
own.”
“I don’t think I should be in a prison due to my state of health but the healthcare team do a good job
for me and the prison is trying to get me access to the gym and programmes.”
“I see the Mental Health Nurse quite often and the doctor (Psychiatrist) now and again to help me cope
with my mental and emotional health problems.”
40 NB this case is not included in the statistics highlighted above as no formal interview took place; however, the
indidividual’s comments are expressed in some quotes used in the report.
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“This unit is meant to be for people with high dependencies but it is full of young, fit, loud people –
apart from that, my needs are being fully met by the hall and the jail.”
“The Governor is doing his best to create more disabled and buddy cells in this hall to cater for the
elderly and infirm like me – I get a better service in here than out there so, yes; my own care needs
are definitely being met.”
6.1.2 Prisoner views - slightly positive examples
“I would say my needs are being partially met as there are few work opportunities in this place for
people like me with disabilities.”
“I would like to see the Occupational Therapist again who I saw before and also get a physio in here –
I would get physio outside for my condition.”
“I see the Rehab Nurse every day and she helps me a lot.”
“The disabled cells aren’t big enough and my wheelchair doesn’t fit into normal cells which makes
association hard – the jail tries but it doesn’t meet all my needs; only some.”
“To put it simply and diplomatically, the jail partially meets my needs but don’t tell them I said this or I
might get in trouble!”
6.1.3 Prisoner views - negative examples
“I would be cell bound and if another prisoner didn’t help me – prison staff don’t care about me,
surgery staff don’t care about me, the Governor doesn’t care about me; even the Chaplains don’t care
about me – I should be in a nursing home but I know I’m going to die in here.”
“This jail isn’t suitable for disabled people - my shower is in another building - the shower isn’t properly
equipped and is dangerous – my cell is not suitable either – I have fallen twice getting in and out of
bed – I am also isolated with only one other prisoner in my area ... and you.”
“My disability is preventing me from getting progression to a top end or the open estate – that can’t be
right surely.”
“If I was in the community, I would have a guide dog and be supported by my wife and helping
agencies - in here, I get a bit of tape stuck outside my cell and around my shower area; and get left to
my own devices to get on with it.”
“Trying to see a doctor in here is murder – you need to wait for ages then get limited time because
half the people in here have mental problems – I guess this means my so called high care needs are
not being met.”
6.2 Family Members’ Views
Only one family member of a prisoner with high care needs was interviewed as part of
the study. The individual initially reported that her partner’s needs are not being met
by the prison. The prisoner himself reported that his needs are being met which
prompted his partner to change her assessment and report that her husband’s needs
are partially been met, as illustrated below:
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“I suppose most of his needs are being but he is not getting the same amount of care and support in
here than we would at home.”
“I have not been involved in anything to do with my partner’s care plan despite knowing everything
about his health problems and how to control this.”
6.3 Prison Staff Views
Interestingly, compared to prisoner views, lower proportions of SPS staff but higher
levels of healthcare staff who work in prison settings reported that the needs of
prisoners with high care needs are being met. Of the 19 prison based SPS staff
consulted, 6 (32%) reported that the aggregated needs of prisoners with high care
needs are being fully met. A further 9 (47%) SPS staff reported that this prisoner
population’s needs are being partially met; whilst the remaining 4 (21%) SPS staff
reported that the needs of prisoners with high care needs are not being met.
The most common reason cited by SPS staff for not or only partially meeting the
needs of prisoners with high care needs centred on the built environment in terms of
the accessibility of cells, halls and the wider prison. Other reasons included the
suitability of mainstream prisoner focused hall and wider prison regimes, tight
operating budgets, limited staffing resources, lack of specialist staff training, other
policy initiatives, health and safety concerns including staff involvement in pushing
prisoners in wheelchairs, ambiguity over the role of Local Authority social care
providers in prison settings; and lack of social care.
These views are generally captured in the quotations below:
6.3.1 Prison staff views - positive examples
“This prison is leading the way in meeting the needs of prisoners with high care needs.”
“The facilities here are first rate and everything is accessible; from the large, fully equipped disabled
cells to the entire prison infrastructure.”
“In this hall alone, there are Prison Officers with social care responsibilities, Nurses, a Rehab Worker,
Healthcare Assistants, specialist Social Care Workers from an outside agency, prisoner peers and a load
of other types of helpers catering for the every need of each prisoner who requires intensive support.”
“We have learned from experience and prison inspections and invested in innovative SPS social care
resources to provide the best possible care and support for our clientele.”
“We work in an integrated and effective manner, endeavouring; and I think, managing to meet the
often challenging needs of high care prisoners.”
“HQ has been supportive in assisting us with capital refurbishment business cases to increase the cell
capacity for prisoners with high care needs.”
“We transferred in a prisoner with complex needs and have received positive feedback that his needs
are being met.”
“The HDU (High Dependency Unit) was created to help prisoners with high care needs and continues to
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serve this function well.”
“There are people throughout the prison estate who should be in nursing homes, care homes, mental
hospitals, hospices, etc. but we do an excellent job meeting their needs, despite the vast challenges.”
6.3.2 Prison staff views - slightly positive examples
“For the most part, I would say we meet the needs of high care prisoners, although we can always do
more and better; especially with increased resources.”
“I would say that certain prisons cater better than others for people with high care needs – if you were
to push me, I would say that across the service, this prisoner populations needs are being partially
met.”
“We have good integrated working arrangements in place to meet the needs of all prisoners – for
prisoners with multiple complex needs such as acute psychiatric illness, severe learning difficulties,
severe physical problems or terminal illness, we might call on specialist external resources as we are
not fully resourced to cater for such cases and demand is never constant.”
“We tend to invest in capital refurbishment projects in response to needs, rather than in anticipation to
needs or based on up to date internal and external intelligence.”
“SPS has implemented ‘mentalisation training’ for staff which is relevant to all prisoners including high
care needs; nonetheless, we need to do much more in practice.”
“It doesn’t matter who pushes the wheelchair, does it; as long as somebody does – we are Prison
Officers and we are not here to tuck people into their beds, read to them or wash them – we do our
job and we do it very well.”
“Until the SPS invests in a national or local high needs facility, we will never achieve our potential or
meet the aggregated needs of prisoners with high care needs. In the meantime, we will continue to do
a decent; in fact, good job; the best we can under the circumstances and with the budgets in place.”
6.3.3 Prison staff views - negative examples
“Anyone who thinks or says the service meets the needs of every prisoner including those with high
care needs is kidding themselves on.”
“Jails are not geared up for managing prisoners with acute psychiatric illness who display psychosis,
prisoners who are paralysed, blind, deaf or suffering terminal illness. These types of cases are
common in practice and not only are we not equipped, we are not that great at managing these
problems either.”
“Pay a passman a tenner a week as a wheelchair runner and that will solve the problem on the face of
it: I don’t think so – we need to change the culture to meet the high care needs of prisoners before we
even start talking about new builds, hall and cell reforms, etc.”
“We need to bump disabled people out of disabled cells for prisoners with more severe needs so we
certainly do not meet all high care needs.”
“In a word, ‘no’.”
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6.4 Prison-Based Healthcare Staff Views
Of the 10 prison based healthcare staff consulted, 8 (80%) reported that the needs of
high care prisoners are being met; and 2 (20%) reported that this population’s needs
are partially being met. Again, these views are illustrated in the quotation examples
below:
6.4.1 Prison-based Healthcare staff views - positive examples
“Let’s be realistic here; the healthcare service in prisons is at least as good as it is the community and
access is quicker. A patient can see a GP within a day or two, a nurse daily, a mental health nurse
within a few days and a Psychiatric doctor within a couple of weeks. There is also access to many
other types of healthcare professionals and regular clinics.”
“We use healthcare assistants to provide social and health care.”
“Our rehab worker is in the hall every day working at ground level with the prison staff and (external)
social care staff; supporting people with high care needs.”
“The level of mental health problems and learning difficulties among prisoner groups, male and female
alike is breathtakingly high but we do everything possible to meet individual and collective needs.”
“The healthcare service in the prison has always been good but since it has transferred to the NHS, it
is even better in meeting the needs of all prisoners.”
“We are a team of highly trained and dedicated healthcare professionals who pull together with prison
resources to meet the needs of all patients, whatever the setting; and we do not get many cancelled
appointments in here.”
“The healthcare team provides personal care to patients who require this.”
“The healthcare team is fully integrated in prisoner management and providing effective, holistic care
based on individual need. In short, we all do a good job for the people we serve.”
“The demand for healthcare in any prison is incredible, especially in large local prisons. However, from
basic care to more concentrated care, we pull together and do a tremendous job for those we care
for.”
6.4.2 Prison-based Healthcare staff views - slightly positive examples
“The prison itself is partially meeting the needs of prisoners with acute psychiatric illness through
treatment, support and integrated case management; however, the system falls down when a patient
requires hospital treatment as there are waiting lists for adult men in secure psychiatric settings.”
“The needs of people with high care needs are generally met – as practitioners we don’t get embroiled
in whose job it is to provide social care; we simply get on with providing the best care we can with the
resources available.”
“Occasionally the healthcare manager will receive a complaint from a patient which is clearly addressed
with a view to resolving it satisfactorily; meeting the patient’s needs and supporting learning and
development.”
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“Physiotherapy is rare, as is occupational therapy but everything else is in place, I think.”
“The high care needs of some prisoners are met, but not all - Glenochil introduced a social care model
which the NHS should look at – in the meantime, we get on with doing our job professionally and
caringly.”
6.5 Key Findings
In summary, the evidence based on prison based fieldwork (particularly the views of
healthcare staff and prisoners themselves) suggests that the high care needs of
current prisoners are generally being met by prisons and the Scottish Prison Service.
An interviewed prisoner with the most severe level of high care needs, who is
receiving social care support, reported complete satisfaction in the levels of care he
receives. This rating was similar among the majority of prisoners consulted during the
study. Another prisoner, with the most severe level of high care needs, with whom it
was not possible to formally interview but who attended a brief meeting with the
research team, reported that his needs were being partially met.
Feedback from the qualitative prison based fieldwork also highlights the nature and
scale of the health and social care related challenges facing healthcare and prison
staff. Feedback generally indicates high and effective levels of integrated working
among multi-disciplinary teams.
In terms of issues, these mostly centre on two extremes. Firstly, the example
question of ‘who pushes the wheelchair’ with relation to not just the roles of Prison
Officers but healthcare staff, other staff and volunteers, and peer prisoners
themselves. At the other extreme, the built environment emerged as the main area
for improvement and this is explored further in Chapter 7. Sitting somewhere in
between these different examples is the suitability of the hall and wider regime for
people with high care needs. Despite the study only being able to consult with only
one family member, family engagement is clearly an important facet in this discussion
and one that may require improvement.
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CHAPTER 7: AREAS FOR IMPROVEMENT
This section focuses on a range of improvement areas which have emerged from the
collated evidence. The list below is not exhaustive; although it represents the main
improvement areas expressed by study informants.
7.1 Definition and scope
The single biggest issue that emerged from the study’s deliberations concerns the lack
of definition and wider scope concerning the term ‘high care needs’. This issue is fully
explained in Chapter 3.
7.2 Care plans
From the evidence collated, there is ambiguity regarding whether all establishments
use care plans in respect of prisoners with high care needs. Care plans in use vary in
name. Examples cited in the study, all of which are exclusive to the NHS,are:
Care Plan;
Extended Care Plan;
Stepped Up Care Plan;
Special Care Plan; and
Rehab Care Plan.
Terminology ambiguity appear to be influenced by a number of factors:
Individual informant views which may not be officially representative;
Custom and practice in that local team or establishment;
Associations with new staffing initiatives such as the Rehab Worker in HMP
Glenochil and the SPS Social Care Manager and Officer in HMP&YOI Cornton
Vale; and
Differing baseline terminology used by different NHS Health Boards.
7.3 Built environment
The built environment was identified as a major concern to many study contributors;
as evidenced in the selected quotes below:
“There are not enough disabled cells with wheelchair access in the prison so some of us need to live in
a standard cell – I need to climb out my wheelchair, fold it up, use sticks to get in my cell whilst
carrying my chair, fold it back down, just to get in and out of my cell – I had a disabled cell before but
a prisoner with greater needs now has it.”
“There is no way I can push myself half a mile uphill all the way to the health centre – I rely on a
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wheelchair passman to help me get around the prison.”
“The cell is not fit for purpose for a double amputee and the shower facilities in the other building I use
are even worse.”
“I don’t work, go to programmes or the gym and only attend education occasionally – this is all down
to my disability – on top of that, the hall regime is not set up for stay at home prisoners like me.”
“The builders are never out of this place; widening cells and doors – you would think they would have
built the halls right in the first place.”
“There needs to different visit facilities for people like me (high care needs prisoner) as normal visits
are too difficult for me – even getting to the visit room is hard for me.”
“If the Governor wants to create high care needs facility in this jail, he should to focus on a new build
in another part of the prison; not on creating a few more disabled cells.”
“Buildings, equipment and facilities need to match the hall regime which they don’t do currently.”
7.4 Hall and wider prison regime
“Someone mentioned about activity packs in an English prison but I don’t know what he means,
although I’d like to find out as I am largely idle in my cell due to the hall regime.”
“The staff try but we could do with more activities as half this hall suffers from serious illness or
disabilities.”
“The regime takes no account of learning disabilities and the wider prison regime is not much better.”
“The hall should have small and larger meeting rooms for prisoners to meet to talk and do activities.”
“I go to education but am sometimes late and once I never made it as my (staff) escort didn’t show.”
“There needs to be a separate regime for people with high care needs as most of them cannot cope
with mainstream conditions and activities.”
“The hall has some gym equipment but the PTI rarely comes in as everything is geared up for dealing
with the masses and able bodied.”
“Education and Links Centre staff are good at helping me as an individual but is difficult to do this for
every prisoner as their situations and hopes are uniquely different.”
“This hall is a mix between an asylum and nursing home for old, decrepit, bitter men like me – no
matter what is put in place here, it will always be the same - I rest my case.”
7.5 Wheelchair policy
The research team did not uncover a single wheelchair policy in any establishment; as
illustrated in the following quotation examples:
“It is a joke and embarrassing that some staff and nurses won’t push a prisoner in a wheelchair.”
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“I think we have a wheelchair policy in the prison but I have never seen it and would not know where
to find it.”
“We don’t have a wheelchair policy as nobody wants to answer the question: whose job is it to push
the wheelchair; and whose job is it not to.”
“The union advised staff not to push wheelchairs unless they are trained for health and safety
reasons.”
“The union don’t have an issue with staff pushing wheelchairs if they are willing and trained – some
staff already push wheelchairs.”
“I choose to push wheelchairs even though I get pelters from other staff.”
“I get paid as a passman for pushing wheelchairs and generally helping my buddy – I am happy doing
this and enjoy it.”
“Really, what is so difficult here: just create the (wheelchair) policy?”
7.6 Early release on license on compassionate grounds
A particular interviewee suggested that the SPS advice notice should be reviewed as it
is ‘about 10 years old and possibly out of date’. The advice (21A/05) is dated 6 June
2005 and sets out the policy regarding ‘Early release of prisoners on license on
compassionate grounds’ in terms of health and incapacity and tragic family
circumstances.
“The policy should be reviewed and updated as it is probably out of date and there have been relevant
SPS and Government policy developments since then.”
7.7 Other issues
7.7.1 National Social Care Short Life Working Group
One participant expressed a view that a new National Social Care Short Life Working
Group should be created and that consideration should be given to the following
representation:
SPS (staff);
Serco and Sodexo as the two private prison service providers in Scotland;
NHS Scotland;
COSLA;
Scottish Government (health and social care related departments);
Third sector organisations
Prisoners with high care needs; and
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Families/carers of prisoners with high care needs.
The remit would centre on: debating relevant social care issues; agreeing a joint
policy statement; and developing a joint framework for providing social care in
prisons. If this consideration is approved and implemented, consideration could be
given to placing the group under the auspices of the existing SPS High Care Needs
Working Group.
7.7.2 Prison based hospital facility with overnight beds
Several stakeholders expressed concerns over the lack of prison based hospital wards
including overnight beds. The last facility of this nature closed in HMP Addiewell
around August 2013 due to a combination of: lack of patient demand; cost; limited
regime opportunity; and the ethos of organisational consistency across the Scottish
prison estate. It is noted that every prison operates an out of normal business hours
GP helpline service (normally 9.30pm - 6.30am weekdays; and 5.30pm - 7.30am at
weekends). HMP Barlinnie currently provides overnight nursing cover; however, this
resource appears set to change to fall in line with healthcare arrangements in all other
establishments in Scotland.
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CHAPTER 8: SUCCESSES AND AREAS FOR EXPLORATION
This section identifies areas for the Scottish Prison Service to explore in respect of
knowing and meeting the high care needs of prisoners; underpinned by principles of
quality, learning and improvement. This section also highlights examples of specific
as well as general successes. Achievements of this nature are not always celebrated
which conveys an opportunity for reflection:
“We tend to focus on issues and problems but not successes – we need to change this culture,
demonstrate the effectiveness of services and communicate this widely.”
8.1 General
8.1.1 Multi-disciplinary working
The research team was impressed with the levels and types of multi-disciplinary
working taking place within all prisons. Healthcare teams and practices are fully
integrated within prison practices; as indeed are other external services. There is
good evidence that this approach is working effectively and generally meeting the
needs of prisoners.
“Prison and nursing staff work closely and well together to help me and all the other prisoners.”
“The healthcare team is now NHS but we work with the SPS and wider agencies in an integrated and
successful way.”
8.1.2 Staff attitudes
Notwithstanding one or two isolated negative comments, the research team is equally
impressed by staff attitudes.
“I am a Prison Officer, here to serve along with other staff from all areas of the prison to try to meet
the needs of every prisoner; whatever they are and whatever the challenge.”
“I would call it ‘one for all and all for one’; we do our best and most people know and appreciate this,
especially prisoners themselves.”
“I am proud to be a Social Care Officer and take my role seriously – I act as a role model even though
I respect that my remit is not everybody’s ‘cup of tea’ and every Officer is different.”
8.2 Specific
As indicated immediately above and generally throughout this report, the research
team are impressed by the Scottish Prison Service’s responses to meeting the
considerable challenges posed by prisoners with high care needs. However, without
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underestimating the range of positive initiatives and achievements throughout the
prison estate, several specific examples of successes are highlighted below. Each
example been selected in part due to the desire for further exploration and potential
roll out in other prisons, as appropriate.
8.2.1 HMP Barlinnie High Dependency Unit
Barlinnie prison’s High Dependency Unit (HDU) opened in the mid-1990’s to house
vulnerable prisoners such as those who are elderly, infirm or unsuitable for
mainstream conditions. The unit is housed in a Victorian hall so does not enjoy the
benefits of more modern ‘new builds’ and ‘state of the art’ facilities. However, despite
its physical limitations, the unit appears to continue to serve its prisoner population
well including those with high care needs.
“Bar-l isn’t known as ‘the mad house’ for nothing you know, but this wee unit is a bit quieter and safer;
so not quite as mad.”
“I could not cope with a mainstream hall and the staff in here are ‘brand new’.”
“The building is basic but the regime is good and we get to go to the day service most days from the
hall.”
An interesting point to note is that that the admission criteria for prisoner admission
to the HDU was not available to the research team during the site visit, despite a
request.
8.2.2 HMP Barlinnie Structured Social Care Service
The Structured Social Care Service in Barlinnie prison is known as different names to
different stakeholders, which is a minor issue which the prison should consider
addressing. The service is located on a first floor above the health centre in the
prison’s former hospital area. There is no lift; therefore access for disabled prisoners
is not fit for purpose. The service is managed by a team of Prison Officers from the
same hall where the HDU is located; however, services and activities are
predominantly provided by external agencies. The service is very important to the
prisoners consulted in this study who regularly access it. In addition to structured
interviews with ‘service users’, the researcher mingled and spoke with many other
participants during a visit to the social care service.
“I can’t work due to my disability so the care service is an important part of my life here.”
“There is a good variety of activities on offer from outside agencies and the place is well attended.”
“I’ve been in most jails in Scotland and I don’t think there’s anything like this place anywhere else.”
However, not all observers agree that the service is effective.
“The day service has become a place to get people out their cell who can’t work – there isn’t much
happening and there is a lack of direction and structure which needs addressing – would you believe
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that there is no healthcare involvement in the programme.”
“The building is not fit for purpose for this type of service.”
8.2.3 HMP&YOI Cornton Vale Social Care roles
HMP&YOI Cornton Vale is still the main prison for female offenders in Scotland;
although Edinburgh, Grampian and Greenock prisons also accommodate women. The
research team is impressed by the prison’s initiative in resourcing new social care
related roles; namely a Social Care Manager (First Line Manager) and Social Care
Officer (‘D’ band Prison Officer). The remits of these roles are broad in nature. It
would be useful if the impact of the roles were evaluated, preferably independently to
determine their impact and effectiveness. This option is also in line with the
Governor’s thinking. Nonetheless, the establishment deserves credit for identifying
and resourcing this initiative which might have roll-out potential in other prisons.
“My quality of life is not good these days due to my health problems but I get by with help from the
care staff and am quite upbeat.”
“The Social Care Officer liaises with my Social Worker, Project Worker and family to help me manage
and prepare for my release.”
8.2.4 HMP Dumfries’ flexibility and specific management of a prisoner with high care
needs
It is perhaps unusual to highlight this example as a specific success, given that every
prison endeavours to provide a consistent and high quality of care and opportunity to
all prisoners. However, Dumfries prison is clearly meeting the complex and unusual
needs of a particular prisoner in HMP Dumfries who is unable to mix with crowds of
people. According to the prisoner, prison staff and healthcare staff, the prison is not
only achieving this but exceeding the expectations of the individual at the centre. This
example perfectly illustrates the individualised nature of providing effective treatment,
care and support in a custodial setting.
“We have planned and implemented many improvement initiatives and have an excellent relationship
with all our partners and prisoners – we clearly don’t have the best buildings in the prison estate but
provide the highest standards of care, such as the case of Mr (name deliberately omitted) who has
severely complex needs which we meet well.”
“The healthcare team have no issue whatsoever providing extended healthcare to prisoners with high
care needs – we do this already; willingly and professionally.
8.2.5 HMP Glenochil social care model
HMP Glenochil deserves praise for ‘leading from the front’ regarding the provision of
social care for prisoners with high care needs. Whilst recognising that the model in
vogue dates back to HMP Peterhead before its closure, the prison has been proactive
and solution focused; with support from the centre. The model is based on procuring
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social care resources via a private provider (NursePlus); whereby two Social Care
Workers visit the prison for 2 hours in the morning and 1 hour in the evening. The
service operates 7 days per week. There is overnight emergency provision built into
the arrangement and this has been activated several times. The service focuses on
the social care, including personal care needs, of a prisoner with a severe level of high
care needs.
The service is complemented by the deployment of a Rehab Worker from the NHS
healthcare team and input from a dedicated Social Care Officer. Unfortunately, the
Rehab Worker was on leave during the site visit to Glenochil prison so was not
interviewed. The Social Care Officer is a Residential Prison Officer with designated
social care subsidiary responsibilities, rather than a standalone post which sits out the
shift rota in the hall. Nevertheless, NHS Forth Valley and Glenochil prison deserve
credit for resourcing these important and needed initiatives.
“The rehab nurse is in the hall all the time during the week helping me and other prisoners with our
physical health problems.”
“I didn’t know he was called a Social Care Officer as I still call them warders but he takes in interest in
our welfare and is a good guy; most of them are!”
“I am proud to be a Social Care Officer and take my role seriously – I act as a role model even though
I respect that my remit is not everybody’s ‘cup of tea’ and every Officer is different.”
The last quote above is also outlined in Section 8.1.2; and has been repeated
deliberately to illustrate the important role and benefit of Prison Officers taking on
social care responsibilities.
8.2.6 HMP Glenochil cell refurbishment programme
There is evidence to indicate that Glenochil prison houses the highest number of
prisoners with high care needs in the Scottish prison estate. In one hall alone during
the study site visit, there were 6 prisoners in wheelchairs; and several others using
mobility aids (walking frames and sticks). The prison has embarked upon a cell
refurbishment programme, backed from central funding, following the successful
submission of a business case to SPS Headquarters. This development is not only
responsive and fitting, it is also aligned to longer strategic thinking and planning to
create a more ‘fit for purpose’ high care needs facility in Glenochil prison.
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CHAPTER 9: PRINCIPLES OF CARE AND GUIDELINES FOR
GOOD PRACTICE IN INSTANCES WHERE TERMINAL CARE IS APPROPRIATELY PROVIDED WITHIN PRISONS
9.1 Introduction
In line with study objectives, the research team explored relevant principles of care
and guidelines for good practice in instances where terminal care is appropriately
provided within prisons. Whilst recognising that such instances are likely to be
occasional, it is evident that the SPS is committed to developing guidance regarding
this important issue. The following overview draws upon definitions, principles and
practice of mainly palliative care as a basis for future SPS end of life care policy.
It is suggested that the SPS develops a comprehensive end of life/palliative care
guidance, based upon these principles; and in consultation with the Scottish
Partnership for Palliative Care and other relevant organisations. This guidance should
take account of the context of end of life care in the prison environment, including
access to specialist staffing and resources available within and near each
establishment across Scotland.
9.2 World Health Organisation definition
The WHO (2009) describes palliative care as:
‘An approach that improves the quality of life of patients and their families facing the problem
associated with life-threatening illness, through the prevention and relief of suffering by means of early
identification and impeccable assessment and treatment of pain and other problems, physical,
psychosocial and spiritual.’
9.3 Scottish Government National Indicator
Indicator: Improve end of life care.
Indicator Measure: Percentage of the last 6 months of life which are spent at home
or in a community setting.
Current status: On average in 2011/12, the percentage of the last 6 months spent at
home or in a community setting was 91.2%. This is comparable to the 90.7% in
2010/11, and the 90.4% in 2005/06, the baseline year. There was an increase of
approximately 0.8 percentage points between 2005/06 and 2011/12.
9.4 National Institute for Clinical Excellence (NICE) End of Life Care Quality
Standard Advice
NICE have developed an End of Life Care for Adults Quality Standard, QS13 (2011),
to cover all services and settings in which care is provided by health and social care
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staff to adults nearing end of life. The standard promotes high quality care for
terminally ill patients (as well as a positive experience for families and carers) to
enhance quality of life, ensure a positive healthcare experience, and protect patients
from avoidable harm through treatment and care in a safe environment. They have
set out quality markers, including 16 statements on quality of palliative care41,
recognising that some quality markers need to be adapted to relevant conditions.
Related quality standards are available for a variety of life-threating conditions in
regard to this. NICE hope to contribute to the overarching outcomes of aligning end of
life care to patient needs and preferences; increasing the time spent in preferred care
setting during patients’ final year; reduce unscheduled hospital admissions leading to
death in hospital (if this is against patient preference); and reduce deaths in
inappropriate places.
9.5 The Scottish Partnership for Palliative Care (SPPC)
The SPPC published a three year strategy (2014-17) in April 2014 which centres on
the experiences of death, dying and bereavement have some of the character of
marginal issues in Scottish society:
Low level of public and professional awareness, knowledge, discourse and
engagement;
Frequent omission from relevant national and local policy frameworks;
Lack of good data on the scope and performance of formal and informal
services; and on the experiences of people in the final phases of life and
bereavement.
In terms of formal services, the SPPC believes Scotland should be a place where:
People live, decline and die with good control of pain and other symptoms;
Health and social care staff respond quickly and appropriately to people’s
physical, psychosocial and spiritual needs relating to decline, death and
bereavement;
Systems, processes and resources are in place within health and social care to
give staff the time and support they need to exercise their skills in providing
good palliative care for people and families;
People die in a place of their choosing, where feasible;
People’s dignity is maintained as they approach death; and
People’s end of life care wishes are elicited and respected.
Building on the assets of individuals and communities as they approach the end of
their lives, the SPPC also want Scotland to be a place where people have anticipatory
care plans and are supported by families, communities and professions to plan ahead
for decline, dying, death and bereavement.
41 Source: http://www.nice.org.uk/guidance/QS13/chapter/List-of-statements
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CHAPTER 10: POLICY AND PRACTICE OPTIONS FOR
CONSIDERATION
The policy and practice options for consideration set out below are drawn from the
wide range of evidence collated and analysed in this study, which is summarised and
articulated in this report. They are presented for the consideration of the Scottish
Prison Service and its partner organisations.
1. Agree a single SPS definition of ‘high care needs’ including scope.
2. Following agreement of a definition as above, undertake a comprehensive
Social Care Needs Assessment (in addition to the previous 2012 Healthcare
Needs Assessment) to promote accurate, up to date understanding and
accurately measure the prevalence of prisoners with high care needs; and to
support the strategy and practices being put in place to meet identified needs.
3. In collaboration with the Prison Officers Association Scotland, examine, agree
and develop Prison Officer responsibilities and associated learning and
development initiatives in respect of the management of prisoners with high
care needs. Consideration should also be given to training Prison Offficers (and
other identified SPS staff, if applicable) in a SVQ Health and Social Care
qualification.
4. In collaboration with Prisoners, family members and relevant non-SPS
partners examine, agree and develop Prisoner responsibilities for assisting
peers with high care needs who require assistance with daily living activities;
such as pushing wheelchairs, cleaning and tidying cells, assisting with the
delivery of food, laundry, canteen purchases, etc. Consideration should be
given as to how to mirror such responsibilities on the principles of the existing
Samaritans ‘Listeners’ initiative. Consideration should also be given to training
Prisoners in a SVQ Health and Social Care qualification, with the aim of
developing a cohort of health and social care ‘champions’.
5. Consideration should be given to seeking the support of the Scottish
Government in facilitating the agreement of a national ‘Memorandum of
Understanding’ between the SPS, NHS Scotland and Local Authorities (such as
COSLA or ADSW) in respect of the social care needs of prisoners with high
care needs. The aim of such a Memorandum would be to agree a joint national
approach to prisoners with high care needs, which could then be followed at a
local level. The Memorandum should consider areas of shared responsibilities
as well as mapping out the duty of care for each partner agency. Opportunities
for engaging external, non-statutory agencies in partnership arrangements
concerning social care needs should also be considered.
6. Development of a High Care Needs Strategy, overseen by the High Care Needs
Working Group (HCNWG). The strategy should include consideration of
partnership agreements with (and constituent responsibilities of) NHS Health
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Boards, Local Authorities and other relevant third sector agencies in relation to
the management of High Care Needs Prisoners.
7. Increase the membership of the HCNWG to include more non-SPS personnel
and partners.
8. The creation of a National Social Care Short Life Working Group (as a sub-
group of the national HCNWG), which will be responsible for:
o Clarifying roles and responsibilities (in line with items 3 and 4 above) in
respect of the provision of social care to prisoners with high care needs;
o the development of a draft national care planning model for prisoners with
high care needs;
o the development of an action plan to increase the involvement of families
and carers in the management of prisoners with high care needs;
o drafting of ‘end of life/palliative care’ guidance, based upon the proposed
principles of care and guidelines for good practice; for instances where
terminal care is appropriately provided within prisons; and
o drafting of a national wheelchair policy for consideration of SPS.
9. Conduct an evaluation of the high care needs initiatives in HMP&YOI Cornton
Vale (SPS Social Care resources) and HMP Glenochil (social care contracted
service provider and specialist healthcare resource) with a view to rolling out
any lessons learned.
10. Input into the current review of the SPS’ Governors & Managers Advice Notice
(21A/05) regarding Early Release on License on Compassionate Grounds - as
it is dated 6 June 2005 and has been in use for 9 years.
11. Review prison (including hall specific) regimes for prisoners with high care
needs including the specific issues associated with females.
12. Comprehensive analysis of the SPS built environment, focusing initially on
‘quick wins’ (and relatively inexpensive adjustments) such as Equality Act
(2010) compliance initiatives (e.g. ramps leading into Health Centres, Visit
Rooms and Link Centres).
13. Ensure every prison is endowed to cater for prisoners with high care needs for
very short timescales, pending efficient transfer to fit for purpose facilities
elsewhere in the estate, as appropriate.
14. Identify and equip a specific prison as the first cluster facility specifically
adapted to meet the needs of prisoners with high care needs. Options for
consideration might include: refurbishment of an existing residential area
within an existing prison; creation of a new residential area within an existing
prison; or creation of a new residential area within SPS/Government property
which might be/become suitable for this purpose. Consideration should then
be given to increasing the number of cluster facilities to three or four prisons
in total; conditional upon the evaluation of the first cluster facility
demonstrating effectiveness and cost effectiveness.
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APPENDICES
APPENDIX I: Literature Review – Summaries of papers
Source 1 Health and social care services for older male adults
in prison: the identification of current service
provision and piloting of an assessment and
care planning model.
Author(s) Senior, J., Forsyth, K., Walsh, E., O’Hara,K., Stevenson,C.,
Hayes, A., Short, V., Webb, R., Challis, D., Fazel, S., Burns A.
and Shaw, J.
Year 2013
Key findings Dearth of research on social care needs.
44% prisons did not have an older prisoner policy.
Care needs frequently not met.
Specific training provided to health care staff in less than
50% of prisons.
Buddy scheme most common – 45% of prisons.
56% of prisons had older prisoner plan. 53% had older
prisoner clinic.
Activities for prisoners with mobility issues provided in 33%
of prisons.
64% reported lack of lifts/ramps. 14% said door dimensions
not big enough for wheelchairs.
Ambiguity over roles – some functions such as changing
incontinence pads left to prisoners.
19% used stick, Zimmer frame or tripod to move around. 3%
used wheelchair. 2% unable to get out of bed unaided.
Low mood and depression on entry, worries and concerns
often as a result of a lack of information.
Personal care – Washing and dressing, some uncomfortable
asking cell mate.
55% signs of clinical depression, 23% scoring severe
depression.
Social care needs poorly understood, dealt with by necessity
through healthcare rather than through wider multi-agency
responsibility.
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Recommendations:
Nacro & DoH – Doors and windows easily opened, less harsh
lighting, radiators easily adjustable, special cutlery, plates,
bowls and trays provided for older prisoners, lower TV
shelves in cells.
Relevance to
management of high care
needs prisoners
A diverse range of health and social care needs exist among
older male adult prisoners.
Need for better understanding of how social care needs can
be met such as with washing and dressing.
Reduced mobility for some prisoners and ageing buildings
represent a challenge in terms of access and ability of some
prisoners to participate fully in activities in the prison.
Source 2 Psychiatric Morbidity in Older Prisoners: unrecognised
and untreated
Author(s) Kingston, P., Le Mesurier, N., Yorston, G., Wardle, S. and Heath,
L.
Year 2011
Key findings 50% had a diagnosable mental disorder – depression most
common (83% of cases).
23% had previous history of mental illness; of which 59%
were depression-related.
67% of violent offenders reported depression. In contrast,
36% of sexual offenders had a diagnosis of depression.
Over 65s had higher rates of depression than under 65s
(75%:50%).
12% showed signs of cognitive impairment.
Only 18% of participants with a stated psychiatric disorder
were prescribed medication from the appropriate class – only
12% of those noted in medical records.
Physical problems – average self-report of 2.26 problems per
prisoner.
44% of prisoners reporting physical health problem had been
prescribed medication for complaints.
Relevance to
management of high care
needs prisoners
Diagnosing dementia remains a significant challenge.
Kingston et al. conclude that it remains unclear how best to
approach early diagnoses.
Suggestion that consideration should be given to using
outreach services to assist with the screening tools and to
provide assessments of functional performance and general
daily living activities.
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Source 3 Doing Time: the Experiences and Needs of Older People in
Prison
Author(s) Prison Reform Trust
Year 2008
Key findings More than 80% of male prisoners over the age of 60 have a
chronic illness or disability.
75% of older male prisoners receiving prescribed medication
- some instances showed that medication had been stopped
or did not correspond with recorded medical requirements
once sentenced.
Cases recorded where women had hormone replacement
therapy (HRT) treatments withdrawn.
Delays in hospital referrals - treatment of a prisoner with
prostate issue stopped until new referral was made to local
hospital – delay of 6 months.
Lack of adequate provision for incontinence.
Some palliative care prisoners unable to be moved to
hospital or prescribed morphine whilst in prison which
resulted in unnecessary suffering and pain.
Social care services found to lacking and needs often unmet.
Some prisoners had difficulties even receiving an
assessment.
Walking stick – once case where it took 6 weeks to get
adequate length of stick for prisoner.
Recommendations:
Health:-
Regional units for people with high level of care needs.
Specific training for older prisoners with mental health needs.
Early release for those with less than a year to live.
Social:-
Adult social services should work in prisons to ensure
adequate levels of care provided.
Where significant numbers of disabled prisoners exist other
prisoners could be trained to provide some forms of social
care to others.
Joint health and social care assessments should be
undertaken routinely.
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Relevance to
management of high care
needs prisoners
Disruption or discontinuation of treatments for conditions can
result in great distress for prisoner as well the condition itself
not being treated appropriately.
Requirement for more integrated approach to assessing
health and social care needs rather than treating both as
distinct entities.
Source 4 A Short Thematic Review on the Care and Support of
Prisoners with a Disability
Author(s) HM Inspectorate of Prisons
Year 2009
Key findings
Underreporting of disabilities within the prison service –
systems show 5% of prisoners have a disability or chronic
condition but research found rates to be far higher at 15%
40% of Disability Liaison Officers (DLO) did not feel they had
adequate time to discharge duties – only 11% claimed they
had any sort of formal training for this post.
Dedicated cells only available in two-thirds of prisons, 50%
of which were located within the health centre.
17/82 DLOs reported that their prison had carers for
prisoners – five of those prisons had only unpaid positions.
36% of prisons answering cell call bells within five minutes.
Access to healthcare found to be better for men than women.
Some good examples of meeting needs included; provision of
information in Braille for prisoners with visual impairments;
singing assistant for deaf prisoner; adaptations of activities
to enable disabled prisoners to participate and reduce time
spent in cell.
Recommendations identified:-
Improvements in screening for disability – all prisoners to be
asked about disability on arrival.
Routine screening for older prisoners – basic cognitive
screening to identify early signs of conditions such as
dementia.
Staff training – All good practice models linked to additional
training provisions. Basic training to recognise symptoms and
improve communication with prisoners to reduce risk of
appearing to be belittling or patronising.
Utilise the expertise of specialist external agencies; voluntary
sector found to be particularly valuable with 75% of
participants utilising their support. Charities can provide
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training and awareness for staff and other prisoners. Also
helps to bridge gaps when prisoners are resettled at end of
sentence and for continuity. Inexpensive means of providing
services and meeting performance objectives.
Promote information sharing and adopt clear procedures –
survey revealed lack of adequate communication. Greater
information sharing on good practice in a secure forum –
suggestion is an online-based community.
Low cost modifications to prison living environments –
mobility enhancers such as grab rails, wider doors, additional
lighting, improved signage and labelling of cupboards. Cites
the example of a Japanese prison where there is the use of
incontinence pads and rubber flooring for those with
incontinence.
Disabled prisoners should not be located in the health centre
as a result of their condition and all reasonable efforts should
be made to ensure they are housed within the main body of
the prison.
Named prisoner representatives for those with disabilities.
All prisoners disclosing a disability should have their own
dedicated care plan.
Those who cannot work should be unlocked during the day
and provided with appropriate activities where possible.
Relevance to
management of high care
needs prisoners
Gap in recorded versus actual rates of disability suggests
there is potential for a significant number of prisoners with
additional needs which are not currently being met.
Being unable to participate in work and leisure activities can
result in increased time spent in cell – implications for
feelings of exclusion and mental health.
Involving voluntary sector groups can reduce financial cost of
service provision and allow for continuity upon release.
Source 5 Learning from PPO Investigations
Author(s) Prison and Probation Ombudsman for England and Wales
Year 2013
Key findings 85% of prisons found to have care equivalent to what could
be delivered in the community.
29% did not, however, have a palliative care plan.
Use of restraints when transferring between hospitals and
prisons found to be unsatisfactory in a number of cases. A
lack of risk assessment for potential harm found in 20/170
cases. Concerns were also raised over the excessive use of
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restraint when no obvious risk of escape possible due to
physical condition and lack of mobility.
Examples of good practice found included:
HMP Whatton –Specific nurse with responsibility to lead on
palliative care. Room provided for families visiting where
prisoner is too ill to attend visiting room.
NE England – Macmillan working with prisons to ensure
standards met and put in place tools and assessment
strategies. Staff can gain accredited status for dealing with
palliative care prisoners. Prisoners have at least one
palliative care champion. Example highlighted was of national
standard care plans put into place – Macmillan care nurse
visited prisoner regularly; during last few days of life cell
door kept open to allow frequent visits by staff and prisoners.
Recommendations:
Importance of implementing an end of life care plan for
every prisoner.
Consideration should be given as to how the use of restraints
is carried out in respect of mobility and health issues.
Consideration for early release at the earliest opportunity.
There is a need to involve family in care planning at the
earliest opportunity.
Adequate family liaison cover to be available so that family
are fully aware of situation using staff who are trained to
deal with such issues.
Relevance to
management of high care
needs prisoners
End of life care is crucial and requires input from a range of
agencies and family members to ensure the needs of the
prisoner are met.
Use of organisations such as Macmillan can provide a level of
expertise in a cost-effective way to ensure the needs of
prisoner are met in the final stages of their illness.
Source 6 Scottish Prison Service Prisoner Survey 2011
Author(s) Carnie, J. and Broderick, R.
Year 2011
Key findings 19% have disability.
25% long-term illness.
64% had used drugs in previous 12 months before prison.
39% said drug use was a problem before prison.
24% had seen mental health staff.
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32% of prisoners who had seen mental health staff had a
wait of more than 10 days.
1% of prisoners reported injecting drugs in prison in the
month prior to survey.
56% had been assessed for drug use upon admission.
Of had history of drug use, 83% said would take help if
offered in prison, 84% for on the outside. 44% expressed
concern that drug taking might become an issue upon
release.
Relevance to
management of high care
needs prisoners
High proportion of prisoners seeking mental health staff
appointment had to wait more than 10 days.
Opportunities for those with problem drug use to engage
with support services with the aim of reducing drug taking
during sentence and upon release.
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APPENDIX II: References
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Brutus, L., Mackie, P., Millard, A., Fraser, A., Conacher, A., Hardie, S., McDowall, L. and
Meechin, H. (2012). Better health, better lives for prisoners: A framework for improving the
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Carnie, J. and Broderick, R. (2011). Scottish Prison Service Prisoner Survey 2011. Edinburgh:
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Commission on Women Offenders (2012). Commission on Women Offenders: Final Report
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Couper, S. (2012). Is SPS optimally configured for prisoners who require assistance with
Activities of Daily Living? A Needs Assessment. Edinburgh: Scottish Prison Service.
Farrant, F. (2001). Troubled Inside: Responding to the Mental Health Needs of Children and
Young People in Prison. London: Prison Reform Trust.
Fazel, S., Hope, T., O'Donnell, I., and Jacoby, R. (2001b). ‘Hidden Psychiatric Morbidity in
Elderly Prisoners’, British Journal of Psychiatry, 179: 535–539.
Fazel, S., Hope, T., O’Donnell, I. and Jacoby, R. (2004). ‘Unmet Treatment Needs of Older
Prisoners: A Primary Care Survey’, Age and Ageing, 33: 396-398.
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Miller, J. (2012). Prison Healthcare in the NHS in Scotland – 1 year on: A Report from the
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APPENDIX III: Interview Schedule
Table AIII.1 Interview Schedule – by category
Category: Scottish Prison Service Staff
No Name Title/Status Establishment/Employer
1 Lesley McDowall Clinical Adviser HQ/SPS
2 Vince Fletcher Equality and Diversity Manager HQ/SPS
3 Gordon McKean Head of Professional and Technical
Services
HQ/SPS
4 Dr James Carnie Head of Research HQ/SPS
5 Brian Gowans Chaplaincy Adviser HQ/SPS
6 Jim O’Neill Senior Legal Services Manager HQ/SPS
7 Fraser Munro Governor HMP Open Estate/SPS
8 Jim Kerr Governor HMP Shotts/SPS
9 Rachael McRae Head of Offender Outcomes HMP Shotts/SPS
10 Andy Hunstane Deputy Governor HMP Dumfries/SPS
11 Bob Mackie First Line Manager HMP Dumfries/SPS
12 Karen Norrie Head of Offender Outcomes HMP Barlinnie/SPS
13 John McDavitt First Line Manager HMP Barlinnie/SPS
14 Ian Duff First Line Manager HMP Edinburgh/SPS
15 Dougie Muir Acting Unit Manager HMP Edinburgh/SPS
16 Sarah Angus Unit Manager HMP Edinburgh/SPS
17 Ian Adamson Residential Officer HMP Glenochil/SPS
18 Paula Arnold Acting Deputy Governor HMP Glenochil/SPS
19 Barbara Frederick Social Care Manager HMP&YOI Cornton Vale/SPS
20 Helen McRitchie Social Care Officer HMP&YOI Cornton Vale/SPS
21 Allister Purdie Governor HMP&YOI Cornton Vale/SPS
22 Morag Stirling Women in Custody Strategy Lead SPS College/SPS
23 Heather Keir Deputy Governor HMYOI Polmont/SPS
24 Ruairidh Mackenzie Unit Manager HMP Low Moss/SPS
25 Stevie Murphy Deputy Governor HMP Low Moss/SPS
Category: Prison Officer Association Scotland
No Name Title/Status Establishment/Employer
26 Mick Grattan
Vice Chairman, POAS Prison Officer Association
Scotland
Evaluation of High Care Needs Prisoners - SPS
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Category: Sodexo Staff (HMP Addiewell)
No Name Title/Status Establishment/Employer
27 Harry Mennie Head of Prisoner Management HMP Addiewell/Sodexo
28 David Goldthorpe Unit Manager HMP Addiewell/Sodexo
Category: NHS prison based staff
No Name Title/Status Establishment/Employer
29 Marion Wilson Acting Team Manager HMP Open Estate/NHS Tayside
30 Dr Kathleen Travers Consultant Forensic Psychiatrist HMP Shotts/NHS Lanarkshire
31 David Douglas Psychiatric Nurse HMP Shotts/NHS Lanarkshire
32 Lenny Allen Healthcare Manager HMP Dumfries/NHS Dumfries &
Galloway
33
Doris Williamson Health Improvement Lead for Prisons HMP Barlinnie, Low Moss,
Greenock/NHS Greater Glasgow
& Clyde
34 Steven Devine Practitioner Nurse HMP Edinburgh/NHS Lothian
35 Rosemary Duffy Clinical Manager HMP Glenochil/NHS Forth
Valley
36 Denise Allan Clinical Manager HMP&YOI Cornton Vale/NHS
Forth Valley
37
Darline Reekie Healthcare Manager HMP&YOI Cornton Vale and
HMYOI Polmont/NHS Forth
Valley
38 Alison McIntyre Acting Clinical Manager HMP Low Moss/NHS Greater
Glasgow & Clyde
Category: NHS non-prison based staff
No Name Title/Status Establishment/Employer
39 Andreana Adamson Director of Health and Justice NHS Scotland
40 Moira Cossar Health Lead NHS Dumfries & Galloway
41 Alison McDonald Health Lead NHS Lothian
42 Fiona Gordon Health Lead NHS Forth Valley
43 Joe McGhee Senior Planning Manager NHS Forth Valley
44 Tony McLaren Coordinator - Breathing Space NHS 24
45 Mark McEwan Health Lead NHS Grampian
46 Jayne Miller Health Lead NHS Greater Glasgow & Clyde
Category: External Agencies
No Name Title/Status Establishment/Employer
47 Kathleen Bessos Deputy Director of Integration and
Reshaping Care
Scottish Government
48 Alan Baird Chief Social Work Advisor Scottish Government
Evaluation of High Care Needs Prisoners - SPS
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49 John Walker Director of Housing & Community
Care
Perth & Kinross Council
50 Paul Noyes Social Work Officer Mental Welfare Commission
51 Nancy Loucks Director Families Outside
52 Maria Foster Listeners Samaritans
Category: Prisoners
No Name Title/Status Establishment/Employer
53 DP Prisoner HMP Shotts
54 JH Prisoner HMP Shotts
55 NC Prisoner HMP Dumfries
56 RL Prisoner HMP Dumfries
57 IB Prisoner HMP Dumfries
58 RF Prisoner HMP Barlinnie
59 DM Prisoner HMP Barlinnie
60 AR Prisoner HMP Barlinnie
61 HW Prisoner HMP Edinburgh
62 PF Prisoner HMP Edinburgh
63 WL Prisoner HMP Edinburgh
64 MP Prisoner HMP Glenochil
65 AD Prisoner HMP Glenochil
66 TY Prisoner HMP Glenochil
67 EF Prisoner HMP&YOI Cornton Vale
68 VR Prisoner HMP&YOI Cornton Vale
69 BM Prisoner HMP Addiewell
70 BM Prisoner HMP Addiewell
71 MM Prisoner HMYOI Polmont
72 AD Prisoner HMP Low Moss
Category: Family member
No Name Title/Status Establishment/Employer
73 AF Family member HMP Barlinnie
Evaluation of High Care Needs Prisoners - SPS
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