Ageing in prison used to be the sole privilege of a very small number of notorious individuals, such as Myra Hindley and the Kray twins.  However there are now around 6,000 older prisoners in England and Wales.  This number is increasing and forecast to keep doing so over the coming decades due to the ageing population, trends in sentencing, and improvements in methods of crime detection leading to the successful prosecution of a greater number of serious offences, particularly sexual crimes.

This is a problem in two senses.  Firstly, it is a problem for prisons themselves – there are no nursing homes or care assistants in prisons; and dementia and incontinence do not sit well with disciplined regimes.  A recent thematic review by the Prisons Inspectorate, Old and Quiet, identified individuals who did not get exercise because they physically couldn’t get to the exercise yard, people who had not washed for several months because they couldn’t stand unaided in the shower, and incontinence problems only identified when other prisoners complained about the smell.  On the other side of the coin, older prisoners contribute greatly to stability on the wings, and many prisons have put in place creative and thoughtful initiatives to ensure older prisoners are cared for, and involved in, prison life.

The second problem is for the individual – how you reconcile yourself to the reality of growing old, and dying, behind bars?  How do you think of yourself when society has deemed that you must be punished until your dying day, or so close to it that there is little chance of constructing a new identity for yourself as a valued member of society?  How do you cope when you have had your first heart attack or stroke and know that there will be no nursing by loving relatives, and your death bed may be the same narrow bunk, in the same bleak and featureless cell, in which you are lying now?  And then there are the realities of everyday prison life, where status amongst peers is defined by how you stand up in a society of troubled and sometimes violent individuals, where there is no concept, in the usual sense, of settling into retirement.

Responsibility for prison healthcare is being transferred from the Home Office, to local service providers led by PCTs according to the requirements of the National Service Framework for older people.  PCTs now have a duty to ensure the same level of services are provided to older people in prison, as to older people in the community.  This will mean that an appropriate assessment procedure will be required to be in place in prisons, which will be the responsibility of the PCT, but is likely to be multi-agency, in line with Single Assessment procedure used in the community.

A small number of Age Concerns currently provide services in prisons, and a number of other Age Concerns are trying to get projects off the ground.  Age Concern England has been involved with this issue for a year or so, facilitating a ‘Forum for Older People in Prison’ which includes the Prison Reform Trust, the Inspectorate, Restore50Plus (a small voluntary organisation devoted to the welfare of older prisoners), the Centre for Policy on Ageing (who hold a Department of Health contract to support the development of the Single Assessment Process SAP), Women in Prison, Nacro, the Howard League and several others.  The director general of the Prison Service met us and gave his full support for our plan of action – to support the introduction of a Single Assessment process in prison, and to provide training to prison staff and the voluntary sector to encourage more community activity in prisons.  

The Older People in Prisons Forum identified the transfer of healthcare responsibilities to PCTs, and implementation of the SAP in the prison environment, as a potential avenue to improve the situation regarding the health and social care of older prisoners.  It has resolved to support the successful implementation of this process.  

There are going to be significant procedural issues in adapting a system from the outside.  For instance, Single Assessment was invented to bring together the systems of NHS trusts and social services, but social services tend not to be active in prisons.  The project will probably only be successful in terms of better care for older people if more relevant services are brought into the prison from the outside, including social services in some form, and increased mainstream voluntary and community sector activity.  It will also only be successful if we look beyond the scope of health and social care services to general wellbeing, like life-fulfilment, issues around death, dying and infirmity, social contact, family, and spirituality.  This will be a major challenge, significantly more difficult and long-term than adapting and implementing the SAP itself.

Ryan Sampson is the Head of the Research and Development Unit
at Age Concern England. He leads the identification and encouragement of best practice in the development of Age Concern services nationally, and the use of research and other evidence to inform practice.  His role covers health and social care, in its widest sense.