2014 - Scottish Prison Service Evaluation of High Care Needs Prisoners - SPS Page 1 of 62 CHAPTER 1: INTRODUCTION 1.1 Background The 2012 High Care Needs Assessment1 conducted for

Figure 8 Consultancy Services Ltd

First Floor

30 Whitehall Street

Dundee

DD1 4AF

01382 224846

[email protected]

www.figure8consultancy.co.uk

2010

EVIDENCE INTO PRACTICE

Figure 8 Consultancy Services Ltd

First Floor

30 Whitehall Street

Dundee

DD1 4AF

01382 224846

[email protected]

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

mailto:[email protected]


Evaluation of High Care Needs Prisoners - SPS

Page ii of vi

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)


http://www.f8c.co.uk/


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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.

http://www.ohchr.org/EN/ProfessionalInterest/Pages/BasicPrinciplesTreatmentOfPrisoners.aspx

http://www.euro.who.int/__data/assets/pdf_file/0007/98971/E94242.pdf

http://www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf?ua=1


Page 9 of 62

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.


Page 10 of 62

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.

http://www.scotland.gov.uk/About/Review/commissiononwomenoffenders/finalreport-2012


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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.

http://www.scottish.parliament.uk/S4_JusticeCommittee/Inquiries/Prisoner_Healthcare_-_Annual_Report_to_CEOs_-_November_2012.pdf



Page 12 of 62

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.

http://www.sps.gov.uk/nmsruntime/saveasdialog.aspx?fileName=Prisoner%20Survey%20-%20Bulletin%2020113696_724.pdf



Page 13 of 62

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).


Page 14 of 62

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.

http://www.scotphn.net/pdf/2012_06_08_Health_improvement_for_prisoners_vol_1_Final_(Web_version)1.pdf


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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


Page 17 of 62

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


Page 20 of 62

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.


Page 22 of 62


Page 23 of 62

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?


Page 24 of 62

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?


Page 25 of 62

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


Page 26 of 62

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;


Page 27 of 62

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;


Page 28 of 62

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.


Page 29 of 62

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


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


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


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


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


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.


Page 56 of 62


Page 57 of 62

APPENDIX II: References

Anderson, S. (2011). The Social Care Needs of Short-Sentence Prisoners: A Literature Review.

Revolving Doors Agency. Available at: http://www.revolving-doors.org.uk/documents/the-

social-care-needsof-short-sentence-prisoners/ [accessed 21 March 2014].

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_ver

sion)1.pdf [accessed 08 March 2014].

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].

Commission on Women Offenders (2012). Commission on Women Offenders: Final Report

2012. Edinburgh: Scottish Government.


[accessed 12 March 2014].

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.

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.

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.

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.

Howse, K. (2003) Growing Old in Prison: A Scoping Study on Older Prisoners. London: Prison

Reform Trust.

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.

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].

http://www.revolving-doors.org.uk/documents/the-social-care-needsof-short-sentence-prisoners/

http://www.revolving-doors.org.uk/documents/the-social-care-needsof-short-sentence-prisoners/







Page 58 of 62

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].

Moll, A. (2013). Losing Track of Time. London: Mental Health Foundation.

Prison Reform Trust (2008). Doing Time: the Experiences and Needs of Older People in Prison.

London: Prison Reform Trust.

Prison Reform Trust (2013). Bromley Briefings Prison Factfile: Autumn 2013. London: Prison

Reform Trust.

Prisons and Probation Ombudsman (2013). Learning from PPO Investigations: End of Life Care.

London: COI.

Reimer, G. (2008). ‘The Greying of the U.S. Prisoner Population’ Journal of Correctional Health

Care’, 14: 202-208.

Rutherford, M. and Duggan, S. (2009). ‘Meeting Complex Health Needs in Prison’, Public

Health, 123: 415-418.

Scottish Executive (2006). Reducing Reoffending: National Strategy for the Management of

Offenders. Edinburgh: Scottish Executive.

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).

Singleton, N., Meltzer, H. & Gatward, R. (1998). Psychiatric Morbidity among Prisoners in

England and Wales. London: Stationery Office.

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.asp

x [accessed 10 March 2014].

United Nations Office on Drugs and Crime (2009). Women’s Health in Prison: Correcting

Gender Inequality in Prison Health. Copenhagen: World Health Organisation.

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].

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].

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.





http://www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf?ua=1

http://www.euro.who.int/__data/assets/pdf_file/0007/98971/E94242.pdf


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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


26 Mick Grattan

Vice Chairman, POAS Prison Officer Association

Scotland


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Category: Sodexo Staff (HMP Addiewell)


27 Harry Mennie Head of Prisoner Management HMP Addiewell/Sodexo

28 David Goldthorpe Unit Manager HMP Addiewell/Sodexo

Category: NHS prison based staff


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


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


47 Kathleen Bessos Deputy Director of Integration and

Reshaping Care

Scottish Government

48 Alan Baird Chief Social Work Advisor Scottish Government


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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


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


73 AF Family member HMP Barlinnie


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