In November 2017, Public Health England published a new guidance document, ‘Health and social care needs assessments of the older prison population’. The guidance is aimed at commissioners and providers of prisons, prison healthcare services and social care services. It is intended to lead to collaborative, informed assessments of need and consequently improve the health and wellbeing of older people in prison.
The guidance has been developed in response to increasing numbers of older people in prisons in England, and legal developments arising from the Care Act 2014. It is designed to sit alongside the Prison Reconfiguration Programme and Prison Rebuild Programme in terms of its implementation.
Her Majesty’s Prison and Probation Service defines people in prison over 50 years of age as ‘older’. Since 2002 the proportion of older people in prison has increased by 150%. This is attributed to a number of factors including an ageing population in England, historical sentencing practices (such as indeterminate IPP sentences) and an increase in late-in-life prosecutions. Evidence also suggests there is a high level of physical and mental health problems in the older prison population.
Guidance has previously been issued in relation to Health Needs Assessment (HNA) (which is a systematic method of reviewing the health issues facing a population, leading to agreed priorities and resource allocation to improve health and reduce inequalities) for people in prescribed places of detention, and this is built upon for older people specifically in the new guidance. However, the new guidance addresses health and social care needs together leading to the Health and Social Care Needs Assessment (H&SCNA).
It is considered good practice at the outset of an assessment for the lead agency, usually NHS England or the local authority, to establish and chair a working group consisting of all relevant stakeholders of the prison(s) to oversee the development and delivery of H&SCNA recommendations for prisons in their area.
The total care pathway should be taken into account from reception to discharge. The guidance is structured around 13 chapters addressing key themes that should be considered when undertaking the H&SCNA for older prisoners. The guidance is intended for use in establishments with a larger older population and can be used as a standalone document or as an aid to fully assess an older person’s needs as part of a HNA.
The considerations of the H&SCNA should include:
- the demographics of the population – this will vary between areas and will need to take account of the Prison Reconfiguration Programme which will determine if an establishment is a reception, training or resettlement prison
- a review of the physical environment – this can provide particular challenges for the provision of health and social care where adaptations are difficult to undertake, and prisoners missing out on elements of day to day life due to environmental restrictions is not uncommon
- the risk factors for disease – examples include smoking, substance misuse, alcohol misuse, obesity
- prevalence of disease – usually higher than community peer group or younger population in prison
- medicine optimisation – safe and effective use of medicines for the best possible outcomes, with planned pharmacy services and administration of medicines support
- prevalence of social care needs – social care being defined within the Prison Service Instruction 12/2015 (taken from the Care Act 2014). All aspects of the prison environment are likely to be relevant to this. Planning for discharge is also particularly important to take account of discharge destination and differing social care needs, with statutory obligations relating to assessment set out within the Care Act 2014.
- promoting health and wellbeing – this may include actions such as national screening programmes, immunisation programmes, physical health checks, promoting weight management, smoking cessation
- palliative care services – most prevalent in the older population
- user engagement – this requires pro-active engagement
- mapping of services to meet need - firstly to map out the provision of health services as they currently exist and how well they are currently utilised, and secondly to identify gaps where provision is not currently sufficient
- planning for release and continuity of care – particularly important with the older population and changes in location that can result from incarceration
- prioritisation and implementation – key findings should be summarised in this section, identifying inequalities, comparison with prior needs assessments and priorities for action.
The working group established at the outset can work collaboratively to take a list of recommendations from the above considerations to form an action plan.
The guidance is another step in the drive towards greater integration and collaboration between health and social care. H&SCNA is an important part of the commissioning cycle and results should inform procurement processes.
It should be noted that the movement of prisoners is a significant factor to take into account when undertaking the H&SCNA, hence the overall pathway being considered within this guidance is welcomed to promote greater consistency of service provision to meet the needs of the older prison population. Numerous commissioning, procurement and governance issues are likely to arise in the future where legal aspects of those processes may be complex, particularly due to the collaboration between different organisations.