Royal College of Nursing: Ombudsman’s blog on dementia in prisons

 

As Prisons and Probation Ombudsman, I independently investigate all deaths in prison, immigration detention and probation approved premises as well as complaints from prisoners, immigration detainees and those under probation supervision. Sadly, demand for my services has never been greater, with a record 304 deaths to investigate in 2015-16, 42% more than 5 years ago.

I have had some difficulty explaining the recent sharp increases in suicide and homicide in prison, but the 172 deaths from natural causes last year are easier to explain. Mostly, they reflect a rapidly ageing prison population (due to longer sentences and more late-in-life prosecutions for historic sex offences). As a result, the number of prisoners over 60 has tripled and is now the fastest-growing segment of the prison population. With age come age-related conditions and, sadly, associated deaths.

In recent years, I have published a series of thematic studies setting out the learning from my fatal incident investigations (all of which are available here). A number of these have looked at the mournful consequences of an ageing prison population. Last week I published a bulletin exploring the experience of prisoners with dementia and the challenges facing prisons in providing them with appropriate care and support .

In some ways these challenges are obvious: prisons designed for fit young men are having to adjust to the largely unexpected and unplanned roles of care home and even hospice. Increasingly, prison staff are having to manage not just ageing prisoners but the end of prisoners’ lives and even death itself.

The bulletin explores a number of issues affecting those with dementia in prison. Some of these will be very familiar to nursing practitioners: for example, the need to give prisoners with dementia help to make informed decisions about their care, where they lack capacity. Unfortunately, this doesn’t always happen. Prisons also need to have a local lead for adult social care to coordinate provision for prisoners with dementia and get the best out of newly accessible local authority support under the Care Act 2014. But, worryingly I still point to examples of unacceptable neglect.

Other issues are more prison-specific. For example, the need to train prisoner carers properly and use them appropriately, or the need for prisons to make reasonable adjustments to their otherwise inhospitable environments. Or, in a challenge to usual security concerns, bringing families into prisons to assist with decisions about appropriate care and support. Another security issue that I get particularly exercised about is the inhumane use of restraints on low-risk, frail, confused and terminally ill prisoners, when taking them to hospitals or hospices. Shamefully, the bulletin gives the example of one such prisoner with dementia remaining chained until the point of death.

Despite these concerns, prisons and their healthcare partners are beginning to move in the right direction. The bulletin offers some examples of good practice in the care of prisoners with dementia and encourages prisons to share this good practice. However, there is a long way to go and the findings confirm my view that the Prison Service badly needs a properly resourced national strategy for its rapidly growing population of older prisoners, to guide its staff in their management of age-related conditions such as dementia.

Nigel Newcomen
Prisons and Probation Ombudsman