Matter for Discussion: Prison nursing

Members can view a recording of the debate here.

Changes to the prison demography in relation to years of under investment has resulted in practical, moral, and legal challenges for prison administrators. These issues not only have an impact on prisoners and prison nurses but subsequently, community health and social care professionals on release.

The proportion of older prisoners has increased dramatically, with 14,000 prisoners currently over the age of 50 in UK prisons. Up to 90% aged 50 or over have at least one moderate or severe health condition, whilst 50% have three or more (Criminal Justice Alliance, 2020). Increased frailty and disability expose issues in relation to supporting older prisoners with their activities of living, treatment and access to formal health and social care services (HM Inspectorate of Prisons, 2018). These issues are set to the backdrop of increased disorder, violence, self-harm, overcrowding and increased drug use, which have been exacerbated over years of austerity, resulting in reduced spending and staffing.

In Northern Ireland, prison nurses should be involved in influencing a systems perspective, acknowledging that the various parts of the prison system (and not solely the health care service), work together over a range of health and social care issues across the offender pathway. The design and operation of prisons is based on the ‘age crime curve’, which assumes that prisoners are young and abled bodied (Mann, 2012). This means that accommodation and activities are undifferentiated by age and can lead to increased marginalisation and isolation. There are socio-material issues in terms of the fabric and design of prisons, as well as the quality of equipment and furniture, which can all have an impact on a prisoner’s health, social activity, and accessibility (Stewart, 2018).

With the effects of COVID-19 resulting in longer periods in cell isolation, there are increasing numbers of older prisoners who are living with dementia, thereby raising legal and moral questions on the value of punishing people with capacity issues. In addition, there are also justice issues in terms of longer sentences in later life, leading to increased numbers of people dying in prisons (Shaw et al, 2020).

With increasing numbers of older prisoners importing greater levels of dependence, vulnerability, and social need, social services are not filling the gaps, as such, with prisons falling short of the target of parity with community services, as set out in the Care Act (2014), (Tucker et al, 2018). These issues increase the existential precarity of older prisoners in prisons and on release, make it a public health concern.

Privatisation and austerity have led to pared back models of healthcare delivery, which serve to limit the role of nurses and the time they spend with vulnerable and dependent prisoners. The issues combine to challenge prison nurses’ ability to work within their scope of practice, and this is without adequate training.

The level of need, vulnerability and complexity among the population has increased, whilst the level of resourcing has decreased. Aside from detaining and rehabilitating sentenced prisoners, prisons now serve another purpose, that is, the care and support of people with frailty, physical, sensory, and mental disabilities. It is time to recognise this change and resource prisons not only as a site of punishment, but simultaneously as a site of care. The work of the National Prison Care Network in Scotland owes much to RCN Scotland’s 2016 report, Five Years On, and the subsequent 2017 Scottish Parliament Health and Sport Committee report, Healthcare in Prisons, both of which highlighted the differentiated needs of older prisoners. 

Reading lists for each agenda item can be found here.

References 

Criminal Justice Alliance (2020) Written evidence from the Criminal Justice Alliance, Available at: http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/justice-committee/ageing-prison-population/written/105966.html (Accessed 22 April 2022)

Her Majesty’s Inspectorate of Prisons (2018) Social care in prisons in England and Wales, Available at: https://www.justiceinspectorates.gov.uk/hmiprisons/inspections/social-care-in-prisons-in-england-and-wales/ (Accessed 22 April 2022)

Mann N. (2012) Doing harder time?: the experience of an ageing male prisoner population in England and Wales, Aldergate: Ashgate Publishing 

Royal College of Nursing (2016) POLICY: Five years on: Royal College of Nursing Scotland review of the transfer of prison health care from the Scottish Prison Service to NHS Scotland, Available at: https://www.rcn.org.uk/about-us/our-influencing-work/policy-briefings/SCO-POL-Five-Years-On  (Accessed 22 April 2022)

Shaw J, Norman A, Lyon J, Heathcote L, Bernard A and Worthington N (2020) Avoidable natural deaths in prison custody: putting things right:  Independent Advisory Panel on Unnatural Deaths and The Royal College of Nursing, Available at: 
https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/clinical-topics/nursing-in-justice-and-forensic-healthcare/prevention-of-natural-deaths-in-custody-final-nov-2020.pdf?la=en&hash=0992599A705070ED06C9821DDE97B505 (Accessed 22 April 2022)

Stewart W (2018). What does the implementation of peer care training in a U.K. prison reveal about prisoner engagement in peer caregiving? Journal of Forensic Nursing 14(1) pp.18-26.

Tucker S, Hargreaves C, Roberts A, Anderson I, Shaw J, and Challis D. (2018) Social care in prisons: emerging practice arrangements consequent upon the introduction of the 2014 Care Act, British Journal of Social Work, 48, pp.1627-1644. 

Wahidin A, and Aday RH (2010) Later life an imprisonment IN Dannefer D and Phillipson C, (editors)The Sage Handbook of Social Gerontology. Thousand Oaks: Sage pp.587-596. 

UK Government (2014) Care Act, Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents/enacted (Accessed 22 April 2022)