What standard of care is available in prison?

Basic principles

The care arrangements in prison should be, similarly to healthcare standards, comparable to the provisions in the community. The primary healthcare providers, NHS trusts or private companies, work with the prison service under the National Partnership Agreement and local authorities are expected to replicate such arrangements with care provisions.

This is where problems begin. An assessment must always be appropriate and proportionate. It may come in different formats and can be carried out in various ways, including face-to-face assessment, phone assessment or joint assessment for prisoners with more complex needs. Where relevant agencies work together to avoid the person undergoing multiple assessments. Other methods such as online or supported self-assessment are normally not used because of the obvious practical difficulties.

Local authority statutory duties are shared with prison governors and the National Offender Management Service (NOMS) who are, in part, respectively responsible for care of the prisoners and people in approved premises. Individuals in custody with care and support needs must have continuity of care where they are moved to another custodial setting or where they are being released from prison and are moving back into the community. To ensure that the individual continues to receive care during the move, local authorities should follow a similar process to ensure continuity of care.

Which local authority?

Inter-prison transfers are both common and frequent and prisoners serving long-term sentences will, typically, spend time in several prisons before release. Individuals in custody cannot be said to  ordinarily reside in the borough where their place of custody is located because the concept of ordinary residence relies on the person voluntarily living in that area. As such, they remain ordinary residents of the local authority where they lived prior to their conviction. It is the local authority where the custodial setting is situated which is responsible for assessments and care provisions for the people serving sentences in their area. Where the adult is being released from prison, their ordinary residence will generally be in the authority where they intend to live on a permanent basis.

When people with existing care needs are entering the prison estate it is important to ensure continuity of care consistent with the arrangements they had in place before conviction. This is not always easy. The Prison Service, including the approved premises has been underfunded for many years and does not have the premises, facilities and resources where complex care needs can be easily met. In such cases, the Governor of the prison or a representative, should inform the local authority in which the prison is located that the adult is to be moved or is being released to a new area as soon as practicable. If this is a move to a custodial setting or release into the community in the same authority, then this council will remain responsible for meeting the individual’s care and support needs. However, if the prisoner is being transferred to the new custodial setting or is about to be released, the responsibility will be transferred to the local authority which covers that area.

How is the care delivered?

The care arrangements are the work of several agencies as the local authorities cannot deliver care in such a restrictive environment without co-operation of the Ministry of Justice and primary healthcare providers. This inevitably causes delays as the communication between them and the coordination of steps necessary to satisfy the statutory duties is often unsatisfactory. This is particularly evident when the care arrangements require use of specialist equipment, fittings or deployment of construction contractors to make significant and costly adjustments to cells.

Are there any differences between the care arrangements in custody and the community?

There are several important points that affect care in prisons.

• Prisoners cannot receive direct payments or have personal budgets.
• They cannot have carers or make decisions about their care without approval of senior prison officers.
• Some aspects of care, other than personal care, may be delivered by other prisoners.

Although the Ministry of Justice’s policy envisages that prisoners engaged in care should be carefully selected, trained and supervised, this is rarely followed in practice and these aspects of care tend to be poor in quality, inconsistent, inadequate and unsupervised. The local authorities often delegate the care to the Governors and primary care providers and become uninvolved or completely detached, sometimes knowing very little about the care users they have a duty to support.

What can be done if things go wrong?

Prisoners with eligible needs must insist on the care assessments that accurately reflect their needs and effective care plans which should be implemented promptly. This is not always easy to achieve. Delays can be extraordinary and consequences serious for the wellbeing of prisoners who require care. Inadequate arrangements can also lead to further deterioration of their physical and mental health. If negotiation and complaints do not resolve such issues, prisoners may find themselves in a difficult situation. If their needs have not been fully understood by those in charge of their care they will not have access to independent experts or other evidence to support their entitlement. If so, legal action may be the only way to force the council and prison authorities to review the care provisions and make appropriate changes.