Dissertation - Grade: 2:1 PDF

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Dissertation based upon the healthcare implications for older men in prison....

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Elderly Prisoners; The extensive healthcare needs of older men in prison.

Student Number: 15010198 BSc (Hons) Criminology Module Code: SO0858 Date: 21/03/18

Word Count: 7995 1

Acknowledgements

This dissertation has been the most challenging throughout my academic degree. It is with great appreciation to Adele Irving for her for her support, encouragement and guidance throughout.

I would also like to acknowledge Seema Patel and Eve Smith for their efforts in providing me with the placement opportunity at Kirklevington Grange. Finally, I would like to thank Karren Watts alongside the staff at Kirklevington Grange for participating in the research, enabling me to write this dissertation.

It is with gratitude to all that have taken the time to support and assist me throughout my degree at Northumbria University.

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Contents  Abstract

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 Introduction

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 Chapter One: Literature Review

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 Introduction  The Ageing Prison Population  Overcrowding  The Prison Estate  Healthcare Needs  Policies and Procedures  Chapter Two: Methods and Ethics

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 Methodology  Ethical Considerations

 Chapter Three: Data Analysis

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 Data Overview  Data Analysis

 Conclusion

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 References

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 Appendices

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 Participant Information Sheet  Consent Form  Approved Ethics Form  Prisoner Interview Structure  Prison Staff Interview Structure 3

Abstract “A high percentage of chronically ill and disabled inmates are, however, much older than the rest of the prisoner population” (Katz et al. 2012), the challenges older men in prison face are extensive to that of the younger prison population. The number of older men being incarcerated is constantly on the rise, this group is a minority within the prison service due to the extensive healthcare needs that they face. The older men in prison are often ignored, however they in fact need to be seen as a priority. The factors influencing the needs of older men in prison are increasingly becoming an issue. A qualitative primary research-based project has been undertaken to aid in this study and provide analysis around the issues affecting older men in prison. The research interviewed participants within the prison service themselves regarding what they thought about the healthcare services it provided, how these impacted on older men and the issues surrounding this topic. This dissertation will identify many factors including; overcrowding, budget cuts, healthcare facilities, the prison estate and the policies and procedures all influencing the prison system and those within it.

This study provides research adding to the current literature around older prisoners and their healthcare needs. In conclusion this research is unique, and the overall findings will be analysed. Analysis can be used in future studies concerning the older prison population and their healthcare needs. This study will aim to answer the question of ‘does the prison service meet the health care needs of older men?’

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Introduction ‘Does the prison service meet the healthcare needs of older men?’

“The threshold for men transitioning beyond middle age increased from about age 44 in the 1920s to about 60 today” (Vernon, 2017), this is an increase in the age at which general population are considered old. The increase in age for this transition is due to the positive advances in the community, however within the prison service this is not replicated and is becoming an issue. The older population is growing considerably and is expected to continue growing at speed (NHS England, n.d). The effect of the population growth has also been seen to have affected the prison population, with the growth in the community replicating itself to the growth of older people in prison. The prison system is a system that needs to constantly change to keep up to date with society’s needs. The needs of older people are beyond the needs of those that are younger according to the Office for National Statistics (2013) “The 45 to 64 age group were almost twice as likely (42%) to report a long-standing illness than those aged 16 to 44 (22%)”, this again is replicated in the prison service with issues being more apparent. The health care system in England and Wales has advanced largely, the effect this has had on the general population and those in prison has been significant. The major rise in the prison population especially that of the older generation has impacted on the health implications of the prisoners. “Prisons are now the largest providers of residential care for frail and elderly men in England and Wales” (Hill, 2017a). Prisoners aged 50 and over are currently the fastest growing population in prison, the number of prisoners in this category has nearly trebled since 2002 to 2016 from 4,800 prisoners to 12,600 in 2016 and is continuing to increase everyday (Newcomen, 2017). As seen due to the difference in illnesses reported by older people compared to that of a younger age group, linking this to the ageing process for prisoners being quicker, meaning the health implications for this group are more extensive. The term ‘older prisoners’ is referred to as those aged 50 and above, this being due to the increase in ageing in prison as it is claimed that prisoners have an age of 10 years extra compared to those in the community (Prison Reform Trust, 2011). Older people both in the 5

community and in prison suffer from many more health implications to those of a younger age, therefore this topic is current and important to study. “Although a 50 year old in the community would not usually be described as older, observers suggest that typically prisoners are functionally older than their chronological age” (Ginn, 2012). In prison today, the health implications that incarceration has on the men inside are increasingly worrying. Most prisoners have multiple health problems, this impacted by the ageing process in prison. Older men suffer from a higher number of reported illnesses this meaning that older men in prison are a group affected highly regarding their health, hence this research. This dissertation will aim to answer the question of whether or not the prison service meets the health care needs of older men through a primary research-based project centred around Kirklevington Grange however analysing the prison system as a whole in England and Wales. Kirklevington Grange is an open prison for men that have been through the prison system, this being beneficial to this study as an analysis of what it is like in different prisons will be provided from first-hand experience. Due to the rise in the prison population and the impact prison has on the ageing of older men, the health implications for older prisoners are a current issue that is understudied. The aim of this dissertation is to question the prison system and the healthcare needs of older men. This study is important as it evaluates the lived experiences of older prisoners and how they are effected by the healthcare system during their sentence.

This project will be broken down to analyse all aspects of the prison system and the healthcare needs of older men, clear reference to current literature, the methodology, a primary research project, and an analysis of the data collected will be provided within the chapters. Chapter one is a review that will discuss and analyse the current literature around older prisoners with clear reference to their health care needs. This chapter will discuss; the ageing prison population, overcrowding, the prison estate, healthcare needs and policies and procedures. The literature review will provide broad and specific research to this dissertation to aid meeting the aim of the study. It will provide an insight into the extent to which based on current literature the prison system meets the needs of older prisoners.

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Chapter two will focus on the methodology and the ethical issues of the research. The nature of this project is one of high risk and involves vulnerable adults therefore the methodology and ethical considerations need particular thought before the actual research can be carried out. This chapter will provide an understanding and an explanation as to why the methods chosen are beneficial and how they will be useful, alongside why other methods have been disregarded. The ethics within this chapter will review any issues faced alongside if and how they can be overcome.

Chapter three will provide a data analysis of what has been found throughout this project, assisting this dissertation in reaching a conclusion around the idea of whether or not the prison system meets the health care needs of older prisoners. This chapter will provide an overview of the data collected alongside an analysis of the primary research. The analysis will refer to the current literature and secondary research, leading to a conclusion in the results ensuring that the aim of the dissertation is met.

There are currently no key theories or concepts regarding the healthcare system in prison concerning older men and therefore this dissertation is unique and has been chosen in order to research and evaluate this topic. The research question of ‘does the prison system meet the health care needs of older prisoners?’ will be answered and argued within this dissertation throughout the chapters described.

Chapter One: Literature Review Introduction “Our prisons are struggling to cope with the emergence of this new population whose characteristics and needs differ greatly from those of the average prisoner” (Jewkes et al. 2016), this concerning older men. Ideas around the concept of incarceration and imprisonment have been debated for many years regarding the issues of whether or not prison works and if it is the best option for older men. Overcrowding, the prison estate, healthcare and the policies and procedures will all be evaluated within this chapter. Research into the study of older prisoners is essential due to the current issues this

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minority group face. Older prisoners, their healthcare needs and the prison system are currently understudied and therefore is an important topic to analyse. The Ageing Prison Population

Incarceration and imprisonment are two themes within this research project that influence the healthcare needs and the ageing prison population. The ageing process in prison is quicker to that of those in the community with the difference of 10 years, as suggested by Kratcoski and Pownall (1989). The acceleration of the ageing process in prison according to Public Health England (2017) is due to “their exposure to a variety of social and environmental factors prior, during and after detention in prison”, this showing that incarceration is one of the main issues regarding the ageing population. The strain of incarceration and imprisonment produces an acceleration on the health of prisoners, meaning these themes are central to the healthcare of older men. Prisoners function older than their actual age due to “their previous lifestyle, lack of prior medical care, and the experience of incarceration” (Ginn, 2012) and therefore this dissertation would be beneficial to any current and future research.

Overcrowding Overcrowding in prison is a major issue within itself, the effects this has on older prisoners are increasingly worrying and plays a major role in their health care needs. “Over 80% of older prisoners have a serious illness or disability… …disabilities associated with chronic disease are more common in incarcerated older people than those living in the community” (Moll, 2013). The increase in the prison population and the issue of overcrowding has been rising constantly for many years. There are a number of factors influencing overcrowding, these include; the general population living longer, more people committing crimes, types of sentences, budget cuts and an increase in incarceration for historic offences, all of which have impacted vastly on the older prison population. ‘Overcrowding places pressure on healthcare facilities, so that prisoners do not have access to the level of support they need” (Criminal Justice Alliance, 2012). If men cannot access the support they need in prison their health is suffering, leading to quicker deterioration. “Since 2000 there has been a marked increase in the length of the average 8

custodial sentence” (Criminal Justice Alliance 2012), this is one reason for overcrowding. The increased amount of time in prison is increasing the ageing process for the men inside, the amount of people being sentenced to indeterminate sentences, those serving life, has increased also influencing this. All reasons for overcrowding have impacted negatively on the healthcare needs of older prisoners and is a current issue within the prison system. Prison Estate The prison estate was predominately built for young, fit and able men and therefore there is an argument around whether this is impacting on the healthcare needs of older men. Prisons were built many years ago and are surrounded by lots of steps, small cells and long narrow corridors and are built for the younger generation (Hill, 2017b). The older population suffer from more health issues than the younger generation in the community, the prison estate increases the impacts of this. The health implications for older men are increased due to the struggle and issues faced in response to the way in which the prison estate is built. Tarbuck (2001) states that “the health of older prisoners is inferior to that of the general population and their use of medical services is correspondingly higher”, this statement shows that the older prison population are suffering with more health care issues to that in the community, the state in which our prisons are in is impacting negatively on this issue.

The way in which the prisons are built makes it more difficult for older men to live, their mobility is not at the ability of which the younger prison population has. The stairs, small cells and shared facilities impact on their healthcare needs and make it more difficult for older men to survive in the prison on a daily basis. Healthcare Needs Fatality within the older generation comes with a progressive decline in the individual’s overall health, and the older an individual becomes the frailer they become (Age UK, 2018). The overall health of an older individual in society with the impact of imprisonment increases the speed at which they age, making way for the argument that the prison system may not be meeting the healthcare needs of older prisoners. Møller et al (2007) 9

recognises that the prison service is a public service and therefore prisoners have the same rights to healthcare as those within the community. Møller et al (2007) also provides the idea that it is the role of the prison service, the prisoners and the community to be responsible for the health of prisoners. As it is found that the general older population are a minority group that suffer from extensive healthcare needs it is established that older prisoners are even more disadvantaged. Rethink Mental Illness (2011) provides a fact sheet to people in or going into prison providing them with an idea about the healthcare they should receive during their sentence. This fact sheet outlines the idea that all prisoners are entitled to the same healthcare services that they would receive in the community. The document lists that; health screenings and medical examinations will be carried out upon arrival into prison, there will be a healthcare team within the prison that prisoners will have access too, people to talk to and services you can access if needed. These are the things that should be provided to prisoners concerning their healthcare, however this is not necessarily the case especially in circumstances regarding older men. Reports from doctors to the Guardian written by Taylor (2017) states that “doctors working in prisons have warned that the conditions in which they operate are so unsafe that the services would be closed down had they been outside the prison system”. These reports go against all aspects of what should occur in prison regarding the health care system. There have been many arguments about the healthcare system in prison not meeting the standards of that in the community, policies and procedure should impact this. Policies and Procedures

Policies and procedures have been changing constantly throughout the years to meet the current needs of the population, many of which have affected the prison population. There are many policies and procedures that the prison system must abide by regarding the prisoners and their health, these include; the Equality Act 2010, national frameworks and risk assessments. The policies and procedures will be discussed regarding older men within this review providing an evaluation and an understanding of what this group in prison are entitled to and should receive.

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“The Equality Act 2010 requires the Criminal Justice System to eradicate discrimination, provide equal opportunities, and promote harmonious relations between groups” (Prisonreformtrust.org.uk. 2017). The Criminal Justice System (CJS) are required to support and meet the health care needs of older men in prison as older prisoners are affected by the Equality Act. This act bans any discrimination against individuals due to their age and entitles them to equal opportunities. The Equality Act 2010 replaced the Disability Discrimination Act 2005, this act brought discrimination for older men in prison into place as the requirement of the Disability Discrimination Act came into effect in prisons in 2004 (Docherty, n.d). The components of the Equality Act are in place to protect older men in prison from discrimination, however this is not always the case. Statistics show that in 2004 when the Disability Discrimination Act came into place 44 prisoners aged 60 and over died in prison of natural causes, however in 2016 this rose to 124 prisoners, (Ministry of Justice, 2017). Although the older prison population itself is increasing the policies in place should provide older men in prison with more support and therefore these statistics should be decreasing rather than increasing. Older men in prison should be receiving more support to reduce deaths, this exposing the prison service regarding their care to older men despite the policies in place to support them. Between the NHS and the prison service a National Service Framework (NSF) has been established this is a framework that sets a standard of care that should be provided to older people in prison. The NSF is based upon eight standards these being; rooting out age discrimination, person-centred care, intermediate care, general hospital care, stroke, falls, mental health and the promotion of health and active life (Milburn, 2001). The HM Chief Inspectorate of Prisons (2008) found that “only 11 reports stated that health services had a nurse lead for, or a focus on, older prisoners, although this is a requirement of the National Service Framework for Older People.” It is argued that although there are policies and procedures in place for older men in prison not all prisoners of such age are receiving the care they deserve. This being a current issue within the prison service today.

Risk assessments and reviews are something that should take place in every prison for all men, however these should be extensive for men over the age of 50 due to their healthcare needs being more severe. These reviews also come under the NSF as it states 11

that “newly arrived prisoners have an appropriate health screen that reviews their medical history and conditions” (HM Prison Service, n.d) Appropriate health screenings should be carried out on all prisoners however due to ...