Medical Provision And Personal Care
This report does not seek to provide an assessment of the medical care and treatment given to prisoners who are over the age of 60. It does however report on the views of the prisoners in relation to their perception of care in a medical context and the views of staff spoken to who manage elderly prisoners on a regular basis.
The prisoners interviewed and the respondents to the questionnaire generally commented favourably on their dealings with healthcare professionals. However there were negative comments about getting their normal prescribed medication. Some spoke about their experiences of waiting, sometimes days to get their medication sorted out:
"When I was transferred into my last establishment from Barlinnie, I had to wait three days to get medication which I had been getting and needed at Barlinnie. I was eventually given what I needed but I felt like it was a case of just get on with it, we're busy."
Table 4: Are you on a prescribed medication?
A number of prisoners voiced concerns in relation to the way in which medication was managed and issued:
"You have to put in your requests for medication on a weekly basis. To be honest, it's a bit of a joke. Half the time there's a problem and you have to go back to them or get an officer to phone up and see what the problem is."
Table 5: What medical aids do you require?
Staff stated that there is often not enough for the prisoners to do in order to keep themselves occupied in a meaningful manner. A number of older prisoners said that they want to work even though there is no requirement for them to do so. One prisoner summed it up as follows:
"I might be nearly 70 but I enjoy getting up and going to the work shed. Ok it's not exactly hard graft but I enjoy it. I want to keep going as long as I can and try and keep my mind working."
Clearly for this prisoner, the fear of losing his mind was a very real possibility and he felt if he could work and get out of the hall, then this was helping to stimulate his mind. He explained that this fear arises from witnessing other prisoners who he believes fall into this bracket. Staff may not be equipped to recognise the onset of dementia, nor are trained to offer appropriate dementia care.
A few staff commented positively on some training that they had received to identify signs of the onset of dementia. They acknowledged this is an area of management of prisoners which they may have to deal with in greater numbers in the future:
"We've got prisoners in here suffering from dementia. Surely this isn't the right place to be putting these people. What are we supposed to be doing with them? We're not really trained nor do we have the time to spend on individuals who require that increased level of support. That's a job for a nurse or at least a medically trained person you would think."
"Ok we've had an insight into this but it's a bit of a minefield to be honest. The thing about it is you are being asked to deal with these prisoners in a setting where you also have prisoners who are young, fit and healthy."
Complex care needs
This observation shows that staff are acutely aware of the risks involved in the population management issues which are applicable to many of the elderly prisoners in their care. They are effectively being asked to manage prisoners with very complex care needs in a setting where they also have prisoners who are exactly the opposite - fit and healthy. This requires a constant change in approach from the staff managing them. Many staff and prisoners commented on the kindness they had seen from prisoners towards the elderly who are struggling with aspects of their personal care in prison.
Where care assistants are employed to support older prisoners, staff spoke in positive terms of their work and contribution. They argued that this provision should be increased and clarity around roles and responsibilities improved:
"What happens when there is no care assistant available? Who do they think deals with these guys? That's not what I'm here to do."
In another establishment a member of staff displayed a very high level of care and compassion:
"There's no point asking guys who are not interested in these guys to work with them. Some of these prisoners are incontinent. Now to me you just can't leave some of these guys sitting around in that state. I cared for someone who was like that in the latter stages of their life so I know what I'm doing and to be honest I've not got an issue with that."
This example demonstrates the positive lengths some staff would be willing to go to in order to care for elderly prisoners. It is notable that almost every prisoner we interviewed named specific staff members who they felt went above and beyond what was expected of them in their approach to care:
"X (officer's name) is a really decent officer, whereas when certain individuals are in the hall you just get the feeling from them they are not interested and don't even want to speak to you, never mind deal with any of your care or medication issues."
Lack of decent and humane treatment
Prisoners in several establishments reported that they felt either their medical or general care needs were not treated in a decent and humane manner. It was clear that some prisoners had experienced some very distressing treatment and two prisoners were each in tears when they related the following two examples.
A seventy five year old man spoke of an experience which occurred to him whilst he was out at court that he found very distressing:
"I was going from the cells up to the court and I had previously told the turn-key that when I needed the toilet I really had to go there and then. I tried to explain in as decent and respectful a manner as possible that if I didn't get to the toilet when I asked I would end up messing myself. I was told in no uncertain terms that I would get to the toilet as and when they could let me go, end of story. Sometime later I was being taken to the court and I asked to go to the toilet. This was met with some unhelpful comments and a refusal at that time. The inevitable happened and I ended up messing myself. I didn't go to court and had to be put in to a paper suit. When I was being taken back in the van all the other prisoners were shouting at me. I felt totally humiliated. I know what I have been convicted of even though I never done it, but is that really any way to treat a seventy five year old man who was only asking to go to the toilet. It's not as if I am going to try and get away or anything. I mean I literally have to be close to a toilet or that's what happens."
Another prisoner was very distressed when relating this incident:
"I woke up after having heart surgery and found myself handcuffed to a turn-key. I mean is that some kind of sick joke. I'm in my seventies I can hardly walk never mind run. I'm not exactly a threat to them physically so why on earth am I handcuffed. Then when I go to the toilet trying to push a stand with my drip on it I am also handcuffed. I have never felt so humiliated in my life. The other thing is when you are out at hospital, trying to get clean clothes or stuff from the canteen is just a nightmare. They are just not interested and the fact you are an old man it's as if they think they can treat you any way they like. I know I am a convicted sex offender but surely that's all a bit over the top in terms of security. Where am I going to go even if I could get away? Nobody is interested in me."
At this point the prisoner broke down in tears in front of the research team. He clearly accepted his guilt and felt that he did not deserve to be treated with any exceptional care by anyone. Yet he was hoping to be treated with minimal human decency, but felt that this was sadly lacking.
A number of prisoners raised issues with the research team about the care they received when under escort at hospital. Several other prisoners also described instances where they awoke to find themselves handcuffed to an escort after receiving major surgery in hospital.
Finally, one further issue of concern regarding medical care was brought to the attention of the research team by a prisoner interviewed. During the course of the interview the individual was asked about his experiences with the healthcare team within the prison. Although interviewers reported that he was reluctant to criticise anyone, he did offer up the following insight into his particular situation:
"I am waiting to go out to hospital for an operation. In advance of that operation a number of tests have to be carried out. I have been scheduled to have these tests now on three occasions. The previous two have been cancelled due to staffing issues, or so I am told. What these people don't seem to understand is the fact that I am sitting here not knowing if I have something seriously wrong with me and these tests are part of the way I will find out. It's as if they just don't care but I am the one who has to live with the stress of it all."
Discussion and Recommendations
The testimonies of prisoners interviewed for this review reveal large inconsistencies in their experience of medical and personal care. There appear to be wide variation in the levels of basic human decency and humane treatment of prisoners.
This raises both practical and moral issues for the criminal justice sector in addressing the management of elderly prisoners. These could be tackled through the introduction of a personal care plan for every ageing prisoner. The care plan should highlight the specific care needs of the prisoner and how these should be met. Plans should be readily available to the relevant staff and should accompany the prisoner if they are moved to another location.
A personal care plan should form part of the specification of contractual obligations with other parties who are involved in the management of prisoners for the Scottish Prison Service. In this way problems such as incontinence and the implementation of escort during medical treatment can be managed sensitively, appropriately and consistently to ensure that elderly prisoners receive humane treatment.
When prisoners are transferred from one prison to another, the delays in the provision of medication should be minimised. There is a need to ensure that the care for prisoners taken under escort to hospital appointments is appropriate.