RECOOP’s written response to The Health, Social Care and Sport Committee’s inquiry on Welsh prisoners’ experiences of health and social care services in the adult prison estate.
1. “A one size fits all approach to diet, exercise, rehabilitation and medical treatment is outmoded and is effectively a form of age discrimination.”HMI Prisons and the Prison and Probation Ombudsman (PPO 2017)
“Up to 90% have at least one moderate or severe health condition, with more than 50% having three or more.” MOJ 2018-MOD – Older Prisoners
2. RECOOP’s mission is to help and promote the care, resettlement and rehabilitation of older offenders and ex-offenders. RECOOP aspires to be the leader in the delivery of knowledge and expertise to older people who come in contact with the criminal justice system, supporters and the staff who work with them. We continue to use the views of the people we work with to influence and direct the services that should be delivered.
3. People aged over 50 are the fastest growing group in the prison population and meeting their needs will continue to be one of the biggest challenges facing the criminal justice system for years ahead. A significant number of this population will be eligible for health and social care support in prison, but not all will currently be accessing it.
4. RECOOP has been pioneering new, effective ways to support older offenders and ex-offenders. We are gaining increasing national recognition for our work and have contributed to seminal policy documents, most recently HMPPS’s Model for Operational Delivery (Older Prisoners).
5. We are one of very few organisations working specifically to support the needs of this population. Our services have been recognised as good practice by Her Majesty’s Inspectorate for Prisons (HMIP), Independent Monitoring Boards (IMBs) and Her Majesty’s Prison and Probation Service (HMPPS). With a national footprint, we are a registered charity working to empower older people within the criminal justice system to take control of their lives, to optimise their physical and mental health, well-being and to remain free from re-offending.
6. In 2008 RECOOP developed an informal prisoner Buddy Support Service to reduce the amount of neglect, abuse and manipulation we could see our vulnerable service users were being subjected to. Following the introduction of the 2014 Care Act, Devon County Council and RECOOP formalised and adapted the national Skills for Care Certificate standards with training modules to fit a prison setting. This new Buddy management and training service was introduced into the three Devon prisons and is still running to date. The service is commissioned jointly by the three prisons and Devon County Council. RECOOP has delivered the training in seven other prisons across England and Wales including HMP Usk. We hope to roll out this training and management service in a further six English prisons by the end of the year and discussions have started with HMP Parc. We believe that this tried and tested formalised prison Buddy Support model should be considered alongside other potential improvements for current services in Welsh prisons. Development work to map the standards to a Health and Social Care Level Two Diploma (NVQ) is underway.
7. The main objective of the Buddy service is to empower and support vulnerable individuals to control and maintain their independence, good health and well-being whilst offering safeguarding assurances for the Statutory services. This has increased both confidence and self-esteem, promoting better mental health with reduced anxiety and increasing resilience. Many of those who do not meet the social care threshold for packages of care will have social care and support needs to enable them to live independently and well in a prison environment.
8. “My Buddy provides the help and support I need to maintain health and hygiene. He covers the day to day tasks I’m unable to do such as cleaning my cell thoroughly and making my bed. He helps at meal times and ensures that I have water, as I scold myself. My Buddy is aware of the difficulties I have and he encourages me to maintain personal hygiene and takes me to another wing so that I can use the disabled showers.” (Prisoner quote)
9. We have seen a continual demand for this support, but more troubling is the number of Buddies who are now supporting individuals with palliative and end of life care (EOLC). We’re seeing an increase in individuals resigned to the fact that they will die in custody. This might be due to the combination of age when sentenced and length or resulting from a life limiting diagnosis. The weight of this, both emotionally and psychologically, has a detrimental impact on both physical and mental health. They have a very ‘different sense of time’.
10. To date we’ve trained more than 200 Buddies in 10 prisons. In one prison we have 10 who have also trained as Dementia Friends. The impact of the training and role on those delivering it has been staggering. We have started to see Buddies supporting individuals through to end of life and have now developed two new modules that are being tested and reviewed at the moment. We are supporting our prison healthcare partners and external organisations to introduce an external supervision service for the Buddies. Currently in Devon our optimum number of Buddies fluctuates between 25-35 across the three sites supporting a significant growing number of vulnerable individuals with support plans.
11. The risk assessment and screening process agreed for potential new Buddies implemented within the Devon prisons is working really well. The calibre of new Buddies remains high and the Buddy team is recognised as an integral part of the daily regime. The working relationship, particularly with the prison healthcare department where they immediately highlight deteriorating health or concerns, is saving considerable time and resource; both preventative nursing work and healthcare staff responsibilities. The Buddies are accessible and supporting clients all day, every day. The time invested is far greater and allows a trusting and supportive working relationship between the client and Buddy. The Buddy responsibilities compliment the Prison Service Instruction (PSI 17/2015 Prisoners supporting other prisoners).
12. “Working as a Buddy here has been a brilliant experience and one that I would and will recommend to everyone. I have been in prison for more than two decades and worked within the prison estate in many different roles during my time inside. Working as a Buddy has changed my life and in doing so has given me a new lease of life which I never thought possible. Being able to help other prisoners, many who have very complex needs, disabilities and illnesses has given me so much more from life that I never knew existed. To be fulfilled in this way gets me out of bed in the morning with a head and heart full of purpose and eager to start the day.”
13. “The effect that I have on my client’s daily life is so important that I can’t not go to work. All those little things that able-bodied prisoners take for granted, they just can’t do these simple daily tasks that I help with, cost me nothing, yet how they make me feel is priceless. I feel valued for the first time in my life and now have purpose to the long days in here. I used to feel a bit sorry for myself, a little worthless and more than a little depressed on the occasional day, but working as a Buddy has helped me put everything back in perspective, it’s given me Life! I never knew that I could feel this good about myself just by helping others.”
14. The training modules contained in the training are as follows:
· Understanding your Role and Personal Development
· Duty of Care
· Equality and Diversity
· Working in a person-centred way
· Communication and Advocacy skills
· Privacy and Dignity
· Fluids and Nutrition
· Safeguarding Adults
· Health and Safety
· Handling Information
· Cleaning and Infection Prevention/Control
· Assisting someone in a wheelchair
· Awareness of Mental Health, Dementia and Learning Disability
· Health and Healthy Ageing
· Bereavement
· End of Life Care (EOLC)
15. Buddies are being recognised across the prison more and more as key roles. They’re setting up wing-based small social inclusion and well-being clubs and activities – book clubs, reminiscing sessions, current affairs and quizzes to break up the boredom and offer meaningful activities for those with mobility issues and memory problems.
16. We’re seeing more referrals from prison partners to help those with mental health problems and invest time to those struggling with depression and learning difficulties. A particular individual was boomeranging in and out of the segregation unit and being disruptive. The allocation of a Buddy to provide some 1-2-1 support has resulted in a change of behaviour that has reduced the requirement to manage it with this resource.
17. Trained Buddies are moving between the three prisons as part of their sentence plan and providing consistency in practice.
18. Case study
Prisoner x had a severe stroke and was moved from his prison to the healthcare wing at the local prison in the cluster.
A healthcare wing Buddy was allocated and attended the physiotherapy appointment with the prisoner who had a stroke. He then spent three months walking up and down the wing completing the strengthening exercises and encouraging the recipient with support to work towards getting his independence back.
After three months the stroke victim was well and independent enough to return to his original prison, freeing up a valuable healthcare bed on the local prison unit and reducing the bed blocking difficulties for the prison.
Stakeholder quotes
19. Head of Adult Care Operations and Health, Devon County Council
“DCC believes that the Devon Buddy model is critical to the implementation of new Care Act responsibilities for local government in a prison setting. The support and co-ordination of this model needs to be provided to ensure it is fully bedded into prison practice reducing the costs associated with deteriorating health and care needs. The partnership approach from RECOOP has brought informed and innovative solutions which have enabled Devon County Council to deliver its responsibilities in relation to the Care Act.”
20. HMP Head of Residence
“The role of the Buddies has in no small way helped to prevent cases becoming more complex”.
21. Social Care Manager – HMP Exeter
“Buddies do not just help other prisoners. They are effectively helping staff by ensuring that those with social care needs are assisted in maintaining as positive and productive life as possible. It can also be argued that their work directly saves money and other resources by preventing prisoners from deteriorating to a level that requires medical intervention or outside hospitalisation.”
22. Prison Governor Quote
“Liz (RECOOP) has been instrumental in providing training and support which would be extremely difficult to match if we were to provide the same service. Current operational difficulties would make it impossible to provide the same level of service. F Wing and other prisoners who do not meet the criteria for Social Care benefit greatly from the Buddy role, providing preventative support which, if left unchecked, would result in additional social care needs. The Buddy system and training give us assurance that the relevant PSIs, prisoners assisting other prisoners, are fully complaint.”
23. Quotes from Prison Staff
“Buddy Support workers fit with the drive for efficiency savings and delivering value for money. They are able to assist other prisoners to lead a safe and dignified life in custody in ways that prison staff are not able to do. Buddies have the time to spend with other prisoners and can make a real difference to their quality of life that prison staff would not be able to do, including preventing social isolation.”
Submitted by RECOOP – 10/05/19
Chief Officer