The recent report from the Prison and Probation Ombudsman [1] bears out many of the trends that we have been seeing in our ongoing research study ‘Both sides of the fence: using action research to improve end of life care for prisoners’, which has been examining the complex issues surrounding dying in prison.
Working in a single prison, the population we see exemplifies what the Ombudsman has described; prisoners in their eighties and nineties, with complex co-morbidities, limited mobility and cognitive impairments – to name but a few of the challenges they face.
The prison we are working in, like most of the prisons estate, was built with an overwhelmingly male, young and fit population in mind and has stairs, long corridors and cell doors too narrow for wheelchairs and inaccessible to a stretcher should urgent hospital admission be required.
People aged 60 and over are the fastest growing section of the prison population [2], and this increase in older, frail prisoners is taking place against the background of a significant reduction in staff numbers; the number of staff employed in the public prison estate has dropped by 29% in the last four years [2].
For staff and prisoners this means that managing an already demanding set of circumstances has become even more difficult.
Staff are working in close proximity to people for whom their responsibilities are custodial but who may be seriously ill or close to death. They face considerable challenges in trying to deliver appropriate, compassionate care to those who may represent a significant risk to the public or have committed offences which are likely to provoke strong feelings in most people.
For prisoners, there is distress and fear evoked by living for long periods in such circumstances and the reality that, contrary to popular belief, they are extremely unlikely to be released in the event of a terminal diagnosis.
There is, therefore, an urgent need to address the practical, ethical and moral issues that this raises.
If a man of 80 is sentenced to 10 years for an historic crime then it is quite possible that he will die in prison. Do we as a society wish to sentence people to what are, in effect, life sentences for crimes that would not normally attract this tariff? How can the need for public protection and justice for victims be balanced with the humanity and compassion that is the right of all when facing the end of life? How can the prison environment be improved to rise to these challenges meeting the needs of staff, prisoners and the wider public?
These are some of the complex questions that we have encountered in our study, along with many staff and prisoners who are endeavouring to innovate and begin to tackle the issues. However, there are political and policy decisions which service deliverers cannot address, as the Ombudsman, Nigel Newcomen, makes clear:
“My investigations into deaths from natural causes have identified some lessons which have not previously been of such widespread importance. For example, the need for improved health and social care for infirm prisoners; the obligation to adjust accommodation and regimes to the requirements of the retired and immobile; the demand for more dedicated palliative care suites for those reaching the end of their lives; and the call for better training and support for staff who must now routinely manage death itself.”
The need to address these issues is becoming increasingly urgent, as the rise in the older prison population as yet shows no signs of slowing down.
This research, which is led by Dr Mary Turner and a team of researchers from Lancaster University, is funded by Marie Curie.
References
- Prisons and Probation Ombudsman. Annual Report 2014 – 2015. London: The Stationery Office; 2015. Available from: www.ppo.gov.uk/document/annual-reports/
- Prison Reform Trust. Prison: The Facts. Bromley Briefing Summer 2015. London: Prison Reform Trust; 2015. Available from: www.prisonreformtrust.org.uk/Publications/Factfile
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