Older People: Their Place and Contribution in Society

Lord Ramsbotham Excerpts

Friday 14th December 2012 Lords Chamber

[Lord Ramsbotham]

My Lords, like all other noble Lords who have spoken in the debate, I thank and congratulate the most reverend Primate for obtaining it. I also pay tribute to him for all that he has done during his time in his historic office and the manner of his doing it.

After such a rich variety of speakers and the wonderful mix of wisdom and humour, I am sorry that as the final Back-Bench speaker I should end on a particular and critical note. Although the subject of the debate is,

“the place and contribution of older people in society”,

I deliberately limit my contribution to the place of one small but rising part of the whole, namely older people in prison. Their needs reflect those of older people in the community, which most of them will become on release. I speak in the context of the provisions of the Equality Act 2010, which outlaws harmful age discrimination in the provision of goods and services, and enforces a duty on all public sector bodies to promote age equality.

My interest in older prisoners was aroused by an experience as Chief Inspector of Prisons when, visiting Winchester, I was asked by its excellent doctor whether I felt strong enough to see three very dangerous prisoners. All were elderly and bedridden, one with advanced Alzheimer’s, one with advanced Parkinson’s and the third so mentally ill that he clearly had no idea where he was. The doctor explained that she had found them in the category B Kingston prison, the Prison Service categorising them as being so dangerous that they could not be in less secure custody. In view of their condition and because Kingston did not have 24-hour nursing cover, she had on her own initiative brought them to category C Winchester to die in the dignity of her care.

When I raised the issue of elderly prisoners with the Prison Service, I learned that neither was anyone responsible for them as a group nor were there any special arrangements such as nominated prisons with suitable facilities. I therefore contacted the social services director responsible for the elderly and asked him to work with me on a thematic review of elderly prisoners as part of an overall review of minority groups in prison. When I reluctantly had to abandon that review, having been forbidden by the then Prisons Minister from including race, I forwarded the report of the social services director to the director-general of the Prison Service. It seemed that the director’s comprehensive survey of the problem and sensible recommendation that social services, with their national responsibility for the elderly, should be made responsible for the oversight of conditions for and treatment of elderly prisoners in nominated prisons, required immediate attention.

Needless to say, nothing came of that, and it was not until 2004, when my successor, Dame Anne Owers, published a review of older prisoners, No Problems - Old and Quiet—a title taken from a prisoner’s personal file—that the size and shape of the problem was drawn to public attention. She reported that although some 7% of all prisoners were over 50, few prisons were taking the special healthcare and resettlement needs of older prisoners seriously—a problem exacerbated by the tendency of prisoners to age prematurely by up to 10 years while in prison.

Older prisoners were accommodated in a regime designed for, and largely inhabited by, young and able-bodied people, supported by prison staff who were untrained for their needs. Most disappointingly, in view of my previous attempts, the review found that, in general, local authority social service departments were extremely reluctant even to carry out assessments of older prisoners, still less to offer support either during or after imprisonment. A follow-up report in 2008 found that, although there had been some improvement in healthcare arrangements, the National Offender Management Service had still not developed a national strategy for older prisoners supported by mandatory national and local standards.

That is the background to the situation today, which is that as of 30 September, although there are isolated examples of good practice, there is still no national strategy or guidance relating to the welfare of the 9,913 prisoners over the age of 50. Of those prisoners, 3,333 were over the age of 60; more than 600 were over 70; 42 were over 80 and the oldest was 92. That represents 11% of the prison population, a rise of 4% since 2004. Prisoners over 60 are the fastest growing age group in the prison estate, a rise that is not matched by a corresponding rise in the number convicted by the courts. It cannot be explained by demographic changes, or a so-called elderly crime wave. The most likely cause is harsher sentencing policies, which have resulted in longer sentences being awarded to criminals aged over 60, especially those convicted of sex offences and drug trafficking. The sole guidance is a chapter on older prisoners in a Prison Service order entitled Prisoners with Physical, Sensory and Mental Disabilities, which largely focuses on their health and mobility needs, which prisons are expected to meet by making what are called “reasonable adjustments”.

Inspection reports over the past year confirm that there are still a worrying number of deficiencies in conditions for and treatment of older prisoners, in addition to a general observation that the contrast between their treatment and that of other vulnerable groups has grown. For example, although some older prisoners may be unlocked during the day, as well as them being retired at 60—and so disqualified from earning wages—there is too often no structured activity for them and a general lack of daycare centres.

Although statistics suggest that more than half such prisoners are suffering from a mental disorder, staff training in mental health awareness is poor. Few have the ability to identify the early onset of dementia and, although most prisons have special clinics for older prisoners, few have a special lead nurse in place. A number of older prisoners with mobility problems are unable to use the showers, or have difficulty accessing top bunk beds. However, on the positive side, 85% of older prisoners state that staff treat them with respect, and 84% state that they have a member of staff whom they can turn to with a problem.

Older prisoners also need help in preparing for release, which, disappointingly, received no mention in Ken Clarke’s “rehabilitation revolution” Green Paper, Breaking the Cycle. Life on the out is nothing like life inside prison, and many will find it hard to cope, particularly those who have served long sentences and who may have lost all contact with their families and communities, or be prohibited from making contact because of the conditions of their release. Of course, age itself does not determine either capabilities or needs but, in addition to possible isolation from friends and family, older ex-prisoners are more likely to have health problems than the rest of the population, have less income and be less likely to find work. Furthermore, the frailties of age are likely to accentuate the effects of victimisation against them following their crime and punishment.

In sum, because the problems of older prisoners are often not visible and since they are less likely to complain or make trouble, it is too readily assumed that everything with and for them is satisfactory. However, it is clear from the evidence that that is far from the case and that too many of their well documented specific needs and concerns are not being recognised or met. For example, as reported in 2004, social care provisions for them are as minimal on release as they are in prison and also suffer from a lack of national direction.

Winston Churchill famously said in 1910 that the way in which it treated crime and criminals was the truest test of the civilisation of any country. Applied to the treatment of older prisoners, we currently fail that test. I know that this issue is outside the responsibilities of the Minister, but I hope that she will pass on what I have said to her colleagues in the Ministry of Justice and the Department of Health, in particular. In the Advent spirit of hope, I once again thank the most reverend Primate for the opportunity to raise the issue and wish him all good fortune on his return to Cambridge.