7.4 Prisons, Approved Premises and Bail Accommodation

1. Introduction

This policy sets out Lancashire County Council’s response to the Care Act duty to undertake an assessment of need for any adult (18 years and above) who is in custody in the area’s prisons or residing following release in approved premises, who appears to have a need for social care and support.

2. Policy Aim

This policy aims to support adults who reside in the area’s prisons or approved premises.

• with services, facilities or resources which would prevent, delay or reduce any needs for care and support.
• with care and support interventions and services that maintain safety, dignity and the person’s quality of life.
• to live as independently as possible at the end of their detention.

3. General Principles

The Care Act allows Lancashire County Council to consider its financial resources and how public funds are spent to meet people’s needs.

Lancashire County Council staff will apply their professional judgment and will be supported to do so and as professionals, determine the most appropriate intervention for the adult’s needs and desired outcomes. Consideration will always be given to what would help the person to gain, retain or regain their independence.

4. The Legal Framework

The Care Act 2014 places a duty on Lancashire County Council to undertake an assessment of need for any adult (18 years and above) who resides in the area’s prisons and approved premises, and who appears to have a need for social care and support.

All references to custody or custodial settings relate to prisons, approved premises and other bail accommodation. It also applies to people aged 18 years and above, in young offender institutions, secure training centres or secure children’s homes.

Within Lancashire, this duty is met within five prisons which are located in the Lancashire County Council area:

• HMP Wymott
• HMP Garth
• HMP Kirkham
• HMP Lancaster Farms
• HMP Preston

Between them these prisons accommodate over 4,000 male prisoners at any one time. There are also some approved premises (often known as bail hostels).

It is critical to the vision in the Care Act that the care and support system works to actively promote wellbeing and independence and does not just wait to respond when people reach a crisis point. People in custodial settings can often have complex health and care needs and experience poorer physical and mental health outcomes than the general population.

Evidence demonstrates higher rates of mental illness, substance misuse and learning disabilities among adult prisoners than in the general population. All adults in custody, as well as in contact with the wider criminal justice system, should expect the same level of care and support as the rest of the population. This is crucial in ensuring that those in need of care and support achieve the outcomes that matter to them, and that will support them to live as independently as possible at the end of their detention.

Under the Care Act, adults detained or residing in a custodial setting are treated as if they were ordinarily resident in the area where the custodial setting is located for the purposes of the provision of social care whilst in custody only. Lancashire County Council is responsible for the assessment of all adults who are in custody in Lancashire and who appear to be in need of care and support, regardless of which area the person came from or where they will be released to. To fulfil its duty under section 76 of the Care Act, Lancashire County Council has introduced a Social Care in Prisons and Approved Premises Service to assess needs for care and support of people in custodial settings. Where the eligibility criteria is met, services are provided by the Health and Social Care in Prisons Team in order to comply with the national threshold relating to care and support that is relevant, coherent, timely and sufficient.

The duty placed on Lancashire County Council includes ensuring the provision of lower level non-regulated care and support services in line with those that people can access in the community, to help maintain wellbeing and form part of the wider prevention offer. For the purposes of this policy this support and assistance is referred to as ‘peer support’.

The Care Act also established that carers can be eligible for support in their own right. However, the role of carer as defined by the Act does not apply in the prison and approved premises settings.

Lancashire County Council will make all reasonable adjustments to ensure that all disabled people in prisons and approved premises, have equal access to participate in the eligibility decision in line with the Equality Act 2010.

The population in prisons and approved premises in Lancashire is diverse and through Social Care Policies and Practice relating to people in custody we aim to deliver an appropriate and safe level of service and support to adults in Lancashire’s custodial settings.

4.1 Advocacy

 Care and support should always be centred around the person. Under the Care Act, Lancashire County Council must arrange for an independent advocate to facilitate the involvement of the person with care and support needs in their assessment, care and support plan and any reviews of their care plan, as well as in safeguarding enquiries and Safeguarding Adult Reviews, if two conditions are met:

• The person has substantial difficulty in being involved in these processes.
• There is no appropriate individual willing to support them.

Further information is available in the Independent Care Act Advocacy policy. Further duties to arrange an advocate also apply under the Mental Health Act and Mental Capacity Act (See Independent Mental Capacity and Mental Health Advocacy policy).

 4.2 Safeguarding

Local authorities and Safeguarding Adults Boards are not empowered to conduct safeguarding enquiries or reviews relating to adults who are detained in prison or residing in approved premises. The responsibility to undertake safeguarding adults’ enquiries and reviews lies with each prison, under the accountability of the governing Governor.

Lancashire County Council will meet its duty under the Care Act to safeguard adults with care and support needs (whether or not it is meeting any of those needs) and ensure that all concerns are alerted to the relevant person in each premises, and participating in all following actions and interventions in partnership with all involved agencies and organisations as appropriate.

5. Referrals

Referrals can come from the following sources:

• Self referral.
• Family / carer/ advocate.
• Prison healthcare service.
• HM Prison and Probation Service.
• Offender Managers / HM Probation Service.
• Other Local Authorities.
• Disability Officers.
• Community Acute settings–hospitals.
• Other commissioned providers operating in the custodial environment.
• Peer supporters.

6. Screening

On admission or transfer to the prison or approved premises the onsite Healthcare Service completes an initial health care assessment / reception screening process. This process may trigger the need for a social care assessment and other support. The service will address and respond to the immediate needs of anyone requiring social care, and this will be followed by a full assessment undertaken by a social worker.

Reception screening and health assessments are key opportunities to establish whether a person has been receiving care and support before entering custody, with existing social care assessments and packages of care, which will require a review of their needs. Current care plans are also taken into consideration.

Lancashire County Council will undertake regular visits to its prisons and approved premises to identify any prisoners that may have eligible care needs that may not have been referred by any of the above sources.

7. Information and Advice

For any needs that are not eligible under the Care Act, commissioned social care providers onsite will provide information and advice related to care and support that may reduce or delay the development of care and support needs of people residing in custodial settings. It is important to consider the restricted level of access to electronic media and the most appropriate format for information and advice in custodial settings, such as easy-read leaflets which should include signposting to other services. The level, type and recording of such information and advice given will need to be agreed between the commissioned social care provider on site and / or the Healthcare service and Lancashire County Council and will be recorded on the adult’s case file.

8. Prevention and Early Intervention

Adults in custodial settings, like people in the community, may benefit from low level preventative support and information and advice that will help them maintain their own health and wellbeing.

A key principle of the support provided by Lancashire County Council in custodial settings will focus on reducing the person’s reliance on formal services and, wherever possible, preventing their level of need from increasing. In order to meet this requirement, staff will need to develop a strong relationship with the people they support, have the skills and ability to recognise any signs of deterioration and be able to act upon these.

To help with the health and wellbeing of adults, Lancashire County Council will work in partnership with other organisations to commission aids, adaptations and assistive equipment within the restrictions and regulations in the prisons and approved premises. Technology Enabled Care is available within some prisons, including motion sensors that give early warning of incidents such as; falls, seizures or blackouts as a result of a medical condition, or provide reminders to take medication as prescribed (see Technology Enabled Care Policy).

9. Eligibility for the Service

Following identification of someone who may have a need for care and support, a referral to Lancashire County Council Prisons Social Work Team will be made in accordance with the process detailed in the Memorandum of Understanding that is in force across Lancashire County Council, the 5 prisons, NHS England and the onsite Healthcare providers. The social worker and/or the OT from Lancashire County Council’s Prisons Team will assess needs and determine eligibility for social care. The prioritisation of resources for adults with eligible social care needs, will be carried out in accordance with the Care Act 2014 and within the constraints of the prison environment.

Adults (18 years or over) will be eligible if:

• their needs are caused by a physical or mental impairment or illness, and they are unable to achieve two or more outcomes specified below, and
• as a consequence, there is a significant impact on the adult’s wellbeing.

9.1 Assessing eligibility

Eligibility will be determined during the assessment if the adult is unable to achieve two or more of these outcomes:

• managing and maintaining nutrition.
• maintaining personal hygiene.
• managing toilet needs.
• being appropriately clothed.
• being able to make use of the prison environment safely.
• maintaining a habitable environment.
• maintaining relationships.
• accessing and engaging in work, training, education or volunteering opportunities in prison.

And are unable to achieve an outcome if they are:

• unable to achieve it without assistance,
• unable to achieve it without assistance but doing so causes significant pain, distress or anxiety,
• able to achieve it without assistance but doing so endangers or is likely to endanger the health and safety of the adult, or others, or
• able to achieve it without assistance but takes significantly longer than would normally be expected.

Where the Care Act assessment has determined that a person residing in a custodial setting in Lancashire has eligible needs, the allocated worker from Lancashire County Council must:

• agree with the person which needs they would like the Prison Health and Social Care Service to meet.
• consider how those needs may be met. (Where the support options include services for which Lancashire County Council makes a charge then we will carry out a financial assessment).

10. Assessment

Where Lancashire County Council is made aware that an adult in a custodial setting may have care and support needs, they must carry out an assessment as they would for someone in the community. It is likely that there will be complexities for carrying out assessments in custodial settings and consideration should be given to how such assessments will be carried out in an efficient way for all involved.

The assessment will be holistic and will cover the physical, sensory, cognitive, environmental, psycho-social needs and risks in relation to the prison sentence of the individual taking into account other professional assessments. This will impact on the content and timescale of the integrated support plan which will be discussed and agreed with the person in conjunction with the onsite social care provider and the approaches and support required to achieve the identified needs.

The assessment must consider whether the person’s needs and their inability to achieve the outcomes above, cause or risk causing a significant impact on their wellbeing.

Assessors must determine how the person’s inability to achieve the outcomes impact on their wellbeing. Where the person is unable to achieve more than one of the outcomes, the assessor does not need to consider the impact of each individually but should consider whether the cumulative effect of being unable to achieve those outcomes is one of a “significant impact on wellbeing”. In doing so, assessors should also consider whether:

• the person’s inability to achieve the outcomes above impacts on at least one of the areas of wellbeing in a significant way; or,
• the effect of the impact on a number of the areas of wellbeing mean that there is a significant impact on the person’s overall wellbeing.

The term “significant” is not defined by the regulations and must therefore be understood to have its everyday meaning. Assessors will have to consider whether the person’s needs and their consequent inability to achieve the relevant outcomes will have an important, consequential effect on their daily lives, their independence and their wellbeing.

In making this judgment, assessors will look to understand the person’s needs in the context of what is important to them. Needs may affect people differently, because what is important to the individual’s wellbeing may not be the same in all cases. Circumstances which create a significant impact on the wellbeing of one person may not have the same effect on another.

There is an expectation that assessors will provide objective evidence to support their judgement when applying the criteria.

While it may not always be possible or appropriate to involve family members directly in assessment or care planning, individuals should be asked whether they would like to involve others in their assessment or support planning.

11. Integrated Care and Support Planning

Whilst the custodial setting in which the care and support will be provided is likely to be different from community or other settings, this will be taken into account when considering how to meet the need for care and support as part of the support planning process.

The extent and nature of need will be identified before considering the environment in which the individual lives.

The development of care and support plans produced by Lancashire County Council’s Prisons Team will be consistent with care and support planning guidance under the Care Act 2014 and consider any related guidance.

Such plans will identify the care and support needs and outcomes, the nature of the specific provision needed, including the amount, frequency and duration of care needed. The care and support plan may cover general health, social needs, and rehabilitation requirements and will be reviewed on a regular basis, as defined in the person’s care and support plan. They must be actively involved throughout the planning process and will be given clear information regarding the personal budget available to meet their needs and the limitations of its use in the prison setting.

Where the assessor considers that the person has substantial difficulty in engaging with their assessment, then they must consider whether there is anyone appropriate who can help the person to be fully involved, e.g. family member/carer/peer supporter. If there is no one appropriate, then the service must arrange for an independent advocate to support and represent the person during the care and support planning and subsequent review process.

12. Adults who have Eligible Needs but who Refuse Social Care

If the person has mental capacity to make decisions about their care, they can refuse support even though they may have eligible needs. If this occurs this information will be shared with other professionals, with the person’s consent.

If someone in a custodial setting refuses a needs assessment, Lancashire County Council is not required to carry out the assessment, subject to the same conditions as in the community. This does not apply if:

• the person lacks mental capacity to refuse and Lancashire County Council believes that the assessment will be in their best interests; or
• the person is experiencing, or is at risk of, abuse or neglect.

13. Information Sharing

Lancashire County Council, provider organisations and their staff working in custodial settings should abide by all rules and practices for that establishment, including (but not restricted to) security policies such as restricted items and searches on entry, equality and safeguarding procedures.

Lancashire County Council, the onsite health and social care provider and Prison Social Work Team will ensure the security of information held on people who are in custodial settings, and will develop agreements consistent with the HMPPS Information Sharing Policy Framework, in line with relevant legislation to enable appropriate information sharing on individuals, including the sharing of information about risk to the prisoner and others where this is relevant.

If Lancashire County Council is providing care and support for a person in the community, and that person is subsequently remanded or sentenced to custody, or bailed to an approved premises, or required to live in approved premises as part of a community sentence, Lancashire County Council will share details of the most recent assessment and care and support plan with the relevant custodial setting and the relevant local authority if it is outside the Lancashire area.

14. Prison Social Care Cessation and Continuity of Care

People in custody with care and support needs must have continuity of care where they are moved to another custodial setting or where they are being released from prison and are moving back into the community. This is to ensure that the person continues to receive care during and following the move.

Lancashire County Council are responsible for ensuring continuity of care for people with a package of care moving into Lancashire on release from prison. Provision of care and support, where a person has eligible needs and is to be released into the community, will have those needs provided by Lancashire County Council if this is where the person is ordinarily resident.  See Continuity of Care Policy.

Lancashire County Council’s responsibility in circumstances where an individual with social care needs is being released and moving back to another local authority area is to ensure that relevant details of the assessment and support plan are shared as appropriate with the that council’s Adult Social Care service.

15. Financial Assessments

Lancashire County Council will carry out a financial assessment in custodial settings to assess what the adult can afford to pay in accordance with the financial assessment process.

16. Direct Payments

Direct payments must not be made to people in custodial settings. However, those in bail accommodation and approved premises following release or who have not yet been convicted can request their needs are met through provision of direct payments, as they would have been whilst in their own homes.

17. Ordinary Residence

Determining a person’s ordinary residence on release from prison may not always be straightforward and each case must be considered on an individual basis. Where there is any uncertainty, see the Ordinary Residence Policy.

18. Transition from Children’s to Adult Care and Support

Lancashire County Council retains responsibility for the transition requirements of children and young people in Young Offender Institutions, Secure Children’s Homes, Secure Training Centres or other places of detention as well as children and young people in the youth justice system, who are likely to have eligible needs for care and support as adults and are approaching their eighteenth birthday.

This also applies where a person moves from the youth custodial estate to the adult custodial estate, which may include a change in the responsible local authority. A request for an assessment can be made on the young person’s behalf by the professional responsible for their care in the young offenders’ institution, secure children’s home or secure training centre. Good communication between professionals, institutions and local authorities is essential to prepare for transfer and ensure a smooth transition.

See Adult Social Care Transition Policy.

19. Care Leavers

If a young person is entitled to support and services as a care leaver, this status remains unchanged while in custody, and staff should be aware that where Lancashire County Council is responsible for providing leaving care services to any young person prior to their time in custody, the responsibility is retained during the custodial period and on release

20. Section 117 Aftercare

Where people have previously been detained under sections 47 and 48 of the Mental Health Act 1983 and transferred back to prison, their entitlement to section 117 aftercare will be dealt with in the same way as it would be in the community, apart from any provisions which are disapplied in custodial settings, such as direct payments and choice of accommodation. Section 117(3), as amended by the Care Act 2014, will apply in determining which local authority is responsible for commissioning or providing the section 117 aftercare.

If the person was ordinarily resident in the Lancashire County Council area immediately before being detained in hospital, then Lancashire County Council will be responsible for the aftercare while the person is in prison and upon their release from prison.

However, if the person was not ordinarily resident in any area immediately before detention, the council responsible will be where the person becomes resident or where they have been discharged (i.e., the upper tier council responsible for the prison to which the person has been discharged). Lancashire County Council will be jointly responsible for ensuring that such aftercare is arranged with NHS England while the person is in prison.

See Joint Policy for the Management of Section 117 Aftercare, Reviews and Discharge.

 21. End of Life Care

The provision of care and support for those in custodial settings extends to those who reach the end of life whilst in prison. For this provision of palliative care, some will transfer to a local hospital, hospice or care home or move to an alternative prison where a more suitable environment is available. Eligibility for continuing healthcare will be checked and, in some circumstances, responsibility for care and support will pass to the NHS or the previous local authority (if the person is released on compassionate grounds back into the previous Local Authority area). Where the person is transferred to a new location in a different local authority area, Lancashire County Council’s Prisons Team will ensure the timely transfer of assessments and information to the new host authority.

See also End of Life Care Policy.

22. Complaints

Lancashire County Council will provide information to those in custodial settings on how to make complaints and seek redress about provision of care and support services.

Due to the restricted access to technology devices and the internet, information on how to complain is provided to people in custodial settings in a variety of formats including leaflets.

The Prisons and Probation Ombudsman investigates complaints from prisoners, those on probation and those held in immigration removal centres. The Ombudsman also investigates all deaths that occur among prisoners, immigration detainees and the residents of approved premises.

See also Complaints Procedure.

23. Further Reading

23.1 Relevant chapters

Ordinary Residence

Assessment of Needs

Integration, Cooperation and Partnerships

23.2 Relevant information

Chapter 17, Prison, Approved Premises and Bail Accommodation, Care and Support Statutory Guidance (Department of Health and Social Care)

Adult Social Care Prison Service Instructions: AI 06/2016 • PSI 03/2016 – PI 06/2016