Who cares for women in prison?
Within England and Wales, the Health and Social Care Act 2015 is new legislation for the care of prisoners. Recent research has explained that there is a lack of structured support systems and a gap in knowledge about the role of practitioners (Baldwin, 2015). Despite these issues and it is known that women in prison have complex health, social and welfare needs, the Health and Social Care Act 2015 is specific about how care should be structured. Who cares for women in prison, is an outline of legislation relevant for England and Wales, however some of the issues may resonate with caring for female prisoners in other countries.
Local authorities:
The introduction of legislation which regulates the work of practitioners from local authorities is the main change for the Health and Social Care Act 2015. Local authorities are required to assess the social care needs for women in prison. Research has found that assessments are often judged according to what is considered appropriate support for women who are not involved within the criminal justice system (Baldwin, 2015; Hannah-Moffat, 2011; Rowe, 2011). In one of the few articles which have highlighted the impacts of these new regulations there has been an illustration of the difficulties for local authority practitioners conducting assessments in prison. Hollingsworth and Smith (2015) explain that a very different assessment process is needed, not only because of time and access to prisons but also due to the assessments. Hollingsworth and Smith (2015) explained that on one occasion an occupational therapist was unable to establish the needs of an individual because prisoners are not allowed to make a cup of tea. In a recent report of a meeting which discussed the implementation of the Care Act (published by the Howard League) it was explained that there have been a relatively low number of assessments within prisons. Within this discussion it was claimed that local authority assessments are inconsistent and local authorities are at the beginning of a journey.
The voluntary sector:
Clinks are an organisation which informs the voluntary sector about issues relating to the lives of offenders. Guidance from Clinks about the Health Care Act 2015 describes how this legislation is encouraging the introduction of an internal market and competition to bid for contracts. Local authorities will be assessing the provision of care which is not only different for each individual but also the personal budgets of prisoners. The introduction of these changes can be described in positive ways such as promoting integration of care, personalisation and empowerment. Despite these positive phrases, there has been an introduction of care that may have to be paid for by women in prison. Despite having no ability to increase their income while they are in prison, the Health Care Act 2015 allows local authorities to charge for all or part of the care provided. The Health Care Act 2015 is also introducing a cap on lifetime contribution to social care costs and this will be implemented from April 2016.
Advocacy:
The new legislation has significant implications for the role of advocates who work with prisoners. There is evidence that women enter prison with acute mental health needs (Light et al, 2013) and in 2011, self-harm was ten times higher than for men (Robinson, 2013). The advocacy duty means that when women have substantial difficulties with understanding or retaining information, using information or communication then they are entitled to have an appropriate adult involved with the assessment, planning and review processes. It is suggested by Clinks that an independent advocate could be a relative or suitable friend; however the Social Care Institute for Excellence explains that the appropriate adult cannot be someone who is unlikely to be available to adequately support the persons involvement. Many women are not located in prisons near to their families and if no-one is available then arrangements have to be made for an independent advocate.
Care Quality Commission:
The Care Quality Commission now has extended powers through the Health and Social Care Act 2015. There is a wider range of regulated activities and if a provider carries out these activities without being registered with the Care Quality Commission then they are liable to a fine. The Care Quality Commission is now inspecting prisons as well as voluntary sector organisations which provide specialist services.
While the care and well-being of women in prison is important and the provision of this legislation extends the duties of local authority care, some areas relating to the care of women will not be within the scope of this legislation. For example, women may need care and support with issues relating to becoming pregnant, being a mother or grandmother. In particular some issues such as having been a victim of abuse, wanting an abortion or accommodation when leaving prison are complex and while women may need care and support, this will not be within the scope of local authority interventions. The Health and Social Care Act 2015 has now been in place for nearly one year, however in a recent debate which has been published by the Howard League, there are recognised challenges. This debate did not discuss the care and well-being of women; however other issues such as the need for prisoners to leave prison with access to the right equipment, care and support were discussed. For more information a conference called Building Community Capacity In Prisons is being held in April. The conference is aimed at practitioners working in Local Authorities, prisons and healthcare.
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Originally published at www.r4womeninprison.com on February 28, 2016.
