ADASS/LGA Care Act Stocktake 5 – Autumn 2015 – Prisons and Approved Premises - Summary report
Introduction
This was the second stocktake undertaken since the Care Act went live and in asking for information on activity for the first 6 months of the financial year it gives a fairly clear picture of how things are settling down.
Because this stocktake was covering all aspects of the Care Act, the questions relating to prison activity were limited to 4:
- Are there any prisons, or other approved accommodation, located within your council area?
- Total number of assessments of prisoners (2015/16 - From 1 April 2015 to 30 September 2015)
- Total number of assessments of prisoners where the eligibility threshold was met (2015/16 - From 1 April 2015 to 30 September 2015)
- Total amount your council spent on assessments for its prison population (£) (2015/16 - From 1 April 2015 to 30 September 2015)
Returns were received from all except one of the authorities with either a prison or approved premises
- Are there any prisons, or other approved accommodation, located within your council area?
All of the authorities with prisons correctly identified themselves as such but 12 authorities with approved premises answered that they did not have either a prison or approved premises. At this stage we cannot be certain whether these authorities do not know that they have an approved premises in their area or whether it was an error in answering the question.
It is also possible that there may be authorities who know they have prisons but are unaware that they also have approved premises but this cannot be confirmed from the returns
Action – The 12 authorities that answered that they did not have approved premises but do have should be contacted to confirm whether or not this was a form completion error
- Total number of assessments of prisoners (2015/16 - From 1 April 2015 to 30 September 2015)
The 58 authorities with prisons who responded to the survey had completed 966 assessments between them in the first 6 months since the Care Act was implemented. There was however significant variations between authorities and even recognising that some authorities have more prisons than others and that individual prisons have different populations (size and age profile) and functions these variations should be a cause for concern in some cases.
6authorities report not having undertaken any assessments and a further 16 report 5 or fewer. Between them these 22 authorities account for 29 individual prisons.
In the space provided on the form to insert text to support their answers, 5 of the authorities with no assessments to date describe the work that they have either undertaken or are doing to ensure that prisoners who may have care and support needs are referred to them. As one of them writes:
Although the expenditure is recorded as nil, a significant amount of operational resource has been dedicated to this population, including: information, advice and early intervention resources designed with confidence that these will prevent and/or delay the need of adult social care service intervention for prisoners. We have also held development sessions with the prison
In the authorities with low numbers of assessments there are a few where significantly higher numbers would have been expected and in some cases the authority recognises this and provides an explanation:
Delays in conducting assessments have been experienced due to security clearance, training and finalising operational delivery model
Or in the case of one where there was a dip to due to staffing issues:
14 referrals. 4 prisoners assessed, 4 no further action following Contact as no appearance of social care needs, 2 eligible, 6 referrals not yet assessed.
Against those authorities with low numbers of assessments there are a number who are clearly much more active with 6 authorities having completed over 50 assessments (highest 73) in the first 6 months and while it must be noted that all these are authorities with more than one prison in their area, there may be something in the additional size of the prison population that leads to the authority being able to make a larger investment in working with their prisons to promote better recognition of potential need.
It is also interesting to note that that all of the more active authorities either have a larger number of prisons or specialist sex offender units which were expected to generate more activity due to their older demographics. One Cat B prison has generated 26 assessments, significantly more than most similar establishments and this is undoubtedly due in significant part to the close working relationships that have been developed between the authority, the prison and prison healthcare staff.
It is also worth noting that the recording of assessment activity may understate the number of prisoners who have benefitted from the Care Act as some authorities describe not undertaking a full care and support assessment when it is clear to them that the prisoners needs can be met quickly and simply by the provision of a preventive service such as a simple piece of equipment to aid daily living or advice to the prison on how to support the prisoner better.
- Total number of assessments of prisoners where the eligibility threshold was met (2015/16 - From 1 April 2015 to 30 September 2015)
The 966 assessments completed resulted in 447 (46%) prisoners being assessed as eligible to receive care and support services but conversion rates from assessment to eligibility varied from 0-100%. From recent workshops and discussions that the author has been part of it has become clear that (as in the community) authorities are not recording consistently and similarly to the paragraph above an approach is taken on occasions that recognises that, where the prison regime supports the prisoner, possible needs are effectively met and therefore there is no eligibilitye.g. a prisoner does not need to be able to prepare his food.
In taking this approach an authority may technically not be fully complying with the Care Act Guidance which would suggest that an eligibilitydetermination should be purely based on the individual’s needs and any support that they are receiving should then only be taken into consideration of whether the authority has to meet those needs (see section 6.119 of Guidance).
The key measure of the Care Act’s success has to be the number of prisoners whose lives are significantly and appropriately improved and it is clear that measures of easements undertaken and determinations of eligibility are unlikely fully to describe this.
4.Total amount your council spent on assessments for its prison population (£) (2015/16 - From 1 April 2015 to 30 September 2015)
It is clear from many of the responses to this question that authorities either do not know their costs or are not counting them consistently so a total of £803,555 probably tells us little especially as there was no question relating to the costs of providing preventive support, equipment, advice and information or advocacy let alone meeting eligible care and support needs through hands on care provision.
One authority that probably provided the most detailed response to this question stated:
The Social Care Delivery contract in the prisons is £375,855 per annum (pa) contracted with the cluster’s healthcare provider. Our salaried staff costs for assessment and monitoring £147,000 pa. This is an in house assessment and monitoring function. Equipment provision is £15,000 pa. Training costs for trusted prisoners (for example those who provide non personal care to other prisoners) and prison staff is £7,000 pa.
Total cost of the new burden for the prisons is £544,855 pa … New burdens money received for year 1 was £326,000
It was hoped that the between the LGA/ADASS Stocktakes and the more detailed Quarter 1 analysis undertaken in the summer that we would have some reliable data to help inform both the total funding for the new responsibilities for prisoners and its distribution by individual authority in 2016/17. Disappointingly this is not the case and therefore we should not expect any significant increase on the £10.3 million advised in 2014.
We should expect however that where prisons have changed their function, size or demographic make up that this will be reflected in how the £10.3 million is allocated.
Conclusions
This stocktake, as is often the case, is of more value in the questions it generates than those that it answers and, as in the wider community, it is clear that it is taking time for the Care Act to embed and that further work needs to be undertaken to achieve a consistent and meaningful reporting of activity and costs but ADASS would be pleased to work with the Department of Health to achieve this.
James Bullion, Chair of the ADASS Care & Justice Network
Ian Anderson, ADASS Associate, Care & Justice