The issues for consideration are:

· The effectiveness of current arrangements for the planning of health services for prisoners held in Wales and the governance of prison health and care services, including whether there is sufficient oversight.

· The demand for health and social care services in Welsh prisons, and whether healthcare services are meeting the needs of prisoners and tackling the health inequalities of people detained in Welsh prisons.

· What the current pressures on health and social care provision are in Welsh prisons, including workforce issues and services, such as mental health, substance misuse, learning disabilities, primary care out of hours, and issues relating to secondary, hospital-based care for inmates.

· How well prisons in Wales are meeting the complex health and social needs of a growing population of older people in prison, and what potential improvements could be made to current services.

· If there are sufficient resources available to fund and deliver care in the Welsh prison estate, specifically whether the baseline budget for prisoner healthcare across Local Health Board needs to be reviewed.

· What the current barriers are to improving the prison healthcare system and the health outcomes of the prison population in Wales.

Older People in Prison Settings

We agree that there are various reasons for the increase in older people in prisons including:

· Older people offending.

· People with past issues carrying them on into older age (e.g. substance misuse).

· An increase in people being detained for past offences.

· In order to inform our work going forward; more statistics on older people in the prison estate would be useful.

General Observations.

We are unsure of the data regarding numbers of welsh people detained in prisons in England, but it would be useful to know, in order to understand the impact of the introduction of HMP Berwyn for the North Wales area. Also:

· Distance to prison creates issues for poorer visitors.  Some will rely on Third Sector for access to transport.

· The standard of accommodation is lowering due to additional people in the prison estate – this raises concerns about safeguarding.

· We understand that statistics show that prison staff are reducing in number.

· Also, Deaths in custody are lowering but still high.

· Assaults are the highest on record and increasing.

· Substance abuse occurs within the estate – many people come out worse that when they went in.

· Self-harm numbers keep increasing.  Need more information and statistics needed about this issue. 

· Have specialist staff called to more incidents / there is an increasing call out.  Is this the result of a better response or more incidents?

· Reliance on prisons to deliver care and support to the most vulnerable clients.

Safeguarding.

· There is an issue regarding how safeguarding is handled in prison.  Safeguarding issues in prison  should be referred to a Prison Board.  There may be a need for oversight from another external agency. 

· In relation to Local Authority (LA) clients there is uncertainty about the oversight of safeguarding for them in prisons and how safeguarding issues are reported back to the Local Authority.

Assessment of Need.

· An Assessment of Needs is not undertaken on admission . The Local Authority also needs more information about how care needs are being met. 

· Another barrier is assessing Social Care needs around risk .

· Need to include language under “barriers”.  Can Welsh speakers represent themselves fully?

Communication and Planning for Discharge

· There is a need for better early communication (Local Authority involvement at the start of the process).

· Discharge planning is left until the late stages and there seems to be no transition.

· Better communication and effective discharge planning needed.

· The “door is shut” when an LA known client goes into prison.  Does not facilitate good discharge planning in order to reduce the risks of returning to the community.

Access to Accommodation on Discharge

· Prisoners used to be entitled to Housing on release so previously Housing would effectively create a link between the Local Authority (including Social Care) and the released prisoner.  Now there is no requirement to house, so this link has been lost.

Risk Management

· The Local Authority may have useful information about someone that could be usefully passed to the prison service.

· The prison service is not exploring existing Care and Support plans.  This leads to increased risk.

· There is no “Home Treatment Team” for prison and often no meetings are held before people are released.

· It was agreed that there is a need for an exit plan to be created when a person goes into prison.

· There is a need for better support for people to cope once back in the community - a “Step Down”.

· Distance (to prisoners in distant prisons) makes it harder to co-ordinate.  Also different systems don’t match.

· The local MAPPA meeting discusses and plans for high risk clients but not lower risk clients.

· There is a discrepancy in the system – a Welsh prisoner remains the responsibility of the LA they come from if they are in a prison in England.  In the Wellbeing Act, for a Welsh prisoner in a Welsh prison the responsibility shifts to the Welsh LA where the prison is.

Probation Service

Going forward, its important to further develop working links between the Local Authority and the Probation Service.

Mental Health

· More understanding of mental health (MH) issues that are evident in prison settings.

· Some people return to prison repeatedly because it is a familiar (“Safe”) environment. 

· Who should take the lead on the repeat offender side, especially for those individuals with Mental Health problems ? More guidance on this.

· We are aware of one prison in England that has a good Mental Health facility.  Need to replicate this across the prison settings.

· Also aware of a general prejudice towards people with certain mental health conditions.  More recognition needed for individuals with personality disorders. 

· Also more understanding needed regarding Learning Disability.

· It was also agreed that there may be better solutions for (less risky) people under supervision, such as Rehabilitation.  There is a need for a variety of routes to Rehabilitation.

We are aware of the current White Paper on prison safety and reform.