Dementia care and offender populations

Abstract

284 British Journal of Community Nursing Vol 18, No 6 T he healthcare of offenders was transferred from Her Majesty’s Prison Service to primary care trusts, since April commissioning for services in England now rests with NHS England (formerly known as the NHS Commissioning Board). NHS England is responsible for ensuring that services are commissioned in ways that support consistency; consistency in ensuring high standards of quality across the country (NHS England, 2013). Prison services that provide health care are also required to register with the Care Quality Commission (CQC). The CQC monitors, inspects and reports on services, checking to ensure that they operate like a community health service. Providers in prisons should be able to demonstrate that they comply with CQC regulations using the same information that is used to demonstrate that they meet Her Majesty’s Inspectorate of Prisons (HMIP) expectations (CQC, 2010). Offender care therefore, must be provided on par with those offered by other healthcare services. Dementia care is high on the political agenda. The prime minister has issued the first ever national challenge on dementia care and research. The Department of Health (DH) (2012) has set out its response to improving care for people with dementia. It is estimated that there are approximately 800 000 people with dementia in the UK and by 2040 the number of people affected is expected to double (DH, 2013). Dementia is primarily a disorder of later life; however there are some people under 65 who are also affected. The data noted should be treated with caution as these figures refer to formal diagnosis and as such this may be an under estimation. There are offenders in prisons and other places of detention who have dementia. The strategies suggested by the DH should be applied and extended into prisons, yet there seems to be no evidence of this occurring in a consistent manner across the UK. Given the projected increase in the number of people with dementia in the population generally (this will also apply to the prison population) as well as the fact people are living longer, dementia presents a future problem for prisons who are responsible for a growing population of older people. The issue of dementia has attracted little attention for this population and appears to have been essentially overlooked (Moll, 2013). Prisons are ill equipped to provide and match the level of service provision that the rest of the population receive. Nurses providing care to the offender population are therefore at risk of failing in their duty of care as well as contravening the tenets of the Code of Conduct (Nursing and Midwifery Council, 2008). There is a changing demographic in prisons in England and Wales, the number of sentenced prisoners aged over 50 has risen by 74% to nearly 10 000 in the past decade. Male offenders over 50 are the fastest growing group in prisons. In prisons the over-60s population has increased eight-fold since 1990. Offenders are often considered to be physiologically ‘older’ than their chronological age, this is associated with the psychological and physical impact of imprisonment coupled with preceding issues, for example, substance misuse, suggesting that those suffering from dementia were affected earlier than the wider population (Moll, 2013).