Jim Lees woke up late one night needing to use the toilet. As he sat up in bed, he felt dizzy, then blacked out and fell to the floor.
He remembers: “Everything went blank. I fell and was unconscious. I don’t know how long I was out.” When Lees [not his real name], 80, did regain consciousness, he couldn’t get back up. “My foot wouldn’t grip the floor. There was blood and urine everywhere. I just don’t know what happened to me.”
It wasn’t until 6am the next morning that he was found on the floor of his cell by prison officers. “We had checked him at 11pm and he was fine. When I came in in the morning, he was slumped, and had injured his head,” says Mick Butler, custodial manager at HMP Wymott, in Leyland, Lancashire. Lees was taken to Preston hospital, where doctors discovered, and later removed, a cancerous tumour in his leg. He stayed for weeks, with a prison guard by his bed.
This was not the first time a man had been found collapsed on the floor in the morning. Prison staff were aware that situations such as these could have disastrous consequences, and taking prisoners to hospital was also a drain on resources, says Butler. “We needed a mechanism to let us know when someone had tripped or was in distress,” he says.
The prison approached Laura Hudson, a social worker at Lancashire county council, to find a new solution (local authorities have been responsible for prisoners’ social care needs since the Care Act was introduced in 2015). Together they took the decision to install telecare – a support system that provides assistance at a distance to wearers of bracelets and pendants that contain information and communication technology and sensors. They can detect, for example, when someone has had a fall and alerts a call centre. Telecare is used by an estimated 1.7 million people across the UK, but this is the first system of its kind in a UK prison.
It was adapted for a custodial environment, for 11 prisoners at high risk of falls, seizures, heart attacks and strokes, and comprises bed sensors and a wrist-worn bracelet (pictured). There is a button on the wristband to call for help, and if people are out of bed for more than 10 minutes at night the sensor goes off. An alert is sent through to call centre operators who call the prison operations room, which contacts the prison officer on the wing by radio. They will go to investigate at night or ask carers to check during the day.
In prison, there is no requirement to look in on people at night. Doors are locked at around 8pm until the next morning. “Putting extra staff on the wing at night time was an extra resource we didn’t have,” says Butler. To open a door to see someone at night requires a minimum of three staff, he adds, when sometimes only six are on duty.
Just days after it was installed in September 2017, the telecare system alerted staff to come to the aid of a prisoner having a stroke. The sensor alerted the control centre when he fell out of bed. A team of prison guards appeared and saved his life. Without telecare he could have died because checks in the morning may have been too late.
A third of HMP Wymott’s 1,176 inmates are over 50. Across the prison population in England and Wales, the proportion of prisoners aged over 50 stands at 17%, according to the prisons and probation service. This age group is projected to grow from 13,376 prisoners in June 2017 to 14,800 by the end of June 2021. With an increasingly older population behind bars comes a greater need for social care. Up to 90% of prisoners over 50 have at least one moderate or severe health condition, with more than half having three or more.
HMP Wymott has a reputation for caring for older male prisoners. As a result, it receives requests from prisoners all over the country who want to serve their sentence there. A dedicated re-ablement wing caters for 59 of the prison’s most vulnerable older inmates. The prison operates a group that meets monthly to discuss issues related to older prisoners. Representatives from the prison’s equality, health and resident units, HMP Wymott’s senior management, NHS healthcare workers, Lancashire county council social workers and local charity organisations working within the prison all attend, as well as elected prisoners. It also runs a buddy system where younger men fetch meals for older prisoners, and there is an activities centre for older and disabled prisoners – run by two majors in the Salvation Army – which claims to have reduced the instances of visits to hospital and suicide attempts.
Telecare is the latest scheme they have introduced to care for their older prisoners. As well as saving lives, it has saved money. Before telecare, the council’s adult social care team had carers working in pairs sitting outside the cell of a vulnerable older inmate. “They’d be sat outside a cell in tandem all night but they couldn’t get through to the prisoner, [if they heard that anything may be wrong] because the carers had to call [for assistance],” says Hudson. “We were paying people £13.50 an hour to sit and watch these prisoners and they couldn’t respond meaningfully. The cost was phenomenal and really eating into our budget,” she adds.
Telecare has saved Lancashire county council £172,000 in one year for six prisoners, according to Hudson. As a result, there are plans to replicate the project in three more prisons in the county.
Back in Lees’s cell, he talks about when he first had telecare installed. “I was safe, if you know what I mean, and secure,” he says. He remembers when he fell again and pressed the button on his wristband for help. When prison staff arrived, they found he had hit his head on a pipe and had a serious bleed on his leg.
Recalling the incident, Butler says: “I can’t say [if it saved Lees’s life] though finding him early did make a huge difference.”
The Prison Service says that while it supports measures like telecare, it is up to NHS commissioners and local authorities to decide how best to meet the health and social care needs of prisoners who meet the eligibility threshold. Says a Prison Service spokeswoman: “This is a great example of the prison working with healthcare providers to overcome the challenges faced by our ageing prison population.”
