South Staffs Prison Learning Disability Review

1. South Staffs Prison Learning Disability Review Key Findings and Recommendations

2. Purpose of Review Stated objectives of the review: To identify how current primary care and mental health services can be developed to better support the needs of prisoners with a learning disability. To identify how different departments within the prison can work together to support the needs of prisoners with a learning disability. To identify gaps in healthcare services for prisoners with more complex learning disability needs. To provide recommendations for the provision of learning disability services within a new prison To provide recommendations to inform future commissioning plans for the six existing prisons.

3. Approach Taken Our methodology included the following steps: Start-up meeting Review of key documents/policies Development of interview guides Meetings with key representatives of custodial institutions Consultations with prisoners (tracking of support) Stakeholder interviews Analytical workshops Reporting

4. Estimating Prevalence

5. Headline Findings If support for prisoners with learning disabilities is integrated into mainstream services, this will have significant benefits for the wider population of prisoners with learning difficulties, communication problems and/or serious deficits in literacy and numeracy. Prisons and YOIs have no systematic process for screening or identifying learning disabilities This means that the scale of the problem cannot be fully understood Meaning that prisons are not equipped to build a business case for addressing the needs of learning disabled prisoners. This also means that support cannot be effectively targeted at those who require it.

6. What we have found... General awareness of learning disabilities is low amongst staff working in prisons With significant gaps present in reception, induction and residential settings. Specialised learning disability support and knowledge are not adequately available across prison regimes in South Staffordshire. Prisons demonstrated a number of services that provide adaptable and flexible support, which are capable of meeting the needs of people with learning disabilities However, these services are generally operating beyond full capacity.

7. Highlighting Gaps in the Care Pathway

8. Care Pathway – Cross-Cutting Gaps

9. The following slides look at some of the key gaps in more detail...

10. Gaps Analysis – Health No dedicated learning disability resources No dedicated learning disability training MHIR deal with referrals but don’t have specialism or remit to support these clients In practice DLOs focus on physical health needs Psychology departments are not charged with providing additional input into the support of learning disabled prisoners.

11. Gaps Analysis – Resettlement: Risk and Thinking Behaviour Inequality of access to OBPs – Restricted access for learning disabled prisoners. A result of reduced access to OBP is that a prisoner may spend a longer time in prison due to presence of a learning disability Limited application of adapted courses Toe-by-Toe is often used as a remedial strategy but this is only suitable for a narrow range of needs for some learning disabled people – and is often oversubscribed

12. Gaps Analysis – Residential / Work Lack of prison officer training and awareness reduces the quality of informal support Personal officer schemes under utilised to support learning disabled prisoners Anti-bullying schemes lack information on consequences of learning disability Information provided to prisoners is very word and content heavy

13. Recommendations for filling the gaps in the care pathway

14. Recommendations - Identification Screening: Adopt Learning Disability Screening Questionnaire (LDSQ) No existing screening – and OASys/ASSET rely on self reporting current DoH pilot provides valuable opportunity Highlights individual needs Scope the overall scale of need Screening also quantifies scale of prison population with moderate and severe LDs and use this to inform planning for alternatives to custody/community based and in-patient forensic health services/ secure hospital provision

15. Recommendations – General Skills Awareness training – targeting key staff groups Target audience: Reception, induction, personal officers, DLO’s, management Purpose of training: Tailored to roles of target audience E.g. Prison officers - Why conditions may be concealed, how reasonable adjustments can allow fuller use of prison services, understanding of practical implications: e.g. Anti-Bullying Easy Read Resources Best addressed in partnership with specialist agencies Aim to embed skills into prison based staff

16. Recommendations – Specialist Skills Provision of specialist skills – Three options to address this current gap in provision: Option A: Recruit LD nurse to work across 6 prisons Option B: Deliver programme of specialist training to existing prison-based healthcare staff Option C: Expand remit of community based LD teams Recommended approach – Pursue a combination of embedding specialist skills in existing prison based nursing and expanding remit of community based LD services

17. Recommendations Increase access to OBPs Nationally – this is a key issue of equality Lobby NOMS, Home Office and HMP Prison Service Locally - skills development will be key to enabling greater delivery of adapted courses Integrate different departments responses to prisoner LD needs – E.g. Dovegate’s Offender Health Intervention Department (OHID)

18. Recommendations Acid test mainstream services LDs represent ‘tip of iceberg’ – much larger proportion of prison population have learning difficulties and severe deficits in literacy and numeracy identify reasonable adaptations at operational level Improve strategic awareness – Governors to sign up to high-level strategy & principles of best practice: Definition Vision of service standards Goals

19. Questions?

20. Appendix A – Care Pathway: Model of Core Activities

21. Appendix B – Care Pathway: Key Services

22. Appendix C – Care Pathway: Gap Analysis