1. HMP WAKEFIELD: Physical Education Officer: Neil Evans Older Persons Lead Nurse: Janet Richards Meeting the needs of older prisoners and responding to the challenges of cardiac care in a high security prison.

2. Introduction to HMP Wakefield Maximum Security Prison within the High Security Estate. Established as a prison on this site since 1593. * We currently hold 729 prisoners including 148 Category A ’ s & 4 High Risk. (Correct on the 8-10-15)

3. Facts & Figures In comparison with the prison population, HMP Wakefield has one of the oldest population with nearly 50% of prisoners over the age of 50! This comes as no surprise given the increasing historical sex offender population. Breakdown of age groups at HMP Wakefield at October 2015: 18 – 200 21 – 2413 25 – 2955 30 – 39125 40 – 49185 50 – 59186 60 – 69128 70+37

4. Opportunities/activities for the older population at HMP Wakefield cont…. GYMNASIUM Sports & Social Club Exercise Referral Scheme Education ( Disabilities, Dementia Awareness, Stress man, Sports qualifications) Treatment of Injuries Weight Management Cognitive Care Health & Wellbeing Events Cardiac Care Supervised by Appropriately Qualified Staff.

5. Cardiac Programme…… Gymnasium/Healthcare Every Friday morning: Although not specific to the older population; they do pose a higher risk A programme for those with specific cardiac issues. Minimum 15 week programme. Regular screening by Healthcare. Circuit and Individualised progressive training programmes specific to strengthening the heart. Education. STRICT CRITERIA; THE INDIVIDUALS CONDITION MUST BE STABLE.

6. Service Needs Analysis for Cardiac Care at Hmp Wakefield…… Increasing prevalence of chronic disease/illness due to people living longer Increasing number of hospital re-admissions following cardiac events Security and high risk escorts, needs an upstream approach ( prevention is better than cure) Issued guidelines for PE departments dealing with prisoners experiencing known cardiac issues accessing gym facilities. PE Bulletin (2009) Inequalities between community and custodial services

7. Barriers to Implement Cardiac Care in a High Secure Estate……… Lack of partnerships between clinical and exercise professionals Lack of qualified/dedicated personnel to deliver service requirements Adapting community services to fit into a prison environment/regime Difficulties experienced between care v custody Engaging prisoners due to a lack cardiac education Engaging managers to ‘Buy in’ to the service Funding to deliver and maintain cardiac care services

8. Implementation….. Received funding from the British Heart Foundation (BHF) to employ a cardiac specialist nurse for 2yrs. A member of the PE team received funding from the establishment to gain the necessary qualifications ‘Memorandum of understanding’ was developed between the contracted healthcare services (spectrum) and the establishment to ensure multi-disciplinary approach to the service. Scheduled exercise and clinical appointments allocated within in each discipline Partnership working with community services to ensure quality assurance Linking services to National Resettlement Pathways to maintain sustainability and drive forward change

9. …Success!!!! Acute Cardiac events reduced by 60% within 4 years Blueprint for the service has been established and endorsed by the BHF for other prison establishment Recognised as profiled work within the establishment Empowered and educated patients/prisoners to take responsibility for their own health Prisoners actively engaging with the service (mentors etc) National recognition across the healthcare, community and prison services (BJN, BHF, NOMS, Spectrum) Multi-agency working across cardiac services to develop a better understanding of the prison/patient restrictions Linked to National Pathways to maintain sustainability and raise the profile of this service

10. ….HMP Wakefield Cardiac Care Thank you for your time.