The Independent Monitoring Board (IMB) for the prison, in Perry, said that it had seen evidence that the need to escort elderly prisoners to hospital and temporary personal supervision resulted in a drop in staff available for day-to-day duties.In the past year alone there were 78,362 internal appointments for health services with an average of 214 on-site appointments per day, along with a further 1,309 external medical and dental appointments. With 42 per cent of the prisons population over 50-years-old, inspectors from the monitoring board concluded a shortfall in staffing had been exacerbated by the ageing inmate population but, as a whole, prisoners were treated with fairness and dignity in a relatively safe environment. Inspectors also highlighted the number of deaths in custody was 10 in the past year. The prison has the fourth highest rate of deaths in the country, but, the report stated, these were from natural causes, reflecting the older prison population. This has led to the board urging the government to introduce a new national strategy for imprisoned older offenders. IMB chairman, Harry Chandler, said: Littlehey is doing a good job in developing its own arrangements for managing its changing demographic, but there needs to be a national strategy for older offenders to ensure consistency. Our role is to ensure that prisoners are treated fairly and with humanity, regardless of their offences. It is therefore important that ageing and unwell people in prison are able to maintain their dignity when they may not have much time left. Within the report it also states that 77 of Littleheys single cells are accommodating two inmates, which has placed a strain on resources and has left some elderly prisoners not allocated appropriate accommodation. The monitoring board also remains concerned that the prisons end of life suite, completed in 2013, remains unused due to lack of funding. Inspectors observed that many of Littleheys prisoners are not able to be transferred to a resettlement prison prior to the end of their sentences, with many released directly from Littlehey into the community. The board deemed the prison has not been established with sufficient facilities to address the full needs of its population. Further to the issue, it found that a programme introduced earlier this year to help prisoners obtain bank accounts and citizens cards has already been abandoned due to a lack of resources. The report also noted a lack of intervention programmes available for those who denied their crimes, who make up around 40 per cent of the population, with two major programmes ended earlier this year. [These] will be replaced by Horizon and Kaisen courses. These are available to deniers, but only a small number will be allowed on each course, the report stated. The effect of this is that many in Littlehey will remain unable to access appropriate interventions. A prison service spokesman said: HMP Littlehey is one of 31 sites receiving support for a targeted local recruitment campaign, with officers also in line for a £5,000 pay boost to help increase staffing levels. Since the inspection, the prison has recruited a number of new officers and will shortly be fully staffed.