How is Social Care Provided in Adult Prisons in England and Wales?

There is variation in provision of social care in prisons. Our research aimed to understand variation across adult prisons in England and Wales, including: (1) what social care is provided? (2) who delivers social care? (3) what peer support initiatives are used? (4) what social care indicators are relevant? and (5) are there differences between prison type and social care provision? We analysed Her Majesty’s Inspectorate of Prisons (HMIP) reports (published 2017–2020) from 102 prisons. From these reports we extracted and analysed data on social care provision. Elements of social care are not consistently delivered; need assessments (81.4 per cent) and referrals (75.5 per cent) were most frequently reported. Different providers (health care/social care/prison) deliver social care. Forty-one prisons (40.2 per cent) included peer support (formal to informal). We found no notable differences between prison categories and social care delivery, although, within category D prisons, a significantly larger proportion of those with a disability reported receiving support they needed. Inspection reports highlighted that prison social care should mirror community social care, but we could not fully evaluate this due to reporting issues. Social care provision varies; effectiveness of different models is not yet known. We provide recommendations to improve social care reporting within HMIP reports.

Introduction

The number of older adults living in prison is increasing rapidly in the UK (House of Commons Justice Committee, 2013; Stewart and Lovely, 2017; Scottish Government, 2021) and worldwide (Forsyth et al., 2015). Therefore, many adults in prison, require support with social care needs (Tucker et al., 2021). Adults with a range of conditions (e.g. adults living with dementia, autism, mental health conditions, learning disabilities or frailty) may require social care support in prison (Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018). Improving social care in prisons is a priority across the UK. For example, care acts have been introduced in England (Care Act, 2014) and Wales (Social Services and Wellbeing (Wales) Act, 2014). Scotland has also identified this as a key priority (Levy et al., 2018; Scottish Government, 2019). However, research has shown that these needs are often unmet (Hayes et al., 2013; Senior et al., 2013; Williams, 2013; Forsyth et al., 2015; O’Hara et al., 2015, 2016; Roulston et al., 2021). This lack of social care has been reported by men in prison as having a profound impact on their daily life (Tucker et al., 2021).

More specifically, a review of social care conducted in 2018 found that the delivery of social care in prisons varied substantially in England and Wales and that those who do not meet eligibility for social care were not receiving the social care support that they needed (Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018). This finding is supported by two national surveys of local authority managers which indicated a large need for social care provision, but found that the presence of needs does not equate to delivery of social care and that social care delivery was variable across local authorities (Tucker et al., 2018).

A national survey of eighty-eight local authorities in England identified challenges to implementation of social care provision within prisons, including challenges identifying people with social care needs and difficulties sharing information and coordinating care (Robinson et al., 2022). Recommendations to improve social care have included the assessments of prisoners who required social care, the provision of social care by appropriate professional staff and trained peer support workers, and care plans (Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018). A rapid prioritisation process also highlighted peer support initiatives as one of the top five priorities for further evaluation within adult social care (Cowan et al., 2021).

In recent years, the provision of social care has been supplemented with peer support initiatives to provide a package of social care support (Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018). Peer support workers have supported social care providers to provide non-personal care to other prisoners. Benefits to prisoners (e.g. confidence, independence and trust) and the wider prison (e.g. sense of community, lower costs) have been identified (Toch, 2000; Stewart, 2011; Stewart and Lovely, 2017). A study of 482 men in prison highlighted that 6.5 per cent of the sample indicated that they received a high level of support from other prisoners (Tucker et al., 2021).

Peer support workers should be competently trained, have supervision, clear roles and support (Her Majesty’s Inspectorate of Prisons, 2016; Stewart and Lovely, 2017; Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018); yet, the level of support provided for peer support workers varies in practice (Stewart and Lovely, 2017; Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018). Social care provision also varies across prisons (Anderson, 2016; Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018), despite the implementation of the Care Acts (Anderson, 2016). It is also not clear who is responsible for older prisoners’ social care (Senior, 2013).

An updated and more detailed understanding of how social care is delivered in prisons throughout the UK is needed, including: what types of peer-led initiatives for social care are used and how these are used within the context of wider social care provision. We used HMIP prison inspection reports to understand how social care is provided in England and Wales. This is consistent with previous research which has used the HMIP reports to evaluate mental health provision (Patel et al., 2018) and health and well-being (Woodall and Freeman, 2019). To the authors’ knowledge, there have been no similar reviews of social care provision in prisons in England and Wales. Furthermore, data on social care indicators are limited in previous research; therefore, we hope to identify relevant social care indicators that could be used to evaluate social care provision from the HMIP reports.

Our review of HMIP reports aimed to address:

1. What social care is currently provided in adult prisons in England and Wales?
2. Who delivers social care?
3. What peer support initiatives are used for social care?
4. What social care indicators are relevant to adult prisons in England and Wales?
5. Are there any differences between types of prisons in terms of the social care that is provided?

Methods

HMIP reports

We conducted a documentary analysis of HMIP prison reports (Her Majesty’s Inspectorate of Prisons, n.d.). HMIP reports outline the findings of prison inspections, conducted jointly by Ofsted or Estyn (Wales), the Care Quality Commission, the General Pharmaceutical Council (GPhC) and HM Inspectorate of Probation (HMIP). These reports also present the results of a survey of randomly selected prisoners that is conducted at the start of every inspection. The survey consists of structured questions covering the prisoner ‘journey’ from reception to release, together with demographic and background questions (see Supplementary File S1 for more detailed information).

There are six categories of prisons in England and Wales: category A are high-security prisons; category B are either local or training prisons; category C are training and resettlement prisons; category D are prisons that have minimal security and allow eligible prisoners to spend most of their day away from the prison; Female prisons—females are categorised and held in either closed conditions or open conditions, according to their risks and needs and the final category is Young Offender Institution (YOI) which is intended for offenders aged between fifteen and twenty-one years (Ministry of Justice and Her Majesty’s Prisons and Probation Service, n.d.).

Sample

There are 123 prisons in England and Wales. This research focused on social care delivered in prisons for adults (n = 115). YOIs (for those under the age of eighteen years) (n = 5) and secure training centres (n = 3) were excluded. Prisons that did not have an inspection report for the period 2017–2020 were excluded (n = 13). A total of 102 prison inspection reports were included.

Procedure

HMIP reports (published between January 2017 and June 2020) were downloaded from the Justice Inspectorate website (Her Majesty’s Inspectorate of Prisons, n.d.) between April and June 2020. To update and further develop our understanding of social care provision and peer support initiatives in prisons in England and Wales highlighted in a thematic evaluation of social care provision [published in 2018] (Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018), we included reports published from 2017. As our analysis included reports up until June 2020, this analysis updates previous evaluations of social care provision (Her Majesty’s Inspectorate of Prisons and Care Quality Commission, 2018).

Data were extracted on the following topics: descriptions of social care (quotes from reports), any other information on social care provided in the reports and information on social care indicators. Reports (n = 102) were allocated to one of two researchers (H.W./S.M.T.). Researchers extracted qualitative and quantitative data from these reports.

Once all data were extracted, one researcher (H.W.) checked, coded and summarised the qualitative data (descriptions of social care and other information on social care). The researcher coded a number of aspects of social care, including whether referrals, assessments, care plans or care reviews were carried out and by whom; who delivers social care, and whether peer support initiatives were used in social care delivery, and any descriptive information on whether social care delivered meets the needs of prisoners. Once we had coded information on referrals, assessments, care plans and reviews, we categorised these reports into different categories, including ‘yes’ (reports provide information that the aspect of social care is delivered within that prison), ‘sometimes’ (reports provide information to indicate that the aspect of social care is delivered some but not all of the time), ‘no’ (report provides information to indicate that the aspect of social care is not delivered) and ‘unclear’ (report does not provide information to indicate whether the aspect of social care is delivered or not).

Additionally, once all data were extracted, one researcher (S.M.T.) synthesised the quantitative data (indicators of social care) from collated survey data provided in individual reports. The researcher extracted information about prisoners who considered themselves to have a disability and the support they receive as well as the needs and expected support for social care upon release.

Once the initial findings were developed, they were discussed and agreed by both researchers and the wider team.

Analysis

Descriptive statistics were used to analyse the data, including how many prisons delivered aspects of social care (including referrals, assessments, care plans, care reviews and peer support initiatives), the different providers of social care provision and types of peer support initiatives. Due to the low numbers of prisons in some categories, we combined male prisons into higher risk (categories A, B and A/B) and lower risk groups (categories C, D and C/D) and conducted chi-square tests to identify any notable differences between them.

To explore social care indicators in more detail, we summarised survey findings (see Supplementary File S1 for more details) relating to the support received by prisoners who considered themselves to have a disability and expected social care needs and support of prisoners upon release. We grouped findings according to categories of prisons and gender. Chi-square tests were conducted to see if there were any differences between categories of prison in the degree of support provided for prisoners reporting to have a disability and if there were any differences in expectations for social care support after release.

Results

What social care is currently provided in adult prisons in England and Wales?

A total of 102 HMIP reports were analysed. The most frequently delivered aspects of social care were assessment of social care needs (81.4 per cent) and referrals for social care (75.5 per cent). Care plans for social care (44.1 per cent of prisons) and reviews of social care provision (28.4 per cent) were less frequent. Many reports did not specify whether referrals (21.6 per cent), assessments (17.6 per cent), care plans (49 per cent) or reviews (69.6 per cent) were delivered.

Who delivered social care?

Social care was delivered by a range of providers , including: commissioned care providers (external organisations) (34.3 per cent where providers are known), providers from multiple sectors (12.7 per cent), health care staff (10.8 per cent) and social care staff (10.8 per cent). Many different external provider organisations—private and voluntary sector—were reported. Eight reports did not specify who social care was delivered by and seventeen reports were unclear.

What peer support initiatives are used for social care?

Over a third of prisons (41 reports, 40.2 per cent) reported peer support initiatives, in which other prisoners were involved in the delivery of social care at their institution.  There is no notable relationship between the reported use of peer support workers and prison category, although sample sizes for some categories were low making it difficult to detect any relationship that may exist.

Different types of peer support initiatives for social care were used (see Table 3). Examples of these peer support initiatives included: informal unsupervised peer support (19.5 per cent), buddy schemes (14.6 per cent), buddy schemes with training and supervision (14.6 per cent) and buddy schemes with training (12.2 per cent).

Conclusion

Social care provision varies across prisons in England and Wales; with some aspects of social care being delivered more frequently than others. The most frequently reported providers of social care were externally commissioned care providers. Many prisons included peer support workers to provide social care; ranging from formal to informal. Prison inspection reports highlight that social care provision should mirror community social care provision, but it was not possible to determine whether this has been achieved. There is a need to standardise reporting of social care provision within HMIP reports. We have provided five recommendations of how reporting could be improved.