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Headline
Study found that there is a lack of integration between health and social care services for older male adults in prison, with the most frequent unmet need on prison entry being the provision of information about care and treatment, and release planning for older prisoners frequently being non-existent, but that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP), developed as part of this study, provides a feasible and acceptable means of identifying and systematically addressing older prisoners' health and social care needs.
Abstract
Background:
Older prisoners are the fastest growing subgroup in the English and Welsh prison estate. Existing research highlights that older prisoners have high health and social care needs and that, currently, these needs routinely remain unmet.
Objectives:
(1) To explore the needs of men entering and leaving prison; (2) to describe current provision of services, including integration between health and social care services; and (3) to develop and pilot an intervention for identifying health and social care needs on reception into prison, ensuring that these are systematically addressed during custody.
Methods:
The research programme was a mixed-methods study comprising four parts: (1) a study of all prisons in England and Wales housing older adult men, establishing current availability and degree of integration between health and social care services through a national survey and qualitative interviews; (2) establishing the health and social care needs of older men entering prison, including experiences of reception into custody, through structured (n = 100) and semistructured (n = 27) interviews; (3) the development and implementation of an intervention to identify and manage the health, social care and custodial needs of older men entering prison; and (4) exploration of the health and social care needs of older men released from prison into the community through qualitative interviews with older prisoners prior to and following discharge from prison. Descriptive statistics were produced for all quantitative data, and qualitative data were analysed using the constant comparison method.
Results:
The number of older prisoner leads has increased in recent years but they do not all appear always to be active in their roles, nor in receipt of specialist training. Nearly half (44%) of establishments do not have an older prisoner policy. There is a lack of integration between health and social care services because of ambiguity regarding responsibility for older prisoners' social care. The responsible social service may be located a considerable distance from where the prisoner is held; in such instances, local social services do not co-ordinate their care. The most frequent unmet need on prison entry was the provision of information about care and treatment. Release planning for older prisoners was frequently non-existent.
Limitations:
The study used a cut-off age of 60 years as the lower limit for the definition of an older prisoner; evidence has emerged that supports a redefinition of that cut-off to 50 years. Our study examined the care provided for men and this should be considered if contemplating using the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) with older women in prison.
Conclusion:
The OHSCAP, developed as part of this study, provided a feasible and acceptable means of identifying and systematically addressing older prisoners' health and social care needs. Future work will include the conduct of a randomised controlled trial to examine the impact of the OHSCAP in terms of improving a range of outcomes, including economic impact.
Funding:
The National Institute for Health Research Health Services and Delivery Research programme.
Contents
- Scientific summary
- Chapter 1. Introduction
- Chapter 2. Background
- The growing number of older prisoners
- Defining older prisoners
- Policy and legislation
- The health and social care needs of older prisoners
- Assessing older prisoners' health and social care needs
- Health and social care services for older prisoners
- The commissioning of health and social care services
- Integration between health care and social care services for older prisoners
- Summary
- Chapter 3. Determining the availability and integration of health care and social care services for older adults in prison
- Chapter 4. Establishing the met compared with the unmet needs of older people entering prison
- Chapter 5. The development, implementation and evaluation of an intervention to identify and manage the health, social care and custodial needs of older people entering prison
- Chapter 6. Exploring the health and social care needs of older male adults discharged from prison into the community
- Chapter 7. Discussion
- Current levels of service provision
- The integration of health and social care services
- The health and social care needs of older prisoners at prison entry
- The development, implementation and evaluation of an intervention to identify and manage health, social and custodial needs of older people entering prison
- The health and social care needs of older prisoners discharged from prison into the community
- Methodological strengths and limitations
- Chapter 8. Conclusion
- Acknowledgements
- References
- Appendix 1 Project protocol
- Appendix 2 Questionnaire
- Appendix 3 Staff interview guide
- Appendix 4 Interview guide for prisoners entering prison
- Appendix 5 Interview guide for action-learning group members
- Appendix 6 Interview guide for older prisoner lead
- Appendix 7 Interview guide for prisoners who received the Older prisoner Health and Social Care Assessment and Plan
- Appendix 8 Older prisoner Health and Social Care Assessment and Plan (OHSCAP)
- Appendix 9 Interview guide for prisoners approaching release from prison
- Appendix 10 Interview guide for prisoners released from prison
- Appendix 11 Participant information sheets and consent forms
- Glossary
- List of abbreviations
Notes
Article history
The research reported in this issue of the journal was funded by the HS&DR programme or one of its proceeding programmes as project number 08/1809/230. The contractual start date was in February 2009. The final report began editorial review in August 2012 and was accepted for publication in December 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.
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