Documentary analysis of social care provision in adult prisons in England and Wales

Overview

This chapter draws on a paper by Walton et al.,1 published in the British Journal of Social Work (https://doi.org/10.1093/bjsw/bcac145). Reproduced with permission from Walton et al.1 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) licence, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/. The text below includes minor additions and formatting changes to the original text.

What was already known:

• There is a high need for social care support in prisons in England and Wales.
• Peer support services may be used to support a range of needs, including social care, but it is not known to what extent peer-supported social care is used across England and Wales.

What this chapter adds:

• Social care provision varies across prisons in England and Wales.
• Many prisons included peer support workers to provide social care, ranging from formal to informal.
• Provides suggestions on how the reporting of social care provision could be improved in HMIP reports, to help establish whether social care provision mirrors community social care provision.

Introduction

As outlined in Chapter 1, there is a high need for social care support in prisons in England and Wales but this varies across both countries and may result in unmet needs.16,35 To improve social care in prisons in England and Wales, a more detailed understanding of how social care is delivered in prisons throughout England and Wales was needed, including what types of peer support are used for social care and how these are used within the wider social care provision.

To the authors’ knowledge there have been no reviews of social care provision in prisons in England and Wales. The documentary analysis 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 schemes 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 type of prisons in terms of the social care provided?

Methods

We conducted a documentary analysis of HMIP reports, published between 2017 and 2020 (see Chapter 2).

Findings

A summary of the findings is provided below, for further information see Walton et al.1

RQ1. What social care is currently provided in adult prisons in England and Wales?

A total of 102 HMIP reports were analysed. The documentary analysis highlighted the most frequently delivered aspects of social care (assessment of social care needs: 81.4% and social care referrals: 75.5%) and the least frequently reported (care plans: 44.1% and reviews: 28.4%). Many reports did not specify whether or not these aspects of social care were delivered (see Appendix 2, Table 25).

Findings indicate that the development of social care plans and review of social care provision were more frequently reported for male higher categories and female categories of prisons (54.3% and 50.0% respectively developed social care plans, 32.6% and 40.0% respectively reviewed social care provision), followed by male lower-category prisons (34.9% developed social care plans and 23.3% reviewed social care provision). There were no statistically significant differences in the proportions of higher- and lower-category male prisons delivering these different aspects. The numbers of female and YOIs were too low to make meaningful comparisons (see Report Supplementary Material 7).

Many people were involved in referrals (e.g. self-referrals, single-sector providers and multiple-sector providers), assessments (council staff, social care staff and multiple sectors), care plans (social care staff) and review (multiple-sector providers, social care staff and healthcare staff) (see Appendix 2, Table 26). Many reports did not specify who made referrals, assessments, care plan or reviews.

RQ2. Who delivered social care?

Social care was delivered by a range of providers (see Appendix 2, Table 26), including commissioned care providers (external organisations) (34.3% where providers are known), providers from multiple sectors (12.7%), healthcare staff (10.8%) and social care staff (10.8%). Eight reports did not specify who social care was delivered by and 17 reports were unclear.

RQ3. What peer support initiatives are used for social care?

Over a third of prisons (41 reports, 40.2%) reported peer-supported social care (see Appendix 2, Table 25). There was no notable relationship between the reported use of peer support workers and prison category.

Different types of peer support initiatives for social care were used (see Appendix 2, Table 27). Examples included informal unsupervised peer support (19.5%), buddy schemes (14.6%), buddy schemes with training and supervision (14.6%), and buddy schemes with training (12.2%).

Peer support initiatives varied substantially in the extent to which formalities are in place for these peer support initiatives. For example, some peer initiatives were structured with relevant support, training and job specifications in place, whereas other schemes were more informal.

RQ4. What social care indicators are relevant to adult prisons in England and Wales?

Qualitative findings

Most reports specified the same social care indicators for individual prisons. These indicators focused on ensuring that services meet health, social care and substance use needs while promoting care continuity for health and social care on release. The reports highlight that patients should be receiving the same levels of care that they would receive in the community. Some reports included descriptions of whether social care provided met the needs of prisoners. However, these descriptions were often minimal and inconsistent.

Quantitative findings

His Majesty’s Inspectorate of Prisons survey findings provided other indicators relating to social care provision in prison (or on release) (see Report Supplementary Material 7), including social care support for those considered to have a long-term disability, and social care expectations on release (see Appendix 2, Table 28).

RQ5. Are there any differences between type of prisons in terms of the social care provided?

Of prisoners who considered they had a disability, 29% reported that they were receiving the support they needed (see Appendix 2, Table 28). Although the proportion was higher for female prisoners (31%) compared to males (28%), this was not a significant difference (p = 0.18, see Report Supplementary Material 7). Compared to other categories of male prisons, category D prisons had fewer respondents who considered they had a disability (19%) but had a significantly larger proportion of those with a disability reporting that they received the support they needed (42% compared to 28%, p < 0.001, see Report Supplementary Material 7).

On release, just 22% of prisoners reporting that they expected to need social care support considered they would actually receive it (see Appendix 2, Table 28). For male prisoners this proportion was 20%, which was significantly lower than the corresponding proportion of female prisoners (31%, p = 0.003). Although there was a higher proportion of these prisoners expecting to receive support being released from category D prisons (29%), the numbers were too low to determine any notable difference that may exist.

Discussion

Key findings

Social care provision varies in England and Wales. Some aspects of social care are reported more frequently (e.g. assessment and referrals). Peer support services for social care were frequently used (40% of prisons), but peer support schemes ranged from formal to informal. As recommended in the inspection reports, social care provision in prisons should mirror that in the community, but it was not possible to determine from the reports whether this has been achieved. Findings indicate a large gap between need for social care and provision of social care. Across reports, there was a lack of consistency of reporting. There is a need to standardise reporting of social care provision.

How findings relate to previous research

Findings highlighted variation in how social care is currently delivered in prisons. This suggests that social care processes are currently not implemented consistently across all prisons.16 This finding is consistent with previous research which has highlighted variability in social care provision across different local authorities.35 Findings indicate that there may be a need to standardise social care responses, particularly given previous research on the negative impact of a lack of social care on prisoners’ daily functioning.17

Findings reduce some ambiguity surrounding who is responsible for social care provision in prisons in England and Wales.33 However, it is not fully known how many of these providers are appropriately trained professional staff.16 Over a third of prisons included peer support initiatives, indicating that peer support workers contribute to social care provision in prisons, as outlined in previous research.16 We found that peer support initiatives do not replace social care provision, but supplement it.

Findings extend previous research by outlining different types of peer support initiatives for social care provision (ranging from informal to formal). Findings support previous research which outlines the importance of training,5 but regulation of peer support does not always happen.

Not all reports provide enough detail to fully understand what social care is provided in each prison, and whether the prisons meet the social care needs of their prisoners. Therefore, it was not possible to fully understand how social care is fully delivered in prisons in England and Wales and some of the findings may not fully represent the provision of social care. Standardised reporting on the implementation of social care aspects may be needed.

Strengths and limitations

This review focused on social care provision in adult prisons in England and Wales. We only included reports that were inspected between 2017 and 2020. However, the sample of 102 reports included the majority of adult prisons in England and Wales, therefore enhancing the generalisability of the study.

Findings focus solely on social care as we have not reviewed other aspects of care provision in prisons in England and Wales. Additionally, the findings are limited to the information and wording reported in the HMIP reports. It is possible that actual social care delivery may differ from what is reported (e.g. if details are missing).

For the analysis of social care indicators, we relied on the survey findings provided in the reports. However, the survey questions used were subjective and only reflect perceived needs and expectations of the prisoners. Some of the HMIP reports indicate that the number of prisoners who consider themselves to have a disability may be higher than the number identified by prison authorities.

One limitation is that the initial interpretation of findings was carried out by single researchers (one researcher interpreted qualitative findings relating to descriptions of social care and one researcher interpreted quantitative findings relating to indicators of social care), therefore there could be some subjectivity in the categorisation of reports into ‘yes’/‘sometimes’/‘no’/‘unclear’. However, findings and conclusions were discussed and agreed by the whole research team.

A further limitation is that the study covered prisons only in England and Wales. Therefore, prisons in other areas of the UK were not included. Findings therefore can only be generalised to England and Wales.

Implications

Findings of this analysis may inform research-based evaluations of prison social care models (e.g. types of peer support initiatives). This could help to improve social care provision in prisons.

Findings outlined limitations of reporting in HMIP reports. Findings could help to improve the reporting of social care in HMIP reports in future. Five recommendations to improve transparency, facilitate comparisons of social care provision across prisons, and support research evaluations are shown in Box 1.

Reports should:

1. Clearly outline whether aspects^a of social care are implemented in prison settings.
2. Clearly outline who is responsible for aspects^a of social care in prison settings.
3. Provide details on how the aspects^a of social care are implemented in prisons (where available).
4. Provide detailed descriptions of roles, training,^b supervision and guidelines (for both social care providers and peer support workers).
5. Consider including additional survey questions^c on social care received in prison and consistently report on:
   1. whether prisons meet the social care needs of their population
   2. whether the social care offered is consistent with the social care provision in the community.

1. Aspects include: referrals for social care assessments; assessments of social care needs; development of care plans for social care; review of social care provision; delivery of social care by trained professionals; and delivery of social care by peer support workers.
2. For example, instead of ‘trained providers’, reports could include a description of the training given.
3. While there are questions around social care on release, types of training and support for people living with disabilities, there are currently minimal questions which focus specifically on social care provision. Therefore, these questions are currently difficult to interpret in relation to social care.

Future research

Further research is needed to explore potential ways to reduce variations in delivery of social care in these two countries based on their needs. The current research does not indicate which peer support initiatives are most feasible, effective, or cost-effective for supporting social care provision in prison. Therefore, mixed-methods applied research is deemed necessary for evaluating the effectiveness of peer support initiatives.

Further research is also needed to measure the provision of social care, to determine whether social care provided meets the needs of this population and whether it mirrors community social care provision.

Conclusions

Social care provision varies across prisons in England and Wales. Many prisons included peer support workers to provide social care, ranging from formal to informal. 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 in HMIP reports. We provide recommendations on how reporting could be improved.