Prison population: social care needs

6. Conclusion

The Scottish Government is undertaking a comprehensive, national assessment of the health and social care needs of people who are in prison. This will help to ensure that ongoing efforts to integrate health and social care in prisons are informed by evidence and are person-centred. Self-directed support and the integration of health and social care available to people in the community have so far not been extended to people in prison. Currently, social care in prisons is the responsibility of the Scottish Prisons Service (SPS).^[31] In contrast, responsibility for health services was transferred from the SPS to NHS Health Scotland in 2011 and, subsequently delegated to Integration Authorities when they were established in 2015. A challenge for providing integrated health and social care is the lack of robust estimations of the scale, as well as an evidence-based understanding of the nature of the support needs across the population in prison. The last national prisons health needs assessment was in 2007 and did not include social care. This report aimed to quantify the extent of social care support needs among people in prison in Scotland using statistical techniques informed by qualitative research, and the wider existing evidence base, to assist in interpreting statistical results.

The central, and preferred, estimate produced by this study is that 7-10% of the prison population in Scotland have social care needs. This is based on extrapolating from the non-prison population based on characteristics including age, deprivation levels, gender, and the premature ageing of the prison population. However, there are a wide range of estimates available outside of the central estimate. Extrapolating from the non-prison population receiving care produces an estimate that around 3% of the Scottish prison population would have met eligibility criteria thresholds for support outside of prison. Instead, focusing on social care data in the SPS PR2 extract provides the highest estimate in the range, with a result of 13%. All of these estimates apply to the same definition of social care, although the lowest estimate also factors in eligibility criteria.

Going beyond the scope of the current study, there is the question of whether preventative social care support should also be considered, so that individuals who do not currently have social care support needs become less likely to develop them. For example, more could be done to encourage people in custody to participate in the prison community, socialise more and manage complex relationships, as well as preparing for their transition back into the wider community.

Delivering preventative social care would involve providing services to a larger proportion of the prison population in Scotland than under the approach of only working with existing needs. However, it should be noted that the cost per individual is likely to fall as increasing numbers of individuals receive support. This is because a small number of individuals need very high levels of support (at high cost) but reducing eligibility criteria means working with individuals with lower levels of support needs. Going further, preventative care involves working with individuals where small amounts of support, e.g. providing structured group activities, can reduce their chance of developing social care needs. Lastly, effective preventative care may reduce total funding requirements depending on the success of preventative activities.