Integrated health and social care in prisons: Tests of change: workstream findings and recommendations

Adults Justice

This report results from more than 2 years of intensive exploration of the rationale for and the challenges of delivering integrated health, social work and social care services and support in Scottish prisons.  Seven individual prison sites across five HSCPs undertook tests of change for up to six months, working with the Scottish Prison Service, Scottish Government, Social Work Scotland, IJBs and other stakeholders to provide evidence and learn about what is required for the future. As this report was written in September 2020, it, and the tests of change earlier in 2020, were not in a position to consider the recommendations from the Independent Review of Adult Social Care[1] which was reported in February 2021.  Some amendments have been made to this latest version of our report to incorporate the policy directions from the Independent Review.

This report recognises the positive work already happening in our prisons and HSCPs that supports people in prison and those liberated.  It also identifies some key areas where there are opportunities to improve and strengthen the multi-disciplinary approaches that respond to the complex needs of many people in our prisons; to support them lead positive lives within the prison and then to move on and seek employment, support their families and contribute positively to their communities. These key areas include:

Integrated services: People in prison with physical needs already receive personal care arranged directly by the SPS.  However, they currently are not getting access to integrated services that encompass health, social work and social care and include the opportunity for a holistic assessment of need.  This report explores some of the issues around “personal care”, “social care”, “support” and “social work” and illustrates some potential benefits of shifting some of the traditional boundaries between social work specialisms.

Equivalence of access to health and social work and care assessment and provision in prison is a human rights issue.  This report finds that better access would bring with it the potential for support for the SPS (who design the daily experience for people in their prisons) from health and social services professionals to improve accessibility to work, education and leisure activities. This is equally important for people with poor mobility and for those with needs that may not be visible such as learning disability, mental health, substance use and autism, all of which affect the person’s capacity to manage daily life.

Transitions:  Admission to prison, moving across the prison estate and liberation are all significant events that currently carry a risk that people with support needs (particularly those that are not physical) are not identified early on and that continuity of care and support is jeopardised.  The current system of voluntary Throughcare (for those not subject to statutory supervision upon release) requires the person in prison to understand the supports available and choose whether to engage or not when a service is offered or to actively request available support from local authorities after release.

People in prison may have a range of difficulties engaging with services, for example, remembering appointments and developing relationships and may have had little opportunity to control their daily life whilst in prison.  This report recommends a whole system approach to transitions including the development of existing Throughcare and pre-release approaches to ensure that each person’s circumstances and needs are assessed, extending the current considerations of housing and benefits to encompass wider aspects of health and social care.  With greater support on their return to the community, the likelihood of crisis and thereby return into the justice system can be reduced.

Early intervention, prevention and eligibility for services:  In the community, there are a variety of Third Sector organisations that offer support to people both on a self- or formal-referral basis; drop-in cafes, support groups and so on.  If people can access the internet in the community, there is advice and information for issues of well-being. Friends and family are also a source of informal support and services within the community.  This community supports reducing the need for formal professional assessment by enabling people to successfully manage their health and well-being needs themselves and with their network of friends and family.  Whilst there are a number of well-being services in prison, these have generally grown up organically rather than being based on strategic needs assessment and a commissioning plan.

In the community, if needs cannot be met through these informal supports, people are entitled to ask for an assessment as the gateway to formal services.  Currently, only needs to be deemed sufficiently critical are eligible for formal support through care packages.  This high threshold of eligibility, when applied to the prison setting, excludes people in prison from the support they need for reasons of learning disability, mental health and so on, which are very often related, directly and indirectly, to criminogenic need.  For example, 20% of the prison population in NHS Greater Glasgow and Clyde (NHSGGC) were alcohol dependent and over half of NHSGGC people in custody were under the influence of alcohol when committing their offence (NHS Greater Glasgow and Clyde, 2012).

The people involved in delivering the tests of change from the SPS, health and social work teams undertook a mammoth task in aiming to deliver an integrated service across not only health and social care but including the prison service and justice social work. They did this within a six-month timeframe.  All the test sites were affected by the COVID-19 pandemic and at the time of writing, there is still some data outstanding that once analysed will offer further useful learning for the future.

Some of the recommendations in this report are ambitious; some will require further development and some are likely to have some resource implication. What this report illustrates is that there are significant opportunities to improve the well-being of people in prison through access to integrated health, social work and social care support which will not only ensure their rights are addressed but will contribute to better engagement within the prison and more positive lives on the outside.  These recommendations promote Scotland’s National Outcomes[2] particularly in the areas of strong and safe communities, health, human rights and poverty.

[1] Independent Review of Adult Social Care – (