The effectiveness of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP): a randomised controlled trial

Abstract

Background Older people are the fastest-growing group in prisons in England and Wales and have complex health and social care needs that often remain unmet. Objectives (1) Evaluate the efficacy of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) in improving (i) the ability to meet older male prisoners’ health and social care needs, (ii) health-related quality of life (HRQoL), (iii) depressive symptoms and (iv) functional health and well-being and activities of daily living; (2) assess the quality of care plans produced; (3) explore the experiences of older prisoners receiving, and staff conducting, the OHSCAP; and (4) evaluate the cost-effectiveness of the OHSCAP compared with treatment as usual (TAU). Design Multicentre, parallel-group randomised controlled trial (RCT) with follow-up at 3 months, with a nested qualitative study and quality audit of care plans (n = 150, 68%). Setting Ten English prisons. Participants Four hundred and ninety-seven newly arrived male prisoners aged ≥ 50 years with a discharge date at least 3 months from recruitment. A total of 14 prisoners and 11 staff participated in qualitative interviews. Intervention Randomisation to OHSCAP or TAU. The OHSCAP group had health and social needs assessed by a trained health-care worker or prison officer. Care plans were devised and subsequent actions included professional support and appropriate referrals. Main outcome measures Primary outcome measure – mean number of unmet health and social care needs as measured by the Camberwell Assessment of Need – Short Forensic Version. Secondary outcome measures – measures of functional health and well-being, depressive symptoms and HRQoL. A health economic evaluation was undertaken using service contact between baseline and follow-up and appropriate unit cost information. Results A total of 497 prisoners were recruited (248 to OHSCAP and 249 to TAU). The 404 completed follow-ups were split evenly between the trial arms. No significant differences were observed between the intervention and TAU groups in relation to the primary outcome measure. The OHSCAP did not demonstrate convincing benefits in HRQoL over TAU, and there were no significant differences in relation to costs. Audit and qualitative data suggest that the intervention was not implemented as planned. Limitations As a result of the limited follow-up period, potential long-term gains of the intervention were not measured. Some of the standardised tools had limited applicability in prison settings. Cost-effectiveness data were limited by unavailability of relevant unit cost data. Conclusions The OHSCAP failed in its primary objective but, fundamentally, was not implemented as planned. This appears to have been attributable, in some part, to wider difficulties currently affecting the prison landscape, including reduced levels of staffing, the loss of specialist support roles for such initiatives and increased prevalence of regime disruption. Future work Partnership working and information sharing across disciplines within prison settings require improvement. Research should explore the potential involvement of other prisoners and third-sector organisations in identifying and addressing older prisoners’ health and social care needs to better match community provision. Further examination should be undertaken of how the prison regime and system affects the well-being of older prisoners. Future prison-based RCTs should carefully balance the fidelity of initiatives being evaluated and testing in a ‘real-life’ setting. Trial registration Current Controlled Trials ISRCTN11841493. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 5, No. 31. See the NIHR Journals Library website for further project information.

The Older Prisoner Health and Social Care Assessment and Plan (OHSCAP) versus Treatment as Usual: A Randomised Controlled Trial

“…The main explanation for the lack of difference between the TAU and OSCAP groups is that the OHSCAP was not implemented as intended (Forsyth et al, 2013;Forsyth et al, 2017). An audit of all accessible OHSCAPs was conducted (68%) to identify both the delity of implementation and the quality of the care planning.…”

“…The nested qualitative study generated a valuable understanding of why the OHSCAPs had not been adequately executed (Forsyth et al, 2017). Semi-structured interviews with 14 prisoners and 11 staff members detected fears about healthcare and prison 'silos' resulting in a lack of meaningful multi-agency and partnership working (Forsyth et al, 2017). Prisoners additionally stated that they considered it objectionable for prison o cers to be facilitating the OHSCAP.…”

“…Most strikingly, staff stipulated that they were working within a 'broken prison system', because of the recent considerable staff reductions. Staff stipulated that meeting basic needs such as enabling all prisoners to have showers and remain safe was more challenging since the staff reduction, thus facilitating the OHSCAPs was a low priority (Forsyth et al, 2017).…”

“…This was largely as a result of retention issues in the local (remand) prison sites, where it was more di cult than expected to identify individuals who would remain in prison for the three month follow-up period. Thus, we increased our recruitment period and augmented our baseline recruitment target to a maximum of 502 participants at baseline, from the initial target of 462 (Forsyth et al, 2017). 3) Changes to assessment tools: Several changes were made to the assessment's tools in advance of data collection.…”

“…Additional training sessions held at The University of Manchester, which were attended by facilitators from all prison sites. Continuing assistance was also offered by one of the investigators (EW) (Forsyth et al, 2017).…”