Prison Care Pathways – integrated care pathways and continuity of care at points of transitioning and resettlement for older offenders with complex care needs

Background & Scientific Rationale:

With growing and ageing prison populations and spiralling costs whilst budgets are under strain, providing good governance and clear efficient and cost-effective integrated care pathways of prison health and social care as well as continuity of care upon transitioning in-and-out of prison and resettlement back into the community is one of the top priorities on local, national and international agendas.1

Taking an older offender in the UK to be someone aged 50+, the number of older people entering the UK’s Criminal Justice System has trebled in the last 20 years. More than 80% of older offenders have long-standing illness or disability and over 50% suffer from a mental disorder. 30% have a diagnosis of depression and there are only estimated figures for dementia in the prison environment – between 1% and 30%. People aged 60 and over are now the fastest growing age group in the prison estate. In January 2014, there were 10,587 prisoners aged 50 and over in England & Wales, an increase of 6.8% since 2012. This group makes up 13% of the total prison population (RECOOP).

In light of the new Care Act 2014 implementation, which came into force in April 2015, and based upon our research to date, it is clear that both integrated care and continuity of care is working in pockets of isolation or is lacking (yet highly needed) in the prison environment. Further, there is little data regarding transitioning in-and-out of the prison estate, and upon resettlement in the community although anecdotally from the Justice select review there are stories of failures to support older offenders. This does not only pose significant health and social care services and systems challenges for key-stakeholders involved, but it is also completely unsustainable with very high costs to society (e.g. tax payer) and avoidable suffering and distress at individual, family and community level too (offenders, their families, professionals working with them). Furthermore, lack (and inefficiency) of care provisions, delivery and continuation of care also violates the right to health and care, dignity, compassion, and wider human rights.

Current resettlement pathways are now being delivered through CRCs (Community Rehabilitation Companies). Their current East of England (Sodexo) Service Plan 2015/16 does mention older offenders or those with enduring health problems specifically, but does have a partnership framework including Safeguarding Adult boards and a core value of responding to diverse needs. With the numbers of older offenders growing, ‘firming up’ links with social care providers will reduce crisis interventions by care service providers.

Research aims:

  • To contribute towards development and implementation of efficient, integrated, cost-effective care pathways at points of transition and resettlement for older offenders with complex care needs;
  • Assess feasibility of effectively meeting health and social care needs of older prisoners while adhering both to security, equity and efficient use of resources;
  • Directly contribute to UK-wide effective and sustainable prison policy and implementation around integrated care pathways on resettlement.

Specific objectives of the study are to:

  • Synthesise research on integrated care pathways and continuity of care (and related costs) at points of transition and resettlement for older offenders with complex care needs;
  • Map intended (MoJ NOMS guidance) and current actual process of resettlement work for offenders with health and social care needs in differing establishments (Cat B-Cat D) using scenarios and actual resettlement provider responses;
  • Compare with community delivery to an equivalent person leaving an institution (.e.g. older person leaving hospital) and related cost assessment;
  • In collaboration with stakeholders (offenders, ex-offenders, MOJ and more) develop a pilotable model for integrated care pathways and continuity of care at points of transitioning and resettlement for older offenders with complex care needs (per prison category);
  •  Project cost of (new) integrated care provisions in caring for older prisoners and influencing successful ‘resettlement’, reduced re-offending and reduced care needs;
  • Implement pilot with at least 3 offenders from each category in partner prisons.

Proposed methods:

The project will use a multidisciplinary and mixed-method approach including:

  • Evidence synthesis;
  • Mapping current (and comparable) pathways;
  • Collaborative co-development of pilotable model;
  • Economic assessment.

Expected Output of Research / Impact and added value:

This project is part of a CLAHRC funded programme of work focusing on prisoners living with dementia:  ‘Social care options for older prisoners’ (development research) and ‘Dementia Friendly Prisons’ (implementation work).  As a result of this work the research group have been invited to collaborate directly with the Ministry of Justice’s National Offender Management Service and the King’s Fund to contribute towards developing sustainable, efficient and cost-effective integrated care pathways, operational policies and strategies for older offenders with complex care needs in HMPs, during transitioning in-and-out of prison and upon resettlement in the community. The research holds the potential to become a ‘regional example for national learning’, knowledge exchange and potential rolling-out of a given model(s) at limited cost.

For further information on this project, contact Dr Tine Van Bortel at