Authors' objectives: More adults in prison need social care support. In some prisons, prisoners (‘buddies’) are trained to provide social care support for non-personal care tasks to other prisoners. These services are not mandated but have been proposed as a solution to support social care provision in prisons. Previous research explored delivery of peer support initiatives in prisons, but there has been little research evaluating the effectiveness, implementation and experience of social care peer support. There is a need to establish how best to measure the impact and cost of peer support schemes for social care in prisons in England and Wales. To evaluate peer support schemes for adult social care in prisons in England and Wales (including implementation, experiences, risks and benefits, outcomes and costs, available data, and how to measure impact and cost). The number of those in prison requiring social care support has increased in recent years due to factors such as longer sentences, an ageing prison population, and an increased reporting of historic offences. This has led to many adults in prison needing social care support (personal and practical care and support) for a range of conditions. The Care Act in 2014 provided clarity regarding local authority and prison responsibilities for the assessment and provision of social care (e.g. personal care tasks such as help with dressing and showering). In some prisons, prisoners are providing social care support for non-personal care tasks to other prisoners (called ‘buddies’). While these services are not mandated nationally, they have been proposed as a recommended solution to support social care provision in prisons. Previous research has explored the delivery of wider peer support initiatives in prisons, but there has been little research to date evaluating the effectiveness, implementation and stakeholder experience of peer support schemes for social care. In addition to this, there is a need to establish how best to measure the impact and cost of peer support schemes for social care in prisons in England and Wales. This study sought to fill these gaps and evaluate peer support schemes for adult social care in prisons in England and Wales, looking at the following questions: What evidence on peer support schemes in prisons in general (including health, social care and educational needs) exists internationally (in relation to impact, cost, implementation and experience), what outcomes have been explored, and what data have been used? What social care is provided in adult prisons in England and Wales, and to what extent are peer support schemes for social care used in prisons in England and Wales? How are peer support schemes for social care implemented in adult prisons in England and Wales? What factors influence implementation? What are the experiences of those delivering and/or receiving peer-supported social care in adult prisons in England and Wales? What are the risks and benefits? Do experiences differ across different models of peer support? What are the outcomes and costs of peer-supported social care? What data are available to measure impact and cost? How could impact and cost of peer support schemes for social care in prisons in England and Wales be evaluated in future?

Authors' results and conclusions: ‘Buddies’ are frequently used in prisons in England and Wales, filling an important gap in social care provision. Implementation varies, due to service, prison, staff and prisoner factors. Prison service instruction guidelines for peer-supported social care are not consistently being implemented. This study identified areas for improvement, for example the need for formal training for buddies and staff, and the need for clear standardised employment procedures. Buddy schemes are valued by staff, buddies and recipients. Some barriers were identified, for example, lack of peer and staff training and supervision, and prison regime. Peer-supported social care may have wide-reaching benefits, yet there are several risks for recipients and buddies that must be mitigated, including the potential for exploitation of the role by staff, buddies and recipients. It is currently not possible to evaluate impact and cost due to limited data. We have developed an evaluation guide which outlines operational, cost and outcome data that needs to be collected to enable regular monitoring and/or evaluation in future. Peer support services are well received by different stakeholders, but standardisation is needed to ensure they are sufficiently resourced and appropriately monitored and evaluated to mitigate against risks. These services are well received, but to overcome challenges we need: National guidelines on how they should be used. Regular monitoring. Sites and participants Twenty prisons were selected to take part in the study, and 18 prisons participated. We conducted interviews with 7 national and local leads, 20 prison leads across the 18 prisons, and 7 staff, 18 peers and 19 recipients in the 5 case study sites. We held a workshop with 13 national and local stakeholders. Peer support services for social care are widely used in prisons in England and Wales. Implementation of these schemes varies due to a range of service, prison, staff, and prisoner factors. There were some examples of good practice identified, but none of the prisons had clear processes in place for buddies for all aspects of employment and training (buddies and staff), and some prisons had no formal training for buddies. Additionally, buddies do not always receive the training on offer. Staff, buddies and recipients value peer-supported social care, however there were some challenges that need to be overcome to facilitate the delivery and receipt of social care peer support, for example a need to ensure that peers are recognised for their role and that peers and staff are adequately trained. Peer-supported social care may have wide-reaching benefits, yet there are a number of risks that must be mitigated. It is currently not possible to evaluate impact and cost of peer-supported social care due to limited data. The findings from this study outline implications that should be considered if peer-supported social care services are to be implemented in prisons in England and Wales. For example, national standards need to be developed for peer-supported social care programmes. These should also include guidance on the data prisons need to collect to enable monitoring of these standards, and therefore evaluation of effectiveness, cost-effectiveness, implementation and experience. To monitor and evaluate peer support schemes for social care, we have proposed an evaluation framework. Implications for managing risk, improving implementation, and improving delivery and receipt of peer-supported social care are also outlined. The development of national standards for peer support services for social care (which includes the development of a national data infrastructure) would enable future research to conduct a robust evaluation of effectiveness and cost-effectiveness of peer-supported social care, and monitor against national standards. This would enable further analyses regarding optimal service design and impact on inequalities.

Authors' methods: A rapid mixed-methods study, including a rapid systematic scoping review (n = 70 papers), a documentary analysis of 102 His Majesty’s Inspectorate of Prisons reports, and a multisite study of implementation and experience. The multisite study included 1 workshop with national and local stakeholders (n = 13) and 71 interviews with national and local leads (n = 7), prison leads from 18 prisons (n = 20), staff (n = 7), peers (n = 18) and recipients (n = 19) from 5 prisons. Qualitative analysis took place in two phases: (1) rapid analysis (using rapid assessment procedure sheets) and (2) in-depth thematic analysis. We analysed availability of data to measure impact and cost of services. There is a lack of data collected on impact and cost, so we were unable to measure effectiveness and cost in this study. Instead, we developed an evaluation framework to inform future impact and cost evaluations. A rapid mixed-methods study, comprising of a rapid systematic scoping review, a documentary analysis of His Majesty’s Inspectorate of Prisons (HMIP) reports, a multisite study of implementation and experience (staff, peers and recipients), using interviews with national and local leads, prison leads (18 prisons), staff, peers and recipients (5 prisons), a workshop and a cost survey. Rapid assessment procedures were used to conduct rapid analysis of qualitative data. Following this rapid analysis, a combination of inductive and deductive thematic analysis was used to conduct an in-depth analysis of findings. This evaluation analysed what data are available to measure impact and cost; however, it was unable to explore effectiveness and cost-effectiveness of peer support schemes. Therefore, these findings relate to implementation and what should be considered in situations where peer support services for social care are used or implemented in future. The study included a large sample of prisons, but we were able to include only a sample of staff, buddies, recipients, and national and local stakeholders within each. Additionally, the sample was more representative of older adults and may not represent all types of social care need. Therefore, these findings are not representative of all prisons and all staff, buddies and recipients. Additionally, there is a lack of data collected on the impact and cost of peer-supported social care schemes in prisons in England and Wales. This is, in part, because there is no formal monitoring and evaluation of their effectiveness, lack of agreement as to what a good peer support programme should look like, and the non-standardisation of the buddies’ payments. As a result of these limitations, we were unable to measure effectiveness and thorough costs in this study. Instead, we developed an evaluation framework to inform future impact and cost evaluations.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR135689

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/MWFD6890

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/MWFD6890

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk