Peer support for adult social care in prisons in England and Wales: a mixed-methods rapid evaluation.

Background: 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.

Objective: 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).

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.

Results: '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.

Limitations: 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.

Future work: National standards for peer-supported social care (including national data infrastructure) would enable robust monitoring and evaluations of effectiveness and cost-effectiveness of peer support for social care.

Conclusions: 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.

Study registration: This study is registered as researchregistry8783.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135689) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 1. See the NIHR Funding and Awards website for further award information.