Implications for practice
confusion
There are important public health implications for ensuring that older prisoners’ health and social care needs are adequately met. There is a duty to ensure that older prisoners receive healthcare services that are equivalent to those received by their peer who reside in the community.Furthermore, when prisoners’ health and social care needs are adequately met, although, the direct cost to public services can be high, the resulting gains may offset the initial expenditure.It may be possible for the OHSCAP to better meet the health and social care needs of older prisoners if a number of factors are addressed. Facilitators of the OHSCAP should have knowledge and experience of, and interest in, older prisoners. This, accompanied by clarification of the nature of their role, would assist in establishing how to care for older adults sensitively and humanely within a custodial setting.Interventions are needed to foster more meaningful and effective partnership working and information sharing between prison and healthcare staff. Such initiatives include joint training, designated ‘information sharing and collaboration leads’ within each relevant organisation and the development of clear policies to assist staff in understanding what kinds of information can and cannot be appropriately shared.Measures can be established to minimise the effects of silos and divisive cultures, such as, information sharing policies, shared training and multi-disciplinary meetings. However, health and social care initiatives, such as the OHSCAP, are likely to have limited success in prisons in England and Wales within the current culture of organisational silos; process-focused solutions, and confusion over how to balance custodial versus health and social care needs. Cultural and strategic change is required for interventions, such as the OHSCAP, to be successfully implemented into prison settings.The concept that organisational culture can play a significant role in promoting more integrated system approaches is growing across health and social care systems.Alternatives to custody should also be considered for older adults with complex health and social care needs. These include release on temporary licence, secure nursing homes, specialised care facilities and compassionate release.