Introduction
Older adults are the fastest growing sub-group in prisons. They have complex health, social care and custodial needs and often the support they receive is sub-optimal. The Older prisoner Health and Social Care Assessment and Plan (OHSCAP) aimed to better meet these inter-related needs. As part of a wider study, a randomised controlled trial was conducted to evaluate the OHSCAPs effectiveness in meeting older prisoners’ health, social care and custodial needs in comparison to treatment as usual. This article describes the nested qualitative study which aimed to explore the barriers and facilitators to the effective implementation of the OHSCAP. Semi-structured interviews were conducted with older adults (n = 14) and staff members t (n = 12). Data was analysed using the framework method. Three overarching key themes were identified. These were: (1) balancing care and custodial requirements; (2) prison, health and social care silos; and (3) rigid prison processes. Prison is an important opportunity to engage residents and improve public health. Cultural and strategic change is required for health, social care and custodial interventions, such as the OHSCAP, to be successfully implemented into prison settings.As many as 10.74 million individuals are incarcerated worldwide.There has been considerable increase in the number of older prisoners across many developed countries, including the USA,Older adults residing in prison have multiple health problems. They have more complex health needs than their peers in the community and younger individuals in prison.Providing healthcare in prisons is a universal challenge internationally for four key reasons: (1) the conflict between care provision and security; (2) problems in achieving equivalent care to that received by all persons in general population; (3) difficulties ensuring timely access to services overcoming security restrictions; and (4) achieving clinical independence from custodial management arrangements.In England and Wales, there is no national strategy for older prisoners in spite of repeated calls for one to be developed. Consequently services are sub-optimal and The data that are reported in this article were collected as part of a larger study