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Review

‘Low-Level’ Social Care Needs of Adults in Prison (LOSCIP): A Scoping Review of the UK Literature

by
Deborah Buck
1,*,
Akash Ali
1,
Noor Butt
1,
Helen Chadwick
2,
Lee D. Mulligan
3,
Adam O’Neill
3,
Catherine Robinson
1,
Jenny J. Shaw
3,
Andrew Shepherd
4,
Josh Southworth
1,
Kate Stalker
1 and
Katrina Forsyth
1
1
Social Care and Society, School of Health Sciences, University of Manchester, Manchester M13 9PT, UK
2
Research Institute for Disabled Consumers, London N1 9AB, UK
3
Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester M13 9P, UK
4
Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
*
Author to whom correspondence should be addressed.
Soc. Sci. 2025, 14(2), 112; https://doi.org/10.3390/socsci14020112
Submission received: 20 November 2024 / Revised: 22 January 2025 / Accepted: 6 February 2025 / Published: 17 February 2025
(This article belongs to the Special Issue Social Care, Older People and Imprisonment)
Browse Figure
Review Reports Versions Notes

Abstract

:
In England, local authorities are responsible for providing social care in prison in accordance with the Care Act (implemented in 2015), but little is known about ‘low-level’ needs that do not meet eligibility criteria. These ‘low-level’ social care needs can greatly affect individuals living in prison with limited autonomy. This scoping review aimed to describe the nature, extent, and conceptualisation of ‘low-level’ social care in UK prisons, including prevention and promotion of independence. We adopted the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews checklist and Joanna Briggs Institute guidelines. Papers were screened by pairs of reviewers. In total, 31 papers were included. Findings are reported using descriptive techniques. Types of ‘low-level’ social care discussed included finances (n = 8 papers), feelings of safety (n = 8), and dignity (n = 8). Ten papers included prevention of social care needs and/or promoting independence in relation to social care needs. Evidence is limited, and further research is needed on ‘low-level’ support needs of people in prison. Consensus is needed on what constitutes ‘low-level’ social care needs; how they may vary depending on individual characteristics including age, gender, ethnicity, culture, and neurodiversity; and how individuals should be supported with these needs.

1. Background

People living in prison often come from marginalised and disadvantaged backgrounds, coupled in many cases with physical, mental, or neurodivergent conditions or disabilities, which can render them at greater risk of developing social care and support needs (Buck et al. 2024; Prison Reform Trust 2022; Her Majesty’s Inspectorate of Probation 2021; Australian Institute of Health and Welfare 2019; Williams et al. 2012). Similarly, older people in prison may require support due to escalating levels of frailty and cognitive impairment, a problem exacerbated by an increasingly ageing prison population both nationally and internationally (House of Commons Justice Committee 2020; Turner and Peacock 2017; Turner et al. 2018; Psick et al. 2017; Enggist et al. 2014). Although more common amongst older people, individuals of all ages can have social care needs.
While there is no universal definition of social care generally (Uribe et al. 2023) or specifically in UK legislation (Simpson et al. 2022), it is generally conceptualised as including support for activities of daily living; personal care; getting out of bed/mobilising; meals and nutrition; shopping; taking medication; social interaction; managing relationships; participation in/contribution to society; safety; and maintaining independence, dignity, and human rights (Scottish Government n.d.; The King’s Fund 2024; Department of Health 2022; Quilter-Pinner 2019; Netten 2011).
Despite the lack of consensus regarding definitions, there is increasing acknowledgement that the social care and support needs of people in prison must be adequately and appropriately met (Forsyth et al. 2021; Scottish Government 2021; World Health Organization 2020; Levy et al. 2018; Williams et al. 2012) and that the risk of such needs intensifying or developing in the first place be minimised (National Probation Service 2019; National Offender Management Service 2016). Preventing or delaying the escalation of social care needs in any setting can be of direct value to individuals themselves—for example, being at reduced risk of deteriorating health—and they may feel a greater sense of independence and wellbeing (Social Care Institute for Excellence n.d.; Wavehill Social and Economic Research and Skills for Care 2019). Moreover, the potential value to wider society includes social and economic benefits and, in the specific case of people in prison, reduced risk of recidivism following release back into the community (Hutton 2022; Rowe et al. 2020; Prisoners’ Education Trust 2016; Ministry of Justice 2014; Williams et al. 2012).
In England, the 2014 Care Act (Department of Health 2014) clarified that the responsibility for the assessment of and provision for social care needs in prison lies with local authorities (LAs), alongside their remit to provide social care in community settings. The Care Act covers a variety of needs including mobilising safely, personal hygiene, toileting, nutrition, relationships, education/training, and accessing services. It is important to note that some ‘social needs’, for example housing and debt, are not covered by the Care Act (Barnes et al. 2017) and that assessments do not always reflect the broader social needs of the individual (Mencap n.d. (webpage)).
Some people with social care/support needs do not meet the eligibility criteria under the Care Act, for example those with ‘low-level’ needs or who are ‘at the edges’ of eligibility (Fernandez et al. 2020). For these people, national guidance specifies that LAs must consider what can be done to reduce, prevent, or delay the need for future care and support, and as far as possible to maintain their independence (Department of Health and Social Care 2024).
In the wider community beyond prisons, attention has become increasingly focused on prevention strategies that aim to preserve wellbeing and independence, both in the UK and internationally (Marczak et al. 2024; European Commission 2021; Marczak et al. 2019). Preventing or delaying needs involves supporting people to be well and independent, reduce needs, and/or help regain skills (Social Care Institute for Excellence n.d.).
However, our discussions with key stakeholders suggest that, in the prison setting, most of the focus to date has been on ‘higher-level’ needs, with little attention paid to ‘sub-threshold’ needs, applying prevention in practice, or helping people to maintain some independence. It is crucial that we explore this gap in the assessment and meeting of ‘low-level’ social care needs and preventing future social care needs, because unmet social care needs may impact on the individual’s capacity to engage with the prison regime itself, as well as their engagement with related rehabilitation work. For example, regarding relationships, researchers in Scotland found that prisoners who had no contact with family perceived this to have a negative impact on their overall wellbeing (Levy et al. 2018), while in England a government-commissioned review (Farmer 2017), found that people in prison who received visits from relatives or partners had a reoffending rate of 39% lower than those who did not receive visits. Her Majesty’s Inspectorate of Probation (2023) reported that prisoners who took part in education, training, or employment initiatives were less likely to reoffend than those who did not participate. Moreover, overlooking people’s social care and support needs in prison may be in breach of their human rights such as freedom from degrading treatment (Prison Reform Trust 2014) and may place them at risk of deterioration, thereby adding further burden for individuals, their peers, and prison staff and likely requiring more intensive and costly services and resources further down the line.
According to Maslow’s psychological theory of human motivation (Maslow 1943), there are five types of basic needs that people require to ensure their wellbeing: physiological (e.g., food, shelter, clothing, sleep); safety; love (e.g., friendship, trust, acceptance); esteem (e.g., independence, dignity); and self-actualisation (e.g., learning, fulfilment, helping others). Many of these needs can be linked to people’s journeys through the criminal justice system (Her Majesty’s Inspectorate of Probation 2023). For example, having somewhere safe to live is one of the most basic human needs. For people released from prison, stable accommodation is associated with reduced reoffending and is often related to supportive family relationships (Her Majesty’s Inspectorate of Probation 2023). Similarly, it is apparent that having a suitable cell and not worrying about one’s home, family or finances while in prison constitute basic needs that should be met.
By design, individuals living in prison have limited autonomy and power (Cunha et al. 2023; Edgemon and Clay-Warner 2019). They are often unable to conduct simple tasks themselves such as phoning their bank, finding out how their family are, or ensuring their pets are looked after appropriately. These problems can escalate and lead to stress and potential mental health difficulties for those living in prison. For example, lack of meaningful activity, isolation from social networks, and lack of privacy have been associated with poor mental health in prison (Durcan 2008). The meeting of ‘low-level’ social care needs is therefore particularly challenging and important within the prison environment.

2. Methods

2.1. Protocol

We first developed a protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (Peters et al. 2022). The protocol was registered with INPLASY public registry (INPLASY202370056). The iterative, exploratory nature of scoping reviews means that protocol changes may be needed as reviews progress (Hughes et al. 2021; Pollock et al. 2021). We deviated from the protocol only in that we expanded the inclusion criteria to include people ‘in prison’, as well as ‘on entry to prison’.

2.2. Scoping Reviews

Scoping reviews are appropriate when the aim is to explore the breadth or depth of the literature on a given topic, to inform future research, and/or to determine gaps in the evidence (Peters et al. 2020; Tricco et al. 2016). Unlike systematic reviews, the purpose of scoping reviews is not to produce a critically appraised and synthesised result/answer to a particular question but rather to provide an overview or mapping of the nature of the evidence (Peters et al. 2020; Munn et al. 2018). Nevertheless, it is strongly held that scoping reviews should be conducted systematically and use rigorous and transparent methods (Munn et al. 2018). Our paper adopts the PRISMA extension for scoping reviews (PRISMA-ScR) checklist (Tricco et al. 2018) (Supplementary File S1).
The aim of this scoping review was to explore the nature, extent, definitions, and conceptualisations of the ‘low-level’ social care needs of adults living in male prisons in the UK, including prevention and the promotion of independence. While people living in the male and female prison estates have some social care needs which are similar, there are also important differences. We are exploring women’s social care needs in other studies and will continue to explore how best to meet their needs in future research.

2.3. Development of Search Strategy

In February 2023, we arranged an online discussion group with six social care practitioners who work with prison populations. We advertised for discussion group members via social media (Health and Justice Research Network, University of Manchester) and known social care and criminal justice contacts via the Associate Directors of Social Services. Participants shared their ideas and experiences about ‘low-level’ social care needs and the language that might be used when people entering, living in, or working in prison talk about such needs. We initially consulted with stakeholders to determine what, from their perspective, is meant by ‘low-level’ social care needs in the prison setting. We used their experience/expertise to help develop the strategy alongside what we found after an initial scoping exercise to explore terminology. Specific terms and areas for consideration suggested by stakeholders were ‘support needs’ and ‘self-neglect’ (for some individuals, family members may have provided support in the community, but in prison they lose that support, so there is a potential for self-neglect and deterioration). Participants also referred to the issue of emerging needs, particularly in an ageing cohort, such as loss of mobility, while lack of activity, worsened since the impact of COVID-19, means people may struggle to keep up with physical exercise and therefore deteriorate quicker. The issue of non-eligibility under the Care Act was also raised.
We anticipated that the literature on ‘low-level’ social care would lack consistent terminology and that labels such as ‘low-level’ or indeed ‘social care’ might not always be used. Therefore, to further inform our search strategy, we scoped the wider social care literature (community settings) and relevant websites (e.g., Social Care Institute for Excellence, Age UK, Care Quality Commission) to explore terminology around ‘low-level’ social care (Supplementary File S1).
The final search strategy (Supplementary File S1) was developed with input from an information specialist at the University of [redacted] Library‘s Review Service. We ran the initial search in June 2023, and updated it in July 2024, using the following databases: Criminal Justice Abstracts, Social Policy and Practice (which covers Social Care Online), Embase, and Medline.

2.4. Screening/Selection Criteria

We adopted the ‘population, concept, and context’ (PCC) framework recommended for scoping reviews by the Joanna Briggs Institute (Peters et al. 2020), as follows:
Population: adults (18+) living in male prisons with ‘low-level’ social care needs.
Concept: identifying and/or meeting ‘low-level’ social care needs, preventing or delaying escalation of these needs, and conceptualisations of social care in prison generally.
Context: male prison settings in the UK.
All records identified from the electronic database searches were independently screened by title and abstract by pairs of reviewers, using pre-specified inclusion/exclusion criteria (Table 1). Documents deemed potentially eligible for inclusion underwent full-text screening by pairs of reviewers to confirm eligibility.

2.5. Data Extraction

Scoping reviews do not usually require the extraction of primary research findings such as effect sizes or qualitative results, and it is common to examine each section of document/source including the introduction, discussion, conclusion (Pollock et al. 2023; Munn et al. 2018). Data extracted for the current review included basic study characteristics, methodology, population, the type of social care/support discussed, and definitions of social care. Two reviewers piloted a template data extraction form in Excel before completing the data extraction process.

2.6. Collating, Summarising, and Reporting the Findings

We applied basic descriptive analysis to the extracted data (e.g., frequency counts of types of social care reported), which we visually map in a table (Peters et al. 2020). We also used descriptive qualitative techniques—for example, basic coding of data to specific categories (Peters et al. 2020), which is appropriate for scoping reviews in which the purpose is to identify or clarify concepts/definitions in a particular field or identify key characteristics related to a concept (Peters et al. 2020). Following established practice for scoping reviews, we did not conduct a formal quality appraisal (Peters et al. 2020; Arksey and O’Malley 2005).

2.7. Stakeholder Consultation

As described in the ‘Development of Search Strategy’ section above, stakeholders were consulted as part of our search strategy development. We also held a stakeholder workshop to discuss points towards developing a working definition of ‘low-level’ social care needs in prison.

3. Findings

Full details of the numbers of documents retrieved and retained are provided in the PRISMA flow diagram (Figure 1).
After deduplication, 2692 records were retained, and a total of 31 were included after full text screening, of which 25 alluded to ‘low-level’ social care needs directly. The key characteristics of these studies are provided in Table 2. The remaining six were included on the basis that they offered additional insight as to what might constitute social care in general in prison settings (Alvey 2013; O’Hara et al. 2015; Lee et al. 2019; Scottish Parliament Justice Committee 2013; Stewart 2018; Walton et al. 2019).
The Findings section is organised into two main subsections. The first is concerned with definitions/conceptualisations of social care, or ‘low-level’ social care, as used in the included literature. The second focuses on studies that reported ‘low-level’ social care needs or described aspects of what may be considered social care but is not covered by the Care Act. Some of these studies also reported types of support that are covered by the Care Act 2014. (This information is provided in Supplementary Table S1).

3.1. Conceptualisations of Social Care and ‘Low-Level’ Social Care in Prison

We referred to included documents which contained some definition/conceptualisation of social care generally and/or alluded to the concept of ‘low-level’ social care specifically. A summary of the definitions/conceptualisations in provided in Table 3, which demonstrates the variation between and within included documents. Full details are provided in Supplementary Table S2.
Conceptualisations varied from advice on pensions/benefits, support with routine activities such as getting washed or dressed, to broader social support emphasising wellbeing, the social dimensions of social care, and the preservation of dignity and human rights. Several studies (Supplementary Table S2) referred to the lack of agreement around what social care entails. Based on these findings, we propose that the following points should be taken into consideration for future definitions or conceptualisations of ‘low-level’ social care:
  • ‘Low-level’ social care may encompass support for people who have social care needs but who do not meet the threshold for social care packages under current legislation, such as the Care Act (Department of Health 2014) for England and Wales.
  • This could include needing support with any of the ten domains of the Care Act 2014:
    ∘
    (nutrition, personal hygiene, toilet needs, being appropriately clothed, making use of home/cell safely, maintaining a habitable home/cell environment, developing and maintaining relationships, accessing and engaging in education or training and work/purposeful activity, making use of necessary services/facilities including technology, and carrying out caring responsibilities for one’s child)
  • This could also apply to finance, housing, and personal safety needs and the preservation of human rights and dignity.
  • In prison settings, support with ‘low-level’ social care needs may involve help with fetching meals or items from the canteen, getting around the prison, accessing and taking part in out-of-cell activities and social interaction, help with administrative activities including writing letters, and help with remembering appointments.
  • Support may cover activities of daily living/prison activities of daily living and coping with the prison regime. It may also relate to receiving visits, advocacy, and befriending.
  • Preventing or delaying the development of social care needs, and promotion of independence, are integral to the promotion of wellbeing of people living in prison. Contact with family will be pivotal to this in many cases.
  • It is imperative to recognise that referring to these needs as ‘low-level’ does not necessarily mean that they are insignificant to the individual, especially given the Care Act’s high eligibility threshold, which is also open to interpretation.
    ∘
    There are people who have multiple, complex needs but are nevertheless deemed ‘subthreshold’ and therefore will not qualify for formal support packages. In some cases, these needs may be inadequately met, or go unmet, thereby placing people at risk of ‘care poverty’ in which care is a vital, non-material resource necessary for well-being (Zarkou and Brunner 2023; Kröger 2022).
  • It should be recognised that some individuals living in prison will be reticent to seek support and may be unaware of their rights or that they have social care needs.
  • People involved in providing ‘low-level’ social care/support could include suitably trained and supervised peer supporters, prison officers, education and healthcare staff, voluntary organisations, or family members depending on the nature of the need and with consent from the individual with social care needs.
  • It is imperative to ensure that vulnerable people are protected from abuse and neglect, as specified in the Care Act.
Key organisations that could be meaningfully involved in formulating a prison-specific definition/conceptualisation of social care and/or ‘low-level’ social care in the future could include the Association of Directors of Adult Social Services, HMPPS, Ministry of Justice, the NHS, and key third sector groups such as Recoop, Prison Reform Trust, Shelter, Age UK. People with lived experience of social care in prison should be included in such enterprises, together with social care providers including peer supporters.

3.2. The Nature and Extent of ‘Low-Level’ Social Care Needs in Prison

Of the twenty-five studies referring to ‘low-level’ needs or needs not covered by the Care Act 2014, twelve were based in England, six in England and Wales, five in Scotland, and two in Northern Ireland. Ten discussed the prevention of social care needs and/or promoting independence.

3.2.1. Types of ‘Low-Level’ Social Care Discussed

Table 2 includes details of the types of ‘low-level’ social care discussed. Seven referred to the concept of ‘low-level’ social care needs in general, while the others referred to specific aspects including finances/benefits, safety to self/feelings of security, and human rights/dignity, each of which were mentioned in eight documents.

3.2.2. Preventing or Delaying Social Care Needs

Eight documents referred to issues around the prevention of social care needs. Two common themes were the importance of supporting participation in activities and the role of relationships. The Scottish Government (2021) notes that more could be done to support people to participate in the prison community, including purposeful activities, socialising, and managing relationships, rather than focusing only on people with existing needs. Similarly, Forsyth et al. (2022) described previous models of custody whereby some people living in prison were allocated ‘personal officers’ tasked with supporting individuals to maintain family contact and helping them with vocational activity and skills. This approach could help prevent or delay social care needs as long as officers were suitably trained, although there is no evidence concerning the level of training of officers in that role. While this role no longer exists, the recent introduction across England and Wales of the Offender Management in Custody (OMiC) model has potential to help in the identification of and referral for ‘low-level’ social care needs. In the OMiC model, prisoners are allocated a key worker who must undergo specific training and is responsible for engaging, motivating, and supporting people through their custodial period (Her Majesty’s Inspectorate of Probation 2022). However, as far as we are aware, this model is yet to be formally evaluated. The Howard League for Penal Reform (2016) suggests that maintaining family relationships and socialising with others should be part of normal, healthy life in prison rather than a privilege, and that family members should be able to speak directly with senior staff if they are concerned about their relative’s wellbeing.
In the Bavidge (2020) study, several test sites noted the importance of prevention work particularly around mental health and substance use in prison. This in turn has implications for the development of potential social care needs. The author recommends that prevention work should encompass the social model of care and support including personal capacity and strengths and community support and daily structure, noting that this might facilitate improved daily living skills. Levy et al. (2018) call for greater commitment from social work to prevention work in prison, while Tucker et al. (2021) discuss the responsibility of local authorities to improve the general wellbeing of prisoners who do not meet Care Act eligibility criteria, to prevent, delay, or reduce deterioration by (at a minimum) providing advice and information.
Muirhead et al. (2023a) recommend that consideration be given to how cell-sharing may affect individuals’ wellbeing. They argue that most people should be offered single cells where possible, but that some capacity for cell-sharing should be retained. This is because cell-sharing has the potential to improve wellbeing, for example by providing positive peer support and supporting people with disabilities, if appropriate oversight and vetting procedures are in place. In turn, this may help slow down the development of social care needs.
Preventative care does not necessarily have to be resource intensive. For example, it could involve small amounts of support such as structured group activities (Scottish Government 2021) or harness the potential of third sector involvement (Bavidge 2020) or the provision of suitable furniture (Storry 2022). Preventative care could have wider benefits beyond the individual, such as reducing overall funding requirements (Scottish Government 2021). It could also lower the burden on prison staff in the longer term.

3.2.3. Promoting Independence

Six papers referred to promoting independence regarding social care. Levy et al. (2018) reported that prison governors wanted residents to be as independent as possible and receive the same level of care as people in the community. However, the authors noted that more work is required in this area, with a particular need for clarity around who is responsible for supporting prisoners in their transition into and out of prison and more ‘joined-up’ thinking and working. They also pointed to the need to explore issues around ‘learned helplessness’ (Morgan 2020) (e.g., a lack of self-esteem and low motivation resulting in perceptions of failure), which is likely to develop in people who have experienced trauma. Similarly, Schmidt (2013) suggested that the ‘User Voice’ prison council model helps individuals to reconceptualise their identities through new and positive roles and reversing ‘forced helplessness’. Qualitative work by Senior et al. 2013 found that independence was a common issue discussed by older people living in prison, with many saying that they did not want support and preferred to be as independent as possible.
Tucker et al. (2021) refer to adapting the built environment so that people may remain more independent and access the prison’s facilities without need for additional support. Similarly, Bavidge (2020) refers to simple adjustments that can be made by providing aids and equipment (such as walking aids, handrails, wheelchairs, specialist beds) to help people maintain or improve mobility and support independence in daily living tasks. Finally, The Scottish Government (2021) note that helping people to live independently constitutes part of the definition of social care support.

4. Discussion

4.1. Summary of Findings

This review was conducted to explore how ‘low-level’ social care needs may be defined/conceptualised, and to scope the literature pertaining to what may be considered ‘low-level’ needs of people living in adult male prisons. Conceptualisations varied from support with specific tasks only (e.g., advice on pensions/benefits, or with routine activities of daily living such as getting washed or dressed) to broader social support emphasising wellbeing and the social dimensions of social care. Several studies referred to the lack of agreement around what constitutes social care generally.
The types of ‘low-level’ social care needs described were wide ranging. The most frequent types (not covered by the Care Act 2014) were finances/benefits, safety/security, and humane treatment/dignity.
Included studies reported that rather than focusing solely on people whose social care needs are currently met in prison, more could be done to support people to engage in activities and access facilities, thereby preventing or delaying the further development of needs and potentially reducing overall funding requirements. Prevention work may be particularly important around mental health and substance use in improving people’s daily living skills. Local authorities, in England and Wales at least, have the responsibility to improve the general wellbeing of prisoners who do not meet Care Act eligibility criteria, to prevent/delay deterioration. However, based on the studies included in this review, this does not seem to be happening on a systematic basis.
To successfully promote independence regarding social care needs in prison, greater joined-up working is needed to enable people to be as independent as possible and to prevent ‘learned helplessness’. Greater clarity is needed around who is responsible for supporting prisoners in their transition into and out of prison. The issue of stigma associated with asking for and receiving support is present among older people living in the community (MacIntyre et al. 2023). This problem is equally relevant to older people living in prison, if not more so given the often hyper-masculine environment in male prisons (Ricciardelli et al. 2015), and needs to be acknowledged and sensitively addressed. There should be enough skilled and knowledgeable staff, both at reception and on the wings.

4.2. Comparison with Current Literature

This review found a relatively small literature base explicitly referring to ‘low-level’ social care needs, prevention, or the promotion of independence in prison settings, and no other reviews focusing on this were found. While a scoping review of social care on release from prison has recently been published (Tucker et al. 2024), this focused on eligibility for social care under the Care Act 2014 rather than ‘low-level’ needs. We also found little on ‘low-level’ social care needs in community settings (Fernandez et al. 2020).
While the literature base around ‘low-level’ social care needs, prevention of social care needs, and promotion of independence in prisons is small, there was nevertheless wide variation in the way social care in general is being conceptualised in this setting. Such inconsistency and lack of clarity is mirrored in recent reviews of social care in community settings. For example, in a scoping review examining primary care and social care, Simpson et al. (2022) refer to the lack of clarity (in the literature and in practice) regarding defining and measuring social care need, while in a narrative review Uribe et al. (2023) noted wide variation in the breadth and definition of social care in emerging integrated care innovations. Work centred around the prevention of social care needs and/or promotion of independence in the community is a little more tangible compared to prison settings. For example, an integrative literature review (Verity et al. 2022) found inconsistencies in the way prevention work is categorised and implemented across different regions, and that it is often driven by the desire to reduce costs and future dependence on care systems. The authors argued that prevention work should be aligned with the ‘complexities of the social world’ and ‘everyday realities’ surrounding it.

4.3. Strengths and Limitations of This Scoping Review

As far as we know, this is a unique piece of work exploring the concept of ‘low-level’ social care needs of adults living in prison, using scoping review methods. Research specifically alluding to ‘low-level’ or sub-threshold social care needs was scarce, which is indicative of the lack of an agreed definition of ‘low-level’ social care, and indeed of social care more broadly.
Importantly, stakeholders (social care practitioners with experience of working with people in prison) were consulted as part of our search strategy development, as well as discussion about what factors should be considered for developing a working definition of ‘low-level’ social care needs in prison.
We did not undertake quality appraisal of included documents. However, it is important to note that this is accepted practice for scoping reviews (Peters et al. 2020; Arksey and O’Malley 2005) which aim to provide an overview or mapping of the nature of the evidence rather than a critically appraised and synthesised answer to a particular question (Peters et al. 2020; Munn et al. 2018).
The review focused on UK studies only; therefore, the findings may not be applicable to jurisdictions with different legal systems or models of social care provision.

4.4. Implications for Research, Policy and Practice

Provision of easy-to-understand information about social care needs and the support available could mean that people living in prison would be more likely to self-refer for social care support. It could also reduce the risk of needs deteriorating and enhance independence and general wellbeing. Greater awareness of individuals’ social care and support needs is needed among prison staff and others working with people in prison, to enable them to proactively identify people who are struggling and who may benefit from some form of support. This is especially important when individuals’ needs are not deemed to meet the threshold for support under the Care Act.
It is important to keep in mind that even for social care needs that are included in the 10 domains of the Care Act, individuals must meet the eligibility criteria, which are open to interpretation, meaning some of these needs may also go unmet—for example, if only one type of need within the Care Act is identified, regardless of how severe, or if the assessor does not judge the need/needs to be impacting on the individual’s wellbeing.
There is a clear need for agreement around how to conceptualise and define ‘low-level’ social care needs in prison, and how such needs might be best identified and met. The continued good practice of involving key stakeholders in these discussions, including people living in prison with social care needs, is vital. Reaching consensus would facilitate the development of appropriate interventions to meet needs, prevent deterioration, and promote independence. We plan to develop an initial programme theory and associated logic model around ‘low-level’ social care in prison in the next phase of our work.
Our suggestions towards developing a working definition of ‘low-level’ social care provides a good starting point for future exploratory work, which must include a diverse range of people with the experience of living in prison, with social care needs, their families, custodial staff, and social care practitioners, in addition to the key organisations we suggested in Section 3.1.

4.5. Conclusions

The Care Act (Department of Health 2014) clarified that local authorities are responsible for meeting the social care needs of eligible individuals living in prisons in their geographical regions. To be eligible, individuals must have a physical or mental health condition, which impacts on at least two of the ten domains of the Care Act, as well as their general wellbeing. Local authorities also have a more general responsibility of preventing social care needs and promoting independence. However, confusion remains around who should be responsible for meeting social care needs that do not meet the eligibility criteria of the Care Act (‘low-level’ social care needs) either because the need does not fit into the ten domains or the need is not considered severe enough to impact two domains and wellbeing. The meeting of ‘low-level’ social care needs in prison is challenging because of the vast array of services involved; the limited power and autonomy of those living in prison; and the potential for unmet ‘low-level’ social care needs to impede mental wellbeing.
Our scoping review found that ‘low-level’ social care needs may encompass social care needs that do not meet the severity described in the Care Act but do fit into one of the ten Care Act domains or social care needs that do not fit into one of the ten domains. Social care needs outside of the ten domains include finance, housing and personal safety, and dignity issues. The development and maintaining of relationships and the provision of a structured day were deemed important for preventing further social care needs. ‘Learnt helplessness’ was also considered to be an important obstacle to independence for those living in prison.
There is very limited evidence regarding how individuals should be supported in prison with ‘low-level’ social care needs; however, these unmet needs greatly impact those living in prison. Further research is required to explore how these needs are best met and by whom in order to prevent the escalation of these social care needs and future potential mental health problems.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/socsci14020112/s1, Table S1: Care Act domains covered in included papers; Table S2: Definitions/conceptualisations of social care in included studies (prison settings); Supplementary Methods.

Author Contributions

Conceptualization, A.S., J.J.S., C.R. and K.F.; methodology, A.A., D.B., N.B., H.C., K.F., L.D.M., A.O., J.S. and K.S.; software, D.B.; validation, D.B. and K.F.; formal analysis, D.B. and K.F.; investigation, none; resources, K.F.; data curation, D.B.; writing—original draft preparation, D.B.; writing—review and editing, K.F. and A.O.; visualization, D.B.; supervision, K.F.; project administration, D.B. and K.F.; funding acquisition, A.S., K.F., C.R. and J.J.S. All authors have read and agreed to the published version of the manuscript.

Funding

This work was funded by the National Institute for Health, School for Social Care Research (no grant number). The funder had no role in the conduct or reporting of the scoping review. This research was also supported by the NIHR Manchester Biomedical Research Centre (NIHR203308). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Conflicts of Interest

The authors declare no conflict of interest.

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Socsci 14 00112 g001
Figure 1. PRISMA flow diagram.
Figure 1. PRISMA flow diagram.
Socsci 14 00112 g001
Table 1. Inclusion criteria.
Table 1. Inclusion criteria.
Focus
Must include one or more of the following:
(a)
Social care (either generally, or specific types including domains not covered by the Care Act);
(b)
Initiatives/suggestions to prevent SC needs arising or deteriorating;
(c)
Initiatives/suggestions around promoting independence relating to social care;
(d)
Conceptualisation/definition of social care (in prison settings).
Location
England, Wales, Scotland, N. Ireland, UK/GB.
Population
Adults (18+)
Setting
Male prisons
Table 2. Key characteristics of papers referring to ‘low-level’ social care needs in prison.
Table 2. Key characteristics of papers referring to ‘low-level’ social care needs in prison.
Author, YearCountryMethodSampleRefers to Prevention or Delay of Social Care Needs?Refers to Promoting Independence Regarding Social Care Needs?Type of ‘Low-Level’ Social Care Needs
Forsyth et al. (2021)EnglandMixed methods
Questionnaires (Older prisoner Health and Social Care Assessment and Plan; standard health assessment; Bristol Activities of Daily Living Scale; CANFOR-S).		404 older men living in prisonnn‘Low-level’ generally
Forsyth et al. (2022)EnglandQuantitative.
Audit questionnaire.		497 people living in prisonYnFinances
O’Hara et al. (2016)EnglandQuantitative.
Structured questionnaire		100 people recently entering prisonnnFinances (benefits)
Senior et al. (2013)England and WalesMixed methods. National survey; structured and semi-structured interviews.127 older men entering prison;
110 staff		nYFinances, benefits, accommodation, dignity, safety to self
Barnoux and Wood (2013)England and Walesn/a—discussion/opinion piece.n/a—discussion/opinion piecennFinances
Bavidge (2020)ScotlandMixed methods. Evaluation reports from test sites; questionnaires; meetings; workshops; emails.24 staff responded to questionnaireYY‘Low-level’ generally
Clinks (2018)EnglandQualitative. Consultation and feedback sessions.Experts by experience (numbers not reported); special interest group membersnnHousing; finances
Hayes et al. (2013)EnglandMixed methods.
Interviews (using CANFOR-S, Lubben Scale (social networks); Quality of Prison Life Assessment; open-ended questions).		165 people living in prisonnnWorry or confusion on reception into custody; safety to self
Heathcote et al. (2024)England and WalesQuantitative.
Survey questionnaire.		77 heads of prison healthcare;
85 prison governors		nnSuitability (size and accessibility) of cells; incontinence aids; “social care aids”; low-level’ generally
Her Majesty’s Inspectorate of Prisons for Scotland (2017)ScotlandMixed methods.
Questionnaire survey; interviews;
focus groups.		164 people living in prison;
staff views were also considered		nnSleeping; fear of isolation; lack of decent and humane treatment
Howard League for Penal Reform (2016)Englandn/a—discussion/opinion piece.n/a—discussion/opinion pieceYnFinances; safety; dignity
Hutton (2022)EnglandQualitative.
In-depth, semi-structured interviews.		17 older men who had experience of prison in later life, either in prison or recently released;
7 prison officers		nnFeelings of safety; dignity; privacy; appropriate accommodation
Hutton (2016)England and WalesQualitative.
Semi-structured interviews; observation; informal and ad hoc interviews with visits staff.		61 people living in prison and their adult visitors;
staff (number not reported)		nnHuman rights; privacy
Levy et al. (2018)ScotlandMixed methods. Thematic literature review; qualitative data from interviews, online survey.Interviews: 3 prison governors, 8 people living in prison;
Online survey: 11 Chief Officers of IJB (Integration Joint Boards) 		YY‘Low-level’ generally
Ministry of Justice (2013)England and Wales n/a—discussion/opinion piecen/a—discussion/opinion piecennSuitable accommodation
Muirhead et al. (2023a)Northern IrelandQuantitative.
Random stratified survey.		569 men living in prisonYnPerceptions of safety (n terms of shared cells)
Muirhead et al. (2023b)Northern IrelandQualitative.
In-depth semi-structured interviews.		37 men living in prisonnnFear for personal safety; invasion of personal space in cell; privacy; dignity
Schmidt (2013)EnglandQualitative.
Participant observation; interviews; small group discussions.		People living in prison, staff, and User Voice employees (numbers not reported but over 100 h spent in the prisons by the researchers)nYFeelings of security
Scottish Government (2021)ScotlandMixed methods.
Qualitative interviews; routine data including the Scottish Household Survey, screening results from a Test of Change site, SPS prisoner survey results.		10 staff (qualitative interviews)YY‘Low-level’ generally; housing; preservation of human rights and dignity
Scottish Parliament (2018)Scotlandn/a—discussion/opinion piece.n/a—discussion/opinion piecennHousing benefits/
welfare
Smith et al. (2022)EnglandQuantitative.
Self-completion questionnaire.		282 people living in prisonnnFinances (gambling-related debt)
Stewart and Lovely (2017)EnglandQualitative.
Unstructured interviews.		9 people living in prison who had undertaken peer social support training; 2 members of staff nn‘Low-level’ generally
Storry (2022)EnglandQualitative.
Non-participant observation;
in-depth semi-structured interviews.		38 older men and women living in prison; 19 staff including governors and wing staffYnPersonal safety; privacy; dignity
Tucker et al. (2021)EnglandQuantitative. Face-to-face questionnaires including Revolving Doors Prisoner Social Care Screen; modified version of FACE Social Care Screen Assessment.482 people living in prisonYY‘Low-level’ generally
Williams (2013)England and Walesn/a—discussion/opinion piece.n/a—discussion/opinion piecennAppropriate location of cell; beds; seating
Note: n = no; Y = yes; n/a = not applicable.
Table 3. Summary of definitions/conceptualisations of social care (SC).
Table 3. Summary of definitions/conceptualisations of social care (SC).
Author, YearSummary/Themes
(A) Social care (generally)
Alvey (2013)Needs in relation to adjustment/coping with prison environment; age-appropriate education programmes or work schemes; maintaining family/social supports;
resettlement planning. Achievement of positive personal development.
O’Hara et al. (2015)Much variation between interview respondents (social care and voluntary organisation workers) re: definitions of social care: routine ADLs only (e.g., getting washed or dressed); housing; employment; finances/pensions/benefits.
Bavidge (2020)‘Support to help people live full lives. Encompasses, daily living tasks, housing support, support to work and take part in leisure activities, relationship and connections to community.’
Lee et al. (2019)‘Needing regular help looking after oneself because of illness, disability or old age, … alleviation of social isolation and maintenance of independence…’.
Specific to older people in prison: bullying; ‘prison poverty’ (less access to employment or family help); appropriate activities.
Levy et al. (2018)Supporting the ‘daily living of prisoners’; personal care; functional activities of daily living; physical access; provision of adapted cells.
Broad and holistic definitions from people living in prison and prison governors, emphasising wellbeing and social dimensions of social care.
Connectivity with ‘home’ (prison), family, friends, community; social life.
Scottish Government (2021)Too much focus on physical care needs; not enough attention paid to invisible disabilities. Need to reduce stigma associated with receiving support; improve accommodation; take a holistic approach.
‘Helping people live independently, be active members of the community in which they are part of, and preserve their dignity and human rights.’
Should be more than personal care: focus on ‘wellbeing, the need to support the exercise of agency, citizenship, and opportunities for participation.’
Scottish Parliament (2018)People on remand in prison: less access to services than convicted people living in prison, specifically in terms of access to/engagement in work/productive activity; courses/programmes; social isolation; access to medical services.
Scottish Parliament Justice Committee (2013)Recommend that definition of purposeful activity (in 2011 Prison Rules (Scotland)) is revised to consider the importance of contact with family.
Stewart (2018)In defining peer support: direct practical help and support but also providing care at social and emotional as well as at the physical level.
Walton et al. (2019)NIHR’s School for Social Care Research definitions:
‘The term “adult social care” refers to provision of personal and practical care and support that people may need because of their age, illness, cognition, disability or other circumstances.’
(B) ‘Low-level’ social care
Bavidge (2020)Needs which ‘appear low level but are about everyday routine’: taking part in activities; moving around independently; getting to dining room independently;
receiving visits; help with remembering appointments/taking medication. Refers to high threshold of eligibility; criteria designed to be applied in the community—heavily weighted towards physical need—meaning those with invisible disabilities/needs may be unable to access support with work, education, or maintaining relationships.
Forsyth et al. (2021)OHSCAP: designed to assess social care needs of older people in prison who do not meet the high threshold for social care packages set by LAs.
Heathcote et al. (2024)No definition but refer to subthreshold needs: ‘it is clear that there is great variation and inconsistency between prisons in their provision of social care services or support for prisoners who do not meet the threshold for social care from the Local Authority’.
Levy et al. (2018)Refer to ‘low level care activities’ in defining peer support, including befriending; fetching meals; help tidy cells; out-of-cell activities; social interaction; administrative activities; buying items from canteen; advocacy.
Scottish Government (2021)Preventative social care: work with people in prison with ‘lower levels of support needs’ by reducing eligibility criteria; could include providing ‘small amounts of support’ such as structured group activities.
Stewart and Lovely (2017)‘Low-level help and support’ in context of peer support (befriending; fetching meals; help tidy cells.)
Storry (2022)People with significant social care needs who are deemed ineligible for support.
Tucker et al. (2021)Refer to people in prison in England who do not meet Care Act eligibility criteria for social care and support. The Act stipulates that LAs are charged with looking at how people’s general wellbeing could be improved to prevent, delay, or reduce deterioration by (at a minimum) providing advice and information at an individual level. Promotion of wellbeing.
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Buck, D.; Ali, A.; Butt, N.; Chadwick, H.; Mulligan, L.D.; O’Neill, A.; Robinson, C.; Shaw, J.J.; Shepherd, A.; Southworth, J.; et al. ‘Low-Level’ Social Care Needs of Adults in Prison (LOSCIP): A Scoping Review of the UK Literature. Soc. Sci. 2025, 14, 112. https://doi.org/10.3390/socsci14020112

AMA Style

Buck D, Ali A, Butt N, Chadwick H, Mulligan LD, O’Neill A, Robinson C, Shaw JJ, Shepherd A, Southworth J, et al. ‘Low-Level’ Social Care Needs of Adults in Prison (LOSCIP): A Scoping Review of the UK Literature. Social Sciences. 2025; 14(2):112. https://doi.org/10.3390/socsci14020112

Chicago/Turabian Style

Buck, Deborah, Akash Ali, Noor Butt, Helen Chadwick, Lee D. Mulligan, Adam O’Neill, Catherine Robinson, Jenny J. Shaw, Andrew Shepherd, Josh Southworth, and et al. 2025. "‘Low-Level’ Social Care Needs of Adults in Prison (LOSCIP): A Scoping Review of the UK Literature" Social Sciences 14, no. 2: 112. https://doi.org/10.3390/socsci14020112

APA Style

Buck, D., Ali, A., Butt, N., Chadwick, H., Mulligan, L. D., O’Neill, A., Robinson, C., Shaw, J. J., Shepherd, A., Southworth, J., Stalker, K., & Forsyth, K. (2025). ‘Low-Level’ Social Care Needs of Adults in Prison (LOSCIP): A Scoping Review of the UK Literature. Social Sciences, 14(2), 112. https://doi.org/10.3390/socsci14020112

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