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The older prisoner health and social care assessment and plan (OHSCAP) versus treatment as usual: a randomised controlled trial

Forsyth, Katrina; Webb, Roger T.; Power, Laura Archer; Emsley, Richard; Senior, Jane; Burns, Alistair; Challis, David; Hayes, Adrian; Meacock, Rachel; Walsh, Elizabeth; Ware, Stuart; Shaw, Jenny

The older prisoner health and social care assessment and plan (OHSCAP) versus treatment as usual: a randomised controlled trial Thumbnail


Katrina Forsyth

Roger T. Webb

Laura Archer Power

Richard Emsley

Jane Senior

Alistair Burns

Adrian Hayes

Rachel Meacock

Elizabeth Walsh

Stuart Ware

Jenny Shaw


Background: Older people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU). Methods: The study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016. Results: Data were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs – Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI − 0.276 to 0.449, p= 0.621). No adverse events were reported. Conclusion: The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving theOHSCAP did not experience improved outcomes compared to those who received TAU. Trial registration: Current Controlled Trials: ISRCTN11841493, 25/10/2012.


Forsyth, K., Webb, R. T., Power, L. A., Emsley, R., Senior, J., Burns, A., …Shaw, J. (2021). The older prisoner health and social care assessment and plan (OHSCAP) versus treatment as usual: a randomised controlled trial. BMC Public Health, 21(1), Article 2061.

Journal Article Type Article
Acceptance Date Oct 11, 2021
Online Publication Date Nov 10, 2021
Publication Date Dec 1, 2021
Deposit Date Nov 18, 2021
Publicly Available Date Nov 18, 2021
Journal BMC Public Health
Electronic ISSN 1471-2458
Publisher Springer Science and Business Media LLC
Peer Reviewed Peer Reviewed
Volume 21
Issue 1
Article Number 2061
Keywords Public Health, Environmental and Occupational Health
Public URL
Publisher URL
Additional Information Received: 9 September 2020; Accepted: 11 October 2021; First Online: 10 November 2021; : ; : Approval to conduct the study was granted by the Research Ethics Committee (REC) for Wales in May 2013 (reference number 13/WA/0108). National Offender Management Service (NOMS) research approval was provided in July 2013 (reference number 2013–115).Written informed consent was obtained for all participants.; : Not applicable.; : The authors declare that they have no competing interests.