Experiences of delivering and receiving peer-supported social care in adult prisons in England and Wales

Overview

What was already known:

• Peer support schemes are used for social care in prisons in England and Wales.
• The implementation of peer support schemes for social care is variable and influenced by peer support service factors, prison factors, staff factors and prisoner factors.

What this chapter adds

• Staff, buddies and recipients reported positive views of peer support schemes (e.g. that they are needed, valued, enjoyed by buddies and well received).
• Buddies and recipients generally felt safe delivering and receiving peer-supported social care, with some risks identified (see Chapter 7).
• Key factors that influence the delivery and receipt of peer support schemes for social care include respect, reward and recognition, skills, training and awareness for staff and buddies, access and regime, time and capacity for staff and buddies, attitudes of staff and prisoners, and processes and procedures.

Introduction

Earlier chapters have outlined how peer-supported social care services are being used in prisons in England and Wales (see Chapters 3–5). While earlier chapters provide insights into the implementation of peer support schemes for social care and the factors influencing social care, no studies (to the authors’ current knowledge) have explored the experiences of staff, buddies and recipients who deliver and receive peer support services for social care. Therefore, it is necessary to explore how such services are experienced by staff supporting them, buddies delivering them, and individuals receiving them.

This chapter answers the following questions:

1. How do staff and buddies describe the peer-supported social care offered in prisons in England and Wales?
2. What are the experiences of those delivering or receiving peer-supported social care in adult prisons in England and Wales? Do their experiences differ between different models of peer support schemes?
3. What are the factors influencing delivery and receipt of peer support schemes for social care in prisons in England and Wales? Do these factors differ across different models of peer support schemes?

Methods

This chapter draws on interviews with staff, buddies and recipients at the five case study sites (see Chapter 2).

Findings

Prison and participant characteristics

This chapter draws on findings from the five case study prisons, including interviews with staff (n = 7), buddies (n = 18) and recipients (n = 19) (see Chapter 5 and Report Supplementary Material 6).

How do staff and buddies describe the peer-supported social care offered in prisons in England and Wales?

What do staff, buddies and recipients think are the aims and goals of peer-supported social care?

Staff, buddies and recipients reported a range of aims, goals and outcomes of peer-supported social care (Box 3).

For recipients:

• Independence
• Enablement
• Advocating for health care when needed
• Companionship
• Receiving the support they need

For buddies:

• Employment skills
• Supporting future parole applications
• Receiving pay
• Sense of purpose and pride

For staff (e.g. prison staff):

• Having eyes and ears on the wings
• Having more time to do work
• More time for healthcare teams to spend with others in need

For prison:

• Adhering to a duty of care
• Having a sense of community

For local authorities:

• Reduced costs

What support do buddies offer to fellow prisoners for social care?

Staff, peer and recipient findings supported guidance that buddies should provide non-personal social care to fellow prisoners. Findings indicated that the non-personal social care support offered differs depending on the independence and needs of the individual. Support varied between prompting/encouraging recipients to do things for themselves to maintain or develop independence and doing things for them (e.g. cleaning and fetching meals). There were also some risks relating to people taking advantage of the scheme and asking for support who did not need it (see Chapter 7).

The number of people that buddies reported supporting varied between buddies and sites but ranged from one client to six clients per buddy. Buddies at all sites reported working 7 days a week with variable hours depending on needs.

What makes a good social care peer?

Staff, buddies and recipients gave their views on what makes a good peer supporter for social care. Key attributes are listed in Box 4.

• Having empathy
• Being friendly/cheerful
• Having good communication
• Having good listening skills
• Being helpful
• Making time to support others
• Being non-judgemental
• Having no history of threatening behaviour or bullying/violence
• Being carefully chosen/security checked
• Honest, kind and caring
• Boundaries/instruction follower
• Wanting to help people
• Being understanding of others’ needs
• Being hardworking
• Having a sense of humour
• Being physically fit
• Being supportive
• Being willing to do things others would not want to do

What are the experiences of those delivering and receiving peer support initiatives for social care in adult prisons in England and Wales?

What are the experiences of staff involved in supporting peer-supported social care? Do experiences differ across different models of peer support?

Similar to prison leads (see Chapter 5), staff reported positive views of peer support schemes, including that buddies are valued and do a good job. Staff emphasised that buddies’ help is invaluable in supporting recipients but also notifying staff of any issues. Staff highlighted the service is needed and well received by the community.

They are absolutely brilliant. I don’t know what we’d do without them. They really are amazing lads.

However, staff from one site reported that buddies do not always get praised for their role. Additionally, staff at a further site highlighted that some recipients require reassurance and encouragement to accept care from buddies. One interviewee highlighted that buddies can sometimes find it frustrating when individuals get rejected for formal external social care support as this can put further strain on the buddies.

Benefits and challenges are discussed in Chapter 7.

What are the experiences of buddies delivering social care support? Do experiences differ across different models of peer support?

Motivations to become a peer supporter for social care

There were similarities in the motivations that buddies gave for wanting to undertake the role of social care peer. These included wanting to help people, having previous caring experience in the community (either in paid roles in community or caring for family members) and having previous caring experience in prison settings (e.g. in same social care peer role or a similar peer support role). Additional motivations that were highlighted throughout the interviews included wanting to give back, wanting to prove that they are not bad despite having committed an offence, wanting a highly paid job, wanting to make a difference, meeting new people and achieving freedom around the prison.

Views on enjoyment and value of role

Buddies from all case study sites reported enjoying the role. Buddies gave many reasons for this, including getting satisfaction from helping people and seeing them make progress, helping to put recipients’ family members’ concerns to rest, finding it fulfilling, having a laugh when doing the role, enjoyment from talking to people and listening to their stories, development of own confidence, not being locked up in their cell, making the day go faster and liking to show people that although they committed offences they are not all bad. Many of the buddies reported positive views about the value of the scheme in terms of helping people and helping to improve their independence.

I love my job. I love seeing people happy, knowing that you can take that burden off.

Buddies expressed views that they are happy that prisoners are used to provide peer-supported social care. One peer believed social care is better in prison than outside of prison as the recipient receives support every day.

However, buddies did highlight a few negative aspects of their peer support role, for example challenges communicating with staff, perceived lack of awareness of the scheme, dislike of certain parts of the role (biohazards – cleaning blood and excrement), issues relating to being locked up when in the middle of providing care due to prison regime, potential for pettiness between buddies, or disputes between recipients and buddies.

Views on reward and recognition

One aspect of the peer support scheme that buddies across most of the case study sites spoke about was reward and recognition, in relation to not being paid enough, not receiving adequate non-financial recognition and buddies not always having access to uniforms. Uniforms were felt to be important to enable visibility but also to ensure they do not get their own clothes dirty, resulting in challenges relating to washing their own clothes within the prison environment (e.g. cost and availability) (see Chapter 3 for findings on reward and recognition).

Views on training and support

Views on training and support were highlighted throughout the interviews, with some buddies reporting it was adequate (e.g. that staff were good at supporting them, and were easily contactable and approachable), but other buddies highlighting that improvements to training were needed (see Chapter 3 for findings on skills, training and awareness).

Views on safety

Buddies across all four case study sites that implement peer-supported social care reported feeling safe in their role.

Yes, very safe. I’ve never, ever had a situation – I’ve had a situation where they didn’t want anyone else and they want me. [ … ] but apart from that, no, I’ve always felt safe.

For example, some buddies stated that they felt safe due to their prison’s zero tolerance for violence and that following any trouble people were removed. Others spoke about how they had never had an argument with any of their clients. In one site, buddies spoke about how they work in pairs to ensure their safety and the safety of their clients.

Buddies acknowledged that the risks depended on the client that they were working with, with some recipients being difficult to work with. Some spoke about not feeling safe all of the time. Examples of this included buddies feeling unsafe when receiving accusations from their client of not doing the job properly and experiencing aggression, being shouted at by their recipient to provide attention and listen to their stories again and again, and being blamed if their recipients’ order for medicine did not arrive on time (despite the peer having ordered it).

Buddies across two of the case study sites highlighted some safety concerns regarding provision of social care. Examples included it taking too long (a year) for social care to get involved when clients required social care support, recipients not being able to raise alarms that they needed care due to the call bell being too far away from their bed (resulting in the recipient being in bed for 8 hours without support) and people putting in applications to receive social care, but then the applications disappearing (resulting in individuals falling through the gaps and not receiving the social care support that they need).

Benefits and challenges are discussed in Chapter 7.

Views on scope of the role

Some buddies raised frustrations regarding the scope of the peer support role, with some buddies wanting more responsibilities (e.g. being able to administer first aid, or to be trained for additional duties such as cleaning biohazards).

Across two of the sites, buddies raised concerns that prison officers often ask them to help people who are not their recipients (e.g. to help move people in one site, and to help clean dirty cells in another site). Buddies emphasised that this can put them in a difficult position as this is not in their job description or part of their workload. This emphasises the importance of clear boundaries.

In one of the sites, buddies reported a lack of clarity on what the role entails for each client, reporting that the duties are not written down, and they do not have access to the care plans and so they rely on the recipient telling them what support they need.

Views on future in role

Across all sites, buddies emphasised that the peer support role is one that they are happy to continue while in prison. However, some buddies emphasised that they do not want to be a carer when released but that they like the variety of the role in prison. Some buddies did speak about potentially wanting to do a caring role in the community if it became available (but only if they were released prior to retirement age).

What are the experiences of individuals receiving peer-supported social care, or social care support more generally? Do experiences differ across different models of peer support?

Social care support needed and received

Across the five case study sites, recipients reported a range of social care support needs which mostly related to health conditions and mobility requirements. Of all of the recipients we interviewed, only four currently received support from an external care provider, with one person needing it but not getting it. All recipients in the four case study sites that have a formal peer support service for social care received peer support. In the case study site that did not report having an official peer support scheme for social care, all but one of the interviewees reported receiving support from an unofficial buddy to help with similar tasks that the formal buddies undertook (Table 8).

Views on having a buddy

Recipients (from all four sites with peer support) reported many positive views of receiving peer-supported social care. These included feeling that buddies do a great job and meet the needs of recipients, that buddies are reliable, hardworking and caring and that buddies go the extra mile to provide care 7 days a week. Additionally, recipients felt that the buddies contribute to the running of the prison, including that the prison service would fail without a buddy in place, that they improve the prison atmosphere and that they complete the job quicker than staff would.

I think without the buddies, we’d be a lot poorer, and we’d be lost without them I think, to be honest with you.

In general, recipients across all four sites reported that it did not matter to them that the person providing support was a fellow prisoner and that they are comfortable with their buddy. Some recipients emphasised that they would rather receive support from buddies than paid external social care staff. Many recipients referred to the role of security during the application processes and how this reassured them.

These positive views were also echoed by recipients in the prison that did not have a formal peer support scheme. Recipients reported that they have unofficial buddies that support the recipients informally, and that they do not know how they would cope without them. Recipients highlighted that if they had any issues, they would ask a fellow prisoner for help and that they did not mind (and that some preferred) that the person supporting them was also a prisoner. When asked about their views on having a formal buddy, recipients in this site were mixed, with some emphasising that they were happy to receive unofficial peer support instead of a formal system and that they did not need more buddy support, and others emphasising that a formal peer support scheme would be helpful for those who struggle with mobility and to help them live independently and that it would be good for buddies to be paid for their role.

However, some negative views on peer support were also shared by recipients, including needing more consistent care from buddies (with some reporting that the peer has not offered support more than twice since Christmas and that they still need an informal unofficial buddy in addition), difficulties accessing peer support due to buddies being overworked, difficulties in how the peer support scheme was set up (e.g. reliance on the number-one buddy to keep it running), a need for regular meetings, and difficulties associated with changeover of buddies making it difficult to keep track. In one site, recipients raised concerns about them having unmet needs for social care.

In the prison that did not have a formal peer support scheme, participants spoke about there not being a need for a formal peer support scheme for social care due to the prison being an open prison that tries to make people independent for release, and having support from a club for older prisoners and there being no added benefits. However, when discussing unofficial buddy support, findings contradicted this as participants raised concerns about not knowing what would happen if unofficial buddies stopped providing support, as everyone supports each other.

Views on relationship with buddy

Recipients from all four case study sites that had formal peer support schemes highlighted that they get on well with their buddy and that they trust them. Many of the recipients emphasised the value of receiving emotional support from their buddy. Some buddies did discuss how it took a while to build trust and rapport and that they initially were nervous about receiving peer support until they got to know them.

Views on safety

In terms of safety, recipients across all five sites (including the unofficial peer support) reported that they had no concerns about the use of buddies to provide non-personal social care support. But this feeling of safety was conditional on the recipients knowing that they were carefully picked and security cleared (in sites with formal schemes). Some recipients did however highlight initial concerns and that it took a while to get to know their peer supporter.

However, recipients did acknowledge that there are some buddies that they cannot trust and highlighted some initial worries when they first found out about the buddy scheme (e.g. because of bad past experiences with buddies, or due to worries of being ridiculed). In the site without an official peer support scheme, there was emphasis that the prisoners needed to be honest and that there would be worries if there were dishonest prisoners, therefore highlighting the risks of lack of selection in unofficial schemes such as this one.

One recipient also raised issues surrounding the safety of buddies and not wanting to discuss certain topics (e.g. suicide) to buddies as they would have to report it and would not want the buddy to lose their job, feel unsafe or get told off for something the recipient has done.

Benefits and challenges are discussed in Chapter 7.

Views on understanding of peer support service

Views on recipients understanding of peer support services for social care were only discussed in two of the case study sites. In these sites, some recipients reported being told about the service, but recipients did not receive leaflets about the service or what buddies could and could not do.

Views on peer impact on independence

Recipients across all sites raised the need to stay as independent as possible and that they did not want to rely on the peer too much for support. However, some recipients emphasised that they could not manage without their peer as they would not be able to get dinner.

Views on support from staff

Recipients in two sites reported views that the external support and staff support is appropriate, with one recipient emphasising that it would be preferable for external providers to provide personal care and not prisoners. In two of the sites, recipients raised issues with support from staff, including external support stopping, officers not understanding needs and feeling like an inconvenience (e.g. staff not allowed to push wheelchair). One recipient reported that they do not receive formal social care support but that the prison officers are kind.

What are the factors influencing the delivery and receipt of peer-supported social care in prisons in England and Wales?

We identified 10 themes that influence the delivery and receipt of peer-supported social care in prisons in England and Wales: (1) Respect, reward and recognition; (2) Skills, training and awareness; (3) Access and regime; (4) Time and capacity; (5) Equipment; (6) Relationships and communication; (7) Attitudes of staff, buddies and recipients; (8) Processes and procedures; (9) Boundaries and (10) Continuity. A summary of the themes, subthemes and example quotes are shown in Appendix 5, Table 33.

Some themes and subthemes were more frequently discussed than others. The most frequently reported themes included: respect, reward and recognition; skills, training and awareness; access and regime; time and capacity, attitudes; and processes and procedures. These were reported as barriers or facilitators across all case study sites and participant groups. A summary of the frequency with which themes and subthemes are reported is provided in Appendix 5, Table 34.

Respect, reward and recognition

Findings highlighted that key barriers to delivery included perceptions that pay was not sufficient, nor reflective of the role, time commitment (up to 7 days a week), and demanding responsibilities. While pay differed across prisons (£5–25 + extra for additional responsibilities), findings highlighted that pay was consistently reported to be a barrier across all four case study sites with a peer support scheme, but also in the case study site without a peer support scheme (as this site had informal buddies who are not paid for their role). While this finding was mostly frequently reported by buddies, it was echoed by staff and recipients across different prisons.

A further barrier was a perceived lack of recognition whereby buddies do not receive formal written or verbal recognition for the work that they do. Buddies and recipients felt that buddies were recognised for their role in that it was valued and appreciated by staff, and they perceived verbal feedback from staff as counting towards their parole report and their end goal of release. Staff from two sites also acknowledged peer recognition as a facilitator.

Skills, training and awareness

Buddies, staff and recipients highlighted the importance of training peers, with the provision of training and shadowing of buddies/learning on-the-job facilitating delivery, but a lack of training (whole modules or single courses) limited their ability to undertake their role.

Staff training and awareness was also perceived to be a key barrier to peer support, in that staff do not always understand what social care is, what social care is available and what the peer supporters do. The importance of both peer training and staff training was highlighted by all participant groups across all case study sites with a peer support scheme as both a barrier and facilitator. Additionally, staff training was highlighted as a barrier and facilitator for the prison without a peer support scheme for social care.

Access and regime

Staff, buddies and recipients across most case study sites reported that a restricted regime limits peer support as it means that buddies are unable to provide necessary support to their recipients (e.g. during lock-up, or out of hours), thus making it difficult for buddies to fit all of their work in. However, one site reported that access was a facilitator as they reported having a facilitative regime which allowed buddies to be open all day (with the exception of roll call).

Time and capacity

Time and capacity of both buddies and staff influenced delivery. Peer time helped and hindered peer support, with a lack of peer time restricting their ability to provide care (e.g. when lock-up occurs), versus having time to undertake the job (being open all day). Additionally, having a team of buddies to provide support was felt to enable buddies to undertake their role.

All groups across all sites reported the challenge of staff time, and how limited staff time impacts on the scheme. Participants discussed how staff did not always have time to support buddies in their role due to competing demands.

Equipment

Findings from all participant groups interviews across all sites highlighted that access to and maintenance of equipment for social care (including personal protective equipment and phones) is necessary for the provision of peer-supported social care.

Relationships

Staff, buddies and recipients indicated that lack of positive relationships between buddies and their recipients, buddies and staff (particularly lack of communication), between recipients and staff, and between prisons, limited peer support schemes for social care and made the job more difficult. On the other hand, findings indicate that positive peer and staff relationships (including communication), relationships between buddies, relationships between buddies and recipients, relationships between prison departments and between organisations (e.g. prison and local authorities) facilitated the delivery of peer-supported social care. The importance of positive peer and recipient relationships was highlighted across all sites and participant groups. However, the importance of peer and staff relationships, peer relationships, and across-prison relationships was highlighted only by buddies and staff. The importance of recipient and staff relationships, and relationships between prison departments, was highlighted by recipients and staff. Staff from all prisons highlighted the importance of cross-organisational relationships (e.g. local authority and prison).

Attitudes

Negative staff attitudes towards peer support schemes (e.g. resistance, disinterest, add-on role, lack of understanding and ignorance, or no empathy or compassion) and recipient attitudes (e.g. wanting to remain independent, trying to receive support not entitled to, not wanting to look after themselves, reluctant to receive care, shyness, or stubbornness) limited delivery of peer-supported social care. Buddies highlighted that a facilitator to peer support was their own attitudes towards the role and their own motivation.

Processes and procedures

Findings from all groups of participants highlighted a need for clear processes and procedures. For example, a lack of processes (including succession planning to replace number-one buddies, contracts, training records, and to identify those in need) and lack of standardisation of care was perceived to limit peer-supported social care. On the other hand, buddies being able to make referrals for social care and formal agreements between buddies and recipients facilitated peer-supported social care.

Boundaries

Participants from all groups and prisons highlighted that clear boundaries are key for safety. Some buddies and recipients reported barriers associated with the current rules and regulations of peer-supported social care in that buddies are not allowed to physically touch their recipients. Buddies and recipients reported desires for buddies to have additional responsibilities, including being able to administer first aid, having contact so they can help someone up if they fall, helping someone to pull their jumper down, and helping with physiotherapy exercises would be helpful in supporting peer support provision.

Continuity of care

Some buddies, recipients and staff emphasised the importance of continuity of staff in leading and supporting the peer support schemes and that a lack of continuity has made this challenging.

There were mixed views on the need for continuity of buddies, with some recipients reporting that it would be helpful to build trust, and some buddies reporting that rotation of buddies was helpful to prevent over attachment. Different models of peer support were used in different case study sites, for example in some case study sites buddies worked as a team to provide care to all recipients, whereas in other sites buddies had a caseload of recipients who they worked with every day.

Discussion

Key findings

Generally, staff, buddies and recipients reported positive views of peer support schemes (e.g. that they are needed, valued, enjoyed by buddies and well received). Buddies and recipients generally felt safe delivering and receiving peer-supported social care, with a few exceptions (see Chapter 7). Additionally, the study highlighted that even in the site that reported not having a peer support scheme due to a lack of social care need (see Chapter 5), there was in fact a need highlighted by recipients; needs which were supported by informal buddies. Findings indicated that not all buddies are paid equally, with pay ranging from £5 a week to £25 (+ extra pay for additional responsibilities).

The study highlighted 10 factors that help and/or get in the way of peer-supported social care. The most frequently reported factors included: respect, reward and recognition; skills, training and awareness for staff and buddies; access and regime; time and capacity for staff and buddies; attitudes of staff and prisoners; and processes and procedures. Findings offered insight into what makes a good peer supporter for social care from the perspectives of staff, buddies and recipients (e.g. empathy, good communication and listening skills, being non-judgemental, and being carefully selected). Furthermore, many buddies in these roles have a history of undertaking caring roles in community or prison settings.

How findings relate to previous research

Findings offer staff, peer and recipient perspectives on what makes a good peer supporter for social care that may be helpful when developing guidelines for selecting buddies in future.

Furthermore, findings indicate that even in situations whereby staff perceive there not to be a social care need (e.g. in certain prison types where independence is an important factor), recipients still report the need for some non-personal social care support and report the role of informal buddies in providing this support. This supports findings from the documentary analysis which indicated that informal peer support schemes are used in a number of prisons in England and Wales (see Chapter 41). However, PSIs highlight that informal buddies should not be used when recipients require regular support related to their health and social care support.45 In line with this guidance, there may be a need to formalise informal peer support in these prisons, even with small amounts of need. Differences in perceived need from staff and recipients indicate that it may be challenging to tell when informal support becomes formal support (e.g. perhaps due to factors such as prisoners wanting to show their independence in order to stay in an open prison) and therefore mitigations are needed to ensure that peer support is safely delivered in these situations.

Findings extend previous research that has been conducted into experience of other peer support schemes in prisons (see Chapter 36,40,41), by demonstrating that staff, buddies and recipients generally felt positively about peer support schemes for adult social care in prisons in England and Wales, and that support from buddies is acceptable as long as appropriate safeguards and training are in place. However, findings highlight that these schemes may not be valued by the prison estate, due to the low pay and lack of recognition and that other factors, such as lack of time and regime, make it difficult for buddies to undertake their role. Furthermore, findings highlight the need for staff to have time to support the buddies and also for staff to have an understanding of the peer role in order to ensure that the scheme runs smoothly in practice. Additionally, certain risks must be mitigated against for peer support schemes to be safely delivered (see Chapter 7).

Strengths and limitations

This study was a collaboration between researchers with experience of conducting rapid evaluations of health and social care services and EP:IC consultants who are an experienced team of researchers in conducting research across prison settings. This helped to ensure that the study was able to be conducted efficiently in a rapid way. Additionally, researchers from EP:IC consultants who collected the data are independent from prisons, and some have lived experience of prison. This was a key strength as prisoners wanted to open up and talk to them about their experiences.

We sampled five case study prisons that have different characteristics, including location in England and Wales, type of prison, male/women’s prison and model of peer support. However, findings on staff, peer, and recipient experience do not necessarily generalise across all prisons offering peer-supported social care in England and Wales. Additionally, the number of interviews undertaken with staff, buddies and recipients differed across sites (depending on availability of interviewees and amount of time in each site to collect data). Therefore, the sample was likely to be over-representative of certain characteristics, for example White British and older prisoners and under-representative of others, for example staff members involved in supporting peer support, individuals with other types of social care need (e.g. those with learning disabilities or other needs) and individuals from other ethnicities (e.g. recipients of care). Despite asking to interview recipients of care that were not White British, we were unable to identify any in the sample. The sample was largely dependent on support from the prisons when selecting potential participants, therefore, this may have skewed the sample.

Also, as the study focused on social care and included interviews with recipients of social care, some of the recipients of care may have had both physical (e.g. hearing loss or fatigue) and/or cognitive impairments (e.g. memory difficulties). Therefore, researchers involved in data collection reflected that there may have been some participants who may not have heard or understood all of the questions asked in the interview, which may have limited the responses we received. However, all participants gave informed written or verbal consent, and the researchers from EP:IC consultants who collected prisoner interview data were experienced researchers and used judgement on when to stop interviews early, or when to rephrase questions to ensure that participants were able to take part. For example, one interview was stopped early when a participant appeared too tired to continue or was unable to give an appropriate answer. However, it was important to ensure that we spoke to as many recipients of care with as many varying needs as possible.

Implications

Findings provide lessons on how to improve peer support schemes from the perspectives of buddies, recipients and staff. Potential improvements to the scheme include standardising employment practices (e.g. when recruiting and selecting buddies), using clear governance processes to monitor the peer support schemes in practice (including monitoring of peer social care role), providing regular training and supervision opportunities for buddies on how to do peer support roles, providing regular training and support for staff in terms of what the peer support role is and why it is important for social care, and ensuring that buddies and staff have time to support the peer support scheme.

Furthermore, findings highlight that to prevent informal peer support schemes from happening, formal peer support schemes for social care may need to be established in prisons that do not necessarily have a perceived need to ensure safeguarding responsibilities of both buddies and recipients.

Future research

Future research is needed to explore how stakeholders in other prisons experience peer support schemes for social care and the factors that influence delivery and receipt of peer support in those establishments. If the service and governance processes are rolled out and mandated across prisons, further research would be needed to ensure that peer support schemes are being delivered consistently across establishments.

Conclusions

Generally, staff, buddies and recipients reported positive views of peer support schemes (e.g. that they are needed, valued, enjoyed by buddies, and well received). Buddies and recipients generally felt safe delivering and receiving peer-supported social care, with a few exceptions (see Chapter 7). Factors that influence the delivery and receipt of peer support schemes for social care include respect, reward and recognition, skills, training and awareness for staff and buddies, access and regime, time and capacity for staff and buddies, attitudes of staff and prisoners, and processes and procedures. Buddies must be carefully selected and require a range of skills including empathy, good communication and listening skills, and being non-judgemental.