UK prisoners are up to 67 times more likely to experience harm whilst receiving healthcare, which could have been avoided if sufficient practices, systems and standards were in place, a new study finds.
In this new study, researchers from the Universities of Manchester, Nottingham, and Cardiff reviewed over 15,000 prisoner health records from 18 prisons in England to identify how often they experience harm, including physical or psychological harm, and whether it was avoidable.
Funded by the National Institute for Health and Care Research (NIHR), the researchers found that 247 cases of avoidable harm affected 244 prisoners, estimating that across the prison population in England, around 3,000-3,700 cases of avoidable healthcare harm could occur each year. The identified cases of avoidable healthcare-associated harm for prisoners resulted mainly in moderate harm severity in 62.7% of cases, followed by severe harm (10.9%) and death (10.9%).
Of the 247 cases examined, most patient outcomes involved prisoners experiencing discomfort and pain (40.1%) and delays receiving appropriate healthcare management or assessment (36.8%).
Dr Joy McFadzean, Clinical Lecturer of Patient Safety from Cardiff University's School of Medicine, who led the analysis of these data said: "Most of the patient safety incidents involved prisoners experiencing delays in healthcare assessments, treatment, or management of health conditions, or the worsening of existing health conditions, resulting in prisoners experiencing pain or discomfort."
When compared with previous research focused on avoidable harm in the community, prisoners may face 41-67 times higher risk of avoidable, significant healthcare-associated harm.
The study also highlighted that the prison environment itself can contribute to harm. Factors such as restricted movement, staffing pressures, administrative delays, and poor communication between services contributed to prisoners not receiving timely care.
This is the first study to estimate how often avoidable harm occurs in prison healthcare using medical records, with rates of avoidable harm in prisons occurring at much higher rates than in community healthcare, highlighting inequalities in access to safe and timely healthcare for people residing in prison.
Professor Darren Ashcroft, director of the NIHR Greater Manchester Patient Safety Research Collaboration (GM PSRC), said: "Targeted interventions are urgently needed to address these inequities in safety. Our findings have now highlighted priorities for action to address these safety challenges within prison healthcare."
The research highlights that people in prison often have complex physical and mental health needs, including long-term conditions and higher rates of illness. Ensuring safe healthcare in prisons is important for both individual well-being and public health. The team say that improvements are needed to make prison healthcare safer and more reliable, and to ensure that care is more equivalent to that given in the community.
The researchers say their findings emphasise the need for:
- Better healthcare systems for managing long-term health conditions
- Improved communication between both healthcare teams and prison teams, and enhanced use of medical records to record patient care and to ensure that care plans are monitored and enacted upon
- More timely referrals to other healthcare providers
- Greater attention to patient safety within prisons
Improving healthcare in prisons will reduce health inequalities, support better health outcomes for this vulnerable population, and could reduce pressure on the National Health Service by preventing avoidable complications and the resulting prisoner harm.
The research, 'The incidence of avoidable healthcare-associated harm in prisons in England: a retrospective case', was published in BMJ Quality & Safety. This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme and the NIHR Greater Manchester Patient Safety Research Collaboration.
