Prisoner healthcare puts patients at risk

The healthcare needs of prisoners in England are not being met and essential changes are needed to ensure patient safety, according to new research led by Cardiff University.

The first nationwide analysis of patient safety in prisons in England found that prisoners are experiencing delayed access to healthcare services and medication-related harm. Mistakes by prison staff, such as mixing up patients with similar names, is the most common report in prisons, the team found.

With prisoners using healthcare services three times more than the general population and having poorer health outcomes, the researchers uncovered areas that need to be prioritised  to improve patient safety and outcomes.

The team from Cardiff, Manchester and Nottingham universities analysed more than 4,000 reports from prisons across a whole year, investigating incidents where a patient could have, or did, come to harm.

Their research found that:

• Staff mistakes, such as mixing up similar patient names, were the most common reasons cited in reports.
• A third of cases were related to medication, with patients missing doses or prescribed medication or given the wrong treatment.
• In three out of 20 reports, prisoners were delayed in accessing or unable to access healthcare, including appointments at external hospitals.
• Over 20% of medication-related reports were discovered and mitigated by staff, preventing any harm to patients.

Professor Andrew Carson-Stevens, Professor of Patient Safety and Healthcare Improvement at Cardiff University’s School of Medicine, said: “There are approximately 80,000 people within prisons in England and this number is increasing.

“In prisons, healthcare priorities of patients are often overshadowed by a prison’s main objective - securing detained individuals. This risks adequately considering prisoner needs and their collective responsibility of care.

“Our research analysed the safety incidents that had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019. We sought to characterise the type and nature of commonly occurring patient safety incidents within prisons and identify opportunities to improve existing healthcare systems within secure environments.”

The research highlighted that security, staffing constraints and a high turnover of prisoners are among the main barriers to the safe delivery of healthcare to patients. Security barriers, such as when prison wings are on lockdown, and lack of staff were the biggest causes identified by the researchers.

Several recommendations were generated through the study, aiming to improve how prison and healthcare leaders can work together in the interests of better coordinated and safer care.

Dr Joy McFadzean, Division of Population Medicine at Cardiff University’s School of Medicine, said: “Reviewing staff rotas, improving training and rethinking prison layouts could help improve access to in-house care. For external hospital appointments, revised escalation policies and plans to ensure staff escorts are put in place, as well as increasing the use of remote appointments and ‘in-reach’ clinics, would improve patient outcomes.

“We also think that standard handover practices, policies to ensure the safe transfer of medication and prescription information, and appropriate discharge planning could help to ensure continuity of care when people transfer in or out of a prison.

“This study highlights the importance of improving medication safety and access to healthcare services for prisoners. By analysing the reports, we have been able to pinpoint areas for development, that should improve outcomes for patients in prison.”

The study was funded by the National Institute for Health and Care Research Policy Research Programme.

The paper, Patient safety in prisons: a multi-method analysis of reported incidents in England, was published in the Journal of the Royal Society of Medicine on May 18 2023.