Prison healthcare must be improved, finds National Confidential Enquiry into Patient Outcome and Death

The report finds that people in prison have a significantly reduced life expectancy, with a median age of 67.5 compared to 86.7 in the community. Further, the report highlights the need for healthcare in prison to be underpinned by robust and well communicated processes to ensure needs are properly identified and managed.

The enquiry reviewed the care of 247 prisoners who died from natural or other ‘non-natural’ causes, such as an accidental overdose. Over two thirds (68%) of patients who died had evidence of clinical deterioration prior to their death. The report underlines the importance of improving processes for the timely assessments, monitoring, and interventions to better manage acute illnesses.

Clinicians reviewing the data concluded that 23 deaths from natural causes were potentially avoidable. Sadly, 11 of these deaths were due to a lack of recognition of an acute deterioration in health. The report also finds that the end-of-life process could have been improved in almost half (45.2%) of patients where the death was from a natural cause.

Dr Jake Hard, IAPDC member and Clinical Director for HMP Cardiff, was part of the Study Advisory Group providing advice to the NCEPOD. Dr Hard says:

“This report provides an excellent insight into the provision of healthcare for people in prison. People in prison tend to experience greater health inequalities and the report rightly recognises that the care they receive should – fundamentally – be consistent in range and quality with that available to the wider public. In this way ‘equivalence’ of care is essential for achieving equitable health outcomes.

“The detailed findings from the NCEPOD provide a closer look into many important aspects relevant for highlighting and addressing a number of areas in which improvements in the care provided to our patients can be made. It is only with a collective ambition of improving the quality of care can avoidable deaths in custody be reduced.“

The NCEPOD puts forward a set of recommendations, including steps to:

• Improve healthcare assessments and the monitoring of long-term conditions, by providing enough appropriately skilled healthcare staff.
• Recognise and act quickly on clinical deterioration, using the National Early Warning Score (NEWS2) to aid recognition.
• Plan for emergency transfer to hospital, to minimise delays when it is needed.
• Provide basic life support training.
• Improve palliative and end of life care services.

In 2020, the IAPDC published a joint report with the Royal College of Nursing which identified how natural deaths in prison might be prevented, where possible, and end of life care managed with dignity and compassion. We made a series of recommendations, including improvements to information sharing, end-of-life care, and learning from deaths. We are disappointed and concerned that very little progress has been made improving patient care and safety in prison.

You can read our report here.