UK: Avoidable natural deaths in prison custody

5th October 2020

On the 30th September, 2020 the IAP (Independent Advisory Panel on Deaths in Custody) and the RCN (Royal College of Nursing) published ‘Avoidable natural deaths in prison custody: Putting things right’ which aims to identify how natural deaths in prison might be prevented, where possible, and end of life care managed with dignity and compassion. This report is especially relevant as prisons face new challenges regarding healthcare amidst the COVID-19 pandemic. 

A ‘natural cause death’ is defined as including ‘any death of a person as a result of a naturally occurring disease process’. Juliet Lyon, Chair of the IAP, stated in 2019: ‘For most prisoners the combination of poor diet, psychological stress and inactivity results in their leaving prison in a dangerously degraded physical and mental condition’.

Overall, number of preventable deaths amongst prisoners in the UK is ‘unacceptably high’ according to the RCN and the IAP.

Key findings:

• In June 2009 there were 103 natural deaths in prison, but this figure has steadily been increasing, and in June 2019 there were 165 natural deaths. This figure peaked in June 2017 with 195 natural deaths.
• The average age of someone dying in custody is just 56 years old, while in the general population that significantly increases to 81 years old.
• Some deaths listed as ‘naturally occurring’ were found to have been preventable, upon investigation by the Prisons and Probation Ombudsman (PPO) and Coroners.
• Adequate prisoner healthcare is a key issue, with young prisoners (1534) receiving the poorest quality of healthcare and only 36% of prisoners receiving proper and timely investigation of medical symptoms.
• An ageing prison population was a factor in the figures but not a conclusive one as 39% of natural deaths in prison were of people between 35 and 54.
• Some issues specific to women’s health (e.g. cervical screenings) need to be addressed as women in prison are more at risk to certain cancers than in the general population.
• 1,000 prisoners were identified as eligible for temporary compassionate release due to COVID19, at present fewer than 60 have been released under this scheme.
• According to the PPO, the leading cause of natural death in prison is disease of the circulatory system (43%) followed by neoplasms (cancer) 32%.
   

Recommendations:

• Improve the transfer of health information when someone enters and leaves custody to ensure continuity of care
• Provide specialist services for longterm conditions such as cancer or dementia, which will require an increased supply of registered nurses
• Raise the profile of prison health care as a career path for nursing staff and improved support for healthcare staff working with prisons
• Improve interdisciplinary working between doctors, nurses, pharmacists and prison staff
• Comprehensive ‘medical care pathways’ for prisoners before, during and after their time in custody as well as ‘medical passports’ which the prisoner and healthcare staff both have copies of
• Improved escorting system/staff availability to avoid missed medical appointments
• Improved ‘care after custody’ and optimal strategies for older prisoners, for example a dementia care pathway
• Increased use of ‘compassionate release’ where possible and more formalised, expedient process surrounding same
• Improved end of life care as proposed by the ‘Dying well in custody’ charter which aims to implement a national framework around palliative care

Read Avoidable natural deaths in prison custody: putting things right in full here.