New report published on prisoners’ use of hospital care in England and Wales.

27th February 2020

IPRT’s benchmarking project, Progress in the Penal System, includes Access to Healthcare Services as a spotlight issue to monitor closely (Standard 12). As of 2019, the following actions were required:

• The Department of Justice and Equality and the Department of Health must ensure that the prison health assessment is completed and published by July 2020
• The Department of Health should consider taking responsibility for prison healthcare.
• A national reporting framework should be established to continually assess the quality of prison healthcare.
• The IPS should ensure that terminally-ill prisoners can be released into appropriate care
• The IPS should develop gender-specific healthcare standards for women.

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A new report, entitled Locked out? Prisoners’ use of hospital care, has been published by the Nuffield Trust. This report examines the use of external hospital care by prisoners in England and Wales. The study looks at how prisoners’ healthcare needs are being met, drawing upon evidence from over 110,000 patient hospital records for prisoners at 112 prisons in 2017-2018.       

Prisoners often have more complex physical healthcare needs than the general population, due to the prevalence of issues such as substances abuse, homelessness and histories of abuse, as well as high rates of self-harm. While this would suggest that prisoners are likely to need to attend hospital at the same or higher rates than the general population, the report found that prisoners’ use of hospital services were far less than the general population. Prisoners had 24% fewer inpatient admissions and outpatient appointments, along with 45% fewer attendances at Accident & Emergency departments than their equivalents outside of prison. Findings also show that 40% of prisoner outpatient appointments were not attended, which is double the proportion of missed appointments in the general population. The majority of these were either cancelled in advance, or the prisoner did not arrive at the appointment. Older prisoners (aged 50+) were less likely than other prisoners to miss appointments, but still more likely than the general population of the same age.

The most common reason for prisoners to be admitted to hospital was injury or poisoning. 18% of prisoners were admitted for these reasons compared to 6% of admissions for the general population. Upon further examination, the researchers found the prevalence of head injuries (third most common reason for admission), poisoning (eighth most common reason), chronic kidney disease and cancer were the most common causes of admissions to hospital. Over 40% of prisoners admitted to hospital had at least one chronic condition.        

For female prisoners, diseases of the digestive system and pregnancy-related issues were among the most common reasons for admission. 22% of pregnant prisoners had missed midwife appointments and 30% had missed obstetric appointments, compared to 14% and 17% respectively among the general population. The data discovered ‘potential lapses of care’ for certain cohorts of prisoners. For example, analysis of the data shows that more than one in ten women gave birth before reaching a hospital, meaning birth took place in a prison cell or on the way to the hospital.

Based on these findings, the authors recommend that data on the availability of prison escorts be published, and that the supply of prison escorts be increased. Increased use of telemedicine consultations, whereby patients can consult a doctor by telephone or video, was also a recommendation made in the report. Lastly, the reports recommends:

1. increased use of hospital data for monitoring the healthcare of the prison population compared to the general population
2. identification and monitoring of avoidable health outcomes
3. consistent publication of data on pregnant women in prisons.

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The full report can be read here.