Four in ten hospital appointments made for prisoners are cancelled or missed, they receive around a quarter less hospital care than expected compared to the general population, and there are signs of lapses of care within prison for certain groups.
That’s according to new analysis of prisoners’ use of hospital care in England, published today by health think tank the Nuffield Trust. Drawing on over 110,000 patient hospital records for prisoners at 112 prisons in 2017/18, the study provides the most in-depth look to date at how prisoners’ health needs are being met in hospital.
The analysis also publishes new information on the number of pregnancies and births in prison, revealing that over one in ten pregnant prisoners gave birth either in prison or on their way to hospital in 2017/18. The think tank says this points to wider problems meeting the health care needs of pregnant women in prison.
The Nuffield Trust says these findings raise concerns about how prisoners are able to access hospital care, highlighting the legacy impact of a drop in frontline prison staff alongside the burgeoning prison population. This, the think tank says, is likely to have reduced the numbers of prison escorts to transport and guard prisoners whilst at hospital, meaning cancelled appointments and restricted access to hospital care for all but the most urgent of cases.
Key findings include:
- Prisoners had 24% fewer inpatient admissions and outpatient attendances than the same age and sex demographic in the wider population, and 45% fewer attendances at accident and emergency departments in 2017/18.
- 40% of outpatient appointments for prisoners were not attended (32,987 appointments), double the proportion of non-attended appointments in the general population. Over three quarters of missed appointments were cancelled in advance or recorded as people simply not turning up on the day. The value of the latter equated to around £2 million for the NHS.
- Prisoners have particular health needs related to violence, drug use and self-harm, with injury and poisoning accounting for 18% of admissions compared to 6% in the general population. Psychoactive substance use was recorded in more than 25% of all inpatient admissions by prisoners.
- 56 prisoners gave birth during their prison stay, and over one in 10 of these (six prisoners) gave birth either in prison or on their way to hospital.
Commenting on the research, lead author Dr Miranda Davies, a Senior Fellow at the Nuffield Trust said:
“The punishment of being in prison should not extend to curbing people’s rights to healthcare. Yet our analysis suggests that prisoners are missing out on potentially vital treatment and are experiencing many more cancelled appointments than non-prisoners.
“As well as the moral case for high quality prisoner health, improving prisoners’ access to hospital care makes sense from a practical and financial perspective too. Delays in treating conditions such as cancer or diabetes early can result in longer and more complex treatments when prisoners do eventually get to hospital.
“Ensuring prisoners receive the healthcare they need is also a vital part of rehabilitation and could help ensure people leave prison less likely to reoffend.”
The research, funded by the Health Foundation, points to a number of key recommendations for the public authorities involved in prisoner health. These include publishing data on pregnancies and births within prison, providing greater transparency over prisoner escort numbers, and making better use of hospital data.
By publishing the research and the methods used to link prisons to hospital care the Nuffield Trust hopes that they can be used more widely to establish a regular look at prisoners’ use of hospital care. Further research by the Nuffield Trust will explore prisoners’ use of hospital services over time.
Notes to editors
- Prisoners’ anonymous health records were identified in routine hospital data (Hospital Episode Statistics) based on their postcode. This revealed 11,908 inpatient admissions, 83,176 outpatient appointments (of which 50,189 were attended) and 17,928 attendances by people from a prison postcode in 2017/18.
- 12,176 (15%) outpatient appointments were cancelled by, or on behalf of, the patient; 13,523 (16%) were recorded as ‘did not attend - no advance warning given’; and 7,288 (9%) were cancelled or postponed by the health care provider.
- This work uses data provided by patients and collected by the NHS as part of their care and support. Read more on our website https://www.nuffieldtrust.org.uk/about/corporate-policies#information-security-and-data
- Dr Miranda Davies will be talking about the research at the Nuffield Trust’s annual summit on Friday this week. Please visit https://www.nuffieldtrust.org.uk/summit/summit-2020/ for more information
- The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
- The Nuffield Trust prison health project is funded by the Health Foundation, an independent charity committed to bringing about better health and health care for people in the UK.