Prisoners twice as likely to leave A&E without being treated

One in ten prisoners who attend A&E leave before they are seen or treated by hospital staff – double the proportion for people outside prison – according to new analysis, which also shows many prisoners are not receiving the health care they need. In 2023/24, 2,670 prisoners left A&E without being seen.

The research – the first to offer an in-depth assessment of A&E use by people in prison, and the latest in a series of reports by the Nuffield Trust – adds to mounting evidence that health care is harder for prisoners to access.

Through analysing data from 117 prisons and young offender institutions in England, the researchers found that people in prison attended A&E over 27,000 times in 2023/24 (16,384 prisoners attended, some more than once). Attendances were lower than expected relative to the wider population, suggesting that prisoners face barriers to accessing hospital care despite some health care needs being dealt with in-house. Prison staff are needed to escort prisoners to A&E but staffing shortages in the justice system make this difficult, and not all prisons have 24-hour health care on-site.

The report highlights how failings in preventative prison-based health care, including poor identification and management of long-term health conditions, are exacerbating avoidable A&E attendances, storing up problems for an NHS under severe strain. For example, the research found that A&E attendances linked to reduced blood flow to the heart (Acute Coronary Syndrome) were twice as high for the prison population than the general population. This also highlights an opportunity for intervention to prevent heart disease in a population known to be at risk of poor heart health.

The number of older people in prison is projected to increase over time, threatening to place greater pressure on stretched emergency departments already acting as a safety net when prison-based health services are not available or are over stretched.

Further key findings from the report:

• Paracetamol overdose rates were over six times higher for people in prison than the general population in 2023/24, indicating that prison protocols that are meant to prevent people in prison having access to more paracetamol than is safe are not consistently working.
• The rate of A&E attendances associated with seizures for prisoners was three higher than that seen in the general population in 2023/24. There are more risk factors associated with seizures in the prison population, including underlying diagnosis of epilepsy, use of certain medications, alcohol or drug withdrawal, and a history of head injury.
• Despite the challenges of attending hospital from prison, some people in prison attend A&E regularly. Of the 16,384 people who attended A&E in 2023/24, 30% (4,963 people) attended more than once and 4% (719 people) attended A&E five times or more. This group is characterised by more attendances associated with seizures and self-injurious behaviour compared with people in prison who attend A&E less frequently.
• A&E attendance while in prison is associated with high use of A&E services outside of prison. Looking at people who attended A&E in and out of prison in the same year, outside of prison, almost 1 in 4 attended A&E five or more times over the course of the same year.

To improve prisoner health and reduce the demand in A&E departments, the authors recommend that physical health checks for older prisoners – which should be carried out as standard – need to be prioritised and acted upon. There also needs to be more effective preventative health screening on entry to prison, to identify and manage issues such as high blood pressure before they become an emergency.

Miranda Davies, Senior Fellow at the Nuffield Trust and lead author of the analysis, said:

“Prisoners’ health care needs are not being managed properly, and A&E services are left to pick up the pieces from that failure. Providing health care in prison brings unique challenges, like the need for prisoners to be escorted by prison staff if they need to attend A&E. Prisons also have to rely on hospitals to provide care when prison-based facilities are shut. But that shouldn’t get in the way of prisoners receiving the health care they need.

“There are simple, direct measures that could be taken to provide better health care for prisoners, like carrying out and acting upon physical health checks, particularly for older prisoners, and more effective health screening on entry to prison.

“There is concern, too, about the long-term implications of not effectively meeting the health care needs of people in contact with the justice system. We found that around a quarter of people who access urgent care services while in prison attended A&E five or more times in the same year outside of prison. This is a particular issue post release from prison, when we know people are at high risk when they are trying to reestablish themselves.”