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News Article
Acutely unwell prisoners left in ‘limbo’ due to lack of mental health beds
Patient Safety Learning posted a news article in News
People needing acute mental health treatment are being left in prison for extended periods, HSJ can reveal. Figures HSJ obtained under the Freedom of Information Act show that 3,111 patients were transferred from prisons to mental health facilities between 2018-19 and 2020-21. A total of 481 (15%) of the transfer took more than 14 days from the date the mental health casework section received an application for transfer to the date the transfer took place. Across these three years, 167 transfers (5%) took more than 28 days. The longest wait for transfer was 161 days, which happened in 2018-19. However, the average number of days taken to transfer a patient has remained consistent at between 10 and 11 days. Until the summer, NHS England’s guidance recommended a 14-day time limit for transfers of patients from prisons to mental health facilities. In June 2021, NHSE published new guidance which recommended a 28-day time limit between a person first being referred for inpatient assessment and being admitted to a mental health facility. The timeline, which consists of two sequential 14-day periods, says medical reports should be “completed to be sent to the [MHCS]” between days 15 and 25, while the MCHS should approve and issue a warrant and admission should take place before day 28. Sophie Corlett, of mental health charity Mind, said: “Nobody who has been assessed as needing specialist inpatient care should be left for extended periods of time in prison, as it’s a completely inappropriate setting for anyone in crisis… When people are a risk to themselves, it’s crucial there are enough staff and beds available to make sure they are cared for in a safe and therapeutic environment.” Bethan Roberts, British Medical Association forensic and secure environments committee interim chair, said: “A prisoner who is mentally unwell and cannot be adequately cared for in a prison should… be transferred to a forensic mental health unit as soon as possible." Read full story (paywalled) Source: HSJ, 1 December 2021- Posted
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Content ArticleThis study in the British Journal of Clinical Pharmacology involved searching electronic health records to uncover how many people in prisons have been affected by a potential problem related to their prescribed medication. Researchers looked at published studies and worked with prison healthcare staff to develop and implement prescribing safety indicators (PSIs) for prison electronic health records. The authors found that PSIs provide a significant opportunity to measure and improve medication safety for people in prisons and that more patients were affected by some PSIs than others. The study also investigated how the searches could be used more widely in prisons and interviewed 20 prison health care staff to explore this topic. The staff they spoke to said that it was important to have people who can take on leadership of the searches and to promote team-based responses to them.
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Content ArticleThis report details an independent investigation into a homicide committed by an individual receiving treatment for mental health issues. It identifies lessons that can be learned from this incident and areas where improvements to services could help prevent similar incidents occurring.
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Content ArticleMany prisoners still struggle to access hospital services despite their significant health care needs, and early data suggests the pandemic has worsened access further. This report by the Nuffield Trust considers new evidence relating to pre-existing health conditions before prison, the use of remote consultation, different ethnic groups' use of health services and the early impact of the Covid-19 pandemic.
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Content ArticlePrisons and Probation Ombudsman Sue McAllister has published the independent investigation into the death of a baby (Baby A) at HMP Bronzefield on 27 September 2019. The investigation identified a considerable number of issues and concerns about the care and management of Ms A, the baby’s mother. Sue makes a significant number of recommendations to improve maternity services in Bronzefield. There is wider learning for the whole of the women’s prison estate from the death of Baby A, and the Prison Service must take this opportunity to improve the outcomes for pregnant prisoners so that this tragic event is not repeated.
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News ArticleA catalogue of failures among prison and health professionals has been highlighted in an investigation report into the death of a teenager’s baby after she gave birth alone in her cell at the largest women’s prison in Europe. The Prisons and Probation Ombudsman published the devastating report into the events in September 2019 at HMP Bronzefield in Ashford, Middlesex on Wednesday. The case was first revealed by the Guardian and the baby’s death triggered 11 separate inquiries. The report details a disturbing series of events that culminated with the young woman, who cannot be named, being in “constant pain” on the night of 26 September and eventually passing out while giving birth. According to the report the teenager "appeared to have been regarded as difficult and having a ‘bad attitude’ rather than as a vulnerable 18-year-old, frightened that her baby would be taken away”. Failings included: There was confusion among different health professionals about her due date. The day before her baby was born she told a prison nurse she would kill herself or someone else if the baby was taken away from her, but this information was not adequately shared. On 26 September she was put on extended observation, meaning she should have been regularly checked but this did not happen. She rang the bell twice at 8.07pm and 8.32pm that day. A call was connected then immediately disconnected at 8.45pm. She did not press the bell again. Checks by prison officers at 9.27pm and 4.19am revealed “nothing untoward”. It was left to two prisoners to alert staff to the fact that there was blood in her cell at 8.21am on 27 September. Prisons and Probation ombudsman Sue McAllister said: “Ms A gave birth alone in her cell overnight without medical assistance. This should never have happened. Overall, the healthcare offered to Ms A in Bronzefield was not equivalent to that she could have expected in the community.” The publication of the report has triggered multiple calls for an end to the imprisonment of pregnant women from the Royal College of Midwives, NGOs and academics in the field. Read full story Source: The Guardian, 22 September 2021
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Content ArticleThis article, published by the Institute for Healthcare Improvement, discusses some of the key patient safety issues in the Danish Prison and Probation Service. The author, Christian Vestergaard, a Medical Advisor with the Danish Society for Patient Safety, highlights differences in approaches to patient safety in prisons compared to other areas of healthcare provision in Denmark and stresses the need for action to improve the safety of care in these settings.
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Content ArticleThere are estimated 24 000–60 000 women who are pregnant and incarcerated worldwide and they often lack access to antenatal care at the same level as that available in their communities. Despite clear international standards that mandate equivalent care for people in prison, pregnant women in these settings face significant barriers to adequate antenatal care. The needs of pregnant women are often overlooked in prisons designed to house men . We must not forget this vulnerable and hidden cohort of women. Molly Skerker et al. explore the challenges for pregnant women in prisons worldwide.
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News Article
Covid death rate in prisons three times higher than outside
Patient Safety Learning posted a news article in News
People in prisons are at an increased risk of COVID-19, with a death rate more than three times higher than that of the general population, and should be made a vaccine priority, according to public health experts. There were 118 deaths related to COVID-19 among people in prisons in England and Wales between March 2020 and February 2021, representing a risk of dying more than three times higher than that of people of the same age and sex outside secure environments, the research team at University College London (UCL) found. The higher rate of death comes despite extensive physical distancing measures, including prisons keeping many inmates in their cells for 23 hours a day. The lead author of the study, Dr Isobel Braithwaite of UCL Institute of Health Informatics, said: “Our findings show that people in prisons are at a much higher risk of dying from COVID-19 than the general population, and we make the case that both they and prison staff should be given high priority in the rollout of vaccines." “We believe the current methods of regime restriction are not enough to protect people adequately, and a systematic, ‘whole-prison’ approach to vaccination is key to preventing further outbreaks and reducing overall deaths in prisons.” The Ministry of Justice challenged the authors’ work, however, arguing it failed to adjust for worse health among the prison population than the community and movements of prisoners in and out of prison. Read full story Source: The Guardian, 16 March 2021 -
News Article
Regulator sorry for manager’s ‘five years of hell’
Patient Safety Learning posted a news article in News
Regulators have apologised to a health manager who went through “five years of hell” while being investigated for misconduct, before being told there was no case to answer. Debbie Moore was a senior manager at the former Liverpool Community Health Trust, where there was a major care scandal in the early 2010s. As head of healthcare at HMP Liverpool, where many of the most serious failings were identified, Ms Moore was suspended in 2014 and referred to the Nursing and Midwifery Council. She was accused of multiple failures to take action or escalate concerns, of failing to investigate deaths, and discouraging staff from reporting incidents. However, in a first public interview about her experience, she told HSJ she was “scapegoated” for the problems at the prison, where she says she worked tirelessly to address the issues and had repeatedly flagged concerns to the LCH management team. External inquiries have found the trust would routinely downgrade risks escalated by divisional managers, as it sought to make drastic cost savings in pursuit of foundation trust status. Read full story (paywalled) Source: HSJ, 30 November 2020- Posted
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Content ArticleThis report, written in collaboration with the Royal College of Nursing (RCN), sets out proposals to reduce the number of preventable natural deaths in prisons. It identifies how natural deaths occurring in prison might be prevented, where possible, and end-of-life care managed with dignity and compassion.
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News Article
Coroner orders closer working between five trusts after prisoner’s death
Patient Safety Learning posted a news article in News
Five NHS trusts in the South West have been ordered to make immediate improvements after the death of a 20-year-old prisoner who needed healthcare. Lewis Francis was arrested in Wells, Somerset, in 2017 after stabbing his mother while “acutely psychotic” and taken into custody. Although his condition mandated a transfer to a medium secure mental health hospital, there was “no mechanism” in place to move Mr Francis and he was taken to prison, where he died by suicide two days later, according to a coroner. Contributory factors to his death included “insufficient collaboration, communication and ownership between and within organisations… together with insufficient knowledge of… the Mental Health Act,” according to Nicholas Rheinberg, the assistant coroner for Exeter and Greater Devon. In a Prevention of Future Deaths report, Mr Rheinberg said a memorandum of understanding was in place for the transfer of “mentally ill prisoners direct from police custody” in the West Midlands, and he called on the South West Provider Collaborative to agree a similar deal with “relevant organisations and agencies”. Read full story (paywalled) Source: HSJ, 14 July 2020- Posted
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Content Article
Deaths in custody guidance
Claire Cox posted an article in Prison setting
The Crown Prosecution Service (CPS) prosecutes criminal cases that have been investigated by the police and other investigative organisations in England and Wales. The CPS is independent and make their decisions independently of the police and government.- Posted
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Content ArticleCould prisons be an opportunity to address serious health inequalities? Or do they lead to worse health for people living in prison? In this podcast from the Kings Fund, Anna Charles explores the health and wellbeing of people living in prison, their access to health and care services, and what happens on release. She’s joined by: Dr Jake Hard, Chair of the Royal College of General Practitioners Secure Environments Group Christina Marriott, Chief Executive Officer of Revolving Doors Chantal Edge, Public Health registrar and NIHR research fellow Kate Morrissey, National Implementation Lead for RECONNECT at NHS England and NHS Improvement.
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Content Article
Coronavirus (COVID-19) and prisons (visiting) (last updated 17 March)
Claire Cox posted an article in Guidance
Guidance from the Ministry of Justice and Her Majesty’s Prison and Probation Service about visiting prisons during the coronavirus outbreak.- Posted
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Content Article
Improving standards of asthma management in a prison setting
Claire Cox posted an article in Prison setting
An initiative to raise standards of asthma care in a prison setting has lessons for the management and care of people with asthma in other healthcare settings. This article is published in the Nursing Times. You can register for guest access which gives you 1 week’s unrestricted access to nursingtimes.net. -
News Article
Prisoners suffer cancelled appointments and poorer healthcare
Patient Safety Learning posted a news article in News
Prisoners in Britain frequently have hospital appointments cancelled and receive less healthcare than the general public, a new study has found. As many as 4 in 10 hospital appointments made for a prisoner were cancelled or missed in 2017–18, with missed appointments costing the NHS £2 million. The in-depth analysis of prison healthcare by the Nuffield Trust think tank examined 110,000 hospital records from 112 prisons in England. It revealed 56 prisoners gave birth during their prison stay, with six prisoners giving birth either in prison or on their way to hospital. The Nuffield Trust said its findings raised concerns about how prisoners are able to access hospital care after a cut in the number of frontline prison staff and a rising prison population. 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.” Read full story Source: The Independent, 26 February 2020- Posted
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Content ArticleIt is widely known that prisons in England and Wales are crowded and facing severe difficulties, but the health and health care use of the prisoners within has received little attention. Drawing on over 110,000 patient hospital records for prisoners at 112 prisons, this study from the Nuffield Trust provides the most in-depth look to date at how prisoners’ health needs are being met in hospital.
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News Article
Number of self-harm incidents in prisons reaches record high
Patient Safety Learning posted a news article in News
Levels of self-harm in prisons have hit a new high, with more than 60,000 incidents in a year, official figures show. The number of self-harm incidents was up 16% to 61,461 in the 12 months to September 2019, when there were 53,076, according to data released by the Ministry of Justice (MoJ). Prison reform campaigners have criticised the government for failing to respond effectively to serious mental health problems and called Thursday’s figures a “national scandal”. Deborah Coles, the Director of the charity Inquest, said: “Despite investment and scrutiny, the historical context shows that still more people are dying in prison than ever before. A slight recent reduction in the number of deaths comes alongside unprecedented levels of self-harm, while repeated recommendations of coroners, the prison ombudsman and inspectorate are systematically ignored." "This is a national scandal and reflects the despair and neglect in prisons. Despite this, the health and safety of people in prison appears to be very low on the agenda of the new government." Read full story Source: 30 January 2020 -
Content Article
Deaths in prison: A national scandal (INQUEST, January 2020)
Claire Cox posted an article in Prison setting
Every four days a person takes their life in prison, and rising numbers of ‘natural’ and unclassified deaths are too often found to relate to serious failures in healthcare. The lack of government action on official recommendations is leading to preventable deaths. Deaths in prison: A national scandal exposes dangerous, longstanding failures across the prison estate and historically high levels of deaths in custody, and offers unique insight and analysis into findings from 61 prison inquests in England and Wales in 2018 and 2019. The report details repeated safety failures, including mental and physical healthcare, communication systems, emergency responses, and drugs and medication. It also looks at the wider statistics and historic context, showing the repetitive and persistent nature of such failings.- Posted
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Content ArticleIn 2018/19, ten people died each week following release from prison. Every two days, someone took their own life. In the same year, one woman died every week, and half of these deaths were self-inflicted. This report, co-authored by Dr Jake Phillips of Sheffield Hallam University and Rebecca Roberts of INQUEST, provides an overview of what is known about the deaths of people on post custody supervision following release from prison. It highlights the lack of visibility and policy attention given to this growing problem and calls for immediate action to ensure greater scrutiny, learning and prevention.
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Content Article
Family reference group: INQUEST
Claire Cox posted an article in Patient stories
INQUEST is a charity providing expertise on state related deaths and their investigation to bereaved people, lawyers, advice and support agencies, the media and parliamentarians. Their specialist casework includes deaths in police and prison custody, immigration detention, mental health settings and deaths involving multi-agency failings or where wider issues of state and corporate accountability are in question. What is the Family Reference Group? The INQUEST Family Reference Group is made up of people directly affected by a contentious death (i.e. in detention/custody, where a state body is involved, or where the facts are disputed). It supports and contributes to INQUEST's work from a family perspective. The reference group brings together a range of experiences, taking into consideration race and gender perspectives, types of deaths across custody, immigration detention and mental health care.- Posted
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INQUEST: Skills and support toolkit
Claire Cox posted an article in Prison setting
The INQUEST Skills and Support Toolkit is a resource for families and friends dealing with the aftermath of a death in custody and detention. The skills toolkit has been directed by the thoughts and experiences of INQUEST’s family reference group. The group includes a number of families whose relative has died in police custody or following police contact, prison custody, an immigration removal centre and a psychiatric setting.- Posted
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Content ArticleHealthcare provision in the NHS is very safe but on rare occasions when things go wrong, it is important that those involved are properly informed and supported, compensation is paid fairly, unnecessary costs are contained and that we learn in order to improve. Negligence also comes at significant personal and financial cost for the NHS, not all of which is visible. NHS Resolution has conducted a thematic review into learning from suicide related claims with in the NHS.
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Content ArticleINQUEST's evidence-based report Stolen lives and missed opportunities: the deaths of young adults and children in prison, documents the deaths of 65 young people and children in prison between 2011 and 2014. In the four years covered, INQUEST reveals an average of more than one young death each month.
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