One in 20 patients in community healthcare suffer avoidable harm, but no one knows the rate inside English prisons. This study will find out. The problem is a blind spot. Prisons hold some of the most vulnerable people in society—those with complex physical and mental health needs—yet the evidence base for how often their care goes wrong is essentially empty. Without that data, the NHS cannot design targeted safety improvements for prison healthcare settings. The researchers will review 15,000 patient records across 12 English prisons, with trained nurses and doctors independently assessing a high-risk sample of roughly 2,225 cases. They will classify each incident of avoidable harm by type and severity, and interview prisoners and staff to understand how harm happens in practice. If successful, the findings will give the NHS the first robust estimate of avoidable harm in prison healthcare. That evidence can then drive policy changes, training improvements, and safety protocols tailored to the unique constraints of custodial medicine—ultimately reducing the number of prisoners who are harmed by the care meant to help them.
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Research question What is the frequency and nature of avoidable harm in prison healthcare in England? Background Concerns about the quality and safety of healthcare in English prisons are longstanding. We have just completed the largest ever meta-analysis of avoidable harm across community healthcare settings involving 144 empirical studies. We found that one in 20 patients experience avoidable harm across healthcare but in prisons, evidence is lacking. There is therefore an important need to understand the scale and nature of avoidable harm in prison healthcare in England. Aims and objectives Estimate the incidence of avoidable harm in prison healthcare; Quantify, describe and classify the nature and severity of avoidable harm; Explore key stakeholder perspectives on the nature of avoidable harm in prison healthcare; Advise on interventions and implementation strategies to reduce the incidence of avoidable harm in prisons. Methods We will undertake a large retrospective cross-sectional study involving case note review of patient records in 12 prisons in England (months 10-26): we will identify the total population of prison records on a specific census date in the participating prisons (estimated 15,000); trained nurses will screen all records to identify an enhanced sample of patients at increased risk of avoidable harm (estimated 2,225); experienced and trained prison doctors will independently examine in depth the enhanced sample to identify incidents of avoidable harm and evaluate their nature over a 12 month period. To support and complement this central study, we will pursue: an initial phase of operationalising avoidable harm, training data collectors and piloting research procedures (months 1-9); parallel qualitative interviews with service user/stakeholders to capture their unique and rich perspectives regarding the nature of avoidable harm in prison healthcare (months 10-26); two conferences with service users/stakeholders to assess and translate our findings into research/policy priorities and dissemination materials (months 27-30). Research team We are a multi-disciplinary team of world-leading experts in patient safety and prison healthcare. Shaw has led relevant major projects in prison including a national study of self-inflicted deaths in custody. Several members are leads of the NIHR Greater Manchester Patient Safety Translational Research Centre. We are currently leading the avoidable harm study in primary care, we developed classification systems for the severity of avoidable harm which informs the current proposal, and we have well-established PPI collaborators. Anticipated impact and dissemination Our findings will have an important impact on NHS policy in England. For the first time, the NHS will have robust evidence of the nature and frequency of avoidable harm in prison healthcare and will be able to develop policies and strategic implementation plans to improve patient safety in prison. The research will help practitioners in prison to improve their working practices and minimise the risk of avoidable harm. The findings will help patient groups to advocate for improvements in safety in prison healthcare. We will disseminate via our strong links with the 3rd sector organisations, DHSC, NHS Improvement, NIHR CCF, NHS England, Ministry of Justice and Arms-Length-Bodies.
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