by Maria Panagioti, Senior Research Fellow and Jenny Shaw, Clinical Professor

Preventing patient harm is a public health priority. Over 100 studies have been carried out across different countries in the past 20 years to estimate how often patient harm occurs, to understand its main causes, and to find ways of preventing harm from occurring or minimising its negative effects.
This important patient safety research has focused on hospitals and in primary care. We now know that around six percent of people from the general population experience an avoidable incident of patient harm whilst being treated in healthcare services (e.g. medication errors, misdiagnosis, wrong-site surgery etc).
We know virtually nothing about how common patient harm is in prison, nor what the main causes are, or how serious and lasting are the health consequences for affected people.
Currently, there are over 84 thousand people in prisons in England. People in prison often have complex needs with physical and mental health problems and drug or alcohol dependence being more common than amongst people in the general population. These health problems are in addition to other social issues such as poverty, unemployment, poor education/health literacy and homelessness. While in prison, people are away from their families and carers and at the same time they have few opportunities for self-care or to proactively prevent harm.
Prison is also a very difficult place to provide healthcare services. GPs are the main care providers for people in prison. Other common health services provided include mental health care, which is provided by psychiatrists and psychiatric nurses, substance use services, dentistry, and obstetric/maternity care for women. Patient harm can occur in any of these healthcare interactions but for people in prison, the recording of care, and the care itself, is not always joined-up.
The high percentage of turnover in prisons makes things worse. Turnover is particularly high among un-sentenced people. Transition phases such as the early phase of imprisonment or transfer to other prisons or back into the community are times when continuity of care can break down, with a likely increased risk of patient harm.
An award of £850K has recently been awarded by the National Institute for Health Research Policy Research Programme (NIHR PRP) to investigate the frequency and nature of avoidable patient harm in prison healthcare in England. This new and exciting research programme is led by Professor Jenny Shaw in partnership with several members of the NIHR Greater Manchester Patient Safety Translational Research Centre, as well as colleagues from the University of Nottingham and the University of Cardiff.
This research will generate the first estimates worldwide of how often avoidable patient harm happens, and the types of avoidable harm that take place in prison healthcare. As part of the work plan, a large study of 15 thousand patient records will take place across 12 prisons in England. Interviews are also planned with service users and other stakeholders.
The research will commence in April 2019, with results expected in late 2021 . For the first time, the NHS will have solid evidence of the nature and frequency of avoidable patient harm in prison healthcare and will be able to develop policies and plans to improve patient safety in prisons. This research will help practitioners in prisons to improve their working practices and patient groups to work towards making improvements to patient safety in prison healthcare.
Tags: healthcare, NIHR PRP, patient harm, Patient Safety, prisons, research