Lived experience of avoidable healthcare harm in prisons in England: a qualitative study

Abstract Background People in prison experience high rates of physical and mental health problems and although prison provides opportunities to improve health and wellbeing, they often experience worse health outcomes. This study aimed to explore the perspectives of staff and people in prison, considering their experiences of perceived avoidable healthcare-associated harm and the factors they felt influenced prevention of harm. Methods Qualitative, semi-structured, interviews were conducted with 32 prison staff and commissioners and 23 people in prison across five prisons in England. Interviews were conducted between August 2022 and January 2024 and were analysed thematically. Results Problems with access to timely and appropriate healthcare were commonly raised by participants in relation to issues around medication management and access to healthcare. Prison policies and practice were highlighted by participants as factors that influenced the prevention of harm; interviewees referred to the impact of staffing capacity and the skillsets of staff in terms of trauma and mental health, the impact this had on relationships between staff and people in prison, as well as challenges related to communication and coordination between teams within the prison. Conclusion Experiences of perceived avoidable healthcare-associated harm in prisons centred on medication management issues and difficulties with accessing healthcare. Recruiting and retaining skilled staff and systems lacking communication and coordination were considered important factors influential to harm prevention. A systems-based approach is needed to improve patient safety considering how integration and communication can be improved but this is needed alongside improved health literacy and interventions to increase autonomy that are led by people in prison.