By Miranda Davies, Lucina Rolewicz, Laura Schlepper and Femi Fagunwa

There were, on average, 83,000 people in prison in England and Wales at any one time last year, yet relatively little is known about prisoners’ physical health care needs; how and why they access hospital services; and whether their physical health needs are being adequately met. Drawing on over 110,000 patient hospital records for prisoners at 112 prisons in 2017–18, this study provides the most in-depth look to date at how prisoners’ health needs are being met in hospital. Prisoners use hospital services far less and miss more hospital appointments than the general population • Prisoners had 24% fewer inpatient admissions and outpatient attendances than the equivalent age and sex demographic in the wider population, and 45% fewer attendances at accident and emergency departments. • 40% of outpatient appointments for prisoners were not attended (32,987 appointments) – double the proportion of non-attended appointments in the general population. Our research found that the value of non-attended appointments by prisoners in 2017/18 where no advanced warning was given equated to around £2 million for the NHS. Prisoners have particular health needs related to violence, drug use and self-harm • Injury and poisoning were the most common reason for prisoners being admitted to hospital, accounting for 18% of cases (2,169 admissions) compared to 6% of all admissions in the general population (aged 15+). • Psychoactive substance use was recorded in more than 25% of all inpatient admissions by prisoners in 2017/18. Hospital data reveals potential lapses of care within prisons for certain groups of prisoners • Six prisoners gave birth either in prison or on their way to hospital, representing more than one in 10 of all women who gave birth during their prison stay. • There were 51 hospital admissions by 39 prisoners with diabetes as a result of diabetic ketoacidosis (DKA), an avoidable and potentially life-threatening complication of diabetes caused by lack of insulin. This analysis points to two key areas where more focused policy attention could result in improvements to prisoner health: improving prisoners’ access to hospital care and making better use of hospital data. We therefore make the following recommendations for the five public authorities involved in the National Partnership Agreement for Prison Healthcare – the Ministry of Justice, Her Majesty’s Prison and Probation Service, Public Health England, the Department of Health and Social Care, and NHS England – as well as prisons, health care providers, commissioners, and the research community .

London: Nuffield Trust, 2020. 83p.