Safety incidents in prison healthcare: Lessons from critical illness

Today, we’re speaking to Dr Joy McFadzean,a GP in Swansea and Clinical Lecturer of Patient Safety based at Cardiff University. We’re here to talk about the paper she’s recently published here in the BJGP alongside her colleagues titled, ‘Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England’.

Title of paper: Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England

Available at: https://doi.org/10.3399/BJGP.2025.0239

Using a mixed-methods descriptive and framework analysis, this paper provides new insights into the complexity of care delivery in prisons. Results resonate with and strengthen the recommendations from recent investigations into prison healthcare by further developing an understanding of the complex intersecting factors contributing to safety incidents and quality issues in care delivery. The fundamental importance of good quality and adequately resourced primary care delivery in prisons has been highlighted. It also identifies system-wide interventions that are needed to improve care delivery, and which are likely to interest policy-makers and scrutiny bodies, commissioners and teams working in prisons to inform developments in strategic health needs assessments, workforce profiling, and training requirements for healthcare and prison teams.

Funding

This study/project is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (PR-R20-0318-21001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.560 - 00:01:10.200

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Welcome back to the first season of the BJGP podcast here in 2026.

And we're starting off this season of the podcast with a chat with Dr. Joy McFadyn. Joy is a GP based in Swansea and clinical lecturer of Patient safety based at Cardiff University.

We're here to talk about the paper she's recently published here in the BJGP alongside her colleagues. The paper is titled Critical Illness in Prisons A Multi Method Analysis of Reported Healthcare Safety Incidents in England.

So, hi, Joy, it's really lovely to meet you and to talk about this research, but yeah, just taking a step back, I think it's fair to say that the prison population is an underserved and probably fairly under researched population as well.

But you point out here in the paper that it's not only this, but that the prison population is actually at a much higher risk of early mortality as well. So can you talk us through this at all?

Speaker B

00:01:10.680 - 00:02:31.010

Yeah, that's a really good point. So we know that people who reside in prison, known as prisoners, will have very high rates of physical and mental health needs.

And as you say, there are concerns that they have rates of premature mortality, so they may die up to 20 years earlier than the rest of the population. But they are a population which isn't necessarily the area of focus.

So even though we know the importance of supporting their healthcare as a public health concern, they are often underserved, they're quite vulnerable, and yet there hasn't been enough research to support them to have what we call equivalent health outcomes. So there are lots of definitions of what is considered to be equivalence of care for people in prisons.

So the Royal College of General Practitioners Secure Environments Group, they have defined what equivalence of care is for people in prisons, thinking that they should have the same quality of care, the same level of staffing, the same resources as anyone who is residing in the community in order to get the same health outcome. And currently that is not being realised.

Speaker A

00:02:31.330 - 00:02:38.210

And just as a background to all this work, how many of these early deaths do you think are preventable?

Speaker B

00:02:38.930 - 00:03:39.270

So we carried out a study which was called the Avoidable Harm in Prison Study. So it was focusing very much on healthcare events where people were harmed or could have been harmed whilst they reside in prisons.

So our focus is very much on these patient safety incidents, reports and incidents themselves, and ultimately the findings of the other space of the study. We haven't released yet they're still embargoed.

But we were seeing within our sample of patient safety incident reports, events where prisoners were undertaking significant harm. So within our paper, we haven't seen any evidence of the deaths which could be considered to be avoidable.

But our focus was very much on events where without urgent treatment, there was a high risk of death. And we considered many of those events to be avoidable.

Speaker A

00:03:39.590 - 00:04:10.690

And I guess all this is tied into what you're aiming to do here in this research, which was to look at and characterize patient safety incidents in the prison population and find opportunities to improve care.

So you used a really detailed approach here and looked at patient safety i