{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T06:48:36Z","timestamp":1794293316553,"version":"4.9.0"},"reference-count":39,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research (NIHR) Policy Research Programme","award":["PR-R20-0318-21001"],"award-info":[{"award-number":["PR-R20-0318-21001"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2026,3,9]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Objective<\/jats:title>\n To estimate the incidence of avoidable healthcare-associated harm for prisoners in England.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A retrospective cross-sectional case note review of prisoner healthcare records.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n 18 prisons in England were purposively sampled for maximum variation of characteristics based on prison category (open, local, training, high security and female), type (publicly and privately run) and population size.<\/jats:p>\n <\/jats:sec>\n \n Population<\/jats:title>\n After screening 15\u2009027 prisoner records, two cohorts were selected: a sample of 6294 \u2018enhanced risk\u2019 prisoners and a random sample of 853 prisoners not included in the enhanced risk sample (n=7147).<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n The primary outcome was the incidence of patient harm per 100\u2009000 patient-years, judged at least probably avoidable. The secondary outcome was the incidence of patient harm judged at least possibly avoidable. Cases of avoidable harm were characterised in terms of patient impact, known as patient outcome(s), and the severity of harm experienced.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Within 18 prisons, 247 cases of avoidable harm were experienced by 244 prisoners and were identified from 7147 patient records. The incidence of avoidable harm was 2241.4 (95% CI 1970.5 to 2539.0) per 100\u2009000 patient-years, and this rate could be as high as 3412.0 (95% CI 3075.8 to 3774.9) based on the records screened during this study. Most patient outcomes involved prisoners experiencing discomfort and pain (99\/247, 40.1%) and delays receiving appropriate healthcare management or assessment (91\/247, 36.8%). The identified cases of avoidable healthcare-associated harm for prisoners resulted mainly in moderate harm severity (157\/247 cases, 63.6%), followed by severe harm (27, 10.9%) and death (27, 10.9%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Compared with community settings, people in prison experience a 41\u201367 times greater risk of avoidable significant healthcare-associated harm. This stark disparity underscores the urgent need for government and policy action. Delivering safe, equitable healthcare in secure environments remains a major challenge that demands focused attention.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjqs-2025-019935","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:12Z","timestamp":1778198412000},"page":"602-613","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["The incidence of avoidable healthcare-associated harm in prisons in England: a retrospective case note review"],"prefix":"10.1136","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-2681","authenticated-orcid":false,"given":"Isobel Joy","family":"McFadzean","sequence":"first","affiliation":[{"name":"Division of Population Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saied","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Division of Psychology and Mental Health, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9876-250X","authenticated-orcid":false,"given":"Verity","family":"Wainwright","sequence":"additional","affiliation":[{"name":"Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Panagioti","sequence":"additional","affiliation":[{"name":"Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK"},{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Jordan","sequence":"additional","affiliation":[{"name":"School of Sociology and Social Policy, The University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Flynn","sequence":"additional","affiliation":[{"name":"Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-8154","authenticated-orcid":false,"given":"Richard N","family":"Keers","sequence":"additional","affiliation":[{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"},{"name":"Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Millar","sequence":"additional","affiliation":[{"name":"Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren M","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"},{"name":"School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Edwards","sequence":"additional","affiliation":[{"name":"PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J","family":"Avery","sequence":"additional","affiliation":[{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"},{"name":"Centre for Academic Primary Care, The University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Shaw","sequence":"additional","affiliation":[{"name":"Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Carson-Stevens","sequence":"additional","affiliation":[{"name":"PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"2026081902150709000_35.9.602.1","unstructured":"World Health Organization . 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