Critical illness in prisons: a multi-methods analysis of reported healthcare safety incidents in England

Isobel J McFadzean; Lauren Donovan; Thomas Hewson; Jake Hard; Jenny Shaw; Adrian Edwards; Andrew Carson-Stevens

doi:10.3399/BJGP.2025.0239

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Equitable palliative care in prisons: integrating advanced care planning
Jack W. Tallentire and Ryan E. Tallentire

Published on: 14 February 2026

Published on: (14 February 2026)
Page navigation anchor for Equitable palliative care in prisons: integrating advanced care planning
Equitable palliative care in prisons: integrating advanced care planning
Jack W. Tallentire, Medical Student (5th year), Lancaster University Medical School
Other Contributors:
Ryan E. Tallentire, Advanced Clinical Practitioner, Primary Care (prison healthcare)
We thank the authors for their robust and impactful study and appreciate the opportunity to respond.

The authors cite an existing definition of ‘critical illness’ requiring reversibility, distinguishing from illness-related deterioration at the end of life. Whilst analytically useful, this distinction may be less clear in ageing prison populations – where frailty and advanced multimorbidity coexist with episodes of acute deterioration.

Notably, 16% of reported incidents resulted in avoidable hospital admissions.¹ In community settings, advanced care planning (ACP) and early palliative involvement reduce admissions.² More consistent integration of these approaches within custodial healthcare could support clearer treatment-escalation decisions and reduce unnecessary transfers.

Barriers to palliative care include limited hospice access (often superseded by security constraints) and logistical challenges with opioid prescribing. Short staffing, identified in 15% of incidents, further restrict timely symptom control and anticipatory prescribing, particularly out of hours. ACP documentation is often absent in prisoners approaching end of life, contributing to patient uncertainty and inappropriate escalation.³

The authors rightly recommend strengthened emergency response and clearer access protocols. We suggest that routine ACP, including documented ceilings of care and anticipatory prescribing pa...
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We thank the authors for their robust and impactful study and appreciate the opportunity to respond.

The authors cite an existing definition of ‘critical illness’ requiring reversibility, distinguishing from illness-related deterioration at the end of life. Whilst analytically useful, this distinction may be less clear in ageing prison populations – where frailty and advanced multimorbidity coexist with episodes of acute deterioration.

Notably, 16% of reported incidents resulted in avoidable hospital admissions.¹ In community settings, advanced care planning (ACP) and early palliative involvement reduce admissions.² More consistent integration of these approaches within custodial healthcare could support clearer treatment-escalation decisions and reduce unnecessary transfers.

Barriers to palliative care include limited hospice access (often superseded by security constraints) and logistical challenges with opioid prescribing. Short staffing, identified in 15% of incidents, further restrict timely symptom control and anticipatory prescribing, particularly out of hours. ACP documentation is often absent in prisoners approaching end of life, contributing to patient uncertainty and inappropriate escalation.³

The authors rightly recommend strengthened emergency response and clearer access protocols. We suggest that routine ACP, including documented ceilings of care and anticipatory prescribing pathways, should also form part of efforts to deliver equitable prison healthcare – reducing avoidable admissions labelled as ‘critical illness’ and mitigating uncertainty for primary care teams.

References

1. McFadzean IJ, Donovan L, Hewson T, Hard J, Shaw J, Edwards A, Carson-Stevens A. Critical illness in prisons: a multi-methods analysis of reported healthcare safety incidents in England. Br J Gen Pract 2026 Jan 12:BJGP.2025.0239. doi: 10.3399/BJGP.2025.0239
2. Brinkman-Stoppelenburg A, Rietjens JA, van der Heide A. The effects of advance care planning on end-of-life care: a systematic review. Palliat Med 2014 Sep;28(8):1000-1025. doi: 10.1177/0269216314526272
3. Le Gautier R, Panozzo S, Bryan T, Lethborg C, Philip J. A thematic analysis of hospital medical records of patients with advanced illness experiencing incarceration in the last 3 months of life. Palliat Med 2023 37(4):638-645. doi: 10.1177/02692163221124033.
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Competing Interests: None declared.

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