Death in Prison Custody - Clinical Review Series

This article is part 3 in a series of pieces on clinical reviews in death in prison custody inquests. Part 2 is here. 

Clinical Reviewers are asked to conclude whether the care the person received was equivalent to what they would receive in the wider community. It is important to note that equivalence does not mean exactly the same. Given the fact that healthcare is being provided within a prison setting means sometimes it simply cannot be the same and compared, and the regime constraints and system differences in providing healthcare within a prison setting need to be taken into careful consideration.

The National Prison Healthcare Board helpfully described equivalence as ensuring that those in prison are afforded provision of and access to appropriate services and treatment (based on assessed population need and in line with current national or evidence-based guidelines) and this is considered to be at least consistent in terms of range and quality with that available in the wider community. The intention of delivering equivalent healthcare in a prison setting is to achieve equitable health outcomes and to reduce health inequalities for those in a prison environment.

There are times when a Clinical Reviewer identifies that the healthcare the person received was actually better and more equivalent than what is provided in a community setting, and it is the Clinical Reviewer’s responsibility to set that out as good practice in the clinical review report.

Equivalence is typically concluded as not equivalent, partially equivalent, equivalent, and on occasion a conclusion of equivalence just cannot be drawn due to the aforementioned system differences already discussed. 

The conclusion of equivalence is understandably important to healthcare providers, but when a conclusion of non-equivalence is given this should not be taken as a reflection of the whole of healthcare delivery in its entirety where it is inevitable there will be some really good practice identified too.

Quite often the conclusion of non-equivalence is given due to a few areas of healthcare delivery (for example, a delayed resuscitation attempt) that when balanced with the healthcare provided in its entirety tips it towards non-equivalence. The conclusion should not be read by itself as a conclusion of the overall healthcare provided, and should be balanced with where care was equivalent and where good practice is identified. It is the role of the Clinical Reviewer to explain this within the report.  

Hill Dickinson is one of the leading lawyers providing legal advice and support to national and international healthcare organisations. We have a wealth of knowledge and experience in handling complex cases involving NHS and Public Health authorities and the health and justice system. 

Our legal expertise spans across multiple NHS and public health sectors from mental health and social care, mental capacity, clinical negligence to inquiries and investigations. 

This article was co-authored by Lorna Warriner, RMN, Clinical Reviewer, on behalf of NHSE and HIW. 

This article is part 3 in a series of pieces on clinical reviews in death in prison custody inquests. Part 4 is here.