Why are so many people dying in our prisons?

Many natural deaths in prison should be avoided, say independent government advisory body and world’s largest nursing union.

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Avoidable prison deaths

The Royal College of Nursing (RCN) and the Independent Advisory Panel on Deaths in Custody (IAP) have urged the Government to act quickly to reduce the number of preventable natural deaths among prisoners.

Figures from a new report by the RCN and the IAP, ‘Avoidable natural deaths in prison custody: putting things right’, published today (30 September 2020), shows that the number of natural deaths in prison custody increased from 103 in the year to June 2009 to 179 in the year to June 2020, with a high of 190 in the year to June 2016. The average age for someone dying of natural causes in prisons is 56, compared with 81 in the general population. At the start of the pandemic up to 1,000 people in custody were identified as medically vulnerable and thus eligible to be considered for temporary compassionate release. To date, fewer than 60 have been safely released under this scheme.

A rise in prison deaths

The number of natural (i.e. not self-inflicted or homicide) deaths in prison has risen rapidly. Deaths in 2020 are set to be the highest yet, partly due to the challenges presented by the COVID-19 pandemic. The report asks: “Are any of these deaths, classified as natural, avoidable? And, if so, what can be done to prevent or reduce natural deaths in custody?”

‘Natural cause deaths’ are defined by HMPPS as including “any death of a person as a result of a naturally occurring disease process”. Even though the death may be classed as naturally occurring, investigations by the Prisons and Probation Ombudsman (PPO) and Coroners have revealed that, in some cases, these deaths could have been prevented. The charity INQUEST has called these types of deaths “‘far from natural” arguing that they are often premature and avoidable deaths as they stem from a lapse in care. The PPO also categorises ‘other non-natural’ deaths, in which illicit drugs were thought to be a contributory factor. By 2019 the total ‘natural and other natural’ deaths per year increased to 231, more than double the 2009 figure. According to the PPO, the leading cause of natural death in prison is disease of the circulatory system (43%) followed by neoplasms (cancer) (32%).


Although the increasing age of the prison population is a key factor in the rising number of deaths, it is far from being the sole cause. PPO investigations show that 39% of natural deaths in prison were of people aged between 35 and 54. The average age of someone dying in custody is just 56 years-old, a significant contrast to almost 81 in the general population.

A key issue concerns prisoner healthcare, with the quality of care received closely dependent on age and sentence length. The PPO have found that care is particularly poor for the youngest age groups (15-34 years), with just over half receiving equivalent care compared to that received in the community. It found that 71% of people with physical health conditions who had been in custody for ten years or more had care plans in place, compared with 58% of people who had been in custody for less than twelve months. Overall, only 36% of prisoners received a proper and timely investigation of their symptoms.


Recommendations from the report include:

  • Improving the transfer of information when someone enters and leaves custody to ensure their care continues as necessary
  • Making sure prisoners can attend all medical appointments in the community by ensuring an escort is available
  • Providing specialist services for prisoners for long-term conditions such as cancer or dementia which will need the appropriate workforce including an increased supply of registered nurses
  • Reviewing and overhauling the system for compassionate release
  • Developing a joint health and justice older persons strategy for the criminal justice system. This should be integrated with local social care plans and provision.


Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here.

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