Learning from the Past to Prepare for the Future: A Thematic Review of Recommendations Following Natural-Cause Deaths in Welsh Prisons (2013–2022)

Deaths from natural causes (e.g., cardiovascular disease, respiratory illness, and cancers) are increasing in prisons in England and Wales. Many are believed to be avoidable and related to prisoner premature mortality. The circumstances around each death in custody are investigated by the Prisons and Probation Ombudsman (PPO), who provides recommendations for improvement. Learning from these recommendations can inform future healthcare to prevent avoidable deaths and improve the management of chronic diseases related to natural-cause deaths. Fatal Incident reports were accessed from the PPO website for deaths from natural causes in Welsh prisons between January 2013 and December 2022. Inductive content analysis was used to organise the recommendations into themes. Descriptive analyses subsequently profiled the characteristics of the deaths. Themes were analysed to inform the design of future prison healthcare. A total of 165 PPO recommendations were analysed from 51 reports. Six themes were identified: care planning and provision, transportation, emergency response, administrative, fundamental safety, and system level. Learning from natural-cause deaths can inform suggestions for future models of prison healthcare delivery. Learning emphasises the need for improvements in electronic sharing of clinical records, strengthening the links between prison health services and governance processes of national health provision, and sharing learning at a system level to drive system improvements.