Frequent Accident and Emergency Hospital Attendance by People in Prison in England—Describing High-Intensity Service Use in a Prison Context

There is an association between frequent Accident and Emergency (A&E) hospital attendances—high-intensity service use—and contact with the justice system. This paper addresses the lack of evidence regarding the scale and nature of high-intensity service use in a prison context, including while people are in prison and before and after prison. Using 2023/24 Emergency Care Data, we looked at A&E attendances for 16,384 people in prison in England. While in prison, 698 people (4.3%) attended A&E five or more times over a year, meeting the criteria for high-intensity service use, with attendances commonly due to chest pain, seizure or self-injurious behaviour. A total of 5227 people (32%) attended A&E in and out of prison in the same year, with nearly 1 in 4 (n = 1282) attending five or more times outside of prison. There is a need for mechanisms to enable identification and support for high-intensity service use in a prison context. This may include facilitating data linkage, developing prison-specific services and/or enabling routes of access for community services to operate within prisons. Effective management of high-intensity use in a prison context would have the dual benefits of reducing inappropriate use of urgent care services both in and out of prison.