Yohannes Kidane

Birmingham and Solihull [iN/ZE9

Mental Health NHS Foundation Trust

Chair & Chief Executive's Office
Unit 1, B1

50 Summer Hill Road
Ladywood

Birmingham B1 3RB

Tel:
Fax:

RECEIVED |
94 oct 20th

24 October 2014

Mrs Louise Hunt
Senior Coroner
Coroner's Court
50 Newton Street
Birmingham

B4 6NE

Dear Mrs Hunt

| am writing further to your letter of 3 September 2014 addressed jointly to the Trust
and HMP Birmingham pursuant to Regulation 28 of the Coroners (Investigations)
Regulations 2013.

Thank you for informing me of your concerns following the inquest into the death of
Yohannes Kidane. | appreciate receiving your independent views on this matter.

In your letter of 3 September 2014, you raised the following concerns:

1. There are insufficient staff present on the wards at night to provide for all the
healthcare and other needs of the prisoners. At night the healthcare wards
are staffed by 1 nurse per ward and 1 prison officer who is shared between
both wards. Each ward holds a maximum of 15 patients. Evidence confirmed
there were a number of prisoners on Ward 2 who required ACCT observation
plus other prisoners requiring attention. At the time only 1 nurse was present
on Ward 2 as the Prison officer was on Ward 1.

2. The ability to undertake effective ACCT observations is compromised by the
lack of sufficient staff.

3. The fact that staff do not take breaks during the night and the impact that this
would have on them and on the care and wellbeing of prisoners. Staff must
need to take comfort breaks throughout the night which would add an
additional burden on the already stretched staffing levels.

In order to respond to the concerns that you have raised, the Trust has liaised with

Birmingham Community Healthcare Trust (who provide physical healthcare on Ward

1 of the healthcare centre) and G4S who provide healthcare prison officers in the
Chair: Sue Davis, CBE Chief Executive: John Short

PALS Patient Advice and Liaison Service Customer Care Mon-Fri, 8am — 8pm
Tel: 0800 953 0045 Text: 07985 883 509 += Email: pals@bsmhft.nhs.uk | Website: www.bsmhft.nhs.uk

impreving mental health wellbeing

healthcare centre. The Trust has also forwarded a copy of your letter to the
Commissioner responsible for funding healthcare services within the prison.

Overview of the Healthcare Centre and night staffing

As you will be aware, the healthcare centre at HMP Birmingham has two, fifteen
bedded wards. Ward 1 provides physical health needs for prisoners and deals with a
range of clinical activity from self-harm to wounds that prisons receive through
assaults, to more serious physical health problems that require inpatient care. When
prisoners are transferred out to general hospitals, on return to the prison there is a
process in place where prisoners will be placed on Ward 1 for a period of observation
‘prior to returning to their normal location. Ward 1 also has a high dependency cell
“where prisoners with more serious health problems, for example terminal illness, can
be cared for until the point where they may need to be transferred out of the prison
for hospice care. /

Ward 2 provides a service for prisoners with mental health problems and again
ranges from prisoners who can have a period of admission to the ward for
assessment and treatment and be returned back to normal location, through to
prisoners who have severe and enduring mental health problems who will also
require assessment but may need to be transferred out to a medium secure hospital
for treatment pursuant to the Mental Health Act. Both wards have the same
establishment of staff providing clinical care. During the day there are two qualified
nursing staff on each ward and two healthcare prison officers. During the night shift
the establishment of staff reduces down to one nurse on each ward and one
healthcare prison officer who is shared between both wards. Although two prison
officers are allocated to ward 2 often based on the acuity on the ward, there will often
be three healthcare prison officers allocated during the day; however, this is not a
permanent feature as part of the establishment.

In addition to the Healthcare Centre, there is also an emergency response registered
general nurse based in main prison building as well as a night IDTS (Integrated Drug
Treatment Service) nurse. Both of these nurses need to be escorted to and from an
incident by a prison officer.

Duties that night staff undertake for both wards

The duties that night staff undertake on Ward 1 and Ward 2 are split between clinical
and non-clinical roles.

Nursing staff duties — Ward 1

Nursing staff provide clinical input, for example, on Ward 1 nursing staff will
administer medication for the night shift. Nursing staff will be required to complete
PER forms for prisoners who are going out for hospital appointments the following
morning. Nursing staff also order medication, are involved in ACCT observations,
provide clinical updates for all fifteen patients on the ward and respond should an
emergency admission be required.

Nursing staff duties — Ward 2
On Ward 2 the nursing staff will be required to administer evening medication,
complete PER forms for prisoners who are going out on a hospital escort, provide

summaries for. patients on the ward, order medication, respond if an admission is
required during the evening due to an emergency. When prisoners are due to be
transferred out nursing staff will be required to print off System One notes. At night
the Ward 2 nurse can sometimes be called to the CSU to provide an algorithm if a
prisoner has been placed in the CSU during the night. Ward 2 nursing staff also carry
out observations under the ACCT process.

Heaithcare prison officer duties

For both wards, healthcare prison officers can respond to cell bells where a patient
may require assistance; be it hot water for a drink, general enquiries or to report any
medical complaints they may have. Healthcare prison officers can complete the
ACCT observations and support nursing staff with their clinical duties.

Review of staffing levels

As | have mentioned above, the Trust has liaised with Birmingham Community
Healthcare Trust and G4S regarding night staffing levels. In principle, there is
agreement that extra help during the night would assist both nursing staff and the
healthcare prison officer in their duties.

For Ward 1 and 2, should a medical emergency occur during the night there is an
emergency response nurse within the prison who can respond and assist as
required. , ;

Birmingham Community Healthcare Trust have reviewed their skill mix for ward 4
which has resulted in a change to the skill mix whereby the current funding for
unqualified staff will now be converted into qualified nurses. This will allow for an
additional primary care nurse to be present during the night shift.

| understand that recruitment for these extra posts will commence shortly, however
recruitment for prison nurses is historically challenging. It is envisaged that that nurse
would assist the emergency response night nurse as well as providing cover on Ward
1 so that the Ward 1 can have their break. An additional nurse would also mean that
the healthcare prison officer on duty could move upstairs to assist the Ward 2 nurse if
they are busy.

Regarding Ward 2, as mentioned above, an IDTS nurse is also present within the
main prison building during the night. The Trust anticipates that that nurse could
undertake part of their administrative duties on Ward 2 in order that the Ward 2 is
able to take their break and vice versa.

Where the IDTS nurse is occupied, it is also anticipated that a member of primary
care staff could assist on Ward 2 whilst the Ward 2 nurse takes their break. While
this would mean that an RGN would be covering the break of an RMN, in reality the
RMN would be able to return to an immediate mental health emergency as they
would still be taking their break within the healthcare centre. In this way, we consider
that we are able to allay your concern regarding staff not being able to take their
breaks.

| am disappointed to report that we asked our Commissioner to attend two meetings
regarding funding of an extra staff member for Ward 2. They declined to attend

these meetings on the basis that the “PFD” report was not directly addressed to them
and therefore did not require them to respond to it. We have been unable to make
progress on this point within the time allowed by the Regulations to provide a
response, We will continue to pursue this matter with them.

We have met with G4S and representatives from the National Offenders
Management Service as the evidence at the inquest identified that a significant part
of the duties during the night are non-clinical, for example responding to cell bells,
general enquiries and undertaking ACCT observations. | understand that they will be
providing a separate response to you.

| would like to thank you for raising your concerns about the need for an extra staff
member in the healthcare centre at night. | hope that this response demonstrates to
you that | have taken those concerns seriously and have attempted to solve them as
much as | can within the means available to this organisation. | would invite you to
consider specifically addressing a letter to our Commissioners for healthcare
provision within the prison to facilitate the process of future discussions.

Yours sincerely

John Short
Chief Executive

Ministry of Equality, Rights and Decency Group
National Offender Management Service

J U ST | C E “4th Floor, 70 Petty France,

National Offender Lontion SW1H 9EX
Management Service t: 0300 049 7051

Mrs Louise: Hunt

Senior. Coroner

Birmingham and Solihull Area
50 Newton Street
Birmingham

B4 6NE

4 November 2014

Dear Mrs Hunt

Thank you for your Regulation 28 report dated 3 September 2014 addressed to Michael
Spurr, Chief Executive of the National.Offender Management Service (NOMS), concerning
the recent inquest into the death of Yohannes Kidane lon the 19 December 2013 at HMP
Birmingham. . Your letter has been passed: to the Equ lity, Rights and Decency Group in
NOMS as we have policy responsibility for sulcide. prevention and self harm management
and.for sharing learning from deaths in custody, | haye consulted with the.Controller at
HMP Birmingham in formulating this response.

You, have raised three: matters of concern. | am awate that the first of which concerns
matters for Birmingham and Solihull Mental Health NHS Foundation Trust who will be
responding separately. | will therefore address the second and third in turn.

The night. staffing level for HMP. Birmingham was reviewed when responsibility for its
Operation was transferred to G4S, and NOMS is satisfled that it is acceptable. G4S has
chosen to deploy a Prison Custody Officer {PCO) to patro] the healthcare centre at night, and
this is beyond the public sector benchmark which would require the use. an Operational
Support Grade (OSG) for this purpose. This allows extr flexibility, as a PCO Is trained and
authorised to perform additional duties, such as to unlock cell doors if required,

Each evening the PCO on night duty recelves a handovet from the PCO who has completed
the day shift, and decides on the basis of the operatiohial needs identified where best. to
locate themselves for that shift. At night the PCO and twb nurses have access to both wards.
In-an emergency they use the alarm to summon assistande and the Night Orderly Officer and
incident response PCOs-from elsewhere in the prison respond and attend.

Staff breaks at night

The Night Orderly Officer arranges cover for breaks with the staff on duty at the beginning of
each night shift. if there is.a particularly high number of prisoners subject to Assessment,
Care in. Custody and Teamwork (ACCT) process in one location, the Night Orderly Officer may
choose.to locate an additional member of staff in that afea. This is not common practice as
night staffing levels are assessed as sufficient, but it is-a option that can be used. If there

are prisoners located in the Healthchre Centre who are the subject of continuous supervision
additional staff will be provided. :

| hope this provides you with assurance that the matters of concern you have identified have
been fully addressed.

Yours sincerely