Prevention of Future Deaths reports · 2017

John Williams

Regulation 28 report to prevent future deaths, reference 2017-0094, written 28 Mar 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report28 Mar 2017
Reference2017-0094
DeceasedJohn Williams
CoronerMary Hassell
Coroner areaInner North London
CategoryState Custody related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

Regulation 28: Prevention of Future Deaths report

John WILLIAMS (died 26.06.16)

THIS REPORT IS BEING SENT TO:

1. Mr Mike Parish
Chief Executive
Care UK
29 Great Guildford Street
London SE1 0ES

(see points 5.1, 5.2, 5.3 and 5.5)

2.
Governor
HMP Pentonville
Caledonian Road
London N7 8TT

(see points 5.4 and 5.6)

. Professor Sir Bruce Keogh
National Medical Director
NHS England
PO Box 16738
Redditch B97 9PT

(see points 5.3 and 5.5)

. Mr Michael Spurr
Chief Executive
National Offender Management Service
Clive House :
70 Petty France
London SW1H 9EX

(see points 5.3 and 5.7)

CORONER

lam: Coroner ME Hassell
Senior Coroner
Inner North London
St Pancras Coroner’s Court
Camley Street
London N1C 4PP

CORONER’S LEGAL POWERS

| make this report under the Coroners and Justice Act 2009,
paragraph 7, Schedule 5, and

The Coroners (Investigations) Regulations 2013,
regulations 28 and 29.

INVESTIGATION and INQUEST

On 1 July 2016, one of my assistant coroners, Richard lan Brittain,
commenced an investigation into the death of John Williams aged 54
years. The investigation concluded at the end of the inquest on 24 March
2017. The jury made a narrative determination, which | attach.
CIRCUMSTANCES OF THE DEATH

Mr Williams hanged himself whilst a prisoner at HM Prison Pentonville,

however, he had told members of staff that he would do so if his
perceived needs were not met, rather than with the aim of taking his life.

CORONER’S CONCERNS

During the course of the inquest, the evidence revealed matters giving
rise to concern. In my opinion, there is a risk that future deaths will occur
unless action is taken. In the circumstances, it is my statutory duty to
report to you.

The MATTERS OF CONCERN are as follows.

1. The first reception nurse who saw Mr Williams when he entered HMP
Pentonville gave evidence that he had no thoughts of self harm or
suicide, but she recorded that he had.

It appears she may benefit from additional training and/or supervision.

. There was no second reception screen conducted. If Mr Williams was
not brought to healthcare staff for his second reception screen then
healthcare staff needed to follow this up.

. The first reception nurse did not make the referral to the mental health
team (though this took place in any event because the court diversion
team had already made the referral).

| heard that it is now done automatically when that box is ticked on the
system, and | wonder whether other prison healthcare providers
would benefit from such a system.

. Mr Williams said to several members of staff that he would self harm
or hang himself if he wanted something done and it was not
happening quickly enough (rather than because he actually wanted to
die.)

This was recorded on his assessment, care in custody, teamwork
(ACCT) document. Some prison officers did not seem familiar with
the very important contents of the ACCT, not even the inside cover.

The senior officer in charge on the weekend of Mr Williams’ death did
not look at the inside cover or record any events within. Again, It
appears there may be benefit in additional training and/or supervision.

. Mr Williams also told the member of Phoenix Futures who saw him
that he felt cannabis gave him what the mental health team did not.
However, the staff member felt he did not have the training or
experience to explore either of these issues in greater depth.

It may be that Phoenix Futures staff would benefit from additional
training, perhaps alongside prison healthcare staff.

. The issue of the difference between a code blue and a code red is
one about which | have written before.

One senior prison officer said in evidence that if she did not know the
difference between a code blue and a code red, then there would be
some serious concerns. She did not.

She had been given a small card describing code blue and code red
(a card which another officer kept about her person and even
produced from the witness box), and she still retained that card.
However, she had never considered it worthwhile to read.

She said in court that she still thought it appropriate that she had
never read the card.

. The prison officers did not have even the most basic first aid and
cardiopulmonary resuscitation (CPR) training. | am aware from other
inquests that this is not provided at a national level.
| have written about this before. It seems a significant gap, even
allowing for the fact that there are always two trained nurses on site.

ACTION SHOULD BE TAKEN

In my opinion, action should be taken to prevent future deaths and |
believe that you have the power to take such action.

7 | YOUR RESPONSE
You are under a duty to respond to this report within 56 days of the date
of this report, namely by 29 May 2017. I, the coroner, may extend the
period.
Your response must contain details of action taken or proposed to be
taken, setting out the timetable for action. Otherwise you must explain
why no action is proposed.

COPIES and PUBLICATION

| have sent a copy of my report to the following.

e HHVJ Mark Lucraft QC, the Chief Coroner of England & Wales

e HM Inspectorate of Prisons

| am also under a duty to send the Chief Coroner a copy of your
response.

The Chief Coroner may publish either or both in a complete or redacted
or summary form. He may send a copy of this report to any person who
he believes may find it useful or of interest. You may make
representations to me, the Senior Coroner, at the time of your response,
about the release or the publication of your response by the Chief
Coroner.

SIGNED BY SENIOR CORONER

WWE to

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Care UK (PDF)
HMP Pentonville 
Healthcare Department 
Caledonian Road 
London 
N7 8TT 

Dear Madam, 

Regulation 28: Prevention of Future Deaths report 
The inquest  touching the death of John Williams Deceased 
HMP Pentonville 
Date of death: 26

June 2016 

th 

Thank you  fo r your  Regulation  28  Prevention  of Future  Deaths  Report  dated  28  March 2017  issued  to 
Care  UK following  t he  inquest into the death of M r John Williams Deceased. 

Care  UK  is  the  provider of primary  healthcare  services  at  HMP  Pentonville. I  have addressed  the  issues 
you have directed to Care UK only which you have highlighted as  paragraphs 5.1,  5.2,  5.3  and  5.5 

The  matters  of  concern  to  you  in  so  far  as  they  relate  to  Care  UK  is  highlighted  in  bold  with  the 
response set out below each  concern. 

5.1. The first reception nurse who saw Mr Williams when he entered HMP Pentonville gave 
evidence that he had no thoughts of self-harm or suicide but she recorded that he had. 

It appears she may benefit from additional training and/or supervision 

The nurse  who completed the First Reception Health Screen  on 30 May 2016 recorded  in  the free text 
section in Syst mone that Mr Wi lliams had  made a statement  of int ent to self-harm and that was a 
reason  as to why  Mr Williams was placed on  an  open ACCT. This was clearly recorded by the nurse at 
the time. 

The nurse has  been  reminded  of t he process of giving evidence at an  inquest and to listen carefully to 
th e question that  is  being and to take t ime in  considering  her answer.  Enquiries  have been made by the 
Interim Head of Healthca re  who is satisfied that the nurse in giving evidence at the inquest was 
confused and  made a mistake in response to your question. Further reassurance, support and guidance 
has already been  given to the nurse involved. 

5.2. There was no second reception screen conducted. If Mr Williams was  not brought to 

healthcare staff for his second reception screen then healthcare staff need to follow this up. 

On  this  occasion  no  Second  Reception/Wellman  assessment  was  completed.  An  appointment  was 

arranged  for 1  June  2016  but was  not completed  as  Mr Williams  did  not attend  his  appointment. This 

was  marked  as  "DNA" in  Mr Wil liam's Systm0ne record. 

As  you  heard  in  evidence,  it is  the  case  now that a  register  is  kept  of any  Second  Reception/Wellman 

assessments  that are  not completed . It  is  then  th e  responsibility of t he  Lead  Nu rse  to arrange  for the 

 
 
 
 patient t o  be contacted  and an  appointment for the  assessment to be  completed. In the event that the 

patient declines  the  Second  Reception/Wellman  assessment  then  t hey  are  asked  to  sign  a  disclaimer 

which  is  then  scanned  into  Systm0ne.  I  have  set out  below  a copy  of the  register for  December 2016 

and January 2017 as  follows: 

Snapshot for December 2016 

388  receptions for t he month (100%) 

18  patients in  prison less than 72 hours (5%) 
100 patients refused (26%) disclaimer signed 
12 patients transferred from a Care  UK prison with a Valid Wellman Assessment (3 %) 
88  missed assessments due to location other than  Fi rst Night Centre (23%) 
0 patients outstanding for assessment (0%) 
170 completed assessments (44%) 

Snapshot for January 2017 

476 receptions for the month (100%) 

23 patients in  prison less than 72 hours (5%) 
58 refused  (12%)  disclaimer signed 
7 patients transferred  from a Care UK  prison with a Va lid Wellman Assessment (2%) 
128 missed assessments due to location other t han  First Night Centre (27%) 
23 patients outstand ing for assessment (5%) 
231 completed  assessments (49%) 

5.3. This first reception  nurse did not  make the referral to t he mental  health team (although this 
took place  in any event because the court diversion team had already made the referral). 

I heard t hat it is  now done automatically when that box is ticked on the system, and I  wonder 
whether other prison healthcare providers would benefit from such a system 

As you heard in evidence,  we have  investigated t he process with reg ard to t he templates and referrals 
to mental health as  part of the First Reception  Health Screen and whether it would be possible to not 
being able to pass onto a second  page until the task  has been  completed. 

The investigation has  been completed and t he template has been changed at HMP Pentonville with 
immediate effecr. It is  now a mandatory box to say  if a Mental  Health referral is required  and that one 
has  been  made. The referral  is then made electronically directly to the mental health in-reach team. 
As of Friday 24 March  2017, this revised tem plate is  being followed at HMP Pentonville. 

Care UK are looking into implementation of this template at  all the prisons where they undertake the 
First Reception Health Screen. In addition we will raise the revision with NHS  England and ask them to 
inform other healthcare provi ders  of the revision we have made. 

5.5. Mr Williams also told the member of Phoenix Futures who saw him that he felt cannabis gave 
him what  the mental health team did not. However, t he staff member felt he did not have the 
training or experience to explore either of these issues in greater depth. 

It may be that Phoenix Futures staff would benefit from additional training, perhaps 
alongside prison healt hcare staff. 

Page 2 of 3 

 Again as you  heard in evidence, this service is commissioned  by NHS England. As  you were also advised 
th is service has also gone out to tender and we await details as to who has  been awarded t he 
procurement. It is our understanding that NHS  England  are  making t he service specification very much a 
j oint, integrated and collaborative working model. 

It was  confirmed to you t hat at this stage there are daily handovers where we capture staff attendance 
and prisoners and the attendance of Phoenix Futures is  requested at handover. However we are unable 
to comp el their attendance. 

We trust that the above response  provides the information that you require but please do not hesitate 
to contact  us if Care UK can be  of any further assistance. 

Yours sincerely. 

Head of Healthcare 
HMP Pentonville 

Page 3 of 3

Related reports

Other reports by Mary Hassell

See all →

More reports categorised “State Custody related deaths”

See all →

Track State Custody related deaths

See every Prevention of Future Deaths report matching State Custody related deaths, and how often a new one appears.

What would an alert for this have sent me? Search the full text

Free to try — the preview shows the real matches and how many arrived in the last 12 months. Your first email alert is free.

These reports are published by the Chief Coroner's office at judiciary.uk and are © Crown copyright. The text here is reproduced from the published PDF so it can be searched. If something on this page is wrong, or you are a person named in it and want it reviewed, email drcjar@gmail.com and we will act promptly.