Prevention of Future Deaths reports · 2019

William Vickers

Regulation 28 report to prevent future deaths, reference 2019-0255, written 26 Jul 2019. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report26 Jul 2019
Reference2019-0255
DeceasedWilliam Vickers
CoronerTom Osborne
Coroner areaMilton Keynes
CategoryEmergency services related deaths (2019 onwards) · State Custody related deaths
Sourcejudiciary.uk record · original PDF
Responses published2

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

PRIVATE AND CONFIDENTIAL 

Mr Tom Osborne 
Senior Coroner for Milton Keynes, 
Civic Offices 
1 Saxon Gate East 
Central Milton Keynes 
MK9 3EJ 

2nd September 2019 

Dear Mr Osborne 

Northern House, 
 7 - 8 Talisman Business Centre, 
 Talisman Road, 
 Bicester, 
 Oxfordshire, 
 OX26 6HR 
Tel: 01869 365 000 

Re: Inquest Touching on the Death of William Vickers 

Thank you for your report dated 26th July 2019 and for giving SCAS the opportunity to work with 
you regarding your concern. 

To  confirm,  your  concerns  relate  to  the  provision  of  radios  to  private  provider  colleagues  and 
assigning  a  paramedic  to  attend  incidents  within  a  prison  environment.  I  will  respond  to  your 
concerns separately below. I will also provide you with details of the work we are undertaking with 
our local prisons as part of this response.  

1.  Provision of radios to private provider staff 

The  airwave  radio  system  used  by  SCAS,  and  NHS  Ambulance  Trusts  nationally,  is 
governed  by  strict  licence  conditions.  I  have  included  a  copy  of  the  ‘Airwave  Code  of 
Practice – NHS Ambulance Service Profile’ with this letter. The licence terms (copied below) 
dictate that any private provider using the radio system must have their own licence. 

‘5.2 TEA2 Sub-Licencing 

Before an organisation can procure, use or handle any Airwave Service radio terminals, it 
is required to hold a valid TEA2 Sub-Licence which is a ‘confidentiality and restricted usage 
undertaking’. 

It is a mandatory requirement that all individual organisations with a business requirement 
to handle and/use Airwave within the context of the Ambulance Radio Programme, must 
hold  their  own  TEA2  sub-licences.  This  includes  each  Ambulance  Trust,  Air  Ambulance 
providers  (e.g.  Bond  and  Medical  Aviation  Services),  St  John  Ambulance,  British  Red 
Cross, equipment maintainers/suppliers and private companies used for Patient Transfer 
Services  etc.  This  is  managed  by  and  carried  out  through  the  Airwave  Accreditation 
Secretariat which also has the facility to provide ambulance Trusts with a list of relevant 
sub-licensees in each area’. (Our emphasis added). 

Registered Headquarters: 7 and 8 Talisman Business Centre, Talisman Road, Bicester 0X26 6HR 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Under section 7.4.3 of the licence, we are permitted to temporarily loan a radio to another 
organisation for a particular incident. However, the licence is clear that this cannot be for a 
period over 28 days.   

‘7.4.3 Loaning Radio Terminals 

Under  the  terms  of  the  Airwave  Public  Safety  Radio  Licence  issued  by  OFCOM, 
organisations can temporarily loan terminals provided that: 

• 

It is for the purposes of carrying out public safety functions during a particular incident (i.e. 
for public safety related coordination and communication) and not for ‘business as usual’ 
public safety functions; and 

•  The duration of the loan should not exceed twenty-eight (28) days, subject to compliance 

with the requirements of section 7.4.3.2’, 

For private provider crews to have permanent access to the radio system, they must apply 
for a licence for their own organisation and procure the radio equipment. Following receipt 
of your report, we will ensure that the private provider firms that we work with are aware of 
this option so they can consider whether it is an option they would like to pursue. 

However, it is important to note the following: 

a.  The Airwave coverage contract  for emergency services guarantees coverage in 
outdoor roadside locations. It does not guarantee coverage in a building or vehicle. 
As such the ambulance vehicle should always be in coverage but coverage is not 
guaranteed for handheld portable radio devices.  

b.  The  Airwaves  radio  system  is  due  to  be  replaced  by  the  Emergency  Services 
Network  critical  communications  system  which  will  make  radio  use  within 
emergency services obsolete. The initial intention of the Home Office was for this 
to be in place by the end of 2019. We understand this has now been postponed 
until 2022 due to unexpected difficulties surrounding the technology available. 

2.  Skill set of crews sent to an emergency within a prison.  

As  you  will  be  aware,  there  are  a  number  of  different  operational  job  roles  within  the 
prehospital  environment.  These  include  Specialist  Paramedics,  Paramedics,  Ambulance 
Technicians and Emergency Care Assistants. Nationally there is a shortage of Paramedics 
which means that it is not feasible for  us to guarantee a Paramedic is part of a crew on 
every resource.  

When  we  receive  an  emergency  call,  it  is  really  important  that  we  receive  accurate 
information  regarding the patient’s condition to ensure that we are able to triage the call 
appropriately. This is something which will be expanded on further below in the section on 
the  work  we  are  undertaking  with  our  local  prison  services.  It  is  not  appropriate  for  the 
location of the incident to be included as part of the triage; the focus must be on the clinical 
condition of the patient. Therefore, we are unable to provide a different response to a call 
for help just because the location is a prison.  

To offer you assurance that a Paramedic will always be dispatched to attend immediately 
life-threatening  incidents,  within  our  standard  operating  procedures,  there  is  already  a 
specification for a paramedic crew to be sent to all patients who are in cardiac or respiratory 
arrest (see below).   

Registered Headquarters: 7 and 8 Talisman Business Centre, Talisman Road, Bicester 0X26 6HR 

 
 
 
 
 
 
 
 
 
 
 
 It  is  possible  that  the  first  attending  resource  to  a  time  critical  event  will  not  have  a 
Paramedic  on  board  if  they  are  the  closest  available  resource  to  the  incident  scene. 
However, a Paramedic will always be dispatched to attend along with them. This is to ensure 
that there is not a delay in a resource arriving with the patient if a Paramedic crew has a 
further distance to travel to the incident location.   

Registered Headquarters: 7 and 8 Talisman Business Centre, Talisman Road, Bicester 0X26 6HR 

 
 
 
 
 
 
 
 Collaboration between SCAS and our local prison services 

As part of the review we are undertaking with our local prisons, we are facilitating a fixed process 
regarding call triaging, access to the prison and retention of our personnel’s operational radios 
and mobile telephones.  I will detail each point separately below.  

1.  Call triage 

As detailed above, it is vital that  we receive the correct information regarding a  patient’s 
condition to ensure that an appropriate triage can take place. Within a prison setting, it is 
often someone within their control room which undertakes the call to the ambulance service 
based  on  a  code  they  have  been  provided  with  by  prison  staff  at  the  patient’s  side. 
Unfortunately, their coding of a ‘red’ or ‘blue’ emergency is lacking the information required 
for an accurate and appropriate triage to take place. This is also often the only information 
that the caller has regarding the patient’s condition. As an example, the criteria for a code 
‘red’ prison emergency is a prisoner who is either bleeding heavily, has sustained a severe 
burn  or  has  a  suspected  fracture.  Whilst  a  fracture  may  be  painful  and  does  require 
emergency medical treatment within a hospital environment, it is not a time critical event 
which requires an  immediate ambulance dispatch.  In comparison, significant bleeding  or 
substantial burns do require an urgent response.  

The work we are completing will ensure that an accurate account of the medical emergency 
and the patient’s condition will be provided by the caller to ensure the appropriate response 
is provided. In the case of Mr Vickers, the person making the call was telephoning from the 
prison  control  room.  Importantly,  the  caller  was  unaware  of  whether  the  patient  was 
breathing and conscious. The only information they were able to provide was that he was a 
male prisoner and the incident was a code blue which indicated a possible fit or potential 
breathing  difficulties.  This  resulted  in  a  category  2  disposition  requiring  an  ambulance 
response within 18 minutes. If the caller had been aware that Mr Vickers was unconscious 
and  was  not  breathing,  a  category  1  disposition  would  have  been  reached  which  would 
have ensured a Paramedic was allocated to attend the incident.  

2.  Access to the prisoner (patient). 

Our joint working agreement will also ensure that the ambulance crew will be provided with 
timely access to their patient. To assist the prison with their security protocols, we will aim 
to provide the prison with the call sign of the resource and the number of staff on board. 
The call sign is visibly displayed on the outside of a resource and staff will be instructed to 
have their NHS photographic ID cards ready to show prison gate staff. The provision of the 
vehicle call sign will enable gate staff to recognise that the vehicle is expected and requires 
emergency access to the prisoner.  

3.  Operational radios and mobile telephones 

The  joint  agreement  will  seek  to  ensure  that  ambulance  staff  can  keep  their  operational 
radios and work mobile telephones with them whilst they attend to the prisoner. This is to 
ensure that they have the ability to contact our control centre directly as well as being able 
to  access  their  clinical  guidelines  via  the  Joint  Royal  Colleges  Ambulance  Liaison 
Committee  mobile  app.  As  detailed  above,  radio  coverage  is  not  guaranteed  within  the 
prison building so their mobile telephones may be required to contact our control centre. In 
addition, access to the guidelines via their mobile telephone is vital to ensure that the correct 
treatment and / or medication and doses of medication are provided to the patient.  

Historically crews had access to the guidelines via a pocket book which they carried on their 
person. With the advance of technology, these are now provided to them via a mobile app. 
The  benefit  of  the  app  is  that  any  updates  or  changes  to  specific  topics  of  the  clinical 
guidelines  can  be  released  and  made  available  to  crews  almost  instantaneously.  Our 
internal clinical memos and directives are also available to our crews via the mobile app.  

Registered Headquarters: 7 and 8 Talisman Business Centre, Talisman Road, Bicester 0X26 6HR 

 
 
 
 
 
 
 
 
 
 
 
 We will ensure that the memorandum of understanding produced will apply to our private 
provider colleagues undertaking work on our behalf.  

I  hope  this  response  has  addressed  your  concerns.  However,  we  would  like  to  offer  you  the 
opportunity to meet with our Clinical Governance Leads, who are working with our local prisons, 
and  our  Head  of  Communications  /  Lead  Airwave  Advisor  to  discuss  these  matters  with  you 
further. If you would like to accept this offer, please ask your office to liaise with Jennifer Saunders 
to arrange a convenient time for a meeting to be held.  

Yours sincerely  

Will Hancock 
Chief Executive 

Enc. Airwave Code of Practice – NHS Ambulance Service Profile 

Registered Headquarters: 7 and 8 Talisman Business Centre, Talisman Road, Bicester 0X26 6HR
Also filed under 2019-0255: William-VICKERS-2019-0255.pdf
Regulation 28: REPORT TO PREVENT FUTURE DEATHS (1)

NOTE: This from is to be used after an inquest.
REGULATION 28 REPORT TO PREVENT DEATHS

THIS REPORT IS BEING SENT TO: Head of Health Care, HMP Woodhill

1 CORONER

I am Tom OSBORNE, Senior Coroner for the area of Milton Keynes

2 CORONER’S LEGAL POWERS

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and
regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.

3 INVESTIGATION and INQUEST

On 08/08/2018 I commenced an investigation into the death of William VICKERS, aged 37.
The investigation concluded at the end of the inquest on 19 July 2019. The conclusion of
the inquest was a Narrative Conclusion:

The deceased was detained at HMP Woodhill on 18th July 2018, on arrival he was seen by
medical staff and in view of his drug addiction he was taken to the detoxification unit and
placed in a double occupancy cell. At some time around 5:30 am on 19th July 2018 he
suffered a cardiac arrest of unknown cause and despite resuscitation he suffered hypoxic
brain damage and died at Milton Keynes University Hospital on 26th July 2018.

His cause of death was confirmed following a post mortem examination as:

I a Bronchopneumonia

I b Hypoxic Ischaemic Encephalopathy

I c Cardiac Arrest

II Chronic obstructive pulmonary disease

4 CIRCUMSTANCES OF THE DEATH

William Vickers was found collapsed in his cell at HMP Woodhill on the 19th July 2018.
There was a delay in gaining access to his cell by prison staff and a delay in an ambulance
crew gaining access to him once they had entered the prison but he was successfully
resuscitated and taken to Milton Keynes University Hospital but had suffered hypoxic brain
damage. He remained in hospital until he passed away on 26th July 2018.

5 CORONER’S CONCERNS

The MATTERS OF CONCERNS are as follows:

During the course of the evidence I was concerned that not all staff within the prison,
including those within healthcare, were confident in using the AED (Automatic External
Defibrillator) and believe that the training of all staff should be reviewed so all are both

 familiar and confident in its use.

6 ACTION SHOULD BE TAKEN
In my opinion action should be taken to prevent future deaths and I believe you (and/or your
organisation) 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 19th September 2019.

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.

8 COPIES and PUBLICATION

I have sent a copy of my report to the Chief Coroner and to the following Interested Persons

The family of Mr Vickers

-
- HMP Woodhill
- Westminster Drug Project
- Northamptonshire Police
- GEO Amey

I have also sent a copy of the Prison and Probation Ombudsman who may find it of interest.

I 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 coroner, at the time of your response
about the release or the publication of your response by the Chief Coroner.

9

Tom OSBORNE
Senior Coroner for
Milton Keynes
Dated: 26 July 2019
Also filed under 2019-0255: William-VICKERS-2019-02552.pdf
Regulation 28: REPORT TO PREVENT FUTURE DEATHS (1)

NOTE: This from is to be used after an inquest.
REGULATION 28 REPORT TO PREVENT DEATHS

THIS REPORT IS BEING SENT TO: Governor, HMP Woodhill

1 CORONER

I am Tom OSBORNE, Senior Coroner for the area of Milton Keynes

2 CORONER’S LEGAL POWERS

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and
regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.

3 INVESTIGATION and INQUEST

On 08/08/2018 I commenced an investigation into the death of William VICKERS, aged 37.
The investigation concluded at the end of the inquest on 19 July 2019. The conclusion of
the inquest was a Narrative Conclusion:

The deceased was detained at HMP Woodhill on 18th July 2018, on arrival he was seen by
medical staff and in view of his drug addiction he was taken to the detoxification unit and
placed in a double occupancy cell. At some time around 5:30 am on 19th July 2018 he
suffered a cardiac arrest of unknown cause and despite resuscitation he suffered hypoxic
brain damage and died at Milton Keynes University Hospital on 26th July 2018.

His cause of death was confirmed following a post mortem examination as:

I a Bronchopneumonia

I b Hypoxic Ischaemic Encephalopathy

I c Cardiac Arrest

II Chronic obstructive pulmonary disease

4 CIRCUMSTANCES OF THE DEATH

William Vickers was found collapsed in his cell at HMP Woodhill on the 19th July 2018.
There was a delay in gaining access to his cell by prison staff and a delay in an ambulance
crew gaining access to him once they had entered the prison but he was successfully
resuscitated and taken to Milton Keynes University Hospital but had suffered hypoxic brain
damage. He remained in hospital until he passed away on 26th July 2018.

5 CORONER’S CONCERNS

The MATTERS OF CONCERNS are as follows:

During the course of the evidence I was concerned that once the ambulance was admitted
through the main gate it then took 11 minutes for the ambulance to be escorted through 5
sets of gates to the incident. Consideration must be given to a robust system of ensuring that

 all gates are opened and manned by security staff so that the ambulance is not in any way
hindered in getting to their patient. The present system in my view puts prisoners’ lives at
risk.

6 ACTION SHOULD BE TAKEN
In my opinion action should be taken to prevent future deaths and I believe you (and/or your
organisation) 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 19th September 2019.

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.

8 COPIES and PUBLICATION

I have sent a copy of my report to the Chief Coroner and to the following Interested Persons

The family of Mr Vickers

-
- HMP Woodhill
- Westminster Drug Project
- Northamptonshire Police
- GEO Amey

I have also sent a copy of the Prison and Probation Ombudsman who may find it of interest.

I 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 coroner, at the time of your response
about the release or the publication of your response by the Chief Coroner.

9

Tom OSBORNE
Senior Coroner for
Milton Keynes
Dated: 26 July 2019
Also filed under 2019-0255: William-VICKERS-2019-02553.pdf
Regulation 28: REPORT TO PREVENT FUTURE DEATHS (1)

NOTE: This from is to be used after an inquest.
REGULATION 28 REPORT TO PREVENT DEATHS

THIS REPORT IS BEING SENT TO: South Central Ambulance Service

1 CORONER

I am Tom OSBORNE, Senior Coroner for the area of Milton Keynes

2 CORONER’S LEGAL POWERS

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and
regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.

3 INVESTIGATION and INQUEST

On 08/08/2018 I commenced an investigation into the death of William VICKERS, aged 37.
The investigation concluded at the end of the inquest on 19 July 2019. The conclusion of
the inquest was a Narrative Conclusion:

The deceased was detained at HMP Woodhill on 18th July 2018, on arrival he was seen by
medical staff and in view of his drug addiction he was taken to the detoxification unit and
placed in a double occupancy cell. At some time around 5:30 am on 19th July 2018 he
suffered a cardiac arrest of unknown cause and despite resuscitation he suffered hypoxic
brain damage and died at Milton Keynes University Hospital on 26th July 2018.

His cause of death was confirmed following a post mortem examination as:

I a Bronchopneumonia

I b Hypoxic Ischaemic Encephalopathy

I c Cardiac Arrest

II Chronic obstructive pulmonary disease

4 CIRCUMSTANCES OF THE DEATH

William Vickers was found collapsed in his cell at HMP Woodhill on the 19th July 2018.
There was a delay in gaining access to his cell by prison staff and a delay in an ambulance
crew gaining access to him once they had entered the prison but he was successfully
resuscitated and taken to Milton Keynes University Hospital but had suffered hypoxic brain
damage. He remained in hospital until he passed away on 26th July 2018.

5 CORONER’S CONCERNS

The MATTERS OF CONCERNS are as follows:

Firstly, I was told during the course of the evidence that the ambulance crew who attended
the prison in response to the emergency call, do not have access to the radio system of
SCAS. The ambulance which attended is operated by Jigsaw Medical Services which is

 denied access to the system.
consideration given to ensure that all ambulance crews have access to the radio system.

I believe this policy should be reviewed urgently and

Secondly I am concerned that the first response did not include a “paramedic”.
I believe that
consideration should be given to a review to ensure that the first responder to an emergency
at the prison should always include a fully qualified paramedic.

6 ACTION SHOULD BE TAKEN
In my opinion action should be taken to prevent future deaths and I believe you (and/or your
organisation) 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 19th September 2019.

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.

8 COPIES and PUBLICATION

I have sent a copy of my report to the Chief Coroner and to the following Interested Persons

The family of Mr Vickers

-
- HMP Woodhill
- Westminster Drug Project
- Northamptonshire Police
- GEO Amey

I have also sent a copy of the Prison and Probation Ombudsman who may find it of interest.

I 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 coroner, at the time of your response
about the release or the publication of your response by the Chief Coroner.

9

Tom OSBORNE
Senior Coroner for
Milton Keynes
Dated: 26 July 2019

Responses

2 responses 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 Cnwl NHS Trust (PDF)
INHS|

Central and
North West London

NHS Foundation Trust

Executive Office
Tel: 020 3214 5760

13 September 2019

Mr Thomas Osborne

HM Senior Coroner for Milton Keynes
Civic Offices

1 Saxon Gate East

Central Milton Keynes

MK9 3EJ

Dear Mr Osborne,

Regulation 28 Report to prevent future deaths following the Inquest of
Mr William Vickers

| am writing in response to the Regulation 28 Report issued on 26 July 2019
following the inquest into the death of Mr William Vickers. We are saddened by the
untimely death of Mr Vickers and our deepest condolences are offered to his family.
Our aim in addressing the Regulation 28 Report is to provide assurance to both you
and to Mr Vickers’ family on the steps that we are taking to ensure that staff and the
Trust, as an organisation, learn from Mr Vickers’ death and that measures are put
into piace with the aim of ensuring that such issues can be avoided in the future.

The concern raised in the Regulation 28 report is set out below in bold followed by
details of the actions taken by the Trust.

During the course of the evidence, | was concerned that not all staff within the

prison, including those within healthcare, were confident in using the AED (Automatic
External Defibrillator) and believe that the training of all staff should be reviewed so
all are both familiar and confident in its use.

New AED’s with data cards are now in place at HMP Woodhill, which record activity
during its use. This data will include the following:

° Incident duration - Elapsed time of the recorded incident from when the
AED was turned on.

° Shocks delivered - The total number of shocks that were delivered during
the recorded incident.

Trust Headquarters, 350 Euston Road, London NW1 3AX
Telephone: 020 3214 5700
www.cnwi.nhs.uk

“aed

PARTNERSHIP London Milton Keynes Kent Surrey

DPS

ee SS 3 for life

Hampshire

* First shock time - Elapsed time to first shock delivery from when the AED
was turned on.

e Presenting ECG - Up to 15 seconds of the presenting ECG from the time
the pads were applied to the patient.

In July 2019, with the introduction of the new AEDs there have been a number of
training sessions held to ensure CNWL Offender staff are competent and confident
in their use.

The Trust Resuscitation Lead has confirmed that all emergency response training
(BLS, ELS, ILS) includes information on the verbal instructions (and their meaning)
that is given by an AED. The meaning of the wording ‘shock cancelled’ has been
added with immediate effect to the training delivered.

We have, with immediate effect, ensured that all Offender Care Services including
Woodhill will have:

. Monthly refresher sessions held locally for familiarisation and training on
the use of the AED and emergency equipment.

* Attendance by clinical staff to a refresher session at least quarterly.

° Records of attendance at the refresher sessions which will be monitored
locally.

. A requirement for staff to complete a signed statement of competence

following refresher sessions.

‘Know your AED’ posters have been developed and are displayed throughout HMP
Woodhill to maintain familiarisation with it.

A ‘How to use the AED’ guide has also been sent to all healthcare staff at HMP
Woodhill and will be used as part of the refresher training sessions.

It has been agreed with the Governor that CNWL will offer AED training sessions to
officers at HMP Woodhill. Officers will be able to attend the refresher sessions
scheduled each month.

In addition to the above, all CNWL Offender Care staff are required to complete
mandatory emergency response training (e-learning annually and face to face bi-
annually) at a level appropriate to their role.

. Basic Life Support (BLS) - administrative staff

° Emergency Life Support (ELS) — non-qualified clinical staff (e.g.
Healthcare Assistants)

° Immediate Life Support (ILS) — qualified clinical staff (e.g. Nurses,
Paramedics)

Compliance is monitored by the Trust and 100% compliance has been achieved at
HMP Woodhill.

All new CNWL staff at HMP Woodhill complete a detailed local induction which
includes location of emergency equipment and its use.

In December 2018, the Offender Care Directorate established a Resuscitation
Review Group with the purpose of sharing best practice, standardising emergency
equipment and response and to review the training needs of staff. The review group
is led by the Lead Nurse for Offender Care and includes senior clinicians from
services and the Trust Resuscitation Lead.

A ‘resuscitation/medical emergency’ audit form has been introduced to enable a
review of care delivered during a medical emergency. These audit forms are
reviewed at the Offender Care Resuscitation Review Group and any learning shared
across services in their local Care Quality Meetings. Any concerns are reported and
monitored by the monthly Business and Performance Meeting by the Offender Care
Senior Management Team. Any learning is shared through Learning Lessons
Circulars which are disseminated to staff and discussed in local quality and team
meetings.

On 27 June 2019, the CNWL Primary Care Lead at HMP Woodhill, who is a senior
paramedic, completed a ‘Train the Trainer’ course which will enable local emergency
response and refresher training detailed above to be carried out on a regular basis
within the Woodhill Team.

An external independent review has been commissioned to review the practice of
emergency response within Offender Care and make recommendations for policy,
practice and training. The findings will form the basis of a detailed action plan to
ensure staff are equipped by the training provided and equipment available to
respond to a medical emergency according to their role and expertise. These
actions are expected to improve patient safety and outcomes.

| hope this provides you with sufficient assurance that the Trust has taken action
following the death of Mr Vickers, and has accepted your recommendation and
continues to work to improve the service we provide both in HMP Woodhill and in our
wider Offender Care Services. If you have any questions or comments, please do
not hesitate to contact me directly on the number above.

Yours sincerely,

Claire Murdoch
Chief Executive
Response from Hm Prison and Probation Service (PDF)
Phil Copple
Director General Prisons
HM Prison and Probation Service
‘ 8" Floor Ministry of Justice
Y 102 Petty Franca
London SW1H 9AJ

HM Prison & Email:DirectorGeneralPrisons@justice.gov.uk
Probation Service

Mr T Osborne
Senior Coroner

HM Coroner's Office,
Civic Centre,

1 Saxon Gate East,
Milton Keynes,

MK9 3EJ

Date: 30" September 2019

Dear Mr Osborne

Thank you for your Regulation 28 Report dated 26 July 2019 following the inquest into the
death of Mr William Vickers at HMP Woodhill. | am also grateful to you for granting a short
extension to the usual deadline for reply.

| know that you will share a copy of this response with Mr Vickers’ family and | would like
first to express my condolences for their loss. Every death in custody is a tragedy and the
safety of those in our care is my absolute priority.

You raised one matter of concern for Her Majesty’s Prison and Probation Service (HMPPS):
that, once the ambulance was admitted through the main gate, it took eleven minutes for it
to be escorted through five sets of gates to the incident. You asked that consideration be
given to a robust system for ensuring that all gates are opened promptly by staff so that the
ambulance is not in any way hindered in getting to the patient.

Since Mr Vickers’ inquest the contingency plans at HMP Woodhill have been updated to
ensure that there are no delays to the process of receipt of any emergency vehicle,
including ambulances during night state. When a code red or blue is called, the control
room contacts South Central Ambulance Service (SCAS) immediately. When this occurs
during night state, members of staff report to the prison gate to await the arrival of the
ambulance, and to assist the responding dog handler with opening the gates to the units.

An additional Operational Support Grade (OSG) also attends the gate to assist with
receiving the emergency vehicle into the prison and searching. The level of search of the
vehicle is determined on the basis of an assessment of the circumstances of the
emergency, to avoid any unnecessary delay.

in the meantime, staff arriving at the scene and entering the cell give further details of the
person’s name and current condition to the control room who pass this on to SCAS so that
the attending ambulance staff are informed and prepared on arrival.

All Custodial Managers will have had the opportunity to take part in a live test of the
arrangements for the receipt of emergency vehicles. Training for OSGs is being delivered
on the establishment's bi-monthly training afternoons, and all will have completed it before
the end of 2019.

Thank you again for bringing this matter of concern to my attention. I hope this response
has provided reassurance that it is being fully addressed by the Govemor at HMP Woodhill
and HMPPS.

Yours sincerely,

Vo Capple

PHIL COPPLE

Director General for Prisons

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