Prevention of Future Deaths reports · 2023
Regulation 28 report to prevent future deaths, reference 2023-0063, written 27 Jan 2023. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 27 Jan 2023 |
|---|---|
| Reference | 2023-0063 |
| Deceased | Andrew Shirley |
| Coroner | David Reid |
| Coroner area | Worcestershire |
| Category | State Custody related deaths · Mental Health related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | 3 |
Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.
REGULATIO 28: REPORT TO PREVE T FUTURE DEATHS (1) NOTE: This form is to be used dtol' an inqU6st. REGULA1il 211 REPORT ii'C IP IFlUTUR!E DEATHI THDI Rlc!PORT 8 BED G SIE 'ii' 11'0: i. Govemc!I', Iii · P Hli1m!IDI, ~Bl Ull'll3, ~Sddltch, mf@~irahDl'IS ISllllf @QS. 1 I am David Donald Wllllam Reid, HM Senior Coroner for the coroner ar&& of Worcestershire 2 CO O ER'S LEGAL PO R.S I make this report under paragraph 7, Schedule 5, of the Coroners end Justice Ad 2009 and ragulatlons 28 and 29 of the Coroners (Investigations) Ragulelfons 2013. 3 INVESTI On 31.3.21 an investigation wes commenced Into the death of Andrew Paul SHIRLEY, e prisoner at HMP Hewell who died In his cell at the prison on 23.3.21 having daUberately suspended himself by a ligature. He was 25 years of age at the tlm& C;>f his death. This lnvestlgetion concluded st the end of the inquest on 20.1.23. The medical cause of death was: 1a external net:k compression ( hanging ). The conclusion of the inquest was ss follows: · nAr1drew Shirley died as the result of deDbsrately suspending himself by a ligature. It Is not possible to determine what his intention was et the time he did this. Sea questionnaire. Questionnaire: 1. Did healthcare and mental haalthcsre staff at HMP Hewell: (a) take sufficient steps to Identify and reeord Ar1drew"s risk.of suicide and/or self- hann? NO (b) put In place sufficient measures to try to reduce thet risk of suicide and/or self- hann, whether ( for example ) by locating Andrew on the Targeted Care Pethwey, opening an ACCT docum&nt, recording concerns on the Initial Segregation Health Screen dooument, formul&tlng· e mental health care plan, or otherwise ? NO (c) share sufficient lnfomt~n about Andrew's risk of suicide and/or self hann with prison staff, so as to.enable prison staff to make approprtate decisions themselves about reducing thet risk? NO 2. If any of your answers to Questions 1(aHc) above Is NO (a) did that failure/those faUures probably cause or contribute to Andrew's death on 23 March2021? YES 1 3. (a} on 20.3.21 should the Duty Govemor, after reading the Initial Segregation Health Screen document before making the decision that Andrew should remain on the Segregation Unit, have made any more enquiries about the answers given on that document? YES If YES to Question 3(a}: (b) would those enquiries prob.11bly have lad to furihe infonnsition being provided about sn Increased risk of Andrew committing en act of suicide or self-herm? YES If YES to Quest!on 3(b}: (c) should the Duty Govemor have taken eny action to try to reduce that risk ( e.g. by opening an ACCT document)? YES 4. If YES to Question 3(c): · (a) Old the failure to take such actioo probably cause or contribute to Andr&W's death? CANNOT SAY (b) If NO or CANNOT SAY to Question 4(&), did that failure possibly cause or contribute to -Andrew's death on 23 March 2021? YES Neglect 5. Was Andrew's death contributed to by neglect? YES 4 CIRCUMSTANCES OF THE DEAntl In answering the questions "when, where, how and in what ctrcurnstences did Andrew come by tiis deathr, the jury found as follows: "On 23.3.21 Mr. Andrew Shirley was found unresponsh[e in cell 14 afthe Segregation Unit at HMP Hewa/1 suspsnd8d by a ligature. Advanced life ssvlng measu,es were undertaken but he was pronounced deed st the scene st 1944hrs." To clarify, at the time of these events Andrew was a diagnosed paranoid schizophrenic who had been receiving a monthly depot injection of anti-psychotic medication. He ~lso hed a documented history of eelf-hann end suicide attempts. Andrew hed bean In poUce custody from 25.2.21 until 1.3.21, during which time he had undergone a fonnal Mental Health Ad essessment at the Celudon Centre, Coventry because of concems about his mental health. Those conducting that assessment concluded that he did not require treatment in a psychiatric hospital, whether as e detained or voluntary Inpatient. Following e court hearing on 1.3.21, Andrew was remanded Into custody to await trlal, end was taken to HMP Hewell. At the prison, Andrew's me~I health history was noted and he was allocated a mantal health care coordinator. During the three weeks that Andrew was at the prison, his care-coordinator failed to carry out any In-depth mental health assessment of him, failed even to begin to formulate a mental health c;are plan for him, end faU&d proparly to assess and menage his risk of suicide and/or self-hann. The overall failings of the healthcare end mental healthcare teams eit the prison are reflected In the answers of the Jury to Questions 1, 2 and 5 In the Jury Questionnaire (above]. Throughout his time at the prison, Andrew said on several occasions thet he felt that his medication was not worklna. 2 .. On 20.3.21 Andrew was placed In the Segiragation Unit et the prison, following sin Incident In which he epat at two prison officers. In order to assist the Duty Governor In deciding whsthsr Andrew could be held safely on the Sagregstlon Unit, a nurss completed ein Initial Se;regation Health Scresn document. in which she recorded thiit Andrew was currently on anti-psychotic medlCS1tion. In addition, during the cou 'S8 of her assessment of Andrew, he told her that he was haal"ling voices which were telling him to kill himself, and that h8 wanted a radio so that he could drown those voices out. That infonnation wss not releiyed to the Duty Governor, but the Duty GOV8mor accepted in his evidence thet, In llght of the lnformllltion that Andrew wsis on anti;>sychotlc medication, ha should heive spoken to, end sought further Information from the nurse. In their answers to Questions 3 end 4 In the Jury QuesUonnalrs, the Ju,y found that, had the Duty Governor sought this further Information, ha would probably have taken . ~ctlon to reduce Andrew's risk of suicide and/or self-hann ( e.g. by opening an ACCT document ), and his failure to do so possibly caused or contributed to Andrew's death on 23.3.21. Two further Initial Segregation Health Screen documents were completed on 22.3.21, by a paramedic end mental heelt.ti nurse respactlvely. In the first of th088, the paremedlc concemed concluded that there were no "healthcare reasons• not to segrsgete Andrew at that time. Thet conclusion WES based on two wrong answers In the algorithm contained within that document. The paramedic conceded that she had neither sesn Andrew, nor looked at his medical reool"ds before complstlng this document. The mental health nurse who completed the second Initial Segregation Health Screen document also conceded that he had not seen Andrew beforehand, and accept.ad in evidence that he might have raached a dlfferant conclusion If he had read entries contained within Andrew's medlcal notes. Andrew was found collapsed and unresponsive in his cell on the following evening of 23.3.21, suspended by & Dgeture. He wss confirmed deceased et the scene later thEJt 1hetday. 5 During the course of the inquest the evidence revealed matters giving rise to concem. In my opinion there Is a risk that future deaths will occur uni~ action Is taken. In the cfrcumstances It is my statutory duty to report to you. The TI'IERS Of CO CERN are as follows. - ACCT v.6 training; and SASH ( suicide end self-hem, ) modal 3 training. (1) I heard evidence thEJt v.8 of the ACCT document had been In place at prisons throughout England and Waiss since June 2021, and that training ralevsnt thereto conelS1& of: (I) (II) However, I silso h6Slrd that, as at 20.1.23 ( over 18 mon1he after the ln1roductlon of the latest ACCT document ), 280 out of 400·members of staff at the prison ( 70% ) were yet to have completed that training. llt le of coneldenibls concern thEt such a hlg pa n~ee of staff et the prleon may not be In a pcaltlon to nte0gnlu thra rtek lch a prGeoner presents a eppruprflette etaps to of suicide and/or eelf-henn, and thsrefo,s to nHluce that rlski · (2) I also heard evidence that, despite the Introduction of e new Initial · Segregation Health screen algorithm documsnt for prisoners In the Segregation Unit, Duty Govemors at the prison hed not yet received eny training about the steps they should take In order to complete that document appropriately. 6 ACTDO SHOULD BE TA 3 In my opinion action should be taken to prevent future deaths and I believe you have the power to take such action by conducting an Investigation Into the deficiencies and failures outlined above, and ensuring that appropriate training Is provided to all relevant staff. 7 YOUR RESPONSE You are under a duty to respond to this report within 56 dsiys of the date of this report. namely by 24.3.23. I, the coroner, may extend the psriod. Your rasponse must contain details of action taken or proposed to be taken, setting out the timeteibla for action. Otherwise you must explain why no action Is proposed. i------,.~--,.---,--------------------------------- COPllES End ~ BUCATDON 8 I heva sent e copy of my 1'19l()Ort to the Chief Coroner end to the following: B5mberg Peirce eollcltors, who represent Andrew's family; Chief Executive of HM Prison end Probetlon Seivlce; HM Chl&f Inspector of Prtsons; chair of the Independent Advisory PBnel on Deaths In Custody; Practice Plus Group; Midlands Pa~ership NHS Foundation T11.1st; The Prison end Probation Ombudsman. I am also under e 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 fonn. He may send e copy of this report to any person who he believes may find It useful or of intereet. You may make represent&Uons to me, the coroner, at the time of your response, about the release or the publication of your respons~ by th19 Chief Coroner. 9 819111ed D. D. • Reid . 2-ri January 2023 H. • Senior Coroner for Worcesterehlre 4
3 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.
Director General of Operations HM Prison and Probation Service 8th Floor Ministry of Justice 102 Petty France London SW1H 9AJ 23 March 2023 Mr David D W Reid HM Senior Coroner for Worcestershire The Civic Martins Way Stourport-on-Severn DY13 8UN Dear Mr Reid, Thank you for your Regulation 28 report of 27 January 2023, addressed to the Governor of HMP Hewell. I am responding on behalf of His Majesty’s Prison and Probation Service (HMPPS) as Director General of Operations. I know that you will share a copy of this response with Mr Shirley’s family, and I would first like 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 have expressed concerns regarding the number of staff that have not yet received the updated Assessment, Care in Custody and Teamwork (ACCT) version 6 (v6) and Suicide and Self-Harm Prevention (SASH) training. It is essential that ACCT procedures are utilised by all members of staff working within prisons, including healthcare colleagues, and that staff feel confident in recognising risk and in making the decision to open an ACCT in order to support prisoners when it is needed. ACCT v6 and SASH training includes guidance on understanding and assessing the risks and triggers of self-harm, the ACCT v6 process and supporting individuals who self-harm while they are under ACCT monitoring and during the post closure period. HMP Hewell is currently delivering training sessions that incorporate both ACCT v6 and SASH training to all staff with the expectation that this will be completed by July 2023. You were also concerned that Duty Governors had not yet received any training about the steps they should take in order to complete the Initial Segregation Health Screen algorithm document for prisoners in the Segregation Unit. HMP Hewell has developed Duty Governor guidance for managing the risk of segregation and delivered a training session to all Duty Governors in March 2023. The training included information on the policy requirements, how to review periods of increased risk and the process of the Initial Segregation Health Screen. Since Mr Shirley’s death, a number of supporting tools have also been published by HMPPS to assist prisons in ensuring segregation is managed appropriately. This has included a learning guide on how to effectively collate, analyse and share data to enhance local decision-making and multidisciplinary practice. Thank you again for bringing your concerns to my attention. I trust that this response provides assurance that action is being taken to address this matter. Yours sincerely, Director General of Operations
Chief Executive
Trust Headquarters
St George’s Hospital
Corporation Street
Stafford
ST16 3SR
Mr D.D.W Reid
His Majesty’s Senior Coroner for Worcestershire
Dear Mr Reid
RE:
Andrew Paul Shirley (deceased)
Report to Prevent Future Deaths
Thank you for your letter dated 27th January 2023, reporting a matter to us, in accordance
with Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.
May I take this opportunity to reassure you that following Mr Shirley’s death, we undertook
a thorough investigation into the care delivered by the Midlands Partnership Foundation
Trust.
MATTER OF CONCERN:
The three areas of concern were;
1. You heard evidence that, following concerns raised in the inquest about failures by
the mental healthcare staff at the prison to complete documentation in a timely
fashion or, (on occasions) at all, a “rigorous” 2 day training package for all mental
healthcare staff at the prison has now been implemented. However, as at
20.01.2023 no data could be provided which showed how many of the current
mental healthcare staff at the prison had actually received this training.
2. You heard evidence that v.6 of the ACCT document had been in place at prisons
throughout England and Wales since June 2021, and that training relevant thereto
consists of;
Together we are making life
better for our communities
i)
ii)
ACCT v6 training; and
SASH (suicide and self-harm) model 3 training
However, you also heard that, as at 20.01.2023 (over 18 months after the
introduction of the latest ACCT document):
a) 42% of mental healthcare staff at the prison had not received the ACCT v6
training (but would be receiving it that very day); and
b) SASH training for all mental healthcare staff had been booked for February and
March 2023.
It is of considerable concern that such a high percentage of mental healthcare staff
at the prison may not be in a position to recognise the risk which a prisoner
presents of suicide and/or self-harm, and therefore to take the appropriate steps
to reduce that risk.
3. You also heard evidence that, despite the introduction of a new Initial Segregation
Health Screen Algorithm document for prisoners in the Segregation Unit, there has
been no training for mental healthcare staff in how to complete these documents
appropriately; and
It is of particular concern that members of the mental healthcare staff at the prison
are expected to have active involvement in the completion of these important
documents, which aim to identify prisoners who may be at risk of suicide and/or
self-harm if placed in the Segregation Unit, without any suitable training to qualify
them to do so.
Following discussions within the mental health services in the Specialist Services Care Group
and with corporate services, I am now in a position to respond to the specific concerns
raised during the course of the inquest.
4. You heard evidence that, following concerns raised in the inquest about failures
by the mental healthcare staff at the prison to complete documentation in a
timely fashion or, (on occasions) at all, a “rigorous” 2 day training package for all
mental healthcare staff at the prison has now been implemented. However, as
at 20.01.2023 no data could be provided which showed how many of the current
mental healthcare staff at the prison had actually received this training.
MPFT take the issue of record keeping very seriously. To support our Prison staff we
provide a range of learning opportunities delivered in a variety of ways.
Record keeping is included as a mandatory element within our Trust Induction during
which new staff have to complete an online Data Security Awareness training module
which covers Information Governance and General Data Protection Regulations (GDPR).
The Trust Induction will be completed within the first 4 weeks. This is currently at 91%
compliance for HMP Hewell, with outstanding training to be completed to achieve 100%
by 31st March 2023.
As part of the local Induction all new staff are given instruction on how to use SystmOne
and what would be expected in regard to record keeping standards. These are detailed in
2
the Inclusion Prisons Good Practice Guide. We have now introduced processes to ensure
that the local induction will be completed within the first four weeks of commencement.
Inclusion have developed a competency based local induction in which Team managers
will sign off staff as competent to practice. Agency nurses complete the same Induction
process as permanent staff.
There is a Prison specific record keeping training provided for all staff on an annual basis.
We will video record this session so it can be made available to people to watch as part of
their induction pending completing the course face to face. Topics covered in this training
include:
The importance of keeping good health records.
The requirement to record contacts contemporaneously
The requirement to gather relevant information from other parties involved in
their care.
Informed consent
Making a clinical formulation which directs decision making
Care coordination – roles and responsibilities
MPFT Risk Management processes
The most recent training was delivered in June 2022 at which point we were 100%
compliant. Due to staff turnover compliance is currently at 67%. Therefore a further
record keeping training session has been planned for 25th April 2023 at which point 100%
of all our staff will have completed the Prison Specific Record Keeping training.
Attendance at the training will be recorded and monitored locally.
Any new staff will view the recording of the training as part of their induction pending
attending a face to face session. At the next training we will be using Mr Shirley’s case as a
case study to demonstrate the importance of good record keeping.
During supervision sessions we review two random case records to ensure that these
meet the expected standards of record keeping. In cases where the records don’t meet
expected standards an improvement plan will be developed with the individual.
Supervision occurs at least 6 times a year. This is inclusive of agency staff. Where there are
performance issues the frequency will be increased to monthly.
As part of our mandatory training compliance process, service leaders receive monthly
monitoring reports detailing current compliance in regard to supervision. If necessary this
can also be checked on the live system.
5. You heard evidence that v.6 of the ACCT document had been in place at prisons
throughout England and Wales since June 2021, and that training relevant thereto
consists of;
iii) ACCT v6 training; and
iv) SASH (suicide and self-harm) model 3 training
3
However, you also heard that, as at 20.01.2023 (over 18 months after the introduction
of the latest ACCT document):
a) 42% of mental healthcare staff at the prison had not received the ACCT v6
training (but would be receiving it that very day); and
b) SASH training for all mental healthcare staff had been booked for February and
March 2023.
It is of considerable concern that such a high percentage of mental healthcare staff
at the prison may not be in a position to recognise the risk which a prisoner presents
of suicide and/or self-harm, and therefore to take the appropriate steps to reduce
that risk.
ACCT training is provided by the Prison and it is expected that all MPFT Prison staff attend
this training as part of their Induction. Attendance at ACCT training is recorded and
monitored locally.
An understanding of the ACCT process is part of the Inclusion Prison Induction and needs
to be signed off by a manager/supervisor.
As well as attendance at the training all MPFT staff are given a copy of the Inclusion Good
Practice Guide to working in Prisons which includes information on ACCT processes.
The use and function of the ACCT process is discussed in internal team meetings, MPCCC
meetings and in specific ACCT meetings so new staff get the chance to familiarise
themselves with how an ACCT is used.
As at March 2023 Mental Healthcare staff at HMP Hewell are 100% compliant with ACCT
training.
Suicide and Self harm Training
Clinical Risk Management Training is one of MPFT’s mandatory training standards. This
includes the identification and management of suicidality. As at March 2023 staff at HMP
Hewell were 84% compliant with a plan to achieve 100% compliance by the end of March.
In February 2023 MPFT launched a three level Suicide Mitigation Training which is detailed
below. This will be part of the Prison Induction process and will be in place of the current
two day training module.
Training
ESR Course
Name
Who For
Delivery
Method
Duration
Course Aims
LEVEL 1 Zero
Suicide
Alliance
LEVEL 2
Suicide
000 MPFT
Zero Suicide
Alliance
Awareness
(Level 1)
301 Suicide
Awareness
All MPFT
Staff
E-
Learning
30
Minutes
All Clinical
Non
MS
Teams
2 Hours
To raise
awareness of
suicide
prevention and
mitigation
To increase
understanding
4
Awareness
for
Professionals
for
Professionals
(Level 2)
LEVEL 3
Suicide
Response
Part 1 & 2
301 Suicide
Response
(Level 3)
Registered
&
Registered
Practitioners
in ALL fields
of practice
All
Registered
Practitioners
working in
Mental
Health &
Learning
Disability
fields
MS
Teams
1 Day
and compassion
and reduce the
stigma associated
with talking
about suicide.
To provide
clinical tools to
enhance the
processes of
suicide
assessment and
promote
common
language to
improve
prioritisation and
referrals.
Completing all three levels will be essential for all registered Clinical Prison staff and will
be monitored via our Electronic Staff Record (ESR). 100% Mental Health staff have
completed level 1 training and level 2 and 3 are booked to take place in June/July 2023.
Staff continue to have access to the Inclusion Suicide Prevention and Awareness Toolkit.
A HMP Hewell suicide prevention strategy is being developed as a partnership approach
which includes the Prison, PPG, MPFT as well as other partner agencies such as education
and Chaplaincy services.
6. You also heard evidence that, despite the introduction of a new Initial Segregation Health
Screen Algorithm document for prisoners in the Segregation Unit, there has been no
training for mental healthcare staff in how to complete these documents appropriately;
and
It is of particular concern that members of the mental healthcare staff at the prison are
expected to have active involvement in the completion of these important documents,
which aim to identify prisoners who may be at risk of suicide and/or self-harm if placed
in the Segregation Unit, without any suitable training to qualify them to do so.
Health Screen Algorithm training is provided to MPFT staff by PPG. This is now in place
and all registered nurses at HMP Hewell, inclusive of agency nurses, had completed the
training by 3 February 2023. A new member of staff who started 2 weeks ago is the only
member of staff not to have completed this but will do as part of their induction.
This is part of the required training for staff working in prisons and is provided as part of
and will monitored within our Induction process. We are in dialogue with PPG about how
we can get our staff trained to also deliver this training.
5
While Segregation Health Screening is the responsibility of PPG, MPFT mental health staff
will support this process and, where appropriate, contribute to the completion and review
of the algorithm.
All new staff will shadow an experienced member of staff supporting the completion of
the Algorithm prior to doing so on their own.
I hope this response helps to address your concerns. However, if you require any further
information please do not hesitate to contact me.
Yours sincerely
Chief Executive
Midlands Partnership NHS Foundation Trust
6
Annex A
Call Handlers Aide Memoire – Self referral
To be used to gather relevant information when patients call to self-refer.
Find patient on RiO. IF THEY ARE ALREADY OPEN TO A PATHWAY, AND ARE CALLING
DURING THEIR WORKING HOURS, PROVIDE THE NUMBER FOR THEIR PATHWAY AND
ADVISE THEM TO CALL THE PATHWAY DIRECTLY (END CALL).
Check demographics of caller and update contact details as required. Take tel. number
caller is calling from. Check caller’s current location. Are they with anyone?
MENTAL HEALTH CONCERNS
Ask the caller to explain in their own words why they are calling Access and what are
their current Mental Health issues? How do they feel this is affecting them?
Are they currently receiving / or have previously received support from any other
Mental Health services? (i.e. counselling /IAPT/ Social Services etc.).
Establish risks:
RISKS
Have they ever Deliberately Self Harmed? If yes, when was the last time? How do they harm
themselves?
If actively self-harming at the time of call then to go to Shift Co, or if OOH to relevant Crisis
Team and consider calling Emergency Services (follow the UK Triage Tool)
Are they having any thoughts to harm others?
Are they having any suicidal thoughts? YES/N0 if Yes is there a plan? If Yes, is the plan
imminent?
(If Yes, call to go to Shift Co, if OOH’s this must be discussed with the relevant Crisis Team).
Place caller on hold and ensure unvalidated progress note is inputted on RiO. Speak with
Access shift co. who will advise how to proceed.
Plan:
Document next steps clearly in progress notes i.e. Referral opened to Access. Tracker sheet
to Shift Co (document full name of Shift Co). Or Tracker sheet updated and passed to Shift
Co etc.
If OOH, discuss with / advice sought from CRHT Shift Co and include any advice given and
steps to be taken either by Access or Client.
7
Practice Plus Group Hawker House 5-6 Napier Court Napier Road Reading Berkshire RG1 8BW Tel. 0333 999 2570 Fax 0333 200 4063 practiceplusgroup.com H.M. Senior Coroner Mr D.D.W. Reid Coroner’s Court Martins Way Stourport-on-Severn Worcestershire DY13 8UN 21 March 2023 Dear Sir Regulation 28: Prevention of Future Deaths Report – Andrew Shirley I write in response to your Regulation 28 Prevention of Future Deaths Report issued to Practice Plus Group on 27 January 2023 following the inquest touching upon the death of Mr Andrew Shirley at HMP Hewell. Practice Plus Group would like to express its sincere condolences to Mr Shirley’s family and friends. This response addresses the matters of concern in so far as they relate to Practice Plus Group Health & Rehabilitation Limited (“Practice Plus Group”), the lead provider of healthcare services at HMP Hewell since 1 April 2016. Matter of Concern: A high percentage of healthcare staff at the prison may not be in a position to recognise the risk which a prisoner presents of suicide and/or self-harm, and therefore to take appropriate steps to reduce that risk (due to not having received ACCT training). Response: The ACCT process is governed by the prison and to date Practice Plus Group have been reliant upon the prison to run the training required. Training on ACCT and SASH (suicide and self-harm) are done together as part of the same sessions. In a new joint collaborative initiative between our prison colleagues, Practice Plus Group and the Midlands Partnership NHS Foundation Trust (MPFT), a cohort of healthcare staff have been identified to be trained to deliver the ACCT training. This will significantly improve our ability to Practice Plus Group Health and Rehabilitation Services Ltd. Registered in England No 10498997 Registered Office: Hawker House, 5-6 Napier Court, Napier Road, Reading, Berkshire RG1 8BW ensure training for our workforce as it enables Practice Plus Group and MPFT to train our staff on the ACCT process without the current reliance upon the prison. Following a recent period of focused training activity, including a training session on 9 March 2023, compliance for ACCT training for the healthcare team at HMP Hewell is now 76.8%. Our aim is to have all staff at HMP Hewell trained by the end of April. In addition to the above, and to provide further assurance, Practice Plus Group’s Health in Justice service has identified clinical induction as one of its three top corporate priorities this year. A new national clinical induction is being developed, which will incorporate foundation training in the ACCT process, ensuring that all staff receive this prior to commencing work in prison. This will serve as an introduction to the full ACCT training, which will be delivered within the first six months of employment, once our healthcare professionals have acquired practical and contextual experience to support this. It is intended that the Clinical Induction will have an implementation date of no later than 1 October 2023. There are no requirements or national standards in regards to ACCT and SASH refresher training. However, to further embed understanding of the ACCT process, Practice Plus Group will introduce a refresher training session to be completed at 2 yearly intervals following completion of initial training. This will be monitored on an ongoing basis via our organisational Learning Management System (LMS). Matter of Concern: Members of healthcare staff at the prison may be completing a document which aims to identify prisoners who may be at risk of suicide and/or self-harm if placed in the Segregation Unit, without any suitable training to qualify them to do so. Response: As part of the revision of Prison Service Order 1700 (Segregation) in June 2022, a new Initial Segregation Health Screen (ISHS) algorithm document for prisoners in the Segregation Unit was introduced. It is Practice Plus Group’s understanding that previously no healthcare provider within the Health in Justice estate has provided specific training to staff around the completion of the algorithm document. In correspondence with , Head of Healthcare at HMP Hewell, (Segregation Policy Lead for HMPPS) has confirmed that there is “no centrally provided training available to healthcare staff on the completion of the OT014”. OT014 is the Initial Segregation Health screen algorithm document. Page 2 of 4 Practice Plus Group has taken immediate action to address this concern and our Director of Nursing & Quality has developed a comprehensive training session. The training incorporates an overview of the prison processes for segregation, clinical assessment (utilising ISHS and other available information to support decision making) and professional accountability. The session includes a knowledge-based test and scenario-based learning. The training session and associated resources are enclosed to support this response. The training was delivered at HMP Hewell on 25 and 26 January 2023 and was attended by , Regional Primary Care Lead, to enable her to deliver the same training face- to-face across the region. Training compliance at HMP Hewell is currently 88%, and further dates have been arranged to ensure full compliance by 31 March 2023. Our Director of Nursing & Quality and the Head of Healthcare at HMP Hewell are currently liaising with the governor of the prison ( ) to ensure that the training is delivered as a collaborative initiative between prison and healthcare colleagues. We aim to promote shared understanding of the risks associated with segregation, and the requirement for joint care planning to ensure appropriate care for those who are segregated. We also intend to share this work more widely through prison and healthcare networks to encourage shared learning for safer segregation. I hope that the above response provides assurance that Practice Plus Group are committed to providing a high quality healthcare service at HMP Hewell and trust this response addresses the concerns you had. I would like to end this response by taking the opportunity of inviting you to visit the healthcare team at HMP Hewell should you wish to discuss and review first-hand the services that Practice Plus Group provide, as set out in this letter. Yours sincerely, Page 3 of 4 National Medical Director, Health in Justice Practice Plus Group Enclosures: 1. The role of healthcare professionals in completing the Initial Segregation Health Screen (PowerPoint presentation) Initial Segregation Health Screen Scenarios Initial Segregation Health Screen Test 2. 3. Page 4 of 4
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