Prevention of Future Deaths reports · 2024

Christine McDonald

Regulation 28 report to prevent future deaths, reference 2024-0278, written 21 May 2024. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 May 2024
Reference2024-0278
DeceasedChristine McDonald
CoronerCharlotte Keighley
Coroner areaCheshire
CategorySuicide (from 2015)
Sourcejudiciary.uk record · original PDF
Responses published1

The report

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

Regulation 28: REPORT TO PREVENT FUTURE DEATHS 

NOTE:  This form is to be used after an inquest. 

REGULATION 28 REPORT TO PREVENT DEATHS 

THIS REPORT IS BEING SENT TO: 

1  HMP Styal 
2  MOJ and Inquests Team 1 (Leeds) 

1  CORONER 

I am Charlotte KEIGHLEY, Assistant Coroner for the coroner area of Cheshire 

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 March 2019 I commenced an investigation into the death of Christine MCDONALD 
aged 55.  The investigation concluded at the end of the inquest on 10 May 2024.  The 
conclusion of the inquest was that: 

Narrative Conclusion - Suicide - Contributed to by: 
- Failings in communication and/or information sharing between healthcare staff at HMP 
Styal. 
- Failings in communication and/or information sharing between prison staff at HMP Styal. 
- Failings in communication and/or information sharing between healthcare staff and prison 
staff. 
- Failure to pass on information in respect of Christine's daughter's wellbeing. 
- Failure to assess Christine on her return from Wythenshawe Hospital. 
- Failure to action Christine's request to see a nurse. 
- Failures by healthcare to follow the clinical guidance in respect of the assessment and/or 
treatment of Christine's drug dependency. 
- Neglect 

It was also found that the emergency response codes were not used which led to a delay in 
bringing the required emergency medical equipment, namely oxygen and the emergency 
bag and there was a significant delay in locating the defibrillator, although these issues did 
not contribute to Christine’s death. 

4  CIRCUMSTANCES OF THE DEATH 

Christine  McDonald  was  55  years  old  at  the  time  of  her  death  on  the  3rd  March  2019.  On 
the 1st  March 2019 Christine was arrested at her home address and around the time of her 
arrest  had  witnessed  her  daughter  fall  from  third-floor  window  and  was  concerned  about 
her.  Christine  was  taken  to  Blackpool  Magistrates  Court  and  sentenced  to  12  weeks 
imprisonment to be served at HMP Styal. Christine had a long history of drug dependency 
and  at  the  time  of  her  arrest  she  was  known  to  be  a  user  of  Heroin,  Crack  Cocaine  and 
Amphetamine.  On  the  2nd  March  2019  Christine  was  taken  to  Wythenshawe  Hospital 
following  concerns  raised  during  a  healthcare  assessment  in  HMP  Styal.  Christine 
discharged herself from hospital and was returned to HMP Styal.  Just after 11pm on the 2nd 
March  2019  Officers  went  to  speak  to  Christine  in  her  cell  and  found  her  unresponsive, 
.  The  emergency 
having  tied  a  ligature 

Regulation 28 – After Inquest 
Document Template Updated 30/07/2021 

 response  codes  were  not  used  and  consequently,  when  Healthcare  attended,  they  were 
unaware  that  they  were  attending  an  emergency  and  did  not  have  the  necessary 
emergency  equipment  with  them.  Although  the  failure  to  use  the  emergency  response 
codes  was  not  a  contributory  factor  in  the  death,  it  caused  a  delay  in  providing  the 
necessary  medical  treatment.  Christine  was  taken  to  Wythenshawe  Hospital  but  sadly 
passed away the following day with her family by her side. 

5  CORONER’S CONCERNS 

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

The MATTERS OF CONCERN are as follows: 
(brief summary of matters of concern) 

I heard evidence during the course of this Inquest in respect of the process for using the 
emergency response codes, this is something which arises in many cases of this type.  I 
heard evidence in this case that the emergency response code was not used and as a 
consequence, those responding to the call were not prepared in the sense of emergency 
equipment, nor were they prepared mentally for the situation they had been asked to 
attend. 

I heard evidence in respect of the training and integrity testing that is now conducted to try 
to simulate the unexpected nature of an emergency, the evidence being that it is very 
difficult and that no training can fully prepare those staff who are first on scene for what 
they may find. 

I also heard evidence relating to measures within the control room, which might assist 
those first on scene in terms of the use of emergency codes and provide additional 
safeguards for those whose lives are 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 July 16, 2024.  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 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. 

Regulation 28 – After Inquest 
Document Template Updated 30/07/2021 

 
 9  Dated: 21/05/2024 

Charlotte KEIGHLEY 
Assistant Coroner for 
Cheshire 

Regulation 28 – After Inquest 
Document Template Updated 30/07/2021

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 Hmpps (PDF)
Director General of Operations 
HM Prison and Probation Service 
8th Floor Ministry of Justice 
102 Petty France 
London 
SW1H 9AJ 

Email:

26 July 2024 

Ms Charlotte Keighley 
HM Assistant Coroner for Cheshire 
The West Annexe 
Town Hall 
Sankey Street 
Warrington 
Cheshire 
WA1 1UH 

Dear Ms Keighley, 

Thank  you  for  your  Regulation  28  report  of  21  May  2024,  addressed  to  HMP  Styal.  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 Ms McDonald’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 use of medical emergency codes, the effectiveness 
of  training  in  this  respect,  and  measures  taken  within  the  control  room  during  incidents  of  this 
nature. 

Nationally, a video was launched in January 2024 that demonstrates how staff should respond to 
a medical emergency. This includes instructions on when to enter a cell in an emergency and the 
appropriate  use  of  Code  Blue  and  Code  Red  communications.  This  video  has  been  made 
available to all HMPPS staff, including Officer Support Grades (OSGs) and staff completing night 
duties  who  may  need  to  respond  to  a  medical  emergency.  Since  January  2024,  the  video  has 
been  delivered  to  all  new  officers  via  foundation  training  and  has  been  shared  locally  with 
Governing Governors. 

Staff are directed to utilise either Code Blue or Code Red communications in the event of 
discovering a prisoner whose life is at risk. Most staff have not experienced a traumatic event, 
therefore, to prepare them, a demonstration of a prisoner being discovered having ligatured has 
been included within the video to illustrate a traumatic situation they may sadly witness. 

As per PSI 03/2013, staff who discover a medical emergency are required to use either Code 
Red or Code Blue, which will alert the communication room staff. It is mandatory for the 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 communication room staff to automatically call an ambulance and await updates from the scene. 
The staff present at the scene must provide relevant information about the condition of the 
prisoner to the communication room staff, so that it can be relayed to the ambulance service for 
use in the triage process. These directions are reiterated within the Responding to Emergency 
Situations video.  

HMP Styal are committed to showing the video to all current operational members of staff by 
November 2024, which will aid in preparing staff for being first on scene at an unexpected or 
traumatic medical emergency. In the interim, staff are regularly issued Emergency Response 
Information Cards, which provide convenient and accessible information on when it is necessary 
to call an emergency code and are also regularly briefed on the importance of utilising the code 
system in the event of a medical emergency. Additionally, communication room staff have been 
issued a notice to staff that reinforces their duties in a medical emergency. 

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

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