Andrew Craig

Dear Ms Griffin , Thank you for your Regulation 28 reports of 25 June following the conclusion of the inquest into the death of Andrew Craig at HMP Guys Marsh on 16 September 2016 am responding on behalf of Her Majesty's Prison and Probation Service (HMPPS): would also like to apologise for the delay in responding to your concerns_ This delay was in order for us to be able to provide you with a full and detailed response know that you will share a copy of this response with Mr Craig's family and would first to express my sincere 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 concern about the use of drugs at Guys Marsh As well as saying that there should be further consideration around restricting the supply of drugs you have suggested that thought be given to replacing or adapting cell windows at the prison_ You have also asked that the policies and procedures relating Town like

to the dispensing and monitoring of medication are reviewed. am grateful to you for bringing these matters to my attention: In terms of your concern about the design of the cell windows at the prison, as yoU know; in January 2017 the Governor submitted an estate investment proposal to replace the cell windows throughout the prison: am pleased to tell you that the plan to upgrade the windows has now been approved and is provisionally on Ministry of Justice programme for delivery in 2019/20, subject to funding from the Strategic Asset Management Board. The new windows will be compliant with 'safer cell' standards and will be vented which will restrict the opportunity to pass items between cells With regard to wider drug strategies and procedures, the Governor and staff at Marsh are committed to helping men to address their substance misuse issues and are determined to prevent the number of illicit substance misuse related deaths in custody: The prison has made a number of changes following the tragic death of Mr Craig and will continue to monitor actions in order to improve safety and reduce the supply and misuse of drugs in the prison: Staff are committed to working to reduce the use of illegal drugs and recognise that the trading and consumption of illegal substances can have a serious impact on the welfare of those who are in custody: new local substance misuse policy has been developed in line with the Government Drug Strategy: The policy emphasises the importance of information sharing to tackle the problems associated with drugs in custody and prioritises reducing the availability of drugs in the prison through the use of search dogs and mandatory testing: The prison also tries to monitor any distribution of drugs around the prison through patrols and the use of CCTV 'Spice; an all prison approach' is an action plan designed to tackle the culture at the prison. As part of the plan, briefing sessions aimed at improving knowledge and understanding about substance misuse are available to all staff: To the sessions have covered psychoactive substances (PS) , prescription medication and steroids and have been well attended by both operational and non-operational staff: Staff different areas in the prison including security, safer custody and healthcare attend weekly meetings which are held to discuss and review the action plan. The meetings provide an opportunity to discuss a wide range of relevant issues such as security intelligence and the dissemination of information about spice use. The prison has also devised the Persistent Psychoactive Substances Intervention Plan (PPSIP) which works in a similar way to the ACCT document: This plan is used as a monitoring and reviewing tool for prisoners who persistently abuse PS_ Effective information sharing is and the care of men on a PPSIP document is through a multi-disciplinary approach, the skills of different staff as appropriate The initiative allows early intervention and preventative work to promote prisoners' wellbeing: It also helps them to take responsibility for themselves and to make informed, safer choices whilst in custody and out in community: At a national level, we have created the Prison Improvement Directorate within HMPPS HQ, in which is a new Drugs Taskforce set up to tackle the use of drugs in the Guys drug drug date, from key using the

prison, including psychoactive substances (PS): The Taskforce includes secondees the Police and NHS England, and experienced senior operational managers from prisons, so that expert advice and support can be provided to prisons_ In addition to directly supporting the operational in the coming months the Taskforce will publish a strategy for tackling drug misuse in prisons, alongside practical guidance and good practice for prisons to follow_ Speakers from the taskforce attended a symposium at Guy's Marsh in August alongside partners from NHS England, Specialised Services AWP Mental Health NHS Trust and the Exeter Drugs Project: The event was attended by staff and also prisoners with PS issues, some of whom of their experiences_ know that Care UK is responding to your concerns about the dispensing and monitoring of medication a healthcare perspective, but it may be helpful if set out the steps which the prison has taken: HMP Guys Marsh and Care UK are working together to make improvements to the way that medication is dispensed and have introduced a number of measures to reduce the opportunity for prisoners to access medication which has not been prescribed to them_ In future, managing the conduct of those queuing for medication, ensuring that there is no bullying and that no medication is concealed, will be the responsibility of one person, rather than a different officer every day: This will both provide consistency and improve security information sharing between prison and healthcare_ The floor in front of the dispensary has been clearly marked so that prisoners know where to stand both for security purposes and to ensure that their own and other people's privacy is respected. CCTV is in place in the dispensary area and staff are provided with lists of those who should be attending healthcare for medication_ Having seen the response from Care UK | understand that healthcare staff will not be checking each person's mouth to ensure that have swallowed their medication. However, prison staff will be present to deal with any issues and will support healthcare staff when they have reason to believe that a prisoner has not swallowed medication or is being otherwise non-compliant: Finally; HMP Marsh has implemented a practice of medication management by which certain drugs will not be in the possession of prisoners but will be dispensed by healthcare: This is to prevent the drugs being diverted from one prisoner to another. Individual secure medication boxes have been ordered and will be fitted in each cell by the end of the year to allow each prisoner to safely store their in-possession medication. It is hoped that this will help to reduce the opportunity to take and misuse prescription drugs from others. Thank you once again for bringing these concerns to my attention_ Please be assured that learning from the circumstances of Mr Craig's death will be shared more widely with colleagues across the prison estate: from line _ key spoke from and wing they Guys

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care Response: We are aware that medication is diverted from the Healthcare department and we have already implemented a number of factors that will help to reduce this We have CCTV working in this area and we follow the adjudication process diverting of medication is observed, All healthcare staff understand that if suspect a patient is concealing medication then they can confront the patient and ask them to show the evidence that the medication has been swallowed. However; we don"t think it is practical or appropriate to embed this practice into individual medication administration. The prison service is looking at creating a specitic job description for the officer working within the healthcare department which will improve the management of behaviour in the medication queues and help prevent diversion. Action: See below table which outlines the actions that have been implemented: Objective Immediate action Training To be completed by Review the role and New Job Description nla Prison Service responsibilities of the that identifies the officer working within expectations and healthcare. responsibilities Ensure staff have the AIl relevant staff invited ACGP online Healthcare relevant substance to partake in the RCGP substance misuse misuse training to Substance Misuse training: Completed 27lh June identify diversion training to enhance 2018 techniques and understanding: understand behaviours_ ISMS agreed to provide ISMS department training package to all to arrange in healthcare staff. house training: November 2018 Matter of Concern 2 Evidence was given by the Head of Healthcare, tthat there are 3 allocated times during the day when Prisoners collect medication: During these tlmes, there are around 70 prisoners collecting thelr medication: The room can be quite chaotlc and loud, and prisoners can be in close contact clambering over each other. She described the hatch as overloaded: This Is an Ideal scenario to pass medication to one another wlthout detectlon: Response: We have made some changes to our practice already to improve this situation: We have reviewed our prescribing in line with the 'In Possession Policy' and as a consequence, the number of prisoners in receipt of supervised medication in the morning and evening has been reduced to approximately 55 patients per medication dispensing times. Care UK Heallh & Aehabililafion Senvices Limiled Aegislered in England No 10498997 Reglslered Oifice: Connaught Hausa, 850 The Cresceni , Colchester Buslness Park, Colchester, Essex CO4 9Q8 they every

care We have marked the floor in front of the dispensary with a large green box that indicates to the patients where are able to stand, in order to respect confidentially and allow for patient privacy: The healthcare staff are aware that they must not start medication rounds until there is a prison officer present. The prison service coordinates and controls the level of attendance for medication by calling individual units to send their patients. However, we acknowledge that we need to manage this better and have requested that smaller numbers attend so that the healthcare waiting area doesn"t overcrowded_ A medication list is sent to each unit every day and only the patients on this list should be allowed to collect medication. Action: We have implemented the actions outlined in the table below: Obiective Immediate action To be completed by Place written guidance on Make a poster that clearly Healthcare indivvidual dispensaries to educate advertises the purpose of the the purpose of green box: green box 23r July 2018 Ensure officers enforce patient Officers to encourage prisoners Prison Service confidentially and privacy to to respect other prisoner's prevent potential bullying of personal space to prevent vulnerable patients_ bulling and knowledge of personal information: Continue t0 monitor Not In Review NIP patients during Healthcare Possession (NIP) status of patients medication management and change to weekly or monthly meeting; Patients booked for possession when safe t0 do sO. review with pharmacy technicians if appropriate changes could be made. Review the process of coordinating Create a new job description for Prison Service controlling the amount of the Prison Officer detailed to patients in the healthcare waiting work within healthcare. area at one as currently we have three wings at a time arrive in Review the volume of prisoners healthcare which could be 20+ attending healthcare at each prisoners. medication session: Continue t0 encourage prison wing All prison staff reminded of the Prison Service staff to use the lists provided for purpose of medication Iist and approved patients for medication. how must to adhere to it. Care UK Health Aehabililalion Sarvices Limiled Aeglstered in England No 10498997 Aegisterad Oliice: Cannaughi Hause, 850 The Crescent; Coldhustar Business Park; Colchester, Essex CO4 908 they get the and time , they

care Improve the appearance and Replace broken chairs Prison Service furnishing within the waiting area. Increase seating capacity Completed 16h July 2018 Paint the waiting area and remove Matter of Concern 3. During the routine medication dispensing, there are no checks done to confirm that Prisoners have actually swallowed the medication. This can allow them to retain the medication for redistribution: Response: Whilst we understand the diversion of medication happens we do not think it is acceptable to ask for visual evidence each time. We do not have the within the medication queues to ensure prisoners show us they have swallowed their medication. We have physical wall between medical staff and the patient and would not be able to ensure this happens: Due to confidentiality reasons we do not feel it would be appropriate for officers to check patients mouths either. However , healthcare staff do ask to check a patient's mouth if we have reason to believe that a patient has diverted their medication: Currently the officer working within healthcare could be any prison officer in the establishment which doesn't provide any consistency: Expressions of interest have been sent out on a notice to staff to have a pool of officers that will be attached to healthcare. This will enable consistency and enhance sharing of information between healthcare and prison staff. Plans to move the ISMS dispensary to the healthcare department have been discussed, This will enable uS to dispense all controlled drugs under the same scrutiny and security as ISMS medication. However this requires investment by the prison. Action: The prison service has implemented the actions outlined in the table below: Objective Immediate action To be completed by Expressions of interest sent out to Prison Service staffing group for a dedicated group of prison staff to work within healthcare_ All cells to have suitable secure This task is carried out Prison Service storage facilities to store weekly and via the decanting and monthly medication: refurbishing of each unit: Care UK Heallh & Rehabilitallon Sarvices Limiled Aegislered England No 10498997 slerad Olfice: Connaughi House, 850 Tha Crescanl; Calchaslar Business Paik, Colchester, Essex CO4 908 graffiti. ability being Aan'

care Capital bid to move the ISMS Governor to write capital bid: Prison Service dispensary to the healthcare department: Matter of Concern At the last inspection by Her Majesty's Inspectorate of Prisons these issues were raised and attempts have been made to improve the situation: There are now Prison Officers at the Healthcare department during dispensing times; but usually only one Officer stood in the room where the medication hatch is located and another outside the room: Despite these changes; Mrs Jameson advised that the arrangements at medication dispensing times continue to be an ongoing problem that facilitates the illicit supply of prescription drugs in the Prison: She advised that the process could be made saferandmore secure: Similar concerns were also raised by one Of the Prison GPs Response: The role of the Healthcare Prison Officer needs to be addressed and organised by the prison service Action: The prison service has implemented the actions outlined in the table below: Objective Immediate action To be completed by Review the role and New Job Description that identifies the Prison Service responsibilities of the officer expectations and responsibilities: working within healthcare All cells to have secure These have already been ordered and Prison Service safes to store in possession will be incorporated as each wing is medication: refurbished: Matter of Concern 5. lalso gave evidence that the Prison is overwhelmed with illicit drug particularly psychoactive substances and that the Healthcare team receive 3 emergency calis a week at HMP Guys Marsh to assist In resuscitating Prisoners from overdoses: Response: This is predominantly matter for the prison service in terms of looking at how t0 reduce and control the use of illicit drugs within the prison. Care UK Health Rohabllitation Sorvices Umiled Registered in England No 10498997 Aegisterod Office Connaughl House, 850 The Ciesceni, Calcheslor Business Park, Calchesler, Essex CO4 9Q8 uset drug

care As you heard evidence on, the HMP Guys Marsh has large amounts of new psychoactive substance ("NPS") use These drugs cause a variety of problems in the prison estate, in addition to drug overdoses such as debt; bullying, diverting medication, staff assaults, conditioning of staff, on gong illegal activity and prisoner on prisoner assaults. The table below details the amount of NPS incidents that are responded to by healthcare each month from April 2017 July 2018: Month NPS incidents requiring treatment April 2017 May 2017 6 June 201 July 2017 August 2017 September 2017 October 2017 November 2017 Danwanbeozo" 1 February 2018 March 2018 April 2018 May 2018 June 2018 July2018_ 30 We have worked closely with the prison service to provide first aid training by prison staff. Objective Immediate action To be completed by Healthcare staff to provide a bite Lead Nurse and Paramedic to Healthcare size training first aid session. provide this training: Completed 2nd July 2018 Prison CM's to have bespoke Training arranged via external Prison emergency response training provider. Training is named as Service COIL (Custody Officer Immediate Life Support) On-going health promotion New posters sourced from NHS Healthcare advertised around the estate England highlighting the risks of using Completed NPS 19lh July 2018 Caie UK Hballh Auhabililalion Services Umned Aegislered In England No 10490997 Registered Otfice: Connaughl House , 850 The Crescent, Cokchesler Business Park; Colchesier, Essex CO4 908

care We are committed to providing high quality healthcare service at HMP Guys Marsh and are doing everything we can to ensure that prisoners are as safe as possible and receive the best quality care. We will ensure that the lessons arising this inquest are not just implemented at HMP Guys Marsh but across Care UK's services: We trust that the above responses provide the information that you require but please do not hesitale to contact us if Care UK can be of any further assistance.