HM Prison and Probation Service
Central Government
Action Taken
HMP Frankland revised local contingency plans and re-issued instructions to staff following Sharon Butcher's death to ensure that staff do not delay in calling an ambulance in all cases where there are serious concerns about an offender's health. The local protocols provide clear guidance to all staff to ensure timely, appropriate and effective response to medical emergencies. (AI summary)
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Dear Coroner; RE: the death of Sharon Butcher on 25 August 2014 whilst In HMP Frankland Thank YOu for your ketter dated 31 March addressed to the Govemor of HMP Frankland and the National Offender Management Service conceming the Inquest into the death of Ms. Sharon Butcher: Your letter has been passed to Equality Rights &d Decency (ERD) Group in the National Offender ement Service (NOMS) to respond, a8 we have policy responsibllity for sulckde prevention and selcham management and for sharing keaming from deaths In custody: am als0 responding on behali HMP Frankland: In your report,_YOU expressed your concem about the delay in for an ambulance when the emergency medical code was broadcast You may be aware of PSI 03/2013 Medical Emergency Response Codes which sets the national instructions for calling & medical emergency over the establishment radio network in all prisons and NpMS operated Immigration Removal Centers. HMP Frankland revised their local contingency plans and re-issued instructions follwing death of MMs: Sharon Butcher t0 ensure that all staff understand, that must not delay in calling an ambulance irall cases where there are serous concems about the health ofan offender; The local protocols now provide clear guldance to all staff to ensure timely, appropriate and efiective response to medical emergencles and thereby maximise the likelihood of a positive outcome for the patient: The protocol defines the nature of the medical emergency with the use of a two level code (code Red and Code Blue) system that differentiates between blood and other injuries, such as breathing difficulties, unconscious casualties as specified by PSI 03/2013. In April 2015 an additional learing bullketin was issued nationally by ERDG (please see attached): In addition HMP Frankland are also working with the North East Prisons cluster and the North East Ambulance Service to ensure joint working and conslstency of approach across all establishments. hope that you find this response helpful and reassuring: