Nigel Keenan

Dear Mr Cohen, Re: Regulation 28 Report to Prevent Future Deaths – Nigel John Keenan who died on 13th March 2025.

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 13th May 2026 concerning the death of Nigel John Keenan on 13th March 2025. In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Nigel’s family and loved ones. NHS England is keen to assure the family and yourself that the concerns raised about Nigel’s care have been listened to and reflected upon.

Your Report raised the following concerns:
1. Mental health provision is only commissioned within HMP Haverigg during the week and is not available at the weekends.
2. Category D 'open' prisons do not allow for very regular or constant observation when required, meaning prisoners have to be transferred to a closed prison for these observations. You were concerned this may mean prisoners in crisis deny their intent to self-harm to avoid being transferred.

With regards to overnight staffing levels and the lack of clinical presence overnight, outside of weekday hours; the commissioning and provision of healthcare services across the England prison estate is based on a national service specification and health needs assessment for each establishment. It is overseen by the NHS England regional health and justice commissioning team. HMP Haveriggg is a Category D establishment, which means it is considered as someone’s ‘usual residence’, or home. There is therefore no provision for overnight healthcare. The national service specification details the need for access to community out of hours service for any concerns that need to be assessed and treated out of prison healthcare hours.

National Medical Director NHS England Wellington House 133-155 Waterloo Road London SE1 8UG

22nd June 2026

A review of the NHS England national health and justice service specifications is currently underway, with a view to finalising this in Summer 2026, and any learning from this case will be used to ensure that the primary care specification continues to support commissioners to be able to tailor services to meet the needs of their prison population. They ensure providers are clear on core service delivery and standards they are expected to prioritise which includes access to Out of Office Hours services. Delivery of these specifications is the responsibility of regionally regional commissioners under contract management processes

Regional Response NHS England has liaised with the NHS England’s North West Region Health & Justice team regarding your Report. They have advised that there is a 7-day service at HMP Haverigg. The hours are 8am-6pm Monday to Friday and 8am – 4.30pm Saturday and Sunday. The provider operates an ‘on call’ service over the weekend, with a core service delivering Monday to Friday, following a review of engagement over the weekends and prisoners reporting a preference for appointments during the week.

Practitioners are contactable via an on-call number and will attend the prison to see anyone who requires assessment or intervention. There have been some issues with communicating this to the primary care provider and this has been rectified.

Further communications and meetings have occurred with HM Prison and Probation Service (HMPPS) to outline the offer and this has been agreed. The North West Health & Justice will review the provision over the next 6 months, looking at need and demand for weekend on site presence.

I would also like to provide further assurances on the national NHS England work taking place around the Reports to Prevent Future Deaths. All reports received are discussed by the Regulation 28 Working Group, comprising Regional Medical Directors, and other clinical and quality colleagues from across the regions. This ensures that key learnings and insights around events, such as the sad death of Nigel, are shared across the NHS at both a national and regional level and helps us to pay close attention to any emerging trends that may require further review and action.

Thank you for bringing these important patient safety issues to my attention and please do not hesitate to contact me should you need any further information.