Individual at Channings Wood

Investigation into the circumstances surrounding the death
of a man in hospital on 14 October 2005 whilst a prisoner at HMP
Channings Wood.
REPORT BY THE PRISONS AND PROBATION OMBUDSMAN FOR
ENGLAND AND WALES
August 2006
This is the report of an investigation into the death of a prisoner. The man
who is the subject of this report was a prisoner at HMP Channings Wood and
died from a ruptured aortic aneurism in the early hours of the day on
14 October 2005 in hospital.
I offer my sincere sympathy and my condolences to the man‘s widow and to
his other family and friends for their loss.
The man completely denied the offences for which he was imprisoned and
was appealing against both sentence and conviction when he died. His
widow and his solicitors continued with the appeal and arranged for it to be
heard at a later date. In January 2006, the Appeal Court quashed his
convictions.
My office investigates the deaths of all prisoners in custody, including those
due to natural causes. In this case the investigation was carried out by one of
my investigators. The investigator asked Teignbridge Primary Care Trust to
commission an independent clinical review. Their assistance is much
appreciated.
I am also grateful to the Governor of Channings Wood and to the Principal
Officer who acted as liaison officer for their assistance during the
investigation.
Stephen Shaw CBE
Prisons and Probation Ombudsman August 2006
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Contents
Summary 4
The investigation process 5
Background 6
The Man
HMP Channings Wood
Key findings 8
Recommendations 17
3
Summary
1. The man who died was accused of serious sexual offences and
committed for trial on 3 April 2002. While awaiting trial, he was given
bail. On 24 March 2003, he was convicted of 10 charges and was
remanded in custody to HMP Winchester while pre-sentence reports
were prepared. On 4 April, he was sentenced to 5 years 6 months
imprisonment and ordered to register under the Sex Offenders Act
indefinitely.
2. He completely denied the offences and was appealing against both
sentence and conviction when he died. On 26 January 2006, the
Appeal Court posthumously quashed his convictions.
3. During 2003, the man spent just over five months at HMP Winchester.
Because of difficulties he had in walking after breaking his right ankle,
he could not be accommodated in the vulnerable prisoners unit. As a
consequence, he spent all his time in the Healthcare Centre.
4. He suffered from poor health throughout his time in prison. In addition
to his limited mobility, he had angina and also consulted a doctor about
dermatitis, indigestion, insomnia, shoulder pain and chest pain. He
continued to smoke and put on weight during his imprisonment.
5. On 4 September, he was transferred to Channings Wood, a training
prison. He was placed in the vulnerable prisoners unit which
specialises in running Sex Offender Treatment Programmes. The man
maintained that he had not committed any offences and refused to
undertake the courses. However, he did attend basic literacy classes
and was awarded certificates for the progress he made.
6. He was seen by healthcare staff at regular intervals during his time at
Channings Wood. In mid October 2005, he complained of pain in his
groin. During the afternoon and early evening, he was seen three
times by healthcare staff who gave him medication to ease his
symptoms. A doctor’s appointment was made for him the following
day.
7. At 8:00pm, a member of staff found the man collapsed on the floor of
his cell. An emergency ambulance attended and the paramedics
resuscitated him before taking him to a local hospital. Doctors
diagnosed that he had a ruptured aortic aneurism and told prison staff
to advise his next–of-kin to go to the hospital as quickly as possible.
His wife, who lived some distance away, arrived at 11:35pm. The man
died an hour later.
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8. The following day, a governor and chaplain visited the man’s wife at
her home and offered her information and support. She visited
Channings Wood the following Monday. A memorial service was held
in the prison and many prisoners signed sympathy cards that were sent
to the man’s wife.
9. My report includes one recommendation in addition to those in the
clinical review.
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The investigation process
10. The man died on a Sunday in mid October 2005, and the investigation
was opened by letter three days later.
11. My investigator, visited Channings Wood on 24 November and 15
December 2005. She spoke to the Governor, to a member of the
Independent Monitoring Board, and to a representative of the Prison
Officers’ Association. She also spoke to both uniformed and non-
uniformed staff. Some formal interviews were conducted and my
investigator was given access to all the man's prison records, including
his medical records.
12. One of my Family Liaison Officers contacted the man’s widow. On 23
November, she and the investigator visited her. The man’s widow
raised several questions, particularly about the healthcare her husband
received. I trust this report will go some way to answering those
questions.
13. A member of Teignbridge Primary Care Trust and a member of the
Devon Prisons Health Partnership carried out a clinical review of the
man’s medical treatment. Their report is at Annex 1. They make eight
recommendations, all of which I endorse. I particularly commend the
four that concern the pro-active management of patients with coronary
heart disease.
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Background
The Man
14. The man who is the subject of this report was born in 1939. He died at
the age of 66 in October 2005 from a ruptured aortic aneurism. (An
aneurism is a bulge in the wall of an artery, in this case, an artery of the
heart.)
15. The man was a skilled manual worker. However, following two
industrial accidents, he retired and was registered as disabled.
16. He was charged with serious sexual offences and committed for trial on
3 April 2002. While awaiting trial, he was given bail. On 24 March
2003, he was convicted of 10 charges and remanded in custody while
pre-sentence reports were prepared. On 4 April 2003, he was
sentenced to 5½ years imprisonment and ordered to register
indefinitely under the Sex Offenders Act.
17. Both during his trial and subsequently, the man denied absolutely the
offences with which he had been charged. On 23 February 2005, he
was given leave to appeal against his convictions and sentence and
the appeal was set down for late October. Sadly, he died one week
before the hearing. At his wife’s request, his solicitors arranged for it to
be heard at a later date. On 26 January 2006, the Appeal Court
posthumously quashed his convictions.
HMP Channings Wood
18. Channings Wood is a Category C training prison built on the site of a
former Ministry of Defence base. The prison officially opened in July
1974. A building programme took place in the 1980s and early 1990s
adding further accommodation.
19. The prison takes men with a wide range of sentence lengths. It
contains a specialist Therapeutic Community for tackling drug abuse
and a vulnerable prisoners unit which specialises in Sex Offender
Treatment Programmes.
20. Not all prisons have Healthcare Centres that provide 24-hour care and
inpatient beds. Channings Wood falls into this category. Its Healthcare
Centre operates from 8:00am to 8:00pm on weekdays and from
8:00am to 5:00pm at the weekend. General practitioner surgeries are
held Monday to Friday. Prisoners who want to see a doctor go to the
Healthcare Centre between 8:15am and 8:45am or between 11:30am
and noon, and appointments are booked for as soon as possible
thereafter. The same procedure is followed for seeing a dentist or
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optician. When necessary, Health Care staff directly refer prisoners to
the doctor, dentist or optician.
21. The vulnerable prisoners unit houses 150 men in a house block and a
prefabricated building. It forms a separate unit in the prison and is in its
own compound. During the week, prisoners spend a reasonable
amount of time out of their cells. They are unlocked at 8:00am and, if
they attend work or education, remain out of their cells until lunchtime.
Those who do not attend activities are locked up from 8:45am until
10:30am. After lunch, prisoners are unlocked for activities at 1:40pm;
those who do not take part are unlocked at 3:30pm. All prisoners are
again locked up at 4:40pm and unlocked an hour later for tea.
Prisoners on association are out of their cells from 6:15pm to 7:30pm,
at which time all prisoners are locked in for the night. A similar
schedule operates at the weekend, although prisoners do not attend
work and the evening lock up is at 5:00pm.
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Key findings
HMP Winchester
22. In March 2003, the man was convicted of serious sexual offences. He
was remanded in custody to HMP Winchester for a pre-sentence report
and a medical report. It was his first time in prison.
23. When he arrived at the prison, he went through the reception process
which included a first reception health screen. However, his original
medical record, including the health screen form, was lost at some
point between 24 and 29 March. A replacement form was completed
on 25 May. It noted that the man had limited mobility because of an
injury to his right ankle. He had broken it in September 2002 and was
still experiencing pain and difficulty in walking. It also recorded that the
man also suffered from angina for which he had a GTN spray to ease
the symptoms. He asked to be segregated from other prisoners
because of the nature of his convictions. The vulnerable prisoners unit
could not accommodate him on the ground floor (which would have
been necessary because of his mobility problems), so he was admitted
directly to the Healthcare Centre.
24. The continuous medical record began on 29 March with an entry
recording the man’s return from Royal Hampshire County Hospital in
Winchester with medication that the prison doctor had prescribed. On
the same day, he fell in a corridor in the Healthcare Centre but got to
his feet unaided and told staff that he was not hurt. An accident form
was completed. Two days later, he told staff that his ankle was more
painful after the fall and he could not put his weight on it. He attended
hospital for an x-ray which showed that there was no new fracture and
the old break appeared to have healed.
25. Late in the evening of 28 April, the man complained of pains in his arm
and a tight chest. Staff administered his GTN spray and gave him
oxygen, and this eased the symptoms. He was later reviewed by the
prison doctor and then admitted to hospital. He returned to Winchester
the following day. Hospital staff contacted prison staff to say that the
man had had an angina episode.
26. During May, the man attended Healthcare with chest pain and angina.
He also continued to complain of pain in his leg and insomnia for which
he was prescribed medication. On 20 May, his medication was
reviewed. The medical notes refer to his missing an appointment with
the orthopaedic surgeon, but no reason for this is given. However, the
plan was to arrange an appointment at a local hospital once his notes
had been received from his family doctor.
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27. By 23 May, the prison doctor felt that, once the man had attended a
cardiac appointment, he could leave Healthcare and move to a
vulnerable prisoners unit that could accommodate a prisoner on
crutches. Staff contacted HMP Maidstone and agreed with staff there
that he would be transferred after his cardiac appointment. A week
later, he hurt his right foot and Healthcare staff arranged for him to
attend hospital for an x-ray. The x-ray results were clear. An entry on
17 June noted that he had an appointment for an electrocardiogram on
24 June and that he was fit for transfer.
28. As a sentenced prisoner who was serving a long sentence, the man
could not have remained at Winchester as he needed to be in a training
prison where he could undertake courses to address his offending
behaviour. Although he denied the offences of which he had been
convicted, he still needed a sentence plan that included the opportunity
to participate in such courses.
29. Healthcare staff contacted his family doctor who confirmed that, prior to
his imprisonment, he had used a TENS machine to help reduce his
pain. He was then issued with one by the Healthcare staff. Over the
next two months, the man was treated for dermatitis, indigestion,
insomnia, shoulder pain and chest pain.
30. On 19 August, a member of probation staff assessed the man’s training
needs as part of the development of his sentence plan. The targets set
were for him to be referred to the Education Department to receive help
with literacy skills and to be assessed for his suitability for the
Enhanced Thinking Skills programme. It was noted that the man
denied the offences of which he had been convicted and refused to
undertake the Sex Offender Treatment Programme. The two other
targets were for him to continue to receive support from Healthcare
staff and to be transferred to a training prison.
HMP Channings Wood
31. On 4 September 2003, Healthcare staff at Winchester reviewed and
discussed the man’s medical records and noted again that he was fit
for transfer. Later that day, the man was transferred to Channings
Wood in Devon. He was accommodated in a single cell on the ground
floor of the vulnerable prisoners unit.
32. The following day, a reception health check noted that the man had
experienced two heart attacks eight years previously that appeared to
have been treated with an angioplasty. (An angioplasty is a surgical
procedure to widen one of the arteries leading to the heart.) He
smoked six cigarettes a day and reported experiencing continued
angina episodes. He was assessed as being unfit for physical
education and work, but fit for food handling. His weight was recorded
as 83kg with a blood pressure reading of 160/100.
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33. On 15 September, probation staff noted that he was still denying the
offences of which he had been convicted and did not want to do any
offending behaviour courses. Although unable to work because of his
disabilities, he said that he would like to work in the gardens, perhaps
potting. He was assigned to Basic Education classes on 13 October,
but had difficulty getting up the stairs to the classroom. A note in his
personal record on 6 November says that he had then agreed to attend
the classes. On 21 November, the Psychology Department recorded
that he had not been referred for the Enhanced Thinking Skills course
as he had told staff that he was fine as he was and would not take a
place if one were offered.
34. In January 2004, staff assessed whether he should be moved from the
standard level of the Incentives and Earned Privileges Scheme (IEPS)
to the enhanced level. However, because he refused to undertake
offending behaviour courses, staff decided he should remain on the
standard level. All subsequent reviews reached the same decision for
the same reason. Channings Wood, like many other prisons, explains
to prisoners that moving from standard to enhanced level depends on
them meeting certain criteria, one of which is to address their offending
behaviour. Those who do not meet the criteria do not move to the
enhanced level with its extra privileges. The man therefore remained
on standard level of the IEPS throughout his time at Channings Wood.
35. When he was assessed as to his suitability for Category D status, this
was also refused because he refused to undertake offending behaviour
courses.
36. The man’s health was not good during the first half of 2004, and he
was treated by Healthcare staff for a number of problems. These are
listed in detail in the Clinical Review at Annex 1, but are summarised
below.
37. On 3 January 2004, he was seen in his cell by a nurse after he
complained of chest pain and dizziness that was worse when lying
down. His blood pressure and pulse were taken and the nurse noted
that his colour was good. He said that his anti-acids were not working.
His GTN spray was administered but this did not have much effect. A
prison doctor reviewed him on 5 and 7 January 2004. By then, his
blood pressure had decreased. The doctor ordered tests but the
results showed no abnormalities.
38. A month later, he again complained of angina and the doctor ordered
more tests. Most found no abnormalities, but an electrocardiogram
revealed that one of the chambers of his heart was enlarged and at
some time in the past some of the tissue had died. On 1 March 2004,
he complained of shortness of breath on exertion and his medication
was increased. He was further reviewed on 24 March and it was noted
that his weight had increased to 89kg.
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39. During April 2004, he was seen on four occasions for abdominal
symptoms. He was examined and investigated and no abnormalities
were detected.
40. On 3 June 2004, the man presented with chest pain but with no further
symptoms. Observations were taken and he was reassured. On 23
June, staff in Healthcare noted that he was now 8kg heavier than when
he arrived at Channings Wood
41. At 1:15pm on 27 July 2004, the man was found on the floor of his cell
complaining of chest pain. Healthcare staff treated him in his cell and
then he was taken to the Accident and Emergency Department at
Torbay Hospital. He was admitted for observation and tests. The
doctors diagnosed “non-cardiac chest pain” and no new medication
was prescribed. He attended Healthcare on a number of occasions
over the next four months and staff continued to monitor his blood
pressure and pulse rate.
42. On 6 December, he applied for release on temporary licence so that he
could attend his sister’s funeral without an escort. This was refused,
but he was permitted to attend with an escort.
43. The man attended Healthcare on 22 December when he complained of
abdominal and groin discomfort.
44. On 20 April 2005, he again complained of abdominal pain which he
said he had had for two years. An examination and history was taken;
although the Inmate Medical Record was not available to the examining
doctor. No gross abnormality was detected and the man did not agree
to be referred to another doctor. A specimen was sent for analysis on
28 April 2005 with no abnormality reported. The intention was for the
patient to be reviewed in one week, but this did not take place. No
reason for the lack of a review was given in the medical notes.
45. On 6 June, he attended Healthcare because of pain in his left shoulder
which he said had persisted for four months. He did not mention
having any abdominal pain at that time.
46. He was then seen on 13 July as he was concerned about his right
ankle. On examination, there were a few dilated capillaries with
nothing more sinister detected. He received advice and reassurance.
47. He asked for, and received, two blood pressure checks in August and
September. He was advised to stop smoking. He was reassured by
his doctor later that month after he expressed concerns about
longstanding benign (non-cancerous) tumours on the wall of his
abdomen. Although anxious, he appeared otherwise well.
Events leading up to his death
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48. The man was seen by a nurse at 2:00pm on the day he died, as he
was complaining of pain in his right groin. She gave him
Mismagtrisilicate, a drug to treat wind, and advised him to drink plenty
of fluids and move around. An appointment to see a doctor the
following day was also made. At 4:15pm, with the man still in pain, the
nurse gave him further Mismagtrisilicate and two paracetamol tablets.
At 6:30, an officer saw him lying on his bed and he told her he had
stomach pains. She asked him if he wanted to see a member of
Healthcare staff and he replied that he had seen someone earlier.
However, as he was not feeling any better, the officer called Healthcare
and asked someone to attend.
49. A healthcare officer (HCO) saw the man in his cell at approximately
6:45pm. The man told him that he had stomach pain that began on the
lower right of his back and moved round to his stomach, and that it
came and went. He said that he had taken six paracetamol through the
day and had two tablets left in case he needed them. He said that he
was most comfortable when he was lying down quietly and that he was
not too uncomfortable at the moment. The HCO checked his blood
pressure, temperature and pulse, and offered him further
Mismagtrisilicate which he refused. He satisfied himself that the man
was in a stable condition and did not need to see a doctor at that time.
He also noted that the man had an appointment with the doctor in the
morning.
50. At 8:00pm, the prisoners were all in their cells for the night, and day
staff went off duty. There was only one officer present in the unit until
the night shift staff arrived at approximately 9:00pm. Shortly after
8:00pm, the prisoner in cell 27 heard a bang on the wall of his cell. He
thought his neighbour was complaining that his television was too loud,
so he turned down the volume. A few moments later, he heard a thud
from the man’s cell and the man called to him to ring his bell as he
needed help. (Each cell has an emergency bell positioned about five
feet from the floor with which to call an officer. However, to use it, a
prisoner must be capable of reaching it which the man was not.)
51. The prisoner in cell 27 rang his cell bell to summon an officer. When
the officer went to see what was wrong, the prisoner told her that he
had heard the man next door shouting and he was in a bit of trouble.
The officer immediately went to cell 26, and looked through the flap in
the door. She saw the man lying on the floor, on his side with his back
to the bed. He was conscious but had a slight graze on his forehead
and appeared to have fallen out of bed. (The man had been supplied
with a high bed to replace the standard prison bed for medical
reasons.)
52. By now it was about 8:10pm. The officer called for the Orderly Officer,
the most senior person in the prison at that time, to come to her
assistance. She entered the cell and told the man to lie still as she did
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not know the extent of his injuries. He did not want to remain on the
floor, so she took a pillow from the bed and put it under his head to
make him more comfortable.
53. The Orderly Officer, a principal officer and his assistant, a senior
officer, were both in the gate room when the officer called. The
principal officer grabbed his keys and radio and both men immediately
went to the vulnerable prisoners living block. On the way, the principal
officer asked the communications office for the exact location and was
told it was cell 26. It took about five minutes for them to get there.
54. Once they had arrived at the cell, the principal officer asked the man
what was wrong. He replied that he had a pain in his right groin. He
was sweating profusely, looked grey and was very hot, even though the
window was open. The senior officer went to the office at the end of
the landing to phone for an ambulance. The principal officer thought
that the man was having a heart attack and asked if he had taken any
medication. The man pointed to all his medication on his locker and
said that he was on medication for his heart, but that he did not need it.
The principal officer asked him if he wanted his GTN spray but he said
that he did not. The senior officer returned and said that an ambulance
was on its way. The principal officer went to organise two officers to
escort the man when he went to hospital (this is the normal procedure
when prisoners are taken by ambulance to hospital). When the
principal officer returned to the cell, the man was trying to sit up as he
said he was uncomfortable on the floor. Staff tried to keep him in the
recovery position, but he resisted so they left him lying on his back.
55. The ambulance arrived and drove into the prison as far as the internal
fence that separates the vulnerable prisoners unit from the other
accommodation blocks. The two paramedics, a man and a woman,
went through the pedestrian gate and into the unit which is roughly 20
yards away. They arrived at 8:30pm and began to treat the man. They
moved him to his bed and put an oxygen mask on him. They tried to lift
him onto the stretcher, but he did not want to get on it. The principal
officer helped the male paramedic to lift the man onto the stretcher.
They then put a blanket over him, put on the safety straps and wheeled
him out into the back of the ambulance. He was conscious while all
this happened.
56. At that point, the principal officer went off to collect the paperwork for
the officers who were to accompany the man. While he was away, the
paramedics radioed for assistance as the man had lost consciousness
and his condition had become more serious. At 8:55pm, a third
paramedic arrived and the principal officer ran with him through the
prison to the ambulance where the first two paramedics were giving the
man cardiopulmonary resuscitation (CPR). (CPR is given to a patient
whose heart has stopped and involves mouth-to-mouth resuscitation
and chest compressions.) The third paramedic joined the other two in
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the ambulance and they stabilised the man. At 9:10pm, the ambulance
left the prison for Torbay Hospital.
57. At 9:30pm, the ambulance reached the hospital and the man was taken
to the resuscitation room. Hospital staff did not permit the two
escorting prison officers to enter the room, so they remained outside.
Ten minutes later, the hospital staff advised the officers to contact the
man’s next-of-kin to tell them to come to the hospital. A senior officer
had taken over from the principal officer as the senior person on duty at
the prison and he looked for the man’s wife’s telephone number. It was
not listed on his records, but the senior officer found it by looking in the
telephone records.
The Governor should ensure that, as far as possible, all prisoners
provide next-of-kin details for their records and that these are
checked and updated on an annual basis.
58. At 9:50pm, the senior officer telephoned the man’s wife, told her what
had happened, and advised her to go to the hospital as quickly as
possible. At 10:00pm, he was taken for x-rays and 20 minutes later the
officers were told that he was breathing unaided. However, at
11:00pm, the consultant told the escort that his condition was
untreatable, and that all they could do was keep him alive until his next-
of-kin arrived. The man’s wife arrived at the hospital at 11:35pm. The
officers at the hospital had been told by prison staff to be unobtrusive
when she arrived and they were. He passed away at 12:35am.
59. The Head of Resettlement and one of the chaplains visited the man’s
widow in her home the next morning. They offered her information and
support, including help with the funeral costs. They invited her to visit
the prison and, if she wished, to be shown her husband’s cell. It was
arranged that she would visit the prison the following Monday. As she
lives some distance from Channings Wood, the chaplain drove her
there and back. She also accompanied her when she identified her
husband’s body. While at Channings Wood, she visited her husband’s
cell and some of his possessions were returned to her. The remainder
were returned to her when she and the chaplain met again several
weeks later.
60. Staff held a debrief meeting to discuss the events of October 2005 and
managers ensured that support was in place for those who needed it.
The chaplaincy team and staff supported the prisoners on the unit who
were shocked at the man’s death, particularly those who were his
friends.
61. Prisoners who knew the man that died asked if they could send a
wreath to the funeral and sympathy cards to his widow. The chaplain
arranged for this to be done. After discussion with the man’s widow, it
was decided that no prison staff would attend the funeral. However, a
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memorial service was held in the prison chapel on the day of the
funeral and over 20 prisoners attended.
Medical care
62. The man’s medical record shows that he was treated by Healthcare
staff on a regular basis for a number of conditions. The clinical review
concludes that his “care and treatment was reasonable and appropriate
under the circumstances and the presentation of the patient”.
However, although it would probably not have altered his death from an
aneurism, the man might have benefited from more pro-active
management of his coronary heart disease. The clinical reviewers
recommend a number of actions to care for prisoners with heart
problems and other serious health concerns. I endorse them as means
of ensuring that care is planned, pro-active and personal to each
prisoner.
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Recommendations
Local
The Governor of Channings Wood should ensure that, as far as
possible, all prisoners provide next-of-kin details for their records and
that these are checked and updated on an annual basis.
The Governor has put in place the following measures:
1. All new receptions will have next of kin details checked on arrival, and
amendments will be updated by Reception Staff.
2. An annual review will be conducted in May of each year by Wing Staff,
next of kin details will be updated on the computer system where
necessary.
Healthcare
Note keeping in the Inmate Medical records should be legible, especially
when photocopied and each entry signed, with the name and
designation of the practitioner making the entry.
The Department of Public Health and Policy has started a programme of
education around recording included in the annual mandatory update
stressing the Nursing and Midwives Council requirements. This is a regular
issue for Health review meetings where the quality and accuracy of recording
healthcare data etc. is reinforced to all practitioners around their
responsibilities with regards to record keeping.
A chronological summary sheet should be maintained for all patients,
outlining the major medical events and history; assisting healthcare
staff in making comprehensive assessments of patient’s needs.
Where a patient is experiencing a major health event, comprehensive and
chronological notes will be maintained for future reference.
Care should be taken in ensuring that medical notes are maintained in
chronological order and that sufficient continuation sheets are available
in the notes.
The prison’s Healthcare centre is awaiting the installation of NHS computers
which should improve record keeping.
The Inmate Medical Record should be available for all consultations, to
ensure appropriate record keeping and reference to a patient’s medical
history by the practitioner.
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The Inmate Medical Record is now utilised for all face to face consultations
and a record made whenever any advice is given outside of a formal
consultation.
A detailed treatment/care plan should appear in the medical record,
outlining the proposed management of a chronic disease problem,
indicating the frequency of review.
Depending on the severity of the chronic disease, staff endeavour to achieve
this.
Consideration should be given to maintaining a register of patients with
Coronary Heart Disease (CHD), providing support and interventions
reflecting an agreed protocol endorsed by the host PCT.
The chronic disease register has been in place since June 2005 including
CHD and all other chronic illnesses. The protocol reflects the CHD National
Service Framework.
The Head of Healthcare is liasing with the PCT to develop agreed protocols
across all their activities and aims to have achieved this by September 2006.
Patients with a history of CHD should be prescribed an exercise regime
appropriate to their needs and ability.
Prison staff encourage prisoners to use the gym as much as possible. The
Gym staff and Healthcare staff liaise to agree what level of exercise is most
appropriate for people with a range of chronic diseases where this is thought
useful to a patient’s health maintenance.
Patients with a history of CHD should be reviewed at least once every 3
months by a nurse.
This has been in place since September 2005.
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