Individual at Risley

INVESTIGATION INTO THE CIRCUMSTANCES SURROUNDING THE
DEATH OF A MAN AT HMP RISLEY IN JULY 2007
Report by the Prisons and Probation Ombudsman
for England and Wales
January 2008
This is the report of an investigation into the death of a man in July 2007 at HMP
Risley. He died of natural causes and was 70 years old.
This investigation was undertaken by one of my colleagues. Both he and I would like
to thank the Governor of Risley and his staff for their participation in the
investigation.
The clinical reviewer was identified by Warrington Primary Care Trust (PCT) to
undertake a review of the man’s clinical care. I appreciate his assistance and report.
In circumstances such as those described here, where a prisoner has died from
natural causes, the findings of the clinical review play a large part in my report. The
review of the man’s care shows that, broadly speaking, he received good care whilst
in Risley. However, there were some concerns and questions about provision for
prisoners with long-term chronic diseases. There are three recommendations as to
how the prison and the PCT can improve the care they provide to prisoners with
long-term conditions. In this version of the final report the Prison Service has
partially accepted one of the recommendations and fully accepted the other two.
The man was not in contact with any of his family and so the prison arranged and
paid for his funeral. Staff from Risley were the only people present. There was also
a memorial service in the prison chapel so that the man’s fellow prisoners could pay
their respects. I judge that this was all handled well and with sensitivity.
This report has been anonymised for publication on my website.
Stephen Shaw CBE
Prisons and Probation Ombudsman January 2008
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CONTENTS
Summary
The Investigation Process
HMP Risley
- Healthcare
- Previous deaths at Risley
- Night state
- Access to cells during night state
- Her Majesty’s Chief Inspectorate of Prisons
Key Findings
- 3 July 2007
- The man’s cellmate
- After the event
- Next of kin
- Funeral
- Clinical care
Issues
Recommendations
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SUMMARY
The man was serving a prison sentence at HMP Risley. He was 70 years old
when he collapsed in his cell in July 2007. His cellmate alerted staff, and
attempts were made to revive him. Unfortunately, they were without success.
Having been sentenced to four years’ imprisonment in October 2002, with a
further three years’ supervision, the man was allocated to Risley. He was already
diagnosed with epilepsy, and was not in good health. He had numerous contacts
with healthcare and the records show over 50 incidences of fits, loss of
consciousness, suspected fits or collapses, plus a number of other contacts
following asthma attacks and chest pains. In December 2003, the man became
depressed, partly linked to the frequency of his fits, and threatened to take his
own life. He was placed on self harm support and monitoring arrangements for a
time.
The man was due to be released on licence in early 2005. The anticipation
caused him some distress, and again he was placed on special self harm
monitoring and support. He was released on 25 February 2005, with a condition
to report to an Approved Premises (a hostel run by the Probation Service). He
failed to do so and his licence was revoked. He was arrested the following day
and returned to prison.
The man’s health continued to be poor and his contact with healthcare resumed.
He persisted in smoking 25 cigarettes a day despite efforts to persuade him to
stop. He seemed unconcerned about his health, did not always comply with his
medication and, despite guidance, his inhaler technique was poor. Referral to a
specialist regarding the episodes of loss of consciousness suggested that they
were not epileptic fits, and he was referred to a second specialist. However,
there was a delay in making the referral and he was awaiting an appointment
when he died.
The man’s health deteriorated further from April 2007, and he attended
healthcare up to three times a day to use the nebulising machine. Consideration
was given to providing a machine in his cell, but his previous lack of compliance
with medication, coupled with his own reluctance, meant that he continued to be
treated in healthcare.
At 9:08pm on 3 July, the man’s cellmate alerted staff that he had collapsed.
Healthcare were told and staff quickly attended. An ambulance was called, and
the man was moved out of his cell so staff could attempt resuscitation. They
were unsuccessful and he was moved to a private room and staff began the
procedures that follow the death of a prisoner. The duty governor, chaplain, and
head of healthcare all returned to the prison, the chaplain giving him the last rites.
The care team attended to ensure that staff had support available. The man’s
cellmate was supported and relocated to another cell.
Unable to trace any relatives wishing to be involved, the prison arranged the
funeral in the man’s home area. The service was conducted by the prison
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chaplain and attended by a representative of the Governor. The prison also held
a service in the prison chapel for the man’s fellow prisoners.
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THE INVESTIGATION PROCESS
1. My investigator visited HMP Risley and spoke to staff who knew the man. He
interviewed seven members of staff and one prisoner. Notices were posted to
staff and prisoners about the investigation, inviting contributions if necessary.
In addition, the investigator studied all relevant prison records relating to the
man who died. These included his main prison record, medical records and
statements made by staff. The investigator also visited a cell on E wing
identical to the man’s cell.
2. Warrington Primary Care Trust identified a medical practitioner to carry out a
review of the man’s clinical care. I am grateful to the clinical reviewer for
undertaking this review. My investigator discussed aspects of the man’s
treatment with both healthcare staff at Risley and with the clinical reviewer.
3. My investigator contacted Her Majesty’s Coroner for Cheshire to inform him of
the nature and scope of my investigation and request a copy of the Post
Mortem report. Upon completion, my report will be sent to the Coroner to
assist in his enquiries into the man’s death.
4. The man had not left details for any next of kin. The prison and the police
made efforts to trace his family, but no-one wished to be involved.
Consequently, my family liaison officers were unable to speak to any of the
man’s family.
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HMP RISLEY
5. Risley is a modern, purpose built prison which opened in 1964. It is a
category C training prison with a capacity of 1,085. Its original function was
as a male and female remand centre. Following a major disturbance in 1989,
the male part of the prison became a training prison, and in 1992 a sentenced
male prisoner allocation centre was introduced. During the latter part of the
1990s, the female prison and allocation centre roles were removed and Risley
became a category C training establishment for over 800 male prisoners. The
prison was further expanded and refurbished, and in 2003 a new wing was
opened (G wing) bringing the capacity of the establishment to over 1,000,
making it the largest category C prison in the country. E wing, where the man
was located, is the vulnerable prisoners’ wing.
Healthcare
6. Healthcare staff are available in Risley 24 hours a day. By day, there is a
doctor in the prison; at night, cover is provided by nursing staff. Prisoners
who require in-patient treatment are referred to other prisons or to outside
hospital. In the event of an emergency, Risley has not used identifying codes
to indicate different types of incident. However, in light of a recommendation
in one of my previous reports I am led to believe that such a system is being
introduced from January 2008.
Previous deaths at Risley
7. This is the third death which my office has investigated since I became
responsible for investigating all deaths in custody in April 2004. The
circumstances of this man’s death are different to the previous two.
Night state
8. At night the prison is locked up and the number of staff in the establishment is
much lower than during the day. The Night Orderly Officer (NOO) is in overall
charge of the prison and has an Assistant Night Orderly Officer (ANOO). The
NOO visits each wing at intervals through the night. Wings are in the care of
night patrol officers, responsible for monitoring security and safety. The
number of officers on patrol varies from wing to wing.
9. The NOO (or the Assistant Night Orderly Officer) carries cell keys. Wing
patrol officers carry cell keys in a sealed pouch and local instructions state
that these are for emergency use only. The instructions further say that:
i. under normal circumstances authority to unlock a cell at night will be
given by the Night Orderly Officer;
ii. under normal circumstances no cell will be opened unless three
members of staff are present;
iii. where there is, or appears to be, immediate danger to life, cells may be
unlocked with one member of staff;
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iv. the Control Room must be informed and a response gained before
such action is taken;
v. the Night Orderly Officer will deploy staff immediately to the cell.
Her Majesty’s Chief Inspector of Prisons (HMCIP)
10. The most recent HMCIP inspection was unannounced and took place in
February 2006. None of the issues raised in that report are relevant to the
circumstances of the man’s death.
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KEY FINDINGS
11. The man was remanded into custody in June 2002, and was held in HMP
Altcourse. After sentence in October, he was received in Risley on 25
October 2002.
12. It was noted at reception that the man suffered from poor health. He was
asthmatic and had been diagnosed as having epilepsy. His sentence was
punctuated with numerous incidences of fits or suspected fits and asthma
attacks. Between sentencing and his death, medical records indicate in the
region of 80 fits or suspected fits, ten asthma attacks, ten incidents of chest
pain, and a dozen occasions when the man collapsed. For these reasons, he
was in frequent contact with healthcare.
13. The man had a long history of smoking – some 50 years – and smoked about
25 cigarettes a day. He did not take a great interest in his own health and
showed poor motivation when staff tried to persuade him to do so. Often his
contacts with healthcare came as a result of fellow prisoners alerting staff
when he had collapsed or appeared to be suffering a fit. Compliance with his
medication was poor, as was his technique when using his inhaler despite
staff attempts to help him be more effective. He also resisted numerous staff
attempts to help him to stop smoking.
14. Having suffered a number of fits, asthma attacks and collapses in the space
of a few weeks, the man was taken to the Accident and Emergency
Department of an outside hospital on 29 November 2003. He was admitted to
the hospital on 4 December, and remained there for six days until 10
December. He continued to suffer with fits and occasions in which he
collapsed.
15. On 30 December 2003, the man was placed on F2052SH (the then system of
special observations and support for prisoners at risk of self-harm). His
recent health had been particularly bad. He was depressed, was concerned
at the frequency of fits and had threatened to take his own life. He remained
on F2052SH until 21 January 2004.
16. The man continued to suffer from a number of fits, collapses and asthma
attacks. In February 2004, a partial assessment of his lung function showed
his capacity as poor. However, his medical record does not show whether the
significance was properly evaluated. A specialist report on 29 April indicated
that the man had not been taking his prescribed medication.
17. On 18 June, staff responded to the cell bell to find the man standing in his cell
with a ligature made from a bin-liner attached to the curtain rail. He said that
he wanted to take his own life. The man was again placed on F2052SH, and
remained so for 12 days.
18. In early 2005, the man was preparing for release on licence, which he faced
with a considerable degree of apprehension. On 14 February, he expressed
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thoughts of self-harm which again led to him being placed on F2052SH. He
remained on special observations for two days.
19. The man was released on licence on 25 February 2005 and left the prison at
9:30am. One of the conditions of his licence stipulated that he must report to
an Approved Premises (a hostel) at 1:00pm. However, he failed to do so, and
did not contact the Probation Service. His licence was revoked and he was
arrested the following day.
20. The man was returned to HMP Altcourse where he was placed on self-harm
and suicide prevention support and observation measures because he had
been recalled so soon after release. He remained in Altcourse until 18 March
2005 when he was re-allocated to Risley.
21. The man was not a well man, and even when not suffering from any attack,
his oxygen saturation levels were low. Between his return to Risley in March
2005 and his death in July 2007, he continued to suffer a number of fits and
suspected fits. Healthcare staff worked closely with him through this time.
This included yet more attempts (again unsuccessful) to persuade him to give
up smoking.
22. From April 2007, the man’s health began to deteriorate further. Between then
and his death, there were some 55 occasions when he consulted healthcare
in relation to breathing difficulties. He was due to have an echocardiogram (a
test for the function of the heart) at an outside hospital on 29 May. However,
it was cancelled due to a lack of staff available to provide an escort. The
decision was taken in consultation with medical staff.
23. As his health deteriorated, he visited healthcare every day to be treated with a
nebuliser. Towards the end of his life, he attended up to three times a day.
Consideration was given to allowing him to keep a nebuliser in his cell, as
other prisoners had been allowed to do. But his history of poor compliance
with his medication, along with his history of poor technique in using his
inhaler, meant that this option was rejected. The man had also indicated that
he did not want to use a nebuliser in his cell.
24. On 1 July, the man complained of shortness of breath on a number of
separate occasions. Healthcare requested that an out-of-hours doctor attend,
although in the event an emergency care practitioner was sent. There was a
delay between the request being made at 4:15pm and the visit at 8:30pm.
The emergency care practitioner assessed that the man might have left
ventricular failure.
25. On the morning of the day he died, healthcare staff discussed the possibility
of transferring him to HMP Preston which has in-patient facilities. But Preston
only treats prisoners who are acutely ill, whereas the man was suffering from
a chronic illness.
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3 July 2007
26. At 9:08pm the cell bell on the man’s cell was activated. Two night patrol
officers on E wing responded to the call. The man’s cellmate told them that
the man had collapsed. The officers could see that the man was lying on the
cell floor and was being supported by his cellmate.
27. The cellmate said that the man was mumbling to him, and the first night patrol
officer told my investigator that he could see that the man was breathing. The
man had often required medical assistance after collapsing, suffering fits, or
suffering asthma attacks in the past. This had included occasions during the
night. The officers did not judge that they needed to break the seal on their
cell keys at this stage, and the second patrol officer radioed through to Control
that healthcare assistance was required. The first night patrol officer opened a
running time log of events.
28. At 9:10pm, Control told the Assistant Night Orderly Officer (ANOO) to collect a
nurse from healthcare immediately and take them to E wing. He went to
healthcare and collected the staff nurse.
29. In the meantime, Control had contacted the staff nurse and told her that the
man had collapsed and that she was required on E wing. The nurse was
familiar with the man and the state of his health, having treated him on
numerous occasions in the past. She therefore took a nebuliser, a blood
pressure machine, and a Sats machine (for checking oxygen levels) and went
with the ANOO to E wing.
30. Control also informed the Night Orderly Officer (NOO) that the man had
collapsed, and he made his way immediately to E wing The NOO, the ANOO,
and the staff nurse all arrived on E wing at 9:13pm, five minutes after the cell
bell rang.
31. The ANOO opened the cell door and the staff nurse and the NOO went in.
The staff nurse looked at the man and immediately requested an ambulance,
even before checking his blood pressure, pulse or breathing. The first night
patrol officer contacted Control and requested an ambulance at 9:15pm.
32. The staff nurse administered oxygen to him, but he showed little if any
response. She and the NOO attempted to perform cardio-pulmonary
resuscitation (CPR) in the cell. However, the cell was quite small, and the
man had fallen at an angle with his head by the wall, and his cellmate was still
present. This rather cramped space made it difficult to perform CPR, so staff
moved the man out of the cell onto the landing and continued there. The staff
nurse inserted an airway tube into the man’s mouth and staff carried out
cycles of assisted breathing and chest compressions.
33. While the staff nurse and the NOO continued to perform CPR, the ANOO
went to the gate so he was ready to escort the ambulance when it arrived.
However, a paramedic was also dispatched to the prison, and he reached the
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gate before the ambulance. The ANOO therefore took the paramedic to E
wing before returning to the gate to continue to await the ambulance.
34. The staff nurse presented the man’s medical history to the paramedic, and he
inserted a longer tube into the man’s airway. He observed his reactions to the
resuscitation attempts, and checked the reading on the defibrillator. The man
was not responding. At 9:30pm, the paramedic asked the staff nurse and the
NOO if they all agreed that attempts at resuscitation should stop. At 9:33pm,
staff began to carry out the tasks necessary when a prisoner dies.
35. The ambulance arrived at 9:32pm, and the ANOO escorted the ambulance
staff to E wing. At 9:43pm, the officer assisted the ambulance staff to lift the
man onto the ambulance trolley and off the wing and into the NOO’s office so
that he was afforded some privacy.
36. Other staff who had been contacted arrived in the prison. They included the
chaplain, the duty governor, the head of healthcare, and two officers from the
Care Team. A member of Independent Monitoring Board also attended, as
did a Detective Sergeant. The chaplain read the man’s last rites.
The man’s cellmate
37. The man’s cellmate had been understandably quite distressed by events, and
a number of staff made efforts to ensure his wellbeing throughout. When staff
were performing CPR on the man on the landing, staff ensured that the cell
door was pushed to (though not shut) so that the cellmate did not have to
witness it. As soon as possible, he was taken for a cup of tea and to sit on
the wing landing rather than be next to events.
38. Staff asked another prisoner, an older man who would be a calming influence,
if the man’s cellmate could move into his cell with him for the rest of the night.
He agreed and, even though he was a non-smoker, was content for the man’s
cellmate to smoke by the window if he felt he needed to. It was explained to
the man’s cellmate that it was standard procedure that he would need to hand
over his clothing, and new clothes were provided for him.
39. As well as being protected from seeing staff attempting to resuscitate the man
and being relocated to another cell, the cellmate was spoken to by a number
of staff through the evening. This included the chaplain, the NOO, and the
duty governor, all of whom were concerned to reassure and settle him. The
member from the Independent Monitoring Board also spoke with the man’s
cellmate.
40. When interviewed by my investigator, the cellmate was accompanied by his
wing representative. Although the man’s cellmate accepted that staff had
taken trouble to look after him on the night the man died, his wing
representative expressed concern at how events had affected him in the
following weeks. He seemed to have lost his appetite, was sleeping for long
periods, and his wing representative was concerned that he might be suffering
from depression.
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41. Healthcare records show that the man’s cellmate was seen by the doctor the
morning after the man had died. He was subsequently seen a number of
times that week. He was also referred to the community psychiatric nursing
team, was seen by the prison’s psychiatrist, and was referred on to other
psychiatric services. In interview, the head of healthcare, noted that the
man’s cellmate had missed some psychiatric appointments, but had not been
seen by the doctor in recent weeks. He undertook to arrange for him to see
the doctor again within a few days.
After the man’s death
42. A short hot debrief was held that night for staff involved. The following
morning, a follow-up meeting was held to ensure that everything was in order.
Any outstanding issues were allocated to specific members of staff to
address. This included ensuring that all prisoners at risk of suicide or self
harm were reviewed in case the man’s death had had a detrimental effect on
them. It also included ensuring that Care Team services were offered to all
staff involved. As noted above, the Care Team attended E wing to support
staff at the time. All staff interviewed said that they were offered appropriate
support.
43. The man had listed his probation officer as next of kin. However, when
contacted, the officer said she had only dealt with him on a very few
occasions. The police and the prison made further efforts to trace any family,
but only succeeded in locating an elderly, distant cousin who did not wish to
be involved.
44. As no family had been traced, the prison arranged and paid for the man’s
funeral. It was held in the town from which the man originated. The prison’s
chaplain conducted the funeral, and the head of reducing re-offending
attended to represent the Governor. In addition, the prison arranged a
memorial service in the chapel. The man’s fellow prisoners could therefore
attend and pay their respects.
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ISSUES
Clinical care
45. As noted, a review of the man’s medical care was undertaken on behalf of
Warrington Primary Care Trust. The clinical reviewer finds that, as a whole,
the man received appropriate treatment in prison, equitable with that which he
could have expected in the community. As well as his main medical
conditions, his subsidiary health needs, such as a hernia, were addressed in
an appropriate manner.
46. Although coronary artery disease was suspected, the man did not show any
overt signs, which may be explained by his sedentary lifestyle in prison.
Healthcare also diagnosed his right sided cardiac failure, and took the view
that it did not require treatment on a long-term basis. Moreover, medication
prescribed to him was kept under review and changed as was required. The
screening which took place on reception properly addressed his mental
health. However, the clinical reviewer comments that, whilst the man
received care of an appropriate standard, it was not delivered to a set plan
and he was not given continuous oxygen therapy.
47. The man was in the main appropriately treated for his episodes of loss of
consciousness. Healthcare staff correctly judged that he did not present the
pattern of a typical epileptic fit, and that his symptoms were not brought under
control by anti-epilepsy medication. The man was referred to a consultant
neurologist in November 2003 who confirmed that the symptoms were not
epileptic in origin. Tests did show an aneurysm of one of the cerebral
arteries, and the man remained under treatment for this.
48. Although the neurologist advised in January 2004 that the man’s symptoms
were not due to epilepsy, he was not referred to an alternative specialist until
March 2007. The absence of a referral was not recognised when he was
taken to Accident and Emergency. The reasons for his loss of consciousness
remained unexplained at the time of his death. It is the view of the clinical
reviewer that this did not materially contribute to the man’s death, but that
follow-up should have been earlier. The reviewer notes that there has been a
turnover of medical staff at the prison and lack of continuity may have played
a part in the delay.
49. The man was correctly diagnosed with, and received appropriate treatment
for, his chronic obstructive pulmonary disease (COPD, a result of damage to
the lungs, usually through smoking). He was treated appropriately each time
he came to healthcare for his COPD, but no overall plan was put into place to
manage his condition.
50. In interview, a fellow prisoner expressed concern that the clinical review
should address the care the man received in the last six months of his life
when his health appeared to be deteriorating. Whilst the reviewer feels the
overall treatment to be broadly appropriate, prisoners who present themselves
to healthcare for frequent treatment for similar symptoms should receive an
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early diagnosis, and this should be picked up in a management plan. The
man was seen regularly in the asthma clinic. His lung function was measured
on a number of occasions, and his symptom control until April 2007 seemed
to be satisfactory. However, the severity of his underlying condition was not
properly established.
The Head of Healthcare should consider systems to ensure that
management plans are put in place for patients, which includes
ensuring secondary appointments are followed up where necessary.
51. The man had an appointment to go to hospital for an echocardiogram on 29
May, but it was cancelled due to the lack of an escort being available. The
decision was made after consultation with healthcare staff. I have not
checked the frequency with which this has happened to other prisoners, but
the head of healthcare may wish to check how often prisoners have to miss
hospital appointments due the unavailability of an escort.
52. Prison healthcare is not linked into wider Primary Care Trust initiatives,
including guidance, care initiatives and staff training. As such, they were not
able to avail the man of the benefits of assessment by the community matron,
which might have led to him being assessed for continuous oxygen therapy.
Nor were they linked into the Quality and Outcomes Framework (which aims
to improve the management of chronic diseases) or the National Institute for
Health and Clinical Excellence guidelines for long term conditions. Nor are
they linked to the new PCT agenda on chronic disease management
(although I understand that this is currently under review).
The Head of Healthcare should liaise with the PCT to ensure that
healthcare are linked into wider PCT initiatives which would benefit staff
and patients.
53. The prison doctor was confident that the man received appropriate care in
Risley. However, he stated in interview with the clinical reviewer that he had
wanted the man to be transferred to HMP Preston which provides in-patient
healthcare for prisoners. Transfer was not possible because of the prison’s
acceptance criteria. There is a memorandum on the man’s medical file from
the deputy healthcare manager dated the morning of his death which says
that the man would benefit from in-patient facilities. No option other than
Preston seems to have been considered up to this point.
54. The prison doctor also felt that the man would have benefited from receiving
oxygen on a continuous basis, which he would have done in the community.
He did comment that it was possible that the man might have died sooner in
the community because of his reluctance to ask for help.
55. Many of the man’s contacts with healthcare stemmed from fellow prisoners
alerting staff when he was unwell. The prison doctor said that there are a
number of prisoners who have high dependency levels that cannot be met at
the prison. There is currently no register of prisoners who require long-term
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healthcare, whether or not their needs can be met at Risley, and there is no
system to alert the Governor or the Chief Executive of the PCT to their needs.
The Governor, PCT Chief Executive and Head of Healthcare should
consider introducing a register of prisoners with long-term care needs
that cannot be met at Risley, and management plans to ensure that the
needs of these prisoners are met.
Response to the man’s death
56. I was impressed at the speed and content of the staff response when the man
collapsed for the last time. A nurse was in his cell within five minutes of his
cellmate pressing the cell bell. Staff moved him out of his cell and attempted
to resuscitate him. When he was pronounced dead he was moved to a
private space. His cellmate was well supported on the night that he died.
When alerted to events, the duty governor, head of healthcare, and prison
chaplain all came back to the prison. The care team attended for the benefit
of staff who might have needed them.
57. I was also impressed with the way the prison organised the man’s funeral in
the absence of any family willing to do so. Arranged in his home area,
conducted by the prison chaplain, and the only attendee being a
representative of the prison, this was a sensitive way of dealing with the
funeral. There was also a memorial service in the prison chapel for the
benefit of any fellow prisoners who wished to attend.
58. The man’s cellmate was treated with sympathy and understanding at the time.
He was followed up by healthcare the next day and in subsequent weeks.
However, he missed one or two appointments and his care slipped a little. I
was pleased to see that, when speaking to my investigator, the head of
healthcare agreed to arrange for him to be seen and assessed further in the
very near future. While I make no recommendation, I would draw to the
Governor’s attention the need to ensure ongoing care for prisoners who may
have suffered an upsetting experience.
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RECOMMENDATIONS
59. The Head of Healthcare should consider systems to ensure that management
plans are put in place for patients, which includes ensuring secondary
appointments are followed up where necessary.
This recommendation has been partially accepted by the Prison Service.
Management plans are in place. There are resource implications for the
number of escorts available. Alternatives to alleviate the numbers of out-
patient appointments are being investigated i.e. telemedicine and review of
services that can be provided within the prison e.g. IV therapies.
60. The Head of Healthcare should liaise with the PCT to ensure that Healthcare
is linked into wider PCT initiatives which would benefit staff and patients.
This recommendation has been accepted by the Prison Service. They note
that links with the PCT are improving with services from the PCT coming into
HMP Risley. However, there are financial implications linked to this.
61. The Governor, PCT Chief Executive and Head of Healthcare should consider
introducing a register of prisoners with long-term care needs that cannot be
met at Risley, and management plans to ensure that the needs of these
prisoners are met.
This recommendation has been accepted by the Prison Service. The register
will improve once Healthcare is fully computerised. The target date for
commencement is February 2008.
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