HM Prison and Probation Service
HSSIB recommends that HM Prison and Probation Service, in collaboration with the Association of Ambulance Chief Executives, reviews and amends the design of the medical emergency response card, to better support staff in identifying emergency situations and providing the situational information required by ambulance service call handlers. In scenarios where direct communication between staff at the scene and the ambulance service emergency centre call handlers is not possible, this will ensure that the control room receives and can provide sufficient information to the call handlers to triage the situation.
HM Prison and Probation Service is grateful for this feedback on the medical emergency response cards that we provide for our staff.
In partnership with the Association of Ambulance Chief Executives we have reviewed the design of the medical emergency response cards. We will now arrange for revised cards to be printed and distributed.
We will do this alongside the introduction of new guidance for control room staff which will equip them to ask staff at the scene for the information that they require to respond to the triage questions that are asked by ambulance service call handlers. This will be supported by the provision of revised posters for control rooms to provide a visual reminder of the triage questions. We will introduce a regular audit check to ensure that these posters remain visible to control room staff.
We will also be exploring whether and how we can include an assessment of the effectiveness of the response to medical emergencies in future safety audits.
We recently issued a new training video on ‘Responding to emergency situations’ designed to help staff to understand what they need to do in a medical emergency, including when they find a prisoner who has ligatured. The video shows a member of staff calling a code blue and following up by giving the control room relevant information about the condition of the prisoner and explains that this information is required so that ambulance control can arrange the appropriate response. The video has been viewed over 2,000 times on the HMPPS intranet and is also available on the ‘My Learning’ platform which can be accessed by staff from partner organisations and contracted prisons.
Actions planned to deliver safety recommendation:
- Review design of medical emergency response cards. By: Completed.
- Print and distribute revised cards. By: 31 March 2025.
- Issue guidance to control room staff. By: 31 January 2025.
- Print and distribute revised posters. By 31 March 2025.
- Introduce audit check on control room posters. By: 31 March 2025.
- Explore the inclusion of the response to medical emergencies in future safety audits. By: 31 March 2025.
Response received on 3 December 2024.
HM Prison and Probation Service
HSSIB recommends that HM Prison and Probation Service enhances the existing training delivered to prison officers, to increase their ability to identify medical emergencies that require 999 calls to be made by prisons, thereby reducing the number of calls and diverted ambulances and easing the burden on the emergency care system. The training should be delivered on a recurrent basis.
HM Prison and Probation Service is committed to equipping staff to respond appropriately when they encounter a medical emergency.
All new Foundation Prison Officers are now required to complete Emergency First Aid at Work as part of the Foundation Course.
We recently issued a new training video on ‘Responding to emergency situations’ designed to help staff to understand what they need to do in a medical emergency, including when they find a prisoner who has ligatured. The video has been viewed over 2,000 times on the HMPPS intranet and is also available on the ‘My Learning’ platform which can be accessed by staff from partner organisations and contracted prisons.
We have worked with St John Ambulance to produce five training films for staff who are first on scene. These are available on the ‘My Learning’ platform, which can also be accessed by staff from partner organisations and contracted prisons.
The films have been sent to Governors and Directors who have been informed that it would be advantageous for all Prison Officers and other front line staff to view them and for them to be used to supplement annual refresher training for emergency first aiders.
We are committed to updating the films to include the same content as the redesigned medical emergency response cards, which identifies to staff the information they will need to share with the control room about the condition of the prisoner.
Actions planned to deliver safety recommendation:
- Launch first on scene training films. By: Completed.
- Update the films to include the content from the redesigned medical emergency response cards. By: 31 March 2025.
Response received on 3 December 2024.
HM Prison and Probation Service
HSSIB recommends that HM Prison and Probation Service reviews and implements changes to current communication methods between staff at the scene of an incident and the ambulance service call centre. This is to ensure that situational information about the patient is passed directly from the scene to the call handlers, meaning faster and more accurate triage and categorisation of the emergency response.
HM Prison and Probation Service is very aware of the communication challenge presented by medical emergencies in prisons, where mobile phones are not available to facilitate direct contact between staff at the scene and ambulance control.
We have considered including the facilitation of direct communication to ambulance control amongst the requirements for our reprocurement of prison radios. However, our reprocurement is initially focused on support for the existing hardware and infrastructure, and is unlikely to deliver new radios to prisons until 2029, so this is not an option that could facilitate improvements in the short or medium term. Moreover the project team has not been able to identify a suitable system that would facilitate direct communication with ambulance control, and it has therefore been decided that this will not be within the scope of the project.
We will conduct a review to consider how to improve communication between the incident scene and ambulance control within the confines of the current policy and technology. The review will include workshops involving operational staff and partners, including the Association of Ambulance Chief Executives.
Actions planned to deliver safety recommendation:
- Consider prison radios as an option for direct communication to ambulance control. By: Completed.
- Arrange workshops involving operational staff and partners. By: 31 March 2025.
- Complete review of communications between incident scene and ambulance control. By: 30 June 2025.
Response received on 3 December 2024.
Association of Ambulance Chief Executives
HSSIB recommends that the Association of Ambulance Chief Executives, in collaboration with HM Prison and Probation Service, sets up formal communication routes, at both national and regional levels, between prison and ambulance services to escalate concerns, review risks and improve systems for emergency care response and ensure continuous improvement of the service.
Since receiving the HSSIB report, representatives from the Association of Ambulance Chief Executives (AACE) have worked in close co-operation with counterparts in His Majesty’s Prisons and Probation Service (HMPPS) to agree actions to address all four of the safety recommendations outlined in the report.
Specifically in relation to this action assigned to us we have agreed through our National Directors of Operations Group (NDOG) that ambulance service Operations Directors (or Chief Operating Officers) will be the lead point of contact for regional communications with prisons. We have agreed with HMPPS that Prison Group Directors (PGDs) are the appropriate regional counterpart and we will be mapping prison regions onto ambulance regions and establishing connections between Operations Directors and PGDs.
At a national level we will formalise the existing relationships between HMPPS and AACE to offer a national channel for regional colleagues to escalate issues and conversely for national issues to be cascaded to regional teams.
We expect that these arrangements will build on existing local relationships that may exist between individual prisons and individual ambulance services and that the overlaying of regional and national channels will strengthen those relationships and encourage greater consistency.
We will document these arrangements in a brief, simple partnership agreement and cascade to colleagues in the prisons and ambulance environment in order to improve communications at all levels
Actions planned to deliver safety recommendation:
- Agree regional and national points of contact for ambulance services. By: November 2024. Other dependencies identified: Corresponding agreement of HMPPS points of contact. Additional comments: Complete.
- Agree regional and national points of contact for HMPPS. By: November 2024. Other dependencies identified: Internal approval required.
- Develop simple partnership agreement. By: January 2025. Other dependencies identified: Internal approval required from AACE and HMPPS.
- Cascade partnership agreement. By: February 2025.
Response received on 27 November 2024.
HM Prison and Probation Service
HSSIB recommends that HM Prison and Probation Service updates Prison Service Order 3050, ‘Continuity of healthcare for prisoners’, including guidance on communication of information about prison patients when transferring between prisons, and on the process when prison patients are released from court. This will reduce variation and ensure better continuity of care for patients when being transferred or on their release.
HM Prison and Probation Service (HMPPS) is grateful for this feedback on the Prison Service Order 3050 Continuity of Healthcare for Prisoners.
We are working with health partners, including NHS England (NHSE), The Welsh Government, OHID, Association of Directors of Adult Social Services (ADASS) and the Association of Ambulance Chief Executives (AACE) to improve access to health and social care services for people who encounter and move through the criminal justice system. This includes at court, in the community, in custody and returning to the community.
A multi-agency Continuity of Care Steering Group has been considering the changes necessary to PSO3050 and agreement reached to extend the remit of the current policy to include people under probation supervision and pre and post custody transitions. The Steering Group oversaw 10 workshops between October 2023 and April 2024 involving a range of internal and external stakeholders. The policy will include an agreed definition for Continuity of Care for those in touch with HMPPS services, mandatory actions, as well as supporting guidance and a chapter specific to continuity of care for women.
The policy will cover requirements in relation to transition points from court, community, custody and back to the community, including unplanned releases, including via court appearances. It will strengthen existing guidance in relation to information sharing between prison and healthcare services at transition points, including transfer between prisons and on release. Additionally, the policy will reference the partnership working required to support NHS pre and post release services and reinforce the expectation that prison and healthcare staff follow required pre-release processes designed to support Continuity of Care.
The detailed findings in the report will further inform the development of the revised Continuity of Care policy.
Actions planned to deliver safety recommendation:
- Establish a Steering Group to review PSO3050 identifying updated practices and instructions to include those on probation and update to a Policy Framework. By when: completed. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place.
- Draft new policy framework considering Steering Group advice, instruction and direction. By when: April 2025. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place.
- Consult draft with internal and external partners and stakeholders. By when: August 2025. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place.
- Submit policy to HMPPS governance gateway. By when: November 2025. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place.
- Publish and promote policy framework. By when: March 2026. Organisational lead: HMPPS Health & Social Care Team. Resources in place: Identified leads in place.
Response received on 21 February 2025.
HM Prison and Probation Service
HSSIB recommends that HM Prison and Probation Service standardises the approach to the provision of prison officer escorts for outpatient appointments to protect the dignity of patients and reduce variability of escort slots. This will assist in reducing the likelihood of patients refusing to attend healthcare appointments, while balancing appointment availability, thus improving the continuity and equality of care.
A comprehensive review of escort provision, including longer term hospital admissions is currently being jointly undertaken between HMPPS and NHSE (and Wales). A priority of the review is to improve prisoner / patient access to health services, considering demand and understanding how this is influenced by factors such as age or gender. This work will also consider how to optimise appointment times, factoring in prison regimes, the timings of clinics, and the geographical proximity of health facilities.
Separate work is underway to improve standardisation of resource allocation across the estate across a range of service areas including escort provision, in the longer term this work will support greater consistency of provision. The review recognises the need to reduce demand through improved access to (and uptake of) telephone and video consultations, and telemedicine services, drawing on best practice from across the health sector and beyond.
Actions planned to deliver safety recommendation:
- Model actual demand for outpatient escorts. By when: February 2026. Organisational lead: Head of Workforce Modelling. Resources in place to deliver actions: Joint working arrangements between HMPPS and NHSE, with identified leads from each department. Other dependencies identified: Access to anonymised patient data. Qualitative research and analysis. Other data sets.
- Improve access to (and uptake of) telemedicine. By when: February 2026. Organisational lead: Head of Workforce Modelling. Resources in place to deliver actions: Joint working arrangements between HMPPS and NHSE, with identified leads from each department. Other dependencies identified: Qualitative research and analysis. Secondary Care engagement.
- Preventative action (recommendations). By when: February 2026. Organisational lead: Head of Workforce Modelling. Resources in place to deliver actions: Joint working arrangements between HMPPS and NHSE, including the Health & Wellbeing team. Other dependencies identified: Qualitative research and analysis. Sufficient evidence supporting ‘what works’ to consider whether the need for medical appointments might be reduced, through tackling the root causes of poor health and the use of Social Prescribing.
- Escorts - Workforce Delivery Model. By when: April 2026. Organisational lead: Workforce Delivery Project Senior Lead. Resources in place to deliver actions: Limited project team. Other dependencies identified: Assurance and testing of all WDMs, including affordability.
Response received on 21 February 2025.
NHS England
HSSIB recommends that NHS England, via regional commissioning teams, works with HM Prison and Probation Service to identify barriers to using telemedicine for outpatient appointments, and then implements local solutions to promote and enhance the capability and usability of telemedicine. This aims to reduce the burden on prisons of providing escorts and the likelihood of patients not attending appointments.