HSSIB investigation report – Healthcare provision in prisons: emergency care response (29 August 2024)

Summary

This is the first in a series of reports by the Health Services Safety Investigations Body on the theme of healthcare provision in prison. This initial investigation focuses on the delivery of emergency care to patients in prison, looking specifically at access to 999 emergency services and the ability of ambulance services to respond to 999 calls.

Content

Emergency care delivery in prisons is complicated by the environment and security restrictions that are in place. Delays in providing emergency treatment can affect the health outcomes for patients. The investigation explored the processes in place for responding to medical emergencies in prison and how these impact on patient safety.

Findings of this report include:

• Ambulance services spent significant time diverting resources to callouts in prisons that were then cancelled, or attending medical emergencies that were not serious enough to have warranted the presence of an ambulance crew.
• Prisons are making large numbers of 999 calls for non-emergency incidents, because of a low-risk approach caused by fear among prison staff of having to attend an HM Coroner’s court and being blamed for making a wrong decision.
• No situational information about patients experiencing a medical emergency is provided direct from the scene to the 999 call handlers. Information is passed from the scene via multiple handovers before it is received by the call handlers, which can result in misrepresentation of the situation.
• Response categories of ambulances attending prisons are regularly assessed using minimal information and ambulance services spoken to therefore defaulted to category 2 (18-minute response time). This is often not the appropriate categorisation for the nature of the situation, which has delayed appropriate care to patients both in the community and in prisons.
• The emergency response card (code blue/code red card) that prison staff are given is not designed to best support staff in identifying a medical emergency and supplying the situational information that the emergency services need to triage the situation properly.
• There is no embedded recurring training to support prison staff to recognise medical emergencies that require a 999 response, to help reduce the number of calls for scenarios that are not emergencies.

In this report 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 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 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.
• 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.