Dear Mr Osbore Thank you for your Regulation 28 Report dated 26 July 2019 following the inquest into the death of Mr William Vickers at HMP Woodhill, am also grateful to YoU for granting a short extension to the usual deadline for reply know that you will share a copy of this response with Mr Vickers' family and would like first t0 express my condolences for their loss. Every death in custody is a tragedy and the safety of those In our care i3 my absolute priority: You raised one matter of concern for Her Majesty's Prison and Probation Service (HMPPS): that; once the ambulance was admitted through the main it took eleven minutes for it to be escorted through five sets 0f gates to the incident, You asked that consideration be given to a robust system for ensuring that all are opened promptly by staff s0 that the ambulance is not in any way hindered in getting t0 the patient Since Mr Vickers' inquest the contingency plans at HMP Woodhill have been updated to ensure that there are no delays to the process of receipt of any emergency vehicle, including ambulances during night state. When a code red or blue is called, the control room contacts South Central Ambulance Service (SCAS) immediately: When this occurs during night state, members of staff report to the prison to await the arrival of the ambulance, and to assist the responding dog handler with opening the to the units_ An additional Operational Support Grade (OSG) also attends the to assist with receiving the emergency vehicle into the prison and searching The level of search of the vehicle is determined on the basis of an assessment of the circumstances of the emergency; to avoid unnecessary delay In the meantime, staff ariving at the scene and entering the cell give further details of the person's name and current condition to the control room who pass this on to SCAS s0 that the attending ambulance staff are informed and prepared on arrival Petty gate, gates gate gates gate any

All Custodial Managers will have had the opportunity to take part in a test of the arrangements for the receipt of emergency vehicles. Training for OSGs is being delivered on the establishment's bi-monthly training aftemoons, and all will have completed it before the end of 2019. Thank you again for bringing this matter of concer to my attention_ hope this response has provided reassurance that it is being addressed by the Govemor at HMP Woodhill and HMPPS_

Dear Mr Osborne Regulation 28 Report to prevent future deaths following the Inquest of Mr William Vickers am writing in response to the Regulation 28 Report issued on 26 July 2019 following the inquest into the death of Mr William Vickers. We are saddened by the untimely death of Mr Vickers and our deepest condolences are offered to his family_ Our aim in addressing the Regulation 28 Report is to provide assurance to both you and to Mr Vickers' family on the steps that we are taking to ensure that staff and the Trust; as an organisation, learn from Mr Vickers' death and that measures are put into place with the aim of ensuring that such issues can be avoided in the future_ The concern raised in the Regulation 28 report is set out below in bold followed by details of the actions taken by the Trust. During the course of the evidence, was concerned that not all staff within the prison, including those within healthcare, were confident in using the AED (Automatic External Defibrillator) and believe that the training of all staff should be reviewed s0 all are both familiar and confident in its use New AED's with data cards are now in place at HMP Woodhill; which record activity during its use. This data will include the following: Incident duration Elapsed time of the recorded incident when the AED was turned on: Shocks delivered The total number of shocks that were delivered during the recorded incident: Trust Headquarters, 350 Euston Road, London NW1 3AX Telephone: 020 3214 5700 WWW cnwlnhsuk Wellbeing for life PLRTTEREHDP London Milton Keynes Ken: Suney Hempshire Jan from

First shock time Elapsed time to first shock delivery from when the AED was turned on_ Presenting ECG Up to 15 seconds of the presenting ECG from the time the pads were applied to the patient: In July 2019, with the introduction of the new AEDs there have been a number of training sessions held to ensure CNWL Offender staff are competent and confident in their use_ The Trust Resuscitation Lead has confirmed that all emergency response training (BLS, ELS, ILS) includes information on the verbal instructions (and their meaning) that is given by an AED: The meaning of the wording 'shock cancelled' has been added with immediate effect to the training delivered. We have, with immediate effect; ensured that all Offender Care Services including Woodhill will have: Monthly refresher sessions held locally for familiarisation and training on the use of the AED and emergency equipment: Attendance by clinical staff to a refresher session at least quarterly: Records of attendance at the refresher sessions which will be monitored locally: A requirement for staff to complete a signed statement of competence following refresher sessions. 'Know your AED' posters have been developed and are displayed throughout HMP Woodhill to maintain familiarisation with it_ A How to use the AED' guide has also been sent to all healthcare staff at HMP Woodhill and will be used as part of the refresher training sessions_ It has been agreed with the Governor that CNWL will offer AED training sessions to officers at HMP Woodhill Officers will be able to attend the refresher sessions scheduled each month_ In addition to the above, all CNWL Offender Care staff are required to complete mandatory emergency response training (e-learning annually and face to face bi- annually) at a level appropriate to their role. Basic Life Support (BLS) administrative staff Emergency Life Support (ELS) non-qualified clinical staff (e.g: Healthcare Assistants)

Immediate Life Support (ILS) - qualified clinical staff (e.g. Nurses, Paramedics) Compliance is monitored by the Trust and 100% compliance has been achieved at HMP Woodhill All new CNWL staff at HMP Woodhill complete a detailed local induction which includes location of emergency equipment and its use_ In December 2018, the Offender Care Directorate established a Resuscitation Review Group with the purpose of sharing best practice , standardising emergency equipment and response and to review the training needs of staff: The review group is led by the Lead Nurse for Offender Care and includes senior clinicians from services and the Trust Resuscitation Lead: A 'resuscitationlmedical emergency' audit form has been introduced to enable a review of care delivered during a medical emergency These audit forms are reviewed at the Offender Care Resuscitation Review Group and any learning shared across services in their Iocal Care Quality Meetings. Any concerns are reported and monitored by the monthly Business and Performance Meeting by the Offender Care Senior Management Team. Any learning is shared through Learning Lessons Circulars which are disseminated to staff and discussed in local quality and team meetings On 27 June 2019, the CNWL Primary Care Lead at HMP Woodhill, who is a senior paramedic, completed a 'Train the Trainer' course which will enable local emergency response and refresher training detailed above to be carried out on a regular basis within the Woodhill Team: An external independent review has been commissioned to review the practice of emergency response within Offender Care and make recommendations for policy, practice and training: The findings will form the basis of a detailed action plan to ensure staff are equipped by the training provided and equipment available to respond to a medical emergency according to their role and expertise. These actions are expected to improve patient safety and outcomes_ hope this provides you with sufficient assurance that the Trust has taken action following the death of Mr Vickers, and has accepted your recommendation and continues to work to improve the service we provide both in HMP Woodhill and in our wider Offender Care Services If you have any questions or comments, please do not hesitate to contact me directly on the number above