First reported 16 Sep 2013•Latest report 29 Jun 2026
Definition
What this concern includes
Includes deficiencies in controls dedicated to the ACCT process, including quality assurance, observations, reviews, documentation, information sharing, staffing or training, where the failure undermines reliable ACCT risk prevention or management.
Not included
Excludes generic organisational quality assurance, staffing or training failures that are not explicitly tied to ACCT.
Excludes unrelated prison, healthcare or mental-health processes that do not form part of ACCT.
Excludes outcomes, individual clinical judgments or underlying causes unless the assertion identifies a failure of an ACCT control.
Reports
92
Distinct published reports
Individual concerns
184
A report can raise multiple concerns
Date range
2013–2026
First to latest report issue date
Stated actions
276
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
HM Prison and Probation Service41
Ministry of Justice27
NHS England15
Care UK6
Department of Health and Social Care6
HM Prison Service6
Central and North West London NHS Foundation Trust5
Hewell Prison5
Oxleas NHS Foundation Trust5
HM Inspectorate of Prisons4
Practice Plus Group4
Birmingham and Solihull Mental Health NHS Foundation Trust3
Birmingham Prison3
G4S3
Greater Manchester Mental Health NHS Foundation Trust3
Prison or young offender institution51
Executive agency41
NHS trust32
Ministerial department29
Executive non-departmental public body15
Sub-organisation8
Multi-service care provider6
Independent healthcare provider5
Prison operator5
Justice inspectorate4
Private limited company4
Type not available4
Community interest company3
Advisory non-departmental public body2
Ombudsman2
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Derby and Derbyshire
Concerns raised2
Failure of ACCT observation scheduling to avoid overly long gaps
Failure to use appropriate cells for ACCT prisoners subject to cellular confinement
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Implement ACCT version 6 to support person-centred, multidisciplinary case management.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 26 June 2024.
Action
Produce guidance on ACCT ongoing records and observation timing to support staff in completing checks safely.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 26 June 2024.
Action
Convert cells in older prisons to ligature-resistant standards through the estate-wide programme.
Stated by HM Prison and Probation ServiceStated in progressThe respondent said that this action was in progress when they made their response on 26 June 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Cellular confinement does not itself require a specialist cell because not all prisoners undergoing it are at risk of self-harm.
Stated by HM Prison and Probation ServiceDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Dorset
Concerns raised3
Lack of automatic flagging of missed ACCT reviews
Lack of ACCT quality assurance between day 7 and post-closure review
Failure to invite relevant individuals such as key workers to ACCT reviews
This report raised 14 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Share ACCT process concerns with regional commissioners and request monitoring through contract reviews and feedback to the Health and Justice Oversight Delivery Group.
Stated by NHS EnglandStated plannedThe respondent said that this action was planned when they made their response on 6 June 2024.
Action
Conduct weekly ACCT completion checks and monthly regional ACCT summaries.
Stated by Guys Marsh PrisonStated in progressThe respondent said that this action was in progress when they made their response on 6 June 2024.
Action
Enable Band 3 officers to attend ACCT reviews from October 2024.
Stated by Guys Marsh PrisonStated plannedThe respondent said that this action was planned when they made their response on 6 June 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
Other report recipients are responsible for addressing prison healthcare guidance, ACCT operations and family engagement because these concern day-to-day prison operations.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
HMPPS is responsible for overseeing the ACCT process, including establishment-level training, and is responding independently to ACCT concerns.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Current staffing levels prevent Band 3 officers from attending ACCT reviews until October 2024.
Stated by Guys Marsh PrisonUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Nottinghamshire
Concerns raised2
Lack of understanding and training on key dates or anniversaries as self-harm risk factors
Failure to recognise the ACCT threshold without a verbalised self-harm statement
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Deliver the national ACCT, ACCT Assessor and Case Coordinator training packages using nationally trained Sodexo facilitators and HMPPS facilitators.
Stated by SodexoStated completedThe respondent said that this action was complete when they made their response on 25 January 2024.
Action
Provide ACCT refresher training to all staff when operational management returns to Sodexo, unless they have completed it earlier.
Stated by SodexoStated plannedThe respondent said that this action was planned when they made their response on 25 January 2024.
Shropshire, Telford and Wrekin
Concerns raised1
Failure to carry out scheduled ACCT observations
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Present an operational briefing to all staff on assigned ACCT-check responsibilities.
Stated by HM Prison and Probation ServiceStated plannedThe respondent said that this action was planned when they made their response on 3 April 2024.
Action
Incorporate the Governors Order on ACCT checks into ACCT V6 training delivered to staff.
Stated by HM Prison and Probation ServiceStated plannedThe respondent said that this action was planned when they made their response on 3 April 2024.
Action
Require Supervising Officers to complete daily checks and challenge staff where necessary.
Stated by HM Prison and Probation ServiceStated plannedThe respondent said that this action was planned when they made their response on 3 April 2024.
Action
Require staff working at HMP YOI Stoke Heath to complete suicide prevention and ACCT training.
Stated by Midlands Partnership University NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 3 April 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Senior Officers and Custodial Managers are not responsible for allocating ACCT checks; responsibility is assigned to designated operational staff.
Stated by HM Prison and Probation ServiceRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Exeter and Greater Devon
Concerns raised3
Inconsistent conducting of ACCT observations
Different staff interpretations of ACCT observation timing requirements
Failure to accurately record ACCT observation times
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Implement an ACCT assurance procedure with supervising-officer allocation, daily observation checks and escalation of discrepancies.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 22 September 2023.
Action
Provide two ACCT safety Floorwalkers to deliver regular staff upskilling on accurate observation completion.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 22 September 2023.
Action
Display ACCT V6 observation posters in wing offices and produce staff guides.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 22 September 2023.
Liverpool and the Wirral
Concerns raised1
Failure to ensure mental health team attendance at ACCT reviews
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing multidisciplinary ACCT arrangements, including healthcare involvement based on individual need, are considered sufficient; universal mental health nurse attendance is not required.
Stated by HM Prison and Probation ServiceExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Hampshire, Portsmouth and Southampton
Concerns raised2
Failure of ACCT audits to identify inadequate document completion
Failure to provide adequate ACCT training and refresher training for all relevant staff
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Operate an accountability system for ACCT quality assurance, feeding findings back to staff and rectifying serious concerns.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 22 November 2023.
Action
Deliver monthly ACCT v6 and SASH training and awareness sessions, supported by a monitored staff training plan.
Stated by HM Prison and Probation ServiceStated in progressThe respondent said that this action was in progress when they made their response on 22 November 2023.
Birmingham and Solihull
Concerns raised1
Failings in use of the ACCT system
This report raised 10 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Worcestershire
Concerns raised1
Failure to ensure staff completion of ACCT v.6 and SASH model 3 training
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.8
Action
Require managers or supervisors to sign off staff understanding of the ACCT process during prison induction.
Stated by Midlands Partnership University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 27 February 2023.
Action
Disseminate ACCT process guidance through the Inclusion prison guide and internal team, MPCC and ACCT meetings.
Stated by Midlands Partnership University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 27 February 2023.
Action
Achieve full compliance with mandatory clinical risk-management training for HMP Hewell mental-health staff.
Stated by Midlands Partnership University NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 27 February 2023.
Action
Roll out the three-level suicide mitigation training programme through induction and monitor completion using the Electronic Staff Record.
Stated by Midlands Partnership University NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 27 February 2023.
Action
Deliver combined ACCT v6 and SASH training to all prison staff.
Stated by HM Prison and Probation ServiceStated in progressThe respondent said that this action was in progress when they made their response on 27 February 2023.
Action
Train healthcare staff to deliver and complete ACCT training at HMP Hewell, reducing reliance on prison-led provision.
Stated by Practice Plus Group Health And Rehabilitation Services LimitedStated in progressThe respondent said that this action was in progress when they made their response on 27 February 2023.
Action
Develop and implement national clinical induction covering foundation ACCT training before prison employment, followed by full ACCT training within six months.
Stated by Practice Plus Group Health And Rehabilitation Services LimitedStated in progressThe respondent said that this action was in progress when they made their response on 27 February 2023.
Action
Introduce ACCT and SASH refresher training every two years after initial training, with completion monitored through the Learning Management System.
Stated by Practice Plus Group Health And Rehabilitation Services LimitedStated plannedThe respondent said that this action was planned when they made their response on 27 February 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
The Prison provides ACCT training, while attendance by mental healthcare staff is expected and locally monitored.
Stated by Midlands Partnership University NHS Foundation TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
The prison governs the ACCT process and had responsibility for running the required training.
Stated by Practice Plus Group Health And Rehabilitation Services LimitedRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Swansea and Neath Port Talbot
Concerns raised3
Lack of regular access to ACCT training for bank nurses
Failure to apply ACCT opening criteria to information indicating current self-harm or suicide risk
Inadequate frequency and currency of ACCT training for prison officers
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.12
Action
Make suicide and self-harm prevention training, including new modules, available to partner-organisation staff at HMP Swansea.
Stated by HM Prison and Probation ServiceStated in progressThe respondent said that this action was in progress when they made their response on 20 September 2022.
Action
Reserve two places in each ACCT training session for Health Board staff.
Stated by Swansea Bay University Local Health BoardStated plannedThe respondent said that this action was planned when they made their response on 20 September 2022.
Action
Prioritise and roster Health Board staff to attend ACCT Awareness training.
Stated by Swansea Bay University Local Health BoardStated plannedThe respondent said that this action was planned when they made their response on 20 September 2022.
Action
Make ACCT training mandatory in induction for new prison Health Board staff and provide refresher access.
Stated by Swansea Bay University Local Health BoardStated plannedThe respondent said that this action was planned when they made their response on 20 September 2022.
Action
Provide ACCT version 6 training to eight prison health staff.
Stated by Swansea Bay University Local Health BoardStated completedThe respondent said that this action was complete when they made their response on 20 September 2022.
Action
Secure ACCT training places for medical staff as national training dates are released.
Stated by Swansea Bay University Local Health BoardStated in progressThe respondent said that this action was in progress when they made their response on 20 September 2022.
Action
Produce and deliver ACCT version 6 training materials and presentations across the prison estate.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 20 September 2022.
Action
Prioritise staff with identified concerns for updated ACCT refresher training and provide an ACCT version 6 upskilling session.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 20 September 2022.
Action
Deliver the new risk-identification training module to fifteen staff working mainly in reception, induction and healthcare.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 20 September 2022.
Action
Issue guidance on risk identification and schedule additional training on risks, triggers and protective factors for staff in key areas.
Stated by HM Prison and Probation ServiceStated in progressThe respondent said that this action was in progress when they made their response on 20 September 2022.
Action
Request that bank nurses are not deployed in reception and that permanently employed ACCT-trained nursing staff complete initial screenings there.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 20 September 2022.
Action
Produce updated ACCT training and implement a programme for all HMP Swansea staff to complete refresher training by November 2024.
Stated by HM Prison and Probation ServiceStated in progressThe respondent said that this action was in progress when they made their response on 20 September 2022.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
Healthcare staff concerns are addressed by Swansea Bay University Health Board, the healthcare provider at HMP Swansea.
Stated by HM Prison and Probation ServiceRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Responsibility for ACCT training adequacy rests with the prison and will be addressed in the prison’s response.
Stated by Swansea Bay University Local Health BoardRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
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Includes deficiencies in controls dedicated to the ACCT process, including quality assurance, observations, reviews, documentation, information sharing, staffing or training, where the failure undermines reliable ACCT risk prevention or management.
