Recurring concern

Unreliable management of food and fluid refusal in prisons

First to latest report 21 Mar 2024 — 10 Mar 2026

Reports that mention this concern: 3
Times this concern has been raised: 8
Stated actions linked to this concern: 10

What this concern includes

Includes failures in prison arrangements for recognising and assessing food or fluid refusal, applying relevant policy, informing healthcare and custodial staff, monitoring intake and deterioration, considering medical or psychiatric review and hospital transfer, involving next of kin appropriately, and escalating when risk increases.

What is not included

Excludes general nutrition, hydration or meal-provision deficiencies where food or fluid refusal is not the material unsafe condition.
Excludes generic staff training, communication, documentation or escalation failures unless they directly impair the prison food-and-fluid-refusal management process.
Excludes ordinary treatment or care decisions after refusal-related risks have been reliably identified and escalated.
Excludes food or fluid refusal outside prison settings unless the assertion explicitly concerns the same prison refusal-management process.

Trends

Reports over time

Reports mentioning this concern, over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Reports about this concern sent to each recipient.

Recipient name withheld2

Cardiff Prison1

Cardiff & Vale University LHB1

Government Legal Department1

Midlands Partnership University NHS Foundation Trust1

Ministry of Justice1

Practice Plus Group1

Swansea Bay University Local Health Board1

Reports and published responses 3 reports

See individual reports that have raised this concern, and the actions taken in response

10 Mar2026
Worcestershire
Concerns raised4
1. Failure to inform Next of Kin of a prisoner’s decision to refuse food or fluids
2. Lack of prison staff awareness of the HMP Hewell food refusal policy
3. Lack of healthcare staff awareness of the food refusal policy
1. Failure to ask the prisoner whether food refusal information should be shared
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses

HM Prison and Probation Service
Midlands Partnership University NHS Foundation Trust
Practice Plus Group
Stated actions 5
1. HM Prison and Probation Service
  Deliver awareness sessions to prison and healthcare staff on supporting prisoners who refuse food, including contact with next of kin.
2. Midlands Partnership University NHS Foundation Trust
  Ensure partner healthcare policies affecting mental health services are shared in advance for clinical input and alignment.
3. Midlands Partnership University NHS Foundation Trust
  Disseminate relevant policies within mental health teams with guidance on roles, responsibilities, and interfaces with primary care.
1. Practice Plus Group
  Provide local feedback to primary healthcare staff on the inquest outcome and food-and-fluid refusal pathway.
2. Practice Plus Group
  Deliver national talks in July 2026 on recent food-and-fluid cases and the need to follow the pathway fully.
Respondent positions 2
1. Practice Plus Group
  The food and fluid refusal pathway is considered robust and fit for purpose regardless of the reason for refusal.
  Existing arrangements considered sufficient
1. HM Prison and Probation Service
  Practice Plus Group is responsible for responding to concerns about healthcare delivery at HMP Hewell.
  Redirects responsibility
AI-generated summary

Surendrakumar Patel · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Surendrakumar Patel died at Alexandra Hospital, Redditch, on 31 October 2024 after collapsing with a lower respiratory tract infection, with self-neglect through malnutrition contributing to his death. While on remand at HMP Hewell, he stopped eating, expressed that he no longer wished to live, lost weight, and developed acute kidney injury. The report identified concerns about healthcare staff’s failure to recognise the need for a timely mental capacity assessment, consider hospital transfer and expedited senior medical and psychiatric assessment, and consider family contact; prison staff also lacked awareness of procedures for informing or consulting next of kin about food refusal.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to inform Next of Kin of a prisoner’s decision to refuse food or fluids
Wider context from the report
“1. Healthcare staff (MPFT and PPG) lacked awareness of the food refusal policy: a. Failure to recognise that a mental capacity assessment was required as soon as food refusal began b. Failure to consider hospital transfer for prisoners severely weakened by weight loss c. Failure to expedite full medical assessment by a senior healthcare professional, including psychiatric assessment where physical health posed a risk to survival d. Failure to consider and advocate for family contact 2. Prison staff lacked awareness of HMP Hewell food refusal policy, including: • Not informing Next of Kin of the prisoner’s decision to refuse food/fluids • Not asking the prisoner whether such information should be shared ”
Source location
Surendrakumar Patel · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of prison staff awareness of the HMP Hewell food refusal policy
Wider context from the report
“1. Healthcare staff (MPFT and PPG) lacked awareness of the food refusal policy: a. Failure to recognise that a mental capacity assessment was required as soon as food refusal began b. Failure to consider hospital transfer for prisoners severely weakened by weight loss c. Failure to expedite full medical assessment by a senior healthcare professional, including psychiatric assessment where physical health posed a risk to survival d. Failure to consider and advocate for family contact 2. Prison staff lacked awareness of HMP Hewell food refusal policy, including: • Not informing Next of Kin of the prisoner’s decision to refuse food/fluids • Not asking the prisoner whether such information should be shared ”
Source location
Surendrakumar Patel · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of healthcare staff awareness of the food refusal policy
Wider context from the report
“1. Healthcare staff (MPFT and PPG) lacked awareness of the food refusal policy: a. Failure to recognise that a mental capacity assessment was required as soon as food refusal began b. Failure to consider hospital transfer for prisoners severely weakened by weight loss c. Failure to expedite full medical assessment by a senior healthcare professional, including psychiatric assessment where physical health posed a risk to survival d. Failure to consider and advocate for family contact 2. Prison staff lacked awareness of HMP Hewell food refusal policy, including: • Not informing Next of Kin of the prisoner’s decision to refuse food/fluids • Not asking the prisoner whether such information should be shared ”
Source location
Surendrakumar Patel · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to ask the prisoner whether food refusal information should be shared
Wider context from the report
“1. Healthcare staff (MPFT and PPG) lacked awareness of the food refusal policy: a. Failure to recognise that a mental capacity assessment was required as soon as food refusal began b. Failure to consider hospital transfer for prisoners severely weakened by weight loss c. Failure to expedite full medical assessment by a senior healthcare professional, including psychiatric assessment where physical health posed a risk to survival d. Failure to consider and advocate for family contact 2. Prison staff lacked awareness of HMP Hewell food refusal policy, including: • Not informing Next of Kin of the prisoner’s decision to refuse food/fluids • Not asking the prisoner whether such information should be shared ”
Source location
Surendrakumar Patel · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Deliver awareness sessions to prison and healthcare staff on supporting prisoners who refuse food, including contact with next of kin.

Verbatim wording from the response
“HMPPS recognises the importance of family involvement at times of increased vulnerability including where a prisoner is refusing food and/or fluid. A joint review of HMP Hewell’s food refusal policy has since been undertaken in partnership with healthcare colleagues. This review has strengthened clarity around the consideration of contact with next of kin when a healthcare professional identifies a serious risk to an individual’s health. Following the completion of the review, awareness sessions will be delivered to prison and healthcare staff involved in managing and supporting prisoners who refuse food, including contact with the next of kin, to support consistent, compassionate, and informed practice.”

Source location
Response from HM Prison & Probation Service
Page 2 · response
Published 12 March 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Ensure partner healthcare policies affecting mental health services are shared in advance for clinical input and alignment.

Verbatim wording from the response
“MPFT recognises that where policies held by partner organisations have implications for mental health services, there must be clear engagement to ensure shared understanding and effective implementation across providers.”

Source location
Response from Midlands Partnership NHS Foundation Trust
Page 3 · response
Published 12 March 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Disseminate relevant policies within mental health teams with guidance on roles, responsibilities, and interfaces with primary care.

Verbatim wording from the response
“2. Targeted Dissemination and Awareness MPFT will ensure that relevant policies impacting mental health practice are clearly disseminated within its teams, with explicit guidance on roles, responsibilities, and expected interfaces with primary care services.”

Source location
Response from Midlands Partnership NHS Foundation Trust
Page 3 · response
Published 12 March 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Provide local feedback to primary healthcare staff on the inquest outcome and food-and-fluid refusal pathway.

Verbatim wording from the response
“reason for the food and fluid refusal. In addition to local feedback to the primary healthcare staff at HMP Hewell following the outcome of the Inquest, Practice Plus Group has planned to roll out a series of talks nationally across the Group in July 2026 to feedback on the recent high profile food and fluid cases they have been involved in, and to reinforce the need to follow the food and fluid pathway in full.”

Source location
Response from Practice Plus Group
Page 4 · response
Published 12 March 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Deliver national talks in July 2026 on recent food-and-fluid cases and the need to follow the pathway fully.

Verbatim wording from the response
“reason for the food and fluid refusal. In addition to local feedback to the primary healthcare staff at HMP Hewell following the outcome of the Inquest, Practice Plus Group has planned to roll out a series of talks nationally across the Group in July 2026 to feedback on the recent high profile food and fluid cases they have been involved in, and to reinforce the need to follow the food and fluid pathway in full.”

Source location
Response from Practice Plus Group
Page 4 · response
Published 12 March 2026
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
The food and fluid refusal pathway is considered robust and fit for purpose regardless of the reason for refusal.

Verbatim wording from the response
“This does not mean that Practice Plus Group has not reflected on this case. The outcome of the Inquest follows a period whereupon the food and fluid refusal pathway has robustly been tested and, as a result, Practice Plus Group considers it to be robust and fit for purpose regardless of the”

Source location
Response from Practice Plus Group
Page 3 · response
Published 12 March 2026
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Practice Plus Group is responsible for responding to concerns about healthcare delivery at HMP Hewell.

Verbatim wording from the response
“Following evidence heard at the inquest you raised concerns directed to both HMPPS and Practice Plus Group (PPG). I understand PPG will respond to those issues relating to the delivery of healthcare at HMP Hewell, for which they are responsible. I am therefore responding to the issue relating to HMPPS.”

Source location
Response from HM Prison & Probation Service
Page 1 · response
Published 12 March 2026
Open published response
22 Jul2024
County Durham and Darlington
Concerns raised1
1. Failure to escalate information about food and fluid refusal
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response

HM Prison and Probation Service
Stated actions 1
1. HM Prison and Probation Service
  Write to all Governors highlighting the case and requesting staff reminders and assurance that local food-refusal recording and healthcare-sharing systems are in place.
Respondent positions 1
1. HM Prison and Probation Service
  Governors are responsible for assuring that local processes record and share information about food and fluid refusals effectively.
  Redirects responsibility
AI-generated summary

Russell Ian IRVINE · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Russell Ian Irvine took his own life by hanging in his prison cell at HMP Durham on 7 November 2022, three days after entering custody. He had reportedly told reception healthcare staff that he had refused food and fluids for the previous two days, but this information was not escalated and his intake was not adequately monitored. The report identified concerns about failures in reception screening, healthcare compliance with relevant policies, and the absence of a formal policy for monitoring whether prisoners collected meals.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to escalate information about food and fluid refusal
Wider context from the report
“Russell Ian Irvine died three days after his entry into HMP Durham on 4 November 2022 following his nicotine recall into custody, about which he protested and told reception healthcare staff that he had refused food and fluids for the previous two days. The evidence demonstrated that this information was not escalated in accordance with established policy which meant that Mr Irvine's food and fluid intake was not adequately or at all monitored by prison wing staff. ”
Source location
Russell Ian IRVINE · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Write to all Governors highlighting the case and requesting staff reminders and assurance that local food-refusal recording and healthcare-sharing systems are in place.

Verbatim wording from the response
“are operating effectively. I will ensure all Governors are written to so that this case is brought to their attention and to ask them to remind staff of their role in early identification of food and/or fluid refusals and to satisfy themselves that there are systems in place for recording information and sharing it with healthcare providers.”

Source location
Response from HMPPS
Page 2 · response
Published 1 August 2024
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Governors are responsible for assuring that local processes record and share information about food and fluid refusals effectively.

Verbatim wording from the response
“I understand your concern to ensure that this policy is translated into practical action, but in view of the range of catering and food service arrangements across the prison estate I do not believe that the introduction of a single process or form would be operationally viable. I believe that a better way forward is to ask Governors to assure themselves that their local reporting processes”

Source location
Response from HMPPS
Page 1 · response
Published 1 August 2024
Open published response
21 Mar2024
South Wales Central
Concerns raised3
1. Failure to provide staff with clear information about food and fluid refusal duration and warning signs
2. Failure to devise and implement a clear plan for assessing capacity to refuse food or fluid
3. Lack of a food and fluid refusal policy
This report raised 10 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response

Cardiff & Vale University LHB
Stated actions 4
1. Cardiff & Vale University LHB
  Establish and train staff on a joint food and fluid refusal policy at HMP Cardiff.
2. Cardiff & Vale University LHB
  Provide basic life support, mental capacity and bespoke prison-nursing training, with the bespoke programme underway from May 2024.
3. Cardiff & Vale University LHB
  Provide mental capacity assessment training to medical staff and plan annual refresher updates.
1. Cardiff & Vale University LHB
  Develop electronic templates to support application of the food and fluid refusal policy.
AI-generated summary

Alan Richard Miles Davies · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Alan Richard Miles Davies was transferred to HMP Cardiff after 16 days of refusing food and was found collapsed in his cell 10 days later; he later died in hospital. The reported concerns included inadequate communication and handover of information, insufficient care planning and observation, the absence of a food and fluid refusal policy, inadequate staffing, and missed opportunities to escalate his care.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to provide staff with clear information about food and fluid refusal duration and warning signs
Wider context from the report
“(11) The Nurse, Health care assistant and Custodial manager responsible for Mr Davies on the night of his collapse were not provided with clear information regarding the duration of his fluid and food refusal or the warning signs to consider in the context of the known risk of sudden collapse ”
Source location
Alan Richard Miles Davies · Prevention of Future Deaths report
Page 4 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to devise and implement a clear plan for assessing capacity to refuse food or fluid
Wider context from the report
“(7) No clear plan for the assessment of Mr Davies’ capacity to refuse food or fluid was devised or implemented at HMP Cardiff ”
Source location
Alan Richard Miles Davies · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of a food and fluid refusal policy
Wider context from the report
“(8) No food and fluid refusal policy was in place to guide healthcare staff. ”
Source location
Alan Richard Miles Davies · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Establish and train staff on a joint food and fluid refusal policy at HMP Cardiff.

Verbatim wording from the response
“A Joint Food and Fluid Refusal Policy is in place at HMP Cardiff, with training provided to healthcare and prison staff. Efforts are underway to develop electronic templates supporting the policy’s application. Training on Mental”

Source location
Response from Cardiff and Vale University Health Board
Page 2 · response
Published 25 March 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Provide basic life support, mental capacity and bespoke prison-nursing training, with the bespoke programme underway from May 2024.

Verbatim wording from the response
“Since September 2021, there has been a shift in the Healthcare Team's skill mix, with the appointment of more nurses possessing general medical skills. These nurses are better equipped to identify and respond to patients at risk of deterioration. Training initiatives, including basic life support and mental capacity assessment, have been implemented, supported by a Practice Development Nurse. Additionally, a bespoke training program for Prison Nurses in Wales has commenced. in May 2024.”

Source location
Response from Cardiff and Vale University Health Board
Page 2 · response
Published 25 March 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Provide mental capacity assessment training to medical staff and plan annual refresher updates.

Verbatim wording from the response
“Capacity Assessment has been imparted to medical staff, with plans for annual updates.”

Source location
Response from Cardiff and Vale University Health Board
Page 3 · response
Published 25 March 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop electronic templates to support application of the food and fluid refusal policy.

Verbatim wording from the response
“A Joint Food and Fluid Refusal Policy is in place at HMP Cardiff, with training provided to healthcare and prison staff. Efforts are underway to develop electronic templates supporting the policy’s application. Training on Mental”

Source location
Response from Cardiff and Vale University Health Board
Page 2 · response
Published 25 March 2024
Open published response

Actions and positions describe what organisations say in published responses. Implementation is not independently verified.

Data last updated 7 September 2026

What this concern includes

Trends

Reports mentioning this concern, over time

Concerns raised4

Failure to inform Next of Kin of a prisoner’s decision to refuse food or fluids

Lack of prison staff awareness of the HMP Hewell food refusal policy

Lack of healthcare staff awareness of the food refusal policy

Failure to ask the prisoner whether food refusal information should be shared

Linked responses

Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2

Concerns raised1

Failure to escalate information about food and fluid refusal

Linked response

Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1

Concerns raised3

Failure to provide staff with clear information about food and fluid refusal duration and warning signs

Failure to devise and implement a clear plan for assessing capacity to refuse food or fluid

Lack of a food and fluid refusal policy

Linked response

Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4

Stated actions 5

Respondent positions 2

Stated actions 1

Respondent positions 1

Stated actions 4