Form 6.2

RESPONSE

SHERIFFDOM OF TAYSIDE, CENTRAL AND FIFE at FALKIRK

Court ref: FAL-B334-23

DETERMINATION OF SHERIFF PINO DI EMIDIO

UNDER THE INQUIRIES INTO FATAL ACCIDENTS AND SUDDEN DEATHS ETC (SCOTLAND) ACT 2016

in the inquiry into the death of

SARAH JANE RILEY

To the Scottish Courts and Tribunals Service

1.    The Scottish Prison Service (SPS), being a body to whom a recommendation under section 26(1)(b) was addressed, do respond as follows. 

2.    Recommendation 1– The Scottish Ministers and SPS should consider (a) establishing a system in respect of prisoners who have been sentenced to an OLR to allow for a psychological formulation focussed on the prisoner’s risk to themselves, based on the information already available from the Risk Management Plan (“RMP”), to be prepared and shared with the prisoner’s personal officer and other SPS and NHS staff working with the prisoner’s personal officer on a regular basis; (b) providing training to SPS and NHS staff on the impact of OLR sentences on prisoners. 

SPS Response – (a) The Scottish Prison Service accepts this recommendation and intends to implement processes by the end of 2026 that will enable SPS to prepare and share with an OLR prisoner’s personal officer and other SPS and NHS staff working with an OLR prisoner a psychological formulation focused on the prisoner’s risk to themselves, based on the information already available from the Risk Management Plan (“RMP”). (b) SPS already provides awareness training to SPS staff concerning the legislative requirements of the OLR sentence and the SPS processes put in place to support this sentence type. During 2026, SPS will undertake a review of the current OLR training. The purpose of the review will be to ensure that the complexity of OLR cases is reflected in the training and to take account of   the requirements of this recommendation. The review will also consider what staff have to attend the training and the frequency of the training. SPS will make the training available to NHS staff who work with OLR prisoners.
3.    Recommendation 2 - Training should be provided to SPS and NHS staff on OLR’s and the impact of these sentences on prisoners.

SPS Response – As detailed in SPS’ response to Recommendation 1, SPS will develop and implement training by the end of 2026 on OLRs and the impact of OLR sentences on prisoners, which will be available to SPS and NHS staff.
4.    Recommendation 3 -  The Scottish Ministers and SPS should consider (a) making a requirement that an urgent case conference should take place within 7 days of the arrival of a recalled prisoner who is within the scope of the current TSG policy to decide if the prisoner requires to be transferred to another prison; (b) specifying that the case conference should be chaired by a person of at least the rank of deputy governor; (c) the person chairing the case conference should be required to take action to secure that any decision as to transfer is actioned promptly; (d) the chair should within 7 days submit a report to SPS HQ detailing the reason for the decision of the case conference; and (e) the report should be considered forthwith by the most senior person on duty at the time it is received at SPS HQ.  

5.    Response – a) The SPS Policy for the Management of Transgender People in Custody Operational Guidance implemented in February 2024 requires that a case conference takes place for any person who enters SPS custody, which includes those recalled to custody, who are transgender, or have requested assistance to transition whilst living in custody. As far as reasonably practicable, this case conference should take place within 72 hours of such prisoner’s admission to SPS custody. The purpose of the case conference is to inform placement and accommodation decisions for the transgender person. b) Whilst we note that it is recommended that the case conference should be chaired by a person of at least the rank of deputy governor, the case conference detailed above is chaired by a unit manager. SPS considers that the unit manager is the appropriate level for these purposes. The current process has been in place for circa. 18 months and is operating satisfactorily. The current process does require the unit manager chairing a Transgender Case Conference (TCC) to notify the deputy governor in any cases where the TCC is unable to make a decision regarding the individual’s placement because the circumstances surrounding the individual are of a particularly complex nature or the individual has a history of violence against women and girls, or present a risk to women and girls. In such cases, the case will be escalated to the local risk management team, which is chaired by the deputy governor for further discussion and consideration. c) The 2024 Operational Guidance requires that detailed minutes are recorded on our prisoner record system for all transgender case conferences concerned with placement and accommodation decisions. The Operational Guidance also requires that all actions and decisions from the case conference are recorded, captured and followed up. (d) The 2024 Operational Guidance requires staff in establishments to contact the HQ Duty Manager, when a transgender person is admitted to SPS custody and to provide them with updates on the outcome of the initial assessment concerning where the transgender person will initially be accommodated and managed. Establishments are also required to upload into SPS Prisoner Records System copies of the Transgender Case Conference (TCC) meeting minutes, which will detail any discussions concerning any actions and decisions made at the TCC. Currently there is no specified timescale for establishments to upload these documents to the SPS Prisoner Records System, but SPS will take the necessary steps to amend the 2024 Operational Guidance by the end of February 2026 to require establishments to upload them within 7 days.  SPS HQ Policy Manager reviews the TCC documentation uploaded to SPS Prisoner Records System to ensure that appropriate case conference processes have taken place and that outcomes and decisions are consistent with The SPS Policy for the Management of Transgender People in Custody Operational Guidance This mechanism has operated for 18 months and is operating appropriately. (e) As detailed above in the 2024 Operational Guidance, an establishment will contact the HQ Duty Manager, when a transgender person is admitted to SPS custody and provide updates on the outcome of the initial assessment concerning where the transgender person will be accommodated and managed.  Transgender Case Conference (TCC) meeting minutes, which will detail any discussions concerning any actions and decisions made at the TCC will be reviewed by the SPS HQ Policy Manager to ensure that appropriate case conference processes have taken place and that outcomes and decisions are consistent with The SPS Policy for the Management of Transgender People. These processes have been in place for 18 months and are operating appropriately

6.    Recommendation 4 - Where an OLR or a TSG prisoner has been removed from association for more than 30 days for their safety, the Scottish Ministers and SPS should consider requiring that there should be an urgent high-level SPS HQ review at least at deputy governor level based on full reporting of the circumstances that has resulted in removal from association.  

7.    Response – SPS will amend its Removal from Association Policy (published in 2019) by the end of February 2026, to specify that only SPS HQ Senior Operational Managers at G Band and above (Deputy Governor level) will be permitted to approve an application for the removal of a prisoner from association for a period of more than 30 days on behalf of Scottish Ministers.  As detailed in the current Removal from Association Guidance (published in 2019) application to extend a prisoner’s removal from association for a period of more than 72 hours must include as much relevant detail as possible to enable SPS HQ Senior Operational Managers to make an informed decision on behalf of Scottish Ministers.

8.    Recommendation 5 - Where a prison has removed a prisoner from association without the prison staff having initiated the Rule 95 process timeously, the Scottish Ministers and SPS should consider making a requirement that the local prison should disclose the fact that the prisoner has been held in segregation without legal warrant to SPS HQ forthwith, and provide an explanation for the failure to apply within the correct timescale.  

9.    Response – SPS will amend its Incident Reporting Policy by the end of February 2026, to require all prisons to notify SPS HQ of all incidents where a prison has removed a prisoner from association without the prison staff having initiated the Rule 95 process timeously. Adding this to the list of incidents prisons are required to notify SPS HQ of may assist in eliminating or reducing the likelihood of further similar incidents happening again because of the lessons learned from the post incident investigative process that follows notification of any reportable incident. 

10.    Recommendation 6 – The Scottish Ministers and SPS should consider making a requirement that any request by a prison psychologist for the appointment of a personal officer to an OLR or TSG prisoner must be actioned within 7 days at deputy governor level.  

11.    Response – SPS will incorporate into the SPS standards, which all establishments are required to comply with, by the end of February 2026, that any request by a prison psychologist for the appointment of a personal officer to an OLR Prisoner must be actioned within 7 days at deputy governor level. 

12.    The SPS Policy for the Management of Transgender People in Custody Operational Guidance implemented in February 2024 requires that a case conference takes place for any person who enters SPS custody, who are transgender, or have requested assistance to transition whilst living in custody. It also requires as detailed at para 5.2 that mandatory participation in TCC will include “The individual’s personal officer”; therefore, a personal officer requires to be appointed within the first 72 hours of admission of a transgender individual.

13.    Recommendation 7 – The Scottish Ministers and SPS should consider making a requirement that: (a) a record should be kept of non-attendance by NHS staff at case conferences and the record monitored; and (b) if two successive case conferences are missed, this should trigger an obligation that a suitably experienced member of NHS staff must attend the next case conference.  

14.    SPS Response – From 1 November 2011, the healthcare of prisoners in SPS custody transferred to local NHS health boards which means that SPS cannot place any obligations on NHS staff to attend case conferences.  SPS will engage with National Prison Care Network with a view to seeking an agreement from NHS boards that if two successive case conferences are missed, this will trigger an obligation that a suitably experienced member of NHS staff must attend the next case conference.  

15.    SPS currently records all attendance at case conferences and if an agreement is reached with NHS in regard to their attendance at the case conferences, SPS would thereafter put in place measures to monitor NHS attendance and ensure appropriate escalation measures are put in place should there be nonattendance by NHS staff at two successive case conferences. 

16.    Recommendation 8 - The Scottish Ministers and SPS should consider making a requirement that when the need for a mental health assessment is identified on reception at prison or at a case conference or requested by a recently recalled OLR or TSG prisoner such an assessment should be commenced within 7 days.  

17.    SPS Response - From 1 November 2011, the healthcare of prisoners in SPS custody transferred to local NHS health boards. This means that SPS cannot require that when the need for a mental health assessment is identified by a healthcare professional when a prisoner is admitted to custody or at a case conference or requested by a recently recalled OLR or TSG prisoner such an assessment should be commenced within 7 days. These are matters for the NHS. 

18.    SPS will engage with National Prison Care Network with a view to seeking an agreement from NHS boards that when the need for a mental health assessment is identified by a healthcare professional on reception at prison or at a case conference or requested by a recently recalled OLR or TSG prisoner such an assessment should be commenced within 7 days.  

19.    SPS are truly sorry for the loss of Sarah Jane Riley, and our thoughts remain with her family.  

20.    The recommendations and learning from this Determination will be shared across the SPS to support wider learning and compliance.

Scottish Prison Service 
December 2025