Published on September 22 2015

The Prisoner Ombudsman for Northern Ireland today published an investigation report into the death of a Maghaberry prisoner, Alec Smyth who died in December 2013. He had been released to receive palliative care at hospital two days earlier in order that he would not die in custody.

From 2003 onwards Mr Smyth became increasingly reclusive in prison. He was very difficult to motivate or manage and consistently refused offers of help. These factors became more significant in 2013 when he developed cancer.

The clinical reviewer fully recognised the management challenges Mr Smyth posed, but was critical of his physical healthcare, particularly the fact that it took over seven months to diagnose his lung cancer. Staff shortages and time pressures may contribute to an explanation for this delay, but the clinical reviewer’s summary was that Mr Smyth’s health needs were neither fully assessed nor properly met during 2013.

The main findings of the investigation are:

  • Six opportunities to diagnose Mr Smyth’s cancer were missed;

  • He did not receive palliative care for several months;

  • After a CT scan confirmed Mr Smyth was seriously ill, no action plan was implemented apart from a referral to hospital;

  • There were no procedures in place to follow up missed medical appointments;

  • Prison GPs did not visit Mr Smyth after his diagnosis and they prescribed medication without seeing a dying patient.

While healthcare and custody are separate functions, the investigation also found that considerable improvement is required in their coordination at Maghaberry Prison.

The report makes thirteen recommendations for improvement, all of which have been accepted by the SEHSCT and the NIPS. Two were previously made to, and accepted by the SEHSCT, before the onset of Mr Smyth’s illness.

The SEHSCT indicated a number of improvements have been agreed through a prison healthcare reform project which includes systemising the coordination of clinical care for complex patients and establishing clinical meetings.

The NIPS said it is determined to use this report to strengthen systems already in operation throughout Northern Ireland’s prisons.

Prisoner Ombudsman Tom McGonigle, in expressing sympathy to the next of kin, said

“While Mr Smyth did not help his own diagnosis or treatment, his case highlights the difficulties that sick prisoners encounter since they cannot visit       their GP or an A&E Department in the same way as someone in the community. His end of life experience emphasises the need for the prison healthcare       reform project to deliver better diagnosis and palliative care.”

Media contact:

McCann Public Relations, Telephone: 02890 666322
Maria McCann: 07802934246 or Natalie Mackin: 07974935855 Notes to editors:  

1. The Prisoner Ombudsman’s Terms of Reference require the Office to investigate all deaths in prison custody since September 2005. For further information see  

2. In line with the Prisoner Ombudsman’s Terms of Reference a copy of this report has been sent to the Coroners Service for Northern Ireland.  

3. The Prisoner Ombudsman aims to provide the facts of the case and publicise all material that is necessary to serve the public interest. This is balanced against legal obligations in respect of data protection and privacy, and next of kin views are therefore important when publication is being considered. In this case the next of kin are content that all the investigation details should be made public.  

4. Mr Smyth’s next of kin have requested that their privacy be respected. Media enquiries should be directed to their solicitor, Paul Farrell on 028 9032 4565 or 07989539261