Crown Censure of Prison Service
June 17, 2009

An inmate at Nottingham Prison was diagnosed with Legionnaires Disease on 8 March 2006. HSE conducted a thorough and detailed investigation to determine the likely source of exposure. High levels of legionella bacteria were discovered in the hot and cold water system in the prison's Health Unit.
HSE found the Approved Code of Practice for controlling legionella bacteria in water systems had not been followed. This was a breach of Section 3 of the Health and Safety at Work etc Act 1974.
HM Prison Service attended a formal Crown Censure Hearing at HSE's Nottingham Office. HM Prison Service accepted the Crown Censure after explaining the action it had taken to prevent a recurrence at Nottingham Prison or its other prisons.
HSE Director for the Midlands Nick Ratty says the system for managing health and safety at Nottingham Prison had not been effective in controlling this well-known risk.
"The standard was far below what is appropriate for a Prison," Mr Ratty said.
"This case points out the need for employers to properly manage hot and cold water systems and manage the risk from legionella bacteria where vulnerable people may be at risk."
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