DCI Red Metcalfe's renowned ability to get under the skin and into the minds of deranged killers is put to the ultimate test when he is forced to confront an old adversary - Pace Tierney, an enemy Red thought he had put inside forever. An inquiry into prison brutality, conducted by DS Kate Beauchamp, suddenly explodes into a terrifying ordeal when inmates, led by Pace Tierney, riot and take hostages.

The death toll at the hospital continues to rise as the chief suspects are murdered. DCI Red Metcalfe uncovers the unwelcome connection between the victims.