Repeated warnings
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342 chains, most recent report first. The order is by date only; there is no ranking of organisations.
- Insufficient social care provision leading to discharge delays
Department of Health and Social Care · National body
8 reports · 3 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier report - Missing person coordinator absent weekends and insufficient 24/7 PolSA coverage
College of Policing · National body
2 reports · 2 coronersClosely relatedConfidence 0.80 · moderateNo published response to an earlier report - 2 reports · 2 coronersClosely relatedConfidence 0.90 · high
- Standing water on road leading to hydroplaning
National Highways · National body
5 reports · 5 coronersClosely relatedConfidence 0.80 · moderateNo published response to an earlier report - Obscured observation panels hinder monitoring
His Majesty's Prison and Probation Service · National body
3 reports · 3 coronersIdentical hazardConfidence 0.90 · high - Inaccurate and inconsistent care plan entries and record keeping
Care Quality Commission · National body
10 reports · 9 coronersClosely relatedConfidence 0.85 · high - Lack of national guidance for antenatal fetal monitoring
Royal College of Obstetricians and Gynaecologists · National body
2 reports · 2 coronersClosely relatedConfidence 0.85 · highNo published response to an earlier report - Overcrowded emergency department increases patient mortality
Department of Health and Social Care · National body
5 reports · 4 coronersClosely relatedConfidence 0.87 · high - 2 reports · 2 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier report
- 55 reports · 32 coronersClosely relatedConfidence 0.80 · moderateNo published response to an earlier report
- Delayed referral for neurosurgical care
NHS England · National body
2 reports · 2 coronersClosely relatedConfidence 0.90 · high - Lack of verbal warning and fire risk flag for paraffin emollient creams
Department of Health and Social Care · National body
3 reports · 3 coronersClosely relatedConfidence 0.85 · high - Missing pedestrian crossing on busy ring road
National Highways · National body
3 reports · 3 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier report - Inadequate medical documentation oversight
NHS England · National body
2 reports · 2 coronersClosely relatedConfidence 0.80 · moderate - Ambulance crew waiting in corridor due to insufficient clinical space
Department of Health and Social Care · National body
2 reports · 2 coronersClosely relatedConfidence 0.90 · high - 3 reports · 1 coronerIdentical hazardConfidence 0.95 · high
- Lack of basic first aid training and CPR among prison officers
His Majesty's Prison and Probation Service · National body
12 reports · 12 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier reportReviewed dossier - Lack of regular first aid training among custodial staff
Department of Health and Social Care · National body
2 reports · 2 coronersClosely relatedConfidence 0.90 · high - Overly rigid right care right person policy leading to deployment delays
College of Policing · National body
3 reports · 3 coronersClosely relatedConfidence 0.85 · high - Lack of CPR training among carers
Health and Safety Executive · National body
2 reports · 2 coronersIdentical hazardConfidence 0.90 · highNo published response to an earlier report