Recurance · prevention of future deaths reports
Pre-inquest brief
Lack of communication between prison healthcare and operational staff
The earlier warning
Richard Walsh · 25 Oct 2016 · Andrew Harris, London Inner (South)
“There appeared to be not only serious failures of communication, but failures from inadequate processes of communication between custodial and health professionals, between police, court, health care and prison services”
judiciary.uk/prevention-of-future-death-reports/richard-walsh
What was promised
Stated action 1 · response to Richard Walsh (25 Oct 2016) · stated timescale: 19/12/2016
“We attach as Appendix A a copy of the”
judiciary.uk/…/2016-0377-Response-by-Virgin-Care-Limited.pdf
Stated action 2 · response to Richard Walsh (25 Oct 2016) · stated timescale: 2018
“We will ensure that the new regulator is aware of this report and our correspondence.”
judiciary.uk/…/2016-0377-Response-by-Health-Care-Professions-Co…
What recurred
- 8 Apr 2026 · Jonathan Thornton · Alexandra Pountney · Closely related · confidence 0.80 (moderate)
The clearest link, quoted from both reports:
Earlier · Richard Walsh · 25 Oct 2016
“There appeared to be not only serious failures of communication, but failures from inadequate processes of communication between custodial and health professionals, between police, court, health care and prison services”
Later · Jonathan Thornton · 8 Apr 2026
“I am concerned that the lack of formal information sharing between the two departments gives rise to a risk of future death. Information sharing between Prison Healthcare and Operational Prison Staff.”
What happened next
No web check of the stated actions has been published for this chain.