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recurance

Christopher Smith

28 Oct 2015 · Coroner Simon Jones · Manchester (West)

A similar concern from this report was raised again 1 time later. See the linked reports.

The coroner's concerns

  1. 1. delay in police contacting ambulance

    “It was clear from the evidence that there was a 12 minute delay in the police contacting the ambulance - the police were notified of the incident but did not contact North West Ambulance Service immediately.”
  2. 2. breakdown in communication between police control room and Motorway Control

    “I was told that the 12 minute delay was due to a breakdown in communication between Greater Manchester Police control room and the Motorway Control - Greater Manchester Police thought that the Motorway Control were contacting the ambulance and vice versa.”
  3. 3. absence of clear responsibility for calling ambulance

    “It seems to me that procedure should be in place whereby it is immediately established who is going to be responsible for calling the ambulance to avoid any delays, and the ambulance is called for at once.”

Linked reports

Raised again laterSamuel Curless19 Feb 2024 · 8 years 4 months later
Closely relatedConfidence 0.80 · moderate

This report

“It seems to me that procedure should be in place whereby it is immediately established who is going to be responsible for calling the ambulance to avoid any delays, and the ambulance is called for at once.”

Later report

“That in respect of GMP Call Handler's being required to call an ambulance to attend the scene, even where it is reported that someone is”
Original on judiciary.uk ↗
Full chain: Ambulance not called promptly when person reported dead

Responses

No published response was found on judiciary.uk.

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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error