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recurance

Hayley Cowan

29 May 2024 · Coroner Joanne Kearsley · Manchester North

The coroner's concerns

  1. 1. inconsistent definition of Section 17 leave

    “The court heard evidence as to the lack of consistency and clarity for Mental Health trusts in understanding and defining how Section 17 leave should be conducted”
  2. 2. inconsistent definition of escorted leave

    “There is a lack of consistency as to how "accompanied leave" and "escorted leave" are defined”
  3. 3. inconsistent guidance on eye-line or reasonable distance

    “Guidance as to whether a patient should remain in "eye-line" or at a "reasonable distance" is inconsistent and does not assist trusts”
  4. 4. inconsistent guidance across policies

    “The Mental Health Act Codes of Practice, Guidance from the MOJ to Forensic providers and Trust policy are inconsistent”

Responses

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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.

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