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recurance

Janette Insley

16 Dec 2014 · Coroner Lisa Hashmi · Manchester (North)

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

The coroner's concerns

  1. 1. lack of qualified psychologists and resources

    “During the course of the evidence | was told that whilst the Consultant [name redacted] considered that a referral to a Psychologist was the most appropriate course of treatment available, staff were unable to make any such referral for inpatients due to lack of i) availability of suitably qualified practitioners and ii) resources. There is therefore a clear service gap.”
  2. 2. over-reliance on community therapy

    “most, if not all, Psychological therapy now takes place within the community. It would appear that undue emphasis is currently being placed upon this setting of care, to the detriment of inpatient services.”
  3. 3. delayed community psychologist referral

    “any referral to/consultation with a Psychologist based within the community would have taken at least 3-4 weeks post-discharge, thus leaving the patient without therapy during a particularly vulnerable period.”

Linked reports

Raised again laterJohn Haines16 Nov 2017 · 2 years 11 months later
Identical hazardConfidence 0.95 · high

This report

“staff were unable to make any such referral for inpatients due to lack of i) availability of suitably qualified practitioners and ii) resources.”

Later report

“patients cannot access a qualified Psychologist whilst under the care of the Home Treatment Team (HTT') etc.”
Original on judiciary.uk ↗
Full chain: Lack of access to qualified psychologist during home treatment team care

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.

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