Delayed entry to residence due to underestimated urgency
Greater Manchester Police received 2 coroners' reports about this hazard between 7 Jul 2015 and 7 Jul 2025.
They came from 2 different coroners in 2 coroner areas. A similar concern was raised again 1 time after the first warning.
A published response was found for 1 of the 1 earlier reports, stating 2 specific actions.
The story, report by report
Spacing grows with the time between reports.
“There was an inordinate and inexcusable delay in gaining entry to the premises where it was known that the caller to the ambulance service had apparently collapsed mid-call.”
Original on judiciary.uk ↗ Greater Manchester Police responded, stating 1 specific action.Response (PDF) ↗
“The Specialist Operational Training Unit which is responsible for training officers in both decision making and tactics will use this example during their method of entry training modules.”
- 10 years laterClosely relatedConfidence 0.90 · higha different coroner
“The full background of the deceased, her history of falls, her recent bereavement and high risk to have suffered an adverse medical episode, or deliberate or unintended physical harm raised the expectation on the part of the family, that having called the emergency services, entry would be forced to the deceased's residence as they were of the view that there was a real and immediate risk of death or serious harm having occurred.”
Original on judiciary.uk ↗ Greater Manchester Police responded, stating 1 specific action.Response (PDF) ↗Response (PDF) ↗
“NWAS, in partnership with Greater Manchester Police (GMP), has identified a recurring thematic issue involving calls being passed from GMP to NWAS that do not meet the agreed threshold for Concern for Welfare as outlined in the Right Care, Right Person stakeholder meetings. These concerns have been formally escalated to Senior Leaders within GMP and to the Deputy Mayor for further consideration and action.”
- All reports to Greater Manchester Police
Each row is one judged link between an earlier and a later report. Open a row to read both quotes, found word for word in the originals.
2015 → 2025Elaine Tarbuck10 years after Michael Thorley · different coronerClosely relatedConfidence 0.90 · high
Closely relatedConfidence 0.90 · highBoth reports highlight a delay in gaining entry to a residence because responders underestimated the urgency of the situation.
Michael Thorley · 7 Jul 2015
“There was an inordinate and inexcusable delay in gaining entry to the premises where it was known that the caller to the ambulance service had apparently collapsed mid-call.”
Original on judiciary.uk ↗ Elaine Tarbuck · 7 Jul 2025
“The full background of the deceased, her history of falls, her recent bereavement and high risk to have suffered an adverse medical episode, or deliberate or unintended physical harm raised the expectation on the part of the family, that having called the emergency services, entry would be forced to the deceased's residence as they were of the view that there was a real and immediate risk of death or serious harm having occurred.”
Original on judiciary.uk ↗ Stated action in the response to the earlier report
“The Specialist Operational Training Unit which is responsible for training officers in both decision making and tactics will use this example during their method of entry training modules.”
Stated action
“The Specialist Operational Training Unit which is responsible for training officers in both decision making and tactics will use this example during their method of entry training modules.”
No specific action could be extracted with a verified quote.
Stated action
“NWAS, in partnership with Greater Manchester Police (GMP), has identified a recurring thematic issue involving calls being passed from GMP to NWAS that do not meet the agreed threshold for Concern for Welfare as outlined in the Right Care, Right Person stakeholder meetings. These concerns have been formally escalated to Senior Leaders within GMP and to the Deputy Mayor for further consideration and action.”
- Each report's concerns were extracted by Nemotron 3 Nano on Nebius Token Factory, each with a quote copied from the report.
- Concerns from reports to Greater Manchester Police at least six months apart were compared by meaning (Qwen3 embeddings) and wording (TF-IDF).
- The closest pairs were judged by Nemotron 3 Super with reasoning on. Only identical or closely related, with confidence of at least 0.70, are shown.
- Every quote was checked by code as an exact substring of the original text. Names of staff and family are redacted, and the deceased are named by report title only.
| Link | Meaning | Wording | Judge | Coroner |
|---|---|---|---|---|
| 2015 → 2025 | 0.77 | 0.10 | Closely related · 0.90 | different |
Judge model: nvidia/nemotron-3-super-120b-a12b. How Nemotron did the work · Full methodology.
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This shows that a similar concern was raised again after an earlier report. It does not say why, and it is not a finding about any organisation or person. To report an error, see the corrections route.