Recurance · prevention of future deaths reports
Pre-inquest brief
Lack of meaningful family involvement in care process
The earlier warning
Dean Saunders · 17 Feb 2017 · Caroline Beasley-Murray, Essex
“The meaningful involvement of families in the ACCT process, including by ensuring the formal recording, and communication of concerns raised by a prisoner's family.”
judiciary.uk/prevention-of-future-death-reports/dean-saunders
What was promised
Stated action 1 · response to Dean Saunders (17 Feb 2017) · stated timescale: none stated
“The following information describes the commissioning arrangements for healthcare for someone being held in police custody.”
What recurred
- 16 Aug 2019 · Justin Gallagher · Alan Craze · Closely related · confidence 0.90 (high)
The clearest link, quoted from both reports:
Earlier · Dean Saunders · 17 Feb 2017
“The meaningful involvement of families in the ACCT process, including by ensuring the formal recording, and communication of concerns raised by a prisoner's family.”
Later · Justin Gallagher · 16 Aug 2019
“There was no involvement of the family and so a source of important information was missed.”
What happened next
Evidence found · stated action 1
“The commissioning of Healthcare for Police Custody Suites is to transfer to NHS England by 2016. This work will continue to be developed and”
Health and Justice Commissioning Intentions 2015/16 · england.nhs.uk/…/hj-comms-ints-refresh.pdf