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recurance

Alfie Gildea

18 Nov 2020 · Coroner Alison Mutch · Greater Manchester South

This report repeats 2 earlier warnings. See the linked reports.

The coroner's concerns

  1. 1. suspects not placed on bail with protective conditions

    “The inquest was told that at the time of the allegation of assault in July 2018 suspects in domestic abuse cases were not placed on bail with conditions, to protect alleged victims, where further investigation was required. Instead they were placed under investigation.”
  2. 2. inconsistent definitions of serious/serial domestic abuser

    “The inquest was told that the GMP/CPS definitions of a serious/serial domestic abuser perpetrator were different. It was unclear why that was the case. However as a result there are different points at which an offender's background triggers the requirement to treat the suspect as a serial/serious DA perpetrator.”
  3. 3. information location unclear in GMP systems

    “It was unclear where the information that an individual met the | criteria for a serial and serious DA Perpetrator should or did sit in | GMPs systems. Officers giving evidence did not understand how | such information could be accessed or recorded”
  4. 4. police misunderstanding of GMP serial/serious DA policy

    “There was a lack of understanding amongst police witnesses about the GMP policy in relation to serial/serious DA perpetrators and the actions that were required under GMPs policy.”
  5. 5. limited officer training on coercive control

    “Evidence at the inquest suggested that the majority of officers had received very limited training in relation to DA and in particular coercive and controlling behaviour. Understanding of how coercive and controlling behaviour in a relationship could be identified was limited.”
  6. 6. limited DASH risk assessment training

    “The inquest was told that the DASH risk assessment is a national tool. However training of GMP officers on understanding how to evaluate risk and score risk was limited.”

Linked reports

Repeats an earlier warningAdele Blakeman15 Apr 2016 · 4 years 7 months earlier
Closely relatedConfidence 0.90 · high

Earlier report

“The GMP computer system hinders officers and does not afford them easy access to important information within the time scales they have available to them, in order for them to adequately assess a situation.”
Original on judiciary.uk ↗

This report

“was unclear where the information that an individual met the | criteria for a serial and serious DA Perpetrator should or did sit in | GMPs systems”
Full chain: Inadequate information access in GMP systems
Repeats an earlier warningThomas Gallagher11 Aug 2016 · 4 years 3 months earlier
Identical hazardConfidence 0.90 · high

Earlier report

“The lack of formal training in relation to risk assessment and child mental health.”
Original on judiciary.uk ↗

This report

“The inquest was told that the DASH risk assessment is a national tool. However training of GMP officers on understanding how to evaluate risk and score risk was limited.”
Full chain: Lack of formal risk assessment training for officers

Responses

2020-0242-Response-from-Childrens-Services-Trafford-Council-Redacted.pdf ↗· Crown Prosecution Service

Stated action

“the Council has made significant improvements to its policies and procedures since 2018”

2020-0242-Response-from-CPS-Redacted.pdf ↗· Greater Manchester Police

Stated action · July-October 2020

“CPS Direct have also trained all prosecutors on 'Domestic Abuse Evidence Led Prosecutions'. This built on the Case Analysis and Strategy training focussing on the importance of case-building DA cases from the very start, where possible strengthening the case to ensure that it could proceed without the victim. It also gave refresher guidance on the available legislation and gateways for the admission of evidence without calling the victim, stressing the need to ensure scrupulous policy compliance”

2020-0242-Response-from-Dept.-of-Health-and-Social-Care-Redacted.pdf ↗· Home Office and Department of Health and Social Care

Stated action

“the GMHSCP provided assurance that the actions will be closely monitored.”

2020-0242-Response-from-Home-Office-Redacted.pdf ↗· Home Office and Department of Health and Social Care

Stated action · last Summer

“The Domestic Violence Disclosure Scheme (DVDS), also known as Clare's Law, is an important tool designed to keep people safe and we are working with the police to review the guidance used by forces.”

Stated action · Domestic Abuse Bill

“Under Clause 70 of the Domestic Abuse Bill, we are seeking to place the guidance that underpins DVDS onto a statutory footing to drive greater use and consistent application of the scheme by placing an express duty on the police to have regard to the guidance.”

Stated action · Royal Assent

“the Domestic Abuse Bill will introduce new Domestic Abuse Protection Orders (DAPOs). Once the Bill receives Royal Assent, we intend to pilot the Orders before rolling it out more widely.”

Stated action · post Royal Assent

“Police training will be an integral part of the rollout of DAPOs and we will produce detailed statutory guidance and a programme of training and toolkits for professionals”
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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