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Craig Chappell

8 Sept 2015 · Coroner Rosemary Baxter · East Riding and Kingston Upon-Hull
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The coroner's concerns

  1. 1. lack of formal communication mechanism for family concerns

    “There was no formal mechanism for communicating family concerns to relevant decision making professionals and inadequate information sharing.”

  2. 2. insufficient guidance for prison staff on victim support

    “There was insufficient guidance given to prison staff on appropriate support for potential victims of abuse.”

  3. 3. inappropriate reliance on subject's presentation and views without investigation

    “There was on occasions some inappropriate reliance by non health care staff on the subject's actual presentation and the subject's own views without investigating this further.”

Responses

No published response was found on judiciary.uk.

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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