Skip to content
recurance

Gracie Spinks

27 Nov 2023 · Coroner Matthew Kewley · Derby and Derbyshire

The coroner's concerns

  1. 1. inadequate stalking investigation

    “Stalking - during the inquest I heard evidence from the police officers who were involved in investigating [the deceased]'s stalking complaint in February 2021. Derbyshire Constabulary accepted that there were serious failings in how [the deceased]'s complaint was investigated by these officers. I do recognise that Derbyshire Constabulary has taken some steps following [the deceased]'s death to improve knowledge around stalking. However, as the Detective Chief Superintendent who gave evidence for the Constabulary accepted”
  2. 2. missing risk assessments

    “Risk assessments - during the inquest I saw a number of good quality risk assessments completed by police call handlers/officers who were involved in the very early stages of [the deceased]'s stalking complaint in February 2021 and also the rucksack incident in May 2021. However, it became apparent during the inquest that the police officers who were subsequently allocated to deal with the stalking complaint and the rucksack incident failed to record any form of risk assessment or fully assess the”
  3. 3. inadequate note taking

    “Contemporaneous note taking/record keeping - during the inquest I heard that police officers failed to make any contemporaneous notes of important steps in the police investigation including, for example, conversations with an informant/member of the public, words of advice given to a suspect, a telephone call to a potential witness and also an internal police discussion between a police constable and police sergeant discussing the closure of an investigation. The written crime reports reviewed”
  4. 4. mishandling of dangerous items

    “Potential weapons/dangerous items found in the community - during the inquest I heard that police officers attended to a report of a rucksack containing weapons found by a member of the public in May 2021. Despite the rucksack containing weapons, it was treated by the attending police officers as if it were an item of found property. Derbyshire Constabulary accepted that there were serious failings in how the officers dealt with this incident. During the inquest, I heard that there has been”
  5. 5. lack of stalking advocacy

    “Independent Stalking Advocates - during the inquest I heard evidence about the benefits that stalking advocates can provide to those who are victims of stalking. Whilst I was reassured to h”

Responses

  • Built with
  • NVIDIA Nemotron Nano, Super and Ultra
  • Nebius Token Factory inference
  • Qwen3 Embedding 8B on Token Factory
  • Tavily follow-up web search
  • Postgres and pgvector search
  • Next.js site

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