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recurance

Jacqueline Cobain

25 Mar 2024 · Coroner Michelle Haste · London Inner (South)

The coroner's concerns

  1. 1. lack of review of concerning questionnaire responses

    “When Mrs [name redacted] cancelled her appointment scheduled for Monday 6 September 2021 by email on Saturday 4 September 2021, the system nevertheless generated an automatic questionnaire which is normally is sent 24 hours prior to a scheduled assessment appointment. The system had not recognised that Mrs [name redacted] had cancelled her appointment. She completed the questionnaire. Mrs [name redacted] responses to the questionnaire contained what were accepted to be concerning responses. Due to the cancellation the questionnaire”

Responses

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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.

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