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recurance

Seweryn Glowinski

15 Oct 2014 · Coroner Geraint Williams · Worcestershire

The coroner's concerns

  1. 1. lack of communication between Residential Wing and Segregation Unit

    “There appeared to be no communication between the Residential Wing and the Segregation Unit as to the plan for Mr [name redacted]. It appeared that the Segregation staff were unaware that the wing staff wanted to have him risk assessed for a move to another location and in fact the risk assessment was not commenced until the day before his death.”
  2. 2. incorrect transposed documentation

    “The documents to review and authorise his further detention in the Segregation Unit were completed by the way of "cutting and pasting" from other prisoner's files. It was clear that the information on Mr [name redacted] paperwork was incorrect and had been transposed from another prisoner”
  3. 3. lack of awareness of Prison Service Orders requirements

    “The Senior Custodial Managers in the wing were unaware of the requirements of Prison service orders which meant that an individual on an open ACCT should not be transferred to segregation unless there were exceptional reasons for doing so”

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