Skip to content
recurance

Ursula Keogh

21 Nov 2018 · Coroner Martin Fleming · West Yorkshire (West)

This report repeats 1 earlier warning. See the linked reports.

The coroner's concerns

  1. 1. inappropriate referral of at-risk students to school

    “e To review the current practice of referral by GP to the school for consideration as to the appropriateness of referral to CAHMS”
  2. 2. communication breakdown between health and education

    “e Consider improving communications between professionals, particularly health and education to eliminate contradictions offered in the advice”
  3. 3. delayed preventive measures at North Bridge

    “e Consider the appropriateness of fast tracking the implementation of preventative measures currently under consideration at North Bridge Halifax”

Linked reports

Repeats an earlier warningMwitumwa Ngenda20 May 2018 · 6 months earlier
Identical hazardConfidence 0.90 · high

Earlier report

“To consider the appropriateness of taking urgent preventative measures on the bridge in order to prevent recurrence.”
Original on judiciary.uk ↗

This report

“Consider the appropriateness of fast tracking the implementation of preventative measures currently under consideration at North Bridge Halifax”
Full chain: Preventive action needed for north bridge safety

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

Ursula Keogh · Recurance