57 Prevention of Future Deaths reports name this organisation, 2014–2026. Every report below links to the original on judiciary.uk.
45 of 57 reports (79%) have at least one response published on judiciary.uk.
For reports written in the same years, 83% of all PFD reports in the corpus have a published response — so this page is in line with the corpus rate — the difference is within what chance alone would produce for this few reports.
This is not a reply rate. It counts responses published against the report by anyone — the organisation named here, a government department, a regulator or another body — because most response letters do not identify their author in a form that can be resolved reliably. A report with no response listed does not mean nobody replied: publication is at the discretion of the Chief Coroner's office, is often delayed, and was far less consistent in the corpus's early years. Treat a low figure as a prompt to read the reports, not as a finding about this organisation.
| Date | Deceased | Category | Coroner | Response | |
|---|---|---|---|---|---|
| 7 Apr 2026 | Mark Smith | State Custody related deaths | Jenny Goldring | none published | source |
| 24 Mar 2026 | Thomas Ruggiero | State Custody related deaths | Ian Potter | none published | source |
| 24 Mar 2026 | Thomas Ruggiero | State Custody related deaths | Ian Potter | none published | source |
| 24 Mar 2026 | Thomas Ruggiero | State Custody related deaths | Ian Potter | none published | source |
| 9 Feb 2026 | Josh Tarrant (1) | Alcohol drugs and medication related deaths | State Custody related deaths | Scott Matthewson | Frimley Health NHS Foundation Trust, NHS England | source |
| 9 Feb 2026 | Josh Tarrant (2) | Alcohol drugs and medication related deaths | State Custody related deaths | Scott Matthewson | none published | source |
| 9 Feb 2026 | Josh Tarrant (3) | Alcohol drugs and medication related deaths | State Custody related deaths | Scott Matthewson | HMP Elmley | source |
| 15 Dec 2025 | Sundeep Ghuman | State Custody related deaths | David Manknell | HM Prison Probation Service | source |
| 29 Jul 2025 | Azroy Dawes-Clarke | State Custody related deaths | Ian Brownhill | Department of Health and Social Care | source |
| 29 Jul 2025 | Azroy Dawes-Clarke | State Custody related deaths | Ian Brownhill | HM Prison Probation Service, South East Coast Ambulance Service, Oxleas NHS Foundation Trust | source |
| 25 Jul 2025 | Sheldon Jeans | Alcohol, drug and medication related deaths | State Custody related deaths | Rachael Griffin | HM Prison Probation Service, Oxleas NHS Foundation Trust, HM Prison and Probation Services, Department for Health and Social Care | source |
| 25 Jul 2025 | Michael Pugh | State Custody related deaths | Suicide (from 2015) | Patricia Harding | HM Prison Probation Service | source |
| 18 Jul 2025 | Patryk Gladysz | State Custody related deaths | Mental Health related deaths | Priya Malhotra | HM Prison and Probation Service, NHS England, Department for Health and Social Care | source |
| 30 May 2025 | Colin Lovett | Alcohol, drug and medication related deaths | State Custody related deaths | Rachael Griffin | HMPPS, Department of Health and Social Care | source |
| 11 Mar 2025 | Sean Higgins | State Custody related deaths | Mental Health related deaths | Suicide (from 2015) | Patricia Harding | HMPPS | source |
| 21 Feb 2025 | Paul Dunne | Hospital Death (Clinical Procedures and medical management) related deaths | Mental Health related deaths | Suicide (from 2015) | Andrew Harris | Care Quality Commission, NHS England | source |
| 21 Feb 2025 | Luke Worrell | Mental Health related deaths | Andrew Harris | NHS England, Care Quality Commission, MHRA, DHSC | source |
| 25 Nov 2024 | Jonathon Lawlor | State Custody related deaths | Alcohol, drug and medication related deaths | Catherine Wood | HMPPS | source |
| 8 Aug 2024 | Sean Davies | Suicide (from 2015) | Patricia Harding | none published | source |
| 19 Jul 2024 | Benjamin Harrison | State Custody related deaths | Alcohol, drug and medication related deaths | Patricia Harding | HMPPS, Oxleas NHS Foundation Trust | source |
| 27 Jun 2024 | Emily Collishaw | Alcohol, drug and medication related deaths | Andrew Harris | NHS England, Ministry of Housing Communities Local Governments, DHSC | source |
| 31 May 2024 | Frazer Williams | State Custody related deaths | Suicide (from 2015) | Rachael Griffin | NHS England, DHSC, Unilink, HMPPS HMP Guys Marsh | source |
| 17 May 2024 | Jada Monoja | Suicide (from 2015) | Xavier Mooyaart | DHSC, NHS England, South London and Maudsley NHS Trust | source |
| 4 Mar 2024 | Lee Hughes | Alcohol, drug and medication related deaths | Fiona Wilcox | Oxleas NHS Foundation Trust, NHS England | source |
| 2 Feb 2024 | Samuel Jordan | Suicide (from 2015) | Nicholas Rheinberg | NHS England | source |
| 21 Dec 2023 | Denise Porter | Suicide (from 2015) | Hannah Hinton | none published | source |
| 5 Dec 2023 | Samuel Jones | State Custody related deaths | Rachael Griffin | HM Prison and Probation Service, Ministry of Justice, NHS England | source |
| 27 Nov 2023 | Luke Whitelaw | Suicide (from 2015) | Ian Potter | Oxleas NHS Foundation Trust | source |
| 3 Jul 2023 | Liam Bentley | State Custody related deaths | Suicide (from 2015) | Patricia Harding | HM Prison and Probation Service | source |
| 2 Feb 2023 | Jason Williams | Alcohol, drugs medication related deaths | State Custody related deaths | Rachael Griffin | HM Prison Probation Service, HM Prison Probation Service 2, NHS England | source |
| 31 Jan 2023 | Nathan Forrester | Alcohol, drugs medication related deaths | State Custody related deaths | Andrew Harris | HM Prison and Probation Service 2, NHS England 2 | source |
| 17 Jan 2023 | John Henderson | State Custody related deaths | Ian Brownhill | Oxleas Forensic and Offender Healthcare Services | source |
| 10 Nov 2022 | Samuel Pearson | Alcohol, drug and medication related deaths | Jonathan Landau | Oxleas NHS Foundation Trust, London Borough of Bromley Council, Clarion Housing Group | source |
| 8 Nov 2022 | Liridon Saliuka | State Custody related deaths | Suicide (from 2015) | Philip Barlow | Oxleas NHS Foundation Trust, HM Prison and Probation Services | source |
| 24 Oct 2022 | Bradleigh Barnes | State Custody related deaths | Suicide (from 2015) | Rachael Griffin | NHS Oxleas, NHS England, HM Prison Probation Service 1, HM Prison Probation Service | source |
| 4 Nov 2021 | Christian Hinkley | State Custody related deaths | Scott Matthewson | HMPPS | source |
| 4 Oct 2021 | Caden Stewart | State Custody related deaths | Child Death (from 2015) | Patricia Harding | HMPPS | source |
| 10 Sep 2021 | Lee Thrumble | State Custody related deaths | Suicide (from 2015) | Mental Health related deaths | Scott Matthewson | none published | source |
| 25 May 2021 | James Devenny | State Custody related deaths | Mental Health related deaths | Suicide (from 2015) | Ian Brownhill | HMPPS | source |
| 10 Feb 2021 | Jason O’Rourke | State Custody related deaths | Mental Health related deaths | Suicide (from 2015) | Henrietta Hill QC | HMPPS | source |
| 11 Dec 2020 | Claire Lilley | Hospital Death (Clinical Procedures and medical management) related deaths | Mental Health related deaths | Suicide (from 2015) | Dr Julian Morris | Oxleas NHS Foundation Trust | source |
| 18 Aug 2020 | Viktor Scott-Brown | Suicide; Community healthcare related deaths | Oliver Longstaff | Oxleas NHS Foundation Trust, Tees Esk and Wear Valleys NHS Foundation Trust Redacted 1, BNF Publications, NICE | source |
| 26 Jun 2020 | Gary Etherington | Mental Health related deaths; Community healthcare related deaths; Suicide | Andrew Harris | Oxleas NHS Trust | source |
| 21 Feb 2020 | Billy Jenkins | Alcohol, drug and medication related deaths; Mental Health related deaths; Community health care related death; Suicide (from 2015) | Jacqueline Devonish | Oxleas NHS Foundation | source |
| 28 Jun 2019 | Feni Lee | Community health care related deaths | Philip Barlow | Bexley Medical Group | source |
| 8 May 2019 | Bernard O’Flynn | State Custody related deaths | Christopher Williams | none published | source |
| 15 Apr 2019 | Jennifer Lewis | Hospital Death (Clinical Procedures and medical management) related deaths | Roger Hatch | Oxleas NHS Trust | source |
| 29 Oct 2018 | Thomas McAuley | State Custody related deaths | Andrew Harris | Metropolitan Police | source |
| 27 Sep 2018 | Julia MacPherson | Hospital Death (Clinical Procedures and medical management) related deaths | Sonia Hayes | CQC, Department of Health | source |
| 12 Feb 2018 | John Sloan | Mental Health related deaths | Christopher Williams | none published | source |
| 29 Jan 2018 | Michael Vukovic | Hospital Death (Clinical Procedures and medical management) related deaths | Philip Barlow | Respondent not named | source |
| 18 Dec 2017 | Anne Morris | Hospital Death (Clinical Procedures and medical management) related deaths | Christopher Williams | Priory Group, Oxleas NHS Trust | source |
| 5 Dec 2016 | Christopher Brennan | Child Death (from 2015); Hospital Death (Clinical Procedures and medical management) related deaths | Selena Lynch | none published | source |
| 18 May 2016 | Ratidzai Sangare | Hospital Death (Clinical Procedures and medical management) related deaths | Selena Lynch | none published | source |
| 28 Dec 2014 | Alex Kelly | State Custody related deaths | Patricia Harding | Medway Youth Offending Service, Oxleas NHS Trust, Tower Hamlets, Ministry of Justice, Central North West London NHS Trust | source |
| 27 Oct 2014 | Philip Allen | Community health care and emergency services related deaths | Philip Barlow | Eltham Palace Surgery | source |
| 31 Mar 2014 | Deanne Smith | Alcohol, drug and medication related deaths | Dr R N Palmer | United Pharmacy | source |
These counts are a floor, not a total. A report is listed here only when it names the organisation in text our pipeline could read; scanned reports with poor OCR, and reports that name only a hospital site or an individual, are missed. Always check the source report.
Get notified when a new PFD report naming Oxleas NHS Foundation Trust is published.
What the recurring concerns are, and which were raised more than once.
The cleaned, OCR'd, metadata-tagged corpus.