Cumbria
Coroner Area
Reports: 87
Earliest: Aug 2013
Latest: 16 Mar 2026
82% response rate (above 62% average).
Carl Morris
All Responded
2014-0092
3 Mar 2014
Professional Association of Diving Inst…
Other related deaths
Michael Telford
Historic (No Identified Response)
2014-0045
3 Feb 2014
Cumbria County Council
Road (Highways Safety) related deaths
Amanda Vickers
All Responded
2014-0052
3 Feb 2014
NHS Cumbria Clinical Commissioning Group
Mental Health related deaths
Concerns summary
A severe shortage of specialist crisis home beds, with no clear availability, contributed to a patient's death while awaiting admission, highlighting inadequate commissioning by the CCG.
Martin McGlasson
All Responded
2014-0001
6 Jan 2014
British Precast Concrete Federation
Alcohol, drug and medication related deaths
Concerns summary
Widespread use of an unsafe work method, failure to implement inexpensive safety measures despite known risks, and inadequate dissemination of risk assessments to operating staff were key concerns.
Action taken summary
Thomas Armstrong Holdings Ltd has implemented a new system of work and adopted a new Risk Assessment and Method Statement for moving staircases. They have also provided health and safety …
Damion Stanley Joseph Henson
Unknown
2013-0307
11 Dec 2013
Other related deaths
Concerns summary
A homeless unit, housing drug users, lacked 24-hour supervision, allowing unauthorized individuals to enter out of hours, thereby increasing risks in a facility not designed for drug rehabilitation.
Keith Thomas Graham
Unknown
2013-0327
4 Dec 2013
Hospital Death (Clinical Procedures and medical management) related deaths
Concerns summary
Hospital procedures for seriously injured trauma patients require urgent review, specifically concerning summoning on-call clinicians, CT scanning protocols, and minimizing delays to theatre for surgery.
Kathleen Rosemary Dixon
All Responded
2013-0292
11 Nov 2013
Mental Health related deaths
Concerns summary
Repeated critical incidents in the Trust, evident across multiple inquests, necessitate an independent assessment of its operations.
Action taken summary
The Department of Health reports that the Care Quality Commission (CQC) has already issued two warning notices and published an inspection report identifying shortfalls at Cumbria Partnership NHS Foun
Wilhelmina Isobel Newton
All Responded
2013-0283
31 Oct 2013
Care Home Health related deaths
Concerns summary
The care home lacked clear written protocols and guidance for staff on responding to head injuries in elderly residents, particularly those on anti-clotting medication.
Action taken summary
Cumbria County Council has developed a new policy and guidance for staff on how to respond to potential head injuries in elderly residents, especially those on medication affecting blood clotting. …
Brian Belfield
Historic (No Identified Response)
2013-0270
21 Oct 2013
Fell Runners Association
Other related deaths
Concerns summary
Failures in race management included an inaccurate system for tracking participants, lack of a single responsible person for checks, and unreliable communication between race control and marshals, leading to a missing runner.
Janet Richardson
Partially Responded
2013-0261
16 Oct 2013
Newmarket Promotions Limited
Cruise and Maritime Services Internatio…
Redningsselskapet
Other related deaths
Concerns summary
The deceased fell into the sea during a rescue medical evacuation.
Action taken summary
Cruise Maritime Services International Limited (CMI) maintains its existing ship-to-ship medical evacuation procedures are appropriate, noting the inquest concluded the rescue method was reasonable. T
Matthew Thomas Hamilton
Historic (No Identified Response)
2013-0180
8 Aug 2013
Cumbria County Council
Road (Highways Safety) related deaths
Concerns summary
A narrow footpath lacked a barrier, allowing children to emerge suddenly into traffic, compounded by restricted vision from a fence and shrubbery.
Peter Moorby
All Responded
2022-0194
Cumbria County Council
Alcohol, drug and medication related deaths
Concerns summary
A low, unlit wall provides inadequate protection from an 8-10 foot drop into a dangerous river, creating a significant risk of future accidental deaths.
Action taken summary
This resident strongly disputes the need for further action regarding the low wall, stating the death was a single unfortunate accident by an intoxicated individual. They argue that raising the …