Milton Keynes

Coroner Area
Reports: 81 Earliest: Sep 2013 Latest: 24 Mar 2026

65% response rate (above 63% average).

Response Status
Responded 53 No Response 2 Historic 26
AI Classification
Action Taken 39%
Action Planned 38%
Noted 18%
Disputed 5%
Based on 82 classified responses
Top Categories
Hospital Death (Clinical Procedure… (32) Suicide (from 2015) (14) State Custody related deaths (12) Mental Health related deaths (11) Road (Highways Safety) related dea… (9)
Quarterly Trend
Category Breakdown
How does this area compare?
vs South East average: -1 reports · +5pp response rate
vs national average: -3 reports · +2pp response rate
81 results
Sean Brock
All Responded
2014-0381 8 Aug 2014
National Offender Management Service
State Custody related deaths
Concerns summary (AI summary) A significant reduction in prison officer numbers at HMP Woodhill directly compromises prisoner safety and poses a risk to lives.
Noted (AI summary) HMP Woodhill staffing levels have been benchmarked and agreed upon, with ongoing local and national recruitment efforts to address vacancies. Information sharing between prison staff and contractors is a priority.
Ross Boyd
All Responded
2014-0313 23 May 2014
Care Home Health related deaths
Concerns summary (AI summary) An inadequate assessment of the deceased's needs resulted in an inappropriate placement at a care home, failing to meet his specific requirements.
Noted (AI summary) Milton Keynes Council reviewed the case and believes the placement was appropriate given the information available at the time. They will ensure managers discuss the use of respite beds with their teams and the need for clear assessment and support planning.
Kevin Scarlett
All Responded
2014-0174 15 Apr 2014
National Offender Management Service
State Custody related deaths
Concerns summary (AI summary) The prison service and healthcare failed to assess the deceased's suicide risk, as staff lacked access to proper risk assessment tools or protocols.
Action Taken (AI summary) HMP Woodhill reviewed the local ACCT process in December 2013, revised the case review process, and issued guidance to staff. A governor grade is appointed to manage the case of each prisoner subject to the ACCT process who is assessed as having complex needs.
Doris Phoebe Miller
Historic (No Identified Response)
2013-0318 28 Nov 2013
Care Quality Commission NHS England Hertfordshire and South Mid…
Hospital Death (Clinical Procedures and medical management) related deaths
Concerns summary (AI summary) Patient medical records were unavailable to the GP surgery after a practice closure, indicating a failure in transferring and making accessible essential patient information.
Sally King
Historic (No Identified Response)
2013-0196 23 Sep 2013
Care Quality Commission Milton Keynes General Hospital
Hospital Death (Clinical Procedures and medical management) related deaths
Concerns summary (AI summary) The provided concerns text is too truncated to identify specific safety issues.
Yvonne Sydney Annie Perry
Historic (No Identified Response)
2013-0195 23 Sep 2013
Care Quality Commission Milton Keynes General Hospital
Hospital Death (Clinical Procedures and medical management) related deaths
Concerns summary (AI summary) A lack of robust processes for tracking radiology reports led to critical delays in patient care. Additionally, GPs in the intermediate care unit lacked access to electronic hospital notes, impeding effective treatment.