Wiltshire and Swindon

Concerns summary Significant delays in implementing care packages and providing respite support for vulnerable carers, compounded by inadequate signposting of adult care services, complicated funding routes, and lengthy application processing times, put carers under severe strain.

Concerns summary The Armed Forces' victim support code lacks specific provision for serious sexual assault victims within the military, and staff managing suicide vulnerability risk assessments receive insufficient training and follow-up.

Concerns summary There's no national system allowing doctors to proactively share concerns about a patient's ongoing suitability for a firearms license, with patient confidentiality potentially overriding public safety.

Concerns summary The 'legal high' AMT is readily available for purchase despite clear evidence of its deadly effects, raising concerns about its unregulated status and accessibility to the public.

Concerns summary After a previous overdose attempt, a patient undergoing mental health assessment in a hospital unit was able to leave unnoticed, leading to his subsequent death by suicide.

Concerns summary Paramedics are inappropriately applying Do Not Resuscitate documents to non-natural deaths, such as overdoses, leading to a failure to intervene appropriately and placing them in a difficult position.

Concerns On the 7 June 2021 I accepted the transfer of an investigation into the death of Albert Thomas Stafford Manley who was known to his family as "Jim". I went on to open Jim's Inquest on the 14 June...