“Door security ~ no final decision has been made yet, but my uncerstanding is that it is…”
Dated 27 Jan 2014, from the coroner for South Yorkshire West. Sent to 1 organisation or person.
A coroner wrote this report after an inquest, to warn the organisations below about a risk of further deaths.
The 56-day response deadline
Deadline passedReplies were due by 24 Mar 2014. A reply may have been sent and not yet published.
Organisations that receive a report must reply to the coroner within 56 days, saying what they will do or why they will do nothing. We show whether a response is published on judiciary.uk.
- Report dated27 Jan 2014
- Deadline24 Mar 2014
- Published on judiciary.uk27 Jan 2014
- Today23 Oct 2026
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Responses from each recipient
| Sent to | Response |
|---|---|
| Sheffield Teaching Hospitals NHS Foundation TrustNamed in the report as “Sheffield Trust” | Deadline passedNo response published on judiciary.uk so far. The 56-day deadline was 24 Mar 2014. A reply may have been sent and not yet published. |
The coroner’s concerns
This report was published as a scan, so its text was read automatically. Check the wording against the original before you quote it.
— (1) Door security ~ no final decision has been made yet, but my uncerstanding is that it is proposed to introduce a system for all secure wards, whereby there is a dual system involving key code and swipe card. Is this the proposed alternative to the current system, and bearing in mind it is now about ten months since this incident, when is it proposed such action should be taken? (2) On Saturday 23° March 2013 the staffing on Hawthorn Ward was only three, whereas it should have been (at least) four. Attempts had been made by the previous shift to obtain a replacement, although it had not involved contacting senior management, having failed to obtain a replacement by contacting either existing staff or flexi staff. The Action Plan reveals that as regards staffing there is a proposal that there will be no difference between weekdays and weekends, as Is now the case. It also indicates that a senior manager is to be made available to manage and not as now also involved in clinical duties. Please confirm what action is to take place. (3) There was no photograph available, of Mrs Bailey, to the Police when she disappeared. This clearly raises a number of difficult issues, as to the obtaining and retaining of a photograph. What decisions have been made in this regard?
An extract. Read the full report, including the circumstances of the death, on the Courts and Tribunals Judiciary website.
- Source
- judiciary.uk, Prevention of Future Deaths reports, 2014-0040
- Added to Minute Book
- 8 Oct 2026
- Reuse
- We show short extracts and link to the original. We don’t host the full report.
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Contains public sector information licensed under the Open Government Licence v3.0. Source: Courts and Tribunals Judiciary, judiciary.uk. Open Government Licence v3.0
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