“Whether there is appropriate support and systems in place to encourage Junior Midwives…”
Dated 17 Oct 2019, from the coroner for Gloucestershire. 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
All responses publishedReplies were due by 12 Dec 2019.
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; a reply may have been sent and not yet published.
- Report dated17 Oct 2019
- Deadline12 Dec 2019
- Published on judiciary.uk17 Oct 2019
- Today23 Oct 2026
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Responses from each recipient
| Sent to | Response |
|---|---|
| Gloucestershire Hospitals NHS Foundation TrustNamed in the report as “Gloucestershire Hospitals NHS Trust” | Response publishedPublished on judiciary.uk in October 2019. |
The coroner’s concerns
– (1) Whether there is appropriate support and systems in place to encourage Junior Midwives and Junior Doctors to escalate any concerns they have to more Senior Colleagues, (2) Whether there is sufficient understanding of the need to retain placentas post delivery Gloucestershire Coroner's Court, Corinium Avenue, Barnwood, Gloucester, GL4 3DJ Tel 01452 305661 for a specified time period prior to disposal.
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, 2019-0481
- Added to Minute Book
- 8 Oct 2026
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- 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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