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Coroner’s reportPrevention of future deaths · 2023-0116

“Delayed progress of the Autism Strategy work across the Trust”

Dated 4 Apr 2023, from the coroner for Nottinghamshire. Sent to 2 organisations or people.

A coroner wrote this report after an inquest, to warn the organisations below about a risk of further deaths.

Read the full report on judiciary.uk

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The 56-day response deadline

Deadline passed

Replies were due by 30 May 2023. 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.

  1. Report dated4 Apr 2023
  2. Deadline30 May 2023
  3. Published on judiciary.uk14 Apr 2023
  4. Today23 Oct 2026

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Responses from each recipient

Responses from each recipient
Sent toResponse
Nottinghamshire Healthcare NHS Foundation TrustResponse publishedPublished on judiciary.uk in April 2023.
Nottinghamshire Integrated Care BoardDeadline passedNo response published on judiciary.uk so far. The 56-day deadline was 30 May 2023. A reply may have been sent and not yet published.

The coroner’s concerns

– 1. Delayed progress of the Autism Strategy work across the Trust. I ask that the Nottingham and Nottinghamshire Integrated Care Board provide a joint response with the Trust to address this concern, as I accept progress with the Autism work will depend upon resources and the agreed Commissioning of specific services 2. Insufficient progress with Complex case management 3. The Serious Incident Investigation process I am not reassured that necessary actions to address these serious issues identified are in place.

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, 2023-0116
Added to Minute Book
8 Oct 2026
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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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