“Laura Farmer and her family found her diagnosis of an E coli infection difficult to…”
Dated 16 Sep 2024, from the coroner for Inner North London. 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.
The 56-day response deadline
Deadline passedReplies were due by 11 Nov 2024. 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 dated16 Sep 2024
- Deadline11 Nov 2024
- Published on judiciary.uk17 Sep 2024
- Today23 Oct 2026
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Responses from each recipient
| Sent to | Response |
|---|---|
| UK Health Security Agency | Response publishedPublished on judiciary.uk in September 2024. |
| University College London Hospitals NHS Foundation TrustNamed in the report as “University College London Hospitals NHS Trust” | Response published, not yet matchedA response is published with this report. We haven’t yet matched it to the organisation it’s from, so it may be this one’s. |
The coroner’s concerns
Laura Farmer and her family found her diagnosis of an E coli infection difficult to understand. She was a vegan who took great pains with food preparation. As a family, they were extremely hygiene conscious, particularly as has a nut allergy. When Ms Farmer became ill, her family members wanted to understand what had happened and to keep themselves as safe as possible. 1. Someone from what was described to me as public health (I assume the UKHSA) spoke to Laura Farmer the day before her death, asking for information. However, she was in intensive care at the time and not able to give a full, detailed picture. There was apparently no exploration of potential contact with animals or water sports and I was told that only scant details of a recent restaurant visit were obtained. 2. The UKHSA did not at any stage ask for information to assist in attempting to determine the source of the E coli infection that ultimately killed his wife. If asked, Mr Farmer would have explained that on 6 April 2024, not only did he and his wife visit a local restaurant, they also had drinks at a nearby club, and they had recently eaten and drunk at local military establishments. None of that information appears to have been considered by the UKHSA. 2 3. After his wife’s diagnosis, Mr Farmer was given no advice about how to keep himself and their child safe. He cleaned the bathroom in anticipation of his wife’s return home, but did not use any personal protective equipment. When he later became unwell, he did not know whether he had put himself at risk. Having heard his description in court, I think it is not an exaggeration to say that he was then terrified that his own actions might leave his child an orphan. 4. The clinicians treating Ms Farmer gave evidence at inquest that they did not know if the source of the infection that killed her had ever been identified. Mr Farmer saw in the news that there was a local E coli outbreak in Waverley, Surrey. The clinicians at UCLH knew which strain of E coli had infected Ms Farmer, but not whether that strain had been discovered in Waverley or indeed elsewhere, because after reporting to the UKHSA they received no feedback, no advice on infection control and no information they could give Mr Farmer. After a death from E coli, there seems to have been no closing of the loop of safety information that could have assisted those most closely involved. 5. Mr Farmer explained to me that he had spent some considerable time and effort since his wife’s death trying to obtain basic information from the public health authorities without success. He struck me as a person of significant drive, and yet he found it incredibly difficult to find the correct person to speak to and then incredibly difficult to gain any meaningful understanding of what had happened. This cannot inspire public confidence and seems a very offhand way to treat a grieving relative. I did not call anyone from the UKHSA to give evidence at inquest, because I had expected that UKHSA would have shared relevant information with both clinicians and family. It may be, therefore, that there are explanations for what seem to be surprising actions and inactions. If that is the case, then of course you will be able to explain as much in your response.
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, 2024-0496
- 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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