Source · Prevention of Future Deaths
Wendy Eyles
Ref: 2025-0641
Date: 22 Dec 2025
Coroner: Hassan Shah
Area: Northamptonshire
Responses identified: 0 / 2
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No protocol exists for managing patients under both NHS and private psychiatry, leading to critical medication changes not being communicated, creating confusion and patient safety risks.
Date
22 Dec 2025
56-day deadline
16 Feb 2026 est.
Responses identified
0 of 2
Coroner's concerns
No protocol exists for managing patients under both NHS and private psychiatry, leading to critical medication changes not being communicated, creating confusion and patient safety risks.
View full coroner's concerns
One of the findings of the the Patient Safety Incident Investigation (PSII) was that “.. there is no protocol for patients open to private and NHS psychiatry at Northamptonshire Healthcare Foundation Trust. The Psychiatrist’s role in patient care is to review and recommend appropriate medication and it is problematic if two Consultants are overseeing this at the same time. It can cause confusion and detriment to the patient if medication changes are not communicated between parties and represents a risk to patient safety… It is notable that CMHT operational managers from across the service differ in their views on the appropriateness of a patient being open to NHS and private services at the same time..”. It also emerged at Inquest that a NHS Consultant may not be aware that the patient is also receiving private psychiatry. Where the GP is notified of private psychiatry, it does not trigger a notification to NHS mental health services. Notification of the dual treatment may then be entirely dependent upon the information being shared by the patient.
Report sections
Investigation and inquest
On 04 November 2024 I commenced an investigation into the death of Wendy Siobhan EYLES aged 55. The investigation concluded at the end of the inquest on 15 December 2025. The conclusion of the inquest was that: Wendy Siobhan Eyles died on the 31st October 2024 when she was struck by a train at Kettering station, Appropriate mental health support and intervention had not been provided.
Circumstances of the death
Wendy Siobhan Eyles died 31.10.2024 when she was struck by a train at Kettering Station . Appropriate mental health support and intervention had not been provided. The medical cause of death was:- 1a Multiple traumatic injuries. The conclusion was Suicide.
Similar PFD reports
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Report details
- Reference
- 2025-0641
- Date of report
- 22 December 2025
- Coroner
- Hassan Shah
- Coroner area
- Northamptonshire
Responses identified
Responses identified
0 of 2
2 responses not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 16 Feb 2026 (estimated).
Sent to
- Northamptonshire Healthcare Foundation Trust
- Northamptonshire Integrated Care Board
Part of a series
2026-0153
All responses identified