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Investigations in the NHS

896 investigations 8078 recommendations 11 regions

Independent investigation reports and reviews commissioned by government or NHS bodies. Includes mental health homicide investigations, major maternity reviews, patient safety reviews, and other independent investigations into healthcare failures.

Coverage

By region & key findings

Investigations by region

Key findings

896 independent health investigations across 11 regions, producing 8,078 recommendations. 76% of investigations have extracted recommendations. 683 investigations have recommendations tracked.

Investigations

Click an entry for full report & recommendations
North East and Yorkshire
Independent investigation: Tony Petersen, Newcastle (2009)
MH patient fatally batters disabled man with claw hammer. Critical Inquiry report (Graham 2013)
-1 recommendations Report PDF
South West
Independent investigation: Tracey Baker, Chard (2015)
Mentally ill man bludgeons ex-wife to death with a hammer. Took his own life afterwards
15 recommendations Report PDF
East of England
Independent investigation: Tracy Anstice, Flitwick (2011)
Mentally ill man fatally stabs ex-wife
8 recommendations Report PDF
London
Independent investigation: Trevor Spencer, Dagenham
MH patient fatally shoots acquaintance during a robbery. MH History with previous violence. Verita 2010.
8 recommendations Report PDF
South East
Independent investigation: Tyler Warmington, Faringdon, Oxon (2017)
Mentally ill woman repeatedly & fatally stabs five year old son. Convicted of Manslaughter by diminished reponsibility
7 recommendations Report PDF
London
Independent investigation: Unknown, Unknown (2004)
Paranoid schizophrenic with history of violence fatally stabs man. Long history of violent offending and inpatient staysInd Inq 2011 NHS London
4 recommendations Report PDF
North West
Independent investigation: Valerie Donnelly, Preston (2011)
Paranoid schizophrenic fatally stabs and slashes Mother 80 times. MH History – due for ’emergency appointment’
3 recommendations Report PDF
East of England
Independent investigation: Valerie Jozunas, Wimbish, Saffron Walden (2020)
Mentally ill man repeatedly and fatally stabbed mother. Later died in prison.
12 recommendations Report PDF
South East
Independent investigation: Valerie Sexton, Gosport (2000)
MH patient strangled wife. Ind Inq 2004
4 recommendations Report PDF
Wales
Independent investigation: Valerie Thomas, Cardiff (2005)
MH patient fatally stabs elderly stranger (2nd choice). Long MH history. Critical Ind Inq. No Risk ass. CCTV
6 recommendations Report PDF
East of England
Independent investigation: Vera Croghan, Norwich (2020)
Man with schizophrenia starts fatal fire at his grandmother’s house. Recent inpatient – Diminished responsibility Sec 37/41
4 recommendations Report PDF
London
Independent investigation: Vethanayagam Anthonypillai, East Ham (2013)
Paranoid schizophrenic fatally stabs father
5 recommendations Report PDF
London
Independent investigation: Vincent Douglas, Lewisham (2017)
Mentally ill man fatally stabbed fellow hostel resident. History of previous violence when unwell – Restricted patient
3 recommendations Report PDF
South West
Independent investigation: Vincent Francis, Wells (2009)
MH patient fatally stabs friend’s boyfriend 17 times. MH historyInd. Inq. Dale
9 recommendations Report PDF
London
Independent investigation: Vincenzo Gianni, Chelsea, London (1998)
MH homicide. Ind Inq 1999
-1 recommendations Report PDF
South West
Independent investigation: Virginia (Ginny) Sivil and unborn baby, Bath (1998)
Schizophrenic fatally strangled partner whilst she was in labour with his child. Ind Inq 2001 13 prev admissions. Prev. violence. Records a mess, No Insight
-1 recommendations Report PDF
London
Independent investigation: Virginia Griffiths, Hornchurch (2008)
Schizophrenic man kills mother. Former inpatient – Much previous violence and threats to kill
1 recommendation Report PDF
South East
Independent investigation: Vittoria Baker, Oxford (2012)
Schizophrenic woman fatally stabs mother two days after release from psychiatric hospital. Evidence MH Trust knew she was a risk. Victim also MH patient
-1 recommendations Report PDF
North East and Yorkshire
Independent investigation: Warren Duke, Slough (but Tees patient) (2015)
Mentally ill man off meds fatally stabs man. Convicted of Manslaughter by diminished reponsibility
6 recommendations Report PDF
London
Independent investigation: Waveney Mclure, Hoxton (2008)
Paranoid Schizophrenic repeatedly batters mother with a hammer after failing to take meds. detained under MHA
2 recommendations Report PDF
North East and Yorkshire
Independent investigation: Wendy Pashley, Rotherham (2006)
MH patient strangles& batters wife with iron then sets body on fire at home in front of children. Ind Inq (2006/1787) 2008. MH recent history, recent release
8 recommendations Report PDF
Midlands
Independent investigation: Wilfred Marchant, Leicester (1999)
Psychotic MH patient stabs young boy (stranger) and father then beats pensioner to death (also a stranger). Ind Inq 2001 – prev hist of violence, left hospital day before, terrible failures, stopped meds.
-1 recommendations Report PDF
South West
Independent investigation: William Bodle, Bournemouth (1998)
MH homicide. Ind Inq 2002
-1 recommendations Report PDF
London
Independent investigation: William Kean, Canning Town (2004)
MH patient repeatedly and fatally batters grandfather. Ctitical Ind Inq
5 recommendations Report PDF
North West
Independent investigation: William Lound, Salford (2016)
Paranoid schizophrenic with history of violence fatally stabs man. Had previously made threats to kill
7 recommendations Report PDF