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Investigations in the NHS

896 investigations 6864 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 6,864 recommendations. 76% of investigations have extracted recommendations. 680 investigations have recommendations tracked.

Investigations

Click an entry for full report & recommendations
London
Independent investigation: Diego Pineiro Villar (12) (A), Covent Garden (2000)
fatally stabbed 12 yr old child 30 times. Ind Inq 2002. Judge had previously wanted to section him
-1 recommendations Report PDF
London
Independent investigation: Dolores Smith, Earlsfield (2012)
Paranoid schizophrenic fatally beat mother then slit her throat. 20 year history of mental illness
3 recommendations Report PDF
London
Independent investigation: Donald Fletcher, Camden (2007)
Paranoid schizophrenic fatally batters boyfriend and stabs him 17 times. Long MH history – inquiry found many failings. 2011 Verita
6 recommendations Report PDF
South East
Independent investigation: Donald Lock, Findon (2015)
Paranoid schizophrenic repeatedly and fatally stabs stranger. MH history, some previous violence, family not listened to
21 recommendations Report PDF
South West
Independent investigation: Donna Smart, Shepton Mallet (2000)
MH homicide of wife (alc). Ind Inq 2001
-1 recommendations Report PDF
East of England
Independent investigation: Doreen Griggs, Wisbech, Cambs (2004)
Paranoid schizophrenic smothers and stabs grandmother fatally. Indep Inq. Hanson 2009
8 recommendations Report PDF
North East and Yorkshire
Independent investigation: Doreen Mann, Dewsbury (2008)
MH patient fatally batters wife and cuts her throat before committing suicide. MH history
-1 recommendations Report PDF
South West
Independent investigation: Dorothy Shepherd, Winchcombe (2010)
Paranoid Schizophrenic fatally stabs grandmother. History of prev. violence. V many failings in care
26 recommendations Report PDF
North East and Yorkshire
Independent investigation: Douglas Heathwaite, Newton Aycliffe (1995)
MH homicide of stranger.. Ind Inq 1998
-1 recommendations Report PDF
London
Independent investigation: Douglas Scott, Manor Park (2007)
Schizophrenic repeatedly and fatally stabs mother’s boyfriend with scissors. MH patient in Tower Hamlets, had stopped meds
4 recommendations Report PDF
South West
Independent investigation: Earl Swaby, Bristol (2010)
Mental Health Patient convicted of manslaughter after fatal stabbing. MH history
-1 recommendations Report PDF
North East and Yorkshire
Independent investigation: Eddie Thorpe, Dewsbury (2008)
Paranoid schzophrenic fatally batters father
-1 recommendations Report PDF
North West
Independent investigation: Edna Gadsby, Liverpool (2010)
Paranoid schizophrenic fatally stabs mother (had previously murdered father in Feb 2004 – released 2006). MH staff unaware of previous warning signs
-1 recommendations Report PDF
London
Independent investigation: Eduardo Mendoza, Hammersmith (2007)
Mentally ill woman fatally stabbed uncle 111 times. Had attacked him before. (Ind Inq 2012 Verita)
5 recommendations Report PDF
London
Independent investigation: Edward Miles, Tower Hamlets (2003)
Fatally and repeatedly stabbed husband. Ind Inq 2006
12 recommendations Report PDF
London
Independent investigation: Edward Shaw, Ladbroke Grove (2006)
Mentally ill woman with history of substance abuse repeatedly and fatally stabs friend. History of previous violence
4 recommendations Report PDF
Midlands
Independent investigation: Edwin Whatsize, Glen Parva (2019)
Mentally disordered man repeatedly and fatally stabs grandfather. Diminished responsibility
3 recommendations Report PDF
South East
Independent investigation: Eileen Cameron, Reading, Berks (1997)
MH homicide of mother. Ind Inq 2000
-1 recommendations Report PDF
North West
Independent investigation: Eileen Halewood, Liverpool (1998)
Paranoid schizophrenic fatally stabs mother. Ind Inq 2000
-1 recommendations Report PDF
North East and Yorkshire
Independent investigation: Eileen McLachlan, Wallsend, Tyne &Wear (1995)
Schizophrenic kills mother.. Ind Inq 1997
-1 recommendations Report PDF
London
Independent investigation: Eleftheria Demetriou, Wood Green (2012)
Mentally ill man repeatedly stabbed elderly neighbour. Recently discharged patient
6 recommendations Report PDF
South East
Independent investigation: Elizabeth Cook, Langley, Berks (2006)
Paranoid schizophrenic fatally stabs mother. Ind Inq 2006
4 recommendations Report PDF
North East and Yorkshire
Independent investigation: Elizabeth Gallagher, North Tyneside (2002)
MH patient stabbed wife.. Ind Inq 2005. Had previously threatened to kill wife.
-1 recommendations Report PDF
South East
Independent investigation: Elizabeth Thomas, Oxted (2014)
Mentally disordered teenager fatally stabbed young friend. Convicted of murder
11 recommendations Report PDF
London
Independent investigation: Ellen Boland, Paddington (1994)
MH patient strangled and repeatedly hit elderly mother with hammer ( + subsequent suicide). Ind Inq,1995 later suicide in Wandsworth Prison
-1 recommendations Report PDF