Source · Deaths in custody

PPO Fatal Incident Reports

6,395 incidents 5,660 published 1,165 recommendations 1,632 self-inflicted 3,362 natural causes

Deaths in custody investigated by the Prisons and Probation Ombudsman. 26% of deaths are self-inflicted. Source: PPO.

Learning & thematic publications

74 cross-establishment publications

Learning Lessons Bulletins (50), thematic reviews (2), consultation responses (11), Policy into Practice (5) and annual reports (6): the systemic patterns the Ombudsman draws from many investigations.

TitleTypeDateSource
PPO response to JSC Inquiry into Children and Young Adults in the Secure Estate  Consultation response Jun 2026 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 21: Segregation Learning Lessons Bulletin Mar 2026 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 22: Self-inflicted deaths in reception prisons Learning Lessons Bulletin Mar 2026 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 20: Epilepsy Learning Lessons Bulletin Nov 2025 PDF
Annual Report 2024 to 2025 Annual report Jul 2025 PDF
Policy into Practice: Handling of prisoners’ property Policy into Practice Mar 2025 PDF
Policy into Practice: Handling of property complaints Policy into Practice Mar 2025 PDF
Complaints Investigations Learning Lessons Bulletin Issue 11: Property complaints Learning Lessons Bulletin Mar 2025 PDF
PPO response to JSC Tackling Drugs in Prison Inquiry Consultation response Feb 2025 PDF
PPO response to JHAC Inquiry into Prison Culture Consultation response Feb 2025 PDF
PPO response to JSC inquiry into Rehabilitation and Resettlement Consultation response Feb 2025 PDF
Policy into Practice: Emergency Response Policy into Practice Jan 2025 PDF
PPO response to the Independent Sentencing Review 2024/25 call for evidence Consultation response Jan 2025 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 19: Post-release death investigations 2 Learning Lessons Bulletin Jul 2024 PDF
Annual Report 2023-24 Annual report Jul 2024 PDF
Annual report 2022-23 Annual report Jul 2024 PDF
Policy into practice: Use of force Policy into Practice Feb 2024 PDF
PPO response to the inquiry into prison population and capacity Consultation response Nov 2023 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 18: Self-inflicted deaths of IPP prisoners Learning Lessons Bulletin Sep 2023 PDF
Investigating deaths after release from prison – a pilot evaluation Learning Lessons Bulletin Jan 2023 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 17: Post-release death investigations Learning Lessons Bulletin Jan 2023 PDF
PPO response to the inquiry into the Prison Operational Workforce Consultation response Jan 2023 PDF
Annual Report 2021-22 Annual report Oct 2022 PDF
Policy into Practice: Use of restraints on escort Policy into Practice Sep 2022 PDF
PPO Response to the Inquiry into IPP sentences Consultation response Jan 2022 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 16: Second wave COVID-19 related deaths Learning Lessons Bulletin Dec 2021 PDF
Annual Report 2020-21 Annual report Sep 2021 PDF
PPO responses to the Inquiry into Women in Prison Consultation response Aug 2021 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 15: COVID-19 PPO fatal incident investigations Learning Lessons Bulletin Feb 2021 PDF
Complaints Investigations Learning Lessons Bulletin Issue 10: COVID-19 PPO Complaints Learning Lessons Bulletin Dec 2020 PDF

Incidents

6,395 records
Name Establishment Cause Status Date of death Recs
David Benson HMP Leeds Pending inquest
Billy Payne HMP Belmarsh In progress
Andrew Neal HMP Wayland Pending inquest
John Hyde HMP/YOI Parc Pending inquest
David Roadknight HMP Oakwood In progress
Peter Wrigglesworth HMP Full Sutton Natural Published
Ryan Martin HMP Winchester Pending inquest
Stephen Ansbro HMP Frankland In progress
Anthony Copeland HMP Forest Bank Pending inquest
Colin Storey HMP Northumberland Self-inflicted Published
Adam Goulding Albion Street Approved Premises In progress
Daniel Serban HMP Lewes Pending inquest
Derrion Adams HMP Birmingham Pending inquest
Gareth Jones HMP Peterborough Pending inquest
Stephen Strutt HMP Dovegate In progress
Oliver Mulangala HMP/YOI High Down Pending inquest
Perrie Melladay HMP Lowdham Grange In progress
Peter Magloire HMP Wormwood Scrubs Self-inflicted Published
Shamraze Hussain HMP/YOI Doncaster In progress
Denis Passingham HMP Highpoint Pending inquest
Jason Stevens HMP Kirkham Pending inquest
Michael Maharaj HMP Brixton Pending inquest
Richard Hunt HMP Stocken In progress
Peter Campbell HMP Pentonville Pending inquest
Patryk Skupinski HMP Gartree Other Published
Albert Walkom HMP Littlehey Natural Published
Samuel Ross HMP Long Lartin Pending inquest
David Algie HMP Wymott Pending inquest
Stephen Bingley HMP Rye Hill Natural Published 11 Jul 2025
Thomas Reay HMP Holme House Natural Published 9 Jul 2025
Jaheim Grant Abingdon Road Approved Premises Other Published 6 Jul 2025
John Dawes HMP Nottingham Natural Published 5 Jul 2025
Trevor Brazier HMP Cookham Wood Natural Published 17 Jun 2025
David Kelly HMP Whatton Natural Published 9 Jun 2025
Mohammed Fethaullah HMP/YOI High Down Natural Published 13 May 2025 1
John Farrell HMP Wormwood Scrubs Natural Published 5 May 2025
Brian Lomas HMP Birmingham Natural Published 2 May 2025 1
Nigel Malt HMP Gartree Natural Published 29 Apr 2025 1
Ryan McArthur HMP Hull Other Published 26 Apr 2025
George Stephenson HMP Full Sutton Natural Published 20 Apr 2025
Sidney Matthews HMP The Verne Natural Published 13 Apr 2025
Ryan Kenny HMP Altcourse Unascertained Published 9 Apr 2025
Sydney Mimer HMP Littlehey Natural Published 26 Mar 2025
Dennis Coe HMP/YOI Moorland Natural Published 22 Mar 2025
Paul Ward HMP Fosse Way Natural Published 22 Mar 2025
Peter Long HMP Oakwood Natural Published 10 Mar 2025 1
Roy Anderson HMP Ranby Natural Published 10 Mar 2025 2
David Stead Box Tree Cottage Approved Premises Other Published 9 Mar 2025
Ernest Jones HMP/YOI Doncaster Natural Published 8 Mar 2025
Glen Candler HMP Wakefield Natural Published 6 Mar 2025 1