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
Donner, David HMP Risley Natural Published 21 Feb 2021
Individual at Stoke Heath HMP Stoke Heath Natural Published 20 Feb 2021
Individual at The Verne HMP The Verne Natural Published 20 Feb 2021
Individual at Dovegate HMP Dovegate Natural Published 19 Feb 2021
Individual at Wakefield HMP Wakefield Natural Published 19 Feb 2021
Individual at Morton Hall IRC IRC Morton Hall IRC Self-inflicted Published 19 Feb 2021
Individual at Bure HMP Bure Natural Published 18 Feb 2021
Eral Morgan HMP Oakwood Other Published 17 Feb 2021 3
Individual at Long Lartin HMP Long Lartin Natural Published 17 Feb 2021
Przemyslaw Wozniak HMP Wandsworth Self-inflicted Published 17 Feb 2021 8
Individual at Wakefield HMP Wakefield Natural Published 17 Feb 2021
Clive Pinder HMP Risley Natural Published 17 Feb 2021 5
Individual at Stocken HMP Stocken Natural Published 16 Feb 2021
Individual at Lewes HMP Lewes Natural Published 16 Feb 2021
Individual at Long Lartin HMP Long Lartin Natural Published 15 Feb 2021
Individual at Ranby HMP Ranby Natural Published 15 Feb 2021
Individual at Swaleside HMP Swaleside Natural Published 14 Feb 2021
Individual at Long Lartin HMP Long Lartin Natural Published 14 Feb 2021
Individual at Littlehey HMP Littlehey Natural Published 14 Feb 2021
Individual at Altcourse HMP Altcourse Natural Published 14 Feb 2021
Individual at Elmley HMP Elmley Natural Published 14 Feb 2021
Individual at High Down HMP High Down Natural Published 14 Feb 2021
Tuckwell, Peter HMP Oakwood Natural Published 13 Feb 2021
Individual at Altcourse HMP Altcourse Natural Published 13 Feb 2021
Individual at Lewes HMP Lewes Natural Published 12 Feb 2021
Individual at Wakefield HMP Wakefield Self-inflicted Published 11 Feb 2021
Dennis, Nigel HMP Bullingdon Natural Published 9 Feb 2021
Individual at Leeds HMP Leeds Natural Published 9 Feb 2021
Individual at Trent House Trent House Natural Published 9 Feb 2021
Individual at Stafford HMP Stafford Natural Published 7 Feb 2021
Individual at Lewes HMP Lewes Natural Published 6 Feb 2021
Individual at The Verne HMP The Verne Natural Published 6 Feb 2021
Individual at Winchester HMP Winchester Natural Published 5 Feb 2021
Individual at Jackie Harriett House Jackie Harriett House Other Published 4 Feb 2021
Individual at Dovegate HMP Dovegate Natural Published 4 Feb 2021
Individual at Hewell HMP Hewell Self-inflicted Published 3 Feb 2021
Individual at Littlehey HMP Littlehey Natural Published 3 Feb 2021
Deejay Blampey HMP Exeter Self-inflicted Published 2 Feb 2021 7
Individual at Littlehey HMP Littlehey Natural Published 30 Jan 2021
Individual at Isle of Wight HMP Isle of Wight Natural Published 29 Jan 2021
Individual at Gartree HMP Gartree Natural Published 29 Jan 2021
Individual at Kirklevington Grange HMP Kirklevington Grange Self-inflicted Published 28 Jan 2021
Individual at Garth HMP Garth Natural Published 28 Jan 2021
Individual at Liverpool HMP Liverpool Other Published 27 Jan 2021
Individual at Littlehey HMP Littlehey Natural Published 24 Jan 2021
Individual at Birmingham HMP Birmingham Self-inflicted Published 23 Jan 2021
Individual at Hewell HMP Hewell Natural Published 22 Jan 2021
Individual at Elmley HMP Elmley Self-inflicted Published 22 Jan 2021
Rahman, Khairul HMP Pentonville Natural Published 22 Jan 2021
Individual at Woodhill HMP Woodhill Self-inflicted Published 21 Jan 2021