Source · Deaths in custody
PPO Fatal Incident Reports
6,401 incidents
5,674 published
1,165 recommendations
1,633 self-inflicted
3,373 natural causes
Deaths in custody investigated by the Prisons and Probation Ombudsman. 26% of deaths are self-inflicted. Source: PPO.
Top recommendation themes
Learning & thematic publications
| Title | Type | Date | Source |
|---|---|---|---|
| PPO response to JSC Inquiry into Children and Young Adults in the Secure Estate | Consultation response | Jun 2026 | |
| Fatal Incident Investigations Learning Lessons Bulletin Issue 22: Self-inflicted deaths in reception prisons | Learning Lessons Bulletin | Mar 2026 | |
| Fatal Incident Investigations Learning Lessons Bulletin Issue 21: Segregation | Learning Lessons Bulletin | Mar 2026 | |
| Fatal Incident Investigations Learning Lessons Bulletin Issue 20: Epilepsy | Learning Lessons Bulletin | Nov 2025 | |
| Annual Report 2024 to 2025 | Annual report | Jul 2025 | |
| Policy into Practice: Handling of prisoners’ property | Policy into Practice | Mar 2025 | |
| Policy into Practice: Handling of property complaints | Policy into Practice | Mar 2025 | |
| Complaints Investigations Learning Lessons Bulletin Issue 11: Property complaints | Learning Lessons Bulletin | Mar 2025 | |
| PPO response to JSC Tackling Drugs in Prison Inquiry | Consultation response | Feb 2025 | |
| PPO response to JHAC Inquiry into Prison Culture | Consultation response | Feb 2025 | |
| PPO response to JSC inquiry into Rehabilitation and Resettlement | Consultation response | Feb 2025 | |
| Policy into Practice: Emergency Response | Policy into Practice | Jan 2025 | |
| PPO response to the Independent Sentencing Review 2024/25 call for evidence | Consultation response | Jan 2025 | |
| Fatal Incident Investigations Learning Lessons Bulletin Issue 19: Post-release death investigations 2 | Learning Lessons Bulletin | Jul 2024 | |
| Annual report 2022-23 | Annual report | Jul 2024 | |
| Annual Report 2023-24 | Annual report | Jul 2024 | |
| Policy into practice: Use of force | Policy into Practice | Feb 2024 | |
| PPO response to the inquiry into prison population and capacity | Consultation response | Nov 2023 | |
| Fatal Incident Investigations Learning Lessons Bulletin Issue 18: Self-inflicted deaths of IPP prisoners | Learning Lessons Bulletin | Sep 2023 | |
| Investigating deaths after release from prison – a pilot evaluation | Learning Lessons Bulletin | Jan 2023 | |
| Fatal Incident Investigations Learning Lessons Bulletin Issue 17: Post-release death investigations | Learning Lessons Bulletin | Jan 2023 | |
| PPO response to the inquiry into the Prison Operational Workforce | Consultation response | Jan 2023 | |
| Annual Report 2021-22 | Annual report | Oct 2022 | |
| Policy into Practice: Use of restraints on escort | Policy into Practice | Sep 2022 | |
| PPO Response to the Inquiry into IPP sentences | Consultation response | Jan 2022 | |
| Fatal Incident Investigations Learning Lessons Bulletin Issue 16: Second wave COVID-19 related deaths | Learning Lessons Bulletin | Dec 2021 | |
| Annual Report 2020-21 | Annual report | Sep 2021 | |
| PPO responses to the Inquiry into Women in Prison | Consultation response | Aug 2021 | |
| Fatal Incident Investigations Learning Lessons Bulletin Issue 15: COVID-19 PPO fatal incident investigations | Learning Lessons Bulletin | Feb 2021 | |
| Complaints Investigations Learning Lessons Bulletin Issue 10: COVID-19 PPO Complaints | Learning Lessons Bulletin | Dec 2020 |
Incidents
| Name | Establishment | Cause | Status | Date of death | Recs |
|---|---|---|---|---|---|
| Hellyer, Lee | HMP Exeter | Self-inflicted | Published | 26 Jul 2019 | — |
| Individual at Doncaster | HMP Doncaster | Self-inflicted | Published | 24 Jul 2019 | — |
| Individual at Wakefield | HMP Wakefield | Natural | Published | 23 Jul 2019 | — |
| Individual at Holme House | HMP Holme House | Natural | Published | 23 Jul 2019 | — |
| Individual at Long Lartin | HMP Long Lartin | Other | Published | 14 Jul 2019 | — |
| Individual at Whatton | HMP Whatton | Natural | Published | 13 Jul 2019 | — |
| Individual at Durham | HMP Durham | Natural | Published | 12 Jul 2019 | — |
| Individual at Leeds | HMP Leeds | Natural | Published | 11 Jul 2019 | — |
| Lucy, Raymond | HMP Forest Bank | Natural | Published | 11 Jul 2019 | — |
| Individual at Parc | HMP Parc | Self-inflicted | Published | 11 Jul 2019 | — |
| Individual at Wymott | HMP Wymott | Natural | Published | 7 Jul 2019 | — |
| Individual at Quay House | Quay House | Natural | Published | 7 Jul 2019 | — |
| Individual at Hewell | HMP Hewell | Self-inflicted | Published | 6 Jul 2019 | — |
| Individual at Foston Hall | HMP Foston Hall | Self-inflicted | Published | 5 Jul 2019 | — |
| Individual at Liverpool | HMP Liverpool | Natural | Published | 5 Jul 2019 | — |
| Individual at Wakefield | HMP Wakefield | Natural | Published | 4 Jul 2019 | — |
| Individual at Manchester | HMP Manchester | Natural | Published | 3 Jul 2019 | — |
| Individual at Rookwood | Rookwood | Self-inflicted | Published | 3 Jul 2019 | — |
| Individual at Thameside | HMP Thameside | Other | Published | 2 Jul 2019 | — |
| Individual at Standford Hill | HMP Standford Hill | Natural | Published | 1 Jul 2019 | — |
| Individual at Moorland Closed | HMP Moorland Closed | Natural | Published | 1 Jul 2019 | — |
| Individual at Hull | HMP Hull | Natural | Published | 1 Jul 2019 | — |
| Paul David Horrocks | HMP Thorn Cross | Other | Published | 30 Jun 2019 | 7 |
| Individual at Doncaster | HMP Doncaster | Self-inflicted | Published | 29 Jun 2019 | — |
| Individual at Garth | HMP Garth | Natural | Published | 29 Jun 2019 | — |
| Individual at Lancaster Farms | HMP Lancaster Farms | Homicide | Published | 28 Jun 2019 | — |
| Individual at Cookham Wood | HMP Cookham Wood | Natural | Published | 27 Jun 2019 | — |
| Individual at Garth | HMP Garth | Natural | Published | 26 Jun 2019 | — |
| Individual at Inner London Crown Court | Inner London Crown Court | Self-inflicted | Published | 26 Jun 2019 | — |
| Individual at Norwich | HMP Norwich | Natural | Published | 25 Jun 2019 | — |
| Individual at Hewell | HMP Hewell | Self-inflicted | Published | 25 Jun 2019 | — |
| Individual at Leicester | HMP Leicester | Other | Published | 24 Jun 2019 | — |
| Individual at St Josephs | St Josephs | Other | Published | 22 Jun 2019 | — |
| Individual at Whatton | HMP Whatton | Natural | Published | 22 Jun 2019 | — |
| Individual at Ford | HMP Ford | Natural | Published | 18 Jun 2019 | — |
| Individual at Elmley | HMP Elmley | Natural | Published | 15 Jun 2019 | — |
| Individual at Bedford | HMP Bedford | Natural | Published | 11 Jun 2019 | — |
| Individual at Bullingdon | HMP Bullingdon | Natural | Published | 10 Jun 2019 | — |
| Individual at Wakefield | HMP Wakefield | Self-inflicted | Published | 10 Jun 2019 | — |
| Individual at Lindholme | HMP Lindholme | Natural | Published | 9 Jun 2019 | — |
| Individual at Manchester | HMP Manchester | Other | Published | 9 Jun 2019 | — |
| Individual at Doncaster | HMP Doncaster | Self-inflicted | Published | 9 Jun 2019 | — |
| Anthon van der Hoven | HMP Exeter | Other | Published | 8 Jun 2019 | — |
| Individual at Wealstun | HMP Wealstun | Other | Published | 7 Jun 2019 | — |
| Individual at Norwich | HMP Norwich | Self-inflicted | Published | 5 Jun 2019 | — |
| Individual at Brixton | HMP Brixton | Self-inflicted | Published | 5 Jun 2019 | — |
| Individual at Wandsworth | HMP Wandsworth | Self-inflicted | Published | 4 Jun 2019 | — |
| Individual at New Hall | HMP New Hall | Other | Published | 2 Jun 2019 | — |
| Individual at Coldingley | HMP Coldingley | Natural | Published | 1 Jun 2019 | — |
| Individual at Ripon House | Ripon House | Natural | Published | 31 May 2019 | — |