John McGovern

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Independent investigation into
the death of Mr John McGovern,
a prisoner at HMP The Verne,
on 13 June 2024
A report by the Prisons and Probation Ombudsman
Third Floor, 10 South Colonnade Email: mail@ppo.gov.uk T l 020 7633 4100
Canary Wharf, London E14 4PU Web: www.ppo.gov.uk
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© Crown copyright, 2026
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1. The Prisons and Probation Ombudsman aims to make a significant contribution to
safer, fairer custody and community supervision. One of the most important ways in
which we work towards that aim is by carrying out independent investigations into
deaths, due to any cause, of prisoners, young people in detention, residents of
approved premises and detainees in immigration centres.
2. If my office is to best assist His Majesty’s Prison and Probation Service (HMPPS) in
ensuring the standard of care received by those within service remit is appropriate,
our recommendations should be focused, evidenced and viable. This is especially
the case if there is evidence of systemic failure.
3. On 6 May 2016, Mr John McGovern was sentenced to 19 years imprisonment for
sexual offences.
4. Mr McGovern died from pancreatic cancer on 13 May 2024 while a prisoner at HMP
The Verne. He was 58 years old. We offer our condolences to Mr McGovern’s
family and friends.
5. The Ombudsman’s office contacted Mr McGovern’s family to explain the
investigation and to ask if they had any matters they wanted us to consider. Mr
McGovern’s family asked questions about Mr McGovern’s clinical care, which have
been addressed in the clinical review, and asked for a copy of our report.
6. The PPO investigator investigated the non-clinical issues relating to Mr McGovern’s
care.
7. We did not find any non-clinical issues of concern.
8. NHS England commissioned an independent clinical reviewer, to review Mr
McGovern’s clinical care at HMP The Verne.
9. The clinical reviewer concluded that the clinical care Mr McGovern received at The
Verne was of the required standard and was equivalent to what he could have
expected to receive in the community. He found that Mr McGovern’s reported chest
pain in February 2024 could have been a possible missed diagnosis, and he had
concerns regarding the distance of travel for Mr McGovern when he transferred
from Ashfield to The Verne. We make the following recommendations:
The Head of Healthcare at HMP Ashfield should ensure clinical staff are up to
date with guidelines on assessment of chest pain in the primary care setting.
The Head of Healthcare at HMP Ashfield should ensure clinical staff are aware
of local and national guidelines relating to the management of ascites in a
non-hospital setting.
The Governor and the Head of Healthcare at HMP The Verne should ensure
that a clear protocol is in place for the transfer of prisoners with a limited life
expectancy.
10. The initial report was shared with HM Prison and Probation Service (HMPPS).
HMPPS did not find any factual inaccuracies and their action plan is annexed to this
report.
Prisons and Probation Ombudsman 1
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11. Mr McGovern’s family received a copy of the draft report. They did not make any
comments.
Adrian Usher
Prisons and Probation Ombudsman October 2025
Inquest
12. At the inquest held on 26 November 2025, the Coroner concluded that Mr
McGovern died of natural causes.
2 Prisons and Probation Ombudsman
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Third Floor, 10 South Colonnade Email: mail@ppo.gov.uk T l 020 7633 4100
Canary Wharf, London E14 4PU Web: www.ppo.gov.uk
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