Robert Rixon

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Independent investigation into
the death of Mr Robert Rixon,
a prisoner at HMP Parc, on
17 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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OFFICIAL - FOR PUBLIC RELEASE
© Crown copyright, 2025
This report is licensed under the terms of the Open Government Licence v3.0. To view this licence,
visit nationalarchives.gov.uk/doc/open-government-licence/version/3
Where we have identified any third-party copyright information you will need to obtain permission
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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. In November 2022, Mr Robert Rixon was sentenced to 25 years imprisonment for
several sexual offences. He died of pneumonia (infection to the lungs) which was
caused by chronic obstructive pulmonary disease (COPD – a group of lung
conditions which cause breathing difficulties) on 17 June 2024 in hospital. He was
77 years old. We offer our condolences to Mr Rixon’s family and friends.
4. The Ombudsman’s office wrote to Mr Rixon’s next of kin to explain the investigation
and to ask if they had any matters they wanted us to consider. They did not
respond.
5. Healthcare Inspectorate Wales commissioned an independent clinical reviewer to
review Mr Rixon’s clinical care at HMP Parc.
6. The clinical reviewer concluded that the clinical care Mr Rixon received at HMP
Parc was of a high standard and equivalent to that which he could have expected to
receive in the community. He found that Mr Rixon’s medical records contained
evidence of excellent individualised end of life care planning. The clinical reviewer
made recommendations not related to Mr Rixon’s death that the Head of Healthcare
will wish to address.
7. The PPO investigator investigated the non-clinical issues relating to Mr Rixon’s
care. We did not find any non-clinical issues of concern. We make no
recommendations.
8. The initial report was shared with HM Prison and Probation Service (HMPPS).
HMPPS did not find any factual inaccuracies.
Adrian Usher November 2024
Prisons and Probation Ombudsman
Prisons and Probation Ombudsman 1
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Inquest
The inquest hearing was held on 13 February 2025. The Coroner concluded that Mr Rixon
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
OFFICIAL - FOR PUBLIC RELEASE