Wayne Domeney

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Independent investigation into the
death of Mr Wayne Domeney,
a prisoner at HMP Isle of Wight,
on 31 December 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, 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. In February 2018, Mr Wayne Domeney was sentenced to 12 years in prison for
sexual offences. In September 2018, he was transferred to HMP Isle of Wight.
4. Mr Domeney died of pneumonia with left-sided pleural empyema (collection of pus
around the lung) on 31 December 2024. He was 58 years old. We offer our
condolences to Mr Domeney’s family and friends.
5. The Ombudsman’s office wrote to Mr Domeney’s next of kin to explain the
investigation and to ask if they had any matters they wanted us to consider. They
had no questions about the circumstances of Mr Domeney’s death but asked for a
copy of our report.
6. We shared the initial report with Mr Domeney’s family. They did not identify any
factual inaccuracies. We also shared the initial report with HM Prison and Probation
Service (HMPPS). HMPPS did not find any factual inaccuracies.
7. The PPO investigator investigated the non-clinical issues relating to Mr Domeney’s
care. We did not find any non-clinical issues of concern.
8. NHS England commissioned an independent clinical reviewer to review Mr
Domeney’s clinical care at Isle of Wight.
9. The clinical reviewer concluded that the clinical care Mr Domeney received at Isle of
Wight was not of the required standard and not equivalent to that which he could
have expected to receive in the community. She found that there was a lack of a
documented mental health assessment when Mr Domeney began to self-neglect in
the last week of his life. The clinical reviewer also found that there were knowledge
and training gaps for healthcare staff regarding local procedures when prisoners
declined healthcare appointments and a lack of escalation to senior clinical staff.
We make the following recommendation:
The Head of Healthcare should review local policies and training needs to
ensure that staff understand their roles and responsibilities when prisoners
neglect their health, including that they understand when and how to make
timely assessments and referrals to safeguard prisoners, and when to
escalate to senior clinicians.
10. The inquest into Mr Domeney’s death concluded on 11 May 2026, recording a
verdict of natural causes.
Prisons and Probation Ombudsman 1
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OFFICIAL - FOR PUBLIC RELEASE
Adrian Usher February 2026
Prisons and Probation Ombudsman
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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