Preventing future deaths

During an inquest or investigation into a death something may be revealed that gives the Coroner concern that future deaths may occur if action is not taken to reduce the risk of death.  In such circumstances the Coroner has a duty to issue a Report to Prevent Future Deaths (or a ‘PFD report’) to the person, organisation, local authority, government department or agency, who the Coroner believes has the power to take that action.

PFD reports are intended to improve public health, welfare and safety. These reports are vitally important if society is to learn from deaths. The Coroner has no power to require action to be taken however, the Coroner can only report their concern.  It is also not for the Coroner to dictate precisely what action should be taken. A prevention of future deaths report raises issues and is a recommendation that action should be taken, but cannot specifiy what that action should be. 

Normally, the PFD report will be made after the inquest is concluded although it can be made at any stage of the investigation.  The report may shed light on a system failure that has regional or even national implications. Receiving individuals or organisations have a statutory obligation to respond to a Coroner’s PFD report within 56 days, stating what action they have taken or intend to take.

The West Sussex, Brighton & Hove Coroner Service will send a copy of the Coroner's report and the replies we receive to the bereaved and all other Interested Persons in an inquest. 

The Chief Coroner publishes PFD reports from all Coroner areas (and any responses to them) on the Coroner section of the public judiciary website here.   PFD reports issued by Coroners in West Sussex, Brighton & Hove can also be found on the links below. 

2025

William Radford:  https://www.judiciary.uk/prevention-of-future-death-reports/100065-2/

Barry Myers:  https://www.judiciary.uk/prevention-of-future-death-reports/barry-myers-prevention-of-future-deaths-report/

Alonzo Wood:  https://www.judiciary.uk/prevention-of-future-death-reports/alonzo-wood-prevention-of-future-deaths-report/

Aeran Taylor:  https://www.judiciary.uk/prevention-of-future-death-reports/aeran-taylor-prevention-of-future-deaths-report/

Morgan Betchley: https://www.judiciary.uk/prevention-of-future-death-reports/morgan-betchley-prevention-of-future-deaths-report/

Harry Southern: https://www.judiciary.uk/prevention-of-future-death-reports/harry-southern-prevention-of-future-deaths-report/

Sapphire Bernard:  https://www.judiciary.uk/prevention-of-future-death-reports/sapphire-bernard-prevention-of-future-deaths-report/

Mark Summersett: https://www.judiciary.uk/prevention-of-future-death-reports/mark-anthony-summersett-prevention-of-future-deaths-report/

June Liddell: https://www.judiciary.uk/prevention-of-future-death-reports/95600-2/

Kenton Beasley: https://www.judiciary.uk/prevention-of-future-death-reports/kenton-beasley-prevention-of-future-deaths-report/