Increase in Coroner Prevention of Future Death (PFD) reports

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It was recently reported by the BBC that there has been an increase in Prevention of Future Death (PFD) reports being sent by Coroners to health bodies and the Government.

PFD reports are issued by a Coroner following an Inquest when there is evidence that further avoidable deaths could occur if preventative action is not taken. PFD reports highlight issues such as long waiting lists, lack of resources or staff shortages as impacting care.

The BBC reports that PFD reports rose to 109 in 2023, compared with substantially lower figures from previous years (62 in 2022, 45 in 2021, and 37 in 2020).

Whilst healthcare bodies that receive a PFD from a Coroner must respond to it, there is currently no legislation which allows the Coroner to enforce any recommended changes.

The concern from families, the charity Inquest and Claimant lawyers is that there is currently no national body to ensure that recommendations are being implemented and PFDs are audited and reviewed.

The “No More Deaths” campaign is pushing for a National Oversight Mechanism to ensure transparency, responsibility and accountability for recommendations raised in Inquests and PFDs.

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