Safety concerns raised by coroners
Explore concerns raised in Prevention of Future Deaths (PFD) reports.
Recurring concerns bring together individual concerns from different reports that describe the same underlying safety problem.
1,669 recurring concerns
Concern
Trend
Reports
Recipients
Latest report
Incomplete composite child health records
2
4
19 Jun 2019
Incomplete recording of contributory factors in road-collision statistics
2
1
17 Apr 2025
Inconsistent clinical guidance for antibiotic decisions in suspected sepsis
2
5
12 Aug 2023
Ineffective site security patrols
2
3
25 Aug 2020
Insufficient access to cardiac screening for young athletes
2
20
16 Apr 2026
Insufficient awareness and training for sudden cardiac death risks in sport
2
20
16 Apr 2026
Insufficient capacity for time-critical cardiac interventions
2
8
9 May 2022
Insufficient commissioned monitoring for high-risk eating-disorder patients
2
10
17 Dec 2021
Insufficient consultant histopathologist workforce capacity
2
2
2 Apr 2024
Insufficient frontline staff competence to recognise and explore substance-related mental-health risks
2
5
16 May 2022
Insufficient inpatient detoxification capacity
2
7
18 Dec 2017
Insufficient orthogeriatric provision for elderly orthopaedic trauma patients
2
4
18 Apr 2023
Insufficient out-of-hours healthcare availability
2
8
16 Mar 2016
Insufficient pathology capacity for timely sample analysis and reporting
2
6
17 Oct 2023
Insufficient public awareness of button-battery ingestion risks
2
7
7 Mar 2018
Insufficient residential rehabilitation placements
2
6
27 Jun 2024
Insufficient student mental-health support capacity
2
4
1 Mar 2019
Insufficient suitable housing for vulnerable young people
2
5
14 Mar 2024
Lack of overarching responsibility for patient safety risks from ambulance delays
2
1
3 Oct 2024
NHS smoke-free policy inadequately protects safety in mental health hospitals
2
3
22 Nov 2024
Private mental-health providers failing to obtain relevant clinical information
2
5
24 Jul 2019
Unclear accountability for allergy services and provision
2
13
6 Apr 2023
Unclear maternity service classifications and operating parameters
2
8
3 Jun 2025
Unclear police assistance arrangements for mental health assessments
2
8
22 Oct 2019
Uncontrolled asbestos contamination creating exposure risks
2
3
21 Dec 2020
Recurring concerns bring together reports that describe the same underlying safety problem. Open one to compare the individual concerns and original wording.
Data last updated 7 September 2026