Methodology pages

Methodology

Limitations and responsible use

PFD Monitor makes an important public record easier to explore. It does not contain every fact needed to explain a death, assess an organisation, or decide whether an action worked.

The most useful way to read PFD Monitor is as a starting point for further investigation.

The published record has limits

PFD Monitor covers Prevention of Future Deaths reports and official responses that it has been able to collect from public sources. This is not a complete record of every safety concern, death, response, or organisational action.

Coroners decide when to write a report, and publication practices can change. Documents may also be published late, corrected, or temporarily unavailable. Differences in report numbers can therefore reflect the reporting and publication process as well as differences in the underlying safety problems.

Do not use PFD Monitor to estimate how common a problem is in the wider population.

AI can make mistakes

PFD Monitor uses AI to extract, describe, classify, and connect information. Reports and responses can be long, visually complex, or open to more than one reasonable interpretation.

The AI may miss relevant text, divide a passage incorrectly, write an imperfect summary, or make the wrong connection. Source links, automated checks, targeted review, versioning, and corrections reduce these risks but cannot remove them.

Inspect the original wording when a finding is important to your work.

Interpret with care
A confident-looking label is still an analytical judgement. Read it alongside the source evidence and the limits described on the page.

A recipient is not necessarily responsible

A report may be sent to several organisations without saying which one was responsible for each concern. PFD Monitor can show that an organisation received a report containing a concern, but it does not treat receipt as proof of ownership, fault, or legal responsibility.

Likewise, reports linked to the same recurring issue share an underlying safety problem. This does not mean that the deaths had the same cause or that every case had the same circumstances.

Stated actions are not verified outcomes

PFD Monitor records what an organisation says in its official response. A status such as Completed reflects the respondent's statement at that time. It does not independently confirm that the action happened, was sufficient, or improved safety.

External evidence about implementation and effectiveness is outside the first version of PFD Monitor.

Appropriate uses

PFD Monitor can help readers:

  • find related reports and official responses;
  • explore concerns across organisations and time;
  • identify questions for policy, safety, or academic research;
  • inspect what organisations said they planned or had done; and
  • locate source evidence for further investigation.

Do not use it on its own to:

  • rank organisations or create performance league tables;
  • decide that an organisation ignored a warning or failed to act;
  • establish the cause of a death;
  • judge legal compliance or responsibility;
  • claim that an action was effective; or
  • measure the prevalence or severity of a problem.

Technical note
PFD Monitor describes patterns within a defined collection of documents. Its outputs are documentary and analytical relationships, not causal findings or independent assessments of organisational performance.

Corrections and feedback

Readers can challenge a record by sending us the page address, the relevant source passage, and an explanation of the concern. Corrections improve both the individual record and the method used in later releases.