In this edition:

  • INQUEST is recruiting
  • Priory group plead guilty
  • Grenfell - dignity and defiance after disasters
  • Families’ struggles and resilience
  • Prison failures, missed opportunities
  • Legal aid: time for action
  • Police misconduct and accountability
  • Fatal police shootings
  • Fundraising
  • Other news
  • Upcoming events

INQUEST have been incredibly saddened by the death of Barbara Montgomery. Barbara was a big part of the INQUEST family. A brave and spiritual woman, with uncompromising integrity and steadfast determination, she did so much to help effect change after the death in police custody of her only child, James Herbert. She gave such hope and inspiration and will be missed by us all. Our thoughts and love go out to Barbara’s family and to everyone she meant so much to. 
Barbara’s family are raising money for UK Sepsis Trust. Please donate via JustGiving if you are able to. 

INQUEST is recruiting

INQUEST is recruiting a Family Participation Officer to join our team in London. Underpinning all our work is our commitment to working with families to seek the truth, feel empowered to hold state agents to account and become self-advocates for systemic change.

To find out more about the role and how to apply, visit our website.

Priory group plead guilty

The Priory Group have pleaded guilty to health and safety charges following the death of 14 year old Amy El-Keria. On 12 November 2012, Amy was found unresponsive with a ligature in her locked hospital room at Ticehurst House, run by the Priory, and died the following day. This is understood to be the first prosecution of its kind and is a historic moment in terms of accountability following deaths of children in private mental health settings. 

Amy’s mother, Tania El-Keria, spoke to Channel 5 NewsThe only thing that has kept me going is to achieve justice for Amy and to stop other families going through the torture we have endured. Today is a huge step forward achieving this. The guilty plea is a bitter but long-awaited acknowledgement from the Priory of their criminal failure.”

Victoria McNally, INQUEST caseworker, was quoted in the Guardian, the Times and the Telegraph “This family have been completely failed by a system that placed Amy in the care of a private company now exposed as operating criminally inadequate standards”.

Grenfell - dignity and defiance after disasters

Although the hearings for Phase 1 of the Inquiry concluded at the end of 2018, the Inquiry processes are ongoing. Phase 1 focused on the detail of the events on 14 June 2017. Phase 2 is looking at the circumstances and decisions prior to the fire that enabled it to occur, such as the design and construction of the building and the decisions relating to its modification, refurbishment and management.

INQUEST continues to work alongside those bereaved by the Grenfell fire, to ensure that meaningful change is the lasting legacy of Grenfell. We are holding a family consultation day with families bereaved by deaths in Grenfell Tower to hear about their experiences of the inquiry process to date and their recommendations for change.

Families’ struggles and resilience

INQUEST had its first Family Reference Group meeting of the year. This meeting was a dedicated session on INQUEST’s photography project, an initiative bringing together families to present their fight for justice, alongside portrayals of their loved ones and the impact of grief.

The project will be followed by a social media campaign later on in the year, inviting other families to upload their own photos. It will culminate in an exhibition and dedicated project webpage, paying tribute to those who have died, and families’ enduring struggles and resilience.

Prison failures, missed opportunities

An inquest has concluded that systematic failures and consistently missed opportunities caused the self-inflicted death of Ryan Harvey at Woodhill prison. The jury found a failure by healthcare staff to undertake an adequate assessment of Ryan’s learning disability, and to conduct an assessment of his mental health, may have contributed to his death.
The inquest into the death of Tyrone Givans at HMP Pentonville found systemic failures and missed opportunities contributed his death. Tyrone was profoundly deaf and had been at the prison for less than three weeks, for the most part without any access to hearing aids, when he died from self-inflicted injuries. 

Deborah Coles, Director of INQUEST said: “The trauma Tyrone must have experienced, newly arrived at prison, experiencing mental ill health, and unable to hear for weeks, is unimaginable. The prison and Care UK failed to provide astoundingly basic levels of care. The failings exposed by this inquest must be acted upon at a national level.”
Two prison officers are being investigated by police for perjury and misconduct in public office, in relation to the inquest into the death of John Ahmed at Manchester prison in 2015.  At the inquest, the coroner raised concerns about significant inconsistencies in the evidence of two officers.
Tommy Nicol died in 2015, after he was found hanging at HMP The Mount. He was in prison on an ‘Imprisonment for Public Protection’ sentence (IPP); indeterminate sentences which have since been abolished for new prisoners.

“I can just see how much this sentence has impacted him – it’s made my brother take his life... He had a complete loss of hope”, Donna Mooney, Tommy Nicol's sister, told the Guardian.

The detrimental harms of these sentences are well known, yet 2,800 people remain in prison not knowing when they will be released.  
A Freedom of Information request to NHS boards in Scotland has revealed a lack of out-of-hours mental health care for people in Scottish prisons. Deborah Coles, Director of INQUEST told The National Clearly night-time and weekends can be a time of heightened vulnerability for those suffering mental ill health and at risk of self-harm and suicide and so it is very concerning to see such limited cover.”

Legal aid: time for action

The parents of Natasha Abrahart, a physics student who took her own life whist studying at Bristol University, are determined to find out the truth so that lives of other students are protected. And yet they are having to crowdfund to pay for legal representation.

INQUEST will be launching our legal aid for inquests campaign next month. If you have been affected by a state related death and would like to support the campaign, please get in touch with our Family Participation Officer Ayesha Carmouche. In August, INQUEST and INQUEST Lawyers Group submitted responses to the initial call for evidence from the Ministry of Justice on legal aid for inquests. A consultation on changes to the guidelines for legal aid funding is now imminent and we will be ready to respond with a strong collective voice, based on our longstanding work with families and lawyers.

Police misconduct and accountability

A police misconduct panel, considering allegations of gross misconduct against five police officers in relation to the death of Sean Rigg, is currently underway and anticipated to last up to six weeks.

The five officers, who are all accused of breaching numerous standards of professional behaviour, have denied charges of misconduct. If you wish to attend you must register in advance.
New statutory guidance from the Home Office rejects the mandatory separation of police officers, and a complete ban on officers conferring, after an serious incident or death in custody. Deborah Coles said: Officers not conferring is vital to the truth. Anything less undermines confidence that the police can be held to account. This is watered down and the government and IOPC appear to have caved to the police.

Fatal police shootings

INQUEST is concerned to hear about the fatal police shooting of Sean Fitzgerald at the beginning of the year. We spoke to Vice“There is rightful disquiet about Sean Fitzgerald's death, and it must be subject to extensive scrutiny. Many fatal shootings by police have raised profound concerns about possible operational and intelligence failings.”
Josh Pitt, a 24 year old man from Luton, was fatally shot by armed Bedfordshire police officers on 9 November 2016 at the flat he shared with his fiancée Katherine Moore. The inquest into his death concluded that the shooting was ‘lawful killing’, as directed by the Coroner.

Josh’s partner Katherine Moore responded to the conclusion saying: “I have sat through all the evidence in the inquest and it seems to me that the police had no plans for when they arrived at my flat and could have got to me before Josh got back. I want Josh to be remembered for the caring loving person he was, and I want people to know the way he was that day was not his normal self, the way he behaved was down to his breakdown.”


We are delighted to have been awarded grants from the John Ellerman Foundation for our policy and campaign work, and from the Henry Smith Charity for our casework function. We are grateful to our funders and individual donors for their ongoing support, ensuring the sustainability of our work programmes and enabling us to support and empower bereaved families.

In other news:

  • The latest edition of Safe Journal, published by Women’s Aid, features an article from INQUEST Director, Deborah Coles and Head of Policy, Rebecca Roberts. The article explores deaths in women’s prisons and draws on our 2018 report Still Dying on the Inside, reframing deaths in custody as a form of violence against women.
  • The latest Femicide Census report also acknowledges the deaths of women in a range of detention settings, and draws on Still Dying on the Inside.

Upcoming events:

Saturday 2 February (Manchester) – Campaigning Against Deaths in Police Custody, is an event organised by Northern Police Monitoring Project which will hear from the experiences of brilliant family campaigners. Tickets are free, reserve here.
Saturday 2 February (London) – A fundraiser against state violence is taking place at the Penarth Centre in Peckham from 7.30pm-midnight, raising money for the National Memorial Family Fund and Campaign against Prison Expansion.
27 February – 23 March (London) – Clean Break Theatre Company are performing at the Royal Court Theatre with Inside Bitch, a comedic take down of media representation of women in prisons devised and performed by members. Deborah Coles, who is a trustee at Clean Break, said “The fantastic thing about Clean Break is that their plays are informed by the lived experiences of women in prison. They are always a must see.” Get your tickets here.

Supporting INQUEST

Kirsten Sjovoll, of Matrix Chambers has entered into the Fred Whitton Challenge - a 112 mile bike ride in the notoriously hilly Lake District. It is a very tough route, which has been referred to as 'the hardest one day ride in the UK'. Kirsten is taking up this intense challenge to raise money for INQUEST. To find out more and to show your support, please visit the JustGiving page.