Two reports from the Prisons and Probation Ombudsman found missed chances to support men at risk of suicide, including suicide and self-harm monitoring at HMP Wandsworth that ended after 16 hours.
An officer who found Brian Holland unresponsive had no radio and had to look for a colleague to raise the alarm, a Prisons and Probation Ombudsman report has found.
Raymond Wallace died after taking synthetic cannabinoids. His death was the fourth of five linked to drugs at HMP Lowdham Grange in a five-month period.
Adrian Usher says his investigation into the death of 74-year-old Malcolm MacDougal found evidence of systemic failure and unnecessarily harsh treatment.
The Prisons and Probation Ombudsman says HMP Liverpool should have kept the 22-year-old while a secure hospital place was found, and that HMP Forest Bank failed to share key information.
Craig Lamb, 45, died from a heroin and cocaine overdose in September 2025 after receiving appropriate drug support in prison, the Prisons and Probation Ombudsman found.
CCTV showed an officer did not carry out an evening check on Stephen Baddeley, despite a record saying it was done. The officer resigned before a disciplinary investigation finished.
In his third annual report, Adrian Usher says HMPPS investigates its own staff, and highlights lost property complaints and the continuing high number of deaths in custody.
Jamie Graham, 28, died of acute cardiac failure caused by synthetic cannabinoids and cocaine shortly after his release. The Prisons and Probation Ombudsman made no recommendations.
A Prisons and Probation Ombudsman report into the death of Norman Loseby in November 2020 found that his care fell short and that past recommendations had not been fully acted on.
