Coroner Slams Police After Inmate's Tragic Suicide

Matthew Osborne, aged 39, was found hanging in his cell at HMP Lowdham Grange on November 25, 2023. An inquest at Nottingham Coroner's Court returned a verdict of suicide, with the jury finding Osborne should not have been placed in the prison's segregation unit. The jury also cited that his detention after November 16, 2023, was unlawful due to insufficient risk assessment and a lack of measures to mitigate risks in segregation.

Concerns were raised about the algorithm used for segregation suitability and a care plan template that created a false impression of personalized care. Numerous reviews for segregation suitability were not properly conducted, and information was not shared between prison and healthcare staff. Understaffing was identified as a significant issue across both teams.

The inquest heard that on the afternoon of Osborne's death, two prison officers were filmed playing football with a toilet roll in the segregation unit. These officers, Asa Whibberley and Stefan Wilson, were subsequently dismissed for gross misconduct. Another officer, Josh Clark, resigned before disciplinary action.

Laurinda Bower, the area coroner, criticized Nottinghamshire Police regarding criminal investigations and the Ministry of Justice for issues accessing CCTV evidence. Sodexo, the prison operator at the time, apologized for the actions of some staff and acknowledged long-standing cultural and operational challenges at Lowdham Grange, stating they were working to rectify them.

Nottinghamshire Healthcare NHS Trust also apologized for care that did not meet the standard Matthew deserved. The Ministry of Justice stated that since taking over the jail in December 2023, safety measures and support for at-risk prisoners have been strengthened. Matthew Osborne's sister expressed shock at the failings but welcomed the findings, highlighting a perceived lack of care for human life.