Response to concern for welfare and missing person’s reports - North Yorkshire Police, April 2017

At 1.07pm on 17 April 2017, a man contacted North Yorkshire Police (NYP) to report he had concerns for the welfare of a neighbour and friend. The man informed the police that there were keys on the inside of both the front and rear door locks; he also told them the man had type 1 diabetes.

At 3.58pm, three police officers went to the man’s home. They found the house locked and secured with keys on the inside of both the front and rear doors. Officers forced entry into the house, which contained piles of books, magazines and correspondence, making the search difficult. The officers commenced a search of the house, but did not find the man.

At 4.25pm on 20 April the man’s cousin contacted NYP and informed them her cousin’s diabetes could cause him to slip into a coma/unconscious state and advised them that he once awoke under his bed following a hypoglycaemic episode.

At approximately 7pm on 20 April, officers went back to the man’s home to search the loft area. While officers carried out the search, the man’s cousin spoke to his neighbour and informed him of her concern that the man had suffered an attack of hypoglycaemia and asked the neighbour to inform officers to check under the man’s bed. The neighbour did so and a police officer advised they had searched the entirety of the house.

In the early hours of 21 April, a police inspector asked officers to search the man’s house again, in ‘daylight hours’ citing new information which indicated the man had previously passed out at his home.

At 8.30am on 21 April, officers undertook a third search of the man’s house and discovered him dead underneath his bed.

During the investigation, investigators interviewed the officers who searched the house, examined national and local policies on search procedures and reviewed the risk assessments carried out by police personnel. Investigators served notices of investigation on six officers and interviewed them under misconduct cautions.

Based on the evidence available, we were of the opinion that one police officer had a case to answer for misconduct for failing to undertake an effective search of the man’s home, incorrectly informing the man’s neighbour that the entirety of the man’s house has been searched, and incorrectly informing a police inspector that the area under the man’s bed had been searched.

We also identified performance issues for three other officers for failing to ensure that the man’s house was searched in line with North Yorkshire Police policy.

In addition to individual learning for officers – including around risk assessment when dealing with missing persons where diabetes is a known risk factor – we also identified what appeared to be a chain of missed opportunities involving a number of police officers and police staff in NYP. We suggested that NYP may wish to consider what learning can be taken from this incident and how this can be shared to reduce the likelihood of a similar incident occurring again.

After reviewing our report, NYP agreed that the performance of three officers would be dealt with under stage 1 of the unsatisfactory performance procedure, and that they would hold a misconduct meeting for one officer. The force acknowledged the missed opportunities and advised that they would take various actions to use learning from this case, including in their training (including for student officers), to prevent a reoccurrence in future.

The force held a misconduct meeting for the officer in autumn 2018, at which the chair concluded that the officer had been diligent in exercising his duties and carrying out the search. Misconduct was not proven for the officer, and no further action was taken.