Fatal Accident Inquiries: follow up review

Chapter 7 – Role of Other Regulatory and Investigative Bodies

157. There is a wide range of other organisations and agencies that have a duty to investigate certain types of deaths including Healthcare Improvement Scotland (HIS),^[58] the Mental Welfare Commission for Scotland,^[59] the Care Inspectorate,^[60] Local Authorities,^[61] Child Protection Committees and the SPS. In many cases, the death will also be reported to the procurator fiscal. Whilst the nature and extent of such investigations vary, the common objective is to ensure that any lessons learned are brought to the attention of those who are in a position to implement measures to prevent similar circumstances arising again.

Primacy of Investigation

158. In the thematic report we reported that organisations who have responsibility to investigate certain types of deaths would welcome greater clarity on whether it is appropriate to carry out internal investigations where criminal proceedings and/or an FAI are in contemplation. Many advised that internal investigation was often put on hold until the conclusion of any criminal investigation and proceedings. Conversely we found that SFIU often delays progressing FAIs to await the outcome of internal investigations.

159. The need to ensure that evidence in criminal proceedings is not prejudiced requires to be balanced against the need to address any deficiencies or inadequacies of practice as soon as possible to prevent any deaths arising in similar circumstances. Delaying internal investigations can also adversely impact the well-being of staff within organisations.

160. To provide reassurance and clarity to other investigative agencies on the roles and responsibility of each agency, the primacy of investigations and likely timescales, we recommended:

Recommendation 12

SFIU should agree a Memorandum of Understanding (MoU) with all investigative agencies that have responsibility to investigate the circumstances of certain types of deaths.

Recommendation 12

Action Taken

161. While there has been some preliminary discussion with some agencies, no MoUs have yet been agreed.

Status: Not achieved.