Deaths in custody - Independent Review of Fatal Accident Inquiries 2025: report

Foreword and acknowledgements from the Chair

I want to begin this report by paying tribute to the families of those who have died in prison and police settings in Scotland. Every death is a distressing event but families and loved ones of those who have died in custody have told me their stories clearly, honestly and with dignity. Their experiences, often harrowing, are at the heart of this report. It would not have been possible without their courage and support.

I am especially grateful to the Scottish Human Rights Commission (SHRC) and INQUEST for holding a Family Listening Day, where I heard directly from people who have lost loved ones in detention in Scotland. This was a privilege to attend, and I was humbled by the stories I heard. I am indebted to the Family Reference Group Chair, Nancy Loucks, and all its members for inviting me to attend one of their meetings to hear their concerns first-hand, and also to Linda and Stuart Allan and John Reilly for being generous with their time and their experiences.

A great number of people and organisations of many kinds have supported me in this Independent Review. I would like to thank in particular the Scottish Prison Service (SPS), Police Scotland, the Scottish Government, the Crown Office and Procurator Fiscal Service (COPFS), the Lord Advocate and the Police Investigations and Review Commissioner (PIRC) for their expertise, guidance and helpful evidence. I am also extremely grateful to all who responded to the formal call for evidence, which ran during August and September 2025.

I express my sincere gratitude to the Advisory Group who supported me in chairing this Review, Sarah Armstrong, Wendy Sinclair-Gieben, Gillian Mawdsley and Michelle Macleod. The group directed, supported and challenged me in my thinking and I am grateful to them for their time, insight and expertise. However, the recommendations below are entirely my own, based on what I have heard and what I believe will improve the Fatal Accident Inquiry (FAI) system for those who interact with it.

I also extend my thanks to the Review secretariat team, who supported me in my work and proved invaluable at every stage of the Review.

Given the very tight timescale in which I was asked to conduct this Review, I set out to produce a report that was not overly long or complicated. There is, of course, much more work that can be done in this area, but my Review aimed to produce a number of short, sharp and practical recommendations which will improve the FAI system in Scotland when dealing with deaths in custody. Whilst some of my recommendations may require primary legislation, many do not and instead offer practical improvements which may be implemented quickly and relatively easily.

I commend my report to Scottish Ministers and urge them to consider implementing the recommendations in this Review.

SHERIFF PRINCIPAL IAN ABERCROMBIE KC

December 2025