Prevention of Future Deaths reports · 2025

Paul Williams

Regulation 28 report to prevent future deaths, reference 2025-0036, written 21 Jan 2025. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 Jan 2025
Reference2025-0036
DeceasedPaul Williams
CoronerAlison Mutch
Coroner areaManchester South
CategorySuicide (from 2015)
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS  

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

Department for Levelling Up, Housing and Communities (Local Government.) 

1 

CORONER 

I am Alison Mutch ,Senior Coroner, for the coroner area of Manchester South 

2 

CORONER’S LEGAL POWERS 

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 
and Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. 

3 

INVESTIGATION and INQUEST 

On 2nd August 2024 I commenced an investigation into the death of Paul Williams. The 
investigation concluded at the end of the inquest on 9th December 2024. The 
conclusion of the inquest was suicide. The medical cause of death was 1a) hanging. 

4 

CIRCUMSTANCES OF THE DEATH 
On 9th July 2024, Paul Williams was found suspended from a ligature outside Screwfix 
at Unit 5 Haigh Park. Police found no suspicious circumstances.  

5 

CORONER’S CONCERNS 

During the course of the inquest the evidence revealed matters giving rise to concern. 
In my opinion there is a risk that future deaths could occur unless action is taken. In the 
circumstances it is my statutory duty to report to you. 

The MATTERS OF CONCERN are as follows.  –  
  The inquest heard that Paul Williams was a hard working family man in employment. 
He and his family had been evicted from their privately rented accommodation and 
became homeless. They were given a period of 2 weeks to leave the property and find 
alternative accommodation. Whilst looking for accommodation the family was forced 
to live in separate locations. In his case that included living in a vehicle in the week.  
The inquest was told that the family was a priority case but a shortage of public 
housing meant that in total they had to wait almost 3 months before suitable 
accommodation became available. 
The evidence before the inquest was that the housing situation including the eviction, 
the homelessness and need to live separately whilst waiting for suitable 
accommodation to become available had a significant impact on his mental health and 
contributed to his deteriorating condition. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you 
[AND/OR your organisation] have the power to take such action.  

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 18th March 2025. I, the coroner, may extend the period. 

Your response must contain details of action taken or proposed to be taken, setting out 
the timetable for action. Otherwise you must explain why no action is proposed. 

8 

COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following Interested 
Persons the partner of Mr Williams on behalf of the family who may find it useful or of 
interest. 

I am also under a duty to send the Chief Coroner a copy of your response.  

The Chief Coroner may publish either or both in a complete or redacted or summary 
form. He may send a copy of this report to any person who he believes may find it 
useful or of interest. You may make representations to me, the coroner, at the time of 
your response, about the release or the publication of your response by the Chief 
Coroner. 

9 

Alison Mutch 
HM Senior Coroner 

21/01/2025

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Ministry of Housing Communities Local Government (PDF)
Deputy Prime Minister and Secretary of State for 
Housing, Communities & Local Government 
2 Marsham Street  
London  
SW1P 4DF  

Your reference: 
Our reference: 

01 April 2025 

Alison Mutch 
HM Senior Coroner 
Coroner’s Court 
1 Mount Tabor Street 
Stockport 
SK1 3AG 

Dear Alison, 

RESPONSE TO REGULATION 28: REPORT TO PREVENT FUTURE DEATHS - INQUEST INTO 
THE DEATH OF PAUL WILLIAMS 

Thank you for your letter and investigative report dated  21 January 2025 into the tragic death of 
Paul Williams, made in accordance with Paragraph 7, Schedule 5, of the Coroners and Justice Act 
2009 and Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.   

First, I want to express my sincere condolences to Mr Williams’ family and friends. I was distressed 
to read about his death, and the situation and circumstances that led to him tragically taking his own 
life.  

It is vitally important that households are provided with the support and care they deserve. From the 
evidence provided and the information in your report, it appears that Mr Williams’ needs were not 
met.  

I have provided more detail below on the relevant frameworks that should have been in place to 
support Mr Williams to access homelessness support. My officials have spoken to the relevant local 
authority. In this letter I set out more information on the specific aspects of his case and explain in 
detail the steps I am proposing to take to increase tenant security and reduce homelessness. 

Matter of concern one – eviction at short notice from private rented accommodation 

In your report you stated that the housing situation, in particular being given two  weeks' notice to 
find  alternative  accommodation  had  a  significant  impact  on  Mr  Williams’  mental  health  and 
contributed to his deteriorating condition.  

My  department  oversees  regulation  of  the  private  rented  sector.  It  appears  from  our  enquiries 
of  Stockport  Metropolitan  Borough  Council  (SMBC)  that  a  section  21  notice  was  served  on  Mr 
Williams’  partner  on  6  November  2023;  following  this  she  approached  SMBC  on  14  November 
2023  for homelessness assistance.   

 
 A section 21 notice must give a minimum of two months’ notice and in this instance, it gave slightly 
longer as it expired on 5 January 2024. Where a household does not leave by the end of the section 
21 notice period, a landlord is entitled to seek a possession order from the court. Where a court 
issues a possession order, this might only provide 14 days’ notice for a household to leave their 
home. This short timeframe is in light of the fact that the tenants will have already received at least 
two  months’  notice  plus  the  time  taken  for  the  landlord  to  obtain  a  possession  order,  to  make 
alternative arrangements, and the court must balance the rights of tenants and landlords. Where a 
household  does  not  leave  by  the  expiry  of  a  possession  order,  a  landlord  can  apply  for  a  bailiff 
warrant. SMBC advised that a possession order was served in April 2023 and a bailiff warrant on 1 
May 2024, which expired 15 May 2024.    

My department is clear that local authorities must step in and assist households when they have 
received a section 21 notice and do so in a timely way. My department is responsible for the statutory 
framework  that  governs  homelessness.  The  Housing Act  1996  Part  7  sets  out  the  duties  local 
housing  authorities  have  towards  homeless  households,  including  the  responsibilities  for 
assessment,  accommodation,  and  support.  The  Housing  Act  makes  clear  that  a  household  is 
considered threatened with homelessness if they receive a section 21 notice which expires within 
56 days and as a consequence is owed various duties under that Act.  

The Homelessness Code of Guidance (the Code) makes clear that once the notice period expires, 
the  local  housing  authority  must  consider  whether  or  not  it  is  reasonable  for  the  household  to 
continue to reside at the property.  

The Code also makes clear at paragraph 6.35 that where a valid section 21 notice has been served, 
if after making enquiries it is clear that the landlord intends to seek possession if the household does 
not leave, it is unlikely to be reasonable for a household to continue to occupy the property beyond 
the expiry of the section 21 notice unless the local housing authority has taken steps to persuade 
the landlord to allow time for alternative accommodation to be found. 

I am aware however that in some cases families prefer to stay where they are as they judge that 
this  will  suit  their  needs  better  than  the  temporary  accommodation  that  might  be  offered.  Local 
housing  authorities  must  ensure  that  temporary  accommodation  is  suitable  for  the  needs  of  the 
entire household. The code makes clear that B&B should be a last resort for families with children 
and  that  it  should  be  used  for  no  longer than  6  weeks.  I  am  aware  that  in  some  instances  local 
housing authorities use B&Bs or hotels for households with children due to pressure on temporary 
accommodation and this leads families to decide to stay put until a possession order or bailiff warrant 
is  received.  Staying  in  accommodation  until  this  point  unfortunately  means  that  families  end  up 
facing a short-notice to leave.  

SMBC does not have a full record of the advice given when Mr Williams’ partner first presented for 
assistance in November 2023, but is of the view that she was probably advised that  a B&B is the 
likely option, and was advised of the same in April and May 2024, which led her to move in with her 
mother on 3 May 2024 until she was allocated social housing in July 2024. 

I am sorry that steps were not taken to offer and provide more suitable accommodation before the 
family faced this stage. I am writing to SMBC to remind them of this part of the code and the need 
to take sufficient action early enough to prevent households from being placed in a crisis situation 
by remaining until a possession order or bailiff warrant is issued. 

I will now set out what my department is doing to increase tenant security. 

On  11  September  2024,  the  Ministry  of  Housing,  Communities  &  Local  Government  (MHCLG) 
introduced the Renters’ Rights Bill into Parliament to transform the way the private rented sector 

 
 
 operates. The Bill will give renters much greater security and stability so they can stay in their homes 
for longer and avoid the risk of homelessness. The Bill will abolish Section 21 “no fault” eviction so 
that  landlords  can  only  evict  their  tenants  in  reasonable  circumstances.  This  will  provide  more 
security for tenants and empower them to challenge poor practice without fear of eviction.  

While our priority is to sustain tenancies as far as possible in all circumstances, we recognise that 
landlords sometimes need to evict their tenants. This may be when the tenant is unable to comply 
with  the  terms of  their  tenancy agreement  or to  respond  to  their  own  changing  circumstances  to 
move in or sell. The Bill will increase notice periods for many grounds for possession, giving tenants 
more time to find a new home, and to avoid homelessness, when a landlord does need to end a 
tenancy. 

Matter of concern two – homelessness assistance 

In  your  report  you  stated  that  being  required  to  live  separately  from  his  family,  whilst  waiting  for 
suitable accommodation to become available, had a significant impact on Mr Williams’ mental health 
and contributed to his deteriorating condition. 

When  making  our  enquiries  SMBC  advised  that  when  Mr  Williams’  partner  presented  for 
homelessness assistance in November 2023, the application was only made for herself and their 
children. Mr Williams was not mentioned or included on the form. It also advised that Mr Williams’ 
partner made an application to join the social housing register on 2 October 2023, shortly before 
being served with the section 21 notice, with further updates made to that application in May 2024. 
That application was also only made for Mr Williams’ partner and their children and Mr Williams was 
not listed in the application. Mr Williams’ name also did not appear on the section 21 notice or the 
possession order. As far as we are aware Mr Williams did not present himself for any assistance. 

This means that sadly, SMBC was not aware that Mr Williams was part of the household and needed 
homelessness assistance. There are several provisions of relevance to the situation faced by Mr 
Williams and his family which I will set out first. 

Section 184 of the Housing Act 1996 provides that when a local authority has reason to believe a 
person  is  homeless  or  at  risk  of  becoming  homeless  within  56  days  (which  will  be  the  case  if  a 
household has been served with a section 21 notice which expires in 56 days or less), it must make 
inquiries to determine what legal duties it owes the person and their household. The local housing 
authority  will  have  a  duty  to  prevent  the  homelessness  where  possible,  and  if  not,  to  assist  the 
person to relieve their homelessness.  

Where a person is homeless, eligible for assistance (which is determined by immigration status and 
residency)  and  in  priority  need  (a  household  with  children  is  automatically  considered  in  priority 
need),  the  local  housing  authority  must  provide  the  household  with  suitable  temporary 
accommodation. A household which has been served a section 21 notice will be deemed homeless 
when it is no longer reasonable for them to occupy the property. As I have set out above, the code 
makes clear that it would unlikely be reasonable for a household to continue to occupy a property 
beyond the expiry of the notice period unless arrangements had been made with the landlord to 
delay possession proceedings whilst alternative accommodation is found. 

A local authority also has a duty to develop a personalised housing plan, tailored to focus on the 
needs and circumstances of the household and what accommodation would be suitable for them 
(s189A Housing Act 1996).  

 
 
 
 Section  206  makes  clear  that  any  accommodation  provided  to  discharge  duties  to  homeless 
applicants under  Part 7  of  the  Housing Act 1996  must  be  suitable. The accommodation must  be 
suitable in relation to the applicant and to all members of their household who normally reside with 
them, or who might reasonably be expected to reside with them. Section 210 sets out that space, 
arrangement and location will always be key factors in determining the suitability of accommodation. 

To summarise, local authorities have legal duties to make sure any accommodation is suitable for 
the needs of the entire household and should keep the suitability of accommodation under review.  

I will now set out what my department is doing to prevent and reduce homelessness.  

In recognition of the scale of the challenge and the priority this  government is giving to reducing 
homelessness, funding for homelessness services is increasing this year by £233 million compared 
to 2024/25, bringing the total spend to nearly £1 billion in 2025/26. This includes increasing funding 
to the Homelessness Prevention Grant to assist local authorities with preventing homelessness in 
the first place. 

To ensure this mission is being driven across government, I am chairing an Inter-Ministerial Group 
focused on developing a long-term strategy to get us back on track to ending homelessness. 

This government is committed to delivering 1.5 million new homes by the end of this Parliament, 
including  the  biggest  increase  in  social  housing  and  affordable  housebuilding  in  a  generation.  In 
October  2024  and  again  in  February  2025,  we  announced  additional  funding  for  the Affordable 
Homes Programme, which will build more social and affordable new homes, including Social Rent 
homes. 

The supply of temporary accommodation is extremely challenging nationwide. MHCLG administers 
the Local Authority Housing Fund, which is providing £1.2bn to local authorities to acquire and create 
homes  for  families  at  risk  of  homelessness  and  will  create  over  7,000  affordable  homes  for 
vulnerable families. 

Additionally,  MHCLG  is  also  working  with  20  local  authorities  through  the  new  programme  of 
Emergency  Accommodation  Reduction  Pilots  to  test  innovative  approaches  and  kickstart  new 
initiatives to provide more suitable accommodation for homeless families.    

The death of Paul Williams is a tragic example of the impact poor and insecure housing can have 
on people’s lives where assistance is not provided soon enough. I want to thank you for bringing 
this to my attention and once again, I wish to express my sincere condolences to Mr Williams’ family 
and friends. 

Yours sincerely,  

Deputy Prime Minister and Secretary of State for Housing, Communities & Local Government

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