How a Probation Mistake Lead to Death.

The family and friends of a woman murdered by her abusive partner say she was let down by a "bankrupt" system.

Just weeks before the death of Michaela Hall the Probation Service wrongly assessed her partner, Lee Kendall, as posing a "medium risk" of harm. Despite an emergency call warning that she was being attacked, police officers did not try to force entry to her home.

Officers went the next day, on 1 June and also had no reply. Officers went again in the evening but there was no answer. Police got a call later from Ms Hall's mother who was also concerned about her.

Later a neighbour called police to say Ms Hall's father had found her dead at the house. One policeman said they did not enter the house because everything looked in order and felt that no-one was home.

At an inquest which ended on Friday, the coroner criticised the Probation Service and the actions of the police. Cornwall Coroner Andrew Cox said "shortcomings and errors" by probation services happened before her death. In a narrative conclusion, he said that Ms Hall had been unlawfully killed.

Mr Cox told the inquest that probation services had "wrongly assessed as medium" the risk of serious harm posed by Kendall. That meant management of Kendall was by local probation services rather than the national Probation Service and that was "inappropriate", he said.

The Coroner also said that a care order meant that both Ms Hall's children had been removed from her home to protect them against Mr Kendall. "This is [a] blinkered perspective because Kendall was equally a danger to Ms Hall. More could and should have been done". He said that Children's Services should have referred her to Adult Services.

Mr Cox pointed out that "no health-related inquiries appear to have been undertaken" into Ms Hall who had shown signs of autism. The coroner said he would send a number of prevention of future death reports. He said he would release who and where they were sent in due course.

Coroners and Justice Act 2009, provides Coroners with the duty to make reports to a person, organisation, local authority or government department or agency where the coroner believes that action should be taken to prevent future deaths. The organisation will then respond within 56 days of the notice.

Michaela's family says her story is a tragic example of how a manipulative and violent man can isolate and abuse a woman and how the system can fail.

On the evening of 31 May 2021, Michaela was on the phone from her home in Cornwall to her friend Clair Basnett, who lived abroad. Michaela told her she was with Kendall, and she feared for her life. "She was whispering. She didn't know what to do," says Clair.

Police Footage 31.05.2021 | Devon & Cornwall Police / BBC

Body-worn camera footage recorded one of the officers talking to the police control room, saying how they had visions of "her lying there with him covering her mouth". Believing they did not have the power to force entry, the officers left and returned to base.

Over the next two years Michaela called the police on more than a dozen occasions. She suffered black eyes and even a fractured cheekbone but could not bring herself to press charges. Michaela's situation was well known to the authorities, who classed her as being "at very high risk" of abuse.

At the inquest into Michaela's death, the coroner, Andrew Cox, singled out the probation service for criticism. Weeks before her murder, Kendall had been classified as medium-risk by a junior officer not qualified to make the assessment.

"Had the shortcomings and errors not occurred, it is more likely than not that Michaela would not have died when she did" the Coroner said.

Research in 2023 shows that in England and Wales, almost half of cases where a suspect killed their partner, the attacker was already known to be at high risk of being an abuser. These figures come from the Domestic Homicide Project which is funded by the Home Office and led by the National Police Chief's Council.

The Ministry of Justice says it is "deeply sorry for the unacceptable failings in this case", and adds that an extra £155m is being put into the system to deliver "more robust supervision, reduce caseloads and recruit thousands more staff".

Devon and Cornwall Police say that the officers concerned have been ordered to "undergo the reflective practice review process" and that following Michaela's death, "the force has implemented learning and improvement and this work continues".

Probation Office | Redfern Building