Kirsten Heaven represented Jacqueline's family at the inquest, instructed by Andrew Petherbridge of Hudgell Solicitors.
The jury inquest into the death of murdered Birmingham woman, Jacqueline Oakes, has concluded that she was unlawfully killed and that a number of failures, including the inappropriate decision to house her eventual murderer in the same accommodation, contributed to her death.
Ms Oakes, 51, who had a long history of mental health issues, was found dead in an Edgbaston tower block in January 2014. She died from multiple blunt force injuries. Marcus Musgrove was found guilty of her murder and sentenced to a minimum of 18 years in July 2014.
Yesterday at Birmingham Coroner’s Court an inquest, heard before the Senior Coroner for Birmingham and Solihull, Louise Hunt, sitting with a jury, concluded that the following failures contributed to Ms Oakes' death:
- The inappropriate placement of Musgrove in the same accommodation as Ms Oakes that facilitated a relationship between the two
- The numerous offences committed against Ms Oakes by Musgrove during 2013 and early 2014 and, despite the offender being charged for the offence committed in September 2013 due to an apparent discrepancy in submitting prosecution papers to the courts, the case was discontinued. This allowed the opportunity for Musgrove to contact the deceased enabling further offences to be committed and ultimately the unlawful killing of the deceased
- A combination of the escalation of events in January 2014, together with the failure to adequately safeguard Ms Oakes and a delay by West Midlands Police to arrest in January 2014 (but it was not clear if this delay contributed to the death)
- After productive Multi Agency Risk Assessment Conference (MARAC) meetings, there were incidences of failure to share information and act upon information accordingly (not clear if this contributed to the death)
- Musgrove committed numerous offences which failed to lead to any prosecution and the support that Ms Oakes needed was unavailable although domestic abuse (when identified) and mental health sufferers need extra attention due to their sensitivity and complexity and this wasn’t always provided
The Coroner stated that she would write a Prevention of Future Deaths recommendation to the Home Office and the Ministry of Justice over her concerns that offenders, such as Musgrove, known to be highly dangerous as regards their risk to women are released back into a community when not subject to licence without any warning or notification to other agencies.
Musgrove was a prolific abuser of women in the Birmingham area over a 15 year period and was convicted of a number of serious offences for violence against women/partners. His record over this period included over 90 arrests, a large proportion of which included biting, strangling, falsely imprisoning, raping and doing serious injury (including broken bones) to his female victims/partners. He was likely convicted of 10 domestic violence-related offences.
Ms Oakes first came into contact with Musgrove in April 2013 while on release from prison (after serving four years for serious violence against an ex-partner) he was placed by a worker in the Birmingham Voluntary Service Centre (whose exact role and involvement remained unclear throughout the inquest) into the same supported accommodation as Ms Oakes (which was accommodation for vulnerable individuals with mental health difficulties). The probation service knew Musgrove was high-risk to women but had no power to monitor him. This accommodation provider was given no information as to his level of risk and past record and if they had known they would not have housed him. He had been asked to leave his previous accommodation because of his drug-taking and abusive behaviour. Within 48 hours of Musgrove moving into this accommodation Ms Oakes reported a physical and sexual assault by Musgrove and this continued until she was hospitalised in June 2013.
For the next 7 months, a catalogue of verbal, physical and sexual abuse and harassment by Musgrove was reported by Ms Oakes and her friends to West Midlands Police and various support services.
In June, Musgrove was charged with assault and harassment and refused bail for attempting to strangle Ms Oakes. The CPS later withdrew the case against Musgrove after he intimidated Ms Oakes into retracting her statement.
Ms Oakes moved to new sheltered accommodation in the city, during which time Musgrove continued to assault her. A panic alarm was installed in her accommodation after one assault in September which left her hospitalised. He was subsequently arrested and remanded into custody on charges of battery, but his trial was discontinued in November after the CPS were alleged to have not made an application to the court in time to admit a hearsay statement from police officers (although this issue remained unexplored during the inquest and where fault lies remains unclear).
In the run-up to Christmas 2013, further reports of abuse and threatening behaviour were reported by Ms Oakes' friends and support workers to West Midlands Police but Musgrove was not arrested.
On 7 January 2014, Ms Oakes, who was by now staying with a friend in Edgbaston, reported being raped, strangled and bitten on the face by Musgrove. He was subsequently arrested, interviewed and released on bail by West Midlands Police 25 minutes after his interview was concluded and bailed on the condition that he did not approach Ms Oakes. Within just over 24 hours police were notified that he had breached his bail when they received a 999 call from a friend of Ms Oakes'. There were no attempts to arrest Musgrove for approximately 48 hours by West Midlands Police and in fact he was not arrested until after Ms Oakes' body was found in the early hours of 14 January. She had been battered to death by Musgrove and sustained injuries consistent with falling from a tower block.
An IPCC investigation in 2017 found that Ms Oakes was let down by a raft of procedural errors and 19 police officers and staff were found to have a case to answer for misconduct/gross misconduct.
A Domestic Homicide Review (DHR) was carried out and made criticisms of a number of state agencies having dealings with Ms Oakes in the period after she met Musgrove but these findings have not been accepted by all state bodies and hence it has not been possible for the DHR to be made public.
Civil liberties and police action specialist Andrew Petherbridge of Hudgell Solicitors represented Ms Oakes' family at the inquest. He says:
Jacqueline’s family are extremely grateful to the coroner and the jury for their diligence in examining the failings that contributed to her untimely and tragic death. It’s hard for anyone to imagine the terror that Jaqueline must have felt during the last 10 months of her life.
The only good that can come from this is that all the agencies and state bodies who came into contact with Jacqueline take responsibility for their failings and make lasting changes. In fact, Jacqueline’s case surely must be an urgent reminder to state bodies everywhere of their duty to protect the lives of those they are in contact with. After all, Jacqueline’s death was entirely avoidable.
This case was reported in the media, including by BBC.
Kirsten Heaven is a member of the Garden Court Chambers Inquests and Inquiries team.