The Cumbria Chief Constable has described the force's investigation into baby Poppi's death as “flawed from start to finish”.

This is a timely reminder that there does not appear to have been any significant improvements since the 2002 Forum 28 investigation when Cumbria police were responsible for investigating how legionella bacteria escaped into public areas resulting in the deaths of seven members of the public and infecting a further 180 people.

Officials and authorities investigating the baby Poppi incident, and any other major investigations, should take note of the lack of any noticeable improvements since the 2002 investigation.

In 2002 although the Barrow Council Management Organisation Chart clearly identified those positions which were responsible for the operation of the AC plant and the chemical dosing system none of these individuals were charged and prosecuted. Neither were the officials identified by the chart as being responsible for health and safety and the contractors contracted by Barrow Borough Council to maintain the AC plant and dosing system, the lack of effective maintenance allowing the growth of legionella bacteria amd its discharge into public areas.

Inexplicably Barrow police appeared determined to prosecute the council design services manager on manslaughter charges even though it was obvious from the chart that she had no responsibility for the operation of the AC plant and the chemical dosing system.

Following two expensive trials the design services manager was acquitted on manslaughter charges and was the only individual employee convicted on health and safety charges and fined £15,000. Barrow council having entered a guilty plea to health and safety charges were fined £125,000 and ordered to pay £90,000 legal costs.

G Bushell

Park Drive

Barrow-in-Furness