The prison service is facing calls for a corporate manslaughter investigation after 18 inmates have taken their own lives within four years at Woodhill Prison.
Daniel Dunkley hanged himself at the prison on July 29 last year and died four days later in hospital.
The jury at his inquest concluded that Daniel took his own life, with neglect contributing to his death.
They also found that the failure by HMP Woodhill to implement recommendations made after previous deaths caused Daniel’s death.
The acting Governor of Woodhill, Nicola Marfleet, who has been in post since November 2016 admitted last week that if the prison had implemented recommendations for changes following previous deaths, Daniel Dunkley would probably not have died.
Deborah Coles, director of the charity INQUEST said: “The unbroken pattern of Woodhill deaths reveals a systemic failure at a local and national level to act in response to critical inquest findings and recommendations for action.
“This raises serious questions about the accountability at senior management level of those responsible for prison health and safety.
“HMP Woodhill and the prison service have repeatedly failed to implement recommendations in the face of a litany of failures.
“They have clearly ignored warnings about the risks to the health and safety of prisoners, and the necessary sanctions should be enacted against those responsible.”
Daniel’s family, along with the family of Ian Brown have brought a judicial review on the high number of deaths in Woodhill Prison.