It was more than 12 hours after Rianna Cleary went into labour before anyone came to help her. She was covered in blood – and her daughter was dead. Why were they failed so appallingly?

The last thing Rianna Cleary remembers before she passed out in the early hours of 27 September 2019, alone and in the throes of labour pain, was a scene involving a chicken leg in the film Killer Joe, which was showing on the TV screen in her prison cell.

Cleary was 18 at the time – an extremely vulnerable care leaver, she had felt judged harshly by the system ever since her pregnancy had been confirmed earlier in the year.

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