Security contractor Serco has been fined more than £2 million for health and safety failings that led to a mentally-ill prisoner kicking a custody officer to death.

Humphrey Burke, 29, attacked 54-year-old Lorraine Barwell as she tried to escort him from his cell in Blackfriars Crown Court in central London in June 2015.

Burke admitted manslaughter by diminished responsibility and was handed an indefinite hospital order at the Old Bailey in January last year.

Ms Barwell’s employer, Serco – which is contracted by the Ministry of Justice to provide security services in courts, pleaded guilty last April to failure to discharge general health, safety and welfare duty from January 2014 to March 2017.

The prosecution claimed that two attacks on custody officers – Ms Barwell and Bernadette Cawley – within that period demonstrated what can happen if the right health and safety steps are not taken.

Ms Cawley, who survived the attack, was strangled and rammed up against a wall in the dock in an annex court at Woolwich Crown Court in June 2016, but no other custody staff were nearby to help when she pressed the alarm.

However, Serco had admitted two limited breaches in relation to the two incidents at Blackfriars and Woolwich, but denied they were “causative” of the harm to the women.

But the prosecution had alleged there were wider failings, with areas including risk assessment, staffing levels, training and monitoring.

On Friday, Mr Justice Jeremy Baker fined Serco £2,250,000 and ordered the firm to pay the Health and Safety Executive (HSE) costs of £433,596.

In his sentencing, the senior judge found Serco’s level of culpability for the offence was “high”.

Our mum was a wonderful loving supportive mother to myself, my brother and her two granddaughters whom she adored and loved, and they adored her

Among the failings, he said there was “insufficient” availability of court custody officers, an issue that had been raised with management “on numerous occasions”.

Mr Justice Baker said there had been an “obvious and avoidable” risk that Burke would kick out forcibly to Ms Barwell, enabling her to be fatally injured.

He highlighted “inadequate communication” of the risk Burke posed and “insufficient regard as to the manner in which he should be safely handled as those involved just got on with the task, rather than having proper regard for their safety, leading to the unsafe manner in which Mr Burke was handled on this occasion”.

He concluded: “I am satisfied that had it not been for Serco’s breach of duty towards its employees, Lorraine Barwell would not have died in the circumstances in which she did at Blackfriars Crown Court on June 29 2015.”

The judge said the impact of Ms Barwell’s death was “all too evident” from reading a statement from her family.

In a victim impact statement, Ms Barwell’s daughter Louise Grennan said: “Our mum was a wonderful loving supportive mother to myself, my brother and her two granddaughters whom she adored and loved, and they adored her.

“She too was a friend to many and loved by many. To lose her has left a huge void in everyone’s hearts.

“Mum was my best friend and she helped me care for my daughter. We spoke about plans to move abroad to live in the sun once mum had retired from work. That has all gone now.”

Everyone in Serco was deeply shocked and saddened when Lorraine was fatally assaulted by Humphrey Burke in 2015 and we continue to send our deepest condolences to her family and friends

HSE inspector Helen Donnelly said: “Serco drastically failed in their duties to protect both Lorraine Barwell and other staff over a sustained period. It is not common to have a case covering such an extended period, but it appeared that Serco Limited were not learning from their mistakes. ​

“Lorraine Barwell and her colleagues were just doing their job and should have been protected from harm. Had Serco carried out their legal duties, these incidents could have been prevented.

“While this investigation has been long and complex, we hope Lorraine’s friends and family will find some comfort in today’s sentence and see that justice has now been served.

“No matter what work environment you are in, health and safety regulation is designed to protect people at work. We will not hesitate to act against those who fail to protect their workers.”

Anthony Kirby, Serco chief executive UK & Europe, said: “Everyone in Serco was deeply shocked and saddened when Lorraine was fatally assaulted by Humphrey Burke in 2015 and we continue to send our deepest condolences to her family and friends.

“Lorraine was a brave and experienced prisoner custody officer who was a popular and highly respected member of our team and had worked for Serco for over 10 years. She is still sorely missed by her colleagues and everyone across Serco.

“The safety and wellbeing of colleagues is our highest priority and, as recognised by the court, we have improved our safety processes. We continuously strive to seek to ensure such an incident can never happen again.”

Following the sentencing, Ms Grennan said: “We welcome the judgment handed down today. We have had to endure an agonising and unnecessary eight-year wait for Serco to be brought to some account for what happened to our mother. Today the court recognised that the way that Serco ran its business in the cells caused mum’s death.

“Our mum went to work for Serco every day for over 10 years, working long days, but she was forced into a position where she wasn’t safe. She wasn’t given suitable information, training or equipment that she needed to do her job safely. The cells were not managed safely. She was helping out in the court cells due to understaffing when her life was cruelly taken away by a violent and unpredictable prisoner who attacked her. My mum did not know about the risks that she was dealing with. She had no warning. She went to work one day and didn’t come home,

“Mum’s death has had a shocking and traumatic impact on our family. She was our best friend, a wonderful and supporting mother, daughter, grandmother and sister. Her death has left an incredible void. We worry that another family will go through what we have done. According to evidence that was given in court, we have no confidence that the problems with the staffing and management have been fixed, or that this will not happen again.

“We thank the Health and Safety Executive for all of their hard work in bringing this prosecution and bringing Serco to account.”

Kate Maynard, partner at Hickman and Rose, said: “The findings of the court today, to the criminal standard, that Serco caused Lorraine Barwell’s death, are a vindication of the family’s fight for accountability over the years. Lorraine Barwell’s death was avoidable.”