A military veteran who served as a pallbearer for Princess Diana before ending up sleeping rough, died from hypothermia after a tragic mix-up saw him miss out on emergency accommodation.
Malcolm Livingstone, who was also a footman for the late Queen, began living on the streets of King's Lynn after struggling with alcoholism and post-traumatic stress disorder.
His body was found in the grounds of the town's St John's church on November 16, 2021. He was 44.
An inquest into his death, held this week, heard that days earlier Mr Livingstone - who carried Diana's coffin as it was brought back from Paris in 1997 and who also served with the RAF in Iraq - had approached a local night shelter seeking a place to stay.
At the time, during the pandemic, the government's 'Everyone In' initiative meant local authorities had to immediately house rough sleepers.
But, due to a series of mix-ups, he fell between the gaps in the system involving the local council and homelessness groups and no bed was found for him.
As a last resort, he was given a blanket and sleeping bag by shelter staff. He died in churchyard next to the shelter.
WHAT WENT WRONG?
Speaking at the inquest at Norfolk Coroner’s Court, Lucy McKitterick, a coordinator at the King’s Lynn Night Shelter (KLNS), explained that she had first met Mr Livingstone on the evening of November 9, 2021.
He had arrived requesting a room but none were available.
In accordance with an arrangement with West Norfolk Council, contact was made with the Merchants Terrace organisation, which provided out-of-hours homelessness triage.
This usually involves staff completing a needs assessment form and passing the information on to the borough council.
In this case, Merchants Terrace provided no evidence of the initial call, and the form was not completed. But a housing officer did call KLNS and advised they could not offer emergency accommodation that day.
Mr Livingstone was advised to attend the council offices the next day for assessment, but there is no record of him doing so. As a last resort, he was given a blanket and sleeping bag by staff at KLNS.
He returned to the shelter on November 14. Although the process was repeated, a new form should have been completed by staff at Merchants Terrace but it was not.
Speaking in court, council bosses confirmed that as well as being likely to have met the criteria for emergency accommodation, Mr Livingstone would have been eligible due to the government’s 'Everyone In’ programme, which was in force at the time.
This meant that even if Mr Livingstone had not been considered a priority, he should have been provided with emergency accommodation.
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Later that day, a room became available at KLNS but by then staff were unable to contact Mr Livingstone, who had left earlier.
His body was later found in bushes in the churchyard next door to the shelter by a passerby on Tuesday, November 16.
A toxicology report found no evidence of alcohol or drugs in his blood the day he died.
Assistant coroner Samantha Goward recorded a short narrative conclusion of: "Malcolm died as a result of hyperthermia after sleeping outside when he found himself without accommodation which should have been provided under the 'Everyone In' government initiative."
LIFE OF SERVICE WHICH ENDED IN TRAGEDY
Malcolm Christopher Livingstone - known as Doc by friends and fellow servicemen - was born in King’s Lynn on February 17, 1977.
He quickly revealed a fearless disposition, climbing trees many times higher than himself from the age of three.
He attended Gaywood Park School where he gained three A-Levels in modern languages. His academic prowess was only exceeded by his athletic one.
He joined the Air Training Corps aged 13 and during his service he gained the rank of Warrant Officer.
His intention was to become an interpreter or Queen’s Messenger, a courier role in the Foreign and Commonwealth Office. But he decided not to go to university and chose an alternative path.
In September 1995, he joined the Royal Air Force (RAF).
After basic training, he was posted to the Queen’s Colour Squadron, an elite body which represents the RAF at state and ceremonial occasions.
One of his roles was to form part of the bearer party for the repatriation of the body of Diana, Princess of Wales, when it was flown from Paris to RAF Northolt, in west London, on August 31, 1997.
He helped transfer the coffin from an aircraft to a hearse. Images of the moment were published around the world.
Mr Livingstone also undertook a number of overseas tours, including operations in Kuwait, Cyprus and the Balkans.
One of his last roles before leaving the RAF in 2004 was to serve in Iraq in 2003, the year the country was invaded.
His parents, Allan and Nancy Livingstone, of West Winch near King’s Lynn, said their son was left troubled by his experience of the war.
Mr Livingstone Snr said: "He said he could not live with himself if he did not go [to Iraq]. I think it’s very, very sad that he could not live with himself because he did go.
"Unfortunately, some time along the way he lost sight of life in general and started to seek solace in the wrong place."
'HE CARED FOR OTHERS BUT FORGOT HE WAS IMPORTANT TOO'
After leaving the RAF, he joined the Royal Household and was appointed as the Queen’s personal footman.
Further promotions soon followed, and he served as Senior Footman, Page of the Presence, and Deputy Sergeant Footman, a role which saw him manage all the serving staff at Buckingham Palace.
For a time he was in charge of travel arrangements for the Queen’s home and overseas tours.
His inquest heard that his family became aware that he was "drinking alcohol to excess" in 2013.
His drinking saw him dismissed from his job in 2015, and soon after was involved in a serious car accident that left him with multiple fractures and injuries.
His parents said that he was "never quite the same" afterwards.
After leaving the Palace, he entered private service and spent time working in Chelsea, Knightsbridge and Devon.
After returning to Norfolk he worked in various restaurants, locally and further afield.
His father said: "He was an absolutely wonderful guy when he was at his best.
"No one cared more for other people. He just failed to care for himself.
"He was a kind and caring person, even in the face of adversity.
"He remains in our memories as someone we are immensely proud of."
Outside of his career, he loved cooking, watching musicals, completing the Times crossword and photography
"This man was not perfect," Mr Livingstone Snr said.
"He had demons. But here was a man, a warrior, a son, a friend, who cared so much for others he forgot he was important too.
"It is perhaps sad that Malcolm had lost sight of the esteem in which he was held.
"He enriched all of our lives with his presence. We all are the poorer for his absence, the hole in our lives may simply be Malcolm shaped, but it is much much bigger than that."
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In 2018, Mr Livingstone was diagnosed with alcoholic hepatitis, an inflammation of the liver due to excessive intake of alcohol, and also post-traumatic stress disorder.
He had been supported by several services including the NHS Wellbeing service, Change Grow Live, and the charity Project Nova, and although he did accept help on occasion, he was inconsistent about keeping in touch.
He spent time living with his parents in West Winch, but due to his recurring drinking problems had been asked to leave temporarily on November 5, 2021.
Although his parents continued to support him with meals and help finding accommodation, he had been "sofa surfing" before finding himself homeless that month.
WHAT DO THE AGENCIES SAY?
Lucy McKitterick, from KLNS, said: "He had been courteous and helpful. He was a gentleman.
Speaking about how calls are logged manually by KLNS, and how on one occasion this was failed to be carried out, she said: "This has become a notorious incident which has stayed with us and taught us all an important lesson."
Assistant coroner, Samantha Goward, said there had been "numerous missed opportunities" by service providers to prevent Mr Livingstone sleeping rough.
Speaking after the inquest, Mrs McKitterick added: "We were very grateful that an inquest was held for Malcolm, and that his family had the opportunity to be present.
"One of the shelter staff, who came to us with a personal lived experience of homelessness, said to me today that the inquest was important because ‘everyone’s voice deserves to be heard’."
A spokesperson for the borough council said: "We were extremely sorry to learn of Malcolm Livingstone’s untimely death.
"It is clear that his situation was complex and of long standing but also, reading the statements of his family, that he was much loved.
"We acknowledge the coroner’s finding that there were missed opportunities to help Malcolm in our interactions with him.
"In early 2022 we concluded a review of our actions and decisions.
"We have subsequently improved our procedures to ensure that we have a consistently high standard in our approach to helping people who are at risk of rough sleeping, as recognised by the coroner."
Mr Livingstone Snr said that although there were clear shortfalls in the way his son was cared for, he accepted "everybody did their best".
"Fundamentally, Malcolm died through eight years of not really looking after himself properly," he said.
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