I remember watching the news and seeing the smoke rising from a car as emergency services tried to put out the final flames that had already killed Hannah Clarke’s three children, Trey, Laianah and Aaliyah. Hannah had been taken to hospital in a critical state.

As I heard the details of the gruesome murder of three children, with their mother fighting for her life after the attack from her estranged husband, I wondered about everyone being on the scene now – police, ambulance and reporters were all there. The feed was live, showing the charred car’s last fumes. But where was everyone one hour before? One day before?

How come everybody was there so quickly but nobody was around to stop it happening?

Since that day I have thought a lot about Hannah Clarke and her children. I have followed the implementation of coercive control laws and kept up with the news about domestic violence prevention strategies that followed these abhorrent murders. I was pleased to see the recognition of forms of coercive control being criminalised as a domestic violence offence. I understood these laws would have somehow helped Hannah and the children by giving the police grounds to charge and arrest Rowan Baxter at any point in the lead-up to the murders. My understanding of these deaths and the law reform was that of an outsider.

Then one day a colleague passed on an inquiry from a whistleblower alleging misconduct in the Queensland coronial system and the Queensland police. I work in the Whistleblower Project at the Human Rights Law Centre, where we help whistleblowers speak up and fight for better laws to create more transparency and accountability.

From our first phone call, it was clear this was not a one-off advice. This whistleblower we are calling Elsie (not her real name) made a number of allegations of police failings at the service delivery stage and at the coronial investigation stage after Hannah and her three children died. As Guardian Australia has reported in its

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