Prevention of Future Deaths reports · 2014
Regulation 28 report to prevent future deaths, reference 2014-0500, written 14 Nov 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 14 Nov 2014 |
|---|---|
| Reference | 2014-0500 |
| Deceased | Dolores Hubbert |
| Coroner | Derek Winter |
| Coroner area | Sunderland |
| Category | Road (Highways Safety) related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | 1 |
Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.
Derek Winter
Senior Coroner for the City of Sunderland
REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO: -
Head of Streetscene
Sunderland City Council
Civic Centre, Burdon Road
Sunderland SR2 7DN
CORONER
Tam Derek Winter, Senior Coroner for the City of Sunderland
CORONER’S LEGAL POWERS
I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009
and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.
http://www. legislation. gov.uk/ukpga/2009/25/schedule/5/paragraph/7
http://www. legislation. gov.uk/uksi/2013/1629/part/7/made
INVESTIGATION and INQUEST
On 2" September 2014 I commenced an investigation into the death of Dolores Mary
Hubbert, aged 81. The cause of death was “Right Pleural Haemorrhage, due to Ruptured
Anterior Right Ventricle, due to Road Traffic Collision”. The investigation concluded at
the end of the inquest on 11th November 2014. The conclusion of the Inquest was a
Road Traffic Collision.
CIRCUMSTANCES OF THE DEATH
On Friday 29th August 2014 the vehicle driven by Mr sHubbert collided with another
vehicle on the A690 Houghton Le Spring at a crossroads giving entry to the west side of
East Rainton. Mrs Hubbert suffered fatal injuries and she was pronounced dead at
University Hospital North Durham at 1338 hours on 29th August 2014.
CORONER’S CONCERNS
During the course of the inquest the evidence revealed matters giving rise to concern. In
my opinion there is a risk that future deaths will occur unless action is taken. In the
circumstances it is my statutory duty to report to you.
The MATTERS OF CONCERN are as follows. —
The family of Mrs Hubbert expressed concerns to me about the overall safety of the
Junction and in particular the speed restrictions before and after the junction as well as
Civie Centre, Burdon Road, Sunderland, SR2 7DN
Teil 0191 5617843 {| Fax 01915537803 { DX 60729 Sunderland
www.sunderland.gov.uk/eoroner
the policy with regard to the frequency of grass cutting as longer grass may have the
potential to obscure the views of drivers.
I heard evidence from the Police that they had met with the Local Authority to discuss
these points. The police did elaborate upon them confirming: -
1) that the grass was cut twice a year and was about to be cut;
2) there had been one other reported road traffic collision at that junction in the
past 7 years.
I should be glad of a formal response from you about the concerns raised.
ACTION SHOULD BE TAKEN
In my opinion action should be taken to prevent future deaths and I believe you have the
power to take such action.
YOUR RESPONSE
You are under a duty to respond to this report within 56 days of the date of this report,
namely by 12th January 2015. I, the coroner, may extend the period.
Your response must contain details of action taken or proposed to be taken, setting out
the timetable for action. Otherwise you must explain why no action is proposed.
COPIES and PUBLICATION
I have sent a copy of my report to the Chief Coroner and to the following Interested
Persons: -
- Family
~ Northumbria Police
I am also under a duty to send the Chief Coroner a copy of your response.
The Chief Coroner may publish either or both in a complete or redacted or summary
form. He may send a copy of this report to any person who he believes may find it useful
or of interest. You may make representations to me, the coroner, at the time of your
response, about the release or the publication of your response by the Chief Coroner.
Dated this 14" day of November 2014
Signature yd {) ts
Senior Coroner for the City of Sunderland
1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.
City Council Office of the Chief Executive Jack Crawford House Commercial Road Hendon Sunderland SR2 8QR Mr D Winter (Senior Coroner for the City of Sunderland) Office of HM Coroner Sunderland Civic Centre Burdon Road Sunderland SR2 7DN Date: 9 January 201 5 Your ref: This matter is being dealt with by: - Network Operations Manager Dear Mr Winter, Re: A690 Junction at East Rainton - Fatal Collision, Mrs Hubbert The following is my response to your Regulation 28 Report of 14th November 2014 regarding the unfortunate death of Mrs Delores Hubbert, and sets out the Council’s proposed course of action at the location of the recent fatal collision. 1. Safety of the Junction Road accidents have been described as multi-factor random occurrences that can happen anywhere and at any time and often for no apparent reason. Any highway authority is unable to predict where the next accident will occur. The approach used by this and many other Councils to target interventions in respect of road safety is based on road accident data. This data, initially collected by the Police, is supplied to us via the Regional Traffic Accident Data Unit, Whilst it is accepted that not all minor accidents will be reported to the Police, this record of accidents is regarded as the best objective reference available for determining and comparing danger on the highway. Furthermore it has been established that what may appear to be a potentially dangerous location can have fewer injury accidents than apparently ‘safer’ areas. Where danger appears obvious people tend to be more careful and take fewer risks. Officers have visited the site on a number of occasions at various times of the day and drivers appeared to be able to manoeuvre safely taking appropriate care. As stated in your report, prior to the occurrence of the recent fatal collision, 1 other personal injury collision, classified as serious, had occurred at the A690/Durham Road, Delivering services for a better future O w INVESTOR IN PS<3MU>- East Rainton junction, in the last 7 years. It is important to note that the circumstances of the previous accident were very different to that in which Mrs Hubbert was killed. This accident was a result of the driver attempting a U-turn manoeuvre and there was no similarity to the crossing manoeuvre that Mrs Hubbert made. In addition, the contributory factors to this previous collision, which resulted in a rear end shunt, was deemed by Northumbria Police to be a combination of factors including nervousness, uncertainty or panic, poor turn or manoeuvre and failing to look properly. In summary, this accident was caused primarily by bad driver behaviour rather than the nature of the junction itself. The Council as Highway Authority, regularly assess the accident data throughout the city to determine where additional traffic management measures are needed and are appropriate. The safety record at this junction was regarded as good, compared to other locations in the city. Priority is given to implementing measures that help reduce the number and severity of personal injury accidents, improve child pedestrian safety at locations that show a significant accident history and which are in line with the Council’s overall transport strategy. With the junction having previously had a comparatively good safety record, intervention has not been considered necessary. As a consequence of this regular view, the Council has already identified the nearby A690/High Lane/Stoneygate junction as a site of concern as regards safety with 11 personal injury accidents in the last 3 years. We have been a progressing a scheme of measures to address these concerns. Extensive public consultations are about to commence and a scheme will be presented to a Planning and Highways Committee for final approval early next year, with a view to implementing the scheme during the financial year 2015/16. As the next major at grade crossing point on the A690, a similar assessment of possible measures for the A690/Durham Road, East Rainton junction will be programmed to be undertaken in 2015. It is not possible to be specific as to what measures will be the most suitable for this location until the investigation and consultation has been completed. We have also been undertaking a review of speed limits throughout the city with priority being given to investigating those on “principal” roads. The A690 falls under this criteria and we intend to commence the statutory process to reduce the speed limit to 50mph on this section of road in January 2015. Subject to a successful statutory consultation it is expected that the speed reduction could be introduced in summer 2015. 2. Verge Maintenance With regards to maintenance activity on the A690, the Council's approach over the years for all principal high speed roads has been to implement a programme of Spring and Autumn closures to facilitate work such as servicing of road gullies, grass cutting, street cleansing, safety barrier and lighting repairs . This year the lane closures on this section of the A690 took place on 27th/28th March and 22nd/23rd September. This schedule was in line with the Council’s intended programme set at the start of the year and is considered to be appropriate to the location in question. I hope this addresses the issues that set out in Section 28 report. Should you however have any queries or would like to discuss the matter in more detail, then please contact my colleague on the number above. Yours sincerely Head of Street Scene
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