Prevention of Future Deaths reports · 2018
Regulation 28 report to prevent future deaths, reference 2018-0368, written 20 Nov 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 20 Nov 2018 |
|---|---|
| Reference | 2018-0368 |
| Deceased | Suleyman Yalcin |
| Coroner | Andrew Walker |
| Coroner area | London (North) |
| Category | Alcohol, drug and medication related deaths · Road (Highways Safety) related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | 2 |
Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.
Her Majesty’s Coroner for the Northern District of Greater London (Harrow, Brent, Barnet, Haringey and Enfield) North London Coroners Court, 29 Wood Street, Barnet EN5 4BE Telephone 0208 447 7680 e-mail:- court.clerk@hmc- northlondon .co.uk REGULATION 28 REPORT TO PREVENT FUTURE DEATHS THIS REPORT IS BEING SENT TO: Commissioner of Police for the Metropolis Directorate of Legal Services, Metropolitan Police Service, 10 Lamb's Conduit Street, London WC1N 3NR 1 CORONER I am Andrew Walker, senior coroner, for the coroner area of Northern District of Greater London 2 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. 3 INVESTIGATION and INQUEST On the 3rd December 2017 I opened an investigation following the death of Suleyman Yalcin on the 3rd December 2018. I opened an inquest on the 7th December 2017. The inquest began on the 1st October 2018. The conclusion of the inquest was “Road traffic collision caused directly by Suleyman Yalcin’s impaired judgement due to alcohol intoxication and contributed to by traffic and lighting conditions of the road at the time of the collision, insufficient refresher training in emergency response driving given to the driver of the van, police under resourcing and inadequate police terminology to describe the urgency of the situation to which the driver was responding”. The medical case of death was 1a Multiple Injuries. 4 CIRCUMSTANCES OF THE DEATH On Sunday the 3rd December 2017 at about 18.39 hrs Metropolitan Police Officers, who were attending an incident in Haringey, requested urgent assistance and a police van. Two Metropolitan Police Officers responded from Hackney Borough, as there were no vans available in Haringey Borough. Whilst making their way to the incident the police van collided with Suleyman Yalcin, who was making his way across Seven Sisters Road, causing fatal injuries. 5 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. Her Majesty’s Coroner for the Northern District of Greater London (Harrow, Brent, Barnet, Haringey and Enfield) The MATTERS OF CONCERN are as follows. – 1, Insufficient refresher training in emergency response driving given to the driver of the van. 2, Police under resourcing 3, Inadequate police terminology to describe the urgency of the situation to which the driver was responding. 6 ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and I believe you [AND/OR your organisation] have the power to take such action. 7 YOUR RESPONSE You are under a duty to respond to this report within 56 days of the date of this report, namely by the 11th January 2019 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. 8 COPIES and PUBLICATION I have sent a copy of my report to the Chief Coroner and to the following Interested Persons;- Representatives for the Met and the Family. 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. 9 20-11-2018
2 responses 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.
DIRECTORATE OF PROFESSIONALISM Mr Andrew Walker, Senior Coroner, North London Coroners Court, 29 Wood Street, Barnet, EN5 4BE Tel.: 020 8 447 7680 Richard Martin Deputy Assistant Commissioner 6th Floor New Scotland Yard Victoria Embankment London SW1A 2JL Email: court.clerk@hmc-northlondon.co.uk Email: Tel: Your ref: Our ref: IX/117/17 and 1802_62 Date: 6th February 2019 Dear Mr Walker, I am the Deputy Assistant Commissioner for Professionalism in the Metropolitan Police Service (MPS). I write in response to your Regulation 28 Report to Prevent Future Deaths dated 20th November 2018. Your report was sent following the conclusion of the inquest into the death of Mr Suleyman Yalcin. In drafting our response we have consulted with the relevant subject matter experts, principally: , Met Command Inspector and Control (Met CC); HQ Strategy and Governance; and the College of Policing Authorised Professional Practice (APP). Driving Academy Learning and Development; Response to Matters of Concern: 1. Insufficient refresher training in emergency response driving given to the driver of the van. The national policy for police driving is determined by the National Police Chiefs’ Council (NPCC) Driver Training Lead. The development and maintenance of driving related national learning standards and supporting materials are the responsibility of the College of Policing, with assistance from the National Strategic Group (chaired by the National Police Driver Training Lead) and the practitioners’ group. Therefore national driving skills and competencies have been applied across all police forces. Prior to 2015, drivers were locally assessed by an experienced advanced driver who was qualified as an MPS driving assessor. In 2015 the Roads Policing and Police Driving Learning Programme set out national learning standards for police driving, including the delivery of driver refresher training. On 1st October 2015, the MPS Driving School introduced a three to five year refresher training course for all response car, covert advanced car and advanced car drivers; this is delivered by a suitably trained driving instructor and complies with the nationally recognised APP. By October 2020, this group of drivers will have received refresher training by the MPS Driving School which will complete the five year cycle. 1 | P a g e The driver of the police van was appropriately trained to drive above the statutory speed limit, whilst responding to an emergency request for assistance. He was consequently acting in accordance with legislation, the College of Policing APP and the MPS Police Driver and Vehicle Policy. 2. Police under resourcing. At the inquest, the jury heard that the police van involved in the collision with Mr Yalcin was travelling from Hackney Borough to an incident in Haringey. Police vehicles have always responded to requests to support colleagues in neighbouring boroughs during serious incidents. Resourcing and demand across the MPS is constantly reviewed to maintain operational effectiveness; this flexibility is essential in preventing crime and keeping London safe. The MPS has implemented a programme to incorporate thirty two boroughs into 12 Basic Command Units (BCUs), providing resilience and consistency across London to help the MPS meet its financial and operational challenges. Evidence based innovation is used through subject matter experts and working groups to update standards so police drivers remain adaptable, resilient and safe. 3. Inadequate police terminology to describe the urgency of the situation to which the driver was responding. The term “on the hurry up” is a widely used term within the police service and means assistance is required as quickly as possible due to officers being involved in a volatile or dangerous situation, for themselves and/or members of the public. The Road Traffic Regulation Act 1984 and The Traffic Signs Regulations and General Directions 2016 exempt emergency vehicles being used for police purposes from: Observing the statutory speed limit Observing keep left/right signs Complying with red traffic lights including pedestrian controlled crossings Use of legal exemptions are applied every day and the driver must be able to justify their actions in the pursuance of their duty. The MPS use the National Decision Model (NDM) to assist operational officers to risk assess their response to a situation in a reasonable and proportionate manner. The NDM provides a framework that can be applied ethically and with integrity to all driving decisions and actions and can be used to justify decision making when responding to incidents. There is no legal definition of what would or would not constitute justification for making use of police exemptions. In all considerations the NDM should be applied, regardless of what terminology has been used to request their assistance. It is the responsibility of the driver responding to the call to make a determination as to how to respond by using the NDM. For example, the grading of emergency calls by Met CC should only be used as a guide for officers and staff when deciding on the appropriate response to a particular call. The van that responded to the urgent call for assistance was driven by an experienced police sergeant. He was aware that the request for the van was to convey one of two suspects involved in a fight which had resulted in an allegation of grievous bodily harm (GBH). There was clear evidence that this request required an immediate response and the driver made a dynamic risk assessment as to how he should proceed to the call. 2 | P a g e Conclusion As detailed in this response, the MPS is committed to ensuring our drivers receive training in accordance with the College of Policing APP and our own driving policies. Refresher driver training is provided every three to five years in accordance with national learning standards for police driving. Resourcing and demand across the MPS is constantly reviewed to maintain our operational effectiveness. Whilst we recognise the use of MPS terminology, we will seek to remind our staff that if required, further clarification should be sought to justify the request. The MPS are committed to enhancing our training and this will be incorporated in Met CC professional development days and initial training for all operational staff. Yours sincerely, Richard Martin Deputy Assistant Commissioner 3 | P a g e
METROPOLITAN POLICE PROFESSIONALISM HQ Mr Andrew Walker, HM Senior Coroner, North London Coroners Court, 29 Wood Street, Matthew Horne Deputy Assistant Commissioner 6" Floor New Scotland Yard Barnet, EN5 4BE Victoria Embankment London Tel.: 020 8447 7680 SW1A 2JL Email: court.clerk@hmc-northlondon.co.uk i Tel: - Your ref: Our ref: IX/117/17 and 1802_62 Date: 3 May 2019 | refer to Miss Rebecca Smith’s e-mail dated 1% April 2019 in which she seeks clarity on DAC Martin’s response to your Regulation 28 report following the death of Mr Suleyman Yalcin on the 3° December 2017. | have succeeded DAC Martin as Deputy Assistant Commissioner Professionalism within the Metropolitan Police Service (MPS) and respond to you in this capacity. Response to Matters of Concern: 1. Insufficient refresher training in emergency response driving given to the driver of the van. a 2: a qualified response driver under the MPS Driving Policy and training regime in place prior to 1st October 2015. The regime in place at the time comprised of ‘check tests’ being conducted by qualified officers. iy completed this in line with the then policy. He is due to receive his next refresher training later this year in accordance with the new MPS Driving Policy, which adheres to the College of Policing’s Roads Policing and Police Driving Learning Programme. All MPS officers now undertake refresher training every 3 to 5 years. | trust that this new regime of refresher training addresses your matter of concern. 2. Police under resourcing. The MPS seeks to balance available resources at times against operational demand, and flexing resources to respond to peaks and critical issues. Since 2017 the MPS has undergone a significant restructure with the implementation of the Basic Command Unit (BCU) model with the final phase being completed in February 2019. The responsibility of implementing the model and operational delivery lies with local 1|Page leadership teams, ultimately BCU Commanders. This has enabled a greater level of flexibility to deploy resources across borough boundaries as one policing command areas spans between two and four London boroughs. This policing restructure allows us to make best use of our available resources and the BCU’s will constantly review the availability of officer to respond to incidents. 3. Inadequate police terminology to describe the urgency of the situation to which the driver was responding. Since DAC Martin's response dated 6" February 2019 | have been updated that our Command and Control Centre (MetCC) informed all call handlers to remind them to always clarify the reason for their request and record this on the Computer Aided Despatch system. This issue has also been incorporated into their professional development days (training days) which started on 5th February 2019. Call despatch courses now include a session on clarifying terminology in these situations. The use of the terminology ‘on the hurry up’, is a recognised use of language to request additional support and assistance at the scene of an incident. It is MetCC’s responsibility to command and control police radio communications; this involves clarifying the reasons for the request and deploying units according to urgency, risk and operational priorities. The MPS does not propose to a change in the language, but clarity as to the specific needs is now incorporated into the revised training above. If you have any further queries, please do not hesitate to contact me. Yours sincerely, Matthew Horne Deputy Assistant Commissioner 2|Page
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