Prevention of Future Deaths reports · 2019
Regulation 28 report to prevent future deaths, reference 2019-0153, written 9 May 2019. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 9 May 2019 |
|---|---|
| Reference | 2019-0153 |
| Deceased | John Alliston |
| Coroner | Katy Skerrett |
| Coroner area | Gloucestershire |
| Category | Other related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | 1 |
Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.
H M Senior Coroner for Gloucestershire Ms Katy Skerrett REGULATION 28 REPORT TO PREVENT FUTURE DEATHS THIS REPORT IS BEING SENT TO The Right Hon. James Brokenshire, Secretary of State for Housing, Communities and Local Government, at 2 Marsham Street, London SW1P 4DF. 1 CORONER I am Katy Skerrett, Senior Coroner for Gloucestershire. 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 9th June 2017 I commenced an investigation into the death of John Charles Alliston. The investigation concluded at the end of the jury inquest on the 1st May 2019. The conclusion of the Jury was a hybrid short form conclusion of Accidental Death and a narrative conclusion. The medical cause of death was 1A electrocution. 4 CIRCUMSTANCES OF THE DEATH Mr and Mrs Alliston moved into a private rental property at the end of May 2017. On the 8th June 2017 Mr Alliston was found lying face down in the garden of his property with a wire clutched in his right hand. He had sustained a fatal electric shock injury from this wire. He was pronounced deceased at scene. The wire was identified as a capillary wire associated with the oil heating system. A fault on the hot water system had made the capillary wire live. Two further faults directly contributed to Mr Alliston’s death. There was no residual current protection of the circuit to the water heater. Secondly there was no equipotential bonding of the metallic services to the property. If the electrical installation had been inspected in accordance with BS7671 these latter two faults would have been identified and the installation would have been assessed as unsatisfactory. 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. The MATTERS OF CONCERN are as follows. – Currently there is no mandatory requirement for electrical installations in the private rental sector to be inspected to the requirements of BS7671. I acknowledge that legislation is due to be coming into force. However it remains unclear when this is going to occur. In the meantime, there remains a risk of further deaths occurring. 6 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 and or expedite the planned legislative changes. Gloucestershire Coroner's Court, Corinium Avenue, Barnwood, Gloucester, GL4 3DJ Tel 01452 305661 | coroner@gloucestershire.gov.uk 7 YOUR RESPONSE You are under a duty to respond to this report within 56 days of the date of this report, namely by 4pm 4th July 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 (1) (2) (3) (4) , Principal Specialist Inspector (electrical engineering) Heath and Safety Executive, Belford House, 59 Belford Road, Edinburgh EH4 3UE. , Senior Associate, Mayer Brown International LLP, 201 Bishopsgate, London EC2M 3AF. , Electrical Safety First, 45 Great Guildford Street, London SE1 0ES 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 Dated 9th May 2019 Signature_________________________ Ms K Skerrett Senior Coroner for Gloucestershire Gloucestershire Coroner's Court, Corinium Avenue, Barnwood, Gloucester, GL4 3DJ Tel 01452 305661 | coroner@gloucestershire.gov.uk
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.
do Rt Hon James Brokenshire Secretary of State for Housing, Communities Ministry of Housing, and Local Government Communities & Ministry of Housing, Communities & Local Local Government ee Fry Building 2 Marsham Street London SW1P 4DF Katy Skerrett Gloucestershire Coroner's Court Corinium Avenue www.gov.uk/mhcig Gloucester — Our Ref: 4246195 Gloucestershire Your ref. TJ/je GL4 3DJ 13! June 2019 Dear Katy, Thank you for your letter of 10 May enclosing a Regulation 28 Report relating to the death of Mr John Charles Alliston. | am saddened to learn of the death of Mr Alliston and offer my sincere condolences to his family. Thank you for highlighting the particular issues which arose from the Inquest and | hope the following response may be informative. The Government is committed to offering greater protection to tenants to prevent similar tragedies and ensuring rented properties are safe. Existing legislation implies a covenant into most short leases that the landlord will keep installations for the supply of electricity in repair and proper working order, and it is currently best practice for landlords to organise periodic inspection and testing and to provide a report to the tenant. We recognise, however, that we must go further. As you are already aware, on 19 July 2018 we announced that we will introduce a mandatory requirement on landlords in the private rented sector to ensure electrical installations in their property are inspected at least every five years, to ensure they meet the electrical safety standards introduced by the Regulations. In addition to this, on 29 January 2019, in the response to our consultation on electrical safety in the private rented sector, we announced that we will produce new guidance to which landlords may have regard in determining who is competent to carry out an electrical safety inspection. Inspectors and testers will sign a checklist certifying their competence or that they are a member of a competent person scheme. This will ensure that electrical installations in the Private Rented Sector are safer and further reduce deaths and injuries due to electric shocks and fires caused by electric faults. Please be assured that this is a matter of paramount importance to me, and my Department is working to bring regulations into force as soon as possible, subject to parliamentary approval and timetable. mr _ RT HON JAMES BROKENSHIRE MP
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