Aaron Lauder

Information Classification: CONTROLLED 

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS  

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1. 

, 

1 

CORONER 

I am Andrew Cox, the Acting Senior Coroner for the coroner area of Cornwall and the 
Isles of Scilly. 

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CORONER’S LEGAL POWERS 

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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. 

INVESTIGATION and INQUEST 
On 27/1/21, I concluded an inquest into the death of Aaron Antony Lauder, 38, who died 
in a road traffic collision on the A30 near Higher Drift Farm, Penzance.   
 . 
The medical cause of death was recorded as: 
1a) Displaced Basal Skull Fracture Traversing Middle Cranial Fossa Vault with 
Underlying Traumatic Brain Injury Cerebral Oedema; Bilateral Rib Fractures 
Complicated by Flail Segment, Pneumothorax and Multiple Pulmonary Lacerations 
1b) Blunt Force Head and Chest Trauma 
1c) Motor vehicle collision 
II) 

I recorded a Conclusion of Road Traffic Collision. 

CIRCUMSTANCES OF THE DEATH 
Mr Lauder was riding his Kawasaki motorbike along the A30 in an easterly direction from 
St Buryan towards Penzance. At the scene of the collision, a John Deere tractor was 
turning right in a westerly direction across Mr Lauder’s path. The national speed limit of 
60mph is in force at the location. The Collision Investigator recorded that there was a 
‘distinct lack of view to the right especially given the speed limit’ available to the tractor 
driver. The view was similarly restricted for Mr Lauder.  

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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.   

I concluded that the prime cause of the collision was the lack of view available to either 
driver at the accident locus. 

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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.  

I understand you are the landowner for the particular hedge/verge in question. It seems 
to me an obvious first step would be for the hedge obstructing the view to be taken 
down.  

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 Information Classification: CONTROLLED 

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YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 26 April. 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. 

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COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following Interested 
Persons: 

 and his insurers. 

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. 

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01.03.21                                               
                                                                     Acting Senior Coroner 

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Information Classification: CONTROLLED 

Mr Andrew J Cox 
Acting Senior Coroner 
H.M Coroner’s Office 

Date: 

18th May 2021 

Dear Mr Cox 

Regulation 28 Report – Mr Aaron Anthony Lauder (deceased) 

Thank you for the extension to the response period to your letter and Regulation 28 Report of 28th 
January 2021. This has been necessary to carry out a series of preliminary investigations and to 
confirm certain legal and financial issues with Cornwall Council. I am now able to reply in full as to the 
highway authority’s response to your recommendations.  

Cornwall Council has agreed to fund a scheme to improve visibility at the farm access. The highway 
authority is intending to obtain the relevant land and set back the Cornish hedge, with the 
landowner’s full cooperation; Cormac’s Safety Engineering team has begun the design process. It is 
likely that the work will be undertaken in the autumn of this year.  

I think it would be worth detailing the reasoning behind this decision, however, if only to set out 
clearly the legal issues and why this situation may be viewed as exceptional.  

The highway authority has no general responsibility or duty to improve visibility from private accesses 
such as this. In fact, using public funds to do so – effectively improving private property at public 
expense – presents obvious difficulties. It would therefore normally be for the property owner to 
make such an improvement, not least as they would generally be the principal beneficiary.  

Nonetheless, in certain circumstances, the highway authority may exercise a power to fund 
improvements to private property where the aim and result would be a gain in public safety. Any 
improvement to private property would simply be seen as an incidental benefit.  

In the case of the access to Higher Drift Farm, a number of factors have been balanced.  

Although visibility to the west out of the access is limited, Mr Lauder’s collision was the first to have 
been recorded here in the 50 years of our accident record system. This is likely to be for several 
reasons. Firstly, approach speed from the west is significantly constrained by the road alignment; our 
recent readings show an average speed of only 38mph and an 85th-percentile speed (generally used 
for road assessment) of 43mph (March 2021, 12,000 vehicles). Only 3% of drivers exceed 50mph.  

Form CSL_DES_LTP 
Version 2.0 
Last Reviewed 29/01/2021 

  A Cornwall Council Company 

Registered in England No. 07737430 

Registered Office  
Cormac Head Office, Higher Trenant Road, 
Wadebridge, Cornwall, PL27 6TW 
www.cormacltd.co.uk 

 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Information Classification: CONTROLLED 

Secondly, as a private access it is used relatively infrequently. The owners tend to turn left out of the 
access due to both the greater difficulty of a right turn and the most common destinations simply 
being to the east. Both factors reduce the ‘exposure’ risk of collision for main road traffic.  

Thirdly, due to the left-hand curvature of the road, drivers approaching from the west have a slightly 
greater view to the front of an emerging vehicle (approximately 55m), than the emerging driver has of 
them (just over 40m). Given the generally moderate speeds at which drivers are travelling, this usually 
gives them sufficient opportunity to react and to warn or brake to avoid an emerging vehicle. 
‘Stopping distance’ is quoted at 38m from 40mph, and 53m from 50mph (Highway Code). Of course, 
all drivers have a duty to be able to stop well within the distance they can see to be clear in all 
circumstances (Highway Code R.126).  

I suspect that the absence of preceding accidents is largely attributable to the combination of these 
factors, protecting the access from the relatively limited emerging visibility.  

Against this, without going into the precise circumstances, Mr Lauder’s tragic death plainly 
demonstrates that the risk exists – however small – of a combination of factors that result in a 
collision.  

Furthermore, following discussion with the landowners, it is plainly impractical to expect that they 
would be able to fund and undertake the relatively extensive scheme required to set back the hedge 
and improve visibility themselves (nor could they be compelled to).  

In summary, while the risk of a similar accident occurring is very low, it cannot be ruled out. As the 
highway authority is the only body that realistically has the ability in this situation to address the risk, 
Cornwall Council is satisfied that it would be a suitable use of public funds in this instance and can be 
justified on the grounds of improving the safety of the public highway.  

I note the other potential suggestions outlined in your Report and thank you for them. There are 
reasons why these would not be particularly effective or appropriate at this location, but as the 
visibility improvement gets to the heart of the safety issue, it is probably not necessary to respond to 
these in any detail here, although I would be happy to discuss them separately if desired.  

I trust this is satisfactory. Please feel free to contact me should you wish for any further information.  

Yours sincerely 

Project Manager (Safety) 
Engineering Design Group, 

Cc 

 Higher Drift Farm, Penzance.