Hemanta Rai

BRECON  BEACONS 
NATIONAL PARK 

Graeme Hughes 

Her Majesty's Senior Coroner 

South Wales Central Area 

Coroner's Office 

The Old Court House 

Court House Street 

PontyPridd 

CF371JW 

Date: 20 September 2022 

Dear Sir 

Joint response by Brecon Beacons National Park Authority and Neath Port 

Talbot Council to the Regulation 28 Report (25 July 2022) in relation to the 

death by accident of Hemeta Kumar Rai on 16 August 2021. 

1.  Introduction 

1.1. The Brecon Beacons National Park Authority and Neath Port Talbot Council 

wish to thank the Coroner for writing to their respective Chief Executives and 

(~~l- H&I: (01874) 624437  Ffacs: (01874) 622574 

Awdurdod Pan: Cenedlaethol Bannau Brycheiniog 
Plas y Ffynnoo. Ffordd Cambnvi.Aberhoriddu.fuv.ys. LD3 7HP 

E-bost)'llholiadau@bannaubl)'che,niog.org 
Safle ar ywe:www.bannaubrycheinog.org 

'" 1tnu•u11 ""'•• 11
N•r•(JH &IU5 

Brecon Beacons National ParxAuthority 
P1as y Ffynnon, Cambrian Wiy. Brecon, Powys. LD3  7HP
Telephone: (01874) 624437  Fax: (01874) 622574 
E-ma.i· enqun,,@breconbeacons.org 
W ebsite: www.brec~cons.org 

7he Aullon!r-

r, Welsh 0t Ellflisl, 

 
 
 
 
 bringing to our attention the various matters of concern that were prompted 

------Ct) 

by her investigation into the tragic death of Mr. Rai. 

1.2. The Brecon Beacons National Park is an area which is designated for its 

special qualities consequently, signage is something we must consider very 

carefully in the context of a natural landscape. 

1.3. Those concerns have been shared with and considered carefully by Brecon 

Beacons National Park Authority and Neath Port Talbot Council. 

1.4. This report is our joint response on  behalf of the Brecon Beacons National 

Park Authority and Neath Port Talbot Council to your Report to Prevent 

Future Deaths dated 25 July 2022, in accordance with the provisions of the 

Coroners and Justice Act 2009. 

1.5. It should be noted that this response is based entirely on the Regulation 28 

Report that was received. Despite further requests for information to the 

Coroner Officer no additional or specific information was provided. 

2.  Aims 

2.1. Both Brecon Beacons National Park Authority and Neath Port Talbot Council 

express their deep regret and sorrow at the death of Mr Rai. We 

acknowledge the coroner's concerns and recognise the need to consider 

signage at the land we own and manage at the waterfall at 

Pontneathvaughan, Powys ('the Site'). This response is prepared to assure 

the Chief Coroner of our commitment to change, ongoing learning and 

improvement. 

2.2. We will seek to respond to the key point of signage that has been raised by 

the Coroner's concerns, and to identify any changes to signage to mitigate 

the risk of any future death by accident by someone visiting the Site by 

undertaking a signage review and implementing any necessary actions (see 

section Error!  Reference source not found.). 

2 

 3.  Other parties 

3.1. We are committed to working in partnership with each other and have 

extended the offer collaboration to other public body landowners and 

colleagues so that a joint approach can be pursued. 

4.  Immediate first steps 

4.1. As a result of the concerns that the Coroner raised in her report,  Brecon 

Beacons National Park Authority has commissioned an independent review 

of signage at the Site and a Site visit has been scheduled for 29th  September 

2022 which is to be led by the external health and safety consultant and 

attended by officers from Brecon Beacons National Park Authority,  Neath 

Port Talbot Council and Natural Resources Wales. 

5.  Longer aims 

5.1.As stated we are committed to working collaboratively with the other public 

body landowners and colleagues to improve our joint management of matters 

that affect visitors to the site. We hope that we can continue the dialogue to 

create a unified approach to health and safety matters within the National 

Park 

5.2. In the interim, Brecon Beacons National Park Authority has commissioned a 

review of all signs within its high-volume visitor areas to ensure they are fit for 

purpose and are uniform in their design, content and application. 

6.  Policy Review 

6.1. Brecon Beacons National Park Authority is in the process of reviewing the 

suite of health and safety policies which includes the policy covering the 

management of our sites and actions to be taken when health and safety 

concerns are received. Neath Port Talbot Council have also looked at the 

access way to such sites that are within its responsibility, to ensure matters 

are being considered appropriately. 

3 

 Ct) 

7.  Initial responses to the Coroner's Criticisms 

7.1. It is important that we offer factual response to the Coroner's findings, both to 

acknowledge and to identify any failings and to correct any misperceptions 

which may be barriers to full learning. 

7.2. The Coroner's key points are summarized here,  and the full table can be 

found in her Regulation 28 Report. 

Coroner's 

Response 

Action already 

Action proposed 

Matters of 

I 

Concern 

completed 

(1) There is no 

This area is not 

We have 

To review signage 

adequate signage  within the 

instructed an 

within the National 

to warn visitors of 

ownership of 

independent 

Park and land in 

the risk of 

Brecon Beacons 

reviewer to 

drowning by 

National Park 

compile a 

the ownership of 

I 

I  Neath Port Talbot 

entering the water  Authority or Neath 

complete review of  Council and 

at Sgwd Gwladys.  Port Talbot 

signage within 

consider 

Council. 

public access 

implementing a 

areas within our 

uniform form of 

land ownership 

signage. 

(2) Existing 

We accept 

We have 

To review signage 

signage in 

additional signage 

instructed an 

and implement a 

'Waterfall Country' 

can explicitly 

independent 

uniform form of 

is overloaded with 

address safety 

reviewer to advise 

signage. 

a variety of 

concerns 

on best practice 

information, which 

although helpful for 

walking routes 

etc.,  is not explicit 

in warning of the 

real danger of 

signs 

4 

 Response 

Action already 

Action proposed 

completed 

Coroner's 

Matters of 

Concern 

death from 

entering the water. 

(3) 

Any sign(s)  We agree with 

We have 

To review signage 

erected ought to 

using signs that 

instructed an 

and implement a 

be easily visible, in  are clear to all 

independent 

uniform form of 

plain English and 

users regardless 

reviewer to advise 

signage. 

spell out the risk of  of language. It 

on the formation 

death by drowning.  should be noted 

and content of new 

that each authority 

signs 

must also comply 

with Welsh 

Language 

Standards which 

will have a bearing 

on any approach 

in signs that can 

be utilised 

(4) It is very 

It is accepted that  Brecon Beacons 

To review signage 

unclear who bears 

land ownership is  National Park 

and implement a 

responsibility for 

divided and can be  Authority will  install  uniform form of 

this particular area,  confusing 

user friendly signs 

signage 

which borders 3 

local authority 

areas, and falls 

within the National 

Park and NRW 

jurisdiction. 

delineating the 

National Park area 

with a contact 

detail regarding 

any queries. 

5 

 Yours faithfully 

Chief Executive 

For and on behalf of Brecon Beacons National Park Authority 

Head of Legal and Democratic Services 

Neath Port Talbot Council 

6

Cyngor Cast ell-nedd Port Talbot 
Neath Port Talbot Council 

Dyddiad/  Date 

201h  September 2022 

His Majesty's Senior Coroner 
South Wales Central Coroner Area 

Coroner's Office 
The Old Courthouse 
Courthouse Street 
Pontypridd 

Dear Sirs, 

Please find attached a response to your Regulation 28 Notice in respect of the 
sad  death of Hemanta Kumar Rai. 

This response has been prepared jointly with Brecon Beacons National Park 
Authority whom the Neath Port Talbot Council is presently working with to 
consider the issues raised in your Notice. 

Yours faithfully 

 - Head of Legal and Democratic Service 

Pennaeth Gwasanaethau Cyfrelthlol a Democrataldd 
Y Gano~an Ddinesig, Port Talbot SA131PJ 

Head of Legal Services and Democratic Services 
Civic Centre, Port Talbot, SA13 1PJ 

Croesewlr goheblaeth yn y Gymraeg a byddwn yn ymdrin agohebiaeth Gymraeg a Saesneg l'r un safonau ac amserlenni. 
We welcome correspondence in Welsh and will deal with Welsh and English correspondence to the same standards and timescales. 

www.npt.gov.uk 

 
 
 
 
 
 
 
 
 
 
 
 Joint response by Brecon Beacons National Park Authority and Neath Port Talbot 

Council to the Regulation 28 Report (25 July 2022) in relation to the death by accident 

of Hemeta Kumar Rai on  16 August 2021. 

1.  Introduction 

1.1.  The Brecon Beacons National Park Authority and Neath Port Talbot Council 

wish to thank the Coroner for writing to their respective Chief Executives and 

bringing to our attention the various matters of concern that were prompted by 

her investigation into the tragic death of Mr. Rai. 

1.2.The Brecon Beacons National Park is an area which is designated for its 

special qualities consequently, signage is something we must consider very 

carefully in the context of a natural landscape. 

1.3. Those concerns have been shared with and considered carefully by Brecon 

Beacons National Park Authority and Neath Port Talbot Council. 

1.4. This report is our joint response on behalf of the Brecon Beacons National 

Park Authority and Neath Port Talbot Council to your Report to Prevent Future 

Deaths dated 25 July 2022, in accordance with the provisions of the Coroners 

and Justice Act 2009. 

1.5.  It should be noted that this response is based entirely on the Regulation 28 

Report that was received.  Despite further requests for information to the 

Coroner Officer no additional or specific information was provided. 

2.  Aims 

2.1.  Both Brecon Beacons National Park Authority and Neath Port Talbot Council 

express their deep regret and sorrow at the death of Mr Rai. We acknowledge 

the Coroner's concerns and recognise the need to consider signage at the land 

we own and manage at the waterfall at Pontneathvaughan, Powys ('the Site'). 

This response is prepared to assure the Chief Coroner of our commitment to 

change, ongoing learning and improvement. 

 2.2. We will seek to respond to the key point of signage that has been raised by the 

Coroner's concerns, and to identify any changes to signage to mitigate the risk 

of any future death by accident by someone visiting the Site by undertaking a 

signage review and implementing any necessary actions (see section Error! 

Reference source not found.). 

3.  Other parties 

3.1. We are committed to working in partnership with each other and have 

extended the offer collaboration to other public body landowners and 

colleagues so that a joint approach can be pursued. 

4.  Immediate first steps 

4.1. As a result of the concerns that the Coroner raised in her report,  Brecon 

Beacons National Park Authority has commissioned an independent review of 

signage at the Site and a Site visit has been scheduled for 29th  September 

2022 which is to be led by the external health and safety consultant and 

attended by officers from Brecon Beacons National Park Authority, Neath Port 

Talbot Council and Natural Resources Wales. 

5.  Longer aims 

5.1. As stated we are committed to working collaboratively with the other public 

body landowners and colleagues to improve our joint management of matters 

that affect visitors to the site. We hope that we can continue the dialogue to 

create a unified approach to health and safety matters within the National Park 

5.2. In the interim, Brecon Beacons National Park Authority has commissioned a 

review of all signs within its high-volume visitor areas to ensure they are fit for 

purpose and are uniform in their design, content and application. 

6.  Policy Review 

 6.1. Brecon Beacons National Park Authority is in the process of reviewing the 

suite of health and safety policies which includes the policy covering the 

management of our sites and actions to be taken when health and safety 

concerns are received.  Neath Port Talbot Council have also looked at the 

access way to such sites that are within its responsibility, to ensure matters are 

being considered appropriately. 

7.  Initial responses to the Coroner's Criticisms 

7.1. It is important that we offer factual response to the Coroner's findings, both to 

acknowledge and to identify any failings and to correct any misperceptions 

which may be barriers to full learning. 

7.2. The Coroner's key points are summarized here, and the full table can be found 

in her Regulation 28 Report. 

Coroner's Matters 

Response 

Action already 

Action proposed 

of Concern 

completed 

(1) There is no 

This area is not 

We have instructed 

To review signage 

adequate signage 

within the 

an independent 

within the National 

to warn visitors of 

ownership of 

reviewer to compile 

Park and land in 

the risk of drowning 

Brecon Beacons 

a complete review 

the ownership of 

by entering the 

National Park 

of signage within 

Neath Port Talbot 

water at Sgwd 

Authority or Neath 

public access 

Council and 

Gwladys. 

Port Talbot 

areas within our 

consider 

Council. 

land ownership 

implementing a 

(2) Existing 

signage in 

We accept 

We have instructed 

To review signage 

additional signage 

an independent 

and implement a 

'Waterfall Country' 

can explicitly 

reviewer to advise 

uniform form of 

uniform form of 

signage. 

 Coroner's Matters 

Response 

Action already 

Action proposed 

of Concern 

completed 

is overloaded with 

address safety 

on best practice 

signage. 

a variety of 

concerns 

signs 

information, which 

although helpful for 

walking routes etc., 

is not explicit in 

warning of the real 

danger of death 

from entering the 

water. 

(3) 

Any sign(s) 

We agree with 

We have instructed 

To review signage 

erected ought to be 

using signs that 

an independent 

and implement a 

easily visible, in 

are clear to all 

reviewer to advise 

uniform form of 

1 

plain English and 

users regardless of 

on the formation 

signage. 

spell out the risk of 

language. It should 

and content of new 

death by drowning. 

be noted that each 

signs 

authority must also 

comply with Welsh 

Language 

Standards which 

will have a bearing 

on any approach in 

signs that can be 

utilised 

(4) It is very 

It is accepted that 

Brecon Beacons 

To review signage 

unclear who bears 

land ownership is 

National Park 

and implement a 

responsibility for 

divided and can be 

Authority will install 

uniform form of 

 Coroner's Matters  Response 

Action already 

Action proposed 

of Concern 

completed 

this particular area,  confusing 

user friendly signs 

signage 

which borders 3 

local authority 

areas, and falls 

within the National 

Park and NRW 

jurisdiction. 

delineating the 

National Park area 

with a contact 

detail regarding 

any queries.