Source · Prevention of Future Deaths

Cameron Chadwick

Ref: 2017-0436 Date: 6 Jul 2017 Coroner: Jennifer Leeming Area: Manchester (West) Responses identified: 1 / 1 View PDF

A pothole exceeding the minimum depth for repair was present in the carriageway, contributing to a fatal accident.

Date 6 Jul 2017
56-day deadline 31 Aug 2017 est.
Responses identified 1 of 1
Child Death (from 2015) Road (Highways Safety) related deaths

Coroner's concerns

AI summary
A pothole exceeding the minimum depth for repair was present in the carriageway, contributing to a fatal accident.
View full coroner's concerns
During the Inquest evidence was heard that:-
i. Evidence was given at the Inquest that there was pothole in the carriageway near to where the accident that caused Cameron Chadwick's death occurred An officer of Wigan Council informed the Court that pothole that was 4Omm Or more deep should be repaired: Police Officer gave evidence that whilst he could not fully guarantee the exactness of his measurement the pothole was 4Smm at the time of this accident; ACTION SHOULD BE TAKEN In my opinion urgent action should be taken to prevent future deaths and I believe that 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 31* August 2017. 1, 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 PUBLICATTON I have sent a copY of my report to the Chief Coroner ad to the following Interested Persons: - (mother) ((father) Iam also under a to send the Chief Coroner a cOpY of your response_ The Chief Coroner may publish either or both in complete or redacted or summary form: He may send 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 Signed "mxJenniDehAA3; 6th July 2017 MJennifer Leeming_HM Senior Coroner deep duty

Responses

1 respondent
Wigan Council Local Authority / Fire Service
6 Jul 2017 PDF
Action Taken

Following the report, the council measured the pothole depth and repaired it, both temporarily and permanently. They assert this was done despite the pothole not meeting the threshold for intervention under their Highway Safety Inspection Policy. (AI summary)

View full response
Dear Professor Leeming Cameron Chadwick - Deceased Regulation 28 Report to Prevent Future Deaths Thank you for your correspondence dated 6th July 2017 relating to the inquest into the unfortunate death of Cameron Chadwick and the Regulation 28 notice that has been served to Wigan Council. I have now been able to investigate the background into this matter and I would like to advise you as follows. Having considered the content of the Regulation 28 - Coroners Report, we have now carried out a number of actions, in particular relating to points 5.6 and 7 which are actions directed to Wigan Council. I have outlined below the specific interventions and actions that we have taken, in response to each of these points. Action Point 5.1.i - Coroners Concerns I can confirm that a Technical Officer (Highways and Streetworks) and a Technical Design Officer (Highways) from the Highway Asset Management Team, who are experienced in carrying out highway safety inspections, attended the location of the incident at Helveyllyn Road, Norley Hall, Wigan on 6th July 2017. The purpose of this site visit was to establish the depth of the carriageway pothole. In the police report (exhibit DJH 2- point 19) the police officer gave evidence that the pothole was 4.5cm (45mm) deep at its lowest point at the time of the accident.

Confident Place, Confident People.

However, I can confirm that the actual depth of the carriageway pothole as measured on site by the two council officers (6lh July 2017) was 36mm deep at its deepest point. I have attached a photograph referenced H1 as proof of this measurement. Action Point 6 - Action Should Be Taken I can confirm that Wigan Council has in place a Highway Safety Inspection Policy for its highway network. All highways are subject to regular safety inspections by competent highway inspectors. Any safety defects found during those inspections giving rise to a real source of dangers to reasonable users would have been subject to repair within certain timescales dependent on the degree of the danger. However, in line with best practice and from the Regulation 28 - Coroner’s Report advising us this incident, the highway asset management service has exercised their discretion to carry out a repair, although it did not actually meet the Council’s highway intervention level for a safety defect. For recording purposes I can advise that a temporary repair to the carriageway pothole was actioned 6th July 2017. This temporary repair was followed up with a permanent one on 17th July 2017. I have attached a photograph referenced H2 as evidence of this repair. Action Point 7 - Your Response Please accept this letter as our confirmation that we have complied with your report and provided details of the actions/dates we have taken to comply with your Regulation 28 request. I trust that the above is satisfactory to you, but should you require any further information relating the above, please let me know and we will do our best to help.

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Report details

Reference
2017-0436
Date of report
6 July 2017
Coroner
Jennifer Leeming
Coroner area
Manchester (West)

Responses identified

Responses identified 1 of 1
All listed responses identified

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 31 Aug 2017 (estimated).

Sent to

Wigan Council

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