John Thomas
PFD Report
All Responded
Ref: 2023-0527
All 1 response received
· Deadline: 9 Feb 2024
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Response Status
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56-Day Deadline
9 Feb 2024
All responses received
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Source: Courts and Tribunals Judiciary
Coroner’s Concerns
In my opinion there is a risk that future deaths will occur unless action is taken. Initial indications by way of witness evidence suggest that the loss of control occurred as a result of Mr Thomas’ motorcycle “slipping on the road”.
My understanding is that this has occurred near to the Sun Trevor Public House, and I have been made aware that some issues regarding flooding and the general condition of this part of the highway had been made known to the Local Authority prior to the accident.
Furthermore my understanding is that concerns have also been raised with the Local Authority in relation to surface water/flooding on another part of the A539 near to Llangollen, namely near to the Wenfrwdd Pocket Park entrance.
Coroner's Office, County Hall, Wynnstay Road, Ruthin, LL15 1YN | I am therefore concerned that if action is not taken to remedy these issues, there is a risk that future deaths may occur.
My understanding is that this has occurred near to the Sun Trevor Public House, and I have been made aware that some issues regarding flooding and the general condition of this part of the highway had been made known to the Local Authority prior to the accident.
Furthermore my understanding is that concerns have also been raised with the Local Authority in relation to surface water/flooding on another part of the A539 near to Llangollen, namely near to the Wenfrwdd Pocket Park entrance.
Coroner's Office, County Hall, Wynnstay Road, Ruthin, LL15 1YN | I am therefore concerned that if action is not taken to remedy these issues, there is a risk that future deaths may occur.
Responses
Response received
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Response of Denbighshire County Council to RegulaƟon 28 Report of His Majesty’s Coroner, Mr John Giƫns
1. Background
1.1 On 15 December 2023, His Majesty’s Coroner sent a RegulaƟon 28 Report (“the Report) to Denbighshire County Council (“the Council”).
1.2 The Report confirmed that a fatal road traffic accident occurred on 2nd December 2023 when John Michael Thomas lost control of his motorcycle on the A539 outside Llangollen, near to the Sun Inn Public House.
1.3 An inquest has been opened and adjourned.
1.4 The Council takes this opportunity to express its sympathy to Mr Thomas’ family for their loss.
2. The Report
2.1 In the Report dated 15 December 2023, HM Coroner sets out the following issues and concerns:
• HM Coroner understands that “issues regarding flooding and the general condition of the highway” at the accident locaƟon (near to the Sun Inn ) “had been made known to the local authority prior to the accident” – The Sun Inn LocaƟon.
• HM Coroner understands that “concerns have also been raised with the local authority in relation to surface water/flooding on another part of the A539 near to Llangollen” near to the Wenffrwd Pocket Park Entrance – The Wenffrwd LocaƟon.
• HM Coroner confirms his concern that “if action is not taken to remedy these issues, there is a risk that future deaths may occur”.
2.2 The Report requires the Council to respond and confirm details of acƟon taken or proposed to be taken and the Ɵmetable for such acƟon.
3. The A539 at the Wenffrwd LocaƟon, Llangollen
3.1 This is located approximately one kilometre from the locaƟon of the accident. It is shown at LocaƟon A on the plan at Appendix 1.
3.2 On occasions of heavy rainfall or extended periods of wet weather, the land (field) adjacent to the highway becomes saturated and can cause excess water to run off the land and onto the highway. This is not uncommon, parƟcularly in rural locaƟons and where there is natural landscape immediately adjacent to the highway.
3.3 Prior to the Report from HM Coroner, the Council was aware of the aforemenƟoned issue at this locaƟon. It was not (and is not) considered to present a specific safety concern or an issue that requires remedial acƟon. As above, such issues are common across the highway network, parƟcularly in rural locaƟons and it is not caused by an issue related to the highway infrastructure. The issue only presents at Ɵmes of heavy or extensive rainfall. It does not result in an amount of water that makes the highway in any way unpassable for traffic and the locaƟon is the subject of winter maintenance and griƫng in accordance with the Council’s winter maintenance policy.
3.4 As a mater of completeness, the Council will contact the owner of the field adjacent to the highway to see if any alteraƟons could be made to this private land that may assist in retaining the water on the land on the occasions when it becomes saturated.
4. The A539 at the Sun Inn LocaƟon, Llangollen
4.1 The area of the A539 at the Sun Inn is approximately 200 metres west of the accident locaƟon. It is shown as LocaƟon B on the plan at Appendix 2.
4.2 At this locaƟon a drainage system from an adjacent road flows into a manhole which is parƟally blocked. As a result, there is an overflow which runs on the highway to flow into a gully approximately 70 metres away, before draining under the road and into the canal.
4.3 At Ɵmes of heavy or extended rainfall, water runs off the inclined bank and onto the highway and the drainage mechanism described above takes Ɵme to carry away the water. The reason for this is mulƟ-faceted and includes:
• The saturaƟon of land adjacent to the highway at Ɵmes of heavy or extended rainfall.
• The incline of the land adjacent to the highway, such that water falls towards the highway.
• The gully being located 70 metres away from this locaƟon.
• The capacity of gully.
4.4 The Council is conƟnuing to invesƟgate this use. It seems likely that a new ouƞall system may need to be installed, potenƟally to include new drainage infrastructure in the car park of the Sun Inn.
4.5 If this work is required, then it will be completed by September 2024 at the latest to ensure it is completed before the requirement for general winter maintenance and griƫng begins.
5.0 Drainage feature east of the accident locaƟon
5.1 On the north side of the road there is a stone feature which collects run – off from the land behind it and feeds it into a culvert which again runs under the carriageway to ouƞall into the canal. This is shown as LocaƟon C on the plan at Appendix 2.
5.2 The stone feature referred to is historical. It was idenƟfied that ongoing use of the private land behind the feature by livestock had altered the layout/surface of the land. This in turn impacted on the flow of water off the land into the feature so that it was not collecƟng all the flow of water from the land. This has been recƟfied. Debris had also collected in the stone feature, and this has been cleared. Whilst it is impossible to eliminate the risk of water
run-off onto the highway, these remedial measures have been effecƟve in improving drainage at the locaƟon and they are measures that will be retained and conƟnued by the Council.
5.3 The council has a list of criƟcal culverts which are known to require higher maintenance standards and this feature will now be added to it a monitored more closely.
6. Other maters
6.1 We have addressed above the specific concerns highlighted in the Report of HM Coroner. More generally, and in an effort to assist HM Coroner, the Council is able to provide further informaƟon in relaƟon to the A539 in this secƟon of its response.
6.2 The A539 is subject to a regular system of rouƟne inspecƟons in accordance with the Council’s policy for highway maintenance. RouƟne inspecƟons are carried out every three months.
6.3 The A539 forms part of the highway griƫng network in accordance with the Council’s Winter Maintenance Policy.
6.4 Following the extensive rainfall and disrupƟon caused by Storm Babet on 20th October 2023, the Council implemented a specific response acƟon of addressing the impact of the storm on drainage gullies and channels on the A539. This work has been completed with all gullies and channels being cleared.
6.5 As an addiƟonal safety measure, the Council has also erected warning signs on the A539 at both the Wenffrwd JuncƟon locaƟon and the Sun Inn locaƟon. These warning signs alert motorists to the possibility of the presence of water or ice.
7. Conclusion
7.1 Across any highway network, there will always be locaƟons where issues of water drainage arise, parƟcularly during Ɵmes of heavy or extended rainfall. There are mulƟple potenƟal reasons for this, to include the topography of the area.
7.2 The safety of the highway network for the public is of paramount important to the Council. I am saƟsfied that the specific concerns idenƟfied by HM Coroner have been carefully considered and reasonable and appropriate measures are in place to address them.
7.3 The Council is of course willing to assist HM Coroner with his inquiry in any way that it can.
Head of Highways and Environmental Services
08.03.24
1. Background
1.1 On 15 December 2023, His Majesty’s Coroner sent a RegulaƟon 28 Report (“the Report) to Denbighshire County Council (“the Council”).
1.2 The Report confirmed that a fatal road traffic accident occurred on 2nd December 2023 when John Michael Thomas lost control of his motorcycle on the A539 outside Llangollen, near to the Sun Inn Public House.
1.3 An inquest has been opened and adjourned.
1.4 The Council takes this opportunity to express its sympathy to Mr Thomas’ family for their loss.
2. The Report
2.1 In the Report dated 15 December 2023, HM Coroner sets out the following issues and concerns:
• HM Coroner understands that “issues regarding flooding and the general condition of the highway” at the accident locaƟon (near to the Sun Inn ) “had been made known to the local authority prior to the accident” – The Sun Inn LocaƟon.
• HM Coroner understands that “concerns have also been raised with the local authority in relation to surface water/flooding on another part of the A539 near to Llangollen” near to the Wenffrwd Pocket Park Entrance – The Wenffrwd LocaƟon.
• HM Coroner confirms his concern that “if action is not taken to remedy these issues, there is a risk that future deaths may occur”.
2.2 The Report requires the Council to respond and confirm details of acƟon taken or proposed to be taken and the Ɵmetable for such acƟon.
3. The A539 at the Wenffrwd LocaƟon, Llangollen
3.1 This is located approximately one kilometre from the locaƟon of the accident. It is shown at LocaƟon A on the plan at Appendix 1.
3.2 On occasions of heavy rainfall or extended periods of wet weather, the land (field) adjacent to the highway becomes saturated and can cause excess water to run off the land and onto the highway. This is not uncommon, parƟcularly in rural locaƟons and where there is natural landscape immediately adjacent to the highway.
3.3 Prior to the Report from HM Coroner, the Council was aware of the aforemenƟoned issue at this locaƟon. It was not (and is not) considered to present a specific safety concern or an issue that requires remedial acƟon. As above, such issues are common across the highway network, parƟcularly in rural locaƟons and it is not caused by an issue related to the highway infrastructure. The issue only presents at Ɵmes of heavy or extensive rainfall. It does not result in an amount of water that makes the highway in any way unpassable for traffic and the locaƟon is the subject of winter maintenance and griƫng in accordance with the Council’s winter maintenance policy.
3.4 As a mater of completeness, the Council will contact the owner of the field adjacent to the highway to see if any alteraƟons could be made to this private land that may assist in retaining the water on the land on the occasions when it becomes saturated.
4. The A539 at the Sun Inn LocaƟon, Llangollen
4.1 The area of the A539 at the Sun Inn is approximately 200 metres west of the accident locaƟon. It is shown as LocaƟon B on the plan at Appendix 2.
4.2 At this locaƟon a drainage system from an adjacent road flows into a manhole which is parƟally blocked. As a result, there is an overflow which runs on the highway to flow into a gully approximately 70 metres away, before draining under the road and into the canal.
4.3 At Ɵmes of heavy or extended rainfall, water runs off the inclined bank and onto the highway and the drainage mechanism described above takes Ɵme to carry away the water. The reason for this is mulƟ-faceted and includes:
• The saturaƟon of land adjacent to the highway at Ɵmes of heavy or extended rainfall.
• The incline of the land adjacent to the highway, such that water falls towards the highway.
• The gully being located 70 metres away from this locaƟon.
• The capacity of gully.
4.4 The Council is conƟnuing to invesƟgate this use. It seems likely that a new ouƞall system may need to be installed, potenƟally to include new drainage infrastructure in the car park of the Sun Inn.
4.5 If this work is required, then it will be completed by September 2024 at the latest to ensure it is completed before the requirement for general winter maintenance and griƫng begins.
5.0 Drainage feature east of the accident locaƟon
5.1 On the north side of the road there is a stone feature which collects run – off from the land behind it and feeds it into a culvert which again runs under the carriageway to ouƞall into the canal. This is shown as LocaƟon C on the plan at Appendix 2.
5.2 The stone feature referred to is historical. It was idenƟfied that ongoing use of the private land behind the feature by livestock had altered the layout/surface of the land. This in turn impacted on the flow of water off the land into the feature so that it was not collecƟng all the flow of water from the land. This has been recƟfied. Debris had also collected in the stone feature, and this has been cleared. Whilst it is impossible to eliminate the risk of water
run-off onto the highway, these remedial measures have been effecƟve in improving drainage at the locaƟon and they are measures that will be retained and conƟnued by the Council.
5.3 The council has a list of criƟcal culverts which are known to require higher maintenance standards and this feature will now be added to it a monitored more closely.
6. Other maters
6.1 We have addressed above the specific concerns highlighted in the Report of HM Coroner. More generally, and in an effort to assist HM Coroner, the Council is able to provide further informaƟon in relaƟon to the A539 in this secƟon of its response.
6.2 The A539 is subject to a regular system of rouƟne inspecƟons in accordance with the Council’s policy for highway maintenance. RouƟne inspecƟons are carried out every three months.
6.3 The A539 forms part of the highway griƫng network in accordance with the Council’s Winter Maintenance Policy.
6.4 Following the extensive rainfall and disrupƟon caused by Storm Babet on 20th October 2023, the Council implemented a specific response acƟon of addressing the impact of the storm on drainage gullies and channels on the A539. This work has been completed with all gullies and channels being cleared.
6.5 As an addiƟonal safety measure, the Council has also erected warning signs on the A539 at both the Wenffrwd JuncƟon locaƟon and the Sun Inn locaƟon. These warning signs alert motorists to the possibility of the presence of water or ice.
7. Conclusion
7.1 Across any highway network, there will always be locaƟons where issues of water drainage arise, parƟcularly during Ɵmes of heavy or extended rainfall. There are mulƟple potenƟal reasons for this, to include the topography of the area.
7.2 The safety of the highway network for the public is of paramount important to the Council. I am saƟsfied that the specific concerns idenƟfied by HM Coroner have been carefully considered and reasonable and appropriate measures are in place to address them.
7.3 The Council is of course willing to assist HM Coroner with his inquiry in any way that it can.
Head of Highways and Environmental Services
08.03.24
Report Sections
Investigation and Inquest
On the 6th of December 2023 an investigation was commenced into the death of John Michael Thomas (DOB 4/5/94) who died on the 2nd of December 2023 following a road traffic collision on the A539 outside Llangollen. An inquest has been opened in relation to Mr Thomas’ death and has been adjourned to allow a Roads Policing Investigation to provide evidence concerning this death.
Circumstances of the Death
The death occurred when the deceased lost control of the motorcycle he was riding and collided with an oncoming vehicle, sustaining fatal injuries as a result.
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.