Barbara Henderson
PFD Report
All Responded
Ref: 2019-0180
All 1 response received
· Deadline: 24 Jul 2019
Coroner's Concerns (AI summary)
Road inspections conducted at speed failed to identify a critical drain problem, indicating an inadequate inspection process that needs urgent review.
View full coroner's concerns
The MATTERS OF CONCERNS are as follows: During the course of the evidence I heard how the roads are examined and monitored on a regular basis but that such inspections are conducted at speed and that the process failed to identify the problem with this particular drain on the A5. I believe that the process for inspection should be reviewed.
Responses
Action Planned
Highways England will issue a memorandum to all Areas highlighting the importance of inspection and defect rectification for recessed gullies. Area 8 will move to the new Asset Delivery approach on 1st October 2019. (AI summary)
Highways England will issue a memorandum to all Areas highlighting the importance of inspection and defect rectification for recessed gullies. Area 8 will move to the new Asset Delivery approach on 1st October 2019. (AI summary)
View full response
Dear Mr Osborne, Regulation 28 Report into the death of Susan HENDERSON and Margaret SHAW On behalf of of Highways England Company Limited, please find attached the Highways England response to the Regulation 28 Report dated 30 May 2019 following the deaths of Susan Henderson and Margaret Shaw. We will also post a hard copy to the Milton Keynes Coroner’s Office in Saxon Gate East, Milton Keynes.
Sent To
- Highways England
Response Status
Linked responses
1 of 1
56-Day Deadline
24 Jul 2019
All responses received
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Report Sections
Investigation and Inquest
On 3rd September 2018 I commenced an investigation into the deaths of Susan Barbara HENDERSON aged 36 years and Margaret Louise SHAW aged 53 years. The investigation concluded at the end of the inquest on 5th April 2019. The conclusion of the inquest was that the drivers had died from multiple injuries and part of the narrative conclusion was that: The standing water had accumulated due to blocked gullies on the side of the road that had not previously been identified on routine inspection.
Circumstances of the Death
Susan and Margaret died on the A5, Milton Keynes when one car aquaplaned across the road into the path of an oncoming vehicle. Both drivers died at the scene as a result of their injuries.
Similar PFD Reports
Reports sharing organisations, categories, or themes
Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.