Roger Hamer
21 Aug 2017 · Coroner Peter Sigee · Manchester (North)
The coroner's concerns
1. pothole deterioration without documentation
“When he inspected the carriageway in January 2016 and February 2016 the highway inspector did not photograph, measure and/or record any details as to the condition of the carriageway where the Pothole developed despite it having started to deteriorate, wear and crack by October 2015. This prevented the Highway Authority from effectively assessing the rate of deterioration of this part of the carriageway which may have helped to inform it as to the need for earlier repair. Also, the lack of images”
2. missing paint markings around potholes
“The jury recorded its concern as to the lack of paint markings around the potholes which may have highlighted their presence to Mr [name redacted] thereby enabling him to avoid them”
3. absence of candour procedure for incident learning
“The Highway Authority does not have a procedure with a duty of candour for the effective investigation of, and learning lessons from, significant incidents comparable to those adopted by other public bodies (for example within the National Health Service)”
4. investigation threshold replacing repair requirement
“With regards to defects in the carriageway, the Highway Authority's current procedure for highway management has an intervention level of 40mm so that any defect which is found to be 40mm or greater is repaired. Under the New Procedure 40mm will be redefined as the "investigation level", so that once a carriageway defect is greater than 40mm a highway inspector will investigate it and consider whether a repair is needed. 2 If 40mm is specified in the New Procedure as the minimum threshold for investigation”