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Following a letter of concern under paragraph 37 of Chief Coroner’s Guidance No 5 (Preventing Future Deaths), Hertfordshire Police have now issued a formal apology to the family of Luke Hobson and announced changes to their investigation processes for sudden child deaths. Nicholas Moss KC represented Luke’s family at his inquest.
Luke (aged 14) died when he was accidentally struck by a player’s hockey stick during a training session at his local club.
A coroner’s investigation and inquest will not usually directly examine the sufficiency or otherwise of earlier investigations by other bodies. The inquest may nevertheless reveal that such investigations were slipshod or perfunctory. Coroners are often reluctant to address investigative failures by other bodies because they are rarely within the scope of the inquest, and post-death investigative failures by other bodies may not give rise to a risk of future fatalities and some come with the coroner’s PFD powers.
However, paragraph 37 of the Chief Coroner’s Guidance on Preventing Future Deaths permits coroners, exceptionally, to issue letters of concern to relevant organisations even if the concern does not relate to a risk of future fatalities. Following submissions at the end of Luke’s inquest, the Senior Coroner for Hertfordshire agreed to raise the family’s serious concerns about the shortcomings of Hertfordshire Police’s original investigation under the para. 37 provision. This led Hertfordshire Police formally to review their earlier investigation.
Following the conclusion of that review, the Chief Constable of Hertfordshire Police has now issued a statement which has candidly accepted the extent of their investigative shortcomings and the inappropriateness of their own press release following Luke’s inquest.
The Chief Constable stated,
“The evidence we presented to the inquest court was sub-standard and I am grateful that our shortcomings have been flagged as it gives us a chance to do things better in the future. It’s clear to me that we could and should have done a much more thorough job in investigating every aspect of the incident, not only for Luke’s sake but also for his heartbroken family too. I am truly sorry for what has happened and we are changing the way we investigate the sudden deaths of young people with immediate effect.”
“Furthermore, we perpetuated our mistakes by publishing a statement at conclusion of Luke’s inquest that knowing what we do now, brushed over our short comings and no doubt would have caused his family huge distress. This is the last thing we would ever have wanted to do and we are very sorry.”
“From now on, all investigations relating to the death of a child should have a senior investigating officer of the rank of detective inspector and any reports prepared for the coroner in relation to the death of a child should be reviewed by a senior officer prior to submission. There will also be measures put in place to ensure bereaved families get the updates and support they deserve. I hope Luke’s family and the coroner see our response as a sign of how seriously we have treated their concerns.”