Concerns raised 1
Failure to provide pedestrian guardrails at a primary informal crossing location View source
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AI-generated summary
Charlotte Marie SAUNDERS · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Charlotte Marie Saunders was struck by a tipper lorry while crossing Christchurch Way in Stone, Staffordshire, on 27 August 2024, sustaining multiple injuries and a severe traumatic brain injury that resulted in prolonged disorder of consciousness and 24-hour care. She died on 13 January 2026; the principal concern was that the road layout, including gaps in pedestrian guardrails between a supermarket and the town centre, encouraged pedestrians to cross at an unsafe location near a busy bypass despite nearby controlled crossings.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Failure to provide pedestrian guardrails at a primary informal crossing location
Wider context from the report “I have concern that there is a risk of future deaths as a result of the current layout of this location, given the following:
1. The ring road is a busy road with heavy, consistent traffic flow, this being a bypass around the town centre
2. There is a busy supermarket with a large car park on one side of the ring road and the town centre on the other
3. There is a purpose-built pedestrian walkway leading to the pavement on the outer side of the carriageway and an alleyway leading directly into the town centre on the other side
4. There are no pedestrian guardrails either side of the carriageway at what appears to be a primary location used by people for their speed and convenience, to avoid the need to walk further to use the pedestrian crossings
” Source location Charlotte Marie SAUNDERS · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Extend the Stone active-travel and structural-maintenance study area to include the Christchurch Way pedestrian desire-line crossing location.
Verbatim wording from the response “Notwithstanding the above, the County Council has a scheme in this year’s capital programme to consider active travel and structural maintenance at a number of locations in Stone; and, following receipt of the Prevention of Future Deaths Report, the study area has been extended” Source location Response from Staffordshire County Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Assess national pedestrian-guardrail guidance and alternative measures to encourage safer pedestrian crossing routes at the Christchurch Way location.
Verbatim wording from the response “to include the Christchurch Way pedestrian desire line crossing location. The study will consider the current national guidance on pedestrian guardrails and whether alternative measures or interventions may be appropriate to encourage safer pedestrian crossing routes at this location.” Source location Response from Staffordshire County Council
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Additional pedestrian guardrails cannot be adopted straightforwardly because they may obstruct vehicle visibility or redirect pedestrians into the carriageway.
Verbatim wording from the response “The provision of additional pedestrian guardrail, to encourage pedestrians to use the formal crossing points, has been considered. However, initial observations have identified that the addition of pedestrian guard rail on the southern side of the carriageway may impede visibility for vehicles exiting the private business vehicle access; and the addition of pedestrian guardrail on the northern side of the carriageway may encourage pedestrians to enter the carriageway at either the bus stop or private driveway access that is situated approximately 47 metres away.” Source location Response from Staffordshire County Council
Open published response
Concerns raised 2
Failure to provide adequate warning signage for pedestrians crossing near the car park View source Lack of assistance for pedestrians crossing the road View source
Linked responses
Nottinghamshire County Council Via East Midlands
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 4
Nottinghamshire County Council and Via East Midlands
Install two pedestrian warning signs on approaches to HMP Ranby alongside existing slow-warning signs.
View source
Nottinghamshire County Council and Via East Midlands
Implement monitoring and verification of highway safety measures commissioned following collision investigations.
View source
Nottinghamshire County Council and Via East Midlands
Complete pedestrian-movement, road-safety and feasibility investigations identifying a preferred location for a signal-controlled puffin crossing.
View source
Nottinghamshire County Council and Via East Midlands
Progress detailed design, statutory consultation, approvals, procurement and construction of a signal-controlled pedestrian crossing adjacent to the prison overflow car park.
View source See 1 more action
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AI-generated summary
Phillip Tetley · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Phillip Tetley died on 1 December 2025 after being struck by vehicles while crossing the A620 Straight Mile in Ranby. The report raised concerns about the lack of provision to assist people crossing the road, the increased use of the overflow carpark, and incomplete warning signage that might leave drivers unaware of the risks.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Failure to provide adequate warning signage for pedestrians crossing near the car park
Wider context from the report “The court heard evidence that the possibility of a crossing is being considered by the council. The overflow carpark to the south of the A620 has been increased in size and there is an increase in the number of people crossing the road to get to the prison estate. Many of those crossing expressed concern about crossing the road safely. The court is concerned that if nothing is done to assist those crossing the road there is a risk of future deaths.
The court also received initial evidence from VIA in the form of a written statement that warning signs had been installed on the approach to the carpark, but then heard evidence that only “SLOW” signage had been installed, and planned “PEDESTRIANS IN THE ROAD/CROSSING” signage had not . As a result, drivers may be unaware of the risks posed at the car park location .
” Source location Phillip Tetley · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of assistance for pedestrians crossing the road
Wider context from the report “The court heard evidence that the possibility of a crossing is being considered by the council. The overflow carpark to the south of the A620 has been increased in size and there is an increase in the number of people crossing the road to get to the prison estate. Many of those crossing expressed concern about crossing the road safely. The court is concerned that if nothing is done to assist those crossing the road there is a risk of future deaths.
The court also received initial evidence from VIA in the form of a written statement that warning signs had been installed on the approach to the carpark, but then heard evidence that only “SLOW” signage had been installed, and planned “PEDESTRIANS IN THE ROAD/CROSSING” signage had not. As a result, drivers may be unaware of the risks posed at the car park location.
” Source location Phillip Tetley · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Install two pedestrian warning signs on approaches to HMP Ranby alongside existing slow-warning signs.
Verbatim wording from the response “Following notification of the fatal collision by Nottinghamshire Police on 3 December 2025, Via East Midlands commissioned the installation of temporary warning signage consisting of both "SLOW" signs and "Pedestrians in Road" warning signs on the approaches to HMP Ranby.” Source location Response from Nottingham County Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement monitoring and verification of highway safety measures commissioned following collision investigations.
Verbatim wording from the response “The Council and Via East Midlands acknowledge that the intended signage should have been installed earlier and regret that this did not occur. The matter has been reviewed internally and steps have been taken to ensure that highway safety measures commissioned in response to collision investigations are appropriately monitored and verified following instruction and implementation.” Source location Response from Nottingham County Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Complete pedestrian-movement, road-safety and feasibility investigations identifying a preferred location for a signal-controlled puffin crossing.
Verbatim wording from the response “Following the fatal collision on 1 December 2025, Nottinghamshire County Council commissioned a review of pedestrian movements and road safety conditions on the A620 Straight Mile adjacent to HMP Ranby.” Source location Response from Nottingham County Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Progress detailed design, statutory consultation, approvals, procurement and construction of a signal-controlled pedestrian crossing adjacent to the prison overflow car park.
Verbatim wording from the response “As a result, the Council has instructed Via East Midlands to progress the detailed design and delivery of a signal-controlled pedestrian crossing at this location. The current anticipated programme is as follows:” Source location Response from Nottingham County Council
Open published response
28 Nov 2025 Gurkirat Singh · Prevention of Future Deaths report Black Country
View report summary
Concerns raised 1
Lack of pedestrian crossings on the High Street View source
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 1
Sandwell Borough Council
Pursue introduction of a zebra crossing near the shop and café at High Street’s north-eastern end, subject to statutory consultation.
View source
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AI-generated summary
Gurkirat Singh · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Gurkirat Singh, a child, died after being struck by a single-decker bus on High Street, Tipton, on 6 December 2024. The report raises concerns about repeated incidents on the road, the absence of pedestrian crossings and central road markings, poor street lighting, and visibility being obscured by parked vehicles and building-line shadows.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of pedestrian crossings on the High Street
Wider context from the report “2. My concern is that in the last five years there have been six incidents including this fatality on this stretch of road and within half a mile approaching the roundabout. Evidence at the inquest emerged indicating there are no pedestrian crossings on this stretch of the High Street and visibility to drivers is obscured due to vehicles parked on either side.
3. In addition, there are no central road markings with poor street lighting resulting in the building line creating shadows on the footpath, which all add to the lack of visibility for drivers.
” Source location Gurkirat Singh · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Pursue introduction of a zebra crossing near the shop and café at High Street’s north-eastern end, subject to statutory consultation.
Verbatim wording from the response “In addition, it is proposed to pursue the introduction of a new zebra crossing in the vicinity of the shop and café at the north-eastern end of High Street. This proposal will be subject to statutory public consultation, as the installation of a crossing would require the displacement of some residential and business parking.” Source location Response from Sandwell Metropolitan Borough Council
Open published response
9 Jan 2025 Anthony John PAINE · Prevention of Future Deaths report Oxfordshire
View report summary
Concerns raised 1
Obscured visibility of the pedestrian crossing for approaching vehicles View source
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
No linked response statements No respondent-stated action or position is linked to these concerns in the published data.
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AI-generated summary
Anthony John PAINE · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Anthony Paine died at the scene after being struck by a car while crossing the A361 in Banbury on 24 March 2023. Concerns were expressed that the 30 mph speed limit may be too high for the road’s characteristics and pedestrian volume, and that a slower vehicle speed might have allowed more time to react or reduced the severity of the impact.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Obscured visibility of the pedestrian crossing for approaching vehicles
Wider context from the report “The speed limit on the A361 North Bar Street at the location of the collision is 30 mph. There was a concern expressed at the Inquest that this speed limit may be too high, given the characteristics of the road and the volume of pedestrian traffic in the area.
The A361 at this location is a long, straight, single carriageway with one lane in each direction. Travelling southbound, the pedestrian crossing is approached from a gradual rise in the road from Banbury Cross Roundabout, some 150 meters away. There is in the road obscures the view of the pedestrian crossing to approaching vehicles.
There are a number of pubs and restaurants on both sides of the road and a number of pedestrians in the area late into the evening.
The Forensic Collision Investigator concluded that in the short window of time in which Mr. Paine was likely visible to the driver, they failed to see him. The Investigator’s evidence was that even if the driver had seen Mr. Paine, there would have been insufficient time to react and avoid the collision. However, the Investigator’s evidence also stated that if the vehicle had been traveling at a slower speed, this may have provided the driver with sufficient time to react and either avoid the collision or reduce the severity of the impact.
In the opinion of the Forensic Collision Investigator, the speed of the driver’s vehicle was 32.6 mph ± 3.6 mph and was a contributing factor to the severity of the collision and that, as a general point, the slower the vehicle is travelling the less severe the effects of any impact.
It was further noted that other nearby town/city centres (eg Oxford) have introduced 20 mph speed limits on roads in the city centre.
” Source location Anthony John PAINE · Prevention of Future Deaths report
Open source report
5 Dec 2024 William Albert Nairn Lardner · Prevention of Future Deaths report Dorset
View report summary
Concerns raised 1
Lack of pedestrian pathway and crossing facility at Parley Lane Parking View source
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Bournemouth Airport Bournemouth, Christchurch and Poole Council
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 6
Bournemouth, Christchurch and Poole Council
Complete the review of the Parley Lane speed limit.
View source
Bournemouth, Christchurch and Poole Council
Consult on reducing the Parley Lane speed limit from 60 to 40 mph.
View source
Bournemouth, Christchurch and Poole Council
Implement the 40 mph Parley Lane speed limit by July 2025.
View source
Bournemouth, Christchurch and Poole Council
Assess the location for a vehicle-activated sign after the speed limit is reduced to 40 mph.
View source
Bournemouth, Christchurch and Poole Council
Re-check the operation of pedestrian crossing facilities at the Hurn Court Lane and Parley Lane junction.
View source
Bournemouth Airport
Make representations to BCP about safety arrangements for Parley Lane, its junction and the Adventure Wonderland car park.
View source See 3 more actions
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AI-generated summary
William Albert Nairn Lardner · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
On 30 June 2023, 16-year-old William Albert Nairn Lardner was struck by a vehicle that went through a red light while he was crossing Parley Lane near Bournemouth Airport, sustaining traumatic injuries that led to his death. The report raises concerns about unsafe pedestrian access around the airport, including the absence of footpaths and crossing facilities, limited public transport, and safety issues identified after the death that remained unaddressed.
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× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of pedestrian pathway and crossing facility at Parley Lane Parking
Wider context from the report “(4) Many people access the airport on foot, either being dropped off and/or picked up on Parley Lane where there is no layby or drop off zone or by using nearby car parks and walking on foot to the airport. One such car park is at the Adventure Wonderland site and is known as Parley Lane Parking (Parley Lane Parking | Bournemouth Airport Parking). This is 0.9 miles from the airport, on the opposite side of Parley Lane which offers cheaper rates than Bournemouth Airport to park. There is no pathway on the side of the road at Parley Lane Parking and no crossing facility, so people will either walk along the road or have to cross the road to access the footpath. Please see attached photograph at JGL/5.
(5) Parley Lane is a busy single carriageway semi-rural road with a national speed limit and BCP Council has responsibility for the road as the local highway authority. Hurn Court Lane is owned by the airport who therefore have responsibility for it. There is no public footpath along Hurn Court Lane after turning off Parley Lane to access the airport. Please see attached photograph at JGL/4. This results in pedestrians walking in the road or on the grass section next to the road on Hurn Court Lane to get to the airport terminal. This is dangerous as it is not a stable, safe public pathway and could lead to people falling into the road or being struck by vehicles, especially as people pull suitcases along. The airport has erected signs stating these is no pedestrian access, however, these are widely ignored.
(6) A site visit and assessment in July 2023 by Dorset Police Road Casualty Reduction Officer and the Senior BCP Council Safety Officer following Billy’s death highlighted some fundamental safety issues. At this time no action has been taken around these safety issues, although matters have been discussed. Accordingly, the safety issues remain the same 17 months on from the site assessment, with a likely increasing number of passengers using the airport going forward.
(7) I, therefore, have concerns that there could be future deaths given the manner in which users are accessing the airport and the lack of public transport and pedestrian access available.
” Source location William Albert Nairn Lardner · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Complete the review of the Parley Lane speed limit.
Verbatim wording from the response “The other two actions were to review the speed limit on Parley Lane including assessing the location for a vehicle activated sign and to check the operation of the pedestrian facilities on the crossing facilities at the junction of Hurn Court Lane and Parley Lane.” Source location Response from BCP Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Consult on reducing the Parley Lane speed limit from 60 to 40 mph.
Verbatim wording from the response “The speed limit review has been completed and the reduction of the speed limit from 60 to 40mph is currently being consulted upon. The intent is to have implemented the 40mph speed limit by July 2025. An assessment for a vehicle activated sign shall follow when the speed limit has been reduced to 40mph.” Source location Response from BCP Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement the 40 mph Parley Lane speed limit by July 2025.
Verbatim wording from the response “The speed limit review has been completed and the reduction of the speed limit from 60 to 40mph is currently being consulted upon. The intent is to have implemented the 40mph speed limit by July 2025. An assessment for a vehicle activated sign shall follow when the speed limit has been reduced to 40mph.” Source location Response from BCP Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Assess the location for a vehicle-activated sign after the speed limit is reduced to 40 mph.
Verbatim wording from the response “The other two actions were to review the speed limit on Parley Lane including assessing the location for a vehicle activated sign and to check the operation of the pedestrian facilities on the crossing facilities at the junction of Hurn Court Lane and Parley Lane.” Source location Response from BCP Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Re-check the operation of pedestrian crossing facilities at the Hurn Court Lane and Parley Lane junction.
Verbatim wording from the response “The other two actions were to review the speed limit on Parley Lane including assessing the location for a vehicle activated sign and to check the operation of the pedestrian facilities on the crossing facilities at the junction of Hurn Court Lane and Parley Lane.” Source location Response from BCP Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Make representations to BCP about safety arrangements for Parley Lane, its junction and the Adventure Wonderland car park.
Verbatim wording from the response “2. Parley Lane/ Adventure Wonderland: BOH has no control over Parley Lane, Parley Lane Junction, or the Adventure Wonderland Parley Lane Car Park. BOH cannot take any action in respect of these areas and can, therefore, only make representations to BCP about what should happen, which it has done. Following the meetings with BCP, it is understood that (i) BCP are intending to reduce the 60mph speed limit to 40mph on Parley Lane which is currently subject to consultation; (ii) BCP have refused a retrospective planning application associated with the Adventure Wonderland Parley Lane Car Park operation; and (iii) BCP have checked the controlled crossing operation.” Source location Response from Bournemouth Airport
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The airport cannot act on Parley Lane, its junction, or the Adventure Wonderland car park because it controls none of those areas.
Verbatim wording from the response “2. Parley Lane/ Adventure Wonderland: BOH has no control over Parley Lane, Parley Lane Junction, or the Adventure Wonderland Parley Lane Car Park. BOH cannot take any action in respect of these areas and can, therefore, only make representations to BCP about what should happen, which it has done. Following the meetings with BCP, it is understood that (i) BCP are intending to reduce the 60mph speed limit to 40mph on Parley Lane which is currently subject to consultation; (ii) BCP have refused a retrospective planning application associated with the Adventure Wonderland Parley Lane Car Park operation; and (iii) BCP have checked the controlled crossing operation.” Source location Response from Bournemouth Airport
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation BCP Council and the Highways Agency are responsible for Parley Lane, rather than the airport.
Verbatim wording from the response “Second, the accident did not occur on land owned or controlled by BOH. The accident occurred on Parley Lane which is the main public highway outside of BOH. BOH does not own and has no responsibility for Parley Lane. Bournemouth, Christchurch and Poole Council ("BCP") and the Highways Agency are responsible for Parley Lane.” Source location Response from Bournemouth Airport
Open published response
5 Nov 2024 Terence William Gillard · Prevention of Future Deaths report West London
View report summary
Concerns raised 2
Lack of certainty that the pedestrian crossing safety redesign will be implemented View source Absence of effective pedestrian crossing controls at Jersey Road View source
Linked responses
Department for Transport London Borough of Hounslow Transport for London
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 6
London Borough of Hounslow
Continue working with TfL and stakeholders to secure priority implementation of the proposed pedestrian and cyclist crossing safety measures.
View source
Transport for London
Develop a formal signalised crossing scheme across the A4 and both sections of Jersey Road, with associated highway-layout amendments.
View source
London Borough of Hounslow
Conduct discussions and site meetings with TfL to improve A4 traffic conditions for vulnerable road users.
View source
London Borough of Hounslow
Consult on TfL’s proposed crossing designs and ensure they are technically sound and aligned with local users’ needs.
View source
London Borough of Hounslow
Work with TfL to facilitate interim temporary pedestrian warning signs at the crossing location.
View source
Transport for London
Review nearby pedestrian and vehicle collisions using historic collision data to identify additional collision-risk reductions.
View source See 3 more actions
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action. 6
Department for Transport
The Department does not oversee or consent to TfL’s traffic schemes, including this pedestrian crossing.
Outside remitThe respondent said that this matter was outside its role or authority. View source
Department for Transport
TfL and the London Borough of Hounslow are responsible for implementing the crossing redesign, subject to funding and public consultation.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action. View source
Department for Transport
TfL and the Mayor of London decide, prioritise and approve investment funding for the pedestrian crossing redesign.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action. View source
Transport for London
DfT consent is not required, and LBH consent is needed only for minor works on its road network.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it. View source
Transport for London
Earlier implementation is constrained by required design, modelling, consultation, governance, contractor mobilisation and funding steps.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action. View source
London Borough of Hounslow
TfL is responsible for safety, maintenance, signs and signals on the A4, while the borough’s highway authority role is limited to Jersey Road.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action. View source See 5 more positions
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AI-generated summary
Terence William Gillard · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Terence William Gillard was struck by a moving vehicle while crossing the A4 Great West Road at an uncontrolled pedestrian crossing on 11 September 2022. He suffered brain and multiple traumatic injuries and died in hospital on 18 September 2022 from a pulmonary embolism. The concern was that the crossing had no pedestrian traffic lights, demand button or sound signals, and that there was no certainty that proposed safety redesigns would be implemented.
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× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of certainty that the pedestrian crossing safety redesign will be implemented
Wider context from the report “The A4 Great West Road is a major route for vehicles of all types travelling in and out of west London. The crossing area, where Mr Gillard collided with the moving vehicle on 11 September 2022, is a designated uncontrolled crossing area across Jersey Road. There are no pedestrian traffic lights, no demand button, no sound signals. This pedestrian crossing area spans across a dual carriageway subject to a speed limit of 40mph. It has three lanes in both directions, separated by a raised central kerb. This crossing point also leads pedestrians into the cycling lane.
I understand that at no point during the normal use of the traffic light controlled junction does traffic cease to flow at the marked crossing area, making it difficult for pedestrian to judge when and from where the next vehicle would approach. This means that pedestrians will need to use their own judgment as to when it is safe to cross this road without the aid of pedestrian traffic lights.
I received evidence that there have been other accidents involving pedestrians and moving vehicles at this pedestrian crossing in the past.
I received evidence from the TFL of existing plans to re-design this pedestrian crossing to improve pedestrian safety. However, their implementation may not take place before the end of 2026 and it remains subject to the consent of the DFT and LBH, the outcome of any public consultation as well as funding considerations.
I am concerned that there appears to be no certainty that the redesign plans for the pedestrian crossing in question will be implemented .
I understand that the TFL, LBH and DFT are the organisations with the power to take the necessary actions to improve pedestrian safety at this junction.
” Source location Terence William Gillard · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Absence of effective pedestrian crossing controls at Jersey Road
Wider context from the report “The A4 Great West Road is a major route for vehicles of all types travelling in and out of west London. The crossing area, where Mr Gillard collided with the moving vehicle on 11 September 2022, is a designated uncontrolled crossing area across Jersey Road. There are no pedestrian traffic lights, no demand button, no sound signals. This pedestrian crossing area spans across a dual carriageway subject to a speed limit of 40mph. It has three lanes in both directions, separated by a raised central kerb. This crossing point also leads pedestrians into the cycling lane.
I understand that at no point during the normal use of the traffic light controlled junction does traffic cease to flow at the marked crossing area , making it difficult for pedestrian to judge when and from where the next vehicle would approach. This means that pedestrians will need to use their own judgment as to when it is safe to cross this road without the aid of pedestrian traffic lights .
I received evidence that there have been other accidents involving pedestrians and moving vehicles at this pedestrian crossing in the past.
I received evidence from the TFL of existing plans to re-design this pedestrian crossing to improve pedestrian safety. However, their implementation may not take place before the end of 2026 and it remains subject to the consent of the DFT and LBH, the outcome of any public consultation as well as funding considerations.
I am concerned that there appears to be no certainty that the redesign plans for the pedestrian crossing in question will be implemented.
I understand that the TFL, LBH and DFT are the organisations with the power to take the necessary actions to improve pedestrian safety at this junction.
” Source location Terence William Gillard · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue working with TfL and stakeholders to secure priority implementation of the proposed pedestrian and cyclist crossing safety measures.
Verbatim wording from the response “- a signal-controlled crossing for pedestrian and cyclists across the A4,” Source location Response from London Borough of Hounslow
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop a formal signalised crossing scheme across the A4 and both sections of Jersey Road, with associated highway-layout amendments.
Verbatim wording from the response “As previously advised at the inquest, we are developing a formal crossing proposal at this location. The proposals are as follows:” Source location Response from Transport for London
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct discussions and site meetings with TfL to improve A4 traffic conditions for vulnerable road users.
Verbatim wording from the response “Following the incident, we have had a number of discussions and site meetings with TfL to improve traffic conditions in the A4 especially for the vulnerable road users. We understand that TfL has undertaken a detailed study of the collision data in the area and is now reviewing the junction with a view to provide a formal pedestrian crossing facility at this location.” Source location Response from London Borough of Hounslow
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Consult on TfL’s proposed crossing designs and ensure they are technically sound and aligned with local users’ needs.
Verbatim wording from the response “The proposals being considered are amending the existing design to accommodate improvements as follows.” Source location Response from London Borough of Hounslow
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with TfL to facilitate interim temporary pedestrian warning signs at the crossing location.
Verbatim wording from the response “We are also working with TfL to facilitate some interim temporary measures such as additional signs to warn pedestrians to take care when crossing the road at this location.” Source location Response from London Borough of Hounslow
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review nearby pedestrian and vehicle collisions using historic collision data to identify additional collision-risk reductions.
Verbatim wording from the response “d. With regards to other collisions involving pedestrians and moving vehicles, we have undertaken a thorough review of the nearby collisions based on the historic collision data and will consider any other changes to the highway layout which may reduce collision risk in addition to changes to the crossing itself. For example, we are also proposing changes to the service road next to the crossing to make it easier for pedestrians and cyclists to access the crossing.” Source location Response from Transport for London
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The Department does not oversee or consent to TfL’s traffic schemes, including this pedestrian crossing.
Verbatim wording from the response “The highway authority, in this case Transport for London (TfL), is responsible for how traffic is managed on its roads. This includes the design and maintenance of traffic light junctions and any associated pedestrian crossings. While the Department for Transport issues guidance to highway authorities, the Department does not oversee or consent to traffic schemes of this nature.” Source location Response from Department for Transport
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation TfL and the London Borough of Hounslow are responsible for implementing the crossing redesign, subject to funding and public consultation.
Verbatim wording from the response “I am not aware of any consents required from the Department to enable TfL to make changes to this site. I understand my officials have been in contact with TfL and it has confirmed that the new crossing designs are in TfL and the Borough's gift to implement, subject to funding and public consultation, and no DfT involvement is required.” Source location Response from Department for Transport
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation TfL and the Mayor of London decide, prioritise and approve investment funding for the pedestrian crossing redesign.
Verbatim wording from the response “On the issue of funding, the Government engages regularly with TfL to understand its investment plans and funding requirements. The Government announced £250 million capital funding in December 2023, and a further £485 million for the coming 2025/26 financial year at the Budget, for TfL’s major capital projects. This is in addition to almost £2.2 billion of business rates for transport retained by TfL in 2024/25. The Mayor of London and TfL consider, prioritise and approve its investment decisions. The re-design of the pedestrian crossing would be funded by TfL from revenue sources outside the Department’s funding.” Source location Response from Department for Transport
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation DfT consent is not required, and LBH consent is needed only for minor works on its road network.
Verbatim wording from the response “e. Finally, I turn to your concern that the implementation of TfL’s plans to redesign the pedestrian crossing will not be until 2026 and it remains subject to the consent of the DfT and LBH, the outcome of any public consultation as well as funding considerations. I explain above the steps which must be undertaken, and the timings involved with delivering appropriate and safe improvement works. In relation to consent from LBH, this is only necessary in relation to any minor works on their road network that may be required to facilitate delivery of the wider scheme. In addition, there is no requirement for consent or approvals to be obtained from the DfT.” Source location Response from Transport for London
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Earlier implementation is constrained by required design, modelling, consultation, governance, contractor mobilisation and funding steps.
Verbatim wording from the response “As my colleague ████████ advised during the inquest, it is likely that delivery of the scheme will take place in 2026, to enable time for the completion of traffic modelling, public engagement, concept and detailed design and contractor mobilisation (including relocating any utility services that are required to be moved by statutory undertakers as part of scheme delivery).” Source location Response from Transport for London
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation TfL is responsible for safety, maintenance, signs and signals on the A4, while the borough’s highway authority role is limited to Jersey Road.
Verbatim wording from the response “The incident took place on A4 which is part of the Transport for London Road Network (TLRN) and TfL is the Highways and Traffic Authority for roads that falls under this network. Similarly, TfL is responsible for road maintenance, traffic signs, traffic signals and road safety of TLRN. LBH is the Highway Authority for Jersey Road which forms a junction with the A4.” Source location Response from London Borough of Hounslow
Open published response
Concerns raised 2
Lack of warning to drivers about pedestrians crossing View source Lack of provision allowing pedestrians to cross the road safely View source
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
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AI-generated summary
Brogen-Lea · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Brogen-Lea, a schoolgirl, was struck by a car while walking home after emerging from a footpath onto the A460 Eastern Way in Cannock on 29 November 2022, and later died from her injuries. The concern was that the busy road and footpath lacked warnings for drivers and pedestrians, measures to prevent pedestrians entering the road, and a safe crossing facility.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of warning to drivers about pedestrians crossing
Wider context from the report “The track along which Brogen-Lea walked is well-used and is bisected by a busy road with traffic travelling at speed.
The road concerned is the A460 Eastern Way, Cannock and the footpath runs through the wooded area of Mill Hayes and Hawkes Green Nature Reserve.
I am concerned that there is nothing to:
1. Warn drivers about the prospect of pedestrians crossing
2. Warn pedestrians about the road ahead
3. Prevent pedestrians walking into the road
4. Allow pedestrians safely to cross the road
” Source location Brogen-Lea · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of provision allowing pedestrians to cross the road safely
Wider context from the report “The track along which Brogen-Lea walked is well-used and is bisected by a busy road with traffic travelling at speed.
The road concerned is the A460 Eastern Way, Cannock and the footpath runs through the wooded area of Mill Hayes and Hawkes Green Nature Reserve.
I am concerned that there is nothing to:
1. Warn drivers about the prospect of pedestrians crossing
2. Warn pedestrians about the road ahead
3. Prevent pedestrians walking into the road
4. Allow pedestrians safely to cross the road
” Source location Brogen-Lea · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue evaluating pedestrian-safety measures at Eastern Way, including vegetation clearance, warning signs and markings, a gate or barrier, and a possible speed-limit reduction.
Verbatim wording from the response “Current consideration is being given to a number of actions that may mitigate further pedestrian incidents from occurring at this location:” Source location Response from Staffordshire County Council
Open published response
26 Jan 2024 PAUL ANDREW FREAR · Prevention of Future Deaths report Black Country
View report summary
Concerns raised 1
Lack of clear and visible pedestrian crossing indications at the junction View source
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 1
Sandwell Borough Council
Commission an independent road safety audit of the proposed pedestrian markings and traffic signal relocation works.
View source
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AI-generated summary
PAUL ANDREW FREAR · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Paul Andrew Frear died at Queen Elizabeth Hospital, Birmingham, from injuries sustained when he entered the carriageway at a pedestrian crossing during a red pedestrian signal and collided with a vehicle. The report raises concern that the junction layout and pedestrian signals were confusing, particularly because indications were positioned only to the pedestrian’s left and were not visible on the opposite side, creating a risk of further deaths.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of clear and visible pedestrian crossing indications at the junction
Wider context from the report “5. My concern is that the design of this junction means that it is not obvious to a pedestrian that the only place to look for indications as to whether it is safe to cross the road is to their left . There are no such indicators on the opposite side of the carriageway which is ordinarily where a pedestrian would be looking . The signals were situated immediately to the left of where Mr Frear was stood/where any pedestrian would be standing.
6. Within the police report the collision investigator (who visited the scene) states as follows; I do however find the layout very confusing with the right turn filter lane (lane 3) not being separated from the main carriageway a pedestrian is faced with stationary traffic. If a pedestrian chose to look up to their right they would be presented with a red traffic light and the only indication that it is still not safe to cross is the pedestrian controls to their immediate left. The green light for lanes 1 and 2 is not visible to pedestrians and there is no pedestrian light indication on the opposite side .’ I share this concern.
7. Coroner understands from the police that there were two previous incidents at this location which occurred prior to the changes resulting in the current road layout. Coroner also understands Sandwell Highways have completed safety reviews and processes throughout the design, implementation and post installation of the junction design.
8. Whilst the current road layout may be legal, the death of Mr Frear highlights the safety issue for pedestrians present at this junction crossing from BOTH sides and highlights that the signage for pedestrians in not clear enough and there is a risk of further deaths now and in the future.
” Source location PAUL ANDREW FREAR · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Commission an independent road safety audit of the proposed pedestrian markings and traffic signal relocation works.
Verbatim wording from the response “Therefore, as an additional reminder to pedestrians, the Council intends to introduce ‘Look Left’ or ‘Look Right’ road markings in appropriate places and to relocate two of the existing traffic signal heads.” Source location Response from Sandwell Council
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The current layout meets all applicable design standards, notwithstanding the planned additional pedestrian safety measures.
Verbatim wording from the response “Although the current layout meets all current design standards, the Council is keen to do all it can to prevent any future incidents occurring.” Source location Response from Sandwell Council
Open published response
8 Jan 2024 Walter FAULDER · Prevention of Future Deaths report Cumbria
View report summary
Concerns raised 1
Risk of further accidents at a busy pedestrian crossing View source
Linked response
Monmouthshire County Council
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AI-generated summary
Walter FAULDER · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Walter Faulder, aged 88, was struck by a vehicle while crossing the A595 at Orton Grange on 13 December 2022 and was pronounced deceased at the scene. Concerns included his apparent misunderstanding of the crossing arrangements and the safety of the busy crossing point, particularly for schoolchildren and older people, with a concern that further accidents and fatalities could occur without safety alterations.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Risk of further accidents at a busy pedestrian crossing
Wider context from the report “(1) Walter seems to have believed that as a pedestrian he had right of way, he may have been a bit confused having forgotten his wallet however the day before the collision be referred to the illuminated pole in the central refuge as a Belisha Beacon.
(2) I heard that this is a busy crossing point, schoolchildren cross morning and evening for busses too and from school. There are also an increasing number of older people living in nearby developments.
(3) I am concerned that without safety alterations further accidents and possible fatalities may occur. Is there a case for lights to be installed?
” Source location Walter FAULDER · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The matter falls outside National Highways’ authority because it is not the highway authority for the A595 at Orton Grange.
Verbatim wording from the response “I am writing to inform you that National Highways is not the highway authority for the A595 at Orton Grange and is therefore not the appropriate authority to respond to the Regulation 28 report. The highway authority for the A595 at the location identified is the responsibility of Cumberland Council.” Source location Response from National Highways
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Responsibility for the A595 at the identified location rests with Cumberland Council, which should respond to the report.
Verbatim wording from the response “I am writing to inform you that National Highways is not the highway authority for the A595 at Orton Grange and is therefore not the appropriate authority to respond to the Regulation 28 report. The highway authority for the A595 at the location identified is the responsibility of Cumberland Council.” Source location Response from National Highways
Open published response
Concerns raised 3
Failure to restrict pedestrian access to the carriageway View source Failure to provide signage prohibiting non-designated crossing or warning of crossing risks View source Inadequate provision of accessible designated pedestrian crossing points View source
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 2
Sunderland City Council
Complete a road safety review of the location and assess the suitability of existing pedestrian crossing points.
View source
Sunderland City Council
Install signs on both sides of Doxford Parkway directing pedestrians to nearby crossing points.
View source
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AI-generated summary
Jean HARDY · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Jean Hardy, aged 71, crossed the B1286 Doxford Parkway at night at a point without a designated pedestrian crossing and was struck by a motor vehicle. She sustained multiple injuries and died in hospital on 8 February 2020. Concerns included common local crossing at non-designated points, lack of fencing and warning signage, and a risk of further deaths requiring a comprehensive review of pedestrian crossing provision.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Failure to restrict pedestrian access to the carriageway
Wider context from the report “(1) The B1286 Doxford Parkway is bordered by Multiple housing estates and the evidence confirmed that local practice of crossing at non designated crossing points which are more easily accessible and convenient is common and well known.
(2) Access to the carriageway is not restricted by fencing (save for limited fencing at designated crossing points) and there is no signage prohibiting crossing at non designated crossing points or warning of the risks to the public of doing so.
(3) There is a risk of further deaths occurring in this location and in similar circumstances. To prevent future deaths there should be a comprehensive review of current pedestrian crossing provision on B1286 Doxford Parkway.
” Source location Jean HARDY · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Failure to provide signage prohibiting non-designated crossing or warning of crossing risks
Wider context from the report “(1) The B1286 Doxford Parkway is bordered by Multiple housing estates and the evidence confirmed that local practice of crossing at non designated crossing points which are more easily accessible and convenient is common and well known.
(2) Access to the carriageway is not restricted by fencing (save for limited fencing at designated crossing points) and there is no signage prohibiting crossing at non designated crossing points or warning of the risks to the public of doing so .
(3) There is a risk of further deaths occurring in this location and in similar circumstances. To prevent future deaths there should be a comprehensive review of current pedestrian crossing provision on B1286 Doxford Parkway.
” Source location Jean HARDY · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Inadequate provision of accessible designated pedestrian crossing points
Wider context from the report “(1) The B1286 Doxford Parkway is bordered by Multiple housing estates and the evidence confirmed that local practice of crossing at non designated crossing points which are more easily accessible and convenient is common and well known .
(2) Access to the carriageway is not restricted by fencing (save for limited fencing at designated crossing points) and there is no signage prohibiting crossing at non designated crossing points or warning of the risks to the public of doing so.
(3) There is a risk of further deaths occurring in this location and in similar circumstances. To prevent future deaths there should be a comprehensive review of current pedestrian crossing provision on B1286 Doxford Parkway.
” Source location Jean HARDY · Prevention of Future Deaths report
Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Complete a road safety review of the location and assess the suitability of existing pedestrian crossing points.
Verbatim wording from the response “In response to your concerns and request for action, the Council has undertaken a road safety review of the location concerned; and has also investigated the suitability of the existing pedestrian crossing point locations on Doxford Park Way. The issues you have raised around provision of fencing within a central grassed reservation and signing has been considered. This was discussed on site, and the view of the Police is that this would encourage barrier hopping by more agile pedestrians and would not be supported by them.” Source location Response from Sunderland City Council
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Install signs on both sides of Doxford Parkway directing pedestrians to nearby crossing points.
Verbatim wording from the response “As an action, the Council are proposing to install signing on both sides of Doxford Parkway to direct pedestrians to nearby crossing points.” Source location Response from Sunderland City Council
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Additional fencing was not supported because it was considered likely to encourage barrier hopping by more agile pedestrians.
Verbatim wording from the response “In response to your concerns and request for action, the Council has undertaken a road safety review of the location concerned; and has also investigated the suitability of the existing pedestrian crossing point locations on Doxford Park Way. The issues you have raised around provision of fencing within a central grassed reservation and signing has been considered. This was discussed on site, and the view of the Police is that this would encourage barrier hopping by more agile pedestrians and would not be supported by them.” Source location Response from Sunderland City Council
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Existing footways and nearby pedestrian crossings were considered adequate provision at the collision location.
Verbatim wording from the response “It is unknown why Mrs Hardy chose to cross at the location where the collision occurred; however, it should be noted that there is an existing footway following the northern side of Doxford Park Way and appropriately located pedestrian crossing points nearby to this location. These are found at the roundabout junction with Moorside Road / Noirnmont Way approximately 120 metres to the west, and a controlled crossing approximately 180 metres to the east near Morrison’s and the local shopping centre.” Source location Response from Sunderland City Council
Open published response
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.