Investigation and inquest
In May 2017 I commenced an investigation into the death of Mr David Worthington. The investigation concluded following an inquest in July/August 2018 where the narrative conclusion set out that:
Mr Worthington suffered fatal injuries whilst taking part in a Cycling Sportif event on the 30th April 2017. He had travelled down the lengthy descent of Finkle Street Lane at Wortley and, like other riders, was most probably travelling at about 30-35 mph. As he rounded a limited visibility bend he was confronted by a 12 metre coach turning right out of Plank Gate. The visibility was limited for both cyclist and coach driver. Mr Worthington braked hard and attempted to miss the vehicle but was unable to do so.
Circumstances of the death
See narrative conclusion above and the detailed findings of the inquest previously supplied. A copy of my decision document is attached for those who have not previously had sight of it.
The published report provides this section by reference to another part of the report.
Coroner’s concerns
a) The risk assessment prior to the event had not identified the particular location as a risk. In many ways this is understandable, Plank Gate is a minor junction.
b) However, more detailed consideration might be thought to show a different picture. There were 2900 cyclists progressing swiftly down a lengthy descent into a blind bend. The organisers efforts in putting a 'slow' sign part way down the descent were, on the evidence of witnesses, largely ignored.
c) Plank Gate is the entrance to a moderately busy riding school and hacking centre. Sunday morning is a common time for such activities.
d) Whilst the risk of a vehicle leaving Plank Gate across the path of fast-moving cyclists might reasonably have been considered low, the other element of a risk assessment is the likelihood of injury if such an event did occur. The risk of harm, as identified by this collision was extremely high.
e) It is accepted that the route of this prestigious and worthwhile event changes regularly so that Finkle Street lane is unlikely to be used again. Nonetheless, in my respectful submission there is room for a review of the risk assessment methods used for future events. As this incident shows, unlikely events can and do occur and where the risk of harm is high proper consideration is essential.