A 2018 tragedy in North Wales ~ Judicial Review ~ Unsuccessful challenge to Coroner's Court conclusion

Great Orme is a limestone headland on the North Wales coast between Llandudno and Conway. 

Great Orme rises to just 679 ft above sea level (207 metres) BUT steep edges (cliffs) are a significant risk as this short video shows - Exploring the climbing routes on the Great Orme, North Wales. Provided those places are avoided, Great Orme offers walking which is not too challenging or remote unlike places such as Tryfan (3009 ft), the Glyderau (several places over 3000ft) and Snowdon (3560 ft). 

Benjamin Leonard (age 16) was a member of The Scout Association and, over the weekend 25 to 27 August 2018, went with his Explorer Unit (ages 14 to 18) to North Wales. The adult leadership

comprised Mr Glaister (Explorer Scout Leader - age 54), Ms Carr (Assistant Explorer Scout Leader - age 26) and Mr Williams (Assistant Explorer Scout Leader - age 26).

On the day of arrival in North Wales, Ms Carr took all the Explorer Scouts on a 3-hour unplanned hike to Great Orme. Ben and two other scouts split off from the main group. On their descent, Ben was reportedly in some discomfort from a recent operation, He slipped from a cliff, suffered head injury, and died.

The death led to a Coroner's Court inquest conducted by David_Pojur (Assistant Coroner for N. Wales) who sat with a jury. On 22 February 2024, a Coroner's jury delivered a unanimous conclusion that Ben's death was unlawful killing.  That was duly recorded in the Record of Inquest.

The Coroner issued a Prevention of Future Deaths Report (dated 22 February 2024). The report is available via the Judiciary website Benjamin Leonard: Prevention of future deaths report - Courts and Tribunals Judiciary. The report contained 20 points including criticisms of the Explorer Scout Leaders and the Scout Association. (The Judiciary website also has links to various responses to the Coroner's report).

Mr Glaister brought a judicial review to challenge the Coroner's Court conclusion of Unlawful Killing. The judgment of Mr Justice Fordham is reported at 

Glaister & Anor, R (On the Application Of) v HM Assistant Coroner for North Wales (East and Central) [2025] EWHC 167 (Admin) (30 January 2025)

It was held that unlawful killing was a proper conclusion for the jury to reach where that conclusion is justified on the evidence. The jury was not deciding any question of criminal liability on the part of anyone, named or otherwise. In the same way, although elements of gross negligence manslaughter would be sufficient ingredients for civil liability, and although they are evaluated on the civil standard, the jury is not making a determination of any question of civil liability. This is so even though the Coroner directed the jury to apply elements of a crime or tort to an identifiable individual. The jury was performing its distinct statutory inquisitorial function of deciding how, when and where the deceased died.

The Scout Association's latest Policy, Organisation and Rules is at por-scouts-autumn-2024-pdf-no-markup-final.pdf and sets out how Scouting is structured, organised, led, managed and governed.   The link is to the 2024 Edition. The 2018 version applied at the time. 

The Association's response to the Coroner's prevention report is April 2024-0106 - Response from Scouts. This includes the commissioning of a Safe Scouting Fatal Accident Investigation into the circumstances relating to the incident. Such a "learning review" is required by the Association's policy document. The Coroner was critical that, as at 22 February 2024, the report was not in existence and "even the prospective panel members" had not been identified. According to the response from the Scouts, this was being actioned.

Adventure

Although it is not the concern of the courts, it seems worth noting that The Scout Association seeks to support young people in their personal development, empowering them to make a positive contribution to society. The association seeks to offer adventurous activities  in which risk is controlled and managed as far as is reasonably practicable. The leadership of scouting at local level is entirely voluntary and requires considerable commitment and time.

It is not clear to what extent, if any, a finding of unlawful killing, will deter suitable adults from offering their services to be leaders or prevent existing leaders undertaking adventurous activities. 

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As a general observation, it continues to be a remarkable fact that there is no statutory appeal process against Coroner decisions. The route to challenge the decisions of Coroners is the expensive process of judicial review in the High Court. This is a review of the way the decision was made, rather than the rights and wrongs of the conclusion reached - Concerns and complaints about coroners - Courts and Tribunals Judiciary

The Coroners and Justice Act 2009 contained provision for an appeal to the Chief Coroner but this was not implemented and was repealed by the Public Bodies Act 2011.

See the Explanatory Notes to the 2009 Act - Coroners and Justice Act 2009 - Explanatory Notes

Other

Great Orme - Wikipedia and Discover the Great Orme, North Wales - Wales Coast Path.