That’s the conclusion of a major report by a working party of legal rights group JUSTICE, ‘When things go wrong: the response of the justice system’, published last week. It looks at the erosion of public confidence in the justice system’s response to major incidents causing multiple fatalities and makes 54 recommendations for change.
JUSTICE’s director, Andrea Coomber said: ‘Our work began before the pandemic, but the current coronavirus crisis reinforces the importance and timeliness of this project.’
One flaw that the 130-page report highlights is the lack of formal implementation and oversight following the end of an inquest or inquiry, which makes the likelihood of future prevention limited.
It proposes creating a Central Inquiries Unit within government, a full-time Chief Coroner and a special procedure inquest for investigating mass fatalities as well as single deaths linked by systemic failure. The special procedure inquest would have powers to consider closed material and make specific recommendations to prevent recurrence.
The working party, which spent a year on the report, calls in the report for greater collaborations between agencies, which would reduce the number of times that bereaved people and survivors are asked to recount traumatic events. It also wants a more structured process for appointing inquiry chairs and panels, setting terms of reference and providing information.
Chair of the working party, Sir Robert Owen, said: ‘A system cannot provide justice if its processes exacerbate the grief and trauma of its participants.
‘We think that this set of proposals, if implemented, will provide a cohesive and cost-effective system, with the prospect of a reduction in duplication and delay, and which in turn should serve to increase public trust.’
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