ON APPEAL FROM Warwick Crown Court
HHJ Godsmark QC
T20100366
Strand, London, WC2A 2LL |
||
B e f o r e :
JUSTICE GRIFFITH WILLIAMS
and
MR JUSTICE SWEENEY
____________________
The Queen |
Respondent |
|
- and - |
||
Merlin Attractions Operations Limited |
Appellant |
____________________
Mr Barry Berlin (instructed by Warwick District Council) for the Respondent
Hearing dates : 2nd August 2012
____________________
Crown Copyright ©
Mr Justice Sweeney :
Introduction
Count 1: | Being an employer failed, on or before 9 December 2007, to conduct its undertaking to ensure so far as was reasonably practicable the safety of persons not in its employment who may be affected thereby, contrary to sections 3(1) and 33(1)(a) of the Health and Safety at Work etc Act 1974. |
Count 2: | Failed, on or before 9 December 2007, in the employer's duty to make and give effect to such arrangements as were appropriate for the effective planning, organisation, control, monitoring and review of preventive and protective measures within its undertaking, contrary to Regulation 5 of the Management of Health and Safety at Work Regulations 1999 and section 33(1)(c) of the Health and Safety at Work etc Act 1974. |
The opposing cases at trial.
"(i) It failed to take suitable and sufficient measures to prevent or protect visitors, when accessing to or egressing from the said Castle via the Bear and Clarence Bridge, from falling a distance likely to cause them injury; and/or
(ii) it failed to provide any or any appropriate barrier or similar means of protection to protect visitors from falling off the said Bridge; and/or
(iii) it failed to warn by signs, delineation or otherwise of the risk of falling from height off the said Bridge; and/or .
(v) it failed to conduct any or any suitable and sufficient risk assessment relating to risks associated with visitors accessing to and/or egressing from the said Castle via the said Bridge."
"(i) It failed to adopt a systematic approach to the identification of hazards, risk and assessment of risks in respect of access and egress across the Bear and Clarence Bridge over the dry moat to and from the said Castle; and/or
(ii) it failed to establish priorities and performance standards for the completion of risk assessments in respect of access and egress across the said Bridge and the implementation of prevention and protective measures, which at each stage minimises the risk of harm to people; and/or
(iii) it failed to monitor how effectively risk was controlled as there were no, or no adequate, routine inspections in respect of access and egress across the said Bridge and/or checks to ensure that preventive and protective measures were in place and effective; and/or
(iv) it failed periodically to review the preventive and protective measures including elements of planning and monitoring relating to access and egress across the said Bridge."
(1) When special events, such as Carol Concerts, were held at the Castle temporary side barriers were erected on the Bear and Clarence Bridge for fire safety purposes as part of the Entertainment Licence, first granted in 1995.
(2) In 2002 the respondent had invited Philip Mitchell of Health and Safety Engineering Consultants Limited to conduct a fabric risk assessment for the Castle, and he had produced a report in 2003. The assessment was "limited to the fabric of the castle only", but it raised a question over whether side barriers were required for the Bear and Clarence Bridge at normal opening times.
(3) The report was never shown to the respondent's Health and Safety Officer, nor to his line manager which the Health and Safety Officer conceded to be a serious systemic failure. Likewise, one of the respondent's witnesses conceded that, whilst the report did not contain a specific recommendation for side barriers, he would have expected the report to be read in its entirety and action taken accordingly.
(4) Despite the mandatory requirement in the 1999 Regulations to do so, the respondent had failed to conduct any suitable and sufficient risk assessment of the Bear and Clarence Bridge, notwithstanding its importance in connection with access to and egress from the Castle. Had it done so it would have recognised the serious and foreseeable risk to members of the public, including children playing on the bridge and the elderly - given the low parapet wall over what was in fact a masked high drop.
(5) There were no warning signs about the drop in the immediate vicinity of, or on, the bridge.
(6) The fact that Mr Townley was walking normally and the shock of witnesses who saw him fall on discovering the height of the drop.
(7) Expert evidence confirming the fact that the drop was masked, and indicating that for someone who had entered the Castle via the Barbican Bridge and then exited via the Bear and Clarence Bridge there was a "nasty surprise" within the meaning of that phrase in guidance published in Managing Visitor Safety in the Countryside.
(1) It had a very good safety management system and a good safety record.
(2) There were many hazards at the Castle which were safely managed in that there was a system for undertaking risk assessment and more than 200 written risk assessments had been done.
(3) Whilst there had been no written or other formal risk assessment in relation to the Bear and Clarence Bridge, it was obviously a bridge; the surface had been maintained to a high standard; temporary side barriers were only required under the Entertainment Licence if there were going to be more than 2,200 people in the courtyard of the Castle; and hence no further steps to protect visitors were necessary or reasonably practicable.
(4) There was no guidance specifically directed to ancient monuments, but the guidance published in Managing Visitor Safety in the Countryside specifically recognised that it might not be desirable to alter scheduled monuments and listed buildings by erecting barriers.
(5) Had a written or formal risk assessment been undertaken it could quite properly have concluded that no barriers were necessary.
(6) Whilst the Entertainment Licence applied if there were more than 2,200 people in the courtyard of the Castle for a performance, the average daily attendance at the entire castle (which includes extensive grounds) was in the order of 2,000 with the numbers being staggered across the day.
"1. Fatal accident to George Townley aged 72 years resulting from serious breaches of health and safety duty.
2. The company's failures substantially caused the accident/death.
3. The accident was entirely preventable.
4. The breach of duty occurred over an extended period of time. It was not an isolated lapse.
5. It was common practice for the public to use this unguarded bridge over a 15' dry moat.
6. There is a significant public element as public safety at the attraction is entrusted to the company see R v Jarvis Facilities Ltd [2006] Cr App. R (S.) 44 CA per Hedley J at para.11.
7. The company failed to comply with many mandatory health and safety regulatory requirements."
(1) The fact that, generally, it took its health and safety responsibilities very seriously, and had good health and safety systems in place.
(2) Its immediate erection, following Mr Townsley's fall, of temporary barriers approved by Warwick District Council.
(3) Its co-operation with the respondent.
(4) Its prompt acceptance of responsibility in that (although contesting guilt) it gave an undertaking to the Coroner that, subject to the approval of English Heritage and Warwick District Council, it would erect a permanent barrier regardless of the outcome of the prosecution (which undertaking was repeated to the Judge).
The judge's sentencing remarks
(1) Generally, the appellant took its health and safety responsibilities very seriously with generally good health and safety systems in place, and with regular meetings of health and safety committees attended by representatives of all departments. Likewise the appellant expended considerable sums in order to maintain the Castle.
(2) Thus its failures in relation to the Bear and Clarence Bridge constituted something of an uncharacteristic blind spot, which had fatal consequences.
(3) Whilst many people, including Health and Safety Officers and others of that ilk, had crossed it over the years without incident, the Bear and Clarence Bridge was "an obvious danger" not so much in relation to adults, but in relation to children.
(4) Against the background of Mr Mitchell's report in 2003, and of the respondent's expert evidence, if a proper risk assessment had been carried out in relation to the bridge then barriers would have been erected.
(5) There had (thus) been a serious breach of the appellant's safety management systems in relation to the Bear and Clarence Bridge, and it had failed in its duty to take such steps as were reasonably practicable to ensure the safety of visitors to the Castle.
(6) The offences were aggravated by the death of Mr Townley.
(7) The offences were mitigated by the appellant's health and safety record and general approach.
(8) Whilst this was not a matter in which the fine should get into the realms of that imposed for corporate manslaughter, it was a matter where the fine had to be measured in hundreds of thousands of pounds.
The grounds of appeal
The Definitive Guideline
a) How foreseeable was serious injury? (The more foreseeable it was, the graver usually will be the offence).
b) How far short of the applicable standard did the defendant fall?
c) How common is this kind of breach in this organisation? (In particular, was it isolated in extent or indicative of a systematic departure from good practice across the defendant's operations).
d) How far up the organisation does the breach go? (Usually, the higher up the responsibility for the breach, the more serious the offence).
a) a prompt acceptance of responsibility;
b) a high level of co-operation with the investigation, beyond that which will always be expected;
c) genuine efforts to remedy the defect;
d) a good health and safety record;
e) a responsible attitude to health and safety, such as the commissioning of expert advice or the consultation of employees or others affected by the organisation's activities.
"(1) Consider the question at paragraph 6;
(2) identify any particular aggravating or mitigating circumstances (paragraphs 711);
(3) consider the nature, financial organisation and resources of the defendant (paragraphs 12-18);
(4) consider the consequences of a fine (paragraphs 19-21);
(5) consider compensation (but see paragraphs 27-28);
(6) assess the fine in the light of the foregoing and all the circumstances of the case;
(7) reduce as appropriate for any plea of guilty;
(8) consider costs; "
The rival arguments
(1) The facts of the case provided no proper basis for the judge's conclusion that the fine in this case had to be measured in hundreds of thousands of pounds.
(2) The order for costs formed part of the sentence, and accordingly the sentence imposed was at the bottom end of the range identified as appropriate for corporate manslaughter, whereas the facts did not justify such a sentence, as the judge himself recognised.
(3) The judge erred in his assessment of the seriousness of the offences and the weight to be attached to the aggravating and mitigating features, and should have concluded that the offences were at the lower end of the range.
(4) By reference to the questions posed in paragraph 6 of the Definitive Guideline:
a) The risk of serious injury was not very foreseeable given that:
i) Millions of people, including children, had crossed the bridge over many years without mishap, and the evidence of the defence expert was that the possibility of any injury occurring was 1 in 4 million.
ii) Local authority and health and safety inspectors, who had visited the Castle in the course of their work, and as visitors, on many occasions had never raised any concerns.
iii) Temporary barriers were only required by the Entertainment Licence if there were more than 2,200 people in the courtyard.
iv) The Head of Building Control at Warwick Council was aware of the temporary barriers (albeit that he had never inspected them) but had not expressed any concern about the absence of permanent barriers.
v) Whilst, in his 2003 report, Mr Mitchell had identified the Bear and Clarence Bridge as a hazard and had noted that permanent barriers could be erected, he had described the risk of injury as remote and had given unchallenged evidence at trial that his report was not a recommendation to erect permanent barriers and that, in his view, barriers were not necessary for the safe use of the bridge.
b) There was no directly applicable standard albeit that it was accepted that the jury must have concluded that there was a failure properly to apply the guidance in the Approved Code of Practice issued under the Regulations.
c) The breach was not common in the appellant's organisation at all. Rather, it was the result of a "blind spot" in what was otherwise a good and effective system for managing safety at the Castle.
d) The failure did not extend beyond site level within the organisation.
(5) None of the aggravating features set out in paragraph 7 of the Definitive Guideline were present.
(6) All of the mitigating factors set out in paragraph 8 were present.
(7) Given the appellant's good record and generally good approach to its health and safety and other responsibilities at the Castle, this was not the sort of case in which a substantial penalty was required in order to achieve a safe environment or to bring a necessary message home.
(8) Whilst in Clifton Steel Limited [2007] EWCA Crim 1537 this Court observed that it did not gain "any great advantage from a consideration of averages", and whilst it was accepted that it is not the Court's primary objective to achieve consistency, consideration of statistics provided by the Health and Safety Executive covering the years 2000 2005 showed that substantially less than 5% of the cases involved fines of £150,000 or more, and for the years 2007 2012 that only some 24 cases (5.6%) resulted in fines exceeding £250,000, of which three involved more than one fatality.
(1) Failures to fulfil the general duties imposed under sections 2-6 of the 1974 Act are particularly serious as those sections are the foundations for protecting health and safety.
(2) In assessing the gravity of a breach it is often helpful to look at how far short of the appropriate standard the offender fell in failing to meet the test of reasonable practicability, and also to consider the degree of risk and the extent of danger including whether the failure was isolated or one that continued over a period.
(3) The objective of prosecutions for health and safety offences in the workplace is to achieve a safe environment for workers and members of the public who may be affected.
(4) A fine needs to be large enough to bring the message home not only to those who manage a defendant company but also to its shareholders.
(5) No tariff applies, nor is it possible to say that fines should bear specific relationship to the turnover or net profit of the defendant each case must be looked at on its own particular circumstances, with the fine reflecting the gravity of the offence and the means of the offender.
(6) When a death has resulted the penalty should reflect public disquiet at the unnecessary loss of life, and a failure to heed warnings is also an aggravating factor.
(7) In any event, the court is entitled to take a more severe view of breaches of health and safety at work where there is a "significant public element".
(8) In a case where a defendant is in a position to pay the whole of the prosecution costs in addition to a fine there is no reason in principle for the court not to make a costs order accordingly.
(9) The Court must look at the whole sum (fine plus costs) that it is minded to order and consider the impact upon the offender.
(1) Serious injury was entirely foreseeable. The law required the conduct of a risk assessment, and if one had been carried out it would have provided the requisite focus on the inherent risks and would have ensured safety.
(2) The appellant's conduct fell well below the reasonably practicable test given that:
(a) It involved the absence of a risk assessment for a major entry and exit point which was (as one of the experts put it) "inconceivable".
(b) It included a systemic failure which had prevented the appellant's Health and Safety Officer at the Castle seeing Mr Mitchell's fabric risk assessment and thereby taking appropriate action or at least conducting a full risk assessment.
(3) Whilst it was not alleged that the appellant commonly committed breaches, the breaches at the bridge continued for many years and exposed millions of visitors, including the vulnerable, to serious injury or death thus, in that sense, there was a significant public element.
(4) There was clear complacency involving the appellant's Health and Safety Officer and his line manager.
(1) The appellant is a company with very substantial resources, hence no accounts were produced by it for consideration by the judge.
(2) A fine is intended to produce "painful punishment" and must also be large enough to bring home the message to those who manage it and to its shareholders.
(3) The defendant ought ordinarily, subject to means, to be ordered to pay the properly incurred costs of the prosecution, and the order made in this case was for less than the sum sought.
(1) The respondent's reliance upon aspects of its case and upon the aggravating features that it had advanced below was of limited relevance and had to be approached with caution unless supported by the factual basis upon which the judge passed sentence.
(2) The respondent had endorsed the appellant's submission that the court must take account of the whole sum (fine plus costs) that the appellant had been ordered to pay when assessing whether the penalty overall was punitive (or, in the present context, excessively so).
(3) This was an isolated lapse in the sense relevant to sentence albeit extended over a period of time. The judge expressly found the failings in relation to the bridge to be a "blind spot" in an otherwise good safety management system.
(4) This case did not involve a "significant public element" in the sense intended in the authorities in relation to cases (like the railway) where public safety is entrusted to companies in the work that they do and where the general public simply has to trust in the competence and efficiency of such companies.
Discussion
"Any court dealing with an offender in respect of his offence must have regard to the following purposes of sentencing
(a) the punishment of the offenders
(b) the reduction of crime (including its reduction by deterrence)
(c) the reform and rehabilitation of offenders
(d) the protection of the public
(e) the making of reparation by offenders to persons affected by their offences."
(1) Paragraph 29 of the Guideline provides, as already noted above, that the defendant ought ordinarily (subject to means) to be ordered to pay the properly incurred costs of the prosecution.
(2) In accordance with s.18(1) of the Prosecution of Offences Act 1985 the judge was entitled to make such order as to costs to be paid by the appellant to the respondent as he considered to be just and reasonable.
(3) The appellant fought the case and chose not to place any financial information about itself before the judge, and hence he was entitled to infer that the appellant was able to pay any penalty or costs that he chose to impose and that it did not wish to put forward lack of resources as a limiting factor see HIP (BODYCOTE) (above) and paragraph 17 of the Guideline.
(4) The judge made the costs order in an amount which was less than that sought by the prosecution, and which was not grossly disproportionate to the fine.
(5) Against that background the costs order was plainly, in its own right, both just and reasonable.
(6) Even if the appellant's means had been a limiting factor no issue of aggregation of the type argued for would have arisen. Rather the proper approach, in accordance with paragraph 37 of the Guideline, would have been first to identify the correct fine and the sum of any compensation order, and then to go on to consider costs by reference to paragraph 29. In the event of the appellant's means then limiting what would otherwise be the appropriate costs order, the correct course would be to reduce the costs order not the fine see the fourth principle identified by Lord Bingham CJ in Northallerton Magistrates' Court ex p Dove [2000] 1 Cr. App. R. (S.) 136.
(1) Given the minimal height of the parapet walls, the masking of the drop and the depth of the drop, foreseeable serious injury was obvious not so much in relation to adults, but in relation to children.
(2) The appellant fell seriously short of the applicable standard it failed over a period of many years to carry out the necessary mandatory risk assessment of the Bear and Clarence Bridge which, over those years, was used by millions of people (and thus, to that extent, involved a public element); such risk assessments are the foundation stone requirement of ensuring compliance with the applicable standard; and if a risk assessment had been carried out then barriers would have been erected, the obvious risk of serious injury would have been eliminated and Mr Townley's death would have been avoided.
(3) This kind of breach was isolated, was limited to the Bear and Clarence Bridge, and constituted something of an uncharacteristic blind spot.
(4) The breach went no higher than the on-site line manager of the Health & Safety Officer.
(1) Contrary to Mr Morton's argument, there was quite plainly no prompt acceptance of responsibility by the appellant. On the contrary the appellant vigorously contested responsibility in a jury trial that lasted for some seven days, and still seeks to argue (for example) that the risk of serious injury was not very foreseeable, whereas the judge clearly concluded that it was obvious albeit not so much in relation to adults but in relation to children. An undertaking to the Coroner and to the judge which, in reality in this case, amounted to no more than a promise not to continue to commit the same (obvious) offence cannot be equated to a prompt acceptance of responsibility.
(2) Likewise, there was no level of co-operation with the investigation beyond that which will always be expected.
(3) There were genuine efforts to remedy the defects albeit that, by virtue of paragraph 34 of the Guideline (which mirrors the approach in e.g. Thames Water Utilities Ltd [2010] 2 CrAppR (S) 90 at paras 39(xiv) & 54 (iv)), there was plainly a duty to do so, and not to have done so would have amounted to the continuation of the failure to carry out a mandatory risk assessment, and to the continuation of an obvious danger.
(4) The appellant had a good health and safety record.
(5) The appellant undoubtedly had a generally responsible attitude to health and safety, as well as to its other duties.
Conclusion