Page 21 - When Things Go Wrong

significant effect on participation, with inquests and inquiries each holding
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perceived advantages and drawbacks. An inquest provides the opportunity for
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questioning of witnesses by one’s own legal representative. In some
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circumstances it will give rise to a duty or discretion to empanel a jury, an
element of the inquest process viewed favourably by all the bereaved people
we consulted. It also may be perceived as an investigation wholly independent

of Government. However, a public inquiry allows for broader scope, opening
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and closing addresses (where core participant status is granted) and, perhaps
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most significantly, statutory funding for legal representation.

2.3 In order to maximise consistency (both in standards and in the type of
investigation established), enhance participation and reduce duplication, this
chapter explores how inquiries are established and managed and the effective
operation of the coronial system.

Establishing public inquiries

2.4 Public inquiries are established to investigate some of the most traumatic
events to which the public is subjected. However, until recently, there has been
no central source of information that inquiry chairs and teams, alongside the
general public, might turn to in order to find out how such an inquiry should
be established and managed. Previous experience has not been routinely
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captured. When the House of Lords Select Committee on the Inquiries Act
2005 “asked the Ministry of Justice for copies of the lessons learned papers for

33 See Clive Coleman, ‘London fire: Inquest versus inquiry’ (BBC, 2017) and INQUEST, ‘INQUEST
Statement on the Grenfell Tower Fire’ (16 June 2017).
34 The Coroners (Inquests) Rules 2013, r. 19.
35 Coroners and Justice Act 2009, s. 7.
36 The Inquiry Rules 2016, r. 11.
37 Inquiries Act 2005, s. 40.
38 Norris and Shepheard, supra note 21, p. 5.
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