A recent Administrative Court decision is an important reminder of the use of section 13 of the Coroners Act 1988 (section 13), and its power to quash findings and conclusions reached in inquests, and to direct a fresh investigation in instances where it is desirable in the interest of justice for a new inquest to be held.
In R. (on the application of Roome) v Senior Coroner for Gloucestershire, the Administrative Court allowed an application under section 13, quashing the original inquest record and ordering a fresh investigation into the death of a 14-year-old boy, who died by ligature suspension.
The child’s mother applied to the High Court on the basis that the original inquest had not sufficiently investigated the circumstances of her son’s death, including the possible role of social media. The Senior Coroner for Gloucestershire and TikTok Information Technologies UK Limited were included as defendants in the application, and neither opposed the application.
At the original inquest, the coroner relied on police evidence that enquiries had been made with the child’s school and friends, and that his devices had been reviewed without anything significant being found. The coroner concluded that he had died by ligature suspension.
Why was the inquest decision challenged?
It later emerged that the device review had been limited, as the Senior Investigating Officer (SIO), who was not a digital forensic expert, had manually checked ordinary device functions only. No forensic review was undertaken.
Although some social media activity had been considered, TikTok data was not properly investigated because a court order to explore this could not be obtained. Reports later commissioned by the child’s mother identified further concerns, including the absence of forensic device analysis, potential Instagram and Snapchat contact shortly before death, and possible blackmail or account-compromise issues arising from an Instagram message sent by “John Smitt”, who claimed to be the child’s friend.
There were also concerns that potentially relevant witnesses had not been spoken to, including those likely to have been the last adult to see the child that day and a friend whom he messaged shortly before his death.
TikTok’s position
TikTok did not oppose the application. It confirmed that it had not been contacted during the original inquest and that two further TikTok accounts believed to be associated with the child had since been identified.
It also explained that some behavioural data had been deleted under its retention policy before it was notified of the death, which is standard procedure, although some retained material, including lists of liked videos, remained available.
The section 13 test
Section 13 allows the High Court to quash an inquest and order a fresh investigation where, among other things, there has been an insufficiency of inquiry or the discovery of new facts or evidence, and a further investigation is necessary or desirable in the interests of justice.
S13(1)(b) of the Coroners Act 1988 states:
- This section applies where, on an application by or under the authority of the Attorney-General, the High Court is satisfied as respects a coroner either—
(b) where an inquest or an investigation has been held by him, that (whether by reason of fraud, rejection of evidence, irregularity of proceedings, insufficiency of inquiry, the discovery of new facts or evidence or otherwise) it is necessary or desirable in the interests of justice that an investigation (or as the case may by, another investigation should be held.
S13(2) allows the High Court to make an order for an investigation into a person’s death, and in the event an inquest has already been held, to quash any inquisition, determination or finding found at that inquest.
When determining whether the test set out in section 13(1)(b) has been met, the right approach was that identified by Lord Judge LCJ in Her Majesty's Attorney General v Her Majesty's Coroner of South Yorkshire (West) & Her Majesty's Coroner of West Yorkshire (West) [2012] EWHC 3783 (Admin) [10]. The test was whether a further inquest was necessary or desirable in the interests of justice. When determining this, a broad approach should be taken, and the identification of fresh evidence which may reasonably have led to the conclusion as to how the deceased met their death, which was not revealed in the first inquest, would normally make it desirable and necessary in the interests of justice for a fresh inquest to be ordered.
Lord Judge LCJ also noted that it is not a precondition that a different verdict would be reached, but it may be desirable for the full extent of the evidence to confirm the correctness of the original verdict to be publicly revealed.
Decision and significance
The court held that a fresh inquest was desirable in the interests of justice. Importantly, the decision did not imply fault by the original coroner, nor did it suggest that a different conclusion would necessarily be reached. However, the court considered that there were unexplored lines of enquiry, particularly around digital and social media evidence. Without those matters being properly investigated, it could not be assumed that the same conclusion would be found.
The original inquest record, findings and conclusion were therefore quashed, and a fresh investigation and inquest into the child’s death was ordered.
The case is a reminder that, where later evidence is revealed, section 13 provides a route to reopen an investigation so that the factual picture is more complete and the correctness of the verdict is explored, regardless of whether a different verdict would be reached.
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