Written by Colin Wheeler for Railstaff
June was Bill Emery’s last month after almost six years as Chief Executive of the Office of Rail Regulation (ORR).
Its current roles as regulator of the industry’s spending, operational performance and as the safety regulator must lead to internally conflicting opinions sometimes.
The latest issue of the ORR’s six monthly review was published in June.
On the industry’s safety culture it promotes ways of measuring the “ability to control health and safety risks”, and then refers to “promoting a culture of excellence in occupational health management”.
Excellent management gobbledegook which may sound impressive to management consultants, but are these comments meaningful?
Will the new Chief Executive Richard Price (previously Chief Economist and Director of Performance at Defra) be able to tackle railway workforce safety issues effectively?
The headlines in the review include the following which deserve to be taken to heart.
“It is hard to hide from the conclusion that the railway operates in an underlying climate of fear that prevents safety incidents being reported by the supply chain or that management systems often fail to identify health and safety risks.”
The COSS jumped clear
Two incidents (one causing serious injury) occurred on the morning of Sunday June 12th. I must congratulate Network Rail on ensuring that the factual details were communicated very quickly in both cases.
At around 0110 hours at Westbourne Park a Thames Turbo was travelling towards Paddington Station on Line 3. There was an electrical flash from Gantry J02/18 and the train was brought to a halt with the driver believing he had struck someone.
A subcontracted Controller of Site Safety (COSS) was applying earths to the overhead line equipment (OLE) of Lines 4, 5 and 6.
This he had done at Gantry J01/35, but when he went to Gantry J02/18 he applied the earths to Lines 4 and 5 before standing in the four-foot of Line 3 and attaching the earth to the overhead there, resulting in the flash.
Crucially another track worker saw the train approaching him on Line 3 and shouted a warning. The COSS was able to jump clear but left the fibre glass isolation pole behind him. It was struck by the train making its driver think he must have hit him.
Subsequent discussions have revealed that although he had worked “in the vicinity” the previous Saturday, he had not worked at the location before, nor had he visited the site before coming to site to apply the earths.
Hit by a train at 60 mph
At around 0530 that same morning, a Track Maintenance Manager was working with his assistant and a gang at Stoats Nest Junction near Purley, South London.
He was struck by the 0500 Gatwick Airport to London Victoria service travelling at around 60 mph on the Up Slow that had been re-opened to traffic just before the accident. He was seriously injured.
Possession of the Up and Down Quarry lines and the Down Platform loop had been taken at 0005 hours that morning leaving the Up and Down Redhill lines open to traffic.
The problems arose when the time came to install the closure rail between the A and B ends of T1666 points. The selected closure rail was too short and another had to be found.
Doubtless the RAIB Inquiry will look at how the Track Manager and others decided to hand back the Up Slow but still carry on and install the replacement closure rail. It is easy to understand the pressures on the Track Manager and Assistant Track Manager to get the job done.
For me it raises again the question of whether we over prescribe by Method Statements and even Task Briefings. Does the documentation dilute the personal authority of track managers when they have to take decisions and alter the work as things change on site?
It travelled a mile with doors open!
The Rail Accident Investigation Branch (RAIB) is investigating a risky incident that occurred at about 6pm on May 26th this year.
The 1630 Brighton to Bedford train made up of two Class 377 units (8 coaches, 476 seats) came to a halt with part of the train still inside the northern portal of Kings Cross Tunnel.
The train which was full and standing, had an electrical fault which had tripped the OLE. By 2020 hours a second train had been coupled to it, but with no electrical systems working, the passengers had opened doors for ventilation and although ready to move by 2103, the move was delayed, since passengers were down on the track in the tunnel.
After they had re-boarded, the train moved off and travelled a mile or so down to Kentish Town with the three sets of rear doors still open! Here the passengers all got off. The safety of this movement will doubtless be questioned by the RAIB.
The Grinding machine ran away down hill
London Underground had a runaway engineering train incident on Friday 13th August last year which could very easily have resulted in major injuries or worse. Shortly before 7 am on that Friday morning a self-propelled, diesel-engined, rail grinding machine ran away! It weighs 37 tonnes and is three cars long (See picture).
It had been working the night shift 12/13 between Highgate and Archway on the southbound line but the machine would not restart so the crew could not drive it away before the morning passenger trains started.
A passenger train was sent to pull it out. This arrived at 0544 hours and was coupled to the grinding machine using an emergency coupling.
The machine brakes had to be isolated so that it could be towed. It set off to go to East Finchley but at 0642, as it was passing through Highgate Station the emergency coupling broke and the grinding machine rolled back down the hill. The on-board crew could not reactivate the isolated brakes.
As it passed through Highgate Station at around 11 mph they jumped clear. It then ran on for some four miles, through six stations before coming to rest at Warren Street Station 16 minutes later.
The Control Room are congratulated
The RAIB report congratulates the Service Manager, Control Room staff and train drivers on their actions which narrowly avoided the occurrence of a serious accident. Control was told of the runaway just one minute after it happened. Passenger services had already resumed.
Train 107 was stood at Archway Station. There were two trains on the Charing Cross Branch (one near Warren Street and the other near Embankment) and Train 102 was about to set off onto the Charing Cross Branch.
There were also four trains on the Bank Branch near Euston, Bank and Borough Stations! The driver of 107 was told of the emergency and instructed to move immediately.
Just 46 seconds behind a passenger train
The Service Manager decided to route the runaway machine onto the Charing Cross Branch, reasoning this would give the best chance of avoiding a collision. The trailing points were set against the runaway to slow it or better still derail it at Mornington Crescent or Charing Cross.
If it was still going he could route it into a reversing siding with buffer stops at Kennington. He did not know that the two machine crew had jumped clear.
At 0646 a mere 3 minutes after being told of the runaway he stopped any more trains from entering the Charing Cross Branch, just one minute after Train 102 had left Camden Town. Train 107 at Tufnell Park was instructed to drive quickly and omit all station stops as the runaway was catching him up.
The gap between them reduced to just 46 seconds approaching Kentish Town with the runaway travelling at 35 mph! They were 650 metres apart when Train 107 cleared Camden Town Junction leaving 45 seconds for the route onto the Charing Cross Branch to be set for the runaway.
It could have run to Waterloo
The grinding unit was slowed by running through the points at Mornington Crescent. When it reached Warren Street at 0658 it rolled back and stopped 60 metres from the north end of the station.
The RAIB concluded that had it run through Warren Street then it would probably have run on downhill all the way to Waterloo.
The report says, “None of the Control Room Staff or Operators had any experience, training, or guidance on how to handle this type of situation. Their performance, and particularly that of the Service Manager, deserves commendation.” They obviously knew enough.
More new handbooks and rules
I regret the plethora of bulky risk assessments and method statements and even task briefings have grown to a useless size. I recall being forced by Railtrack to defer work because they wanted a more detailed method statement for the erection of a site cabin. The bridge erection plans had been accepted!
The Railway Safety and Standards Board’s (RSSB) latest Standards Catalogue has the changes made from June 4th including new briefing leaflets and handbooks. The printers will be pleased.
Handbook 11 is for PICOP’s, 12 for ES’s, 13 for PICOS’s (Persons in charge of Sidings), 14 Persons in charge of loading or unloading rail vehicles during engineering work, and 15 Machine Controller and on-track plant operators.
Naturally there is a new issue of the “Rule Book Index and Glossary”, a “Rule Book Module Issue History” and even issue 20 of a “Rule Book Briefing leaflet”.
At 0200 hours on a wet and windy morning with the words of the project manager (“Whatever happens make sure you get finished on time!”) still uppermost in the supervisor’s mind, what would do more to improve safety? Is the answer more and more tinkering with rules and ways of working or doing more to create a better safety culture?
I am prejudiced as always, but I remain convinced that we have far too many rules and instructions.
We continue to strive to close every loophole whilst ignoring the fact that paperwork overload is contributing to the problems we have with the safety culture within the industry. Is now the time to edit down the handbooks and do away with the Rule Book?
