I did not expect to be writing about track staff being hit by trains again this month. Surely good management means doing the work that is required safely, on time and to the required standard?
To achieve that each manager and supervisor needs to know, listen to and understand the staff doing the work. Instructions by e- mail and management by checking computerised records is never enough!
Management is about people, their motivation and commitment. To manage well you must earn the trust of your staff. Not everyone can do this. Engineering expertise can never compensate for a lack of ability to manage.
I wonder how many rail track managers are now employed elsewhere having failed to ensure that their staff work safely?
Walking alone
The Rail Accident Investigation Branch (RAIB) has published its report on an accident when a team leader signalling technician was struck by a train near Poole in Dorset on 12th July this year.
He was incredibly lucky to be only slightly hurt when the train stuck him a glancing blow. He was walking along the cess of a bi-directional line when a train came up behind him travelling at an estimated 15 mph.
Where he was working is double track, third rail electrified and with a crossover that results in a section of bi-directional signalled working. The work in hand was re-signalling between Poole and Weymouth.
Briefings had been given including specific references to the bi-directional working, but although he had been working in the area for the previous fortnight he had only worked east of Poole Level Crossing for half an hour in total.
At the time of the accident he was walking alone from the site along the Up Cess towards the Level Crossing. The train that hit him stopped at a signal for a minute and a half and then crossed over from Down to Up line.
As can be seen in the picture the cess is overgrown in places which resulted in his moving foul of the track so as to pass. The report suggests that having not seen trains running in both directions on the Up line he may have instinctively thought he was facing traffic as he walked.
Three workers and six protection staff
Another RAIB report details what happened on March 22nd this year when a track worker was struck by a train and seriously injured. It was near West Drayton Station, just a short distance from London Paddington at 1037 in the morning when the First Great Western passenger train from Oxford to London struck and injured a look-out who was standing with his back to the train and his right foot only 50 cm from the nearest rail.
The accident occurred on a four track section of railway. The tracks are known as the Up and Down Relief lines and Up and Down Main lines. Three surveying staff were being protected whilst they worked “red zone” (with trains running), by a total of six safety personnel.
I was surprised to learn that the survey work had been planned that way. The Controller of Site Safety (COSS) organised his staff with an advanced lookout at each end, two intermediate lookouts and a site lookout with the survey team.
The COSS tested the system to ensure that the survey team could reach the place of safety at least ten seconds before any train passed.
Was it right to use lookouts?
For reasons which the RAIB failed to fully discover, the COSS decided to change one of the intermediate lookouts. The substitute was a qualified lookout from the adjacent site yard.
The train passed the survey team who were still in their place of safety after the re-organisation of protection at around 56 mph. The driver realised the intermediate lookout was standing too close to the line.
He made a full service brake application and reached for the horn. Just eleven seconds after passing the COSS the train struck the lookout on the right shoulder causing him serious injuries.
There is a hierarchy of protection with red zone lookout protection being the method of last resort. I find it difficult to accept that it was right from either a cost or safety perspective to plan for six individuals waving flags and blowing horns to be used in this way. At the very least surely some form of automatic/mechanical warning system should have been in use?
Lack of maintenance and monitoring
Also just published is an updated report into the accident that occurred on January 5th last year when a pantograph fell off the roof of the early morning Kings Lynn to Kings Cross London train breaking two train windows as it fell.
It happened near Littleport Cambridgeshire. The pantograph had lost contact with the overhead line electrification (OLE) wire due to a combination of the effects of a long term settlement of the foundation of an OLE mast and a strong wind.
The pantograph arm struck the cantilevered arm of the OLE breaking the insulators resulting in its detachment. The report is specific. The accident was due to a “lack of maintenance, monitoring and adjustment of the OLE to allow for mast foundation settlement”.
It goes on to say that “routine inspection and maintenance was deferred beyond specified limits”.
Standards were not understood by the staff
The “underlying factors however are even more revealing; “specifications and maintenance limits in Network Rail Standards were inconsistent and not clearly understood by the maintenance staff at …”
In the update it states that the “Tottenham Maintenance Delivery Unit (MDU) has now developed a plan aimed at addressing the backlog of six yearly checks on overhead line equipment” and adds that “all wire runs in the area are now planned to be maintained by February 2014”. Management was clearly at fault in allowing or not realising the extent of the deferments I suggest.
In the final paragraph of my article last month I referred to the serious electrical burns from the overhead line equipment received by the 29 year old Harsco employee from Chorley whilst working near Stafford on November 5th.
I now know that he was carrying out routine maintenance on a stabled grinding train when the accident happened. Based on information available at the time I said that the Rail Accident Investigation Branch (RAIB) had launched an investigation.
However, due to the vagaries of our regulatory system I am now advised that because no moving trains were involved the Office of Rail Regulation (ORR) are responsible for discovering just what happened. I expect to report in more detail when they have completed their investigation.
The ORR have also assured me that their inspectors still carry out middle of the night unannounced site visits to see just what is going on. My retired rail safety informant will I hope be pleased to read that I intend to pursue his concerns and report back in future.
Indeed I suggest the use of unexpected site visits to determine the efficacy or otherwise of records and audit results could be a topic for inclusion in the next Rail Safety Summit which will be held in London for the first time.
It will be held at the Royal College of Physicians on Monday 28th April. Ian Prosser of the ORR has accepted our invitation to sit on our advisory board which will discuss and agree key safety issues to be selected as relevant and timely topics for our speakers.
The advisory board will also discuss and then recommend which experts should be approached to present at the conference. This promises to be an interesting Safety Summit, so make a note in your diary now, Monday 28 April.
