RAIL INQUIRIES: WORK ON RECOMMENDATIONS NEAR COMPLETION
14 Sep 2004 05:15 PM
The Health and Safety Commission (HSC) today published its third
progress report on recommendations made following recent rail Public
Inquiries.
The report charts progress on the implementation of recommendations
since HSC published its last report in August 2003. Bill Callaghan,
HSC Chair said:
"This latest report records considerable progress. The rail Public
Inquiries have delivered results because the rail industry has risen
to the challenge of delivering the recommendations; this is part of
the framework for the continued improvement in railway safety. Of
the total of 295 recommendations arising from the three Public
Inquiries into rail safety, only 27 now remain to be completed. The
end of 2003 saw the successful completion of the train protection and
warning system (TPWS) programme. TPWS has already reduced the signal
passed at danger risk and there have been several incidents where
TPWS has effectively intervened in situations where there was
potential for collisions."
He added: "In the recently published White Paper 'The Future of
Rail' the Government set out its plans to merge regulatory
responsibility for rail safety with the Office of Rail Regulation.
That new body must ensure that the process of improving safety
culture on the railways continues, and both the Rail Accident
Investigation Board and the Rail Safety and Standards Board - two
creations of the rail Public Inquiries - will have key roles to play.
In the meantime, HSC remains committed to maintaining health and
safety on the railways."
Bill Callaghan was speaking as HSC published its third progress
report on implementing the recommendations made by Professor John Uff
and Lord Cullen in their reports on the Southall and Ladbroke Grove
rail crashes and their Inquiry into train protection systems.
Professor Uff and Lord Cullen asked HSC to monitor implementation of
the recommendations made in the Public Inquiry reports.
HSC published a first progress report in November 2002 charting
progress on all 295 recommendations. The second progress report was
published in August 2003 showing progress on the remaining 116
recommendations. This third report tracks progress made on the
remaining 79 recommendations.
'The Rail Public Inquiries: HSC report on overall progress as of
March 2004 on the remaining recommendations from the rail Public
Inquiries' can be found at:
http://www.hse.gov.uk/railways/railpublic3.pdf
Notes to Editors
1. The Southall Rail Accident Inquiry Report by Professor John Uff QC
FR Eng was published on 24 February 2000. It contained 93
recommendations on: driver training; operating rules; fault
reporting; maintenance; regulation; vehicle design; research and
development; automatic train protection; accident investigation and
post-accident procedures. Work on all the recommendations is now
regarded as complete.
2. The Joint Inquiry into Train Protection Systems was
established shortly after the Ladbroke Grove crash and during the
Southall Inquiry. It was not concerned with the facts of either
crash, but with broader questions relating to train protection
systems. The report, by Professor Uff and Lord Cullen, was published
on 29 March 2001. It contained 39 recommendations covering:
implementation of TPWS; introduction of the European Train Control
System (ETCS); and further action to reduce the number of SPADS
through defensive driving techniques and other management
initiatives. The industry reports that action on 34 recommendations
is now complete. Action continues on 5 recommendations, mainly
relating to ETCS - the automatic train protection element of the
European Rail Traffic Management System (ERTMS). HSC has published
separately its work on monitoring progress with this (see
http://www.hse.gov.uk/railways/liveissues/tps.htm)
3. The Ladbroke Grove Rail Inquiry Part 1 Report by Lord Cullen was
published on 19 June 2001. It contained 89 recommendations drawing
lessons from the causes of the train crash. The recommendations cover
driver management and training, signalling systems and signal
sighting, crashworthiness and passenger protection, evacuation and
escape. Industry reports that action on 86 recommendations is now
regarded as complete. Action continues on the remaining 3.
4. The Ladbroke Grove Rail Inquiry Part 2 Report also by Lord Cullen
was published on 20 September 2001. It contained 74 recommendations,
1 of which required HSC to publish a report on compliance after six
months, and regular reviews thereafter. The recommendations cover:
use of contractors; establishing a Rail Accident Investigation Branch
(RAIB) and a Rail Safety and Standards Board (RSSB); railway safety
cases; HSE; safety leadership and skills; accreditation and
licensing. Industry reports that action on 55 recommendations is now
regarded as complete. Action continues on 19 recommendations. Annex 1
summarises progress on all four reports.
5. The Health and Safety Executive (HSE) carries out the
monitoring work for HSC. As before, the recommendations are grouped
under eight themes: safety culture; infrastructure; investigations;
organisations and standards; suppliers and contractors; training;
train protection, and vehicle integrity. The first report showed
that of the 295 recommendations, 179 were considered completed. The
second report showed that of the remaining 116 recommendations, 37
were considered completed. This report shows progress on the
remaining 79 recommendations, with 52 considered completed. Both the
industry and HSE agree that work on 27 is still to be delivered. Of
these 27, action on 9 has continued beyond the dates put forward in
the Public Inquiry reports, as well as 9 recommendations where no
timeline was specified. There is a range of reasons for this,
including the complexity of interrelated issues, the need for
legislative change, or because industry is taking a broader look than
the recommendations strictly require. HSE and industry have discussed
and agreed alternative timescales. Annex 2 summarises progress on
the eight themes.
6. Where HSC has accepted that adequate action has been taken to
regard certain recommendations as completed, it does not mean that
industry will not continue to take the issues forward, or indeed that
HSE will not continue to monitor the position as part of its ongoing
planned inspection work. Earlier progress reports can be found on
the HSE website at http://www.hse.gov.uk/railways/information.htm.
See also press releases C040-03 dated 5.8.03
http://www.hse.gov.uk/press/2003/c03040.htm and C053-02 dated
28.11.02 at http://www.hse.gov.uk/press/2002/c02053.htm
7. On 15 July 2004 the Secretary of State for Transport (SoS)
published a White Paper The Future of Rail with outcomes from the
Rail Review that he announced in January 2004. HSC published its
response to the White Paper on the same day - see press release
C032-04 at http://www.hse.gov.uk/press/2004/c04032.htm. The SoS
decided that the responsibility for rail safety regulation should be
transferred from HSC/E to the new Office of Rail Regulation (ORR). A
date for the merger has not been proposed but since primary
legislation is required there will be a transitional period in which
the statutory responsibilities for health and safety on the railways
remain with HSC/E. During the transitional period, and before the
merger takes place, HSE will discuss with the ORR how future progress
on the rail Public Inquiry recommendations should be reported.
8. The report refers to Railtrack PLC (Railtrack) as the owner and
operator of the network and infrastructure. Railtrack PLC was
acquired by Network Rail Holdco Ltd and is known as Network Rail. All
references in the report to what Railtrack is expected to do in the
future should be construed as referring to Network Rail. It also
refers to Railway Safety as the rail industry's own safety body.
Railway Safety's functions are now the responsibility of the Rail
Safety and Standards Board (RSSB), established on 1 April 2003. All
references in this report to what Railway Safety is expected to do in
the future should be construed as referring to RSSB.
PUBLIC ENQUIRIES: Call HSE's InfoLine, tel: 08701 545500, or write
to: HSE Information Services, Caerphilly Business Park, Caerphilly
CF83 3GG.
HSE information and press releases can be accessed on the Internet:
http://www.hse.gov.uk
Annex 1: Rail Public Inquiries Progress September 2004
1. Update on the remaining recommendations
Public Inquiry Total number of Completed to Continuing
recommendations date
Southall 93 93 0
Joint Inquiry 39 34 5
LGRI 1 89 86 3
LGRI 2 74 55 19
Totals 295 268 27
2. Recommendations that have not been implemented by the date put
forward in the Inquiry reports:
Joint Inquiry 5 continuing:
1 had no timeline specified
1 was due by March 2001
2 were due from January 2004
1 is due from 2004 onwards
Ladbroke Grove 1 3 continuing:
1 had no timeline specified
1 was due by June 2002
1 was due by June 2003
Ladbroke Grove 2 19 continuing:
7 had no timeline specified
1 was due by March 2002
3 were due by September 2002
8 were due by September 2004
Annex 2: Summary of progress on the themed recommendations
September 2004
Safety culture. We are now satisfied that each individual
organisation has delivered the full scope of each recommendation as
written. Safety culture is an issue that goes far beyond the
recommendations made by Lord Cullen. Implementing these
recommendations will make a significant contribution to improving
safety culture as he envisaged. This is the first step in the long
process of developing a positive safety culture.
Infrastructure. The remaining 3 recommendations have all been
implemented, all aimed at improving signal sighting and signalling
systems.
Investigations. There are 15 remaining recommendations included in
this report. The Rail Accident Investigation Branch (RAIB) has been
established and further legislation is expected shortly to set out
its framework.
Organisations and standards. Of the 12 remaining recommendations
included in this report, a further 10 have been completed. Action
continues on the other two. A real challenge remains for the industry
to ensure that the Rail Safety and Standards Board (RSSB) succeeds in
filling the leadership and standards development role that Lord
Cullen has set for it.
Suppliers and contractors. 6 remaining recommendations are covered
in this report; a further 5 recommendations aimed at improving the
management of contractors have been completed. Work continues on the
recommendation on the accreditation of safety critical suppliers.
Training. Of the remaining 6 recommendations included in this
report, a further 3 have been completed. Action continues on the
remaining 3.
Train protection. Of the remaining 21 recommendations included
here, a further 16 recommendations have been completed since the last
progress report. Work is continuing on the remaining 5. The end of
2003 saw the successful completion of the TPWS fitment programme
across the network as required by the Railway Safety Regulations
1999. HSE has granted exemptions from these Regulations where the
industry produced good evidence to show that the costs were high and
risks were low. In 2003, exemptions were granted for TPWS fitment at
Permanent Speed Restrictions (PSRs) at diverging junctions and
Temporary Speed Restrictions (TSRs). In granting the exemptions, HSE
accepted that evidence suggests that TPWS is much less effective and
suitable for mitigating overspeed risk than anticipated when
developing the Regulations. HSE is seeking additional information on
this from the rail industry to use in an early review of this aspect
of the Regulations. The National European Rail Traffic Management
(ERTMS) Programme (NEP) 2nd year progress report, published on 18 May
2004, reports good progress being made across the industry in a
number of areas in the development of ERTMS.
Vehicle integrity. Of the remaining 12 recommendations, a further 11
have been completed. Work is continuing on 1 recommendation. Train
operators have introduced improved arrangements for emergency
evacuation, safety information and signage, training of staff, and
provision of equipment. Additional standardised information for
passengers will also help. A substantial programme of research and
investigation is continuing. This is progressing more slowly than the
Inquiries recommended, because the industry is taking a broader look
at the issue than the strict terms of the recommendations demand,
which appears a sensible approach for the longer term. The future
development of European Technical Standards for Interoperability will
influence and eventually determine standards in many of these areas.