STEADY PROGRESS BUT RAIL INDUSTRY MUST DO MORE ON SAFETY CULTURE

HSC press release: C040:03 - 5 August 2003

The Health and Safety Commission (HSC) today published its second progress report on rail Public Inquiries. Bill Callaghan, the HSC Chair said: "This latest report shows that the recommendations continue to deliver results - the new Rail Accident Investigation Branch is being developed, and the new rail industry safety body, the Rail Safety and Standards Board has been established. Fitment of the Train Protection and Warning System (TPWS) programme is almost complete, mitigating the risk from trains passing red signals. The Health and Safety Executive (HSE) is making good progress with its review of rail safety regulations."

He added: "The rail industry continues its work to improve safety and I acknowledge that overall the industry has made significant progress. But I remain concerned that Lord Cullen's core message on safety culture is not yet penetrating down through the whole industry. Of the recommendations yet to be delivered, I regard those dealing with safety culture and management of contractors as the most important. Their delivery will secure lasting improvements in the industry's performance, but I also recognise than such improvements cannot be achieved overnight: it requires sustained action."

"I look forward to the industry delivering lasting change and enjoying the improved performance that a safe railway brings".

Bill Callaghan was speaking as HSC published its second 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 four Public Inquiry reports. HSC published a first progress report in November 2002 charting progress on all 295 recommendations. Today's report charts progress made on the remaining 116 recommendations.

The HSE is carrying out the monitoring work for the 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. This report shows progress on the remaining 116 recommendations, with 37 considered completed. HSE is continuing to 11 that the industry considers complete and both the industry and HSE agree that work on 68 is still to be delivered. Of these 116 recommendations action on 37 has continued beyond the dates put forward in the Public Inquiry reports. 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 strict terms of the recommendation require. HSE and industry have discussed and agreed alternative timescales.

On the key issue of safety culture, all parts of industry have reported a variety of steps to put the appropriate management processes in place, although they have not been able to demonstrate that such actions have delivered a step change in safety culture. There are encouraging developments: of the remaining seven recommendations included in this report a further three have been implemented. There are four recommendations where the action holder reports completion; HSE is not yet able to endorse this view and will report further progress.

Three infrastructure recommendations remain to be implemented, all aimed at improving signal sighting and signalling systems.

Of the remaining 16 recommendations on investigations included in this report, a further one have been completed. Work is progressing well, though establishing RAIB requires legislation.

Of the 31 remaining recommendations on organisations and standards included in this report a further 19 have been completed. One of the key recommendations, the establishment of the Rail Safety and Standards Board was realised on 1 April 2003, and the way it now operates is at the heart of this strand of work.

The suppliers and contractors theme has six remaining recommendations included in this report. There have been major advances, especially at the level of senior management responsibilities, and the introduction of appropriate systems, e.g. Network Rail's high-level maintenance strategy, changes to its safety case arrangements and improvements to the Sentinel work recording system. There are four recommendations where the action holder reports completion, but HSE is not yet able to endorse this view and will report further progress.

Of the remaining eleven training recommendations included in this report a further six have been completed. Since 2000, HSE has found that there has been evidence of improvement in general standards, especially in training and briefing. However, there appears to be considerable variation in the way different companies and organisations are approaching the issue. Opportunities for establishing and spreading best practice may be being missed.

Of the remaining 23 recommendations on train protection included in this report a further two recommendations have been completed since the last progress report. There are three recommendations where the action holder reports completion, but HSE is not yet able to endorse this view: further progress will be reported. Good progress is being made fitting the Train Protection and Warning System (TPWS), which greatly reduces the risk of collisions resulting from SPADs, by the statutory deadline of 1.1.04. Since the last progress report, HSC has published its advice to the Government on the European Rail Traffic Management System (ERTMS). This recognised that investment decisions on ERTMS are not only - or even mainly - about safety. And for the immediate future, because technology suitable for the UK is considered to be at an early stage of development, HSC is not intending to establish at this time a regulatory timetable as proposed by the Joint Inquiry. However, there is now substantial consensus on the way forward for ERTMS development in the UK, through the establishment of a National ERTMS programme under the leadership and strategic direction of SRA.

Of the remaining 19 recommendations on vehicle integrity a further eight recommendations have been completed. As explained in the first progress report, implementation of these recommendations is slower than the Inquiries recommended because the industry is taking a broader, more holistic, look at the issues than the terms of the recommendations strictly demand. HSE supports that approach.
The report, 'The Rail Public Inquiries: HSC report on overall progress as of April 2003 on the remaining recommendations from the rail Public Inquiries', is accessible on the HSE website at: http://www.hse.gov.uk/railways/railpublic2.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. The industry reports that work on 92 of the recommendations is now regarded as complete, with action continuing on the remaining one recommendation (number 10).

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. Since the report was published, measures have been introduced to reduce the number of SPADs and the TPWS fitment programme is almost complete. The industry reports action on 18 recommendations is now complete. Action continues on 21 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 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 68 recommendations is now regarded as complete (i.e. a further 11 closed out since the last progress report). Action continues on the remaining recommendations.

4. The Ladbroke Grove Rail Inquiry Part 2 Report by Lord Cullen was published on 20 September 2001. It contained 74 recommendations, one 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 Body (RAIB) and a Rail Safety and Standards Body (RSSB); railway safety cases; HSE; safety leadership and skills; accreditation and licensing. Industry reports that action on 38 recommendations is now regarded as complete. Action continues on 36 recommendations.

5. HSC will continue to publish progress reports covering all the remaining Public Inquiry recommendations (provisional dates are 2004 with a final report in 2005). HSE will continue to track action on each recommendation to ensure that none are overlooked. Earlier reports are accessible on the HSE website at http://www.hse.gov.uk/railways/information.htm. The first themed progress report is on the same website at http://www.hse.gov.uk/railways/railpublic.pdf

6. The report refers to Railtrack PLC (Railtrack) as the owner and operators of the network and infrastructure. Railtrack PLC has now been acquired by Network Rail Holdco Ltd and will be 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.

7. This document 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.

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