Collision and derailment at Neville Hill Depot (13/11/2019)

[Surreytraveller]

We didn't have these issues before trains had computers on them

 

[Crossover]

Interestingly we also now have the Bromsgrove report, which is again down to driver inattention as he's doing something else (this time on his phone) at a time when he particularly ought to be concentrating as he's about to hit something.

I’m not sure comparisons between the two are particularly helpful. One appears (from my reading) to have involved distraction by a personal device which shouldn’t have been anywhere near the driver where the other was in some way more in the control of the railway

 

[Wilts Wanderer]

We didn't have these issues before trains had computers on them

Bi-mode trains have brought these complexities, not computers.

 

[Swimbar]

Bi-mode trains have brought these complexities, not computers.

Some seem to be spending alot of time suggesting changes to the infrastructure and ways of working due to one accident.
Human error was at fault, albeit with major mitigating factors.
Choose what we do there will ultimately be a human making the decisions.
IET trains transit between Leeds and Neville Hill all day every day and the other 99% of drivers dont hit anything.

 

[Taunton]

IET trains transit between Leeds and Neville Hill all day every day and the other 99% of drivers dont hit anything.

Well with that approach we can do away with AWS/TPWS ("the other 99% of drivers manage to stop at a red"), the deadman ("the other 99% of drivers manage to stay alive"), banner repeaters ("the other 99% of drivers manage to see the signal"), etc ...

 

[ainsworth74]

Well with that approach we can do away with AWS/TPWS ("the other 99% of drivers manage to stop at a red"), the deadman ("the other 99% of drivers manage to stay alive"), banner repeaters ("the other 99% of drivers manage to see the signal"), etc ...

Nice strawman you've got there...

Some seem to be spending alot of time suggesting changes to the infrastructure and ways of working due to one accident.
Human error was at fault, albeit with major mitigating factors.
Choose what we do there will ultimately be a human making the decisions.
IET trains transit between Leeds and Neville Hill all day every day and the other 99% of drivers dont hit anything.

Quite. Human error was at fault and a lot of underlying factors that led to it have been identified. Strikes me that the next step is to make the necessary changes to the training materials (including Hitachi to consider how they present the information to their customers), for LNER to reflect on their training and competency management, possibly to look at further changes to the TMS to make it more intuitive, etc etc. Rather than faffing with beacon locations or changes to the behaviour of the trains (which itself would represent an increased risk as the hundreds of drivers that have learned how it works one way successfully without incident would now have to learn how it works in a different way).

 

[Crossover]

banner repeaters ("the other 99% of drivers manage to see the signal")

To be pedantic, my understanding is that banner repeaters are designed to be used to aid performance (driver sees in advance that the signal is off and can therefore motor earlier) rather than being used as a substitute for spotting a red

 

[heedfan]

To be pedantic, my understanding is that banner repeaters are designed to be used to aid performance (driver sees in advance that the signal is off and can therefore motor earlier) rather than being used as a substitute for spotting a red

You aren't being pedantic. Banner repeaters are used to increase the distance at which the aspect of a signal can be determined by the driver, usually in locations where curvature of the track or lineside structures render the signal impossible to see at the same distance.

Whilst they have their limitations (see the differences between three state banner repeaters and non-colour models for further reading), to suggest that 99% of drivers can see the main signal without the associated banner repeaters in place simply shows a lack of understanding on the subject.

 

[theageofthetra]

The report makes it plain that the driver is the cause of the accident, albeit with very strong mitigating circumstances.
The major issue, to me, identified in the report is that it makes it plain that we should not be surprised if an Azuma derails in a very low speed collision.
Thankfully the train is likely to remain upright.

What if a shunter, track worker or other was standing nearby at track level? Seems a pretty significant risk to me

 

[ComUtoR]

We didn't have these issues before trains had computers on them

These issues have always been there and will continue to be there because of the railways aversion to change. For years, the railway has refused to adjust anything for the human factor in anything and is far too busy being immersed in out of date working practices and culture. They live by their standards and seem shocked that these standards are often factors in incidents.

Computers have just made it worse. I've driven with just "air and amps" and driven the latest and greatest all singing and dancing modern units. "Computer says no" is commonplace and the overly complicated onboard systems have added new incidents and new complications.

 

[theageofthetra]

Nail on the head..

Agreed. How you can develop something without the full involvement of the end user is beyond me.

 

[Taunton]

Whilst they have their limitations (see the differences between three state banner repeaters and non-colour models for further reading), to suggest that 99% of drivers can see the main signal without the associated banner repeaters in place simply shows a lack of understanding on the subject.

Not at all. Installing a banner repeater on the Down at Shenfield was the most effective of the measures to deal with a multiple-SPAD signal. There was an article in Modern Railways a while back describing the various alleviations and which was the most worthwhile.

 

[Crossover]

You aren't being pedantic. Banner repeaters are used to increase the distance at which the aspect of a signal can be determined by the driver, usually in locations where curvature of the track or lineside structures render the signal impossible to see at the same distance.

Whilst they have their limitations (see the differences between three state banner repeaters and non-colour models for further reading), to suggest that 99% of drivers can see the main signal without the associated banner repeaters in place simply shows a lack of understanding on the subject.

Agreed on the first point, but I believe a driver relying on a banner to determine a signal that is on could be more prone to come to grief (assume the signal is on and if the signal is shown to be off, then one can motor a little sooner, aiding performance)

On your second point, I am not suggesting any percentage of anything, that is yourself implying. Either way @ainsworth74 pointed out the strawman arguement and we are deviating wildly off topic so I will leave it there

 

[heedfan]

Agreed on the first point, but I believe a driver relying on a banner to determine a signal that is on could be more prone to come to grief (assume the signal is on and if the signal is shown to be off, then one can motor a little sooner, aiding performance)

On your second point, I am not suggesting any percentage of anything, that is yourself implying. Either way @ainsworth74 pointed out the strawman arguement and we are deviating wildly off topic so I will leave it there

The 99% I was referring to came from the earlier post by another user. I am making the point that suggesting that 99% of drivers can see the main signal at the same distance of the BR misrepresents most instances of where and why they are installed.

But yes, let's get back on topic

 

[Swimbar]

The 99% I was referring to came from the earlier post by another user. I am making the point that suggesting that 99% of drivers can see the main signal at the same distance of the BR misrepresents most instances of where and why they are installed.

But yes, let's get back on topic

The 99% I referred to was regarding the transit from Leeds to Neville Hill.
That's what we are supposed to be discussing not using it to justify, or otherwise, matters unconnected with this.
The RIAB report makes no recommendations to alter the existing procedures on the route used by this particular IET

 

[daikilo]

We didn't have these issues before trains had computers on them

When drivers got personal smartphones they were told to switch them off and put them in their bag. Now they have a built-in PC within hand reach which is on permanently (and at say 60 degrees to the forward sight line). Just saying ...

 

[Undiscovered]

What, if anything, will happen to the person who assessed the driver as competent?

I know from my experiences as an assessor that i have to complete detailed records ensuring i have satisfactorily seen the candidate demonstrate and meet each of the criteria. These are objective, not subjective too.

I'm not pointing fingers, just curious.

 

[Camberman]

The RAIB report does not mention that the TMS screens presented to the driver are not in QWERTY format (see figures 6 and 7 of the report). Like most people who use a mobile phone, laptop or other device I'm totally familiar with QWERTY entry and to be faced with a non-QWERTY layout would mean having to take a little longer to search for the correct keys resulting in distraction from the prime objective of monitoring whatever is ahead. Would there be any reason why these screens are not in QWERTY format?

 

[Grumpy Git]

The RAIB report does not mention that the TMS screens presented to the driver are not in QWERTY format (see figures 6 and 7 of the report). Like most people who use a mobile phone, laptop or other device I'm totally familiar with QWERTY entry and to be faced with a non-QWERTY layout would mean having to take a little longer to search for the correct keys resulting in distraction from the prime objective of monitoring whatever is ahead. Would there be any reason why these screens are not in QWERTY format?

Good spot.

Non-QWERTY keyboards are by and large an absolute nightmare to navigate, (unless you have never had any computer experience whatsoever).

Anyone under retirement age I would suggest would find a non QWERTY keyboard "hard work"? Even my late dad had a dabble on an Acorn back in the day and he would be 90 if he was still alive!

 

[godfreycomplex]

We didn't have these issues before trains had computers on them

We didn’t have this issues when everyone travelled by horse and cart either

 

[Mcq]

Do the heaters use much power - is there a case for connecting them to a thermostat to keep them near op temp?

Sorry if this seemed a daft question but in my house thermostats keep things at the right temperature without me having to turn them on and off to have a bath. Why is this option given to the driver to worry about when it should be automatic?
As an ex tv cameraman, manufactures took enormous care not to present every control they could imagine on the back of the camera - and design of operational controls was always done with input from camera staff - or else they didn't sell any..

 

[bengley]

What decision is there for a driver to make though?

Is a TOC seriously going advise their drivers to park up on the mainline for 10 minutes, stopping the job and causing disruption, just so they can preheat the engines? Of course not. It's easier and more convenient for everyone (and I'd suggest also cheaper) to take the hit on maintenance and worry about the increased wear on the engines after the fact.

I wasn't suggesting the train would have to be 'parked' up on the mainline for 10 minutes.

I don't drive bi-mode trains, but as a driver I would prefer if my train didn't make such a decision to change power modes without my acknowledgement unless it was an emergency.

But obviously I don't know what I'm talking about because I only sign electrics.

 

[heedfan]

I wasn't suggesting the train would have to be 'parked' up on the mainline for 10 minutes.

I don't drive bi-mode trains, but as a driver I would prefer if my train didn't make such a decision to change power modes without my acknowledgement unless it was an emergency.

But obviously I don't know what I'm talking about because I only sign electrics.

That's a fair point regarding acknowledgement. I still don't see what the alternative choice is in normal running - either the set stops on the line to preheat or the engines start up and you carry on, but I appreciate the opportunity to acknowledge could have prevented this.

But, in this instance, if we consider the headcode that the train was running under on the two nights previous (1D29 I think, which was invalid as that headcode should have terminated at Leeds) then according to the APCo equipment this was a train without the correct information travelling with pan up under the wires on a line where the wires are shortly going to run out. I would say this is a situation where urgent intervention is required.

As has been said a few times now, the RAIB report comes down to human factors. The equipment and technology has worked the way it is supposed to, but the training and competency assessment has not.

 

[father_jack]

Good spot.

Non-QWERTY keyboards are by and large an absolute nightmare to navigate, (unless you have never had any computer experience whatsoever).

Anyone under retirement age I would suggest would find a non QWERTY keyboard "hard work"? Even my late dad had a dabble on an Acorn back in the day and he would be 90 if he was still alive!

It was a shock to the system when new technology came in the booking offices- the old APTIS ticket machines were ABCDE not QWERTY !!!

 

[bengley]

That's a fair point regarding acknowledgement. I still don't see what the alternative choice is in normal running - either the set stops on the line to preheat or the engines start up and you carry on, but I appreciate the opportunity to acknowledge could have prevented this.

But, in this instance, if we consider the headcode that the train was running under on the two nights previous (1D29 I think, which was invalid as that headcode should have terminated at Leeds) then according to the APCo equipment this was a train without the correct information travelling with pan up under the wires on a line where the wires are shortly going to run out. I would say this is a situation where urgent intervention is required.

As has been said a few times now, the RAIB report comes down to human factors. The equipment and technology has worked the way it is supposed to, but the training and competency assessment has not.

Aye urgent intervention needed in the sense the pan needed to be dropped - 100% agree. But the diesel engines didn't need to be started.

Ultimately the solution is to enter the headcode properly. I've been given loads of wrong information on training courses before but generally work it out for myself and start doing it correctly.

 

[Horizon22]

Ultimately the solution is to enter the headcode properly. I've been given loads of wrong information on training courses before but generally work it out for myself and start doing it correctly.

I commend your initiative, but really training should be delivered to the letter. If you're being taught something, you should expect it to be correct. It is evident that this is primarily a human factors incident. A lot of experienced drivers of many years have trained with a mechanical mind, and now have to develop technological skills. That's not always a smooth transition and while computer systems can be very helpful, more operators are gradually realising that this might require a slightly different style of training with drivers who have been around 20-30 years that were used to HSTs.

 

[Dieseldriver]

Aye urgent intervention needed in the sense the pan needed to be dropped - 100% agree. But the diesel engines didn't need to be started.

Ultimately the solution is to enter the headcode properly. I've been given loads of wrong information on training courses before but generally work it out for myself and start doing it correctly.

At what point do you work it out for yourself and start doing it correctly? This bloke had only had a couple of solo trips on the new traction.

 

[ComUtoR]

I commend your initiative, but really training should be delivered to the letter. If you're being taught something, you should expect it to be correct. It is evident that this is primarily a human factors incident. A lot of experienced drivers of many years have trained with a mechanical mind, and now have to develop technological skills. That's not always a smooth transition and while computer systems can be very helpful, more operators are gradually realising that this might require a slightly different style of training with drivers who have been around 20-30 years that were used to HSTs.

I've been through a few traction courses over the years and one of the issues isnt about the training being delivered "to the letter" That itself creates more issues than solves. A big problem with trains is that they don't perform as expected or, on many occasions, "by the book" Modern trains are a nightmare for it. Also, during the 700 introduction the software and unit got modified and updated during the introduction. On many occasions there were small but significant changes.

 

[irish_rail]

Surely the main underlying issue is the driver has had 2 SPADs previously. For most drivers that would be career ending. Why did he keep his key after 2 SPADs? The question must come down to driver management and why said driver wasn't moved to alternative duties earlier once it became apparent he maybe didn't have the aptitude for train driving (not everyone does).

 

[Crossover]

Surely the main underlying issue is the driver has had 2 SPADs previously. For most drivers that would be career ending. Why did he keep his key after 2 SPADs? The question must come down to driver management and why said driver wasn't moved to alternative duties earlier once it became apparent he maybe didn't have the aptitude for train driving (not everyone does).

From my recollection of the report, the driver was a long serving one, not new to the role. However they had been out of the seat for much of the previous 2 years following time off for personal reasons. As I recall one of the SPADs was just before they went off and one was on the return to the role