RAIB - Serious operational irregularity at Balham

[Sunset route]

Possibly silly question from an outsider.

If the PICOP isn't going to be on site, wouldn't the best place from which to work be the signal box covering the area of the possession?

Face to face communication with the signaller when handing over responsibility for the trains would seem the safest way to do it.

But which signalbox or more to the point which signalling centre as three were involved. The one that the tamper entered from TBASC, the one where it should of crossed over TBROC or the one where it left from VASC? So if the PICOP is where the trains/machines exit from who’s going to watching where they enter from? I like the idea that PICOPs should be co-located with control or at least in the same building which would help immensely when problems arise and they always do.

 

[Dai Corner]

But which signalbox or more to the point which signalling centre as three were involved. The one that the tamper entered from TBASC, the one where it should of crossed over TBROC or the one where it left from VASC? So if the PICOP is where the trains/machines exit from who’s going to watching where they enter from? I like the idea that PICOPs should be co-located with control or at least in the same building which would help immensely when problems arise and they always do.

I'd say the one where trains leave the possession and re-enter the live railway as that move seems the most risky.

But signallers have said above they don't want PICOPs in their boxes and given valid reasons so I'll accept that my question was indeed a silly one!

 

[Sunset route]

I'd say the one where trains leave the possession and re-enter the live railway as that move seems the most risky.

But signallers have said above they don't want PICOPs in their boxes and given valid reasons so I'll accept that my question was indeed a silly one!

The problem is trains/machines can and do enter and leave possession at both ends as well as in the middle via crossovers.

I’ve been a signalman/signaller since British Rail days in both small one person signalboxes up to Large Area Signalling Centres. The days when the PICOP was both local to the area of work and used to at least pay a visit to a signalbox has dwindled to less and less as the privatised railway has moved along.

I was still under the assumption that when a PICOP changed shifts they at least saw each other face to face at handover when I received the PICOP update details, this report has blown that one open. This report has made me even distrusting when dealing with (some) PICOPs and COSSs than I was before.

You get to know you main PICOPs and how they work and which ones require more in depth discussions to get all the correct information to get that all important “clear understanding”, some are in such a hurry especially when handing back that you have to slow the conversation down or even drag it back to the start to get as I’ve already said “clear understanding”.

 

[ainsworth74]

I must admit this is another incident where I find myself thinking whether or not these are roles which Network Rail should be using contractors for. There will always be some need for contractors to provide elements of the workforce involved in maintenance and upgrade work but I can't help but feel roles like PICOPs, COSSs and similar are just so important to the safety of the railway and those that travel and work on it that they should be roles internal to Network Rail rather than relying on contractors.

 

[edwin_m]

I was still under the assumption that when a PICOP changed shifts they at least saw each other face to face at handover when I received the PICOP update details, this report has blown that one open.

Doing a handover when one of them is driving home and/or the other one is driving in is particularly alarming. Not just the direct risk of causing a road accident (probably more likely for a technical conversation than general chit-chat) but the inability to read or take notes makes it much more likely that an irregularity such as this one will result.

 

[Meerkat]

I am a total amateur but surely the PICOPS surely should be sitting in front of a graphical (either a screen or magnetic/pin board) representation of the worksite with symbols they can move around!
The idea of them trying to picture it in their head and convey it over a mobile whilst driving is pretty scary!
Even the high tech military might of the US Navy aircraft carriers have the ouija board!
https://www.airspacemag.com/military-aviation/how-things-work-the-ouija-board-10048217/

 

[Nicholas Lewis]

I am a total amateur but surely the PICOPS surely should be sitting in front of a graphical (either a screen or magnetic/pin board) representation of the worksite with symbols they can move around!
The idea of them trying to picture it in their head and convey it over a mobile whilst driving is pretty scary!
Even the high tech military might of the US Navy aircraft carriers have the ouija board!
https://www.airspacemag.com/military-aviation/how-things-work-the-ouija-board-10048217/

Any professional SPICOP managing multiple trains movements (8 or 10 quoted in report) with multiple worksites would have set up a magnetic board and ive seem them extensively used on big projects to show position of the trains/worksites. However, on routine possessions it is often the case that contractors SPICOPs would be used and ES's would never meet them as there were no PICOP briefings. As the report eludes to NR being an absentee landlord with respect to oversight of its contractors PICOPs its hardly surprising we have a group of people who have gone ferrule. Its high time this safety critical role was internalised to NR and not left to agencies to provide zero hour contract staff. Furthermore ORR should undertake much more surveillance of NRs oversight of its supply chain as well as more unannounced visits on labour agencies to determine the adequacy of there own competency management arrangements given they are all too often self assuring.

 

[jfollows]

If the PICOP isn't going to be on site, wouldn't the best place from which to work be the signal box covering the area of the possession?

Private Eye 1517 relates that the PICOP was variously at Cover House, taking calls in her car or at home, and that phone calls recorded during the job suggest her "working environment may have been inappropriate"; background noise "may have inhibited the quality and content" of safety-critical communications.

The article observes that she was not allowed to remain working at Cover House when no Network Rail staff were present "because of concerns about office security"

Private Eye 1517 6 March - 19 March 2020

SIGNAL FAILURES

Losing their tamper

THE absurdity of outsourcing railway maintenance is underlined in a recent incident report revealing that Network Rail (NR) doesn’t trust contractors to be in its offices alone - but happily puts those same supposedly untrustworthy individuals in charge of the safety of track workers and passengers on passing trains.

Part of the London-Brighton mainline near Balham, south-west London, was closed on 20 April last year for maintenance when a hefty tamper machine (which packs ballast under railway tracks) erroneously moved from the closed area on to a line that wasn’t closed. The 6.51pm Victoria to East Grinstead train would have smashed into it had the tamper made the move just 75 seconds earlier.

The maintenance job was fragmented across four external firms and NR (part of the Department for Transport). No surprise, then, that the Rail Accident Investigation Branch (RAIB) found: ”The standard of safety critical communications was poor throughout, resulting in no party having a clear understanding of the location of the tamper or the actions to be taken.”

NR expects people overseeing closed-track areas in the Sussex region to sit in the quiet of Cover House at Three Bridges, where they can view paperwork, access information-management systems and retrieve any missing documents. But the RAIB explains: “Vital [Human Resources] staff had been told by Network Rail that they were not allowed to work at Cover House if no Network Rail staff were present, because of concerns about office security.”

Vital Human Resources “engaged and supplied” the person in charge of the closed-track area near Balham. She left Cover House and drove home during the job. (Apparently working from home is “not uncommon” for contractors managing NR worksites, despite the potential distractions and reduced access to critical information.) She had lost the document detailing the route the tamper should have taken.

Phone calls recorded during the job suggest her “working environment may have been inappropriate”; background noise “may have inhibited the quality and content” of safety- critical communications, says the RAIB. Several calls “took place while one or both parties were driving motor vehicles” - ie endangering lives on roads and railways simultaneously. She had lost paperwork and mismanaged trains in closed-track areas twice before in 2019 (just four months into the year). Those incidents weren’t “formally reported or investigated by Network Rail or Vital” and thus weren’t on her personal record or training file.

The only conceivable reason NR outsource recurring maintenance is to use workers who aren’t employed on the usual terms for a government body (Eye 1501). To uphold safety, NR would have to monitor all contractors closely, but “man marking” is far too difficult and costly. Thus it relies on its contractors to manage “supplied” workers properly and report any shortcomings in their own activities – a policy with obvious flaws.

But at least NR has a policy to ensure that people entrusted with the lives of workers and passengers never steal NR paperclips or misuse
photocopiers. So that’s all right then.

‘Dr B Ching’

 

[edwin_m]

Private Eye 1517 relates that the PICOP was variously at Cover House, taking calls in her car or at home, and that phone calls recorded during the job suggest her "working environment may have been inappropriate"; background noise "may have inhibited the quality and content" of safety-critical communications.

Someone at Private Eye has read the RAIB report, which contained all these statements.

 

[Nicholas Lewis]

Someone at Private Eye has read the RAIB report, which contained all these statements.

Yes but they've critiqued it and specifically

..... that Network Rail (NR) doesn’t trust contractors to be in its offices alone - but happily puts those same supposedly untrustworthy individuals in charge of the safety of track workers and passengers on passing trains

or

The only conceivable reason NR outsource recurring maintenance is to use workers who aren’t employed on the usual terms for a government body (Eye 1501). To uphold safety, NR would have to monitor all contractors closely, but “man marking” is far too difficult and costly. Thus it relies on its contractors to manage “supplied” workers properly and report any shortcomings in their own activities – a policy with obvious flaws.

puts it into language that the lay person can make sense of. The sad fact is nothing will come of it and in next years RAIB annual report they will no doubt add this to there list of recommendations that NR have yet to implement.

 

[jfollows]

Nicholas, thank you for your comments.

The thing I didn't have the words for when I posted this morning, and should have done, but now think I do, is that the impression I had gained from various sources initially was of pointing fingers at the people operating the tamper and their lack of adherence to communication guidelines.

This may have been my error, I may have mis-interpreted or mis-read things.

But the Private Eye analysis points the finger in a totally different direction to the one I had assumed.

So my reading, including of the RAIB report, and Private Eye's come to different conclusions.

Which one is right is a different matter, but I'm interested in the points raised in Private Eye and more than happy to admit that my initial thoughts were wrong if so.

 

[PG]

I must admit this is another incident where I find myself thinking whether or not these are roles which Network Rail should be using contractors for. There will always be some need for contractors to provide elements of the workforce involved in maintenance and upgrade work but I can't help but feel roles like PICOPs, COSSs and similar are just so important to the safety of the railway and those that travel and work on it that they should be roles internal to Network Rail rather than relying on contractors.

I agree and I wonder if these roles were ever previously internal or would we have to go back to BR days to find the last time that they were in-house?

 

[Nicholas Lewis]

I agree and I wonder if these roles were ever previously internal or would we have to go back to BR days to find the last time that they were in-house?

In BR days they were most definitely in house in the Southern Region at best you may have got the odd lookout or PICOW (as was) with contractors. However, the level of paperwork was much diminished in those days and to my mind thats where this all started to go awry. The more roles that were created (MC, PICOS, Site Warden etc etc) then required more paperwork and then every time you had an incident invariable a recommendation would come out requiring the paperwork or process to be amended requiring more retraining and certification.

 

[Nicholas Lewis]

I must admit this is another incident where I find myself thinking whether or not these are roles which Network Rail should be using contractors for. There will always be some need for contractors to provide elements of the workforce involved in maintenance and upgrade work but I can't help but feel roles like PICOPs, COSSs and similar are just so important to the safety of the railway and those that travel and work on it that they should be roles internal to Network Rail rather than relying on contractors.

Senior PICOPS (SPICOPS) should be NR staff but the majority aren't in the old Southern region area. A SPICOP is required to manage big geographical possessions with multiple train and on track machines along with the interface to the operational railway. Thus in effect a pseudo signallers but without all the aids of diagrams and protection systems to support them so a a pretty responsible job yet we find in this incident a SPICOP managing it whilst driving there car. RAIB make the observations but never outright say things are wrong always using recommendations to try and lead the owner to that outcome.

 

[Dai Corner]

Nicholas, thank you for your comments.

The thing I didn't have the words for when I posted this morning, and should have done, but now think I do, is that the impression I had gained from various sources initially was of pointing fingers at the people operating the tamper and their lack of adherence to communication guidelines.

This may have been my error, I may have mis-interpreted or mis-read things.

But the Private Eye analysis points the finger in a totally different direction to the one I had assumed.

So my reading, including of the RAIB report, and Private Eye's come to different conclusions.

Which one is right is a different matter, but I'm interested in the points raised in Private Eye and more than happy to admit that my initial thoughts were wrong if so.

A very good example of a journalist leading his readers to reach different conclusions than they would have had they read the report his article was based on themselves.

Was it intentional? Who knows. But it's worth remembering that everything you see in the mainstream media could be similarly misleading and generally we don't have the knowledge or access to detailed reports to realise.

 

[PG]

In BR days they were most definitely in house

Thanks for the clarification.

RAIB make the observations but never outright say things are wrong always using recommendations to try and lead the owner to that outcome.

Come back Major Rose of the Railway Inspectorate, his reports always read like the cause had either already been fixed or was in the process of getting fixed.