Welshpool crossing crash (22/06/20)

[6Gman]

All too easy to open the first gate, drive forward, and then realise the 2nd gate is shut, surely. I don't think anyone would do it on purpose, but it's not unlikely.

In opening the first gate would it not be normal to look at the other side of the crossing? And notice any shut gate obstructing your progress?

 

[gsnedders]

Something I find difficult about the railway is it seems from an outsider's point of view that if there isn't a way to make a 100% reliable safety critical system, the preference seems to be to not have a system at all.

There have been too many accidents at UWCs recently, and they are not intuitive for the general public to use. It would not be too difficult or expensive to come up with a system using GPS and mobile phone technology that switches a green light to red at a crossing when a train is around 2 minutes away, or switches on a flashing red 'contact the signaller' light if it loses contact with the next train (or if that train's GPS says it is on the dogger bank) , but because this couldn't be made 100% accurate (even though in this case it would fail safe), the preference is to keep the current system, which isn't remotely fail safe, especially if the user doesn't need to phone back.

And as with many safety critical systems, UWCs are only as safe as the weakest component, and that will almost always be the user's ability/willingness to follow the process. If we can increase the ability/willingness of the user to follow the process then we can make a net gain in crossing safety regardless of whether the system occasionally falls back to the existing process internally.

 

[Spartacus]

All too easy to open the first gate, drive forward, and then realise the 2nd gate is shut, surely. I don't think anyone would do it on purpose, but it's not unlikely.

There aren’t that many pea souper fogs any more.

The issue with so many solutions is that they don’t solve the problem of wilful misuse, which is the main cause of incidents at crossings. There’ll always be someone who thinks they’ve enough time, thinks it’s broken because there’s not a train due then....

 

[Belperpete]

Something I find difficult about the railway is it seems from an outsider's point of view that if there isn't a way to make a 100% reliable safety critical system, the preference seems to be to not have a system at all.

There have been too many accidents at UWCs recently, and they are not intuitive for the general public to use. It would not be too difficult or expensive to come up with a system using GPS and mobile phone technology that switches a green light to red at a crossing when a train is around 2 minutes away, or switches on a flashing red 'contact the signaller' light if it loses contact with the next train (or if that train's GPS says it is on the dogger bank) , but because this couldn't be made 100% accurate (even though in this case it would fail safe), the preference is to keep the current system, which isn't remotely fail safe, especially if the user doesn't need to phone back.

Who would be liable when your fallible system was the direct cause of an accident? No sane person is going to instal something that has a high likelihood of landing them in jail for manslaughter. The number of lives that it might have saved in the interim would be immaterial.

 

[BayPaul]

There aren’t that many pea souper fogs any more.

No, but there are people who get slightly distracted when carrying out a task, and don't do it 100% perfectly. If a driver gets distracted, and misses a red signal, safety systems cut in and bring his train safely to a halt. If someone gets distracted and forgets to open a gate (perhaps they have just come over a half barrier crossing, and forgotten that this crossing has gates on both sides, perhaps it is dark and their angled headlights don't clearly illuminate the gate on the other sid, perhaps its the end of a long day and they are operating on autopilot, perhaps they figure that because they have called the signaller there is no great hurry to get across as the signaller won't send a train until they are clear), then there is no safety system to protect them . All of these are wrong, but, not difficult to do.

 

[BayPaul]

Who would be liable when your fallible system was the direct cause of an accident? No sane person is going to instal something that has a high likelihood of landing them in jail for manslaughter. The number of lives that it might have saved in the interim would be immaterial.

I think it would be possible to design a system that failed safe. Looking at the reverse case, who would be liable who carried out a risk assessment at a crossing with no safety system if there was an accident

 

[yorkie]

Looks like we are getting into speculative ideas territory here; just a gentle reminder that if anyone has any suggestions for changes to procedures, infrastructure, services or anything else, these should generally be posted exclusively in the Speculative Ideas section. If in doubt, please contact us directly.

I am locking this thread now. If anyone has any updates regarding this incident, please report this post. As always if anyone wishes to add anything to a locked thread, please do submit to us what you would like to post, using the report button, and we will consider all such requests.

 

[ainsworth74]

RAIB published an update on this incident last week and have decided not to continue their investigations after a preminiary examination of the event. They highlight a similar incident at Frognal Farm user-worked crossing in October 2017 and the conclusions from that accident as well as from a few other accidents as well. Details below:

At around 13:44 hrs on Monday 22 June 2020, a Transport for Wales (TfW) train struck a van which was foul of the track at Smiths Lower Cefn user-worked crossing (UWC), near Welshpool. When the collision occurred, the van driver was in the area of the vehicle’s open offside door. The collision caused the van to spin around, projecting the van driver into an adjacent field. The van driver suffered serious, life affecting injuries because of the collision. Based on the evidence found on site, and the position of the van as was seen on the train’s forward-facing CCTV, RAIB considers that it is possible that the far side gate of the crossing began to swing back as the van crossed, causing the driver to stop and attempt to get out of the van while it was still foul of the line.

TfW notified RAIB of the accident soon after it occurred. We have since gathered evidence from the railway industry and carried out a preliminary examination into the circumstances in which it occurred.

Based on the evidence gathered, RAIB has concluded that the accident occurred because the van driver did not call the signaller in control of the crossing to get permission to cross, prior to doing so. RAIB has not been able to determine with certainty why he did not call. The van driver was unfamiliar with the crossing, and with user worked crossings in general. RAIB considers that it is probably the case that the van driver also did not read some, or all of the instructions on the signage at the crossing, prior to using it.

RAIB has reviewed the findings of its preliminary examination and has decided not to carry out any further investigation of the accident. RAIB previously investigated a similar accident at Frognal Farm UWC in October 2017 (RAIB report 10/2019), which covered topics relevant to the accident at Smiths Lower Cefn UWC. Findings from that investigation showed that the van driver in that accident also did not use the telephone to contact the signaller. This was in part because the information on the signs at the crossing were not clear and concise, and unfamiliar users could misunderstand the instructions. Of particular relevance to the accident at Smiths Lower Cefn UWC was RAIB’s finding that the requirement to stop and call the signaller could be overlooked as it was not present in the numbered list of instructions lower down the sign.

RAIB made four recommendations from the Frognal Farm investigation. Two of these, addressed to a combination of Network Rail, the Office of Rail and Road (ORR) and the Department for Transport (DfT), specifically related to the provision of signage, and improving the clarity, conspicuity and wording of instructions to crossing users. At the time of writing, both recommendations are being progressed towards implementation.

Recommendation 1 also considers the issue of how authorised users are expected to be briefed in the context of the ever-increasing use of contractor-driven delivery vehicles to private and commercial properties. This also raises the more general issue of the concept of an authorised user in the current circumstances.

RAIB has previously carried out many investigations into other accidents and near-miss incidents at user worked crossings, including a class investigation (RAIB report 13/2009) into such crossings, which was published in 2009. The class investigation noted a previous collision at Smiths Lower Cefn UWC on 10 September 2008, where the driver of a lorry admitted using the crossing without calling the signaller. Near-miss incidents at such crossings are often notified to RAIB or are seen in Network Rail’s daily control log. An investigation into a near-miss at Coltishall Lane UWC-T on 21 January 2021 is currently ongoing (details on the RAIB website).

Given the risk posed by such crossings, and the large number still present on the network, RAIB remains concerned that accidents and incidents will continue to occur unless substantive action is taken.

RAIB has written to Network Rail, copied to ORR and DfT, to alert them to this event and the need for action to implement previously made recommendations.

Collision at Smiths Lower Cefn user-worked crossing

Preliminary examination into a collision at Smiths Lower Cefn user-worked crossing, near Welshpool, on 22 June 2020.

www.gov.uk

 

[LNW-GW Joint]

The BBC Wales news headline on this report is not exactly neutral about the level crossing situation on the railway.
Wales' level crossings need urgent safety changes, report says - BBC News

It quotes DfT and NR responses, with some action already taken by NR:

Network Rail said safety was its "priority".
Christine Booth, its level crossings risk advisor, said: "We are installing red and green lights to some of the highest risk private crossings and public footpath crossings across Wales to make them safer.
"This includes at Smith crossing in Powys and follows safety improvements already made at crossings such as Ty Gwyn and Pen Uchaf on the north Wales coast."

 

[Meole]

Local paper takes similar stance, fault lies with the railway rather than the driver in this instance :-

Investigators find crossing signs 'not clear' when train collided with van

Investigators have found that railway crossing signs were not clear after a train hit a van that was on a track near Welshpool.

www.countytimes.co.uk

Investigators find crossing signs 'not clear' when train collided with van​

 

[Taunton]

Local paper takes similar stance, fault lies with the railway rather than the driver in this instance :-

Well, that's what the RAIB have said, that the signage was not clear for a first time user

"the information on the signs at the crossing were not clear and concise, and unfamiliar users could misunderstand the instructions. Of particular relevance to the accident at Smiths Lower Cefn UWC was RAIB’s finding that the requirement to stop and call the signaller could be overlooked as it was not present in the numbered list of instructions lower down the sign."

- from the RAIB link above.

The illustration in that link is not clear enough to read the signs, but visible are 5 separate signs, which presumably are all duplicated in English and Welsh, which does seem a lot for a first time user to take in.

 

[Sheridan]

The illustration in that link is not clear enough to read the signs, but visible are 5 separate signs, which presumably are all duplicated in English and Welsh, which does seem a lot for a first time user to take in.

The only one which appears to have both languages is the furthest left. The main one with the red panel above the white one is English-only. (I can only see four signs though so I may be overlooking one!)

 

[Meole]

A reduction in line speed until the recommended warning light upgrades take place would seem appropriate.

 

[Llanigraham]

A reduction in line speed until the recommended warning light upgrades take place would seem appropriate.

Do you realise how many UWC's there are just on the Cambrian?
If you intend reducing speed for all of them it doubt you'd be able to keep anywhere near the timetable.
All it needs is a blasted big sign saying "USE THE PHONE BEFORE YOU CROSS!!"

 

[Llanigraham]

And to add, the sign on the gate is not a railway sign.