Derailment in Summit tunnel, near Todmorden, West Yorkshire
28th December 2010
Details to follow are now below.
The Rail Accident Investigation Branch Summary including their 5 recommendations.
My reports, which if acted upon could have prevented this along with a simple but effective solution I put forward, but for those of you who have been following this website you know what I have to say next...They were as was the norm with TransPennine Express Managers, namely, Peter Turpin, Stephen Percival and Andrew Steele.
IGNORED
The 3 Managers named above are the only Managers that would have had access to my reports at that time, so why did they sit back and do absolutely nothing?
I CHALLENGE ALL 3 OF YOU TO DENY THIS ACCUSATION.
Summary:
In the early hours of 28 December 2010, a passenger train was travelling from Manchester to Leeds when it struck a large amount of ice that had fallen onto the tracks from a ventilation shaft in Summit tunnel. All wheels of the front bogie were derailed to the left in the direction of travel causing the front driving cab of the train to strike the tunnel wall. The train remained upright and once it had stopped, the train crew took action to protect the train and raise the alarm. About three hours later, the passengers and train crew had been led out of the tunnel by the emergency services. No injuries were reported, while the train suffered damage to its cab windscreen, a coupler, bodywork and underframe. There was minor damage to the track.
The ice formed as water, seeping through the lining of a ventilation shaft, froze during a long period of freezing temperatures. This ice fell onto the track after a thaw which started on 27 December 2010. The train, which was the first to pass through the tunnel in over three days due to the Christmas holiday period, then collided with it. A combination of factors led to this accident:
THE FOLLOWING ARE EXTRACTS FROM THE RAIB INVESTIGATION REPORT
1. The sole purpose of a Rail Accident Investigation Branch (RAIB) investigation is to prevent future accidents and incidents and improve railway safety.
I offered my reports to the RAIB just after this incident occurred. “Prevent future accidents and incidents and improve railway safety”! Funny enough, that is all I ever tried to do, but like always, coming up against the proverbial brick wall, because nobody is interested.
19. He (Driver Mark Brooks) had 20 years experience of driving and was very familiar with the route and this type of train. The driver had not been involved in any similar accidents or incidents during his career. However, he had seen ice in tunnels on many occasions during winter months, with icicles brushing the roof of his train but not causing any damage to it.
Did he report this ice build up? If not, then why not? Not that it would have made one iota of difference, hence the reason he and all other Driver's never report anything. Its the culture that TransPennine Express management promote.
Please remember, I supposedly didn`t notify control of a partial failure of the warning horn, supposedly putting the whole of the railway at risk, yet here we have another Driver admitting seeing ice in tunnels, ice that actually brushes the roof of his train, ice that is an evident danger, ice that would one day actually cause this accident. Did this Driver get charges of Gross Misconduct for not reporting?
137 The RAIB searched a national rail industry system for similar incidents in Summit tunnel since 1990 but NONE WERE FOUND. A wider search for incidents involving trains striking ice or icicles in other tunnels listed ten such incidents. These all involved train drivers reporting that their train had struck an object in a tunnel which resulted in little or no damage. Subsequent examinations by the next train through or infrastructure maintenance staff found ice or icicles at the reported location.
Do you think that the 2 reports of mine that appear below were actually in these ten reports?
1st Report dated 16th December 2007
The Rail Accident Investigation Branch Summary including their 5 recommendations.
My reports, which if acted upon could have prevented this along with a simple but effective solution I put forward, but for those of you who have been following this website you know what I have to say next...They were as was the norm with TransPennine Express Managers, namely, Peter Turpin, Stephen Percival and Andrew Steele.
IGNORED
The 3 Managers named above are the only Managers that would have had access to my reports at that time, so why did they sit back and do absolutely nothing?
I CHALLENGE ALL 3 OF YOU TO DENY THIS ACCUSATION.
Summary:
In the early hours of 28 December 2010, a passenger train was travelling from Manchester to Leeds when it struck a large amount of ice that had fallen onto the tracks from a ventilation shaft in Summit tunnel. All wheels of the front bogie were derailed to the left in the direction of travel causing the front driving cab of the train to strike the tunnel wall. The train remained upright and once it had stopped, the train crew took action to protect the train and raise the alarm. About three hours later, the passengers and train crew had been led out of the tunnel by the emergency services. No injuries were reported, while the train suffered damage to its cab windscreen, a coupler, bodywork and underframe. There was minor damage to the track.
The ice formed as water, seeping through the lining of a ventilation shaft, froze during a long period of freezing temperatures. This ice fell onto the track after a thaw which started on 27 December 2010. The train, which was the first to pass through the tunnel in over three days due to the Christmas holiday period, then collided with it. A combination of factors led to this accident:
- the risk of ice, particularly ice falls onto the track, was not identified before the train service resumed so the train was allowed to enter Summit tunnel while running at its maximum permitted speed; and
- the routine maintenance regime did not identify excessive ice in the tunnel and no additional inspections were carried out.
THE FOLLOWING ARE EXTRACTS FROM THE RAIB INVESTIGATION REPORT
1. The sole purpose of a Rail Accident Investigation Branch (RAIB) investigation is to prevent future accidents and incidents and improve railway safety.
I offered my reports to the RAIB just after this incident occurred. “Prevent future accidents and incidents and improve railway safety”! Funny enough, that is all I ever tried to do, but like always, coming up against the proverbial brick wall, because nobody is interested.
19. He (Driver Mark Brooks) had 20 years experience of driving and was very familiar with the route and this type of train. The driver had not been involved in any similar accidents or incidents during his career. However, he had seen ice in tunnels on many occasions during winter months, with icicles brushing the roof of his train but not causing any damage to it.
Did he report this ice build up? If not, then why not? Not that it would have made one iota of difference, hence the reason he and all other Driver's never report anything. Its the culture that TransPennine Express management promote.
Please remember, I supposedly didn`t notify control of a partial failure of the warning horn, supposedly putting the whole of the railway at risk, yet here we have another Driver admitting seeing ice in tunnels, ice that actually brushes the roof of his train, ice that is an evident danger, ice that would one day actually cause this accident. Did this Driver get charges of Gross Misconduct for not reporting?
137 The RAIB searched a national rail industry system for similar incidents in Summit tunnel since 1990 but NONE WERE FOUND. A wider search for incidents involving trains striking ice or icicles in other tunnels listed ten such incidents. These all involved train drivers reporting that their train had struck an object in a tunnel which resulted in little or no damage. Subsequent examinations by the next train through or infrastructure maintenance staff found ice or icicles at the reported location.
Do you think that the 2 reports of mine that appear below were actually in these ten reports?
1st Report dated 16th December 2007
This was Standedge Tunnel, but the issues raised in this report could apply to any tunnel. The contents speak for themselves, especially, "the standing water and leaks along the walls freeze", and, "A build up of standing water represents a serious danger".
What did my immediate management do about this report? We all know the answer to that, ABSOLUTELY NOTHING.
Driver Managers are required apparently from their Post Requirements to:
SAFETY RESPONSIBILITY STATEMENT (You are responsible for)
GENERAL RESPONSIBILITIES.
1. Taking reasonable care of your own health and safety and that of any person who may be affected by your acts or omissions at work.
3. Informing your line manager of any health and safety problems identified by yourself or identified to you by your staff or any other person
Number 3, Looking at my report above, would you describe what I have said as identifying a safety problem?
Route Driver Manager Post Requirements:
Demands of the post.
1.2 Leadership of the driver management team for the allocated TPE route,
ensuring full compliance with safety standards, a constant upward trend on those train performance indicators which are the responsibility of drivers, a cohesive and content workforce and a high degree of briefing and information provision. A characteristic will be empowerment of the driver management team to ensure that the above goals are achieved from their perspective.
Where was this "Leadership"? Is full compliance with safety standards classed as ignoring Driver`s concerns?
KEY ACCOUNTABILITIES
2.4 Ensure all line management issues relating to drivers, including sickness management, recruitment, discipline, welfare and appraisals are managed consistently and comprehensively at local level. Implement company employment policies and procedures as appropriate in relation to the designated team. (Note that these aspects of job accountability will compromise the bulk of the individual leadership workload and challenge on the post).
“Ensure all issues relating to drivers are managed consistently”, hardly consistent when all drivers are guilty if not worse than myself when it comes to carrying out the warning horn procedures and faxing of the blue repair slip. Also where is the consistency in the grievance procedures, absolutely flawed, even to this very day as evidence I have from other Drivers.
2.7 Ensure that safety briefings take place at the required intervals, includes personal input to these and the associated TPE update.
Never, never, never, have these briefs been carried out consistently. In 2008 customer care courses took precedent. Look at my own record of 3 safety briefs in 5 years! Emails from drivers also complain about lack of safety briefs.
2.10 Responsible for relevant interaction with external bodies such as Network Rail, Occupational Health Physicians and others for all driver management issues.
So why was my issues with Siemens on unit defects and my issue on passive smoking involving Network Rail and other TOC`s not taken up? Including the disgraceful state of the messrooms at York and Manchester Oxford Road.
SPECIFIC RESPONSIBILITIES (As Route Manager you must ensure)
1. You are familiar with, understand and discharge to the best of your ability the specific safety responsibilities associated with your post and any other safety responsibilities allocated to you, from time to time and in writing, by your line manager.
2. The health, safety and welfare of any staff or any other persons who are under your control
3. Comply fully with any instruction, procedure or other requirement that is necessary to ensure the safety of any person that may be affected by their acts or omissions.
4. That any unsafe activity is immediately stopped and prevented from continuing until adequate measures have been taken to reduce the risk associated with that activity to as low as reasonably practicable.
This all looks good on paper, but in the real world, with what I have shown so far throughout this website, (with more added on an ongoing basis), do they really care?
What did my immediate management do about this report? We all know the answer to that, ABSOLUTELY NOTHING.
Driver Managers are required apparently from their Post Requirements to:
SAFETY RESPONSIBILITY STATEMENT (You are responsible for)
GENERAL RESPONSIBILITIES.
1. Taking reasonable care of your own health and safety and that of any person who may be affected by your acts or omissions at work.
3. Informing your line manager of any health and safety problems identified by yourself or identified to you by your staff or any other person
Number 3, Looking at my report above, would you describe what I have said as identifying a safety problem?
Route Driver Manager Post Requirements:
Demands of the post.
1.2 Leadership of the driver management team for the allocated TPE route,
ensuring full compliance with safety standards, a constant upward trend on those train performance indicators which are the responsibility of drivers, a cohesive and content workforce and a high degree of briefing and information provision. A characteristic will be empowerment of the driver management team to ensure that the above goals are achieved from their perspective.
Where was this "Leadership"? Is full compliance with safety standards classed as ignoring Driver`s concerns?
KEY ACCOUNTABILITIES
2.4 Ensure all line management issues relating to drivers, including sickness management, recruitment, discipline, welfare and appraisals are managed consistently and comprehensively at local level. Implement company employment policies and procedures as appropriate in relation to the designated team. (Note that these aspects of job accountability will compromise the bulk of the individual leadership workload and challenge on the post).
“Ensure all issues relating to drivers are managed consistently”, hardly consistent when all drivers are guilty if not worse than myself when it comes to carrying out the warning horn procedures and faxing of the blue repair slip. Also where is the consistency in the grievance procedures, absolutely flawed, even to this very day as evidence I have from other Drivers.
2.7 Ensure that safety briefings take place at the required intervals, includes personal input to these and the associated TPE update.
Never, never, never, have these briefs been carried out consistently. In 2008 customer care courses took precedent. Look at my own record of 3 safety briefs in 5 years! Emails from drivers also complain about lack of safety briefs.
2.10 Responsible for relevant interaction with external bodies such as Network Rail, Occupational Health Physicians and others for all driver management issues.
So why was my issues with Siemens on unit defects and my issue on passive smoking involving Network Rail and other TOC`s not taken up? Including the disgraceful state of the messrooms at York and Manchester Oxford Road.
SPECIFIC RESPONSIBILITIES (As Route Manager you must ensure)
1. You are familiar with, understand and discharge to the best of your ability the specific safety responsibilities associated with your post and any other safety responsibilities allocated to you, from time to time and in writing, by your line manager.
2. The health, safety and welfare of any staff or any other persons who are under your control
3. Comply fully with any instruction, procedure or other requirement that is necessary to ensure the safety of any person that may be affected by their acts or omissions.
4. That any unsafe activity is immediately stopped and prevented from continuing until adequate measures have been taken to reduce the risk associated with that activity to as low as reasonably practicable.
This all looks good on paper, but in the real world, with what I have shown so far throughout this website, (with more added on an ongoing basis), do they really care?
2nd Report dated 2nd December 2008
The following are extracts from the RAIB report.
24 At about 21:45 hrs on 24 December, the last train before the Christmas holidays passed through Summit tunnel without incident. No trains were timetabled to run through the tunnel on 25 or 26 December and there was no engineering work taking place in or near the tunnel.
Surely you would have thought that a plan would be in place to restrict the next train through to travel at caution being able to stop short of any obstruction, to me, basic common sense, as stated in my report above.
80 Although no trains ran over this line for about 75 hours, after this length of time there is no requirement in Network Rail’s company standards or in the Rule Book for an infrastructure maintenance inspection to take place before trains start running again, regardless of weather conditions. NR/L2/TRK/001/A01 only requires the railway to be inspected if the line is closed for more than one week.
The simplicity of what I stated, "Trains using tunnels 1 hour or more after (the) last train should go through at caution checking the tunnel", is all that was required to have prevented this accident.
Tunnel management strategy recommendation
82 Part 1 of Summit tunnel’s management strategy (paragraphs 44 and 45)
recommended this tunnel should have an inspection regime for ice. It stated that ‘A system needs to be established to allow the inspection of and removal of icicles in Summit Tunnel in cold weather’. These inspections for icicles would be in addition to the routine fortnightly basic visual track inspections by infrastructure maintenance staff (paragraph 75).
83 Part 1 of a tunnel management strategy does not normally include recommendations, but if the consultants producing this part of the strategy find information that requires actions to be taken, then they can record this requirement by making a recommendation. However, the recipients of the strategy, Network Rail’s structures management engineers, do not have a process for handling any such recommendations.
Why the need for "consultants"? Your own basic risk assessment was all that was required.
Train 1P02 approached the fallen ice at the permitted line speed
96 A causal factor was that train 1P02 was allowed to pass through Summit tunnel at the normal permitted speed for the line.
This would never have happened if my recommendation had been put in place.
Tunnel management strategy action plan
97 Part three of the tunnel management strategy for Summit tunnel, the action plan (paragraph 44), did include a risk mitigation for ice formation that called for a speed or operating restriction to be put in place after a cold night.
Simple solution, so why not implemented?
98 The tunnel management strategy risk assessment (paragraph 44) had identified a risk to the tunnel from freeze‑thaw erosion because groundwater was present, and made a specific note that there was a history of large icicles forming in the tunnel. Because of the hazard of icicles obstructing trains, this risk was rated as significant. However, the risk assessment did not consider the hazards or risks associated with thaw conditions or extended periods of route closure during extreme weather.
I think that my 2 reports make all of this extremely evident.
99 To mitigate the risk of icicles, the action plan called for the first trains through the tunnel to run at a reduced speed after a heavy frost so that they could look for icicles. However, the RAIB found no evidence that this mitigation measure was ever put in place by Network Rail operations. There is no evidence of it being included in the sectional appendix for the route or in a local instruction at the signal box.
As I pointed out, as the Health & Safety Rep at the time, if TPE could have been bothered to speak with me, we could have had a joint meeting with Network Rail and sorted this issue out. realistically, I needed a miracle for TPE Managers to speak with me.
No action taken by the signaller
100 The RAIB found no operating restrictions or signal box local instructions in place at Preston power signal box that required the signaller to take any specific action before allowing a train to pass through the tunnel in any particular weather conditions.
101 Had the signaller been required to do so, he could have stopped train 1P02 and instructed its driver to examine the line. Examining the line is a process where a signaller will instruct a driver to pass over a line at a speed not exceeding 10 mph (16 km/h) (for lines in a tunnel), so that he can visually check that it is safe for trains to pass over and be ready to stop if required. The signaller did not do this because he had no concerns over the status of the line, as there had been no reports of ice or icicles from:
train drivers, as no other trains were running; or infrastructure maintenance staff, as no routine inspections or engineering work had taken place in the tunnel. Network Rail had not considered what the effects of extreme cold weather would be during periods when no trains were running; and Network Rail had not considered, as part of its weather management processes, what risks there might be to the operation of trains when thaw conditions set in after a period of extreme cold weather.
130 Large icicles and ice falls could be encountered by any train. However, the first train to pass over the railway line after a period of very cold weather is the one which is most likely to encounter an ice obstruction.
Basic common sense, if only it had prevailed, the above statement should have been an understanding of any risk assessment carried out.
137 The RAIB searched a national rail industry system for similar incidents in Summit tunnel since 1990 but none were found. A wider search for incidents involving trains striking ice or icicles in other tunnels listed ten such incidents. These all involved train drivers reporting that their train had struck an object in a tunnel which resulted in little or no damage. Subsequent examinations by the next train through or infrastructure maintenance staff found ice or icicles at the reported location.
What chance my 2 reports are in the 10 reports named above?
Severity of consequences
Train Speed
139 The speed of train 1P02 through the tunnel affected the severity of the accident. Had the train been travelling at its permitted speed of 70 mph (113 km/h), it would have struck the pile of ice, and then the tunnel wall, with greater force. This might have caused injuries to the passengers or train crew. In contrast, had the train driver been instructed to pass through the tunnel at a much reduced speed, he might have been able to stop the train short of the ice, or struck the ice with a much reduced force.
If TPE had taken notice of my reports, this accident that happened was TOTALLY PREVENTABLE, IGNORANCE should not prevail, but sadly IGNORANCE is an epidemic throughout the whole of TPE Management.
I CHALLENGE ANY ONE OF TPE MANAGEMENT, TO SHOW THAT MY 2 REPORTS WOULD NOT HAVE STOPPED THE SUMMIT TUNNEL ACCIDENT FROM HAPPENING.
ONE DAY THIS WILL HAPPEN AGAIN!
24 At about 21:45 hrs on 24 December, the last train before the Christmas holidays passed through Summit tunnel without incident. No trains were timetabled to run through the tunnel on 25 or 26 December and there was no engineering work taking place in or near the tunnel.
Surely you would have thought that a plan would be in place to restrict the next train through to travel at caution being able to stop short of any obstruction, to me, basic common sense, as stated in my report above.
80 Although no trains ran over this line for about 75 hours, after this length of time there is no requirement in Network Rail’s company standards or in the Rule Book for an infrastructure maintenance inspection to take place before trains start running again, regardless of weather conditions. NR/L2/TRK/001/A01 only requires the railway to be inspected if the line is closed for more than one week.
The simplicity of what I stated, "Trains using tunnels 1 hour or more after (the) last train should go through at caution checking the tunnel", is all that was required to have prevented this accident.
Tunnel management strategy recommendation
82 Part 1 of Summit tunnel’s management strategy (paragraphs 44 and 45)
recommended this tunnel should have an inspection regime for ice. It stated that ‘A system needs to be established to allow the inspection of and removal of icicles in Summit Tunnel in cold weather’. These inspections for icicles would be in addition to the routine fortnightly basic visual track inspections by infrastructure maintenance staff (paragraph 75).
83 Part 1 of a tunnel management strategy does not normally include recommendations, but if the consultants producing this part of the strategy find information that requires actions to be taken, then they can record this requirement by making a recommendation. However, the recipients of the strategy, Network Rail’s structures management engineers, do not have a process for handling any such recommendations.
Why the need for "consultants"? Your own basic risk assessment was all that was required.
Train 1P02 approached the fallen ice at the permitted line speed
96 A causal factor was that train 1P02 was allowed to pass through Summit tunnel at the normal permitted speed for the line.
This would never have happened if my recommendation had been put in place.
Tunnel management strategy action plan
97 Part three of the tunnel management strategy for Summit tunnel, the action plan (paragraph 44), did include a risk mitigation for ice formation that called for a speed or operating restriction to be put in place after a cold night.
Simple solution, so why not implemented?
98 The tunnel management strategy risk assessment (paragraph 44) had identified a risk to the tunnel from freeze‑thaw erosion because groundwater was present, and made a specific note that there was a history of large icicles forming in the tunnel. Because of the hazard of icicles obstructing trains, this risk was rated as significant. However, the risk assessment did not consider the hazards or risks associated with thaw conditions or extended periods of route closure during extreme weather.
I think that my 2 reports make all of this extremely evident.
99 To mitigate the risk of icicles, the action plan called for the first trains through the tunnel to run at a reduced speed after a heavy frost so that they could look for icicles. However, the RAIB found no evidence that this mitigation measure was ever put in place by Network Rail operations. There is no evidence of it being included in the sectional appendix for the route or in a local instruction at the signal box.
As I pointed out, as the Health & Safety Rep at the time, if TPE could have been bothered to speak with me, we could have had a joint meeting with Network Rail and sorted this issue out. realistically, I needed a miracle for TPE Managers to speak with me.
No action taken by the signaller
100 The RAIB found no operating restrictions or signal box local instructions in place at Preston power signal box that required the signaller to take any specific action before allowing a train to pass through the tunnel in any particular weather conditions.
101 Had the signaller been required to do so, he could have stopped train 1P02 and instructed its driver to examine the line. Examining the line is a process where a signaller will instruct a driver to pass over a line at a speed not exceeding 10 mph (16 km/h) (for lines in a tunnel), so that he can visually check that it is safe for trains to pass over and be ready to stop if required. The signaller did not do this because he had no concerns over the status of the line, as there had been no reports of ice or icicles from:
train drivers, as no other trains were running; or infrastructure maintenance staff, as no routine inspections or engineering work had taken place in the tunnel. Network Rail had not considered what the effects of extreme cold weather would be during periods when no trains were running; and Network Rail had not considered, as part of its weather management processes, what risks there might be to the operation of trains when thaw conditions set in after a period of extreme cold weather.
130 Large icicles and ice falls could be encountered by any train. However, the first train to pass over the railway line after a period of very cold weather is the one which is most likely to encounter an ice obstruction.
Basic common sense, if only it had prevailed, the above statement should have been an understanding of any risk assessment carried out.
137 The RAIB searched a national rail industry system for similar incidents in Summit tunnel since 1990 but none were found. A wider search for incidents involving trains striking ice or icicles in other tunnels listed ten such incidents. These all involved train drivers reporting that their train had struck an object in a tunnel which resulted in little or no damage. Subsequent examinations by the next train through or infrastructure maintenance staff found ice or icicles at the reported location.
What chance my 2 reports are in the 10 reports named above?
Severity of consequences
Train Speed
139 The speed of train 1P02 through the tunnel affected the severity of the accident. Had the train been travelling at its permitted speed of 70 mph (113 km/h), it would have struck the pile of ice, and then the tunnel wall, with greater force. This might have caused injuries to the passengers or train crew. In contrast, had the train driver been instructed to pass through the tunnel at a much reduced speed, he might have been able to stop the train short of the ice, or struck the ice with a much reduced force.
If TPE had taken notice of my reports, this accident that happened was TOTALLY PREVENTABLE, IGNORANCE should not prevail, but sadly IGNORANCE is an epidemic throughout the whole of TPE Management.
I CHALLENGE ANY ONE OF TPE MANAGEMENT, TO SHOW THAT MY 2 REPORTS WOULD NOT HAVE STOPPED THE SUMMIT TUNNEL ACCIDENT FROM HAPPENING.
ONE DAY THIS WILL HAPPEN AGAIN!