Research into health on the railway June 2008

1. Research into health on the railway June 2008 Michael Woods: Head of Operations Research

2. What I’m going to tell you … • I’ve presented at your last two conferences, so there is bound to be some reinforcement of past messages. • There’s a big piece of news about a change of approach by RSSB to ‘health and safety’ following a recent board decision. • I’m also going to update you about where we are with the research programme, and its new funding settlement, but not to go into too much detail. • And ask you for some inputs into the programme.

3. How I’m going to tell you … • I haven’t got pictures and charts about occupational health, because I don’t have that kind of material. • I also use too many words on my slides because • I always do • I want you to have the information available for reference afterwards.

4. But if I had one picture … It would demonstrate the effect of repeated research projects on sickness and absence in the rail industry … Or, what happens to pulmonary wedge pressure after the inflation of a catheter …

5. A new approach to health at RSSB 1 • On 1 November 2007 the RSSB Board agreed that there were opportunities for industry to work together more effectively on the management of occupational health, and that RSSB should take a role in helping to achieve this. • Before then, issues of health had not been a priority on the RSSB agenda. However over the last few years there had been an increasing number of occasions on which RSSB has been asked by industry to undertake specific work in this field.

6. A new approach to health at RSSB 2 • A number of initiatives are now in development including • data gathering and interpretation • some targeted research projects • continued standards development • and toolkits for use by duty holders. • Details can be found on the RSSB website at http://www.rssb.co.uk/occupational_health/index.asp.

7. Stakeholders for health research • As part of the process leading to the development of a board paper and subsequent decision-making about future activities, it was decided that RSSB’s Safety Policy Group (SPG - a board sub-committee) would lead on the issue and also become principal client group for research and development. • So two years after the demise of the RIAC OH working party, we now again have a lead body for our R&D which includes key stakeholders such as Network Rail, the train operators, Office of Rail Regulation, and the Railway Industry Association, with RSSB providing the chairman and logistical support.

8. Research and development 1 • This update covers research into occupational health and is designed to report progress made since the presentation at your meeting in July 2007. • Health research, which includes some public health issues as well as occupational health, is one of four topics managed by the operations section of RSSB R&D: the others cover level crossings; operations; and public behaviour. • Our wider portfolio to date includes 118 published projects; seven completed but not yet published; 26 in progress; two out to tender; 17 in preparation, and plenty of ‘ideas’ on file. • We also do research into engineering and management issues.

9. Research and development 2 • The programme was extended by DfT in late May 2008 with funding for 2009 - 2014 , which will include a new workstream covering Strategic Research. • As I said last time, research is commissioned and published by us, but generally undertaken by outside experts – universities, consultancies etc and funding is provided by DfT. We also utilise the knowledge and experience of our expert advisory team – some from within and some outside RSSB. • In response to stakeholder expectations we are gradually moving much of the research work in-house; although this process will not be sudden, or total: there will always be specialist areas and needs which will continue to be met from outside the industry.

10. Operations Public behaviour Health Level crossings Operations Research topics Railway crime, personal safety and security, suicide, safety at stations Health research Operations issues, including SPADs and communications

11. Health topic research plan 1 • The concept of a topic research plan is that for each area of research there will be a statement of the problem being addressed, the risk profile, costs and benefits for the industry, and what research is envisaged. • The health plan was approved in June 2008 and should be on the RSSB website as this conference opens. • Go to http://rssb.co.uk/research/TopicResearchPlans.htm for more information.

12. Health topic research plan 2 • A decision was taken by SPG that, as the coverage of the topic included some public health issues, it would be appropriate to change the topic name to health (from occupational health). • This has now been done! • We have defined five areas for research, of which three cover occupational health, one is concerned with public health, and finally there is an area which allows us to respond to inquiries, recommendations, policy initiatives and new legislation.

13. Health topic research plan 3 • The research areas are: 1 Managing the health risk to employees from the effects of work on health 2 Research into the effects of employees’ health on work to manage the health and safety risk affecting the workforce, passengers and the public 3 Investigating the interaction between work and health to improve employee (productivity and) performance 4 Research into the effects of passengers’ health on the rail industry, affecting the workforce, other passengers and the public 5 Research to support output from inquiries, government recommendations, policy initiatives and new legislation

14. Health topic research plan 4 • The research ideas being considered following approval of the plan are (in priority order): • T699 Fatigue and shiftwork for freight locomotive drivers and contractor trackworkers (Area 5) - already started • Follow-on work to inform the industry on the contents and implications of previous occupational health research (Area 3) • Collating and analysing railway-related health data to facilitate better investigation of employee health risk (Area 2)

15. Health topic research plan 5 • And • Learning from contractors inside and organisations outside the rail industry on issues such as hand/arm vibration problems (Area 1) • Investigating sources and levels of occupational stress in railway workers (Area 1) • Possible research on any health risk which may result from travelling by rail (Area 4)

16. Published health projects • T050 A survey of drug and alcohol policies in industries undertaking safety critical work • T051 Discharge of toilet waste from trains onto the track • T059 Human factors study of fatigue and shift work • T133 Review of drug testing methodologies • T138 Management strategies for workplace trauma • T299 Human factors study of obstructive sleep apnoea in train drivers • T315 EU physical agents directives: vibration and noise consultation • T317 Minimising the impact of suicides on staff • T382 Management of health conditions and diseases • T385 Managing the health risks from dealing with human or livestock body parts • T389 Management of health needs • T626 When to evacuate trains based on ambient temperatures

17. Health projects in progress • Nearing completion • T630 Investigating the potential for deep vein thrombosis in the rail industry • T661 Scoping research on ageing for passengers and the railway workforce • T662 Developing guidance to assist with the application of medical standards • T663 Managing the risk of sudden incapacity in safety-critical occupations • T664 Use of hearing aids by operational staff • In progress • T699 Fatigue and shiftwork for freight locomotive drivers and contractor trackworkers

18. Three projects detailed • Details are now given of the three principal projects which are in their final stages and which will be of interest to ARIOPS members • These are • T662 Developing guidance to assist with the application of medical standards • T663 Managing the risk of sudden incapacity in safety-critical occupations • T664 Use of hearing aids by operational staff

19. T662 – Developing guidance to assist with the application of medical standards • To conduct a survey of railway occupational health providers to determine the various outcomes of medical examinations carried out in accordance with Railway Group Standards and use information generated to encourage a more uniform application of the standards to deliver – • reductions in time and money spent issuing pass certificates • improvedcompliance with medical requirements • ensuring workers with a disability not unfairly treated

20. T662 – Some of the outcomes • Implications of variation in pass rates • By age: fail rate increases in older workers suggesting there will be fewer able-bodied persons available in the future due to increase in average work age • By supplier: employees passed by one supplier may not be passed by another • Types of restrictions • A wide range recorded indicating restrictions take account of individual circumstances; considered good practice and in keeping with requirements of DDA • Job specific issues – 400 different job titles recorded • Infrastructure technicians failed on vision and hypertension • Operations staff failed on vision, mental health and musculo-skeletal problems

21. T663 - Managing the risk of sudden incapacity in safety-critical occupations • This project is designed to deliver guidance to the rail industry on the acceptable levels of medical risk of sudden incapacity or impairment while performing safety critical tasks, with a view to improving the objectivity of the medical decision-making process regarding fitness for work

22. T663 – Some outcomes • Polling the Industry regarding current practice • Follow specific risk assessment procedure / capability assessments • Accept OH providers’ recommendations • Measurement of total risk of sudden incapacity by disease and job type • Current level of risk equates to 1.6% of total risk from railway operations and maintenance • Total risk dominated by contribution from sleep apnoea, the treatment of which should reduce the risk dramatically • Promotion of fair, consistent and justifiable application of medical fitness standards • Guidance document being developed to aid OH providers implement general health parts of standards more objectively • If used will result in comparable results across all providers

23. T664 - Use of hearing aids by operational staff • A study delivering solutions to the problem of redeployment of staff who are currently non-compliant with the hearing standard • To investigate the costs and benefits of setting up a safe system of work that permits those affected individuals to use digital hearing aids to return to their normal duties.

24. T664 – Main Findings • The size of the problem • Benefits of retaining a driver £42,485 • Benefits of retaining a conductor £6, 380 • Total benefit to industry at present (conservative) £1,000,000 • Outcome of technical assessment • Behind the ear hearing aids better suited to requirements of railway staff generally except where ear defenders worn when in the ear aids must be used • Needs of most hearing-critical tasks met by two programmes • Initial results from trial • Train operators should periodically remind and encourage staff to consult regarding any problems • Staff who use a temporary hearing aid while their own is repaired should use one that has similar settings and programmes

25. New project ideas • As before, ARIOPS members can be a fertile source for identifying what needs to be done in the future. • You haven’t submitted any new ideas over the last year – why is that? • What are your knowledge gaps or what does the industry need to consider in terms of providing better, cost-effective occupational health? • A business-case approach is always more likely to gain support. • Let me know and I will send you an ‘ideas form’ to complete.

26. Contacts and more information • We are happy to brief funders, regulators, stakeholders or other interested parties about any of our research – in as much detail as required. • We are happy to share outputs of our work see http://www.rssb.co.uk/– or you can subscribe free to our e-newsletter at http://www.rssb.co.uk/r_and_d_enews.asp. • I’m easy to find at michael.woods@rssb.co.uk. • Or call 020 7554 4604.