Network Rail has been fined £4m for its predecessor’s part in the Ladbroke Grove collision. Naturally, there are those for whom this is not enough – indeed, for some there will never be enough:
Martin Di Lieto, 57, whose 24-year-old son, Sam, was among those who died, was one of many who believed justice had not been done.
“The corporation has been fined, but the people who were responsible have still not been punished. There is still a need for a corporate manslaughter law and that is lacking.”
Sigh…
While I feel empathy with Mr Di Lieto for his loss, he is talking nonsense. There was no single cause that resulted in this incident and no single person responsible. Much has been made of SN109 and its sighting yet railway signalling does not work as simply as the media would have us believe (and the Telegraph perpetuates this myth).
Michael Hodder was the ninth driver in six years to pass signal SN109 while it was red. Such incidents, known as Spads in the industry, should have triggered a meeting of an emergency group to discuss the issue – but this was not done. The inquiries which did take place were inadequate as were the recommendations which followed, the judge said.
Michael Hodder did not merely pass this signal at danger, he failed to respond properly to the two previous signals that told him this one was showing a red aspect. The sighting of SN109 was indeed most likely a contributory factor. However given the two previous aspects, his train should have been at a crawl on the approach to SN109. It wasn’t. The train’s speed of approach following the driver’s failure to respond to the previous signals, meant that no matter how well sighted SN109 was, it is likely that the train would still have passed it.
Then we have the wild speculation, which always helps to make a good story:
Unable to read the signal he accelerated to a speed of 50 mph, when he should have stopped. He then found himself in the path of the in-bound Cheltenham express.
The only person who could corroborate that version of events is dead. What was available from the data recorders from the rear unit confirms the acceleration, but to assume that this is because he did not see SN109 is guesswork. We simply do not know. What the Telegraph conveniently fails to mention is that train drivers are trained to stop when they are unable to determine the aspect of a signal, not accelerate. The Telegraph’s statement here is unforgivable not only because it is speculation, but it is also hyperbole. We know that he accelerated, we do not know why.
The question I have rarely seen asked is; “What about the previous two signals?” Was Hodder using the driver reminder appliance on the move and forgot to use it on approach to Ladbroke Grove? That too is speculation, but it does offer a possible explanation for his failure to respond appropriately to the double yellow and yellow aspects of the signals prior to SN109. It also offers an explanation for his decision to accelerate on the approach to SN109.
It is true that the recommendations and inquires following previous incidents were inadequate and that there were serious failings in Railtrack Great Western’s safety management systems; not least, a lack of effective planning for jobs to be carried on should the current incumbent move on. This was down to a lack of effective competence management. No one person was responsible for this failure.
If we are to look at signal sighting, then Railtrack Great Western knew that it had a competence problem – no one was providing effective training and there was no assessment regime. The process relied on “grandfather rights” and on-the-job training by peers. The only training course available was seriously out of date and the author had moved onto other things. And getting a signal sighting committee together was no mean feat either.
So too was Thames Trains competence management system seriously lacking. There were weaknesses in the training and assessment regime that Michael Hodder underwent prior to driving a train alone on the main line. Railtrack’s Safety and Standards Board (subsequently RSSB) knew about the problem but were slow to react. Again, that involves a number of people. So, just who does Mr Di Lieto think should be in the dock? The people involved were widespread and worked for different companies. Some were indeed culpable for their failures, but manslaughter? Such a grave charge would require a direct line of evidence from the failure of the individual to the catastrophe that followed – sufficient for proof beyond reasonable doubt. Given the number of people involved and all too often their lack of authority, you are left with very senior managers and directors. So, can one prove that causal link? I very much doubt it.
If you are going to hold people personally responsible for trying to do a difficult and thankless task; one for which they may only have partial control and authority or are inadequately supported when they pick up on problems, and send them to gaol should they fail, then the talent and expertise the industry needs will simply look for a safer profession; one that does not engage in witch hunts. Because a witch hunt is exactly what Mr Di Lieto and those who think like him are proposing.
The judgement here is just. The companies responsible have been found culpable for their failings. One hopes that the lessons have now been learned. Justice has been done. Now let it rest.