Medical Fitness Examination Process for Safety Critical Rail Staff-Some ARIOPS Concerns (PTS and Train

Driver Medicals)

Dr Andrew Colvin, Chairman of ARIOPS

Background

• The Train Driving Licences and Certificates Regulations 2009 : the Train Driver Licensing legislation which considers competency, training, medical fitness assessments and certification of train drivers.

ARIOPS Response;• ARIOPS has already provided detailed feedback on the Medical

Examination Format to ORR.• ARIOPS has already produced peer reviewed guidance on the

competency of Occupational Physicians examining railway workers. • ARIOPS also considers it is important for DFT to consider issues

that are wider than doctor certification, registration or medical competency when performing statutory medical examinations within the railway industry.

Management of Statutory Railway Medical Examinations

The ARIOPS concerns of some aspects of the current support and infrastructure of statutory railway medical examinations can be summarised in 3 main areas;

• Safety

• Equity or Fairness

• Clinical Governance

SAFETY

• Concern No central record is kept of train drivers/PTS workers

who have presented for statutory medical fitness assessment and have been declared medically unfit for train driver or other PTS duties.

• RISK A prospective or current rail worker/driver having failed

one medical examination could simply re-present to a different certificated medical practitioner without declaring relevant medical history or masking examination findings in order to (inappropriately) continue his employment on the railway.

EQUITY or FAIRNESS

Concern • No formal Appeal System for those deemed temporarily or

permanently medically unfit for rail or train driving duties. RISK• A prospective or current rail worker / driver deemed medically unfit

in error or though an overly conservative judgement on the medical evidence (which can be complex) is inappropriately denied employment.

• The employee/employer has no access to any formal Appeal Process which could provide a definitive judgement on medical fitness in a consistent manner using current expert medical opinion.

• An Appeal Process, where such expert opinion was communicated to other railway occupational health practitioners, could also act as an educational tool for practitioners in future cases and thus facilitate enhanced consistency in clinical decision making in difficult or complex cases.

CLINICAL GOVERNANCE

Concern • Despite the efforts of RSSB and ARIOPS amongst others there is

inadequate professional support or clinical guidance to railway occupational physicians in recent years in support of their statutory role. Many practitioners feel a lack of clinical leadership exists.

• This is noticeable when Rail is compared to comparable industries such as the Maritime and Civil Aviation industries for example. This at a time of an ageing workforce (with increased potential morbidity), tremendous change in medical treatments and survival rates after serious disease and a significant increase in rail travel.

RISK• Reduced consistency and quality of clinical outcome between

occupational physicians in determining medical fitness for train drivers/PTS workers or in recommending appropriate restrictions.

CONCLUSIONS and

RECOMMENDATIONS

ARIOPS considers that systematic deficiencies in the support and management of statutory medical fitness assessments in train drivers/safety critical rail workers are important and require urgent corrective action

• ARIOPS recognises the need to communicate the views of our members in a more formal way and communicate these effectively to DfT/ORR and other stakeholders.

• ORR has placed a commitment in its corporate strategy for 2009 to 2014 to ensure occupational health management in the railway industry reflects good practice. As part of this ARIOPS will continue to communicate our views to assist ORR in the better monitoring of occupational health and sharing of best practice.

• How can ORR and other key industry stakeholders attend to our concerns and follow our invitation to assist this process going forwards?

Any Questions?

The Discussion Panel

12.00 – 13.00 Discussion Panel

•12.00The ORR View – John Gillespie, ORR12.10The Union View – Dave Bennett, ASLEF12.20RSSB Representative – John Pullinger12.30ATOC Representative – Barbra Davenport12.40ARIOPS Representative – Dr Howard Watson