1. Do we need a Highways Accident Investigation Branch
Lessons from Rail and the Cullen Inquiry
Steve Gooding, Director – RAC Foundation
Chris Jackson,
Head of Transport Sector, Burges Salmon

2. Overview Why we need an HAIB
Comparators: UK transport modes and the objectives: of independent accident investigation
Lessons from Rail/Cullen/other modes:
Independence
Non-use of witness evidence in criminal process
DfT/RAC Foundation investigation project – progress so far
Discussion/questions

3. Steve Gooding
Director, RAC Foundation
November 2018
2017

4. incident
monitor
investigation
implement
patterns
lessons

5. This is not a
‘block-and-copy’ job

7. Why ? ‘Number Crunching’ by mode (2016 data)
Incidents reported
Fatalities
Serious Injuries
No of AIB investigations
AIB annual cost
Aviation
656
(10 fatal) 16
N/K
38 deployments
208 other
Marine
1190 13 30
£4.058m
Rail
[687 rail movemt]
283 =
237 suicide
27 t/pass
7 p/ger
12 other
469 19
£4.7 m
Road
1792
24,101
None (N/A)
N/A

8. Investigation Objectives
To prevent recurrence/improve system safety
Ability to:
Get at the facts
Establish immediate and root causes
‘Call out’ regulatory as well as operational factors
Not penal/fault finding – separate process
E.g. Rail scope (2004/49/eu – RSD):
Article 19(1) - a serious accident where investigation is mandatory
Article 19(2) - an accident or incident, which under slightly different conditions might have led to a serious accident, ie a near miss of a serious accident

9. Highways

10. Benefits of an AIB
AIB Staff

11. Ladbroke Grove/Cullen Public Inquiry
Collision: 5 October 1999:
31 fatalities
>400 injuries
Public Inquiry(ies):
Cullen/LGRI 1: the collision – immediate causes
Joint Southall/LGRI: Cullen/Uff train protection systems etc
Cullen/LGRI 2: industry structure, regulation and legislation
Industry group representations/submissions including ATOC, Railtrack – now NR, ORR, HSE, Unions, Police, families/survivor groups
Development Railway Safety Directive in parallel and following.
RAIB debate = one of 7 key issues covered

12. Independence and Immediate/Root Cause
Human Error and
System Failings:
Location specific
Generic
Role of:
Operators (infrastructure and
Regulators
(Legislature)
Contrast e.g. Shoreham and Buncefield approaches
Technology, societal perception of risk, and future roads

13. Railway Safety Directive 2004/49
“ (24) A safety investigation should be kept separate from the judicial inquiry into the same incident and be granted access to evidence and witnesses. It should be carried out by a permanent body that is independent of the actors of the rail sector. The body should function in a way which avoids any conflict of interest and any possible involvement in the causes of the occurrences that are investigated; in particular, its functional independence should not be affected if it is closely linked to the national safety authority or regulator of railways for organisational and legal structure purposes. Its investigations should be carried out under as much openness as possible. For each occurrence the investigation body should establish the relevant investigation group with necessary expertise to find the immediate causes and underlying causes.”

14. AIB witness evidence
The safety policy imperative to keep separate from criminal process
MOUs between AIBs, regulators and police
The different purposes of criminal law, civil law and regulation
Need for secondary legislation or equivalent protection
E.g Sussex Police v Secretary of state for Transport & Anor (2016): Police application to Court to access AAIB evidence refused by High Court
Reason = “chilling effect” of deterring witnesses
Compulsion powers/the right against self- incrimination.

15. Rail – Different Roles

16. UK Post Cullen rail safety (2005-2015)

17. £480,000 live crash investigations independent from the police
boil the sea
focus only on casualties

18. Develop a ‘systems thinking’ framework
Consult widely
Develop a ‘systems thinking’ framework
Work with police forces and NPCC
Pursue the true cost of crashes
Interrogate and match data sets
Pursue an ‘agile’ approach
Underway
Commissioned
By year end

19. ?

20. Thank you Discussion