Keeping rail safe, keeping rail workers well

New guidance supports informed decisions on health and fitness for safety-critical rail roles.

Helping occupational health and workplace management make risk‑based decisions

Clare Forshaw
Professional Head of Health and Wellbeing, RSSB

Safety-critical workers play a vital role in making sure that the operation of railway systems is smooth and safe. It is essential that their health does not compromise that. However, individuals can develop health conditions over time. Or, often, we preclude individuals from working on the railway due to their health.

Safety-critical workers

Health can have an important impact on the performance of safety-critical tasks. Workers can develop health conditions over time while employed in rail, or they can apply to take on a safety‑critical role with particular health conditions. Occupational health (OH) and workplace management need a robust way to make judgements about an individual’s ability to perform their job safely.

This is not a new issue. Over 15 years ago, we did research in this area and produced guidance. This was deemed appropriate at the time, but it has come under scrutiny more recently. It was found to not be in line with more recent approaches to making safety decisions, especially the Taking Safe Decisions (TSD) approach. As a result, we withdrew that advice.

Our new guidance is explicitly centred on current best practice and regulatory requirements.

Taking Safe Decisions

The new guidance is based on a robust risk assessment methodology. It emphasises a collaborative approach between duty holders and OH providers. Its structure and scope are informed by the TSD approach and risk assessment results. The advantage of the TSD approach is that it outlines the linked stages in risk assessment, planning, and decisions that affect safety. This gives a clear and useable structure for professionals to use. It is decision making that is transparent and defensible in law.

The guidance is also based on the general medical requirements set out in existing standards, guidance, and legislation. This comprehensive approach ensures that the guidance is practical and can be applied across multiple situations. The risk assessment methodology is designed to help duty holders make well-informed decisions about the suitability of their staff to perform safety-critical work. Decisions using the guidance make sure that the potential safety consequences of any medical impairment are properly considered.

Occupational health and workplace management

The guidance supports both OH practitioners and workplace management. It will help them make informed decisions about the fitness of train drivers with underlying medical conditions.

It is the duty holder’s ultimate decision on whether a train driver is fit to work. However, this depends on a recommendation and advice from OH. Therefore, the decision-making process often involves continuous engagement between OH providers and operators or employers. This collaboration is necessary to ensure the best outcome for both the individual driver and the operator and for keeping the railway running safely.

Promoting fair treatment

Another important issue is fairness and transparency when making decisions about rail employees with medical conditions. The industry may have preconceived ideas or biases about some medical conditions. But decisions should be based on objective criteria and reasonable adjustments.

In addition, the development of new technologies to monitor health, such as continuous glucose monitors (CGMs), can change the risk associated with the management of some health conditions. This in turn can change the safety implications of decisions about the person using them. We have specific guidance for diabetes that is managed with CGMs. We refer to some medical devices in the other guidance documents.

Our guidance about five different situations of medical impairment will avoid discrimination or unfair treatment of train drivers. Our guidance shows what is needed to keep drivers at work when deemed safe to do so and how to make robust decisions when safety cannot be assured.

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The guidance for five medical situations is free for members to use.

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Five situations of medical impairment

We have consulted with industry and developed suitable underlying methods to inform the guidance. We have now published five sets of guidance about train drivers with medical impairment to help those making fitness to work decisions.

There is one for each of the following medical situations:

cardiovascular risk
diabetes
diabetes monitored with a CGM
sleep apnoea
epilepsy.

Each document defines the medical condition and explains the implications that it has for rail. The most thorough sections are explicitly for OH and workplace management. They show the decisions that need to be taken. Sometimes, this includes descriptions of the methods that can be used to collect relevant evidence. They discuss what needs to be done and the issues that need to be considered. This helps the two groups meet the different needs and questions they have.