This leaflet informs those participating in the
roadmapping exercise of some of the health
and wellbeing issues the railway industry
faces from the work we have done in the
past year. Please consider the issues and
recommendations as well as other issues you
believe are missing prior to the workshop.
absence data gathering and should investigated a health
surveillance/ assessment system. The criteria for the
system identified by industry should include:

Ability to undertake trend analysis

Keep rail industry OPEX costs down

Provide ease of data entry

Enable data extraction at local level

Able to accept uploads from a variety of
different systems
ISSUE 1: The railway needs cross industry health
data in order to improve attainment in health and
wellbeing
ISSUE 2: Industry standards on health and
wellbeing are not driving strong enough
improvements
ORR’s overview of ill health in the rail industry suggested
that not enough is being done to promote and control
occupational health issues. Good data is vital within
organisations to drive improvements and key findings
from the ORR baseline survey on railway industry
occupational health management found that:

The true cost of occupational ill health to
business does not seem to be well understood

Reliable, data on occupational ill health within
the rail industry are difficult to obtain.

RIDDOR data does not capture all ill health
issues.
The purpose of the current standards regime is to
delegate to railway organisations the maximum
flexibility to operate standards as they see fit. In practice
the extent to which individual rail organisations have the
capacity to take advantage of the practical implications
of such flexibility may be limited, in view of the lack of
in-house health/medical policy expertise in most railway
organisations.
The RSSB board have already recognised that proactive
management is critically dependent on quality data to
inform and guide decision making and requested:

Development of health data causal
classification and data collection.

Development of suitable proactive metrics and
benchmarking facilities.
RSSB has worked with industry over the past year to
better understand and develop the high level
specifications for future data and reporting.
Recommendation
Industry should consider developing a system (use
available or develop SMIS) on the SART system for health
The medical fitness standards managed by RSSB and
others are restricted to the implications for safety critical
work. They do not relate to the important agendas
recently identified by the ORR in respect the adverse
effects of work on health and wellbeing.
It is no longer considered acceptable medical practice to
make decisions outside of clinical guidance. Rail
physicians will therefore often consult and even cite
other documents from comparator environments such
as the DVLA guidance known as 'at a glance', and clinical
guidance prepared for other safety critical settings. So
far, no organisation has as yet undertaken such work
especially focused on the needs of the UK railway
industry.
Recommendation
Industry should consider the introduction of a more
uniform and/ or less complex range of medical standards
which would cover the whole railway industry
The rail industry should consider the usefulness of
introducing voluntary standards for those areas of health
management identified by the ORR as in need of
development but are not covered by current industry
standards/guidance.
The rail industry might want to consider whether they
should be more involved in the development of clinical
effectiveness and guidance material.
ISSUE 3: The industry lacks senior clinical
leadership in order to drive improvements in
health and wellbeing management
There is no structure for a common source of senior
specialised clinical advice or leadership at the industry
level. Health practitioners' day to day activities are
directed toward meeting the contractual requirements
in individual organisations and there is no forum for
senior health advisors to focus on strategic decisions.
Recommendation
Industry needs to consider how clinical leadership and
senior specialised occupational health advice across the
industry can be fostered. This may be through a senior
industry leadership group.
RSSB and others should work with industry leaders,
sponsors and partners to provide meetings and support
for railway occupational health. An example of support
might include sponsorship of a national railway
occupational health event.
ISSUE 4: Relationships between health providers
and their customers are complacent and lack
effectiveness
The broad knowledge and experience of clinicians can
respond to the challenges facing the industry to address
the adverse effects of work processes and workplace
hazards on employees. This may also include the wider
determinants of wellbeing as identified by the ORR
occupational health programme. However, many
tendered outsource contracts are focused on
measurable outputs such as KPIs rather than on higher
level outcomes.
Provision of health from occupational health providers is
transactional and costly.
Providers and purchasers agree that there is a restricted
choice facing rail organisations looking to outsource or
re-tender their OH service. The restricted occupational
health market prevents the rail industry from gaining
access to some of the more innovative approaches and
contracts for occupational health management.
tend to focus on routine activities, rather on an
organisational strategy to improve health.
There are two main barriers to creating a wider market
in occupational health, these being the need to meet the
specific standards of Link-up accreditation and to
provide clinic facilities in each and every railway centre.
Health and safety managers are well equipped to
identify workplace hazards, but when it comes to the
risk to health, they need to understand whether there
could be any adverse effects on the human body. The
level of knowledge required to be able to understand
the potential severity of effects on health and the
likelihood of an occurrence for a particular individual,
may on occasion, stretch beyond the standard training of
health and safety managers.
Recommendation
There appears to be a poor understanding of the role of
occupational health amongst frontline managers, and
how to get the best value for money from occupational
health professionals and providers.
Recommendation
Commissioners and providers of occupational health
need to find ways of enabling their senior clinicians to
work more strategically with senior operational, human
resource and safety managers in ways which might
include:
1. Regular quarterly health strategy meetings
including lead physicians, safety and human
resource managers.
2. Involvement and inclusion of senior clinicians
in one-off programs tackling issues where
health may be a concern.
Organisations need to consider how to facilitate a
broader approach to tendering for their occupational
health service, ensuring they have sufficient choice and
can take advantage of advances in occupational health
practice. Broader approaches might include contracting
with more than one organisation to ensure national
coverage, or else to gain especial expertise.
Opening up the accreditation scheme by integrating
Link-up into a railway-specific domain of the Safe
Effective Quality Occupational Health Service (SEQOHS)
should lead to a significant widening of the occupational
health provider market.
Further measures to expand this market might include
looking to provide clinics facilities available to rent in
railway centres by landlords such as Network Rail, as
occurs with other railway related services.
RSSB and others might consider developing guidance on
good commissioning in the industry jointly with
occupational health bodies such as the Faculty of
Occupational Medicine and/or the Society of
Occupational Medicine.
ISSUE 6: There is a lack of training and
competence within industry to improve health
and wellbeing attainment
ISSUE 5: The market for occupational health and
health and wellbeing provision is stagnant
There is a lack of internal knowledge available for
determining how to improve health management.
Experienced health professionals from external health
providers are limited to transactional relationships that
Line managers are often expected to manage health risk,
but as a rule, they receive little or no training in relation
to health management
Recommendation
A study by RSSB indicates that a return of 10:1 can be
achieved through better management of occupational
health issues. A good return is therefore available for
those that increase the number of OH professionals.
Organisations need to improve the standard of health
knowledge and training of those with health
responsibilities. NEBOSH offer existing packages for
frontline managers and health and safety managers.
Additional guidance material could also be developed
through RSSB.
Many rail organisations would benefit from increased
support from health specialists. For example, when
health risks such as those associated with silica dust,
diesel engine exhaust emissions and cab design are
considered, consultation with occupational hygienists
and ergonomists could add significant value.
ISSUE 7: Rail companies do not appear to have
complete control over the health hazards facing
them
Between 2005 and 2010, only seven cases of prescribed
occupational disease were reported to ORR; these
included four cases of HAVS plus one case each of
bursitis, Legionnaires ’ disease, and dermatitis. Underreporting of prescribed diseases may, in part, be
attributable to long latency in health problems and the
need for a medical diagnosis of an occupational
causation, coupled with significant movement of the
workforce between employers. There is some evidence
to suggest under-reporting of Schedule 3 diseases under
RIDDOR. In 2002, as a result of a targeted health
surveillance exercise at a single train depot, 24 cases of
HAVS were diagnosed and reported under RIDDOR,
showing the value of effective health surveillance.
RSSB Identified the Top 5 health issues to the rail
industry related to health risk.
1. Anxiety, depression, stress
2. Musculoskeletal Disorders, eg back pain
3. Endocrine Disorders, eg diabetes,
4. Heart/Circulatory Conditions eg heart disease,
high blood pressure
5. Sleep Disorders, eg sleep apnoea, shift pattern
related sleep disorder
The CiPD identifies stress as one of the leading causes of
absenteeism and is a health hazard with little control.
Recommendation
The formation of health hazard such as the Ballast Dust
Working Group.
A project that systematically identifies typical rail
environments and the health risks associated.
Completion of risk assessments and guidance standards
for each environment.
Improvements in health data collection and the
management of health surveillance.
Issue 8: The rail industry works with a supplier
base that is largely overlooked in its contribution
to the railway system. Health management
practices are often poorly integrated within the
management practices of these organisations
From anecdotal discussions with rail professionals it has
been identified that improvements should be made to:

Management of health into equipment that
enters into the rail system

Innovation of new equipment that can
improve health

Management of people working for
contractors lower down in the rail system.

Transient employees, health conditions and
risks passed on to those lower down the
supply chain.
ISSUE 9: To meet future business requirements
the rail industry needs to improve the
management of its workforce. Health and
wellbeing makes this management sustainable
and effective, however, this is largely overlooked
The rail technical strategy (RTS) notes that ‘people are
the key drivers and enablers in business’. As the pace of
technological change increases people will need the
necessary skills to cope and to understand and adapt to
new practices. In relation to the goals of the RTS there is
a need for:






Job design and the professionalization of the
workforce
Job design and training to fit longer working
lifetimes
Psychological wellbeing and sustainable
engagement for committed people
Health management and engagement to
create a culture of continuous improvement
and an ethos of customer service
Resilience, flexibility and communication skills
to become highly competent but prevent
individual burnout.
Design of technology and roles with people in
mind
The RTS also notes that innovation can alter the
workplace as automation could take over repetitive and
arduous tasks. The railway has an opportunity to use
these techniques and technologies to create an
attractive work environment that makes it the
employment sector of choice.
Issue 10: If the aims of the future railway are to
be met the industry needs to be an attractive
prospect for government funding and skilled
employees. The industry is yet to earn a
reputation as an attractive prospect.
For Whole-system costs, revenues and subsidy the
benchmarking carried out in the VfM shows that total
system costs in GB rail are higher than in the comparator
European railways. These higher costs are borne by a
mixture of higher taxpayer subsidy and higher fares. It is
therefore said that the rail industry must earn its right to
grow and be sustainable. Whole system costs should be
important to all railway organisations and whole systems
costs due to ill health are said to be significant.
It is estimated that workforce ill health costs the industry
3.5 million working hours per annum. Independent RSSB
research suggests that the total cost associated with an
identified ‘top five’ occupational health risks is
approximately £220 million per year. This potential cost
was recognised in the Rail VfM study report which
identified the need to ‘increase the focus on
occupational health, which will reduce levels of sickness
and absenteeism as well as encouraging a healthier
workforce’.
The RTS identified a pathway for GB railway to become
a significant global player in its field. The People section
of the strategy, one of its foundation sections, currently
has a gap. It considers ‘People’ from the perspective of
need for skills and does not consider workforce needs.
This gap can be filled by industry focus upon workforce
health, wellbeing and engagement making the industry
attractive to a skilled workforce that has the opportunity
to choose in which industry they wish to work.
Existing reports and industry documents used to develop the issues and are incorporated into baseline roadmap:

The Future Railway the Rail Technical Strategy
http://www.futurerailway.org/RTS/About/Documents/RTS%202012%20The%20Future%20Railway.pdf

Value for money study
http://www.rail-reg.gov.uk/upload/pdf/rail-vfm-summary-report-may11.pdf

Dame Carol Black – working for a healthier tomorrow
https://www.gov.uk/government/publications/working-for-a-healthier-tomorrow-work-and-health-in-britain

Engage for success – The McLeod & Clarke Report
http://www.engageforsuccess.org/ideas-tools/employee-engagement-the-macleod-report/#.Ui3MFEFwY5g

Engagement without wellbeing is not sustainable
http://www.affinityhealthatwork.co.uk/our-work/research/research-line-managers-and-sustainable-employeeengagement/

RSSB Cross Industry Health Data Collection and Usage Report 2013*

RSSB Health Standards Report 2013*

RSSB External Health Relationships Report 2013*

RSSB Internal Health Relationships Report 2013*

ORR report Overview of work related ill health in the GB rail industry in 2010
http://www.rail-reg.gov.uk//upload/pdf/work_related_ill_health_overview_2010.pdf

RSSB Report T382 Management of health conditions and diseases 2005
http://www.rssb.co.uk/RESEARCH/Lists/DispForm_Custom.aspx?ID=847
* Copies available from darryl.hopper@rssb.co.uk upon request