Transcript Medical Fitness Examination Process for Safety Critical

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
•
12.00
The ORR View – John Gillespie, ORR
12.10
The Union View – Dave Bennett,
ASLEF
12.20
RSSB Representative – John Pullinger
12.30
ATOC Representative – Barbra
Davenport
12.40
ARIOPS Representative – Dr Howard
Watson