Summary
At around 17:25 hrs on Saturday 7 March 2015, train reporting number 1Z67, the 16:35 hrs steam hauled charter service from Bristol Temple Meads to Southend, passed signal SN45 at danger. Signal SN45, which is situated on the approach to Wootton Bassett Junction, was being maintained at danger to protect the movement of a scheduled passenger train. At the time that the incident occurred, this scheduled passenger train had already passed through the junction. No injuries, damage or derailment occurred as a result of the incident.
Train 1Z67 was operated by West Coast Railways and consisted of the steam locomotive ‘Tangmere’ and 13 coaches. Although Tangmere is a heritage locomotive, it is fitted with modern safety systems including the Automatic Warning System (AWS) and the Train Protection and Warning System (TPWS).
RAIB’s investigation has found that signal SN45 was passed at danger because the driver did not reduce the train’s speed on approach to the signal. This meant that he was unable to stop the train in time, once he realised it was at danger. The driver had not reduced the train’s speed because he had not seen the preceding signal, which was at caution and should have alerted him that SN45 was at danger. He missed this preceding signal because he had become distracted by activity within the cab and possibly also because he was experiencing a higher workload than normal.
Train 1Z67 also passed signal SN45 at danger because the TPWS system was unable to reduce the speed of the train by automatically applying the brakes. This was because TPWS had been rendered ineffective by Tangmere’s crew when they had isolated the AWS system in order to by-pass an automatic brake application which had occurred at a speed restriction. Isolating AWS in this way was in contravention of the relevant rules but RAIB has found that it had almost certainly become an accepted practice among some train crews on this locomotive. This was probably because warnings from AWS were not always apparent to drivers, who were also anxious to avoid delays resulting from brake demands. Measures intended to prevent the misuse of AWS isolations had either not been adopted by West Coast Railways or had not been effectively implemented.