Risk Management Assignment: Case Analysis of Lorry accidents
Risk Management Assignment Brief:
On the 22nd December 2014 in Glasgow City centre the driver of a local authority refuse lorry lost control of his vehicle, with the subsequent loss of six lives and many serious injuries. Read paragraphs 9-33 and 513 – 559 of the determination of the Sheriff into this incident, which can be found here: http://www.scotcourts.gov.uk/search-judgments/judgment?id=e916fba6-8980-69d2-b500-ff0000d74aa7;
You are the Safety Manager for a large UK local authority which includes a large city and which operates regular refuse collections throughout the city centre. Your Chief Executive has read about the accident and is concerned about the public reaction to the continued use of refuse vehicles in the city after such an incident. However, he is also concerned because he has been informed that there would be significant risks to public health if refuse collection had to be stopped for more than 48 hours in the city centre and that many shops and restaurants may be forced to close if their refuse remained uncollected for longer than this period of time. Therefore, he has asked for a report from you that describe the emergency planning procedures that should be in place for dealing with the consequences of such an event should one take place in the city centre.
He has also asked for an assessment of the possible consequences the local authority (and individuals within in it) could face after such an incident.
You are required to write a two-part report that addresses the requirements of the Chief Executive. As a guide, Part 2 should be no longer than 1200 words as Part 1 should form the bulk of the assignment.
Part 1: Emergency Planning: Consider the information in Module 7 relating to emergency planning and crisis management and prepare a report for the Chief Executive that addresses the steps that could be taken to manage such an incident if it happened in your authority. You should consider the stages in the emergency planning cycle and how this could be applied to this situation (e.g. the immediate incident, cooperating and coordinating with the emergency services, the need to maintain refuse collection while dealing with the reputational risks and communication strategy etc)
Note: you do not have to demonstrate detailed knowledge of waste and refuse collection but should be able to explain how a system for adequate emergency planning could be applied to this scenario.
Part 2: Consequences: This should consider the possible outcomes of any investigation and the consequences could be for the local authority and individuals within it. Consider what enforcement action after a criminal investigation could be taken, what the main health and safety legislation would be and include an assessment of when a charge of corporate manslaughter/homicide might be considered likely.
Lorry accidents are a common problem in the UK that took away several lives. The same incident could be seen in Glasgow city where a lorry driver by the name of Henry Campbell Clarke lost control of his vehicle and hit everywhere leading to the death of six lives and several serious injuries. As a result of this incident, there could be reduced use of refuse vehicles in the city and might force the shops and restaurants to close (Beckett, 2015). Therefore, this report serves the purpose of describing the required emergency planning procedures for dealing with the consequences of an event. The incident happened in Glasgow City when one of the Lorries operated by the council lost its control. Glasgow City Council is the local governmental authority for Scotland, which was formed in 1966 under the Scotland Local Government Act. The authority operates some refuse collection Lorries but due to the lack of preparedness of Mr. Clarke, an accident took place which killed six people and injured various others.
Aims and objectives
The Aim of part 1 of this report is to describe the emergency planning proceduresbased on the incident occurred at Glasgow City Council to prevent such incidents in the future. Further, the Aim of part 2 of this report is to provide the consequences for such incidents if occurred based on the assessment of possible consequences and the enforcement action that could occur.
In order to achieve the above-mentioned aim, following objectives were set: -
- To have a clear understanding of emergency planning cycle and stages in preparing an effective emergency response plan.
- To provide a practical approach towards the preparedness of an emergency response plan.
- To consider the possible outcomes of any investigation and the consequences by authorities.
- To consider any enforcement action taken after an incident occurred.
- To identify and eliminate the health and safety breaches by using an effective risk management approach.
- To provide timely training and awareness campaigns to the operatives to deal with an emergency.
The report is based on the following assumptions –
- The company is a large UK local authority that supplies refuse Lorries for collecting refuse.
- The driver had a good experience of collecting refuse from different areas.
- The incident took place in Glasgow City.
- The emergency planned procedures are relevant to this situation only.
- The consequences are those incidents that happened after the incident.
In order to carry out this report, we adopted a case study analysis where the case study is analysed using other relevant books, journals and websites related to the topic. The approach taken in this report is consistent with the legislation and includes a risk assessment to identify the key risks that affect the people. This is followed by identifying the risks and give mitigation measures along with some recommended actions to solve the problem.
Part 1 – Emergency Planning
Emergency planning cycle
Turoff et al. (2013) stated that the emergency planning cycle helps in mitigating various risks associated with hurricanes, droughts, volcanic eruptions and others. Through this process, one cannot prevent the risks but could somewhat mitigate them from happening. The approach to emergency planning is considered a part of the safety management system of an organization. Process of emergency planning is considered an all-hazards approach because it is a structured management process of looking at the potential risks and their impacts. As a result, this approach not only gives the best method to prevent any risks but also helps to ensure that a decision to mitigate one risk does not affect another one. There are four stages in this cycle – prevention, response, recovery and preparedness.
Prevention could be defined as the sustained action that can reduce long-term risks to people from hazards and their effects. As stated by Reason (2011), an organization needs to have procedures in place so that the risks could be identified through a proper risk management process. One of the ways as identified by HSE (2001) that health and safety risk assessment helps in preventing any sort of ill health, death and injury-like cases.
Preparedness or contingency planning is required to improve an organization’s response to an unexpected event. It is very crucial to make the plan workable and practical, as it would help to combat unwanted contingencies or emergencies. This stage makes an organization ready for the unexpected outcomes within the emergency along with the measures needed to deal with it.
In this stage, the emergency plan is activated to respond to various circumstances. The internal response would be to identify the scale and type of an emergency, contacting key people, contacting other organizations and then setting up proper steps to manage the response activity. This stage is very important because any misappropriate response could lead to a failure in the inability to react to certain emergencies.
As stated by Rasmussen (1997), emergencies tend to occur at any time and so, a recovery plan helps in minimizing the time taken to recover from it. During this phase, it is important to restore the operations as fast as possible. The recovery plan is quite hard to design as it covers a broader scope and so, it is important to create it depending on the duration, which is required.
Application of emergency planning into the scenario
Emergency planning cycle
In order to know how the system failed, it is needed to study the system. Reason (2011) suggests studying the system properly so that the root cause of failures could be identified. By studying the system, it is seen that the entire incident occurred due to unskilled staff and organizational fault. On 22 December 2014, Henry Campbell Clarke, a refuse collection lorry driver who was driving the car along the collection route so that the crewmembers could collect the refuse at defined points. However, during the journey, the driver lost unconsciousness due toneurocardiogenic syncope, which occurred due to a reduction in blood pressure (Beckett, 2015). As a result, six people lost their lives and others were severely injured. This showed that the authority did not take this situation into proper terms. In this case, HSE (2001) recommends using a safety audit so that the risks present in the incident could be identified and proper methods could be used to solve them so that such a problem does not happen again. Rasmussen (1997) suggests using a risk management process to identify the risks so that the safety director could work on them. From the incident analysis, it is seen that the workers here are untrained and did not have sufficient knowledge to acknowledge the hazards. This is due to the negligence of safety culture seen in Glasgow City Council, which is similar to Piper Oilfield, North Sea. In this incident, people were not able to spot the faults unless they were 10 to 15 feet away from the intakes (NASA, 2013). This showed the importance of a safety culture in an organization.
A risk assessment is shown below as –
Table 1: Risk assessment of the incident
(Source: (Beckett, 2015)
Through this risk assessment, it is clear that there were hazards at the road place. Some of them were low bridges, awkward junctions and roundabouts. In addition, the time when the incident took place was a holiday time and that affected the movement of the lorry. Most of the junctions were filled with pedestrians. As the driver was travelling the lorry at a high speed, so, sudden breaks could lead to unnecessary accidents (Beckett, 2015). Through the risk assessment, it is seen that the time was quite busy due to which such risks took place. Therefore, it is required for the safety director to carry out route optimization so that such problems never happen again. Due to the morning time, there were more people, which were solely responsible for creating such incidents where the injuries need to be reduced as much as possible (Beckett, 2015).
Cooperating and coordinating with the emergency services
IOSH (2014) stated that safety culture is very vital for improving the practices so that such incident does not happen again. Safety culture is considered as consisting of shared values and beliefs that interest the control systems and organizational structure to generate behavioural standards. Safety culture is vital in creating an optimum design so that hazard-related incidents could be stopped. In this case, the competency framework could be adopted which is shown below –
Figure 2: IOSH framework
Source: (IOSH, 2019)
IOSH framework should be adopted to address the competencies in the work. In this case, there are three competencies – technical, core and behavioural.
The most important core competency is in leadership and management. Being the Safety Manager for a local authority, I must design a proper emergency plan that could deal with the consequences of such an event so that such kind of incident does not happen again. In order to improve the scenario, we have to adopt collective mindfulness so that the problem could be solved properly. As explained by Hopkins (2007), leaders shape the culture, which ultimately affects in changing the safety practices. Through proper leadership direction and management style, it is better to create proper norms and regulations of safety culture. As expressed by Mehdizadeh, Shariat-Mohaymany and Nordfjaern (2018), it is seen that the lorry drivers create unnecessary accidents, which need to be monitored and changed when important so that such problems never happen again. For this, it is important for me to apply mindful leadership whenever required. It is needed as it helps to identify minute problems in a system. Lekka (2011) expressed that when people tend to apply mindful leadership, then, there is less chance of unexpected events and makes the management team ready for any adverse events.
Figure 3: Mind map of high-reliability organizations
(Source: (Lekka, 2011)
The next competency is related to technical aspects, which is risk management. This is very important, as it would prepare the organization for future problems. Here, Rasmussen (1997) suggests using a risk management process to identify the risks so that the safety director could work on them. From the incident analysis, it is seen that the workers here are untrained and did not have sufficient knowledge to acknowledge the hazards. Through this risk assessment, it is clear that there were hazards at the road place. Some of them were low bridges, awkward junctions and roundabouts. In addition, the time when the incident took place was a holiday time and that affected the movement of the lorry. Most of the junctions were filled with pedestrians. As the driver was travelling the lorry at a high speed, so, sudden breaks could lead to unnecessary accidents (Beckett, 2015). Through the risk assessment, it is seen that the time was very bad due to which such risks took place. Therefore, it is required for the safety director to carry out route optimization so that such problems never happen again.
The last competency is stakeholder engagement. This is a very important approach, as mutual collaboration would help in solving the problems. IOSH (2015) stated that when collaborated with emergency services, then, it is easy for a company to solve the problems. This is required as through risk assessment, we came to know that the drivers were untrained and most of them do not know how to escape busy routes. Therefore,Glasgow City Council must deliver some basic training to the drivers that would help them to operate the steering and braking mechanisms of the Lorries. Boardman and Lyon (2006) suggested that such change is possible when there is an adaptation of safety culture, which would help the people to adopt safety strategies so that everyone stays safe during such a scenario.
Maintain refuse collection while dealing with the reputational risks
In this case, it is important to optimize the routes so that it becomes easy for the refuse collectors to collect without creating any casualties. IOSH (2015) suggested that to create a good response, the PDCA cycle should be used which would guide in taking the real precautionary measures to maintain the refuse collection. PDCA constitutes of four steps – plan, do, check and act.
Figure 4: PDCA cycle
(Source: (IOSH, 2015)
In the planning stage, we identified the incident and then in the do stage, we computed the main risks through the risk assessment. Through this risk assessment, it is clear that there were hazards at the road place. Some of them were low bridges, awkward junctions and roundabouts. In addition, the time when the incident took place was a holiday time and that affected the movement of the lorry. Most of the junctions were filled with pedestrians. As the driver was travelling the lorry at a high speed, so, sudden breaks could lead to unnecessary accidents (Beckett, 2015). Through the risk assessment, it is seen that the time was very bad due to which such risks took place. Then, in the check stage, we carried out safety auditing through which we found serious flaws in the skills of the drivers as well as in the crewmembers. It is seen that the people do not have the proper training to find alternative routes and could not know how to cure a driver he gets unconscious (Beckett, 2015). Therefore, it is important for route optimization and selects those areas where the traffic congestion is relatively less and for this, a specific training is required.
The next worrying factor is the reputational risk, which the company faces as it had hurt several people and some even died of the accident. Due to this, it is very essential to maintain the corporate image as quickly as possible. Boardman and Lyon (2006) showed that reputational risk is very important to consider and this could be improved by embracing every principle of safety culture. In this case, as stated by Human Engineering (2005), safety culture should be incorporated as early as possible. Insurance is an ideal alternative to solve the problem of reputational risks. Through negotiation with external agencies such as insurance companies, the company could get the lost financial assets and this would help to manage the refuse collections as it was continuing for a longer time. This insurance is very much required to embed a safety culture in an organization, which would keep the assets safe and secured (HSE, 2013).
As stated by IOSH (2015), it is seen that an effective communication system is required to generate a continual development of the system. For instance, the NASA disaster that took place was solved with the help of a proper communication plan. This is quite true, as when people are addressed with proper strategies, then, they understand the problems quite easily and work on them. The effectiveness of the communication depends greatly on the comprehensive communication network and the communication action plan to solve the issues identified at the early stages of an emergency. This is very much essential for developing a safety culture and addressing the employees with important health and safety information, which could promote safety in the organization. As explained by Human Engineering (2005), there are various types of communication strategies like top-down communication, safety reporting and horizontal communication.
Based on the concerning case study, the most appropriate communication strategy is top-bottom communication. The reason is that such a communication strategy helps in communicating the health and safety policies and statements from management to frontline staff (Human Engineering, 2005). In this case, the staffs are the driver and the crewmembers who remained untrained due to which, they failed to control the lorry and led to a huge accident that claimed the lives of six people including some serious injuries. In this process, the authority of Glasgow City Council could take verbal as well as non-verbal methods and this could help to communicate safety issues and their associated regulations to the crewmembers (Human Engineering, 2005). As a result, it becomes easy for the management team to communicate the major accident risks to the people so that such problems never happen again. In addition, the management team must conduct management tours so that every minute flaw could be identified and working on it could solve the problems. As a result, of these actions, the management team could identify the strategy and could apply it and help them to recover the position of the local authority back to normal state. In addition, the usage of management feedback could help the authority to take proper decisions that could improve the operation of the lorry drivers.
Part 2 – Consequences
Consequences for the local authority and individuals
As per the incident that occurred on 22 December 2014, it is seen that several injuries occurred including some deaths. As a result, the authority of the Glasgow City Council could be charged with murdering those people, which happened due to their negligence, and improper contingency planning (Beckett, 2015). The outcome is horrific as such, incidents created a bad image for the authority. In addition, there had been a bad public reaction about the use of refuse vehicles in the state after such an incident. Moreover, the people who were injured very badly created a bad name for the company as it could generate huge reputational losses (Beckett, 2015). Even, there was the consequence of failure to comply with the guidelines of Driver and Vehicle Licensing Agency (DVLA).
Despite the consequences faced in the case, it could be suggested that the driver could be booked under any of the provisions of the criminal law. Whatever the consequences occurred, it could be claimed that there had been a permanent loss for the relatives of the deceased ones and so, the local authority and the associated crewmembers should be held guilty for not responding appropriately to counter the incident. Even though the risk assessment, it is clear that there were hazards at the road place like low bridges, awkward junctions and roundabouts (Beckett, 2015). In addition, the time when the incident took place was a holiday time and that affected the movement of the lorry. Most of the junctions were filled with pedestrians. As the driver was travelling the lorry at a high speed, so, sudden breaks could lead to unnecessary accidents (Beckett, 2015). As a result, such a high rate of casualties occurred led to such problems.
Enforcement action rationale
Depending on the incident, it would be logical to create a suspension order for the driver until he gets properly fit for driving the refuse vehicle. In addition, the crewmembers whose leniency leads to casualties in the main street taking the lives of six people and some seventeen were badly injured. Based on this fact, the crewmembers should be suspended for two months, and they must be incorporated in the refuse services after a proper set of training is given to them.
Associated health and safety legislation
Health and Safety at Work Act 1974
As per Human Engineering (2005), it is seen that all companies need to prepare a safety policy. The objective of the Act is to maintain and promote a positive safety work culture that could establish the corporate attitude to the organizational framework through which safety conditions could be attained. This is important in this case, as the main reason behind the low skilled workforce is that there had been less attention on the training programmes. Therefore, it is required for the authority to train the employees so that such a problem does not happen in the future. As per Sections 37(1) and 7 of this Act, it is the duty of both the directors and employees to comply with the safety practices, so, that there is good control over accident like scenarios (Boardman and Lyon, 2006).
Management of Health and Safety at Work Regulations 1999
As per Regulation 3 of Management of Health and Safety at Work Regulations 1999, it is important to make a suitable risk assessment of the hazards, which might arise to implement control measures to reduce the identified risks (Beckett, 2015). In accordance with this Act, there should be competent persons who would be in charge of monitoring the health and safety issues of the people at the workplace. Providing workers with the required information and giving proper training so that they adopt adequate measures to stop such casualties could do this. The outcome would be that the people could be better trained and take practical steps to manage the problem. This is required as the unconsciousness of the driver could be restored had there been proper training of the crewmembers, which was not there due to which the entire incident occurred.
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995
Under these regulations, employers need to report the work related incidents, diseases and injuries to the HSE. This report would include the details of the person affected, date and time of the incident, and the place where the event occurred. As a result, the employer could identify the problem and could take serious actions against the person who committed the incident and generated a reputational loss for the company. In case of the 22 December incident, the employer could identify how many people had died in the accident and even report their casualties. As a result, the company could even determine their injured crew workers (Beckett, 2015). Due to this, they could put an 'over seven-day injuries which would help the company to relieve some of the work for the injured staff members.
Assessment of the rationale of the change of corporate manslaughter
Corporate manslaughter could be defined as a criminal offence where a business is found to generate a person’s death. As a result, of this manslaughter, many businesses could be prosecuted or closed down for their unethical activities. Boardman and Lyon (2006) stated that as per the Corporate Manslaughter Bill 2005, a criminal offence could be created which applies to people when someone had been killed because of the mistakes of the senior management of a corporation. In this incident, the senior management of the authority could be charged with legal punishment as per the Corporate Manslaughter and Corporate Homicide Act 2007. The rationale behind it is that the company paid very little attention to train the crew for which several people had to lose away their lives. Upon investigation, it is seen that the reason behind a low-trained workforce is the negligence of the management unit (Beckett, 2015). As a result, when the driver got unconscious, then, it is seen that the crewmembers could not revive him despite several efforts (Beckett, 2015).
Conclusion and recommendations
The report showed that the case study is the failure of the senior management team who were not able to identify the risks properly due to which many casualties happen. Such kind of incident could lead to reputational loss along with a question on if refuse Lorries should be continued in that area or not. However, through emergency planning procedures, we get a proper plan through which the problem could be removed. In addition, there could be legal consequences but as the driver was unconscious due to a medical problem, so apart from him, others are found to be guilty. Based on the analysis, it could be said that the case is an example of corporate manslaughter & corporate homicide Act incidentally or accidentally.
Based on the following study, the recommendations are –
Proper training programmes As per the incident that occurred on 22 December 2014, it is seen that several injuries occurred including some deaths. As a result, the authority of the Glasgow City Council could be charged with murdering those people, which happened due to their negligence, and improper contingency planning (Beckett, 2015). Therefore, it is required to train the people, which would make them competent in taking practical steps to manage the problem without any difficulty. Moreover, medical knowledge should be imparted to them so that one of the crewmembers could solve the problem at that instant.
Performance monitoring system
The incident of 22 December 2014 created a huge loss of many lives and generated problems in the reputational loss. As a result, the employer needs to identify the problem so that they could take serious actions against the person who committed the incident as his or her actions had generated a reputational loss for the company. This would help the company to appoint a competent workforce who is going to drive the Lorries in the professional sense, which would reduce the casualties and maintain the image in the Scotland.
The incident took place when the driver lost unconsciousness due to neurocardiogenic syncope, which occurred due to a reduction in blood pressure (Beckett, 2015). As a result, six people lost their lives and others were severely injured. This showed that the authority did not take this situation into proper terms. Such incidents occur when people tend to ignore the medical conditions of the driver. Therefore, it is required to organise pre-medical tests of the crewmembers and the driver so that a proper assessment could be done of their fitness regarding their ability to operate a lorry.
The fatality would not have been much if there were less people in the streets. On investigating the situation, it is seen that many people crowded the streets, as it was a festive session. Therefore, the Council should try to generate awareness about the arrival of the lorry so that there are less people on the streets. This should be communicated to the traffic inspector so that the route from where the lorry would be going could be made empty (Flodén and Woxenius, 2021). As a result, there would be less casualties in the streets and could keep the people in safer condition.
Driving skill tests
The incident took place when the driver lost unconsciousness due to neurocardiogenic syncope, which occurred due to a reduction in blood pressure (Beckett, 2015). However, such incident could be reduced if the drivers could find different routes to move to a different location (National Academies of Sciences, Engineering, and Medicine, 2016). It is seen that the people do not have the proper training to find alternative routes and could not know how to cure a driver he gets unconscious (Beckett, 2015). Therefore, it is important for route optimization and selects those areas where the traffic congestion is relatively less.
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