Clare Forshaw
Professional Head of Health and Wellbeing, RSSB
Deciding whether a train driver is fit for work is critical to workforce availability, operational performance, and safety. But these decisions are not always straightforward, and responsibility for making them can be unclear. Too often, Britain’s railways receive different answers from different medical professionals, creating inconsistency and confusion across the system.
That is exactly the problem that a proposed medical advisory panel for train drivers is designed to solve—and why it could become one of the smartest reforms in the railway.
Fixing rail’s medical patchwork
Right now, the way the industry accesses support for train driver medical issues can be slow and inconsistent. Medical decisions can vary, and there is limited specialist capacity, with too few doctors working in rail occupational health. The result is a system that can struggle to deliver quick, clear answers on issues that matter hugely to a safety-critical workforce and in delivering an effective rail service.
The health issues facing our staff and society are becoming more complicated. Drivers may need assessments for complex and sometimes multiple conditions such as diabetes, sleep apnoea, musculoskeletal disorders or heart problems, while new technologies and treatments are raising new questions about risk, monitoring, and fitness to work. Yet, the current system is not always able to respond quickly or consistently across the rail industry.
That matters far beyond the doctor’s office. Train drivers are essential to the smooth and safe running of the railway, so delays or confusion around medical decisions can affect rosters and reliability. A modern rail network needs a modern medical decision-making system to match.
Supporting system-wide health and wellbeing
The new medical panel, which will be run by RSSB, with endorsement from the Department of Transport and the Office of Rail and Road, aligns with RSSB’s commitment to better industry-wide wellbeing support. The panel brings together expert practitioners to offer consensus advice on complex and emerging issues. Instead of the industry wrestling separately with the same challenges, rail would have a dedicated source of specialist expertise—a go-to panel able to guide the industry on best practice systems, shape protocols, develop decision-making standards and tools, and respond faster when new challenges arise.
It can also help move the railway away from some of its standard medical triggers. At present, the system still relies on age-based checks—such as annual assessments for drivers over 55, rather than using a more accurate profile of individual health risk. A medical panel could support a more intelligent, evidence-based approach—one that is based on actual health risk, not just birthdates.
This proposed train driver medical panel is about much more than streamlining administration processes. A panel will help the railway make better, faster, and fairer decisions—while strengthening safety, consistency, and resilience across the network. As an industry built on standards, that could be transformative.