# Network Rail & Type 1 Diabetes



## Zedgeezer (Jun 11, 2018)

My son (aged18) has just been offered a job at Network Rail, subject to passing his medical assessment. I also work for Network Rail and am hearing that he may have problems going On Track unaccompanied. This means he will not pass the requirement for employment. Does anyone have knowledge of the latest attitude to Diabetes Type 1 and going On or Near the Track?


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## Northerner (Jun 11, 2018)

Zedgeezer said:


> My son (aged18) has just been offered a job at Network Rail, subject to passing his medical assessment. I also work for Network Rail and am hearing that he may have problems going On Track unaccompanied. This means he will not pass the requirement for employment. Does anyone have knowledge of the latest attitude to Diabetes Type 1 and going On or Near the Track?


Hi Zedgeezer, welcome to the forum 

There's quite a discussion about train driving and track work here, which you may find helpful:

https://forum.diabetes.org.uk/boards/threads/train-driving-with-type-1-diabetes.3242/

I'd also suggest contacting the Diabetes UK Helpline to see if they can direct you to any sources of information:

https://www.diabetes.org.uk/how_we_help/helpline


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## Donald (Jun 11, 2018)

I Found this but is dated November 2007 


http://www.rmt.org.uk/news/publicat...-guidance/nrdiabetesmanagementguidance-v1.pdf


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## Maz2 (Jun 12, 2018)

I don't know the rules about this but I would imagine it may have something to do with hypos.  If your son passed out or felt ill and he was alone it could be very dangerous in that environment.  He would have to declare the Type I to them.  I hope they would do their best to be sympathetic so that he could still have the job.


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## C&E Guy (Jun 12, 2018)

I'm not sure by your wording of the question. Are we talking about driving a train - or working on a track? Would that not be as part of a team of workers. Surely that would be alright if there's company about (including a mandatory first aider).

Driving a train on his own would be a different matter altogether and the rules would be more stringent.


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## Zedgeezer (Jun 12, 2018)

Thank you all for prompt replies, to try and answer them all.
I am not talking about driving a train, just an individual maintaining the track without being accompanied (although I really don't think either should be discriminated against if their Diabetes control is proven) The main issue is the progress being made in technology (and current discrimination law). It appears that most major employers use external medical assistance teams - OH Assist as an example (the police, fire brigade & the army etc.) to decide if an individual is able to work unaccompanied. These assessments have a default on their form of "Type 1 - Must be accompanied". yet this takes no account of current innovations that Diabetes UK and local health authorities are offering, and I am worried that out of date forms can create unintentional discrimination.
I guess what I'm really saying is that if a person has complete, provable control of Type !, why should they be treated any differently from any other individual?


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## Diabetes UK (Jun 13, 2018)

Hi @Zedgeezer - as @Northerner mentioned there has been a few queries with train driving/maintenance work and diabetes. I also worked as part of the Advocacy team here at Diabetes UK and I know that there have been a number of employment enquiries regarding rail track work. In regards to the Equality Act 2010, the Armed Forces is technically the only employer who can issue a blanket ban on individuals based on medical conditions. However, if an employer has a legitimate safety concern, then things can get a little more complex. I believe we were chasing Network Rail for updated guidance on medical conditions and train driving back in September 2017,  and that the standards were similar to that of a Group 2 driving license. 
But, your son is looking to work on the rail tracks, not as a driver. I have found a document that may help, but it is dated 2014 - so I will try to find out if there is anything more up to date and get back to you.
It is regarding *'Guidance on Medical Fitness for Railway Safety Critical Workers'. *
https://www.rssb.co.uk/rgs/standards/gogn3655 iss 2.pdf

*Page 34* discusses hypoglycaemia and diabetes and seems to imply that suitability/safety is based on the individual's condition and whether they have a an increased risk such as hypo-unawareness. This would fit in with the Equality Act, whereby employers must base decisions on individual circumstances rather than general assumptions of a medical condition.

You may find our Employment & Diabetes guide helpful as well for more broad information about rights at work: https://www.diabetes.org.uk/how_we_...employment-and-diabetes---your-rights-at-work

Best of luck!


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## novorapidboi26 (Jun 13, 2018)

Is working on a track alone not something that would be frowned upon, or the least preferred option for any NR employee or sub contractor? And if so, could that not work positively towards your sons potential employment.....?

I was due to inspect a bridge over a track but ended up letting someone else do it due to the long winded process of the NR medical due to my type one....


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## Emma Lowery (Jun 13, 2018)

Surely regardless of anyone's health conditions working alone on a track could be dangerous? I know there are the chances of your son having a hypo but similarly there is the chance someone could have a heart attack/stroke/seizure and I'm sure all sorts of other issues. I know I have worked in offices previously where they have had a no lone working policy you would think that they would in this kind of profession.


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## Zedgeezer (Jun 13, 2018)

Thanks again for the replies, I am unfamiliar with forum etiquette or how I should answer individuals comments, so here goes with answering them.
*Hannah DUK* - Your thinking is similar to mine but grass roots experience of external medical assessment is that "One size fits all" and is inflexible. I just hope that when my son goes for his medical assessment in a couple of weeks the assessor is aware of current thinking / legislation. I am going to go to the medical with him, not to baby sit, but to hopefully sit outside and be available to discuss the situation with the assessor if he decides my son cannot work alone, because that is a daunting conversation for an 18 year old who's whole career rests on this decision.
*Novorapidboi26 / Emma -* On the maintenance side of the railway it is common place to be on the track unaccompanied. Don't think of this as working dangerously, the track they are on is often (but not always) blocked to trains, but it is a daily requirement to go out on your own for the protection for the workgroup further down the track.
On a slightly different note I must applaud the Peterborough NHS Diabetes team for loaning my son the Freestyle Libra continuous blood / glucose monitoring system and the Medtronic equivalent version to take to the medical assessment to try and convince them that he is not a liability due to hypo risk. I get the feeling there are a lot of people rooting for him (including the guys who interviewed him and offered him the job, knowing the barriers that may have to be overcome).
I just hope the medical goes smoothly because that could help so many other prospective employees at Network Rail.
Just one last caveat: My son was diagnose as Type 1 at the age of two and is very street wise on dealing with it, anyone who has recent diagnosis should obviously fully understand / control their diabetes before assuming they can hope to go on the track unaccompanied!


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## C&E Guy (Jun 14, 2018)

There have been recent programmes on tv where guys do work alone on track but it's always in very remote places in the Highlands.


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## Zedgeezer (Jun 14, 2018)

*Hannah DUK* - I have now carefully read all your suggested links and thanks for the research. Maybe I am fearing jumping hurdles that do not exist. Clearly Network Rail's stated policy is to treat every Type 1 on an individual basis. I hope my son is assessed by an enlightened medical assessor because my experience (from my own assessments) concerns me. Typical examples (True - I promise you)
!/. Several years ago I pulled / tore muscles in my back and occasionally it comes back to haunt me. I went for assessment and when asked if I had any problems I said "Not really, but I get a bit of a pain when I twist sometimes" and the answer was "Well what do you expect, we were never designed to come down from the trees."
2/. Recently I failed a medical due to being short sighted (I'm 60 so no big surprise), I was banned from the track until my eyesight was corrected and was told I would not be allowed back on track unless I wore glasses. My job does not need me to focus in the distance, and when wearing glasses I cannot see to do the detail work that is my job, so I am in the ridiculous position of putting the glasses on to go on the track then taking them off to do my job.
This is why I am slightly concerned about how my son's medical assessment will go, and why I am going with him to try and ensure that someone is fighting his corner.


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## LizzyDiabetic (Oct 2, 2020)

Zedgeezer said:


> *Hannah DUK* - I have now carefully read all your suggested links and thanks for the research. Maybe I am fearing jumping hurdles that do not exist. Clearly Network Rail's stated policy is to treat every Type 1 on an individual basis. I hope my son is assessed by an enlightened medical assessor because my experience (from my own assessments) concerns me. Typical examples (True - I promise you)
> !/. Several years ago I pulled / tore muscles in my back and occasionally it comes back to haunt me. I went for assessment and when asked if I had any problems I said "Not really, but I get a bit of a pain when I twist sometimes" and the answer was "Well what do you expect, we were never designed to come down from the trees."
> 2/. Recently I failed a medical due to being short sighted (I'm 60 so no big surprise), I was banned from the track until my eyesight was corrected and was told I would not be allowed back on track unless I wore glasses. My job does not need me to focus in the distance, and when wearing glasses I cannot see to do the detail work that is my job, so I am in the ridiculous position of putting the glasses on to go on the track then taking them off to do my job.
> This is why I am slightly concerned about how my son's medical assessment will go, and why I am going with him to try and ensure that someone is fighting his corner.



Hia - I’m a signaller. Did your lad get on ok?


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## grovesy (Oct 2, 2020)

LizzieDiabetic said:


> Hia - I’m a signaller. Did your lad get on ok?


Sorry to butt in but it looks @Zedgeezer  has not been seen for some time.


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## Zedgeezer (Oct 4, 2020)

LizzieDiabetic said:


> Hia - I’m a signaller. Did your lad get on ok?


Hi Sarah, Yes my son did get the job and is allowed on track unaccompanied. I must admit there were a few raised eyebrows from work colleagues when we returned from the medical assessment. I have subsequently been told by someone involved in Network Rail training that to their knowledge, he was the first Diabetes Type 1 person to be allowed on the track without restriction. I should emphasise that he has excellent control of his condition, has never had a hypo in the 18 years since diagnosis, and by using the Freestyle Libra was able to prove his blood / sugar control. I would fully understand restrictions being applied if you cannot prove this control.


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## LizzyDiabetic (Oct 4, 2020)

Ah that’s mega!! Good on him :-D


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## Zedgeezer (Jan 22, 2021)

3 years after my original post, my son's situation has just become really messy. He went for a regular mandatory work medical and his examiner was unfamiliar with the Freestyle Libre system, and removed all his safety tickets to work on the railway until his medical team could assure them that he could control his Type 1. Network Rail then insisted he went off "Sick" until this was sorted out. His Union were then contacted because he wasn't sick, he was actually unable to work due to the removal of his safety critical certifications. NWR then rescinded the "sick" decision and put him on "Paid Leave".
However due to all this Covid stuff his medical practitioner did not consider it an emergency to send a letter in reply to requests from NWR to supply medical records (in spite of numerous phone calls) and when eventually they sent his records 5 months later they showed his sugar levels were often higher than desired. My son explained at his last medical this week that as he was a track worker who did not know how much physical work would be required when he got to site (and it could be extreme) he knowingly increased his sugar intake (not massively) to prevent the risk of a hypo because he would be a significant distance from a food source for an unknown period and would adjust his insulin accordingly on return to the van. As a result of this, NWR have now removed several of his safety competencies and he is not allowed on the track unaccompanied (which is a big deal in career progression).
When he first joined network rail, he was one of the first to ever be allowed on track with Type 1 unaccompanied, and I thought Network Rail may be becoming an enlightened employer, now I am seeing a different side.
Has anyone got any comments?


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## everydayupsanddowns (Jan 22, 2021)

Ah sorry to hear how this has unfolded @Zedgeezer 

Difficult for me to comment, not knowing enough about the regulations involved, but it certainly sounds very complex, and made even more difficult by the current covid situation.

Maybe you should contact the Diabetes UK helpline (number at the top of the page) and see if their advocacy service might be able to help?


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## Zedgeezer (Jan 22, 2021)

everydayupsanddowns said:


> Ah sorry to hear how this has unfolded @Zedgeezer
> 
> Difficult for me to comment, not knowing enough about the regulations involved, but it certainly sounds very complex, and made even more difficult by the current covid situation.
> 
> Maybe you should contact the Diabetes UK helpline (number at the top of the page) and see if their advocacy service might be able to help?


I probably need a bit of distance before I contact the help line. I'm close to taking the the discrimination route, because this affects his whole career, but in reality, this would be the David vs Goliath route, and David may not win against NWR


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## Frank87 (Jan 22, 2021)

@Zedgeezer i am type 1 diabetic and work on the railway myself. I am not employed by NWR like your son. I personally haven't encountered any problems with this and my sponsor. I mainly work on track renewals (P-way) and throw down long night shift hours and manual labor. I inject insulin and use the freestyle libre to check my blood, but hoping to get the Libre 2 asap, this monitors over bluetooth and alerts you to out of range blood levels.

I have not had any issues with hypo's while working nor had any competencies removed from me. I rarely find myself working alone, perhaps a distance up or down line, but in sight of colleagues. I don't hold the IWA competency, but I have enquired and not been told I cannot do it.  

From experience over the years, i can straight up tell you that 'occupational health providers' are not equal. I have had some experiences with some rather inept/unskilled ones regarding type 1 diabetes. 
Its frustrating to no ends, and your son having slightly higher than normal blood sugars, like myself is not a deal breaker. He and I will fully understand the severity of the jobs we do and the reason we choose to run slightly high for short term. This is without any doubts a safe guard we implement for ourselves. On a medical report be that hba1c this looks bad long term.       

I was digging around some documents i have (from RMT) both from 2007. One seems to obsolete, but the one that looks to still be valid to some degree is titled RS/505 Issue 1

Direct copy and paste reads;
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*6 Medical assessment of rail workers with diabetes*
Concerns about people with diabetes and their fitness for safety critical work are based on the
knowledge that some of these individuals have a greater than average likelihood of impairment of
awareness or concentration, sudden incapacity or loss of consciousness. Although such impairments
may be due to gradually developing disorders such as visual impairment or ischaemic heart disease
these are normally detectable in the context of the periodic medical examination. Hypoglycaemia is of
particular concern because it is difficult to assess or predict and may affect otherwise healthy, well
controlled patients with diabetes.

The rail environment differs significantly from other workplaces and occupational physicians working
in this field are expected to have knowledge of the hazards involved. Workers may be exposed to
train movements when accessing the lineside environment or be expected to control the movement of
trains when performing a signalling role. The physical demands of these jobs and working hours vary
considerably. Even in the context of a single job such as train driving the risks may vary depending
on the type of locomotive, the route and the train protection measures in operation.
In the UK rail industry, fitness standards apply to workers with safety critical duties but there have
never been requirements specifically relating to diabetes. The Railway Group Standards include a
general health requirement that:
Candidates shall not be suffering from medical conditions, or be taking medical treatment likely to
cause:

a) sudden loss of consciousness
b) impairment of awareness or concentration
c) sudden incapacity
d) impairment of balance or co-ordination
e) significant limitation of mobility.

Technical Specifications for Interoperability (TSI) for the European rail network contain similar
wording.
Whether there are regulatory standards or whether individual duty holders define their own fitness
standards, the underlying principle of excluding people with conditions that are likely to cause these
impairments is still important.

Diabetes and some treatments for diabetes have the capacity to produce effects under one or more of
these categories. It is for the examining medical practitioner to advise the employer whether the
employee can meet the general health requirement for their job. Any medical assessment will be
performed by, or under the supervision of, a doctor having experience of occupational medicine and
knowledge of the hazards of working in the railway environment.

If an individual does not meet all of the medical requirements the employer can still decide to permit
the person to continue with their duties providing they take advice from their occupational physician
and introduce measures to control the additional risks arising from the medical condition. In the case
of an employee with diabetes, the occupational physician will take all of the relevant information into
account and use their professional judgement before advising on fitness.

The employer has overall responsibility for deciding which duties an employee should be given, taking
into account the advice from their occupational health provider. Should the employee disagree with
their employers decision they should use the usual company procedures to resolve the matter.
---------


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## Zedgeezer (Jan 22, 2021)

Hi Frank87,
I think a major problem at NWR is that their health provider (OH Assist) will always default to "Computer says No" because that removes any risk to them. I would never let my son go into an environment where I thought there was a risk due to his Diabetic control, I know the quality of his management & yes, the blue tooth swipe option reinforces my trust. His pediatric team moved mountains to get everything set so there were no barriers to his employment, but now, during covid etc. both his medical practitioner & his consultant (not the pediatric team because he is now 21) are saying this isn't an emergency situation so have withdrawn all support, so I guess I'm just trying to get a feel for where to take this frustration to. This is a young guy who passed all the medicals to be employed, worked totally safely & successfully for two years, adapted his sugar intakes to allow for his working environment (yes, the long drives, the unexpected energy requirements etc.) and now he is restricted in progression because his safety tickets have been removed. Incidentally I have been P/Way track based for 27 yrs so I get the risks, I would never have suggested my son apply if I had the slightest doubt he was at any risk through his diabetes.


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## Frank87 (Jan 23, 2021)

@Zedgeezer I understand completely the frustration for you both. You yourself being track experienced understand exactly (Apologies, I didn't pickup on you being in the same line of work, but i take it you don't work directly for NWR either?). I have had plenty of battles over my own diabetes with various employment over the years, fortunately not been struck with such from NWR competencies (yet).

What competencies did they remove from him ? 

'_*examiner was unfamiliar with the Freestyle Libre system, and removed all his safety tickets to work on the railway until his medical team could assure them that he could control his Type 1*_' - This triggered by someone unfamiliar is extremely unfair.  

Its a seriously irritating position to be in for you both. Personally, I am the type of person that would push back and challenge them on it. 

I don't know how helpful this might be;






						Error - Cookies Turned Off
					






					www.practicaldiabetes.com
				












						Network Rail Diabetes Management Guidance
					





					www.rmt.org.uk
				




From the above link;
'_*where medical restrictions have been placed post an Occupational Health Physician consultation.*_' - this seems to be the deciding factor. Given that things were fine until a medical with an uneducated examiner (towards the glucose monitoring equipment came into the picture) 

I would argue this with them. I have no idea where NWR draw the line on this, I feel they are stepping dangerously close to discrimination here. If your son has proven fitness, and good control (slightly high readings over a shorter time does not count as ill health), I would definitely consider seeking professional advice if you aren't getting anywhere.   

I can't find anything specifically on any NWR documentation about exact restrictions for Type 1 diabetes, they seems to be guidelines, but no crystal clear exceptions other than what seems based on an Occupational Health Physician consultation (if there is anything, I can't find it, nor have I even been shown it). I will definitely reach out to contacts I have, and make some enquiries to see if I help in any way. (As a fellow diabetic, reading about this kind of situation, not only saddens me, but irritates the hell out of me too).


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## Zedgeezer (Jan 23, 2021)

Frank87 said:


> @Zedgeezer I understand completely the frustration for you both. You yourself being track experienced understand exactly (Apologies, I didn't pickup on you being in the same line of work, but i take it you don't work directly for NWR either?). I have had plenty of battles over my own diabetes with various employment over the years, fortunately not been struck with such from NWR competencies (yet).
> 
> What competencies did they remove from him ?
> 
> ...


Thanks for your research Frank87,
Just to answer a couple of your questions, I work for NWR & have done the usual long drives & weekend nights for all those years.
The competencies removed are Lookout, Barrier Man, Possession Support plus presumably any other ticket which could involve him ever being alone on or near the track. As a trackman, these are part of the fundamental requirements for progression up through the gangs, and he will probably always be left as the guy swinging a hammer whilst others gain broader experiences.
There are a lot of ironies in his situation, mostly brought on (I believe) by a fundamental lack of understanding of modern Diabetic control technologies by what is a large and relatively faceless organisation. I wonder if more empathy would be shown if someone senior within the NWR training organisation also had Type 1 and was motivated to look for solutions rather than erecting barriers.
For example, supplying a mentor who understood Diabetes who could guide a young person starting off in a career through these sorts of situations. If I had not worked for NWR and done a bit of work / research in the background to anticipate some of the obstacles on the path ahead I am not convinced he would even have got the original job offer.
As for some of the ironies:
1/. NWR state in their external policy statement that anyone with a disability (as defined by the 2010 Equality Act) will be guaranteed an interview when applying for an apprenticeship to follow the NVQ Level 1/2/3 route, he applied, guess what - no interview even though he quite clearly stated Diabetes Type 1 on the application.
2/. He then joined NWR as a trackman, not an apprentice, I did a bit of research and managed to contact someone senior in training who told me they positively encouraged existing employees to participate in the NVQ Level 1/2/3 training route, all he had to do was talk to his manager. He talked to his manager, who told him he would not be considered as he didn't show enough initiative. When asked for an explanation he was told he had not applied for a Technician post that had been advertised. The irony here is that the advert stated NVQ Level 1/2 (or working towards) preferred, which is why he didn't apply.
3/. He has now had restrictions of "must be accompanied on the track" added to his Sentinal card, yet he can get in a NWR vehicle on his own and legally drive 100 miles up the M1 at the end of a night shift.
4/. Due to improved modern controls, Type 1's can now hold a PSV licence, and as such he could adapt his sugar levels to meet the requirements of that job, yet adapting them to meet his current job and environment has meant the removal of his tickets.


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## countduckula55 (Feb 18, 2021)

Zedgeezer said:


> Thanks for your research Frank87,
> Just to answer a couple of your questions, I work for NWR & have done the usual long drives & weekend nights for all those years.
> The competencies removed are Lookout, Barrier Man, Possession Support plus presumably any other ticket which could involve him ever being alone on or near the track. As a trackman, these are part of the fundamental requirements for progression up through the gangs, and he will probably always be left as the guy swinging a hammer whilst others gain broader experiences.
> There are a lot of ironies in his situation, mostly brought on (I believe) by a fundamental lack of understanding of modern Diabetic control technologies by what is a large and relatively faceless organisation. I wonder if more empathy would be shown if someone senior within the NWR training organisation also had Type 1 and was motivated to look for solutions rather than erecting barriers.
> ...


I'm in a similar position with N/R having worked for them for over 20 years. I have been a type 2 for many years but recently had to start using insulin. Optima Health instantly stood my down from my signalling position and N/R forced me to go off sick. I was told by an optima health doctor about the dexcom/libre devices and how good they were and to try and get one from the NHS, so if/when I get back to work would prevent me having to fingerprick every 2 hours. Now I've been told by N/R that they don't think they accept these as reliable and I will have to test every 2 hours. I have a review with OH soon but not holding my breath.


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