PFD report

Clive OXLEY · Prevention of Future Deaths report

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Issued 23 Dec 2020•County Durham and Darlington

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

View original report
Concerns
2

Raised in this report

Recipients
2

Named on the report

Responses found
2

Of 2 recipients

Stated actions
13

Described in responses

Recipients and published responses

Source document

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

Select any concern, action or position to view the source wording.

Concerns raised2

  1. Inadequate construction of the barrier preventing pedestrian access to the track
    Part of recurring concern: Failure to prevent public access to closed or restricted hazardous sitesPart of recurring concern: Ineffective controls preventing access to railway tracks
  2. Incomplete and gapped wire fencing along the viaduct parapet wall
    Part of recurring concern: Inadequate physical barriers preventing access to dangerous drops or areas
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

Actions described in response An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.4

  1. Action

    Contact Network Rail to seek a joint site visit assuring that the fencing meets rail-industry standards.

    Stated by London North Eastern Railway LimitedStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.
  2. Action

    Provide platform-end gates and fencing at higher-risk locations to restrict unauthorised access to the railway.

    Stated by London North Eastern Railway LimitedStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.
  3. Action

    Complete southbound platform-end alterations, including a lockable gate, robust obscuring fence, audible warning, signage and anti-trespass flooring.

    Stated by Network RailStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.2

  1. Position

    Network Rail is generally responsible for platform end and boundary fencing beyond LNER’s day-to-day station management.

    Stated by London North Eastern Railway LimitedRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Inadequate construction of the barrier preventing pedestrian access to the track

Wider context from the report

“1) It is accepted that the barrier to pedestrian traffic between the southbound platform and the viaduct makes it clear that pedestrians should not access the viaduct from the platform (as does the automatic voice alert which is activated as the barrier is passed). However, I am concerned that the barrier itself is not of a construction adequate to prevent a determined pedestrian such as the deceased from accessing the track at that particular point. ”

Is this part of a recurring concern?

Yes — Failure to prevent public access to closed or restricted hazardous sites; Ineffective controls preventing access to railway tracks.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Incomplete and gapped wire fencing along the viaduct parapet wall

Wider context from the report

“2) The impression from officers from the British Transport Police and Durham CID who gave evidence is that the wire fence that extends the height of the viaduct parapet wall runs along only a short length of the wall, and that there are in any event gaps between the sections of that fence, the deceased gaining access to the parapet wall through one such gap. ”

Is this part of a recurring concern?

Yes — Inadequate physical barriers preventing access to dangerous drops or areas.

Open source report

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Contact Network Rail to seek a joint site visit assuring that the fencing meets rail-industry standards.

Verbatim wording from the response

“LNER have made contact with Network Rail with a view to arranging a joint site visit in order to seek assurance that the fencing meets the requirements of the rail industry standards.”

Source location

2020-0301-Response-from-LNER-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Provide platform-end gates and fencing at higher-risk locations to restrict unauthorised access to the railway.

Verbatim wording from the response

“In order to make suicide and trespass as difficult as possible, platform end gates and fencing is provided, and prioritised at locations deemed higher risk to prevent access to the line wherever possible. With specific regards to Durham, this is supported by signage promoting services offered by the Samaritans and the warning system that is in place at the Station. In addition, LNER have trained a significant number of staff in suicide risk who are given guidance and training in dealing with vulnerable people when they are seen on the rail network.”

Source location

2020-0301-Response-from-LNER-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Complete southbound platform-end alterations, including a lockable gate, robust obscuring fence, audible warning, signage and anti-trespass flooring.

Verbatim wording from the response

“As part of that exercise, in December 2019, we undertook significant alteration to the end of the southbound platform to deter pedestrian access and to obscure the view of the viaduct from the platform. This was done by removing the sloped nose of the platform and installing a lockable gate and robust fence at the platform end. The fence itself is 1.8 metres high with a coarse infill to limit any view of the viaduct from the platform. The platform end also has an audible warning system, signage making clear that pedestrians are prohibited from passing the end of the platform and Samaritans signage. Anti-trespass flooring was also installed either side of the fencing the full width of the platform to further discourage pedestrians from passing the fence.”

Source location

2020-0301-Response-from-Network-Rail-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Liaise with stakeholders and planning authorities to consider installing wire-mesh fencing along the viaduct parapet.

Verbatim wording from the response

“Significant parapet fencing has previously been trialled at this location. However, the viaduct has Grade II listed status, which introduces constraints in this respect. Our mandatory fencing standard was therefore applied. Following receipt of your report we are liaising with relevant stakeholders and appropriate planning authorities to consider whether additional measures can be taken over and above what is required in the fencing standard. Specifically, we are considering whether a wire mesh fence can be installed along the parapet to restrict individuals from climbing over the existing structure. This is something that we have done at other Grade II listed structures. In the meantime, the fencing at the viaduct is compliant with and will continue to be maintained as required by our mandatory fencing standard.”

Source location

2020-0301-Response-from-Network-Rail-Redacted
Page 2 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Network Rail is generally responsible for platform end and boundary fencing beyond LNER’s day-to-day station management.

Verbatim wording from the response

“LNER work collaboratively with Network Rail to reduce the number of trespass and fatality incidents along the LNER line of route, though in practical terms, LNER operate Durham Station under a long-term lease and are generally responsible for the day to day management of the Station. Platform end fencing and general boundary fencing in place to prevent unauthorised access to the track and other infrastructure is generally the responsibility of Network Rail.”

Source location

2020-0301-Response-from-LNER-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

A full-width southbound platform fence cannot be installed because mandatory gauging standards prohibit it.

Verbatim wording from the response

“Decisions in relation to the location and design of these measures took into account Network Rail’s relevant mandatory standards. Standards prohibit fencing to be constructed the full width of the platform due to gauging requirements (i.e. the need to consider the potential for a train to come into contact with the fence when passing the platform). The fence has been placed as far along the platform as standards allow. Consideration was also given to a derogation from standards but it was recognised that a determined individual could in any event access the track by climbing down from the platform edge.”

Source location

2020-0301-Response-from-Network-Rail-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Other statements in published responses

These actions and other statements could not be clearly connected to one concern in this report.

Recipient-stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.9

  1. 1

    Protect the fencing-to-platform gap with anti-trespass underfoot mitigation.

    Stated by London North Eastern Railway LimitedStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.
  2. 2

    Maintain the station warning system to help prevent suicide and trespass incidents.

    Stated by London North Eastern Railway LimitedStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.
  3. 3

    Train staff in suicide risk and provide guidance on responding to vulnerable people encountered on the rail network.

    Stated by London North Eastern Railway LimitedStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.
  4. 4

    Maintain Samaritans support signage at Durham Station to promote suicide-prevention services.

    Stated by London North Eastern Railway LimitedStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.
  5. 5

    Provide Samaritans-trained suicide-prevention patrols at Durham station, with deployment adjusted according to assessed risk.

    Stated by Network RailStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.
  6. 6

    Support LNER in assessing camera systems to detect suicidal individuals moving into positions where they may harm themselves.

    Stated by Network RailStated in progressThe respondent said that this action was in progress when they made their response on 8 January 2021.
  7. 7

    Fund dedicated British Transport Police officers, including an embedded inspector, to identify risks and plan suicide-prevention resource deployment.

    Stated by Network RailStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.
  8. 8

    Install closed fencing and anti-trespass flooring at the northbound platform end.

    Stated by Network RailStated in progressThe respondent said that this action was in progress when they made their response on 8 January 2021.
  9. 9

    Install anti-trespass flooring on both sides of the viaduct to deter access to its parapets.

    Stated by Network RailStated completedThe respondent said that this action was complete when they made their response on 8 January 2021.

Recipient positions A position is what a recipient says about a concern when they do not describe a specific action.1

  1. 1

    Fencing cannot safely or feasibly extend to the platform edge because rail clearance requirements determine minimum separation from rolling stock.

    Stated by London North Eastern Railway LimitedUnable to actThe respondent said that a constraint prevented them from taking the relevant action.

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Protect the fencing-to-platform gap with anti-trespass underfoot mitigation.

Verbatim wording from the response

“In respect of the platform end fencing, it should be noted that there is a requirement for maintaining adequate clearance between rail vehicle and adjacent structures. The amount of clearance between trackside infrastructure, such as fencing, and the rolling stock is determined in line with rail industry standards and can be affected by such as the track curvature, line speed, and those factors are used to determine the ‘swept envelope’ of the various types of rolling stock and the minimum clearance required, so in respect of the platform end fencing, it would not be considered safe nor feasible to have fencing that extended to the platform edge. The ‘gap’ between the fencing on the platform and the platform edge is however, additionally protected by anti-trespass underfoot mitigation which is consistent with that in place at other Stations on the UK rail network.”

Source location

2020-0301-Response-from-LNER-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Maintain the station warning system to help prevent suicide and trespass incidents.

Verbatim wording from the response

“In order to make suicide and trespass as difficult as possible, platform end gates and fencing is provided, and prioritised at locations deemed higher risk to prevent access to the line wherever possible. With specific regards to Durham, this is supported by signage promoting services offered by the Samaritans and the warning system that is in place at the Station. In addition, LNER have trained a significant number of staff in suicide risk who are given guidance and training in dealing with vulnerable people when they are seen on the rail network.”

Source location

2020-0301-Response-from-LNER-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Train staff in suicide risk and provide guidance on responding to vulnerable people encountered on the rail network.

Verbatim wording from the response

“In order to make suicide and trespass as difficult as possible, platform end gates and fencing is provided, and prioritised at locations deemed higher risk to prevent access to the line wherever possible. With specific regards to Durham, this is supported by signage promoting services offered by the Samaritans and the warning system that is in place at the Station. In addition, LNER have trained a significant number of staff in suicide risk who are given guidance and training in dealing with vulnerable people when they are seen on the rail network.”

Source location

2020-0301-Response-from-LNER-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Maintain Samaritans support signage at Durham Station to promote suicide-prevention services.

Verbatim wording from the response

“In order to make suicide and trespass as difficult as possible, platform end gates and fencing is provided, and prioritised at locations deemed higher risk to prevent access to the line wherever possible. With specific regards to Durham, this is supported by signage promoting services offered by the Samaritans and the warning system that is in place at the Station. In addition, LNER have trained a significant number of staff in suicide risk who are given guidance and training in dealing with vulnerable people when they are seen on the rail network.”

Source location

2020-0301-Response-from-LNER-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Provide Samaritans-trained suicide-prevention patrols at Durham station, with deployment adjusted according to assessed risk.

Verbatim wording from the response

“Following successful trials, Network Rail implemented Samaritans-trained patrollers for suicide prevention at Durham and this has been in operation since October 2018. In October 2019, we increased the patrolling presence. These patrollers are present at the station 5 days per week for 12 hours per day (based on an assessment of suicide attempts determining deployment times and days for maximum impact). This has sometimes been increased on a temporary basis to 16 hours a day where risk assessments have shown an increase in incidents or risk prior to the normal shift pattern. Since April 2020, these teams have made four lifesaving interventions at Durham station.”

Source location

2020-0301-Response-from-Network-Rail-Redacted
Page 2 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Support LNER in assessing camera systems to detect suicidal individuals moving into positions where they may harm themselves.

Verbatim wording from the response

“In addition to these patrols, we also fund a team of BTP dedicated officers who provide extra focus north of York on the East Coast Main Line (including Durham station). This is headed by a dedicated Network Rail funded BTP Embedded Inspector who works with our own suicide prevention lead to identify risks and provide plans for deployment of resources and liaison with local authorities and charities. We are also supporting LNER (who operates Durham station) to assess the potential for camera systems which may help to detect suicidal individuals moving into positions where they may harm themselves.”

Source location

2020-0301-Response-from-Network-Rail-Redacted
Page 2 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Fund dedicated British Transport Police officers, including an embedded inspector, to identify risks and plan suicide-prevention resource deployment.

Verbatim wording from the response

“In addition to these patrols, we also fund a team of BTP dedicated officers who provide extra focus north of York on the East Coast Main Line (including Durham station). This is headed by a dedicated Network Rail funded BTP Embedded Inspector who works with our own suicide prevention lead to identify risks and provide plans for deployment of resources and liaison with local authorities and charities. We are also supporting LNER (who operates Durham station) to assess the potential for camera systems which may help to detect suicidal individuals moving into positions where they may harm themselves.”

Source location

2020-0301-Response-from-Network-Rail-Redacted
Page 2 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Install closed fencing and anti-trespass flooring at the northbound platform end.

Verbatim wording from the response

“Works are currently ongoing to install similar closed fencing and anti-trespass flooring to the northbound platform end (although the sloping nose of the platform is not being removed at that location due to the proximity of signalling and telecommunications equipment).”

Source location

2020-0301-Response-from-Network-Rail-Redacted
Page 1 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Install anti-trespass flooring on both sides of the viaduct to deter access to its parapets.

Verbatim wording from the response

“In addition to the measures referred to above, immediately following the death of Mr Oxley, we installed 80 metres of anti-trespass flooring to both sides of the viaduct (i.e. northbound and southbound) to further prevent access to the structure. The works were completed in the week commencing 12 April 2020. The flooring is intended to act as both a physical and a visual deterrent to accessing the parapets. A photograph showing this is also included at Appendix 1.”

Source location

2020-0301-Response-from-Network-Rail-Redacted
Page 2 · response
Published 8 January 2021

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Fencing cannot safely or feasibly extend to the platform edge because rail clearance requirements determine minimum separation from rolling stock.

Verbatim wording from the response

“In respect of the platform end fencing, it should be noted that there is a requirement for maintaining adequate clearance between rail vehicle and adjacent structures. The amount of clearance between trackside infrastructure, such as fencing, and the rolling stock is determined in line with rail industry standards and can be affected by such as the track curvature, line speed, and those factors are used to determine the ‘swept envelope’ of the various types of rolling stock and the minimum clearance required, so in respect of the platform end fencing, it would not be considered safe nor feasible to have fencing that extended to the platform edge. The ‘gap’ between the fencing on the platform and the platform edge is however, additionally protected by anti-trespass underfoot mitigation which is consistent with that in place at other Stations on the UK rail network.”

Source location

2020-0301-Response-from-LNER-Redacted
Page 1 · response
Published 8 January 2021

Open published response
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026