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Phillip Martin: Head of eLearning, IT and Software Development with Neucom and the RDC.

Trevor Williams: IIAI Executive Committee Chairman.

Paul Difford: RDC Director.

Alan Dell MBE: IIAI Memberships Committee Chairman.

Madeleine Abas: Senior Partner, Osborne, Abas, Hunt Solicitors and Chair of the Health and Safety Lawyers Association.




Phillip Martin opened the evening with a review of Heinrich's Domino Theory and the models (e.g. Bird, Reason) that subsequently followed it. Drawing in part from the IIAI Ten Year Study and his work as a systems analyst, he identified the main problem with the subsequent 'causation' models as being an obsession with the notion that 'management failures' cause most accidents. Unfortunately, he said, "the notion is now the basis for most Root Cause Analysis software programs with effect that they default to a steady churning out of management failures as root causes...confirmation bias by design perhaps". Summing things up in his own inimitable style, he said [quoting Holmes] "It is of the highest importance in the art of detection to be able to recognise, out of a number of facts, which are incidental and which vital".




Trevor Williams (IIAI Executive Committee Chairman) spoke next. His message, by way of some of the oldest and most modern of cases, was simple...the HSE and the CPS must, when industry's investigators show it, accept the fact that there is such a thing as a 'pure accident'.

Death, as tragic as it is, can occur despite the system and all due care on management's part. If a management failure is the cause of a death or injury, we will find it...what we must not do, however, nor allow others to do unchallenged, is presume it and go looking for it despite clear evidence to the contrary.




Paul Difford (RDC Director), master of ceremonies for the evening, stepped in at short notice for an unavoidably delayed Douglas Payne (IIAI Executive Committee Vice Chair). Referencing areas of the earlier talks by Messrs Martin and Williams, Paul said that "In most of the UK, for example, it is regularly alluded to that 'management failures' cause around 70% of accidents. However, that figure is generated by the HSE and relates, in fact, to prosecution success rates. I have some difficulty with the word success given that over 95% of the 09/10 successes came by way of guilty pleas. I have even more difficultly comprehending the appalling failure rate of the HSE/LA/CPS in properly contested cases...a wake up call perhaps in the public interest if ever there was one".

Paul then proceeded to touch upon a handful of the many findings from the IIAI Ten Year Study (due for release along with the Lead Accident Investigators' Handbook in the Summer of 2011) and a summary of his talk will be available in due course in the members area.






Alan Dell MBE (IIAI Memberships Committee Chairman) presented a truly sobering talk entitled "In Context: London, July 7th 2005". As the man at the helm in CentreComm on that fateful day, Alan provided the audience with timings of the explosions on the underground and of the final explosion, at approximately 09:49 that morning, on board the Tavistock Square bus. But, everyone present already knew all this; all had clear cut and logical images of the events and circumstances of that terrible morning; it was obvious, or would have been, by 09:15 surely, that London was under attack...or was it? The orderly images that we all have were in fact constructed for us, well after the event by the media. What was actually known by those in CentreComm up until 10:00 that morning was, in reality and in context, a million miles away from that which was only possible after the fact.

The message to the Diploma Finalists and prospective Fellows was clear and powerful; Certified Lead Investigators must remain constantly alert to the threat of hindsight bias and develop ways to guard against it and check for it. Certified Lead Investigators do not judge...they analyse decisions in context.

The Institute extends its deepest sympathies to all who were affected by the events of 7/7/05.




Guardian of the late shift was Solicitor, HSLA Chair and long standing IIAI Member, Madeleine Abas. Guaranteed to grab and hold the attention of any audience, including Boardroom and Courtroom, Madeleine delivered a legal update packed full of must have information.




One of the UK's most respected, energetic and sought after Health and Safety Solicitors, it was easy to see why Madeleine is so widely and highly regarded as an essential advisor to Management Teams and Boardrooms; and, an essential defense team component.



                                                          Right to left: Madeleine, Phillip, Paul, Alan, Trevor.






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