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Annual Report 2004 - 2005

Chief Executive's Report

2004/2005 has been a busy and challenging year for the Commission. We have had increases in the number of occurrence notifications and in the number of investigations launched.

The number of reports finalised and published was up 26 percent on last year, and included 3 difficult investigations. Rail occurrences dominated this year. Notifications increased 28 percent on last year, driving up the overall rate of notifications. Whereas notifications decreased for air by 8 percent on last year, and marine notifications remained steady.

Overall investigations launched increased 3 percent on last year with increases in all modalities. Rail again dominating with 53 percent of the investigations launched in the year. The launch rate for rail investigations is 26 percent. This is 14 percent higher than the Commission's overall launch rate of 12 percent for the year. Marine has a 10 percent launch rate and air a 6 percent launched rate.

The reasons for this overall increase are unclear. Multifactorial elements drive accident events including environmental, social, economic, mechanical and attitudinal factors. There are standard combinations that raise the likelihood of certain events happening. By way of example cost pressures on businesses drive trade-offs in maintaining infrastructure, coupled with operator fatigue, or contemporary attitudes towards recreational substances, at critical points.

In its work the Commission does encounter emerging themes over time of causative factors that stand out amongst the many variables interplaying. In 2002/2003 fatigue in the rail industry, particularly with locomotive engineers, prompted a set of safety recommendations being issued which were aimed at reducing the number of fatigue related accidents and incidents. In this year, substance abuse has given cause for concern, so much so that the Commission has been active in advocating for legal reform in the transport industries, and is now involved with the Ministry of Transport's Substance Impairment Group. This Group involves stakeholders from the transport sector, working together to scope the extent of substance use in the sector, and to make recommendations to the Minister of Transport for improving the management of substance use that supports a safe transport system.

While the Commission can often accurately predict the number of occurrences in any given year, it cannot determine the severity or complexity of the investigations launched. This raises difficulties for the Commission in terms of the resources available to it to carry out its statutory functions.

2004/2005 was an eventful year in terms of the mix of occurrences investigated, and with that mix came a heavy drain on our resources. The nature of the occurrences required us to buy in engineering, scientific and diagnostic capability, which we do not ordinarily have. For example, the marine investigation into the foundering of the fishing vessel Iron Maiden off Pandora Bank in Northland required specialist technical assistance from the Royal New Zealand Navy; and the Convair 580 in-flight break up over Kapiti coast required expensive wreckage retrieval assistance.

For a small organisation, small changes can have large effects. The Commission felt the loss of 2 key staff in the year. Retention of capability in such a specialised environment is an enduring concern. The Commission does experience difficulties in recruiting in what is a tightened labour market that is often short of the skills and experience that are required in successful investigators. Having to recruit for an investigator and Chief Executive Officer added to the strain on the Commission's already lean resources, leading us towards a financial deficit for the year.

The Commission applied for deficit support through the Ministry of Transport to the Minister of Transport, as well as seeking an increase to its baseline funding for 2005/2006. As a result we received an additional $250k to our 2004/2005 baseline, raising Crown revenue received from $2.179m to $2.447m. In addition our baseline funding increased for 2005/2006 by 20 % ($445k). We are appreciative of the Ministry of Transport's efforts on our behalf in helping to secure the increase. Now we look forward to making our contribution towards a safe, secure, integrated transport system in a sustainable manner.


Lois Hutchinson
Chief Executive

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