Our current safety culture, growing like kudzu weed, is based on two misunderstandings: that 100 per cent safety is achievable and that if something goes wrong it’s always someone’s fault. The first is easy. We live at the bottom of a deep gravity well on a small piece of rock whirling round a colossal fusion reactor, and we pass our time by building a civilisation that relies upon billions of people doing dangerous things involving oceans, explosions, knives, fire, poison, pathogens and hurtling lumps of barely stable metal. This is not ever going to be 100 per cent safe. The second – that it’s always someone’s fault, and if we can track them down and a) punish them and b) make sure nobody else does it, it won’t happen again – is a bit trickier.

I spent a while as a director of a leading incident investigation company. As well as running investigations, we trained others to be investigators. As well as methodology, we taught two crucial things. First, it’s seldom, if ever, the last person to touch the thing – whatever the thing is