BOI into the 2012 Tornado Collision over the Moray Firth [Archive]

Distant Voice

31st Jul 2013, 08:59

Bob Viking, I do not consider that the cost cutting statement is too harsh, and yes I realise that TCAS has never been fitted to Tornado; that's the problem. Please read on.

Two years earlier, in June 2010, there was a Category A (just one step down from mid-air collision) near miss east of Roybridge, with visibility at 50 km. One of the pilots reported that he was unaware of the proximity of the other jet above them until it was first seen in the pilot’s rear view mirrors as they turned. The small cross-sectional area of a grey GR4, head on, with no crossing motion “masked it’s [the other aircraft] presence until the last moment” The Airprox report, produced jointly by the CAA and the military concluded;

“TCAS or another form of cooperative CWS (Collision Warning System) would undoubtedly have helped to improve Situation Awareness and aid an earlier visual acquisition. Work is in progress to equip the Tornado GR4 with a CWS”

The Airprox comment leads one to believe that CWS/TCAS recommendations go back to earlier incidents, and that work is in hand to address the equipment deficiency. However, 18 months later in February 2012, and after several other incidents, another near miss took place, this time in the Moray Firth area, between a Tornado GR4 and a S92 helicopter. On this occasion the Airprox report states;

“Fitment of TCAS to the Tornado fleet is still under consideration but it is not yet funded, and it is very likely it would have increased the Tornado crew’s Situation Awareness on the S92”

In fact TCAS had been “under consideration” since 1999, when in January of that year a Tornado GR1 (prior to GR4 upgrade) collided with a civilian Cessna. All four people involved in the accident were killed. The MoD accident summary stated;

“The TCSI [Tornado Combined Safety Investigation] recommended that a Collision Warning System (CWS) for all military and civilian aircraft operating below 2000 feet be pursued with all possible haste.”

But, despite the Haddon-Cave report and the formation of the new MAA very little has changed with regards to aircraft safety and airworthiness. In the Tornado’s case we have gone backwards in two years from “Work in progress” to “under consideration but not yet funded”. Even if and when funding is approved how long will it take to modify the fleet? If we take the URGENT modification of the IFF (Identification Friend or Foe) system, following the Patriot incident in 2004, it could take six years. How many more lives will be lost in that time? In fact the ideal time to install TCAS into the Tornado would have been during the IFF modification programme, as the two systems are inter-linked, or better still during the GR1 upgrade in the early 2000s. The latter being the option outlined in the 1998 Strategic Defence Review;

“The Tornado GR4 squadrons will be given more logistic support to improve their deployability, as well as a new collision warning system early in the next century”

It seems ironic that the Chairman of the newly formed MAA Safety Advisory Committee, Air Marshal (Retired) Sir Colin Terry was Chief Engineer (RAF) from 1997 to 99 and must have been aware of the need for CWS to be installed in Tornado aircraft. And, considering that CWS needs were first addressed in 1990, following the collision two Tornado GR1s and three fatalities, it has to be assumed that his predecessor Air Chief Marshal Sir Michael Alcock was also in the picture on the CWS issue. (Both officers are linked with the accidents and fatalities associated with Nimrod and Chinook). On this occasion (1990) the MoD accident summary stated;

“Technologies which provide electronic collision warning systems are being investigated”

In the end it appears to boil down to costs, but what are the costs associated with several lost lives, and lost aircraft. Cut backs on aircraft numbers and pilots are one thing, but cut backs on flight safety when there is a known problem is criminal. It is interesting to note that the following statement heads the first MAA Defence Air Safety Annual Report;

“If you think safety is expensive, try a crash”

In a 2010 provisional assessment of strategic risks to Air Safety, DG MAA reported;

"Mid-air Collision - a risk during both routine flying operations and on OP HERRICK. Incremental mitigation of this chronic risk, which has a high 'societal concern' factor, has suffered protracted delays over successive PRs since the 1998 SDR. A 'Delete Tornado Collision Warning System' Option is being run in PR11 which would prejudice the Dept's ability to declare this risk ALARP".(PR11 being MoD’s Planning Round for 2011 - the annual budget review)

However, in the DG MAA Annual Report, dated 10 Aug 11, he reported;

"The reprieve of the Delete Tornado CWS PR11 Option is welcome, but there is likely to be more that could be done"

But is the "reprieve" just a paper exercise to give the impression that CWS for Tornado is still under consideration, and therefore the risk can be regarded as ALARP? From experience gained with Nimrod, as long as it can be demonstrated that progress was being made towards ALARP MOD regards everything to be OK. The bottom line is that 15 years have passed since the 1998 SDR, and nothing has been done.

The risk associated with the two Tornados involved in the Moray Firth accident in July was not ALARP. The risk associated with the whole Tornado fleet is not ALARP, and has never been ALARP since the mid-1990.

Fg Off Bloggs

31st Jul 2013, 09:02

Ooooh! Distant LOUD Voice, methinks!

Bloggs!

PS. Would a Moderator please change the title and give the event a 2012 date or summat like that! It's rather too alarming in its present form!

just another jocky

31st Jul 2013, 11:01

It's never as simple as just fit GR4 with TCAS though. As GR4's fly around mostly in pairs, or more, sometimes in close formation, sometimes a couple of miles apart, the TCAS could be giving RA's so often on each other that the crews might become complacent and start to ignore them.

Is there a system whereby you could inhibit a specific response from a specific ac to prevent this? RA's from #2 could be inhibited to prevent nuisance alerts caused by formation manoeuvring.

Trouble is, that wouldn't have prevented the Moray accident, would it?

TCAS & fast-jets seem to be fairly incompatible to me, unless someone could explain how it would be used on a daily basis.

Growbag

31st Jul 2013, 11:07

Who said TCAS wouldn't have prevented the accident?

Chris Griffin

31st Jul 2013, 12:28

Just another jockey

You could select TA only for pairs / multiple work and TA/RA for singleton if necessary. TCAS logic is becoming exceptionally clever - google 7.1.
The TCAS trg instills the bottom line that RAs MUST be followed and within specific timeframe (5s initial 2.5s follow on).

It's not a cure all but increases SA exponentially, and if its installation prevents one midair then its money well spent.

Avtur

31st Jul 2013, 12:47

BOI into the 2012 Tornado collision... Seemed very obvious to me that the thread titled referred to a previous accident: 2012 being the clue.

peppermint_jam

31st Jul 2013, 13:06

Avtur, that's a recent edit to the title mate.

airpolice

31st Jul 2013, 13:11

Avtur, you have come late to the party and not read/understood the original post.

Aynayda Pizaqvick

31st Jul 2013, 13:17

What do we need TCAS for when we have CADS?! :E

Avtur

31st Jul 2013, 15:11

Roger: If original thread title was as per post 4 then fully agree with previous comments.

Onceapilot

31st Jul 2013, 17:14

Just a basic civi TCAS would give some help to any fast jet in certain circumstances. Good bespoke software and a sensible SOP could be very useful. However, it can never be a total panacea in military flying IMO.

LateArmLive

31st Jul 2013, 19:59

Hands up all those who have flown FJs with TCAS. How many of you found you get over-saturated with TCAS alerts in normal training and wish you could turn it off?
In my experience it is a great SA tool when transiting around congested airspace, but it becomes a massive pain in the butt whenever you are doing any dynamic manoeuvring. Constant TCAS alerts from within your formation tend to cause you to become deaf to the system and ignore it at times. "Oh it's just no3 etc...)

There's still a way to go before it becomes truly useful in FJ ops in my opinion.

Bob Viking

31st Jul 2013, 20:50

LAL.
I have. The Hawk T2 and it can be precisely as you say. Every battle turn brings a TA which will then steal one of your MPDs. It also trips off at large angles of climb and bank triggering further avionics warnings (which will self reset but its still annoying!).
It proved useful on several occasions but my worry is the breeding of a blasé attitude to lookout. It is not a panacea in its current form.
As I said previously I'm not going to debate how it could have helped in the accident but I can at least talk from experience when the issue of TCAS in FJs is raised.

Easy Street

1st Aug 2013, 00:40

I feel the need to provide a bit of detail missing from Distant Voice's history of the 'CWS on Tornado' saga. It is not a simple question of funding for TCAS being delayed. At the very start of the programme, TCAS implementation was one of the options on the table, but the weaknesses of TCAS within the FJ operating context were considered to be excessive. In a decision which, in hindsight, seems utterly characteristic of its time, UK plc set out to develop a new FJ-optimised CWS. The aspiration was for this to be TCAS-compatible to 'standard' TCAS units; to other platforms equipped with the optimised unit it would be intelligent enough to ignore 'intentional' proximity such as crossover turns, tanker joins, visual combat etc. It would give warnings for 'unintentional' proximity - and, importantly, without requiring the aircrew to make any in-cockpit selections, so it could remain enabled throughout an entire sortie. A worthy ambition indeed, but one that proved to be pie in the sky, as any number of intra-formation near misses and actual collisions could have told the boffin dreamers. After all, what's the difference between a 'tally-visual' 1000ft pass, and a 'blind-no joy' bubble bust, other than a gnat's cock of pressure on the stick and about 0.01 seconds? By the time this concept was abandoned, years and years had passed; the decision to go with TCAS is comparatively recent in glacial DE&S terms. The regression from "work in progress" to "unfunded" broadly coincides with the abandonment of the CWS project; TCAS had to be funded anew because of its rejection within the earlier project.

And, of course, TCAS has its limitations in the FJ context, as identified all those years ago. I am quite concerned by the following statements from those currently operating the system on other platforms:
Constant TCAS alerts from within your formation tend to cause you to become deaf to the system and ignore it at times. "Oh it's just no3 etc...)Every battle turn brings a TA which will then steal one of your MPDs. It also trips off at large angles of climb and bank triggering further avionics warnings (which will self reset but its still annoying!). It proved useful on several occasions but my worry is the breeding of a blasé attitude to lookout. It is not a panacea in its current form. because these suggest that whoever handled the Concepts & Doctrine work for that system did a disservice to the users.

Consider GPWS for a minute. A great system, especially when IMC or when conducting dive attacks towards rising ground - but one that in certain (VMC!) FJ contexts, such as valley flying or OLF, can become a hindrance and a downright distraction. It has long been accepted practice, documented in ASOs, that if GPWS produces a high rate of false alarms it should be disabled until terrain or flight conditions allow it to be re-enabled. This is specifically to avoid breeding a culture of ignoring GPWS warnings. Why should similar logic not be applied to the use of TCAS?

Self-evidently, there are situations where having TCAS enabled is entirely inappropriate for the training being conducted - would we expect a formation being 'bounced' to receive TAs against the dastardly bounce dropping in from the high six? No - and given the choice of achieving this by having the bounce squawk standby, or having the formation running with TCAS in standby, the latter option is more palatable to external players (such as ATC and other TCAS-equipped aircraft) who would rather not have a singleton batting around semi-randomly whilst squawking standby.

To follow a line of argument once employed by W.S. Churchill, if we can agree on the example above, we have established a principle - and any further discussion is merely negotiation upon where to draw the line! So, should all members of a formation fly with TCAS enabled, and become inured to the frequent TAs? Should wingmen disable TCAS, relying upon their leader for timely traffic calls (the leader will just have to put up with the TAs)? Or should all members of formations engaged in tactical manoeuvring disable TCAS entirely, accepting that it was never designed to prevent collisions in such environments and that its implementation is intended merely to reduce, not remove, collision risk? All players could continue to squawk to give SA to TCAS-equipped 'strangers'. Even the airline world does not insist on TCAS being used on each and every flight - it can be carried U/S for up to 10 days (although I believe there are moves afoot to reduce this to 3 days... but the point still stands).

The examples quoted above say to me that the "R" in "ALARP" has been cast away in whatever SOPs are being applied on those platforms. Given the high profile of CWS amongst the hierarchy, it is understandable how timid staff officers could recommend blanket use of TCAS during all stages of flight; that doesn't excuse the laziness of thought. Those with responsibility for SOPs and regulations need to have the balls to say why the sub-optimal solution that is TCAS needs to be handled in a certain way in order to extract maximum value from it without hindering training. It is quite reasonable to recognise the limitations of the system as provided, and work around them without compromising the (un-changed) flying task.

Unlike the FJ CWS pipe-dream, TCAS was not designed with aggressive manouevring in Class G airspace in mind, and was certainly not designed to guarantee 100% collision avoidance. To use it with that aspiration in mind is to ignore its fundamental nature.

Bob Viking

1st Aug 2013, 01:20

Easy Street.
I'm not going to disagree with anything you've just written. Speaking as the ex UFSO from the T2 (trust me when i say this kind of thing was debated long and hard) I would just like to play devils advocate for a second. If you were the DDH would you want to be the one in court after a fatal mid air when it was pointed out that you willingly allowed crews to turn off a collision avoidance system? There are lengthy SOPs in force to counter the issues you have mentioned but a better system would be preferable.
Now if you want to debate the impact that the MAA has had on everyday operations then we should probably start another thread (or just contribute to one of the dozens already in existence).
BV

Onceapilot

1st Aug 2013, 07:22

Maybe worth pointing out that RAF tankers have been using TCAS for a decade or so. SOP's include utilising different modes to reduce nuisance warnings during certain phases of operation, including formation. Part of the issue is to recognise when the TCAS is not providing a useful function and tailoring your use of it to suit the circumstance.
Easy Street, love that "boffin-dreamers"! Nearly as bad as the retired VSO in-the-loop problem when it comes to military procurement.:uhoh:

OAP

[email protected]

1st Aug 2013, 09:15

BV - MAA a self-licking lollipop??? Surely the reams of pointless staffwork and the generation of fabulously colour-coded risk matrices hasn't actually made day to day operations and training more difficult;)

Bob Viking

1st Aug 2013, 15:14

Crab.
I don't know what you're talking about. I, for one, love pointless paperwork and endless spreadsheets. It's the sort of thing I live for and just regret that flying so often gets in the way of my desk work.
Can you sense the sarcasm? I should also add that I have moved on from that role now so I don't really have the right to complain any more.
BV

Distant Voice

5th Aug 2013, 12:45

certainly not designed to guarantee 100% collision avoidance.

Nothing can achieve that, but we can make flying safer. At present the risk associated with Tornado collision avoidance is not ALARP, and that is unacceptable. That is not my assessment, but that of DG MAA back in 2010.

DV

Pure Pursuit

5th Aug 2013, 19:16

BV, Check PMs

Chugalug2

5th Aug 2013, 21:17

BV:_
If you were the DDH would you want to be the one in court after a fatal mid air when it was pointed out that you willingly allowed crews to turn off a collision avoidance system?
Well, at least you would have a reasonable case to put, as described by those who tells us that high dynamic maneuvering is a vital (and obvious) requirement of FJ training which would make CWS warnings continuous and superfluous. A rather different scenario to that of giving perjured evidence to Airworthiness Related Fatal Military Air Accident Inquests.

The Royal Air Force needs leaders that are prepared to stand up and be counted and not to shelter behind lies, deceit and the protection of the Star Chamber.

As to the MAA, it is a part of the problem and will remain so until it is independent and separated from the MOD. Ditto the MAAIB, which needs to be independent and separated from the MAA also.

On2wings

5th Sep 2013, 22:13

Did you get any news on the surviving crew member? Does anyone know who he is? He's not named anywhere. I've just been up to Califer View Point and saw the Aim Sure XV Cairn in memory of Bailey, Sanders and Poole.

5 Forward 6 Back

6th Sep 2013, 08:33

Plenty of us know him, but I don't think anyone's likely to name him here. He's doing very well, considering!

Wrathmonk

6th Sep 2013, 09:20

5F6B

He's doing very well

Out of the loop these days but that is good to hear :ok:

Growbag

4th Dec 2013, 16:35

Angus Robertson: To ask the Secretary of State for Defence if he will place in the Library a copy of the Board of Inquiry's findings into the collision of two Tornado jets on 3 July 2012 over the Moray Firth. [179565]

Mr Francois: The service inquiry into this accident is now complete and a copy of the report has been provided to the Procurator Fiscal, who determines whether a Fatal Accident Inquiry (FAI) will be held and sets the date. A copy of the report will be placed in the Library of the House following either the completion of a FAI or the Procurator Fiscal's decision not to hold one.

Seems it's all done then?

lj101

4th Dec 2013, 18:38

Yup

Families were (apparently) briefed a couple of weeks ago.

Distant Voice

4th Dec 2013, 18:41

Yes it is done, but MoD will not release the report to the general public until after the Scottish Fatal Accident Investigation. Why not? In the case of the BOI report into the loss of Nimrod XV230 it was released immediately, and some six months prior to the inquest. This gave time to ALL interested parties to digest the report and raise relevant questions at the inquest.

More of Angus Robertsons questions can be seen at;

BBC News - MP says Tornado crash FAI should consider warning system (http://www.bbc.co.uk/news/uk-scotland-highlands-islands-25221551)

Distant Voice

MSOCS

4th Dec 2013, 23:56

Nobody needs to name the surviving crew member on this forum - he is named in the BBC link above and was named back in Dec 12 by the BBC in a linked story.

Trim Stab

5th Dec 2013, 06:52

It would be nice to know if he has recovered enough to return to duty, and has not suffered life-changing injuries.

tucumseh

5th Dec 2013, 07:21

MoD will not release the report to the general public until after the Scottish Fatal Accident Investigation. Why not?

A disturbing turn of events. As the BoI typically only addresses the final act (i.e. ignores its remit) this makes it even more important that interested parties get to see what has been omitted, to better inform proper inquires.

Clearly, MoD is learning lessons from Nimrod, Chinook, Hercules etc, where in each case the BoI remains largely incomplete and the pertinent facts were uncovered by ex-MoD staff. This ethos could only prosper under an MAA that panders to its masters' demands.

MSOCS

5th Dec 2013, 15:50

This is because some people 'could' go to jail over this...

tucumseh

5th Dec 2013, 16:19

MSOCS

Surely the same could be, and was, said about XV230? The likes of Thames Valley Police and the Provost Marshal were, I recall, awful keen to proceed against a couple of junior officers, but as soon as the evidence clearing them and pointing to a few Stars was submitted, they suddenly decided there wasn't sufficient evidence. I look forward to events developing!

Just This Once...

5th Dec 2013, 17:32

Tuc, Service Law was changed after XV230 so the 'could' is a lot closer than ever before.

Distant Voice

5th Dec 2013, 18:49

We also have the Corporate Manslaughter and Corporate Homicde Act 2007, which came into force on 6th April 2008 - too late for Nimrod.

DV

Just This Once...

5th Dec 2013, 18:57

That is true DV but it is an incredibly difficult Act to achieve a prosecution with. Service Law can have you in prison just for failing to check for accuracy for anything airworthiness related, even without an accident. The additional changes in Service Law in recent week makes it an offence for anyone to try and influence a police investigation in any way. Current star ranks do not have the level of protection enjoyed by their predecessors.

tucumseh

5th Dec 2013, 19:03

JTO

Thanks. I seem to recall this being discussed before and, from memory, the Air Force Act 1955 (and successors) included an offence of (for example) making false certification, carrying up to 2 years in gaol. Only, senior officers and ministers actually took the view that refusing an order to make false certification is a disciplinary offence, and remains so. So any attempted prosecution would be interesting, as exhibit A for the defence would be these ministerial rulings. I think that was one reason why TVP didn't want to know about XV230.

Just This Once...

5th Dec 2013, 19:05

Yep, things have moved on.

Fox3WheresMyBanana

5th Dec 2013, 19:24

Corporate manslaughter has been illegal for around 30 years by one statue or another. To my knowledge the only successful prosecution was the one-man owner of the adventurous training company in the Lyme bay canoe tragedy.

There is zero political will to pass an enforceable law on this, in any of the major parties.

Distant Voice

6th Dec 2013, 10:19

Fox3 WMB

The Corporate Manslaughter and Corporate Homicide Act 2007 is a landmark in law. For the first time, companies and organisations can be found guilty of corporate manslaughter as a result of serious management failures resulting in a gross breach of a duty of care. MoD fits the bill.

DV

Fox3WheresMyBanana

6th Dec 2013, 13:47

DV

It's not law that matters, it's effective law.
Since the Act came in, there have been over 700 fatal injuries at work of workers, and about the same again to members of the public related to work, and 4 prosecutions. Two of these were definitely of small/one-owner firms, and I believe the other two were too.

I await prosecutions of large companies......

Distant Voice

14th Dec 2013, 08:19

So it has been one near miss every two weeks for the last 15 years for Tornado,

SNP reveal shocking near-collision aircraft stats | Scottish National Party (http://www.snp.org/media-centre/news/2013/dec/snp-reveal-shocking-near-collision-aircraft-stats)

DV

Cows getting bigger

14th Dec 2013, 09:24

At least they didn't use the collision stats as well. :hmm:

Personally, I do recollect floating around North Rhine Westphalia in the 80s and whenever the 'fins' were about we tended to look out even more. Either that or we flew even lower and hoped that the bleedin' Harriers weren't having fun. :) The perception was that GR1 cockpit toys drew eyes in.

Courtney Mil

14th Dec 2013, 09:48

Another completely useless set of SNP "statistics". Comparing Tornado airprox reports with 737, which takes off, transits and lands under continuous air traffic control in protected airspace. Comparing Harrier with Tornado - how many flying hours did each type fly during the period in question? Just two examples from that one piece.

SNP stats :D:D:D

I wonder what point they are really trying to make.

downsizer

14th Dec 2013, 10:35

I wonder what point they are really trying to make.

Lack of TCAS in fast jets seems to be the thrust of some people and their agenda.

Distant Voice

14th Dec 2013, 11:10

CM.

The 361 near misses in 15 years is not a statistic invented by the SNP, but a documented reality produced by the MoD. If Angus Robertson's comparisons help speed up the introduction of TCAS in Tornado, then good for him. It has, according to MoD, been under investigation/consideration/work in progress for 23 years, a period of time which included Haddon-Cave's "Gold period for airworthiness"; just like Nimrod and Chinook.

I would have thought that these must be "concered" conditions for crews to fly under, and in my opinion is worse than the Nimrod incident with regards to "duty of care". With Nimrod is was plain ignorance of what was going on with the fuel and hot air systems, with Tornado the constant delays to fit TCAS shows a total disregard for human life.

DV

alfred_the_great

14th Dec 2013, 11:22

Dumb question - don't you have a radar for precisely this kind of thing. More importantly, if a 'mate' can get that close without you noticing, so can the enemy.....

dervish

14th Dec 2013, 12:36

Lack of TCAS in fast jets seems to be the thrust of some people and their agenda.

So what is your alternative suggestion to the solution proposed but not implemented by MoD?

downsizer

14th Dec 2013, 14:11

Didn't say I had one. Just saying that TCAS is what some people are driving at. You can crack on now.

5 Forward 6 Back

14th Dec 2013, 15:49

So it has been one near miss every two weeks for the last 15 years for Tornado

No; it's been 46 "near misses" in 15 years, as that was the number of cat A airproxes, where as per the article, there was a "risk of actual collision."

The remaining 315 airproxes could have all been cat C, where there was no risk at all but the situation warranted a report.

Yet more hyperbole.

Courtney Mil

14th Dec 2013, 20:06

Distant Voice,

I really hope you are just ignoring my point, not missing it. I thought it was simple enough. I didn't say they made up figures or any such thing. I simply pointed out that the percentages are meaningles without understanding the underlying data. And that making a comparison between Tornado (flying at low level, not under radar control, doing simulated or actual attacks, etc) and an airliner flying under radar control in controlled airspace is hardly a reasonable (or statistically sound) comparison of percentages.

Similarly, saying that Tornado accounts for X percent of airprox reports and Harrier only Y is only meaningful if you understand what their comparible flying hours are. If you really need me to explain, it there were twice as many Tornado hours it would not be surprising is they had twice as many airprox incidents.

Get it?

dervish

15th Dec 2013, 07:16

Didn't say I had one. Just saying that TCAS is what some people are driving at. You can crack on now.

Well no, you said "their agenda" which is at least consistent with your tendency to criticise others and their ideas without having any original thoughts of your own.

dervish

15th Dec 2013, 07:21

SNP's interpretation of the stats is irrelevant and detracts from the main point. A CWS was apparently promised, funded, then not funded and delayed for donkeys years, while all the time claiming the risk was ALARP. The Procurator Fiscal may decide that is negligence.

Scottie66

15th Dec 2013, 07:53

For those of you who have never been involved in the staff work associated with deciding if a risk is ALARP (and judging by some of the comments in this thread it is a fair few of you), one of the [many] things that is considered is cost. The financial cost of fitting TCAS to an operational FJ platform is not a simple as it might be when pricing fitting TCAS to a large ac....there isn't much avionoic space left on a FJ...so what gives to make way for TCAS or a CWS. Moreover, and Alfred The Great is the only one to mention it, what would be the "cost" of training [Tornado] FJ crews to operate with TCAS in peacetime only to find that it was not useable during operations against an hostile force? Would crews forego sound practices such as look out, use of current on-board systems and operational airmanship in favour of TCAS?

Let's not forget 2 things: the only way to eliminate mid-air collisions is not to fly at all (or only fly one aircraft at a time); and we train RAF FJ crews to operate in worst case operational conditions.

Courtney Mil

15th Dec 2013, 08:10

Very well said, Scottie.

Just This Once...

15th Dec 2013, 08:22

Scottie, you are correct that ALARP judgements, with no explicit regulatory requirement, are extremely difficult. Cost does play a key role but in military aviation we do, on occasion, confuse cost with affordability.

In today's parsimonious times the temptation to cancel or remove programs to balance the budget is just too tempting and having been involved with this for many years I will watch, with a heavy heart, to see if it is judged that we cancelled these efforts due to cost benefit analysis (acceptable) or affordability (not acceptable).

Your argument regarding the military applicability of 'TCAS' is well made and, for the senior brass, well rehearsed. With no easy off-the-shelf solution out there your point about other on-board systems is, in my view, also correct. Most of these other systems contribute by increasing SA. For example, Link 16 is far from a collision avoidance system but it really does help if there is a good link picture available and, of course, you may be able to take this SA to war. But again, we do look weak in this regard by not fitting all operational types with this system. The argument to do something with a more military bias is relevant, but this can drift into doing nothing - for peace and war.

ALARP has to be tested in the courts; it may not be a pleasant experience for a number of us but that is how it should be. For others it has been considerably worse. Given our preponderance to call 'ALARP' even when we breach applicable regulations (perhaps not the case here) the MoD sits on particularly poor foundations.

Cows getting bigger

15th Dec 2013, 09:32

Conversely, there is the simplistic school of thought which says "anything is better than nothing". A PowerFlarm cost about £1500.

downsizer

15th Dec 2013, 09:50

Well no, you said "their agenda" which is at least consistent with your tendency to criticise others and their ideas without having any original thoughts of your own.

Yes, their agenda, not mine, as I don't have one. No criticism intended, but if I hurt your feelings princess I do apologise.:{

MSOCS

15th Dec 2013, 10:27

Is Link 16 ever going to be integrated on the GR4? That should surely have precedence over a TCAS.

Yes, and….yes! Not fleet wide though due to cost and upgrade cycle for jets.

just another jocky

15th Dec 2013, 10:49

How typical, to spend the money and put all the nice gadgets on a jet, just as it starts to go out of service. :rolleyes:

Not convinced about TCAS on a FJ, but I guess it will depend upon how/when it is used.

Bob Viking

15th Dec 2013, 18:32

As was discussed a couple of pages ago, there are very few here who have flown with TCAS on a FJ. I have and I can tell you that as a bog standard civvy grade TCAS it is not really up to the task. It is useful in a few scenarios, such as IFR flight in and around busy airports and non tactical sorties, but actually quite annoying in others. This means that a better, more advanced system should be designed and procured. This is, of course an expensive process. Or we could just buy an off the shelf product simply to please the media and ignore the wishes of crews and the real problem, which is that currently available systems are not well suited to FJ operations.
Of course some of you will disagree, as is your right, but please ensure you speak from a position of authority rather than just based on something you read in the Daily Mail.
BV

Bob Viking

15th Dec 2013, 18:45

Having just reread my post I'm not sure I made my actual point very clear. I agree that we should have an effective collision warning system in all FJs. I'm just not convinced that TCAS in its current form is the solution.
I hope that makes things a little clearer.
BV

Biggus

15th Dec 2013, 19:03

BV,

It made sense to me the first time around..... :ok:

Cows getting bigger

15th Dec 2013, 19:18

I think someone needs to decide what you want. Do you want a conflict resolution system (aka TCAS) or a traffic information system (FLARM etc)? One is far easier to integrate than the other.

Growbag

17th Dec 2013, 13:30

Angus Robertson (Moray) (SNP): I am sure the Secretary of State is concerned, as are many people, about the new statistics on near air misses involving fast jets. The Ministry of Defence committed in 1998 to installing collision warning systems on Tornado aircraft, but it has not yet done so. Does the Secretary of State regret that? Will he also confirm that the Typhoon does not have a collision warning system installed? Are there plans to do so and when will that happen?

16 Dec 2013 : Column 474

Mr Philip Hammond: First, a collision warning system on the Typhoon is currently under test and if that test is successful, we would expect to roll it out. The Typhoon is a platform with a very long life ahead of it. There is also now a plan to install collision warning equipment on Tornados. The hon. Gentleman has raised this issue in the House before in relation to the very regrettable Tornado accident in his constituency in July 2012, and I have, in consequence, looked at whether, if the original procurement had gone ahead, we would have expected that equipment to have been installed on Tornados by the time that accident occurred. The answer is that we would not have expected it to be installed by that stage.

:D

dervish

17th Dec 2013, 14:22

So, if I've got that right, Hammond is saying the 1998 requirement, if it had proceeded on time, would not have been fitted 14 years later? We're building carriers quicker than that. Or are we?

If it is only under test now, how long before it is procured and fitted?

Keep digging Angus!

The_Observer

17th Dec 2013, 14:54

The crew member involved spent some time recovering from his serious injuries. He has recovered enough to get back on his feet, and continues to get better every day.

Distant Voice

17th Dec 2013, 15:27

Dervish,

Hammond is working from a 2008 start date as indicated in a written answer to Angus on 3rd Dec. He gives no explanation for ten years of inactivity between 1998 to 2008, which is what Angus was looking for.

"A commercial off the shelf traffic collision avoidance system was identified as a potential solution to the Department's requirement for a collision warning system on the Tornado GR4 fast jet fleet by the Deep Target Attack Capability Sponsor as part of the Department's 2008 annual planning process"

Even taking 2008 as the start date his statement is nonsense. He is claiming that an off the shelf piece of equipment could not be fitted in four years, and yet according to another written answer an "under development" piece of equipment can be fitted in two years. (Oct 2012 to end of 2014). This will be MoD's answer to the families, "Even if we had gone ahead with the fit it would not have been ready at the time of the collision, so we can not be blamed". You start to get a feel for what is in the SI report. I only hope that the Procurator Fiscal sees through it.

At least Des Browne had the balls to stand up in Parliament on the day the BOI produced it's report and say, sorry we screwed up. Hammond should follow his example.

DV

dervish

18th Dec 2013, 07:03

Thanks for the clarification DV.

So those with a TCAS "agenda" include Tornado DEC. TCAS wasn't new in 2008 so you've got to assume they did the proper assessments before making this decision which makes Hammond's statement even more odd.

Trim Stab

18th Dec 2013, 17:35

I used to fly gliders in Switzerland and most gliders there have an anti-collision system invented by a swiss-boffin. Like FJs, gliders are often flying in close proximity in thermals and so TCAS is useless. I can't remember how the little magic box worked - but it was very effective. It only cost a couple of hundred Francs - I'm sure the MOD could knock up something similar for a few million quid a piece.

Courtney Mil

18th Dec 2013, 17:42

a few million quid a piece

plus £50M for integration, £50M for clearances and £150M to BAES for sundry expenses.

Biggus

18th Dec 2013, 18:13

Ah yes.....

Those hot weather trials in Death Valley (conveniently close to Vegas), cold weather trials in Norway on rates, or maybe Alaska?

Testing to 20g.....

It just goes on and on......

1.3VStall

18th Dec 2013, 18:41

Trim Stab,

It's called "FLARM" and an increasing proportion of the UK glider fleet is thus equipped. It has its limitations, but the kit is definitely an aid to flight safety.

However, if can be a distraction when you are tugging at a competition and there are 50+ gliders in the vicinity of the airfield.

Like any bit of kit, if you use it sensibly and don't become a slave to its indications, it can make you safer.

tucumseh

19th Dec 2013, 05:52

plus £50M for integration,

Optional according to recent pronouncements by DE&S and Min(AF)

£50M for clearances

Optional if you are an RAF VSO

and 150M to BAES for sundry expenses.

I'll give you that one, especially since Walmsley retired. Before that it was 50/50 with Thales!

Blue Bottle

21st Dec 2013, 18:51

more on this subject in today's press

RAF fighter jets almost crash mid-air every TWO WEEKS: New figures show 361 near misses since MoD pledged to install new safety gear in 1998... but never did | Mail Online (http://www.dailymail.co.uk/news/article-2527392/RAF-fighter-jets-crash-mid-air-TWO-WEEKS-New-figures-361-near-misses-MoD-pledged-install-new-safety-gear-1998-never-did.html)

Easy Street

22nd Dec 2013, 08:06

Aaahh, but we're encouraged to report "everything" (it's a reporting culture we're trying to establish, don't you know). Was that another aircraft I just saw? That ATC hadn't mentioned to me? AIRPROX! That, at least, would appear to be the mentality applied by some operating communities in both civ and mil. The fitment of TCAS to fast jets will probably increase the number of AIRPROX reports further due to a likely requirement for mandatory reporting of RAs, which will be somewhat more frequent in uncontrolled airspace than they are inside CAS.

Focussing on total volume of reporting is a mistake - it's the frequency of the serious ones that matters and I don't see that kind of detailed analysis being conducted in this article :hmm:

NutLoose

22nd Dec 2013, 16:38

Can they not simply do it off the transponder?

MAINJAFAD

23rd Dec 2013, 00:42

Need an integrator for those to work, Nutloose, Don't think GR4's have them as part of the avionics fit.

Courtney Mil

23rd Dec 2013, 09:14

Or as some of us keep saying, just look out of the window.

dervish

23rd Dec 2013, 09:47

Or as some of us keep saying, just look out of the window.

This probably explains why it's taken 15 years since endorsement NOT to fit a CWS. One school says it's needed, another doesn't, and the procurers at Shabbeywood sit twiddling their thumbs while London bats it back and forth.

orca

23rd Dec 2013, 11:25

I've never operated with TCAS or CWS but understand that it can be annoying and de-sensitising as well as helpful.

Are there any statistics as to how many actual 'saves' the equipment gives when compared to false alarms or preventions of 'getting close' as opposed to 'actually hitting'?

Also, can anyone offer an opinion on whether CWS if/when fitted to GR4 and/or a Typhoon would be a Go/ No Go system? One assumes it would have to be, but at the same time that seems a bit OTT.

just another jocky

23rd Dec 2013, 11:58

Plenty of other Class G airspace users have TCAS, or a version thereof fitted, so I guess there should be evidence of how useful it is. Whether or not that info translates into 400knots+ (600knot+ closing speeds) I'm not sure. I remain to be convinced that FLARM has any use on a fast jet, bearing in mind the range vs closing speeds.

Distant Voice

23rd Dec 2013, 12:21

Or as some of us keep saying, just look out of the windo

What do you think the guys were doing during the 46 Class "A" misses, between 2000 and 2012?

It's comments like that that gave the "bean counters" an excuse to drop, initially, CWS for Tornado in PR11.

DV

tucumseh

23rd Dec 2013, 12:22

Orca

Interesting question, given a non functioning IFF system was regarded as "Go" even after a GR4A being shot down because of it.

I think a good point was made above. A CWS was endorsed for Tornado in 1998, yet is still not fitted. SOMEONE assessed the pros and cons discussed here and endorsed it - in 1998 that would need to be pretty senior in OR.

Getting back to the July 2012 crash, Hammond has recently claimed this endorsement only dates from 2008, stating that is not sufficient time for it to be fitted in July 2012, so MoD can't be blamed.

At best, Hammond knowingly misled. But given MoD's form in such matters, it is a probably a deliberate lie. As usual, one must follow the lies to uncover the truth. The lie is about the endorsement and funding dates, tests and trials.

Exactly the same happened after the Patriot shootdown of 2003. ACM Sir Brian Burridge's direction that the IFF be made safe was ignored, for more than 6 years. He is also content the Board of Inquiry was grossly misled. Yet he is sanguine about this, meaning (presumably) he was over-ruled from on high. Which, again, must be pretty senior.

Similarly, one must ask WHO these over-rules and lies protect. Who decided that Tornado GR4 (in this case) need not be functionally safe? Again, the perpetrators have form. Sir Brian was ONLY a 3 Star at the time, whereas the people who, in the period 1998-2002, ruled that the aircraft need not be safe were led by a 4 star. Just a little above our pay grade, but that doesn't absolve one of the legal obligation to report the Organisational Failing. Only one person in PE did, as well as Boscombe Down. Both were told to shut up. Boscombe did.

There is MUCH more to this than just the CWS/TCAS question. The same basic policy decision, that aircraft need not be functionally safe, permeates umpteen fatal accidents, and MoD simply does not want this link publicised. But the Nimrod, Tornado/Patriot and Chinook cases, especially, have raised the profile and made the policy public, so it will be interesting what direction the Procurator Fiscal issues in this case.

alfred_the_great

23rd Dec 2013, 13:52

What do you think the guys were doing during the 46 Class "A" misses, between 2000 and 2012?

Not looking out of the window hard enough or well enough. Them's the breaks.

Yet another thread devoted to making an aircraft "safe" without thinking about the combat implications of such action. The aircrew's role is to find and destroy another aircraft (or to prevent them doing the same to you), ideally BVR, if necessary eyeball to eyeball; if they can't do that in peacetime, when will they be able to do that?

Just This Once...

23rd Dec 2013, 15:13

ATG, I've no idea what you are on about as the GR4 has no BVR capability or indeed any reliable way to detect aircraft BVR. Stuff like JTIDS (coming), IRST (not coming), PD Radar/IFF interrogator (not coming), Distributed Aperture (not coming) would all add value for detecting other aircraft in peace and war. Terrain masking at high speed reduces the ability to see and avoid. Have you ever experienced 1000kts closure in less than perfect vis?

Adding a CWS may just stops us thwacking each other without a war - we just need to make sure it works and does not compromise anything or get in the way.

alfred_the_great

23rd Dec 2013, 15:18

JTO - ALARP would indicate that CWS can't be added without

it work[ing] and does not compromise anything or get in the way.

If the way to beat GR4 is to drive at it really quickly, then we've got bigger problems frankly.

Just This Once...

23rd Dec 2013, 15:22

So we should leave the collision risk as it is to punish crews for not spotting each other - WTF???

I think you should leave the sherry alone.

orca

23rd Dec 2013, 15:36

Tucumseh,

In your mind then, GR4 is not functionally safe. Do you mean totally safe? (Not trying to be clever just unversed in degrees of safety)

If CWS was fitted would we need an upgrade to an automatic system which warned and took action so as to prevent a de-sensitised crew ignoring 'the big one'?

A bit like the Auto GCAS does.

Distant Voice

23rd Dec 2013, 16:47

orac

As things stand at the moment the "collision" risk, and flight safety, are not ALARP. That is not my call but that of DG MAA, who in 2010 reported that to remove the option to fit CWS in Tornado would "prejudice the Dept's ability to declare this risk ALARP". This statement was issued after the option had been provisionally removed under PR11. (PR11 being MoD’s Planning Round for 2011 - the annual budget review). Clearly, someone in 2010 had decided that in order to save money it was OK to put Tornado flight safety at risk. --- New Government.

The option was was "reprieved", however the risk remains as being NOT ALARP until CWS is installed. We can talk about various forms of mitigation, but based on my experience with Nimrod this is just a paper excersice to keep the aircraft flying in "apparent" safety.

DV

alfred_the_great

23rd Dec 2013, 16:51

It depends, doesn't it. If the aircraft is so un-safe that without this equipment it shouldn't be flown, then the entire fleet should be grounded until either a) it is made safe or b) taken out of service. If the aircraft is safe enough to fly as is, then it is safe enough to fly. Collisions happen, regardless of equipment fitted and procedures followed. It sounds from this thread that the equipment would be at best, a tiny increase in warning capability and likely increase the risk of collision due to desensitivity to warning alarms.

So is the aircraft safe enough or not?

Distant Voice

23rd Dec 2013, 17:07

CM and ATG

I do not know what planet you are on, but I suggest that you read some Class "A" Airprox reports. With closing speeds of 14nm/min there was "non-sighting by crews" even though the visibility was 50kns. What chance would crews have coming off the Tain range in thick mist. This is 2013, not 1913 with "a Hun out of the sun"

DV

Just This Once...

23rd Dec 2013, 17:08

If the aircraft is safe enough to fly as is, then it is safe enough to fly.

No, time and technology move on. Fixes do not have to be instant as there is a temporal element in ALARP. 'Temporal' cannot be used to stick your head in the sand or to avoid spending money either.

Collisions happen, regardless of equipment fitted and procedures followed.

No, with good procedures, training and the sympathetic use of technology the rate of collisions reduces significantly.

orca

23rd Dec 2013, 17:52

DV,

I am a beginner wrt to CWS but I think your example is a little bit off. If anyone is flying into, in or out of a AWR in thick mist and not aborting, getting a radar service and going home IFR, then they need their brevet torn from their chest - not a CWS.

Knight Paladin

23rd Dec 2013, 18:15

orca - So you've never pushed the weather limits then? Honestly? I suppose it depends on your definition of "thick mist", but I think most LL operators have pushed the envelope at times, especially those in an aircraft designed to operate IMC at LL. Some mental fag-packet maths reckons that even with a "legal" 5km of vis, two aircraft closing at 420kt would have only 12 seconds to see and avoid. I agree that lookout is vitally important, especially for combat aviators, but I don't see why there is such resentment in some quarters to a system designed to save the lives of our friends and colleagues.

orca

23rd Dec 2013, 18:26

KP,

I have no hostility whatsoever with/to any system, I just think that particular example was poorly chosen.

Limits are limits. Pushing limits is pushing limits. Breaking limits is unprofessional. Flying in AWRs in 'thick mist' is imbecility (if one assumes you think you are VFR).

But I take your point about IMC TFR.

I haven't expressed an opinion yet as to what I think about CWS incidentally.

Courtney Mil

23rd Dec 2013, 18:52

JTO,

I can tell you're passionate about this one, but...

So we should leave the collision risk as it is to punish crews for not spotting each other - WTF???

Yeah. I'm sure posters here think a fatal collision is fit punishment for poor lookout. Really, Dude! A bit over the top there.

Knight Paladin

23rd Dec 2013, 18:56

orca - OK, fair enough. I'd agree with you on operation in "thick mist", but again the definition is probably important - a numerical visibility might be more useful. An AWR is probably a much safer place to operate in reduced visibility than the rest of the UKLFS, certainly as a singleton. Of course, at most ranges the pattern extends beyond the AWR boundary, which may be a flaw in that argument! I don't know if it was an issue in this incident, but I think there's a difference between sustained operation in weather that's below limits, and pressing through for a few seconds in the hope/knowledge that the situation will improve. I'm not talking about full-up IMC, but, say, less than 5km vis in a shower.

Chugalug2

23rd Dec 2013, 19:33

CM:-
Or as some of us keep saying, just look out of the window. Rest assured that crews who are protected with CWS are still required to do so, and are liable to get an unpleasant and possibly final surprise if they do not.

So as noted so many times past, RAF crews can take the blame solely for anything untoward, no matter how the MOD and the Services have failed them with duff or non-existent kit. Be it positively dangerous FADECs, illegal RTS's, unresolved UFCM's, dry bays that aren't, IFFs that fail unsafe, Strobe Lights that blind, and Fuel Tanks that explode on receiving a small arms hit; hang the guilty barstewards if by chance they survive!

You don't happen to sport a very sporting moustache and have a famous WW1 General as a distant relative by any chance? Name of Mel... something or other? Meh!

No one is suggesting that going to war is safe. That is palpable nonsense, but the RAF has a vested interest in making itself as safe as it can be subject to training when it is not at war, so that as much of it and its crews survive for when it does go to war. If training for war is incompatible with CWS then there is a case for inhibiting it under certain conditions. There is not a case for therefore not fitting it, other than protecting the 6 o'clock of those who have obstructed in the past. That case is illegal, immoral, and the very reason that UK Military Air Safety is now in crisis mode.

Courtney Mil

23rd Dec 2013, 20:15

Thank you for the lecture. And my only WW1 relative was my grandfather, later sunk on the Manchester.

tucumseh

24th Dec 2013, 06:35

Orca, sorry I’m late replying, but others have posted good replies. In summary, and as Distant Voice says, it is MoD who have admitted this. We’re just discussing it and, in effect, debating whether or not very senior staffs are correct. Some think there are, others (bravely!) think they are not.

My concern is that this debate is taking place so many years after the general problem was reported and staffs threatened with dismissal for seeking to follow these regs. That root problem, confirmed by numerous internal review teams under the RAF’s Inspector of Flight Safety, is the systematic refusal to implement the mandated regulations, often choosing a lengthier and more expensive route that produces a functionally unsafe system.

One example I chose, as it is topical, was the flat refusal to properly integrate IFF failure warnings in (inter alia) the GR4A; which, if present would (according to the BoI) have prevented the 2003 Patriot shootdown. Boscombe followed the mandated regs; the RAF, project office and their friendly 2 Star flatly refused to. (The same 2 Star having management oversight of Nimrod, Chinook.........)

Boscombe were placed under inordinate pressure, and then direct orders, to withdraw their recommendation that MAR should not be granted when an IFF is functionally unsafe as it could (the word used in the regs) result in, for example, friendly fire and loss of aircraft. They, and MoD project staffs, were instructed to falsely state the IFF installation satisfied the regs. The recommendation to inspect the entire fleet was rejected, twice, at 2 Star level. 2 Died. An IFF going u/s during a mission is bad luck. To provide an IFF and claim it is working, knowing it is not, is criminal.

These days I prefer to simply highlight the irrefutable fact that all the cases we discuss here, Nimrod, Chinook, Sea King, Tornado etc, are inextricably linked by this single policy – the regs are optional if it means delivering to time and cost. Safety regulations are irrelevant (to quote MoD at the XV230 inquest). And, perhaps worst of all, it is acceptable to make a false statement that the system IS safe, and issue direct orders to subordinates to make such a statement. That is beyond criminal.

Make no mistake, despite the formation of the MAA this remains the formal policy of DE&S (to be precise, their Policy Secretariat), as advised only this year to Ministers and the Head of the Civil Service, who accepted this advice and issued rulings to that effect.

orca

24th Dec 2013, 07:15

Thank you for the reply Tucumseh.

I am still undecided in my own mind. I totally agree with you wrt IFF which is an entry level requirement, and having read the H-C report recently the Nimrod issue is equally as cut and dried.

Is CWS really an entry level requirement though? I have never operated with one but can see the utility. On the other hand I have flown a machine that gave so many secondary warnings that you got used to ignoring them - to the point that I ignored a really important one once. I understand false alarms are not unheard of with CWS. One also assumes it would be annoying in BFM etc, although there may be a way of suppressing it.

On the other hand I think the 'just keep looking out' argument a little simplistic, naive even. But the counter argument that a close air prox is tantamount to a collision is (to me) daft as well. That would make every time I walked on a pavement the same as actually being run over.

And I can also see that if we aren't safe without it then a failed BIT = crew out, which seems a little extreme. But maybe that's right.

So, in adequately perhaps, I remain on the fence.

I suspect the fence is there because the R in ALARP is multi faceted and allows for human interpretation.

tucumseh

24th Dec 2013, 10:43

There are two parts to this debate. There are those who are arguing against the RAF’s decision that a CWS is needed in Tornado; and those, like myself, who are asking why MoD have decided to serially lie over the events between 1998 (endorsement) and today (still not fitted).

The former is a Requirements issue and we all know the failure to manage this component of acquisition is the biggest cause of late, over-cost and under-performing equipment projects. It is the main reason why the GOCO bid collapsed; largely because I suspect MoD (London) didn’t want to address this underlying failure. It suits them to let procurers in DE&S take the blame. (The problem with DE&S is not the procurers, but those at the top who have yet to attain the basic entry criteria for what was MoD(PE) and DPA. And no, this is not thread drift).

Requirements should always be challenged of course and I wonder if this one is being challenged as a result of this thread. I’ve challenged a few in my time. I didn’t agree with AML buying Active Dipping Sonar kit for Hercules and Sea King HC Mk4. (The latter with the RN’s agreement, which was bizarre and didn’t help my argument). I didn’t agree with the Army plans to buy some video kit from the US with an NTSC output, only to bin it when, for some extraordinary reason, it didn’t work when plugged into PAL kit. I didn’t agree with letting the BOWMAN contract for obsolete VHF & HF radios (also binned), when kit two generations newer was already being delivered and deployed (and, to cap it all, the subject of two concurrent replacement programmes). But hey ho, you can’t win them all.

Merry Xmas, war is over (according to Cameron).

Flugplatz

24th Dec 2013, 20:15

Please tell me that Tornados etc at least have a transponder that can be picked up by a civvy TCAS on the other aircraft? could at least get half the solution right.

Flug

Courtney Mil

24th Dec 2013, 22:09

Flug, yes.

.

muttywhitedog

24th Dec 2013, 22:12

Has the report been published? I cant see a link on these 6 pages.

Courtney Mil

24th Dec 2013, 22:26

lj101

25th Dec 2013, 07:18

Has the report been published? I cant see a link on these 6 pages.
Signed off, families briefed but not in the public domain.

tucumseh

27th Dec 2013, 14:58

Courtney

I think we are at cross purposes because I don't think you really disagree with the opinions I've expressed.

I have no real interest in what system is fitted, although you surprised me by implying JTIDS isn't fitted to any Tornado. Not saying you're wrong by any means, it's just that I recall it being a requirement many moons ago in the mid-80s.

My offerings centre on the fact that, regardless of what system is fitted, it remains MoD policy that (a) it need not be functionally safe, (b) a false declaration may be made that it is safe, knowing it is not, and (c) it is an offence to refuse to make that false declaration. I will never agree with this policy, although I know many do. The MAA are fully aware of it and continue to keep quiet.

Your JTIDS comments reminded me that it was the same MoD Directorate/IPT that implemented the above polices so zealously, their mantra being "It works on the bench in isolation, so there is no need to integrate or test it in the aircraft". Hence, Burridge's recommendations regarding functional safety of the IFF in the ZG710 BoI.

DeskBoundPhlasher

27th Dec 2013, 16:00

For sure, it was fitted to F3's and system testing carried out. I did the armament EMC/EMI testing at Coningsby around Gulf1 times. Not sure re GR1/1a or later gr's.

Distant Voice

6th Jan 2014, 17:52

Over two years ago the Ministry of Transport released the detailed AAIB report into the loss of a Super Puma helicopter on 1st April 2009. The Fatal Accident Investigation into the accident started today in Aberdeen, and in the 2 year period since the release of the report to the general public no one in Government or the Crown Office has suggest that the release of the report could be prejudicial to the Procurator Fiscal’s investigation and findings.

Having set that precedence how can the MoD justify withholding the Tornado SI report on “prejudicial” grounds, unless there is something to hide. Besides is not for the PF or Crown Office to decide what is prejudicial and what is not, and not a Government department with a vested interest in trying to prove they have done nothing wrong.

DV

dervish

6th Jan 2014, 19:00

Your JTIDS comments reminded me that it was the same MoD Directorate/IPT that implemented the above polices so zealously, their mantra being "It works on the bench in isolation, so there is no need to integrate or test it in the aircraft". Hence, Burridge's recommendations regarding functional safety of the IFF in the ZG710 BoI.

Slightly off topic but definitely true on one job I supported in about 1999. JTIDS was bought from the US but integration was ignored by the department you mentioned and had to be contracted to the UK's JTIDS experts. IIRC they also said the sims needn't be modified and no tech pubs or spares either.

theonewhoknows

6th Jan 2014, 19:31

While JTIDS is great when it is working, it relies on a classified crypto load to work. It is also not that robust. So, while a significant SA system, it is not appropriate as a collision avoiding system. I await retorts, but unless you possess the experience and knowledge, then, I'm afraid leave it.

muttywhitedog

6th Jan 2014, 21:10

Has it been put into the public domain yet, or are we still speculating?

Distant Voice

7th Jan 2014, 09:20

MWD.

No speculation, what I have posted are the facts. The Super Puma AAIB report was placed in the public domain, some two years before the FAI started; no suggestion of it being withheld because of a fear of it prejudicing the outcome. On the other hand the Tornado SI report is being withheld until after the FAI (if one is held) because of a prejudicial claim. One has to ask, why? It seems that MOD is placing itself above the law in order to protect those responsible for the delay in fitting CWS. I am sure that their hope is that the the PF will decide not to call a FAI so that the SI report can stand, unchallenged.

DV

Distant Voice

9th Jan 2014, 11:13

I understand that Fatal Accident Investigations are open to the general public, so MoD's attempt to keep the SI report under wraps until some time after an FAI will not work. So let's see it now.

DV

Roland Pulfrew

9th Jan 2014, 13:15

MOD is placing itself above the law in order to protect those responsible for the delay in fitting CWS.

Really? Is that not prejudicing the outcome of the SI?

Having a CWS, or not, may or may not have played a part in this accident. If 2 aircraft are operating in close formation would the CWS have been inhibited/placed on standby? Afterall, the last thing you want when operating in close is some warning constantly going off. I fly an aircraft fitted with a system that becomes very annoying in the circuit because of the constant warnings of other aircraft. SOPs say I cannot turn it off or place it in a standby mode, but there comes a point when you start to tune it out. Great in the open FIR but not so good in certain stages of flight.

dervish

9th Jan 2014, 15:06

Distant Voice is not the one stating a CWS must be fitted, although he agrees it should. It is MoD who has stated it, yet not done it. The question he thinks the Sheriff should ask is why do these MoD requirements never seem to be implemented. Have I got that right? If there is a disagreement about MoD's statement, has anyone here submitted an alternative? Must be a nightmare being in OR. So many people arguing against, but not offering alternatives. It only succeeds in delaying projects. Glad I wasn't clever enough either way.

Distant Voice

9th Jan 2014, 16:35

Yes, Dervish, you are correct. The decision to fit CWS was made by MoD back in the late '90s, and they neglected to follow it throught. We are not sure if facts such as this are brought out in the SI report because MoD refuses to place it in the public domain. A question that I hope gets presented at any FAI is did MoD, in 14 years of inactivity, show a gross breach of a relevant duty of care, not only to the deceased, but to all those who fly in Tornado GR4 aircraft.

DV

Growbag

9th Jan 2014, 17:00

I don't think it is a case of the MOD refusing to put the report or the details into the public domain, that will happen when the report is put on the MAA website. Reading the press reports (Angus Robertson) the Procurator Fiscal hasn't decided if a FAI is going to take place yet and until then the report is kept to a small list of addressees until the decision is made. If they have an inquest it will all come out in court, if they don't, it will be published. I thought the whole point of having an independent regulator was for exactly this situation where details which may be uncomfortable for the MOD actually GET published rather than being hidden? I hope so anyway :hmm:

Distant Voice

10th Jan 2014, 11:53

Growbag: Yes I understand the report will be placed in the public domain, eventually, but by then it could be too late. The Procurator Fiscal may decide, based on the only evidence presented to him (the SI report) that there is no need for a FAI. I suggest that you re-read posts #42 and #123.

Regards
DV

DeskBoundPhlasher

10th Jan 2014, 17:06

DV -are you stating that the only evidence that the PF will consider is that contained
within the SI Report? That he will not entertain any submissions from both the legal and highly experienced and current technical experts that inhabit forums such as this one? An interesting take on the Scottish justice system!

Distant Voice

10th Jan 2014, 18:58

tucumseh

11th Jan 2014, 07:29

DBP: No I am not saying that. I am sure that the PF will consider anything that is presented to him on this matter. What I am saying is that it would be helpful if we knew what was in the SI report so that those of us who believe their could be "holes" could fill them. If the AAIB did that with Super Puma two years ago why can the MAA (MoD) not do the same for Tornado, as they did for Nimrod. At prestent the PF has a report prepared by the invloved party, and I am sure that the involved party would like to keep it that way.

I could post this here or on the Ft Lt Cunningham thread – same principles. What determines the direction of the Inquest (in England) or FAI (in Scotland) is the Pre Inquest Hearing (in England). This is when the Coroner is briefed and he decides direction and, hence, witnesses. Crucially, the Coroners’ Rules require all interested parties to be invited.

This is where the system falls down, seemingly frequently when MoD is involved. Take for example the 2007 Inquest into the 2003 ASaC mid-air. The tapes of the proceedings (MoD didn’t see that one coming!) clearly reveal there to have been pre-inquest meetings between Coroner and MoD, when it was decided who would appear as witnesses and what they would say. It was also “agreed” at these meetings that, for example, the aircraft were serviceable, when they were not in key areas. It was also “agreed” they were airworthy, and the subject would not be discussed, despite the main criticism of the BoI being they were not, again in key areas. (Both were linked to one individual, but MoD won’t answer questions from families. They were simply told both were serviceable and airworthy, the matter would not be discussed). It was also “agreed”, or the Coroner decided, that there would be no attempt to reconcile ludicrously contradictory evidence; particularly relating to the unauthorised encroachment into the CCZ of another aircraft, which clearly distracted the outbound Sea King. And so on. Perhaps worse, the individual named and blamed for the above failings by the post-BoI investigation was not permitted to give evidence; and MoD now claim this investigation did not take place, despite the records being lodged in personnel files and copied to all and sundry. The combination of all this prompted one bereaved father to shout out in court “What a Fix!” Quite.

To this day, MoD denies there was a PIH, but will not respond to questions about a pre-inquest “meeting”, simply referring families to the Coroner. For its part, the Coroner’s Office will not reply. That, I’m afraid, is collusion, denial of justice and denial of the opportunity to prevent recurrence. I could have chosen any one of a number of cases as an example, but the likes of Nimrod, Chinook and C130 are well known. Keep going Distant Voice. Aircrew will thank you eventually. Maybe.

Just This Once...

11th Jan 2014, 08:37

Tuc,

There is no doubt that the MoD has pre-inquest sessions with the Coroner and without such cooperation things would grind to a halt. The Coroner needs access to official documents that may be classified, needs access to personnel and may need access to industry partners that operate within the MoD sphere of influence.

Does this offer an opportunity for MoD to influence things - undoubtedly. Have some in the MoD looked to exploit this - recent history records this as a fact. But the Coroner has primacy and is powerful enough to work through any MoD static. You are correct that the MoD did try to deny access to key witnesses in at least 1 inquest, but the Coroner just issued summons/arrest warrants. This did bring an unexpected reality-check to the Treasury Solicitors(!).

My point is that we have to trust the Coroner. If they use the powers they have correctly they will access the evidence they seek. There may be monsters out there, but they are not under every bed.

Chugalug2

11th Jan 2014, 16:13

JTO:-
the Coroner has primacy and is powerful enough to work through any MoD static.Well history, as testified to by tuc, would seem to disagree. If an air regulator tells a coroner at a pre inquest hearing into a fatal aircraft accident that the aircraft was both serviceable and airworthy he has little alternative than to accept that as a fact. The problem isn't with the coroner or PF per se, the problem is the MOD, which consistently lies, steals, and cheats. We can be certain that as long as it remains air regulator, investigator, and operator combined (via its 'independent' subsidiaries; the MAA, the MAAIB, the RAF, the FAA, the AAC) it will go on doing so.

Every fatal accident that has been reviewed in this forum is presented by the MOD as unique. In truth they are all connected by this very contradiction, that of self regulation. It doesn't work, and in aviation it kills.

Just This Once...

11th Jan 2014, 17:02

Didn't the coroner issue warrants for those who the MoD were not keen on being interviewed or testifying for the Hercules Inquiry?

The Coroner has the job of establishing the facts, even if they have to work through or around obstacles set by one of the parties with a vested interest in the outcome. They seem to do a reasonable job and I have yet to meet a gullible one.

Chugalug2

12th Jan 2014, 10:55

I fully agree with you re the effectiveness in general of HM Coroners. It took an 800 year old institution to tell one that is still now less than 100 years old, "There is something wrong with your bloody aircraft!".
My point is that dedicated as they might be to searching out the truth, if a Department of State is dedicated to obscuring that truth, that it alone holds all the information relating to a fatal accident, and ensures that its version and only its version is what is available to the Court, then the truth is very unlikely to emerge no matter how ungullible the Coroner.
The MOD is the problem, and in the matter of Military Air Safety has to be divested of its strangle hold over Regulation and Investigation. An independent MAA would then have no more reason to mislead a Coroner than the CAA would, for instance. We might then look forward to honest witnesses and proper verdicts.

clicker

12th Jan 2014, 21:41

I know that the GR4 is fitted with Mode S transponders and that these have hex codes allocated for the transponders ID, that these transponders can be linked to an ACAS system and information exchanged between them.

So is it a case here that this part of the GR4 avonics upgrade was only the transponder and therefore the chance to fit some sort of CWS was missed at the time?

If so I think we missing a safety milestone in doing so.

tucumseh

13th Jan 2014, 06:48

My point was that, as with BoIs, the Coroner can only work with the evidence placed before him. And that is DV's point. MoD have a nasty habit of destroying or withholding evidence; or just denying it exists in the first place.

However, in the case I mentioned, the Coroner acted appallingly towards the families, one father in particular. He was a "temp", necessary because of the sheer number of inquests. He did not have a stenographer, due to financial cutbacks, so had to take all the notes himself in longhand. As a result, the proceedings were disjointed and shambolic.

He would not allow questions relating to the three main contributory factors noted by the BoI. He refused to reconcile vastly different witness statements. Time after time he put up with witnesses refusing to answer the question, or offering a wholly unrelated reply.

Most witnesses were patently unsuitable for the questions, and he constantly said "We'll get back to that later" or "Write to me with the answer". Not once did he ever return to get the answer, and both MoD and Coroner's Office confirm that no submissions with the answers were made after the inquest.

Justice was not seen to be done. What was discussed at the 3.5 day inquest could have been finished in a day. Contrast this with Ft Lt Cunningham's inquest, planned to last 3 weeks.

Mr Walker did a fine job on Nimrod. The Government's response? Set up a Committee to look at how to curb his enthusiasm for the truth. A lesser known fact.... The MP representing the family (above) and who had asked Minister some leading questions (MoD actually told the truth in one reply, but this merely exposed the fact they had lied to the original investigators) was placed on this committee, meaning he was not permitted to ask any further questions on related matters. A very effective gag, and stopped awkward questions in their tracks. The more I look at this case, the more it looks far worse than any other.

Distant Voice

13th Jan 2014, 08:07

Clicker

Seeing as successful Tornado CWS flight trials were concluded in 1997, it would have been much better to have installed a CWS during the GR1 upgrade to GR4.

Which avionic upgrade are you talking about?

DV

clicker

13th Jan 2014, 15:13

DV,

I'm presumed that there was an upgrade from the GR1 to GR4 as Mode S was fitted.

I'm not in the service so just my assumption that a chance may have gone begging.

Distant Voice

27th Jan 2014, 18:54

I understand that Bond Helicopters have fitted Honeywell TCAS II to their Super Puma helicopters. It took them six months including flight trials and certification etc. MoD plan on installing Honeywell TCAS II to the Tornado GR4 aircraft, and so far it has taken them six years.

http://aerospace.honeywell.com/~/media/Customer%20Success%20Stories/PDFs/N61-1109-000-000_Bond_TCAS.ashx

As a retired aircraft engineer who has been involved in engineering new fits and and carrying out flight trials testing I believe that the Bond time frame is the more realistic, if there is the will.

DV

Distant Voice

17th Feb 2014, 11:48

I wonder if this event features in the SI,

Tornado collision: Warning system was ?cancelled? - The Scotsman (http://www.scotsman.com/news/transport/tornado-collision-warning-system-was-cancelled-1-3309016)

DV

dervish

17th Feb 2014, 12:14

I wonder if this event features in the SI,

I'm completely confused as to what the MAA does. The Red Arrows thread is a litany of incompetence and failure to act. They seem to have no power over the procurers in DE&S or operators. Yet the last SDSR was delayed by them insisting on some elements of the Nimrod review being funded. BZ. Which only shows someone thought it a good idea not to fund them, which is pretty frightening. :( They need to be "open and honest".

matkat

18th Feb 2014, 07:44

DV you are correct but TCAS 2 is only fitted to the L2 variant.

Distant Voice

25th Feb 2014, 17:40

Has MOD gone completely mad?

Angus Robertson: To ask the Secretary of State for Defence what audible warning the Honeywell Traffic Collision Avoidance System II will give in an imminent collision scenario. [187988]

Mr Dunne: As two suitably-equipped aircraft approach one another, their crews will hear the words, ‘traffic, traffic', If there is a risk of collision the Honeywell Traffic Collision Avoidance System II will direct the crews to manoeuvre to avoid a collision and they will subsequently hear either the instruction: ‘climb, climb now,' or alternatively, ‘descend, descend now.' Once the aircraft have achieved safe separation, the crews will hear the words ‘level off'.

So we have two Tornadoes closing around 14nms/min at 500ft, and one gets "climb, climb now", and the other poor sod gets "descend, descend now". This is the very reason why AAIB advised in 1994 that TCAS was unsuitable because "It resolves conflictions by advising manoeuvers in the vertical plane and this would be inappropriate at low level"

So we have waited 20 years for MOD to select a piece of equipment that they were advised against using in 1994.

DV

Trim Stab

25th Feb 2014, 17:59

So we have two Tornadoes closing around 14nms/min at 500ft, and one gets "climb, climb now", and the other poor sod gets "descend, descend now". This is the very reason why AAIB advised in 1994 that TCAS was unsuitable because "It resolves conflictions by advising manoeuvers in the vertical plane and this would be inappropriate at low level"

Given the rate that a Tornado can climb at low level, does it matter if the other cannot descend much?

Easy Street

25th Feb 2014, 18:13

Come on then DV, propose a better solution. Years were wasted trying to develop a gold-plated bespoke CWS for fast jets.

Just because the AAIB wrote something doesn't make it gospel, especially not when it's 20 years old. Anyone familiar with TCAS II knows that 'Descend' instructions are inhibited below 1000 feet as measured on the radar altimeter, so the lower aircraft in a proximity situation will only receive the advisory call "Traffic, traffic". This will cue the pilots' eyes immediately to the TCAS display, where they will see a plan view showing where to look out for the offending aircraft and hopefully allow them to duck under it.

Meanwhile the higher aircraft will get a "Climb, climb" resolution advisory, because these are not inhibited by low heights. So by following the instructions, the collision will be broken, even if both aircraft are hoofing around at 100 feet. TCAS II is a cooperative system, so if both aircraft are at exactly the same altitude, the system will still make a decision to tell one of the aircraft to climb.

Of course the problem of confliction with non-transponding aircraft will continue post installation of TCAS II. Have you got any bright ideas of how to deal with that, DV? Perhaps Tornado should be fitted with FLARM? There's a nice spot for a COTS unit on the glareshield, it should block the view out of the windscreen nicely.... get in touch with the PT, I'm sure they'd appreciate your guidance.

Distant Voice

25th Feb 2014, 18:26

Just because the AAIB wrote something doesn't make it gospel, especially not when it's 20 years old

MOD accepted this advice at the time and funded a CWS programme for fast jets.

Years were wasted trying to develop a gold-plated bespoke CWS for fast jets.

I understand that flight trials were concluded in 1997 for a fast jet system. MOD decided at that time to procure the CWS with a planned in service date of 2004; hence the statement in the 1998 SDR.

DV

tucumseh

25th Feb 2014, 19:05

Easy Street

All this TCAS stuff is long after my time, so a genuine question - one that arose during the Mull of Kintyre debate.

'Descend' instructions are inhibited below 1000 feet as measured on the radar altimeter

Taken literally, that could mean you have a rock face 1000' in front of you, with your huff and puff altimeter saying, say, 3000'. In other words, most Radar Altimeters measure the RANGE to the nearest fixed object within the beam pattern. The word "altimeter" can be misleading. So, for example, when the Chinook hit the hill at (800'?), the RadAlt indicated zero, or as near as dammit. Have I got this wrong? I remember this on MoK because the various reports seemed at times to confuse barometric with radar. (I've deliberately not mentioned Radio Altimeters!) Thanks.

Easy Street

25th Feb 2014, 21:53

tuc,

You have got me doubting whether I should have said 'radar' or 'radio' altimeter, so I shall stick to 'radalt'!

I don't know what beamwidth a rotary-wing aircraft's radalt would typically have, but the scenario you describe would certainly be possible with the radalts fitted to fast jets. The beamwidth of older ones was about 90° to ensure that they stayed locked on at moderate bank and pitch angles, and they returned the "height" reading from the shortest range return. This was noticeable when flying parallel to vertical cliff walls, when it was possible to get a return from the side at small bank angles. To address your specific scenario, someone flying into a hillside in level flight would see constant barometric altitude, while the radalt progressively decreased to zero.

There are some newfangled 'covert' radalts, designed to be better in tight EMCON. Whether these have a narrow beamwidth, electronically steered to the vertical axis, I know not. If they did, it might be possible to fly into a vertical cliff wall while getting a height reading from the valley floor.

Back on topic, TCAS II believes whatever radalt input it gets when deciding whether to screen out "descend" instructions. They didn't account for covert radalts or valley flying when drawing up the spec! The cooperative decision on vertical deconfliction is taken with reference to barometric altitude at 1013.2hPa, as fed to the transponder, so there should be no chance of undulating terrain compromising the integrity of the instructions (only exception being where the 'low' aircraft is forced to climb by terrain, in which case the 'high' aircraft should get an 'increase climb' instruction). It's worth remembering also that GPWS warnings have primacy over TCAS instructions, even in civvie airliner land; rest assured that system designers had actually considered the possibility that vertically-based deconfliction instructions near the ground might carry their own risks...

TCAS II is not ideal for fast jets but it is better than nothing, which following the failure of the bespoke programme (which I had always understood to be much later than 1997; I thought 2004...) was the only alternative. Even in situations where its deconfliction instructions are inhibited, it will cue aircrew to look in the right place when squawking traffic approaches. It probably would have saved 3 lives in 2012. Let's see what the SI has to say over MoD taking 10 years to actually get round to fitting it.....

tucumseh

26th Feb 2014, 05:47

Thanks Easy Street. Far more up to date than me. Always ask someone who knows!

Distant Voice

26th Feb 2014, 19:28

which following the failure of the bespoke programme (which I had always understood to be much later than 1997; I thought 2004...

It is documented that the initial trials were commenced in 1994, and concluded in 1997. MoD then decided to procure the system with an in sevice date of 2004. This "bespoke" system was persued because of the percieved problems with TCAS, as I indicated in my ealier post. It now seems that we are back to the 1994 position.

The whole thing was summed up by the DG MAA in 2010 when he reported "Incremental mitigation of this chronic risk, which has a high 'societal concern' factor, has suffered protracted delays over successive PRs since the 1998 SDR.

I am not against the TCAS system, it is just that if it is OK to install it now, why not 20 years ago; the basic system has not changed that much.

Let's see if the SI contains this information.

DV

Easy Street

26th Feb 2014, 21:32

I am not against the TCAS system, it is just that if it is OK to install it now, why not 20 years ago; the basic system has not changed that much.

Let's see if the SI contains this information.No need to wait for the SI on that one. This was merely another symptom of the illness diagnosed by Bernard Gray before he became CDM, namely the institutionalised gold-plating of requirements, under-estimation of technical risk as a means of securing funding when pursuing novel programmes, and a systematic refusal to contemplate the off-the-shelf 80% solution. TCAS was only adopted when there was literally no other option - and judging by the time taken to get it into service, I wouldn't be surprised to see evidence of a rear-guard action by the gold-platers....

Courtney Mil

26th Feb 2014, 21:49

Maybe a few areas of misunderstanding about radalt. I was about to try to explain in my own words, but then found the following. Sorry, I have no idea what language this was written in, but it explains some very important priciples about radalt and what it actually measures - notwithstanding East Street points about beamwith.

The transmitted pulse reaches the surface first on a small point. As the pulse advances, the illuminated area grows rapidly from a point to a disk, as does the returned power. The reflecting area depends on the beamwidth of the antenna. The energy from the center of the main beam has to travel the shorter path than the energy from the edges. An annulus is formed and the geometry is such that the annulus area remains constant as the diameter increases. The returned signal strength, which depends on the reflecting area, grows rapidly until the annulus is formed, remains constant until the growing annulus reaches the edge of the radar beam, where it starts to diminish.

It's not just a simple measurement of distance from Tx/Rx to the nearest object.

engineer(retard)

27th Feb 2014, 10:11

It is the dim and distant past but I do not recall TCAS trials in the mid 90s but do remember GPWS being trialled, I think on the SAOEU GR1 at Boscombe. It was being aligned with a Laser IN competition to replace the old mechanical system.

Distant Voice

1st Mar 2014, 14:45

Does anyone have a copy of the Tornado Airworthiness Review Teams (TART) report, dated circa 1996? MoD appears to have lost all their copies.

Please PM me if you have.

DV

Distant Voice

5th Apr 2014, 14:05

I note that over the past couple of months Angus Robertson has made several attempts to obtain a copy of the SI report into the Tornado collision over the Moray Firth; they are listed below along with the repy from MoD. Each reply gets more and more unbelievable with the latest being a flat refusal to comply with their own JSP. What are they afraid of? If this had been a collision between a Tornado and a civil aircraft the AAIB/Ministry of Transport would have published their report as soon as it was completed; well in advance of an Inquest or FAI. It seems that MoD are so unsure of their own investigation that they are only prepared to offer their SI reports for public scrutiny after the case has been closed.

http://www.theyworkforyou.com/wrans/?id=2013-12-03c.179565.h&s=date%3A20131203+column%3A639+section%3Awrans (http://www.theyworkforyou.com/wrans/?id=2013-12-03c.179565.h&s=date:20131203+column:639+section:wrans)

http://www.theyworkforyou.com/wrans/?id=2014-03-19a.191597.h&s=%28section%3Awrans%29+speaker%3A11189#g191597. (http://www.theyworkforyou.com/wrans/?id=2014-03-19a.191597.h&s=%28section%3Awrans%29+speaker%3A11189#g191597.)

http://www.theyworkforyou.com/wrans/?id=2014-04-03a.194550.h&s=%28section%3Awrans%29+speaker%3A11189#g194550.q0 (http://www.theyworkforyou.com/wrans/?id=2014-04-03a.194550.h&s=%28section%3Awrans%29+speaker%3A11189#g194550.q0)

DV

tucumseh

5th Apr 2014, 16:42

Anna Soubry - 19th March 2014

"The publication of Service Inquiry reports is considered on a case by case basis."

Philip Dunne - 17th March 2014

"It has for several years been Departmental policy to publish Service Inquiry reports into fatal accidents at the conclusion of the Coroner's Inquest."

Not entirely contradictory, but disingenious. The determining factor would seem to be whether or not a death has occurred. If it has, the report is not allowed to be scrutinised by independent parties. That is, MoD determines what evidence is heard by the Coroner. The clear aim is to prevent the truth being told in court, because the Coroner isn't involved in other non-fatal cases.

This is exactly what happened with the Red Arrows inquest and, in a particularly obvious case, the ASaC collision inquest of January 2007 when MoD refused to answer questions relating to inconsistencies and outright lies in witness evidence.

The stated aim is to prevent recurrence. The actual aim is to conceal the truth.

Chugalug2

5th Apr 2014, 23:02

tuc:-
The stated aim is to prevent recurrence. The actual aim is to conceal the truth. ...and there in a nutshell is why Air Safety is unsafe in the hands of the MOD, or any of its agency or Service subsidiaries. It lies, steals, and cheats to conceal incompetent and illegal activity. That is something that may be expected and understood, if not condoned, in politics and in the corridors of power. It is not understood nor accommodated by aviation. Because of it people die, 63 in fatal accidents considered in this forum alone, possibly becoming 65 with the subject accident of this thread.

Covering up by pinning the blame on subordinate JOs, SOs, or even 1* VSOs, has been the disreputable policy of the Star Chamber to date, in order to mask the culpability of its own members. In doing so it has severely undermined the security of this country and sullied in particular the honour of the Royal Air Force. It has to stop. The MAA and MAAIB have to be made free of the dead hand of the MOD and of the High Command, and separated from each other in order to do their respective and very different jobs.

Self Regulation Doesn't Work and in Aviation It Kills!

ancientaviator62

7th Apr 2014, 10:10

How would the new Duty Holder Concept be applied in cases like this ?. Would the trail of causation reach back through the civil service to the politicians ? Realist that I am I do not believe so. Yet commanders in the field can only work with the resources they are given by those in authority to carry out the designated task.
It strikes me that the commanders will be but a human shield for those who will not be accountable under this new scheme. It is as if it were dreamed up by the ambulance chaser's union. It can only emasculate an already diluted Armed Force and make us the laughing stock of the world.
And yet Cameron is proclaiming 'his finest hour' is the billions of our taxes squandered on overseas 'aid', effectively trashing the defence budget to do so.

tucumseh

7th Apr 2014, 11:53

How would the new Duty Holder Concept be applied in cases like this ? Well, there was nothing wrong with the OLD Duty Holder concept, except that VSOs and senior Civil Servants ruled it should NOT be implemented. Reverse that decision (which the MAA steadfastly choose to ignore) and you revert to a perfectly good system. It remains an offence in the MoD to refuse to obey an order to make a false declaration about airworthiness. The elephant in this particular room.

The relevant MAA Regulatory Instruction opens up by telling the reader it is going to set out the DH concept for airworthiness, then proceeds to discuss Fitness for Purpose. You will recall the C130 IPTL said at the XV179 inquest he didn’t know how to do this. Perhaps this RI is an attempt to teach these basics. However, having actually spoken to a senior MAA officer, I can assure you he did NOT understand the difference between airworthiness and Fitness for Purpose. He did not appreciate that one first attains airworthiness, and before even considering Fitness for Purpose must have a process in place to maintain airworthiness. MoD has always been pretty good at the first, mainly because much of the work is done by Industry, who have a vested interest in selling us an airworthy aircraft or equipment. MoD simply don’t do the other two very well, although both are relatively simple if properly funded and you follow the regs. (The old ones, not the MAA ones).

The RI explains the DH’s legal obligations but not how he goes about meeting his obligation. (This was laid down in a mandated Def Stan, which was cancelled without replacement a few years ago. The MAA’s attempt to describe this process fails miserably – to be fair, by no means the first time our so called regulatory experts have got this completely wrong). One reason why it was cancelled was because the Chief Engineer had decreed in 1992 that it should no longer be updated, ridding MoD of the department that wrote and issued it. The last amendment was May 1991. MoD no longer has a complete copy. It is the Bible and if you don’t know it by heart, you have little or no chance of avoiding the failures that we discuss here.

Another interesting concept is introduced by the MAA (or perhaps imposed upon them). They say “The DH has no right of veto over the MoD planning and programming decisions”. Why this change? The terms of reference of the engineering posts that are now called Requirements Managers used to say they could use “Engineering Judgement” to over-rule Long Term Costing Assumptions (old money). When I was one, I exercised it daily for two years, almost always in the interests of airworthiness, reliability, maintainability and availability. It of course followed that a non-engineer RqM could not fulfil all his ToRs, which has been a weakness of the system for many years now. See Engines’ post in another thread about properly setting Requirements (and, importantly, interpreting them for Industry). That is not to say non-engineer RqMs have no place, but it is self evident they must be a minority in certain domains, complemented by engineering colleagues. But I’ve worked in IPTs which had none and the RqMs, unwittingly, only did a small percentage of what we (programme managers) expected of them.

Summary: DHs will read the RI and scratch their heads asking, “How can we be legally accountable if we have no control whatsoever over the process which delivers and maintains airworthiness?”

Fox3WheresMyBanana

7th Apr 2014, 12:34

Answer: You can't, but it's the same in many professions now. The root cause is the corporate manslaughter laws. In essence, the Directors (or equivalent) want a 'fall guy'. Careerists accept it and hope disaster doesn't happen on their watch; anyone with principles leaves. Worse still is that the Government/Civil Service doesn't care either. They just needs somebody's head on the chopping block when disaster strikes, to keep the media happy and therefore keep their own jobs. It doesn't matter to them that the person 'responsible' cannot logically be held so.

Chugalug2

7th Apr 2014, 14:11

When the conduct or policy of Directors comes under close scrutiny, then it is they who carry the can as often as not. Witness the Co-operative Bank saga so recently in the news. The difference with Military VSOs, and in particular RAF VSOs, is that they never carry the can for the consequences of their actions or policy because they control the evidence to hand and can direct the outcome of investigations into the outcomes of their actions.

Being a DH in these circumstances is akin to being a tethered goat, staked out for sacrifice as and when it becomes deemed to be appropriate. This is, in relative terms, a fairly recent phenomena, and in the case of Airworthiness Provision (or more accurately its lack of provision) can be dated precisely from 1987. If RAF VSOs will not take responsibility for their own actions then the future of the RAF itself is at stake. That is a matter for the RAF. In the meantime its business of providing for UK Air Power is already very seriously compromised, and it may not have the luxury of presiding over its own demise should a potential enemy have other ideas...

tucumseh

7th Apr 2014, 17:25

Fox3

Agreed.

Worse still is that the Government/Civil Service doesn't care either.

To be fair, many do care, but are hamstrung by those at the top listening to the perpetrators, who are allowed to judge themselves. Those at the bottom who may seem not to care are hamstrung by no longer being trained. Many in DE&S now skip the 5 or 6 grades at which you learn how to do this work, and are simply told that it is a waste of money.

The last 5 or 6 Ministers for the Armed Forces have placed in writing their support for those VSOs who issued orders that the regulations should be ignored and false declarations made that they had been implemented. Likewise, the Head of the Civil Service only last year when ruling it is NOT an offence to issue an order to make a false declaration, but is an offence to refuse to obey.

The MAA is fully aware of this. They were present when the last but one Min(AF) was briefed about these ongoing offences and rulings during the Mull of Kintyre Review, but did nothing. DE&S policy branch is wholly content providing the Ministerial briefings under FoI, which often cite MAA officers by name. That DE&S Policy speak for the MAA on this matter clearly demonstrates collusion, making a mockery of the MAA's supposed independence. That they happily flaunt their briefings shows that they are confident of top cover.

The main question is; Would this new Duty Holder construct have prevented ZD576, XV230, XV179, ZG710, XX177, XV704, XV657? No. What would have prevented them, or at least not stripped them of defences in depth? Implementing mandated regulations of the day. The solution? It's a no brainer. You've got to ask why MoD/MAA flatly refuse to address this simple fact.

thefodfather

7th Apr 2014, 19:54

I'm amazed that no one has mentioned this latest article in the Telegraph. Good to see the MAA sticking it's neck out with acting like a Regulator. Although, it is one thing to tell people you have a risk register but another thing entirely to actually do something about it.

My favourite part was the MOD spokesman who said air safety was "at the core of all MOD aviation activity". He said: "We take very seriously our obligations to ensure that our activities are as safe as reasonably practicable, nevertheless, we accept that there is further work to be done and are committed to addressing the identified residual issues as soon as possible.’

Defence cuts and staff shortages 'increasing risk of military air accidents' - Telegraph (http://www.telegraph.co.uk/news/uknews/defence/10749922/Defence-cuts-and-staff-shortages-increasing-risk-of-military-air-accidents.html)

Chugalug2

7th Apr 2014, 21:45

More smoke, more mirrors, I'd say tff. By blaming Defence cuts, the blame moves towards the despised politicians and away from the High Command. It is there, as well as with the MAA itself, that the long term threat to Military Air Safety exists. The MAA is based on a lie, the Haddon Cave Nimrod Report. No Regulator that refuses to face that reality can be taken seriously, neither can an Air Accident Investigator that is subservient to that Regulator. Above all else, an Air Regulator and an Air Accident Investigator must be independent of the operator and of each other.

The more the 'I' word is trumpeted, the more you know that it is bogus. More smoke, more mirrors...

DeskBoundPhixer

7th Apr 2014, 23:28

Whats an RI relating to Watchkeeper got to do with this thread? Its the only extant one on both of the MAA websites. If you are going to quote something as "fact", at least try to get the references correct!

tucumseh

8th Apr 2014, 07:04

"Shortage of qualified personnel are of more concern than previously understood"

Just to be clear, that should read "understood by the MAA", as it was clearly understood by everyone else involved in airworthiness and, for example, emphasised in a report dated January 2000 and patently obvious in many reports by the RAF's Inspector of Flight Safety from the 1990s.

So, having demonstrated they can read old reports and pprune, what are the MAA doing about it?

Growbag

8th Apr 2014, 09:55

Why is it that the focus of this seems to be all about blame? Surely the focus should be on air safety? Senior Officers (DHs) don't get up in the morning and think, "How can we be negligent today and cover things up so we can carry on allowing flying to be dangerous..." The Moray accident will no doubt show that there have been some questionable actions within MOD throughout time, but it will also, more than likely, show a large degree of bad luck (as all MACs seem to depend upon).

As for sharing the report, this has been done internally (to affect change at the coal-face in the quickest time) and is not released until the Coroner (or PF in this case) allows it. I don't see how that is witholding information or debate? The publication of the report when a decision has been made to carry out a FAI or not will allow public scrutiny - which along with any media attention will demand answers to any questions not posed in the SI. There are PQs via MPs, FOI requests and many other routes to interrogate the MOD if the current Regulator seems to have been less than thorough.

Maybe wait until the report has come out before comparing it to previous ones?

Just a thought.

Distant Voice

8th Apr 2014, 12:43

I read in an AAIB report that RAIDS had/has a basic CWS capabilty. Does anyone know if this is true, or not?

DV

Growbag

8th Apr 2014, 14:00

Yes it does. This was offered as part of the original purchase, but not taken.

MBDA information on RAIDS states:

Advanced software concept
• Readily adaptable weapon simulation software
• Real Time Kill assessment and Removal (RTKR)
• Safety warnings for:
- air collision
- ground collision

Not_a_boffin

8th Apr 2014, 15:23

And explicitly...

House of Commons Hansard Written Answers for 07 Apr 2014 (pt 0004) (http://www.publications.parliament.uk/pa/cm201314/cmhansrd/cm140407/text/140407w0004.htm#1404085000132)

Angus Robertson: To ask the Secretary of State for Defence (1) whether the fitting of the Rangeless Autonomous Information Debriefing System equipment to Tornado aircraft was regarded as mitigation for the collision warning risk over the last decade; [194548]

7 Apr 2014 : Column 96W

(2) what collision warning capability the Rangeless Autonomous Information Debriefing System had. [194549]

Mr Dunne: The Rangeless Airborne Instrumented Debriefing System (RAIDS) as fitted to RAF aircraft has no collision warning capability.

It logs and stores GPS positional data during flight. Data can only be downloaded post-flight to allow replay during sortie debriefing of the positional data for all aircraft fitted with RAIDS. Therefore, it provides no situational awareness to the crew in flight.

Distant Voice

8th Apr 2014, 16:17

Growbag, what sort of time frame are we talking about. When was the original offer made? When and why was it removed? Clearly, from the answer that Angus Robertson got it has never been in.

DV

30mRad

8th Apr 2014, 16:19

I had heard that it had been decided that there would be no FAI. Anyone confirm or deny this? If this is the case, any info on when the SI will be released?

tucumseh

8th Apr 2014, 16:59

I don't see how that is witholding information or debate? The publication of the report when a decision has been made to carry out a FAI or not will allow public scrutiny - which along with any media attention will demand answers to any questions not posed in the SI.

The point is that MoD no longer releases the report for independent scrutiny until after the Inquest or FAI is complete. Families are required to sign a confidentiality agreement saying they will not reveal contents until then.

That means MoD dictates what is revealed in Court, what evidence is heard and what direction the Inquest/FAI takes. The reason for this change of policy is clear. MoD are upset over being caught lying in the past so don't want those who know the truth, or who can do a better job of uncovering the truth, having their say. This militates against the mutual aim of the SI and Inquest/FAI - to prevent recurrence.

The Red Arrows case is a prime example. MoD's claim that they were not told of the servicing instructions in the early 90s has never been put to the test. The family was in no position to challenge because they had no access to specialists who would know the questions to ask. No challenge is taken as acceptance of the truth, which is not the case.

Once the verdict is reported, the media is not interested. MoD, at most, take a minor hit and the issue is compartmentalised instead of being seen for what it is - part of the wider systemic failings MoD seeks to conceal.

Distant Voice

8th Apr 2014, 19:34

I had heard that it had been decided that there would be no FAI. Anyone confirm or deny this? If this is the case, any info on when the SI will be released?

If this is true then there will be an outcry. I sincerely hope the families do not enter into any settlement until the report has been released and scrutinised.

This is what Tuc is on about. The decision to hold an FAI, or not, will be decided by the PF and Crown Office based on the evidence before them. And the only evidence they have has been presented by the MoD/MAA.

"Did you deliberately shoot your girlfriend, Mr Pistorius?" ------ "No, My Lady" -------"OK, case dismissed"

DV

Distant Voice

8th Apr 2014, 19:41

Yes it does. This was offered as part of the original purchase, but not taken

So, some time around 1999 MoD decided not to go ahead with the EASAMS CWS, that had been succesfully tested, and elected not to purchase the RAIDS collision warning software. I wonder if all that is in the SI?

DV

JustT

26th Jun 2014, 12:17

BBC News reporting that the SI could be released next week (http://www.bbc.co.uk/news/uk-scotland-highlands-islands-28038856), two years after the crash.

RIP Sam

JustT

KPax

26th Jun 2014, 18:45

Just watched BBC Scotland news, doesn't sound great for MOD. Squabbling, delays, cutbacks and poor management all mentioned. Relatives pushing for fatal accident enquiry. Also mentioned delay in fitting CWS due to cutbacks, not a great advert.

Fox3WheresMyBanana

26th Jun 2014, 20:29

ISTR AP3207 having something about Inquiries needing to be timely to be effective, and I don't remember anything about massive delays for the purpose of arse-covering :ugh:

Just checked. Still there: para 12.
Full, open, timely and accurate reporting of aviation occurrences
is essential to the maintenance of good flying safety.

Distant Voice

27th Jun 2014, 10:46

It does seem that MoD has had a change of heart on this one; thank God. Their original stance was to withhold the report until after the FAI, if one took place, or a soon as it was decided not to hold one. I understand that the FAI issue has yet to be resolved.

I also understand that the MAA and the Crown office of Scotland have never been opposed to this report being issued.

DV

Distant Voice

29th Jun 2014, 13:48

Could be a bad week for MOD, but will anyone be held accountable?

BBC News - Jets collision warning system 'would have saved lives' (http://www.bbc.co.uk/news/uk-scotland-28071240)

DV

Heathrow Harry

29th Jun 2014, 16:50

don't be silly................

dervish

29th Jun 2014, 18:07

Deliverance

That might seem an acceptable risk but the point being made is the MoD porky machine was in overdrive on this one. It was claiming CWS was only considered recently but was actually rejected in the 90s. I don't know why but that would be a good question if a fatal accident inquiry is held here. Looks like MoD is resisting.

Fox3WheresMyBanana

29th Jun 2014, 18:57

Forgive me, but isn't the issue here that the RAF / MoD have been dishonest, rather than the suitability or otherwise of CWS?
Didn't the RAF/MoD at some point in the past state that, after previous BoI recommendations, CWS would be fitted (SDR 1998 according to DV); then quietly scrap it but not tell anybody? And they scrapped it for budgetary reasons rather than making a case that it wasn't suitable? And they scrapped it by simply not prioritising it 13 times in a row.
If CWS turned out not to be viable after further investigation, then they should have said so, but they never did.
In Hansard 3rd Dec 2013, Sec Def said:
A Tornado traffic collision avoidance system (TCAS) has been developed which is expected to achieve initial operating capability by the end of next year.
Which seems to imply that it wasn't ever rejected; it's just taken 15 years to finish being considered.
In everybody except the MoD's head, delaying it for 13 years in a row, then suddenly deciding it's a priority after another fatal is scrapping it but not telling anybody.
And 13 years worth of Air Force Boards have some questions to answer, as do the Sec Defs.
Can we take their pensions away? Maybe give them to the widows?

Chugalug2

29th Jun 2014, 20:31

F3WMB, some of them deserve losing their liberty never mind their pensions, but the essential thing to take completely away from them is Regulatory Authority. That should reduce the number of future widows markedly.

That would mean that the Regulatory Authority, ie the MAA, and the Accident Investigator, ie the MAAIB, should both be made independent of the MOD and of each other, and both should be headed up by civilian DG's.

...or leave the same old incestuous arrangements in place whereby Investigator is controlled by Regulator is controlled by MOD and up the widows' pensions as you suggest...

Self Regulation Doesn't Work and in Aviation It Kills!

Distant Voice

30th Jun 2014, 09:40

The BBC report states that the Typhoon has no CWS, surely the MOD isn't going to fund a CWS for a fleet shortly going out of service while not fitting one to Typhoon.

Anybody know if Typhoon is also getting equipped with a CWS?

A three phase Technical Demonstration Programme (TDP) for a discrete Fast Jet CWS was completed in 1996 (the civilian TCAS concept was considered unsuitable for FJs). The trials were consider to be so succesful that in 1997/98 DOR(Air) recommended the trials equipment should proceed "straight into prototype/C model production". The ISD for Tornado was set for 2004, with the equipment being fitted during an already planned SIFF installation programme. This was a piece of kit for all FJs.

An earlier paper, dated Oct 1994, which was procuded at the end of Phase 2 of the TDP, made it clear that no aspect of the TD design or implemention should preclude eventual fit on Tornado, Jaguar, Harrier, Hawk and EF2000 (Typhoon).

We now know that this Fast Jet CWS was never developed, but the Moray Firth accident has forced MoD to do something for Tornado; namely fitting a piece of Off-The-Shelf equipment TCAS. It is unlikely that they will purchase the same kit for Typhoon, because they know that it is not ideal for FJs, having rejected it back in 1991.

Over to you MoD.

DV.

Wrathmonk

30th Jun 2014, 12:16

https://www.gov.uk/government/publications/service-inquiry-accident-involving-tornado-zd743-and-tornado-zd812-over-moray-firth

alfred_the_great

30th Jun 2014, 12:56

So, un-surprisingly, there were multiple contributory factors to this incident.

dervish

30th Jun 2014, 15:30

So, un-surprisingly, there were multiple contributory factors to this incident.

Instead of stating the blindingly obvious what about some constructive or knowledgeable comment?

I read the recommendations and convening authority comments first. The former very disturbing because it is the same old failings yet again. The latter dreadful as it doesn't acknowledge the similarities between this and other accidents. Everything's ok, it'll never happen again now we have the MAA. How long can they sustain that line?

Distant Voice

A three phase Technical Demonstration Programme (TDP) for a discrete Fast Jet CWS was completed in 1996

If a 3 phase TDP was completed in 1996, why does the convening authority say the CWS issue only began in 1998? Am I correct in saying this is exactly what Hadden-Cave did, saying nothing was wrong before 1998 despite evidence to the contrary?

BTW, well done persisting with this one.

Cows getting bigger

30th Jun 2014, 16:44

CWS in military aircraft goes back quite a bit further than 1996/8, as does the CVR discussion.

Having quickly scanned the report (bedtime reading tonight), hats off to the SAR chaps for making sense out of confusing information and, as ever, doing a stirling job that many of us would shy away from.

Wrathmonk

30th Jun 2014, 16:45

I'm sure those more closely involved with the Chinook/Nimrod campaigns will not be surprised by Para 1.4.7.84 :

The review of the planning and programming situation that led to Tor CWS being deleted as directed by 2nd PUS could not be provided by MoD

Some might say 'how convenient'....unless I have misunderstood what the panel meant by this observation.

Fox3WheresMyBanana

30th Jun 2014, 17:40

OK, I've read it.
Big Pat-On-Back to the SI Panel, it's clear and doesn't pull any punches.

The crucial stuff on CWS seems to start around 1.4.6 (Other) (Continued), second part.
For a very abbreviated look, try the following paras:
1.4.6.442, 453, 471-497, including the timelines on p259

My $0.05 (Canada no longer has pennies!)
Intra-Squadron Range Booking procedures (if they were any good) could potentially have deconflicted the aircraft. Nevertheless, both a/c were outside booked slots. This kind of thing happens. I almost had a mid-air in 1987 near a SAP target.

A TCAS simulation seems to show that a Tornado CWS would have prevented the collision.

The BoI shows the big decision on Tornado CWS was in 2005 that delayed the program to 2010. It was then later continually delayed. The original report from Plans to the Defence Management Board (DMB) which led to the delay can, unsurprisingly, not be found. It would appear on first reading that the DMB were badly advised. DG Resources & Plans (who prepared the brief for them) has a lot to answer for. It would appear the RAF bods were quite clear about the importance of CWS, and RP rewrote their stuff in several ways without any reference to them (or reality). However, DMB also delayed it in 2002, 2003, 2004 and 2007 despite strong advice about not delaying it.
It was scrapped in 2011. After much aggro, CAS wrote to SoS and said 'on your head be it'. Liam Fox wrote back 6 days later and said it was unscrapped and accelerated.

At all stages and dates, the threat of punitive legal action was highlighted, including reminders that having a program didn't count as having the equipment.
The MoD are going to get their @sses sued for this one, and rightly so.

Distant Voice

30th Jun 2014, 19:02

If a 3 phase TDP was completed in 1996, why does the convening authority say the CWS issue only began in 1998? Am I correct in saying this is exactly what Hadden-Cave did, saying nothing was wrong before 1998 despite evidence to the contrary?

Simple answer is that neither he nor the SI team reviewed the pre-1998 documentation.

DV

strake

30th Jun 2014, 19:05

I'm not quite sure I fully understand the situation with the WSO.
I haven't read the report but the BBC seem to suggest that the aircraft was crewed by someone who had a phobia about flying at medium level.
I presume this is some sort of exaggeration?

m0nkfish

30th Jun 2014, 19:05

Genuine question and not suggesting the current way of doing things is wrong.

Why are board members names redacted as well as the names of those who are nominated advisors or 'in attendance'?

Would accident investigator names in a civilian incident/accident also be hidden?

Fox3WheresMyBanana

30th Jun 2014, 19:19

Given the crap (in the press and elsewhere) that was recently foisted onto a friend of mine who headed up a Court Martial, and when all was said and done in a follow up civilian court case he was seen to be dead right on all counts, I can see why names are redacted. I am not aware that the civvies release Investigators names on specific accidents either.

Personally I think the Panel members did a very thorough job; hats off to them.

Strake: - anxiety, it happens, and in many forms - flying FJ tests limits and human mental issues most people are unaware of. He was under treatment, all supervisors were well aware, and he was cleared to fly. With the withdrawal of specialist RAF mental health services, the Panel criticised the lack of an organised system to return him to full operations, which seems perfectly valid.
One of the points of having a Duty Auth before each flight is to assess fitness to fly.

Just This Once...

30th Jun 2014, 19:55

I think the comment from AOC 1 Gp in 2011 as ODH gives a fair impression of the mentality:

'Our calculation of a Tolerable and ALARP [situation] without CWS was audited by the MAA recently without adverse comment. So assuming the SofS is happy to hold Societal risk we can save some money!'

[Ref:Page 263]

Given the amount of letters the DG MAA wrote at the time articulating his belief that it was not Tolerable & ALARP I am not even sure the AOC's comments were even accurate.

charliegolf

30th Jun 2014, 20:38

Fox3 wrote:

He was under treatment, all supervisors were well aware, and he was cleared to fly. With the withdrawal of specialist RAF mental health services, the Panel criticised the lack of an organised system to return him to full operations, which seems perfectly valid.

Fox, do you regard it as a coincidence that his e-record was erased before being available to the BOI? Implicit in that statement, is that the other 3 crews' reports were not erased?

Accepted that this did not contribute to the collision, but after the way the Reds were mangled for poor record keeping, I'm surprised it only got one line.

CG

Fox3WheresMyBanana

30th Jun 2014, 21:09

CG - I have no info on which to comment. I left a long time ago.
Personally I think it was an extremely bad move getting rid of in-house mental illness treatment, and the WSO (and the RAF) were extremely lucky to get such an experienced nurse. In 10 years time, all the legacy people will have retired, the Service will be a very long way up sh!t creek, and there will be a massive hunt for non-existent paddles. The same applies to a lot of the civilianised contracts. I gave this as one of my reasons for PVR'ing. I said it would take 20-25 years, and I was just about right.

dervish

30th Jun 2014, 21:26

Quote:
If a 3 phase TDP was completed in 1996, why does the convening authority say the CWS issue only began in 1998? Am I correct in saying this is exactly what Hadden-Cave did, saying nothing was wrong before 1998 despite evidence to the contrary?

Simple answer is that neither he nor the SI team reviewed the pre-1998 documentation.

DV

Thanks DV. So, important information withheld from yet another BoI. I think they did a decent job under the circumstances but if the president reads pprune I wonder if he'll ask to be reconvened as it would change a number of his recommendations.

In the past you've often mentioned the TART report. Did they see that?

Worth re-reading recent posts on the Rivet Joint thread which explain the background to a few of the recommendations a lot better than the report does. Its pretty obvious there is no safety case because the report admits important work wasn't carried out. And its pretty obvious the MAA still doesn't understand some basic concepts, confirming the views in the RJ thread.

JTO, -re tolerable and ALARP, I think you're right. Lots of contradictions that need explaining. Any word on a FAI?

Fox3WheresMyBanana

30th Jun 2014, 21:37

The Moray MP is demanding an FAI, based on the BoI report.

With my near mid-air, I spotted and called one of the other formation, then my wingie (who is now DG MAA !) yelled "PAIR!" as he saw the other on a collision with me. I ducked under (at 250', but luckily we'd just crossed a ridge); the other formation didn't see us.

So DG MAA has saved at least one life - me!

Distant Voice

30th Jun 2014, 22:16

In the past you've often mentioned the TART report. Did they see that?

Another simple answer - No

DV

Bob Viking

1st Jul 2014, 04:36

I've been away from Valley for a couple of years now but operated with TCAS in the Hawk for a while. Despite my previous criticism of the system as currently installed it would almost certainly have prevented this accident. It's far from perfect but better than nothing.
May I just add that we may all think this would never happen to us but this report really brings home to me how it is the benign, thumb-up-butt moments that seem to have the greatest ability to bite us in the arse.
RIP chaps and may we never have to read a similar report again.
BV

Cows getting bigger

1st Jul 2014, 05:25

Deliverance, I agree. Whilst this is probably the most thorough military accident report I have ever seen, I can't help thinking that the key messages are somewhat diluted by some of the noise. Sure, someone needs to pick up how air traffickers are authorised but does this really need to be commented on in the SI? At times, I thought the report read like an MAA shopping list, having been passed round all the desks within the organisation, each feeling obliged to make an observation.

That said, it is heartening to see that this accident has warranted far more than the traditional "pilots failed to see each other" and it does seem to reinforce weaknesses spotted after other relatively recent high profile accidents.

Madbob

1st Jul 2014, 09:34

This is all so very sad. 3 good guys dead and two valuable aircraft destroyed. Previous warnings missed and lessons not learned - again.

Apart from the lack of a CWS the other thing that screams at me is the lack of an effective, automatic PLB that works on 406Mhz.:ugh:

As 121.5/243.0 are no longer monitored (and DF capabilities are limited anyway) SARBE 7 is a bit obsolete IMHO. Also, reductions of SAR capability are not good either, so taken together rescue times could become a lot longer that most airecrew are led to believe, especially if there is also a shortage of rear crew - no winching possible - or aircraft un-serviceability means that a more distant SAR asset needs to be tasked.

I believe that individual crews could legitimately say that some sorties would be too risky to carry out in peacetime training. I shudder to think if there had been a QRA mid-air say just 100 miles further to the north-east involving a 1.30 transit. The one survivor, no immersion suit, water at 12 degrees, and not in a dingy spent 75 minutes in the sea and only just survived.

I don't envy future F-35B crews, with their single engine, if they ever got tasked with doing low level maritime attack profiles in the same vein as the Bucc or Tonka if SAR capabilities are stretched so thinly. All it would take is a big fat herring gull down the intake.........:eek::eek::eek:

MB

Fox3WheresMyBanana

1st Jul 2014, 10:01

QRA always used to wear immersion suits all year; silly not to.
I think there was a comment somewhere in the BoI about making sea drills more realistic so aircrew would be prompted to make sensible decisions themselves. Gets my vote. We used to alternate one 'easy' sea drill (say, off the beach in Cyprus) with one 'hard' one (Off Hartlepool in Febrrrrrruary). I recommend one night drill also.

skua

1st Jul 2014, 13:57

Madbob

I agree. It is worth noting that many (most?) civi pilots cough up to pay for a 406mhz PLB. I doubt you would find many 121.5 versions in puddle jumpers these days.

ShotOne

1st Jul 2014, 13:58

Don't make them too realistic (night drill.. please not at sea!), fox or you might find a greater likelihood of losing someone in a drill than a real accident. There are a number of pools which offer top notch training, waves, spray, darkness.

Madbob it's not entirely true to say 121.5 isn't monitored. Airline pilots listen out most of the time so there's still a good chance of a signal being picked up in most areas. But I'm shocked to hear this is the best that's being issued when for a couple of hundred quid you can buy a fag-packet sized 406 MHz PLB

Madbob

1st Jul 2014, 14:15

ShotOne - just because civil air traffic (CAT) listen out on 121.5 doesn't really help much to speed up the likely SAR scramble. As here there was confusion between ELT/PLB reports by a Speedbird near Stornoway and a Loganair near Wick.

What is so hugely depressing it that the MOD has not addressed this effectively by a suitable off-the-shelf procurement plan. I no longer fly so I am not up to date here but I'd be interested to see what other air forces do. I can't imagine RCAF or USAF aircrew being happy to operate in northern Canada/Alaska with the same kit the RAF use.:eek::eek::eek:

MB

RAFEngO74to09

1st Jul 2014, 14:37

The USAF bought 17,000 URT-44 for $30M in 2009 and they were in service from 2011 - there was 8 years notice of the change to 406 MHz:

https://timeswampland.files.wordpress.com/2014/02/an_urt44-ds.pdf

However, there have been a lot of failures and there are already plans to replace the URT-44:

Locator Beacons For Us Air Force Ejection Seats Failing At 'Unacceptable' Rate | Defense News | defensenews.com (http://www.defensenews.com/article/20140206/DEFREG02/302060024/Locator-Beacons-Us-Air-Force-Ejection-Seats-Failing-Unacceptable-Rate)

http://www.af.mil/News/ArticleDisplay/tabid/223/Article/473277/af-to-replace-aviator-locator-beacons.aspx

500N

1st Jul 2014, 14:54

When tested on the shelves, the URT-44 has a 24 percent failure rate, according to Air Force documents.

That is one hell of a failure rate for Electronics.

ShotOne

1st Jul 2014, 15:26

Madbob, I can see why you'd be depressed. I certainly wasn't endorsing 121.5. On the contrary I'm appalled to hear this is still relied upon! Rather than a muti-million £ procurement programme if only someone would pop down to an outdoor shop.

Bob Viking

1st Jul 2014, 15:34

MadBob
Don't get me started on the survival equipment and beacons that the RCAF issue. It's not as great as you may think!
Deliverance
The Hawk T2s will have TCAS on all the time apart from a few notable times which are specifically briefed. For example BFM sorties to avoid nuisance warnings but will usually only happen in segregated airspace.
In this scenario (if both aircraft had been T2s) they would both have had TCAS on. They would probably turn it off once they had entered the range pattern. They would have been well aware of the position of the other aircraft using the TCAS screen. It is actually very well integrated in the Hawk T2. I'm not sure how it would be displayed in a GR4.
The nuisance warnings and constant trips and resets (the TCAS doesn't handle any kind of dynamic manouvering very well) are the downside of the system. It does at least auto reset nowadays but still leads to constant AVBIT warnings especially in range type sorties.
I hope that makes sense.
BV

Onceapilot

1st Jul 2014, 19:07

Sad to say, this could have been avoided with standard TCAS, IMO.

OAP

ShotOne

1st Jul 2014, 21:32

It does sound like it, OAP and that seems to be the view of the BOI too.

But does the blame really lie with the procurement process? The quoted price figure for TCAS fit seemed enormously high. Why? Presumably because someone has insisted on a gold plated specification. Surely an off the shelf system could have been fitted for a fraction? It wouldn't offer protection during air combat or formation but would anything?

Ditto for the PLB. The RAF could have gps-enabled 406 MHz ones in life jacket pockets tomorrow for £199.95 a pop. How many years before that does get sorted and at what cost?

Eul0gy

1st Jul 2014, 21:50

m0nkfish

1st Jul 2014, 21:52

Section 1.3.55 says the CSW contains a fastfind beacon, Is this not 406Mhz?

Not wanting to throw the conversation off topic, however, it did strike me that the SAR crews did a brilliant job under difficult circumstances. Just seems a shame they may well end up being contracted out!

VinRouge

1st Jul 2014, 22:10

Monk,

C0ck all use if unconscious or if you have 2 broken arms... Unfortunately, they need manual activation.

Out of interest, do we have the auto versions in service yet?

The SAR RC

1st Jul 2014, 22:17

The 406 beacon would not have been automatically initiated in the same way that 121.5 and 243.0 are.

Contractorised SAR crews will still have the ability to recover downed aircrew. However, training for such an occurrence may not be as high on the priority list as it is for RAF SAR crews for whom recovery of ejectees would be considered their primary task.

ShotOne

2nd Jul 2014, 06:31

Vin rouge that exactly illustrates the problem. Yes an auto mode would be great. But someone has to design build and test one. Then somebody wants it EMP resistant. Or bulletproof. So we get it years and £millions later.

Or more likely, never!

wiggy

2nd Jul 2014, 06:33

EulOgy

I thought 121.5 was still monitored

It is at the moment over the UK. The weekend flyers usually get quick a response from the fine folks in Distress and Diversion (D&D) to their practise "Pan"/real "Pan" calls on 121.5, and commercial traffic with the luxury of multiple radios will have usually have one set up on 121.5 (as mentioned in report).....oh, and various USAF european bases still insist on running a "dawn chorus" check on the frequency.

However whether the equipment used is still fit for military purpose in the 21st century is one for the experts.

Cows getting bigger

2nd Jul 2014, 06:33

Does MoD have access to Google?

ELT / PLB (http://www.hr-smith.com/hr-smith-eltsplb.html)

Background Noise

2nd Jul 2014, 08:37

I thought 121.5 was still monitored as I work on a station where we look after ground to air comms on the emergancy freqs. If we do any radio servicing or testing we have to get permission from Scampton or boulmer (cant remember of top of my head)

It is, and as wiggy pointed out, folks get a reply. That's fine if you are airborne - you are not going to be heard bobbing about in the water or in some remote part of the countryside. The satellites used to monitor it, buy not anymore. We had 9 years of warning and still failed to procure a suitable beacon in time.

A bit like mode S - 4 years warning for that one I think, and still not all aircraft have it.

And 8.33 radios ...

And ....

dervish

2nd Jul 2014, 17:07

A bit like mode S - 4 years warning for that one I think, and still not all aircraft have it.

And 8.33 radios ...

Mode S Elementary Surveillance implementation was 31st March 2008, although this might have slipped I don't know. This was known to MoD in the late 90s, maybe 1998. I only did one tour in Shabbeywood and it was at this time and was sent to a briefing.

8.33 has been known about for over 20 years. Surely its in service?

Bob Viking

2nd Jul 2014, 18:04

So, I've finally finished reading the report and I have two observations to add.
Firstly (we don't tend to give credit where it's due often enough frankly) but I think the ATC Supervisor did a great job in getting SAR airborne when she did and for calmly confirming the facts. Good to see some balls (you know what I mean) when they were needed.
Secondly, I will need some convincing that politicians and MOD are acting in anyone's best interests. How can a project be repeatedly delayed to the point that it actually takes an accident to galvanise the system into action?
I know how it happens (cost benefit analysis is the key term here) but it still makes me sick. With their figures and probabilities there is unlikely to be another Tornado mid air before the platform OSD so some could argue that spending the money on a CWS is just a waste of money now.
The whole process reeks.
BV:(

Cows getting bigger

2nd Jul 2014, 18:11

Bob V, yes I agree about the ATC Supervisor. There was a time when service personnel were both able and felt empowered to make such decisions. :D

Fox3WheresMyBanana

2nd Jul 2014, 18:13

there is unlikely to be another Tornado mid air before the platform OSD so some could argue that spending the money on a CWS is just a waste of money now.Which is presumably what the HOC said in 2010 when CWS was put up to be axed.

Now we are probably in the worst possible situation; where it now won't prevent another accident, but we've lost 3 guys and 1 VSI, 2 jets, the MoD will get its ass sued off, AND the SoS will insist on buying CWS to make it look like he's done something.

The process as BV says is the problem.
Chances of the entire MoD/DE&S getting sacked and starting again? Sadly zero, but it is probably the only answer.

dervish

2nd Jul 2014, 18:33

The whole process reeks.

Or, the process is fine but implementation isn't?

Fox3WheresMyBanana

2nd Jul 2014, 18:46

I think the evidence shows it is the process, but all they ever change is the implementation.

It's too slow,
there are too many layers,
the aims and objectives of the individual layers are too different in practice
there is zero transparency until accident inquiries (and not much then)

Eul0gy

2nd Jul 2014, 19:35

Cheers guys for the info

dervish

2nd Jul 2014, 22:34

It's too slow,
there are too many layers,
the aims and objectives of the individual layers are too different in practice

I don't disagree.

I was thinking of CWS. I've seen similar omissions solved, but don't ask me how. I mean when there is an obvious requirement and OR have given their endorsement but some VSO has stopped it, which is what seems to have happened here. Another part of an established process has kicked in and the kit has been procured. I'm not talking about UORs. I'm trying to say that, if this can be achieved, then there must be a process that works, if followed. A procurer will explain it better.

Fox3WheresMyBanana

2nd Jul 2014, 22:51

I read the report as the Defence Management Board who stopped CWS, and it is largely civilian.

The objectives are the problem. In WW2 we had relatively efficient systems, largely I feel because if the committees didn't do their job promptly and properly, everybody got bombed.

The objectives of senior politicians, senior civil servants and VSOs are far too different. In terms of careers, the defence procurement chief isn't affected at all if two tornados collide off Tain, but he is if he doesn't deliver the savings the SoS (or more likely the Chancellor of the Exchequer) demands.

tucumseh

3rd Jul 2014, 07:57

Fox3 & Dervish

You’re both right.

Lack of CWS will have been recorded by OR as an Operational Constraint in the aircraft Constraints Document – a process that OR manages. Only an idiot would categorise it as anything other than “Critical” and “Safety” related. Even without the latter, OR would be duty bound to run an Alternative Assumption to fund the programme. In this case it is clear they did, because by 1996 the CWS programme had matured to such a degree that, on MoD’s own admission, much of what used to be called Development was no longer required. That is, the technology had matured.

Then, we have a 1998 Board Submission to OR(RAF) himself seeking approval to proceed. (Again, withheld from SI). Depending on cost, OR (a 1 Star) may have had to escalate this - around this time all our financial delegations had been slashed and his probably had too. This cutting of delegated powers is what causes many of the delays Fox3 mentioned. It is a stealth savings measure (at the expense of safety). Note: I’m simplifying it a bit as the RAF’s Resources and Programmes beancounters would be involved. All R&P branches saw it as their job to waive the red card, and withdraw only if OR had someone good enough to argue the case and the balls to stick their neck out. This is THE major flaw in the process; made worse because it relies on civilian staffs that no longer exist. Your own people should be there to help, not hinder and cost lives.

The gap between 1996 and 1998 is as yet unexplained but I’ve seen worse, due to OR usually being pretty busy (and seldom trained for the job!). Also, in the late 90s, it had been 10 years since the process Dervish talks of had been widely implemented, which is 4 or 5 generations in terms of tour lengths, training and experience. What you saw in the late 90s was probably someone who knew the proper process and was still around. I can guess the job you’re thinking of.

Another factor is the implementation of this process (i.e. to clear Constraints, if possible, even if higher level committees haven’t approved them) was a function of civilian “Requirements Managers” when these posts were in HQs, not DPA/DE&S. The posts were progressively militarised from 1988, and then disappeared as a savings in about 1991; so, again, you rely on the odd civilian who used to do these jobs. The last one retired a few years ago. The “Requirements Managers” you see nowadays do about 10% of the original job, and aren’t taught the other 90% so don’t know it isn’t being done.

What you experienced in the late 90s (Dervish) would be a rare event by then. But it is easy enough to do; a major problem in today’s DE&S would be finding someone junior enough with the right experience. In the 80s it was a routine competence before you were senior enough to get a junior job in MoD(PE). At the beginning of every reporting year you’d be given a list of “Special Tasks” in addition to your normal TORs, which would mainly consist of uncleared Constraints. Someone mentioned £50M. I don’t know if that is what CWS would have cost in Tornado, but that kind of figure would be routine to (what is now called) a civilian Grade D. Today, that concept would frighten almost every member of DE&S, up to and including Bernard Gray. This was all the subject of a submission to DPA Deputy Chief Executive (a 3 Star, David Gould) in January 2000. He didn’t reply. It came about as a result of the Public Accounts Committee criticising DPA, and our senior staffs (3 and 4 Stars) not understanding their own processes sufficiently well to know what their answer should be.

Clearly, all this has been withheld from the SI because they, and of course the MAA (who would be party to the withholding), get these dates and history completely and utterly wrong. This gives you a major clue. Someone is being protected. The key is that the SI, as usual, isn’t allowed to dig deeper, and the MAA is there to make sure they don’t get very far if they do. As a result, there are major holes in the report; which looks good but has little substance. There are many recommendations, but no understanding of why they became necessary. Again, this is a recurring theme. Rafts of recommendations that can be summarised as “implement mandated policy”. In other words, the perpetrators are free to carry on and do it again.

And we haven’t even discussed the fact that all this should be in the Risk Register and Safety Case, and reflected in a very restrictive Release to Service. Funny how the MAA don’t mention this.

As ever, the above comes with a health warning. MoD has dumbed down so much you’ll be hard pressed to find anyone left who understands it.

Hope this helps!

Courtney Mil

3rd Jul 2014, 08:39

A good analysis, Tuc. Thanks.

Chugalug2

3rd Jul 2014, 09:13

Indeed tuc, your usual dose of reality that checkmates the complacent "excellent SI, well done!" postings of others. This SI, in concert with most of the others, has been nobbled. Why? Simply because it could be. The only investigation that it can do is what it is allowed to do, in the same way that the only Regulation that the MAA can do is what it is allowed to do.

We desperately need an Investigator that is able to investigate everything and everybody, including the Military Regulator.

We desperately need a Military Regulator that has the Authority to ensure that UK Military Aircraft are Airworthy and Fit for Purpose.

If the MAAIB and MAA fitted the above descriptions then these two aircraft would almost certainly not have collided, as they would have been fitted with CWS and have been aware of each others close proximity.

If the MAAIB and MAA fitted the above descriptions many other avoidable accidents and needless loss of life would not have occurred, both in the Tornado fleet and others.

If the MAAIB and MAA fitted these descriptions we would have saved money and operational capability rather than wasted them.

Time to free both from the dead hands of the MOD and VSOs.

Self Regulation Doesn't Work and...well, you know the rest!

Fox3WheresMyBanana

3rd Jul 2014, 09:42

Thank you, Tuc. An education, as ever. Would a FAI have the authority to get down to the depths/time periods you describe?

Chugalug. Excellent Effort by the Panel and Excellent SI are not synonymous. If the Panel have info deliberately concealed from them, it explains the difference.

Chugalug2

3rd Jul 2014, 10:35

Well absolutely right, F3WMB, but that is the problem! What is the point of an Accident Investigator that cannot produce excellent SIs because it is part of a corrupt system that covers up and obscures the truth by acts of commission and omission?

We need to remember that the RAF started down this spiral of subversion and cover up by the issuing of illegal orders. Despite evidence being submitted to the RAF High Command, the RAF Provost Marshal, the Civil Police, FAIs, Coroners Inquests, Judicial Inquiries, Houses of Parliament Select Committees, SoS's, Ministers, and MPs, no VSO has ever been formally challenged with doing so, despite it being an offence in Military Law.

SIs that do not turn up all the evidence associated with an aircraft accident are part of the problem and simply ensure that avoidable accidents will simply go on happening.

The MilAAIB and MAA have to be made independent of this corrupt system and of each other if they are to do their job properly, which is to ensure that avoidable accidents are avoided in future.

tucumseh

3rd Jul 2014, 10:37

Fox3

I think the answer depends on the terms of reference laid down by the Scottish Crown Office (to whom submissions have already been made in this case). The Chinook case is a good example. The Sheriff was robust, totally rejecting MoD's claims. The practical difficulty is that MoD (seen to be in another country and subject to different laws) are usually allowed to judge their own case - again, they were simply permitted to ignore the Sheriff and Houses of Commons and Lords on Chinook.

With so few people caring or having the time or energy for 17 year campaigns, we can see the result. Chinook (and Nimrod, C130 etc) are too readily forgotten and we are fobbed off, yet again, with "Now we have the MAA, this can never happen again, so let's move on". The MAA is now over 4 years old and the elephant in the room remains. According to MoD, in reply to an MP, not one of its employees has ever reported airworthiness failings. That means either (a) they have failed in their legal obligation or (b) they are so inexperienced they have never worked in this domain before. There is a (c), that MoD are wrong to say this, but as of January this year they remain absolutely insistent and consistent on this matter. Either way, the current set up is unconvincing, witnessed by........

MoD/MAA and the Secy of State (Hammond) have played their hand on this one, demonstrating willingness to serially lie. For example, Hammond's December 2013 statement in the House, in reply to Angus Robertson MP, that CWS could never have been fitted on time to influence this accident, so the issue is academic. The SI of course totally contradicted this, stating categorically that it could and should have been fitted in time, and would have in all probability prevented the accident. Well done the SI - but did they know they were making career limiting statements?! And how stupid/arrogant are the MAA for allowing this to be released unredacted, knowing it contradicts Hammond. A 5 year Technology Demonstrator Programme had resulted in us being good to go in 1996, the 1998 submission actually specifying we could proceed direct to "C Model". (That is, we were one very small administrative step from Main Gate, in today's terms). Now MAA and Hammond claim that one small step would have taken over 16 years! Will Hammond withdraw? What will the same MoD source (MAA) say in their briefing when the question is asked?

dervish

4th Jul 2014, 05:40

Thanks for the explanation tuc. :ok: So it seems that despite this massive procurement organisation we've got, whether or not we get a safe aircraft with the right kit can be down to what job a junior civvy has had in the past. :ugh: Certainly explains a lot. Seems to me you could strip half the management layers out and things would improve overnight.

Fox3WheresMyBanana

4th Jul 2014, 07:48

Last year I had the dubious pleasure of working with some junior officers in the Department for Education. They were terribly bright, and generally pleasant people who wanted to see their department make real progress; but they knew f#ck all about what goes on in real schools and did not batt an eyelid when a Minister ordered them to break the Law (suppression of free speech in this case).
Furthermore, they have a set of procedures, to which they probably offer sacrifices in secret. Consequently, they really, really do not like it when you prove to them their procedures have not, and cannot, work. Unless you hand them another procedure which does work and let them pass it off as their own 'development', in which case they quietly let you do what you like. Another option I used was to reverse engineer the formulae in their planning and monitoring spreadsheets. I managed to concoct a set of fanciful numbers which both satisfied their criteria and allowed us to basically do what we liked. Since they have little experience of reality, they accepted them.

This would seem to match Tucumseh's description of MoD/DE&S. One could, looking at the structural elements, suspect this is true of all Government Departments these days.

Distant Voice

4th Jul 2014, 12:33

Forgetting about ALARP, for the moment, when the MoD/MAA and Duty Holders refer to the risk of collision as being "Tolerable" they are basing their judgement on the MAA document RA 1210. That fact is clear from the SI report.

However, RA 1201 does not give any guide lines on risk classification in the form identified by Haddon-Cave (and the CAA), but merely presents a HSE table relating to death rates. This table defines the boundary between Tolerable and Intolerable as being 1 in 1000 for the population at risk per year. No guide lines are given on how this figure should be arrived at in practice, but given that during 2012/13 we had 7 Class A near misses (each with a potential for 2 fatalities), plus 3 actual fatalities, the potential death rate must be significantly worse than the 1 in 1000 per year. In other words "Intolerable". RA 1201 advises DHs to include "near misses"

N.B. Using the H-C approach (BP 1201) and that of the CAA the collision risk is also classed as being "Intolerable"

Moving on to a term that is used in all versions of the risk matrix, that of "Remote", or the frequency of the risk. Both H-C (BP 1201) and the CAA define "remote" as being "unlikely to occur during the operational life of the fleet (1.0 E-5 to 1.0 E-6 flying hours). RA 1210 simply defines "remote" as being "Likely to occur one or more times in 10 years" no mention of flying hours. The over all collision risk is defined in the current Risk Register as Remote/Catastrophic and from a matrix places the risk at AOC 1 Gp level. However, when we consider that over the last ten years we have had 25 Class A near misses, plus one collision, the frequency should be set at the "Occasional" level (Likely to occur one or more times a year). This puts it at the door of CAS.

As it stands RA 1210 appears to be "Unfit for purpose", and the MoD/MAA and all Duty Holders (risk owners) should have a big rethink regarding their interpretation of this document. RA 1210 should be rewritten and brought into line with the real world, as failure to do so could result in future accidents and legal implication.

DV

Two's in

4th Jul 2014, 12:55

By all means identify the MoD's failings in getting a CWS solution implemented over the years, but this SI accurately and effectively identified the reasons behind this particular tragedy. There were multiple failings long before any CWS could have potentially affected the final outcome.

I'm all for pointing out the years of neglect, ignorance and malfeasance by the MoD/MAA in upholding the duty of care surrounding airworthiness, but don't conflate that fact with the assumption that every SI has been "nobbled" or lacked objectivity in any way. It does a huge disservice to those members of the SI who are as invested as anyone in preventing a reoccurrence of an entirely preventable accident.

tucumseh

4th Jul 2014, 14:10

Twos In

I think you are correct about the SI panel itself. While one could legitimately argue many BoI/SI members are manifestly unsuitable for the job through lack of training, knowledge or experience, the vast majority do their best. In the same way very many "project managers" in DE&S and its predecessors were never trained to do the job, try their best, but fail to deliver because they haven't been taught the basics. (There's no one left to teach them).

But the issue I and, I believe, others have is the restrictive ToRs of these inquiries, which actively prevent them digging deeper to make sense of the evidence they hear. The result, time after time, is the reports list the same old recommendations. And the penny never drops that all they are doing is recommending application of mandated regs or plain common sense. The Airworthiness Review Teams of the 90s were the same. Chief Engineer Alcock specifically instructed the team leaders, through the Inspector of Flight Safety (RAF), that under no circumstances were the ARTs to go near MoD's airworthiness experts. Such directives immediately raise suspicions. Who are they designed to protect? The reports went to two people; the two with most to lose if their policies and directives became public (i.e. CE and ACAS). When they DID become public, largely by luck (the by now elderly CHART Leader making contact), they lost the biggest case of all and retreated.

Where I believe "nobbling" has taken place is at Reviewing Officer level and above, including the MAA. It is the system, designed to prevent recurrence, that is nobbled. The result is recurring systemic failures. I cited blatant lies in this Tornado case, and this lying has been proven beyond any doubt on Chinook, Sea King ASaC (perhaps the worst yet least explored case), C130, Nimrod etc. These are, frankly, illegal acts. If the MAA were ignorant as well as incompetent it would be bad enough, but they are not ignorant of these facts. They have been presented to the MAA in the presence of Ministers, and they have done nothing.

May I suggest people read up on Tornado ZG710 (March 2003 Patriot shootdown). On the face of it a different set of circumstances, but the root failures are EXACTLY the same. That is, predictable, predicted, notified and ignored. Any reasonable person would ask just what was going on in that area of MoD.

So who has the best interests of aircrew at heart? And who lies to protect the guilty? I know who I'd want on my side.

Fox3 & Dervish

In this particular case I would not be so critical of DE&S/DPA/PE. Their role was to support OR with advice and assistance. As I said, the solution was at a lower level, and procurers should never have been presented with the problem. However, when it became a problem, the procurers would have known it was coming but clearly didn't do very much. We need to know why, yet neither the SI nor the MAA go there. This supine acceptance of critical safety failures is entirely typical of what was going on in Haddon-Cave's "Golden Period" and continues today.

I agree with stripping half the management layers!