Chinook - Still Hitting Back 3 (Merged)

[meadowbank]

Cazatou

You said:

I am flattered that you believe that I, as a Specialist Aircrew Flt Lt, was capable of influencing the viewpoints of so many Air Officers past and present.

Don't feel flattered. It is likely that you and the rest of the Flt Safety chain through HQ 1 Gp and HQ STC unwittingly provided a suitable 'explanation' for the crash that enabled their Airships to pass a verdict that conveniently distracted from the hurried decision to bring the HC2 into service on a Service Deviation - a decision with which CAS was very likely to have been involved.

I, and many others who have expressed opinion on this thread, agree that it is possible that this was a case of CFIT, some (though not I) would even agree that it was probably a case of CFIT. However, due to a lack of CVR or ADR, it is ludicrous to state that this was CFIT and that the two pilots were negligent.

The Flight Safety organisation, of which you were (by your own admission) but a small cog, did not (as far as I am aware) include any lawyers. Perhaps you would care to offer an explanation as to how the HoL Select Committee, which included an appeal court judge, and which had the advantage of evidence to which the BoI, HQ 1Gp and HQ STC Flight Safety staffs were not party at the time, came to the conclusion that there was no evidence of negligence, yet you, "as a Specialist Aircrew Flt Lt" know otherwise "beyond any doubt whatsoever"?

Perhaps you could also offer an opinion as to why the MoD, having studied this ruling by what amounts to the highest appeal court in the Land, refused to alter its position, particularly in light of the Glen Ogle Tornado verdict mentioned above by John Blakely?

[Brian Dixon]

Hi all,
well, I'm back from my travels and ready to continue where I left off...

Back in February 09, I wrote to the MoD and asked for the following documentation:

• Correspondence to the MoD from the Mr Hutton, or his representative, in respect of the Chinook accident on the Mull of Kintyre, 2 June 1994.

• Correspondence to Mr Hutton, or his representative, from the MoD in respect of the Chinook accident on the Mull of Kintyre, 2 June 1994.

• Copies of any press briefings, and responses to be given to media questions, supplied to Mr Hutton, or his representative, in relation to questions being asked about his decision not to overturn the verdict of the Reviewing Officers.

• Correspondence to serving members of the Armed Services from Mr Hutton, or his representative, in relation to the Chinook accident on the Mull of Kintyre, 2 June 1994.

• Correspondence from serving members of the Armed Services to Mr Hutton, or his representative, in relation to the Chinook accident on the Mull of Kintyre, 2 June 1994.

• Correspondence to retired members of the Armed Services from Mr Hutton, or his representative, in relation to the Chinook accident on the Mull of Kintyre, 2 June 1994.

• Correspondence from retired members of the Armed Services to Mr Hutton, or his representative, in relation to the Chinook accident on the Mull of Kintyre, 2 June 1994.

• Correspondence to any individual associated, in any way, with the original Board of Inquiry into the Chinook accident on the Mull of Kintyre, 2 June 1994 from Mr Hutton, or his representative.

• Correspondence to from any individual associated, in any way, with the original Board of Inquiry into the Chinook accident on the Mull of Kintyre, 2 June 1994 to Mr Hutton, or his representative.

• Documentation relating to any meeting attended by Mr Hutton, or his representative, in relation to the Chinook accident on the Mull of Kintyre, 2 June 1994. (Including, but not restricted to, agendas and minutes of said meeting).

Unusually, for the MoD, they chose simply to ignore my request, not even bothering to acknowledge my letter. This resulted in my lodging a formal complaint with the Information Commissioner's Office. On return from my travels, I have received the following email from the ICO:

Your information request to the Ministry of Defence (MoD)

Thank you for your correspondence received on 24/08/09 in which you complain about the MoDs failure to respond to your information request. I spoke to their representative last week in an effort to ascertain that they had in fact received your request and to get a status update on its progress. Unfortunately that verbal request did not generate the information I was looking for.

In cases such as this the Commissioner does not consider that serving a formal decision notice would serve any strong public interest. However, I have written to the public authority to provide them with a copy of your original request reminding it of its responsibilities and asking it to respond to you within 20 working days of receiving our letter. I enclose a copy for your information.

As you will see even though the Commissioner does not intend to issue a formal notice in this case, your concerns have been taken seriously. Thank you for bringing this matter to the attention of the Information Commissioner.

If the MoD responds and refuses to release the information you have asked for and you are dissatisfied, you may, after exhausting their internal complaints procedure, complain to us again.

This case has now been closed with the delayed response element showing as withdrawn on our records. If you do not receive a response within 20 working days or are dissatisfied after having exhausted the internal review process mentioned above and would like us to look into the matter, please contact us quoting the reference number on this letter.

Although the ICO state they will not pursue the matter further, I will not let this go. The MoD are still within the 20 day compliance period, so let's see if they are going to disclose what is requested. One wonders why they appear to be reluctant to do so. I also think that the evidence provided by this, and many other PPRuNe threads and the list of signatures on the Campaign website will suggest to the ICO that disclosure is in the public interest!

The Campaign continues.
My best, as always,
Brian

"Justice has no expiry date" - John Cook

[Al R]

Brian,

My interest in your post was pricked by your dealings with the ICO. The MoD is in breach of the Act by simply failing to deliver a response or denial notice.

The ICO can only usually say whether on the facts available that the MoD was likely, or unlikely to have complied with the Act. Get that asap (the ICO is a toothless thing) and then go to Court applying for an Order directing them to comply and drawing to the Court's attention, the provisional finding of the ICO.

You can claim damages against the MoD don't forget - even if you can't prove earnings, you can claim for about £9+ per hour 'wasted' plus costs. If the MoD is going to say that your approaches are vexatious and consequently, they aren't going to comply, get your mates to submit questions - spread the load.

http://www.ico.gov.uk/upload/documen...guidance_1.pdf

http://www.ico.gov.uk/upload/documen...nce_051208.pdf

[tucumseh]

Brian

What you have is the standard ICO "first response". In too many words, they are saying they are trying to seek an informal solution and have gently reminded MoD of their 20 day obligation.

I think you'll find MoD will respond to that prompt, but perhaps come up with an excuse not to supply any or all you ask. If this happens, go back to the ICO and they will make a judgment on whether the excuses are valid.

However, AI R is right - the ICO are largely toothless, their position weakened by the rather vague legislation. For example, MoD may be obliged to supply information, but the ICO has confirmed there is no legal requirement for it to be accurate or truthful.

[Al R]

Brian,

The ICO might eventually state that '.. my assesment is that it is unlikely that the MoD has complied with the first/sixth (whatever) principle in this case'. Thats the best you're going to get unless you have a fallback in place (the first principle relates to fair and lawful processing while the sixth relates to processing in accordance with the rights of data subjects).

If you know the date of when a particular individual you are interested about made comments (such as in a press conference) ask for details of his diary/briefing sessions with his media handlers.. personalise it. Take it away from simply dealing with the MoD. If you know who the meeja handler was, make an application against that individual person as well. Make them deny you even the most basic and routine of requests so that when they dent you the juicy ones, you can point to a history of constant default obstruction.

Have you applied for a Subject Access Request? If not, do it. It details everything they 'have' on you. It is a useful indicator as to how they are dealing with your case. It is daft for them to say they didn't have the time to deal with your FoI app, if there is an e-mail chain as long as your arm about you, discussing why they shouldn't deal with it.

Finally, the ICO will always finish letters with that awful default phrase; 'We will now consider this matter closed unless..'. Don't let them - have a stock of e-mails ready to e-mail them and chasing them up to do more, just in order to keep it on the burner. Finally, spread the load - don't do it all yourself - it will backfire on you, the MoD WILL look for a way to kiss you off. Have 6 or 7 mates to fire off questions too.. don't do it all yourself. Spread the workload because they can deny requests to you on cost grounds and you need to stay off their radar.

Unusually, for the MoD, they chose simply to ignore my request, not even bothering to acknowledge my letter.

This particular decision then, might give you some comfort and some ammo.

http://www.ico.gov.uk/upload/documen...fs50088452.pdf

[cazatou]

meadowbank

Board of Inquiry para 16e/para 32c/para 45b/para 51/para 54/para 56.

Will that do for starters?

Best wishes

Cazatou

PS My own view is that para 16e has primacy and that everything stemmed from failure to observe that most crucial and basic requirement.

[John Blakeley]

More Speculation and Selective Quotations

Cazatou,

It must be something in the water in France! Yet again you are relying on selective quotations to justify, perhaps to yourself given your apparent involvement at the time, an unjustifiable verdict, and given that verdict you are again you are saying that you know the cause of the accident - nobody knows the cause of the accident and even the Senior Reviewing Officer says that he is relying on speculation to reach his verdict - this is NOT a sustainable basis for a finding of Gross Negligence - it is an opinion that has been tested and failed in the House of Lords with amongst others an Appeal Court judge finding against it. This thread is not about finding the cause of the accident - it is about overturning an unjustified verdict which impugns the reputation of two pilots and their families who were not able to defend themselves at the time of the BoI.

In my opinion the BoI were directed in their investigation and findings, and clear evidence which would have cast doubt on the aircraft’s fitness for purpose on that fateful day, such as the BD position, was withheld not only from them but even later at the Sherriff's FAI. However, even with that excuse the BoI's deliberations on the airworthiness and engineering side were totally inadequate as was any engineering review of the BoI (if indeed there was any) by 1Gp and HQSTC engineering staffs! IMHO given the circumstances of the Chinook Mk 2's introduction to service the whole system was very keen to find aircrew error, and if the Reviewing Officers had stuck to a verdict of "balance of probabilities of aircrew error with potential mitigating circumstances" (effectively the conclusion of the main BoI) they would have "got away with it" - instead 15 years on the arguments have not, and will not, go away because justice has still not prevailed.

We can all speculate - how about this as an alternative!

Imagine you are the Captain of a Chinook Mk 2 helicopter flying 25 VIP passengers, all connected with the security services in Northern Ireland between Belfast and Inverness. As well as being aircraft Captain you are the Flight Commander of the Chinook detachment and you are part of a Special Forces crew. You have a reputation for obeying the rules, and your peers consider you are one of the pilots best able to cope with the many problems that the aircraft is having during its introduction to service. You have planned a low level Visual Flight Rules flight, with a waypoint just before the Mull of Kintyre, where you plan to turn left along the west of the coast staying VFR. The weather was considered, by the subsequent BoI (paras 8, 42 and 67b amongst other comments), to be suitable for undertaking such a flight. You are flying at a fairly high speed, but well within the cleared speed envelope. You have a strong tailwind, which has made the flight a short one up to this point. You are visible to a yachtsman, who can see you, the Mull shrouded in cloud, and the breakers under the lighthouse at the foot of the Mull. You know exactly where you are and you change the planned course at the waypoint, but instead of making the turn you and the two experienced crewmen in the cockpit with you, including your fellow Chinook captain, who is flying the aircraft, decide to fly directly towards the cloud shrouded Mull even though to over fly it would mean breaking the RAF’s rules for operating the aircraft. You then set a rate of climb that will not allow you to clear the Mull, crashing into it some 600 ft below the summit. Twenty-nine people have just died as a result of yours and your colleagues “suicidal” decision and the two pilots will certainly deserve a verdict of “Gross Negligence” at the subsequent Board of Inquiry.

In scenario two, you are still the Captain on the same mission. As before you know exactly where you are and you change the planned course at the waypoint. However, this time you are flying an aircraft that you do not trust, having had your Flight Commander at Odiham refuse your request to retain a Chinook Mk1 for the mission. You know that your aircraft has many operating problems linked to serious flight safety hazards – indeed the RAF’s own flight test authority had recommended against giving it even an interim release to service but had been over-ruled. The trials Chinook Mk2 has just been grounded by the Flight Test organisation at Boscombe Down based on 15 serious incidents on in-service aircraft, one of which, just days before, was on the aircraft you are flying and was judged one of the 5 most serious and unexplained incidents leading to the gounding decision - but you do not know this, and the RAF is continuing, on its own authority, to operate those that are in service. Your aircraft has a very poor recent history of engine, engine control system and flight control system defects, and the investigations on these are still ongoing when the aircraft is transferred to your Detachment just two days previously. Whilst in Northern Ireland the aircraft has had some unrecorded (and hence illegal) maintenance work carried out within the systems that have been part of this defect history, and the aircraft would appear to be carrying an incipient electrical fault. As you make the planned turn, and the vibration levels on the aircraft increase something goes wrong – an engine runaway, a false engine fail caption causing distraction or even a control restriction affecting your ability to fly the aircraft at all (not ruled out in the subsequent AAIB investigation) all being possible scenarios. Your first job is to regain control of the aircraft, and rectify the problem, but first you have to recognise it, and the Chinook Mk 2 fleet has a documented history of false cockpit warning indications as well as very poor Flight Reference Cards. Your aircraft’s problem and the strong tailwind have carried you along your pre-waypoint change track towards the Mull, and now you are possibly IMC in cloud. You put the engines to emergency power to try to gain the height you know you need to clear the Mull. Tragically you fail.

Neither the Reviewing Officers, who for 15 years have gone for the “Gross Negligence” verdict of scenario one, nor myself with scenario two (seen as a perfectly plausible one by many better qualified than myself to put it forward) actually know what happened. The difference is that I am just seeking to put forward a plausible series of events as an alternative (and uninvestigated) cause, not to use speculation as the basis for an unjustified finding of what in civilian life would be a verdict of manslaughter.

I could go further and counter all of the selective quotations you have used (incidentally I think you meant para 30c not 32c) but there is little point – I will just reply with one selective quotation of my own

61. With no ADR or CVR, survivors or eyewitnesses, the Board based its findings on logical argument derived from the limited evidence available to it. There were many potential causes of the accident and despite detailed and in depth analysis, the Board was unable to determine a definite cause. However, most potential causes could be dismissed or considered unlikely, and the Board concluded that there were only 3 likely scenarios that could be considered fully consistent with the evidence. In deciding which one of these 3 was the most probable cause, the Board could not avoid a degree of speculation.

As you were obviously “in the know” how about answering the real questions I asked in my last posting re why the Station Commander’s first 5 paragraphs are totally different from para 6 of his comments (you can see the join!), and how did the analysis of the Glen Ogle accident (which took place at the same time with the same people involved), and where no speculation as to what happened was needed, come to such different conclusions?

JB

[cazatou]

John Blakely

As someone who had completed the Security Officers Course I was concientious enough not to bring a copy of the BOI to France with me when we moved here. What I have to refresh my memory is what is available through the Internet.

The basis of my viewpoint is quite simple; the BOI stated at para 16e of their report "The weather was suitable for the flight but would have required flight in accordance with IFR in the vicinity of the Mull of Kintyre." In addition the Yachtsman stated that when the Chinook passed him it was at 1-200ft and "travelling towards the mass of orographic cloud obscuring the Mull". He also estimated the visibility at that time as 1NM limited by haze.

The aircraft should therefore -without any doubt whatsover -have been flown at or above Safety Altitude in the vicinity of the Mull of Kintyre and should only have descended to low level again when the Flight Conditions were unequivocably VFR. Failure to comply with this most basic tenet of Airmanship resulted in the loss of the Aircraft, its Passengers and Crew.

PS In respect of your earlier Post; I took it for granted that OC RAF Odiham chose his words with great care - as GFSO and I did when drafting our comments on the BOI. The words he chose could, in our opinion, have only one meaning in the context of the BOI; which was that meaning contained in Chambers dictionary.

[John Blakeley]

Caz,

And your explanation for Glen Ogle?

JB

[tucumseh]

Caz

as GFSO and I did when drafting our comments on the BOI.

As a Safety Officer, was it within your remit to comment on that most basic safety requirement – that the aircraft be airworthy? (We already know certain systems were unserviceable and/or vulnerable to trend failures; not least UFCM after a straight run, which is a perfect explanation for this scenario).

All available evidence clearly demonstrates it was not airworthy – dangerous in fact. Surely anyone with a safety remit would make this observation, even if it was not in the BoI’s remit? And because it wasn’t mentioned, the subject seems to have been ignored thereafter.

The above makes any selective quoting of the BoI report rather meaningless, except to expose its limitations, as the MoD’s obligation to investigate all legal and technical aspects is not yet satisfied.



A simple question – Was Sir Donald Spiers asked by any investigation why he signed the CA Release, when Boscombe’s advice was that it should NOT be signed? (The rules require a reasoned explanation). Similarly, Air Vice-Marshal Bagnall? I’d say that is a reasonable starting point for any safety investigation.

[cazatou]

JB

IIRC no-one (even me!!) could come up with an explanation for Glen Ogle - even the Behavioural Scientist struggled with that one and suggested "a startling event". I seem to recall that the possibility of suicide was postulated but strongly rejected. The circumstances in respect of the weather were also totally different, the crew did not have any potential problems with Crew Duty limitations nor did they have an aircraft full of VIP's to whom they owed a duty of care.

tucumseh

The Chinook crew had already flown 6+ hrs that day in that Airframe without incident. At the instigation of the Aircraft Captain unauthorised (and unrecorded) rectification had been carried out on the avionics systems but apart from that there was no hint of anything amiss with the Aircraft prior to the fatal sortie. There was also no hint of anything amiss prior to Waypoint Change and even the HOL Committee accepted that the crew were in control of the aircraft at Waypoint Change.

It was the determination of the Reviewing Officers that the Pilots were negligent by the time of waypoint change in that they had imperilled the Aircraft, its Passengers and Crew by disregarding the strict rules in respect of VFR Flight. I agree with that assessment.

Regards to you both

PS Good thing I only had 1 glass of wine with Lunch.

[Brian Dixon]

Good afternoon Caz,
I trust all is well with you.

Whilst I don't want this to become a Mull v Glen Ogle issue (apart from the RO opinion differences), the 'startling event' conclusion is quite important.

The Tornado had full ADR and CVR. I have a copy of the CVR transcript and there is nothing on there to suggest anything out of the ordinary. I would suggest that had there been a 'startling event' then one, or both, of the crew would have made a comment or sound. They did neither. Likewise there was consideration that the pilot suffered a 'medical episode'. Again there was nothing on the CVR transcript.

However, in respect of the Chinook which, as everyone knows, did not have the benefit of ADR or CVR, the ROs categorically dismissed the possibility of a startling event or medical episode.

So here we have the Tornado which provides a comprehensive history of events in the cockpit and possibilities are accepted without any hard evidence as compared to the Chinook which has nothing, yet these same possibilities are dismissed outright.

As I say, I don't wish to go down the comparison route as the Campaign is about the Chinook and not anything else, and my apologies if this has caused any distress to friends and family of the Tornado crew.

In respect of crew duty limitations, it is accepted that the Chinook crew, at the time of the accident were within limits. Remind me again, where was the waypoint change made?

Enjoy your wine

My best, as always,
Brian

"Justice has no expiry date" - John Cook

[tucumseh]

The Chinook crew had already flown 6+ hrs that day in that Airframe without incident………..

As MoD’s regulations state: that an event has not happened before shall not be taken as evidence it shall never happen.

But, to paraphrase the same regs, if a fault or unexplained event has occurred numerous times, that shall be construed as a trend failure and the (MoD Technical Agency) shall move Heaven and Earth to solve the problem.

Notably, the 2 Stars responsible for attaining and maintaining Chinook airworthiness are on record as disagreeing with the first and cutting funding for the second 2-3 years before the crash. Direct result – A&AEE had stopped flying this immature design yet 8 months before CA had signed the CA Release.

[bast0n]

Thank you Mods..............

Back to rational informed argument without the rancour............Brill

[Chugalug2]

caz:

....but apart from that there was no hint of anything amiss with the Aircraft prior to the fatal sortie

and apart from the fact that, in common with all its sister Chinook HC2's, it suffered from known and identified serious engine and flight control airworthiness deficiencies, eh caz? Amazingly that was not "found" by the BoI, perhaps because it was by design not looking for it! How you can stand full square by this scandalous BoI, let alone the AMs' bizarre finding, I find quite incomprehensible caz. The truth of this cover up has to come out before the whole MOD airworthiness farrago and the RAF tendency to not investigate aspects of accidents that reflect badly on that same farrago and CoC issues is laid bare, which must happen before future avoidable accidents can indeed be avoided. I have addressed you on the Puma accident thread and finish with the same mantra. Self Regulation does not work and in aviation it kills! http://www.pprune.org/military-aircr...merged-13.html

[cazatou]

Brian

Nice to hear from you again - welcome back.

As I said in post # 5740 the BOI stated that the forecast weather clearly showed that Flight in accordance with IFR would have been necessary in the vicinity of the Mull of Kintyre - the Pilots did not fly the aircraft in accordance with that requirement and crashed whilst attempting to fly VFR in IMC.

There is no excuse; as the aircraft approached the Mull it should have been at or above Safety Altitude and if Flight Limitations precluded that then an alternative routing whereby VFR could be maintained should have been taken.

I have said this before and I will say it again - the greatest attribute any Pilot who flies VIP's can have is the ability to say NO.

Best Wishes

[ShyTorque]

I have said this before and I will say it again - the greatest attribute any Pilot who flies VIP's can have is the ability to say NO.

I'll say THIS again. Those higher up the chain of RAF command, responsible for ordering this flight (or any other) in an unairworthy type should have said NO, even before the crew were tasked.

[dalek]

Cazatou,
Long time no hear.
Rather than enter yet again the argument about whether the weather was suitable and legal for this flight, I suggest interested parties go back to this thread in mid May this year. There are many entries on the subject.
The basic jist is the weather "forecast" was suitable for the low level transit around the Mull and up the Great Glen.
The "forecast" did rule out "safe overflight" of the Mull due to the icing limitations of the aircraft.
No one knows the "actual" weather conditions encountered by the crew.
Now unless you have any new evidence, I thought this subject was dead.

[John Blakeley]

What the Yachtsman Really Said

Caz,

Dalek has really made the major point, but I should remind you of what Mr Holbrook really said when he was questioned properly as opposed to his evidence to, and its apparently superficial analysis by the BoI. The HofL took some time over this and this is what they said:

Weather
63. The state of the weather was crucial to the conclusions of the investigating board and of the two Air Marshals. Two witnesses gave oral evidence to the Board as to weather. First Mr Murchie, a keeper at the lighthouse, spoke of visibility there being some 15-20 metres, but 400-500 metres to the north. The Board asked him no further questions about weather. The second was Mr Holbrook, the yachtsman, whose initial statement to the Strathclyde Police contained an expression of opinion "that the helicopter pilot would have been in a position to clearly see the local land mass". In his statement to the Board Mr Holbrook said that the aircraft was well below cloud level and visibility was about a mile limited by haze. At the time he was about two nautical miles south west of the lighthouse. He was asked three questions by the Board of which one was relevant to weather, namely whether he could see the physical features of the cliff on the Mull. To this he replied "no".
64. When he gave evidence at the FAI Mr Holbrook expressed the opinion that the pilot could have seen "the location of the Mull lighthouse" and described the low cloud as "hugging the Mull" (Sheriff's determination, p 110 of HL Paper 25(ii)). He was criticised by the Ministry of Defence for having given different versions of his account to the Board and the FAI. In these circumstances we invited him to give evidence, an invitation which he willingly accepted.
65. Mr Holbrook's evidence to us began with a statement which he had asked leave to make (Q 594). He explained that the low cloud clung to the contours of the high ground so that the location of the Mull massif itself was not in doubt from sea level. He considered that the crew of the aircraft when he saw it could determine without ambiguity where the Mull was and could see the cliffs, beach and lower perimeter walls of the lighthouse complex.
66. Mr Holbrook reaffirmed that when he saw the aircraft he could not see the physical features of the Mull but he went on to explain that he was able to see the location of the lighthouse complex because the buildings and the white perimeter wall showed up as a colour change against the background of the land mass (QQ 594, 602). The top of the lighthouse was in cloud as the cloud level moved up and down (Q 606). Mr Holbrook went on to explain that the cloud was following the contours of the land and was very localised (Q 615). He also remarked, as he had done before the Board, that the helicopter was in sunlight as it passed (Q 619). At that time the aircraft was about two miles to the south west of the lighthouse. He expressed the opinion that the aircraft was flying at a height of between 200 and 400 ft and that the crew would have been better able to see the position of the lighthouse than he was at sea level with a certain amount of spray (QQ 610-13). He estimated the speed of the aircraft to be 60-80 knots but did not feel confident enough to be dogmatic as he had not previously seen a Chinook in flight. However, it was his impression that the aircraft was travelling sufficiently slowly to be involved in a search and rescue operation (Q 639).
67. We do not consider that Mr Holbrook changed his evidence between his appearances before the Board and the FAI, rather that when he was subjected to professional examination and cross-examination at the FAI and to our questioning he was able to expand upon the rather brief evidence which he had given to the Board. We had no hesitation in accepting him as a reliable and convincing witness.
68. In his statement to the police and in his evidence to us Mr Holbrook referred to the fact that the trawlers round which he was manoeuvring appeared to be Scottish as one of them had St Andrew's cross painted on the superstructure (Q 630). When Wing Commander (now Group Captain) Pulford gave evidence to us he was asked whether the Board sought evidence from any of the fishing vessels referred to by Mr Holbrook. He replied that they had tracked down the fishing vessels to Northern Ireland and the RUC could neither find anybody who had seen the aircraft nor trace some of the boats (Q 11).
69. It is perhaps surprising in view of Mr Holbrook's statement to the Strathclyde Police about the trawler with St Andrew's cross on the superstructure that that force were not asked to pursue the matter. It is perhaps even more surprising that the Board asked Mr Holbrook only one question in relation to weather and used the answer as a component in the construction of a theory as to the probable course adopted by the pilots.
70. Mr Holbrook explained to us that he had repeatedly but unsuccessfully asked to see photographs of a Chinook at different heights and ranges, in order the better to estimate the height and speed of the aircraft when he saw it. He clearly felt that he would have been in a better position to assist the Board had he been furnished with such information. We do not know why the Board did not accede to his request or afford him the opportunity of seeing a Chinook in flight.
71. The statements taken by Strathclyde Police which dealt with weather were all from persons on the Mull at or above the height of the lighthouse and did not therefore throw light on the extent to which the land mass could be seen from an aircraft approaching from seaward. These persons all spoke of being enveloped in cloud to a greater or lesser degree.

You are finding Gross Negligence based on something even the BoI appeared to accept that they never intended to do (and incidentally the major non sequitur in the BoI's findings). They planned to stay VFR and had every intention of staying VFR - even MoD has now confirmed in writing that having changed the waypoint in VFR (and with a new course which would have kept them VFR) they would have expected the crew to immediately change course. If they had intended to climb over the Mull and then selected "an inappropriate rate of climb" as per the BoI conclusion what is your explanation (speculation?) for them making the waypoint change? How do you know the aircraft was serviceable at the waypoint change? There was no ADR/CVR and at low level any distress call they may have had time to make would not necessarily have been heard in that area. The AAIB report did not guarantee the aircraft was serviceable - indeed they could not dismiss the possibility of a control restriction, and would not anyway have been able to find any evidence of a major distraction such as a false engine fail caption (part of the RTS but conveniently not mentioned by the BoI). The aircraft would certainly have failed any proper airworthiness assessment for its suitability for such a passenger flight! You are fond of selective quotations - here are a few from Stn Cdr Odiham's comments:

The Board then opine, in making this profile dovetail with other evidence, that the crew, faced with the expected deteriorating weather, consciously elected to make a climb on track over high ground and in doing so used a speed and power combination that is unrecognisable as a Chinook technique. I find this difficult to believe; such actions would go against all the crew’s instincts and training. Moreover it is the very antithesis of the professionalism and careful planning that had gone before. Even taking into account the factors which the Board feel could have deceived the crew into believing a high speed cruise climb would have given them sufficient clearance over the Mull I, and the few, senior Chinook operators that I felt able to consult, find this suggestion incredible.

Aircraft -Speed. Although not stated as such, the implication in the Board's findings is that the transit speed approaching the Mull of Kintyre was unusually high. I doubt this. An assessment based on a time/distance calculation, shows that the average groundspeed from take off to impact was, depending on the parameters used, in the range 135-155 kts which, when corrected for the forecast wind, gives an IAS of between 115-135 kts. In practice, I believe the crew adopted a cruise IAS of 135 kts, which is both range speed and is commonly accepted as the maximum speed for passenger comforts. However, the Board suggest that as the Mk I Chinook experienced high vibration levels above 135 kts, which are not so pronounced in the Mk II, the crew were seduced into accepting a higher speed than that and, as they were unfamiliar with flying at such speeds, this caused them to miscalculate the gradient of the climb that would be achieved. Again I believe this stretches credibility too far. I do not believe even the most junior crew would have selected a cruise climb technique that close to the Mull whatever the cruise speed. They would only have entertained such a profile by starting the climb well clear of the high ground and probably as they coasted out from Northern Ireland. The Board tacitly acknowledges this in para 44, where they accept that the crew’s general NVG training, enhanced by the specialist SF Flight training package, is such that "it (is) most likely that the crew would have adopted (the technique of a cyclic flare and max power climb) in the event of inadvertently entering cloud whilst aware they were directly approaching, and close to, high ground.

Whilst tackling this issue the Board were unable to totally discount the following factors:

a. Spatial disorientation or visual illusion.

b. An unregistered technical malfunction.

c. Human factors.

Human factors.

Any of these, or a combination of them, could, in my view, have sufficiently distracted the crew from the task of turning away from the Mull to cause them both to inadvertently enter cloud and then to fail to take the correct procedure for an emergency climb in a timely manner. The Board consider engine control system malfunctions and it is particularly relevant to note that at this stage of the Chinook Mk II's service spurious ENG FAIL captions, lasting on average 7-8 seconds, were an increasingly frequent occurrence. These are now well understood but at the time they were not. Had such an indication occurred it would have caused crew considerable concern particularly as they were over the water with no obvious area for an emergency landing. Such a warning would also have required an urgent and very careful check of engine instruments and FRCs. (The FRCs of the time were of course incomplete and not easy to use - one of the facts that the BoI did acknowledge.)

So bearing in mind that none of us can say what the cause of the accident was with "no doubt whatsover" and that even the Reviewing officers accept that their verdict contains a degree (I would say major element) of speculation what is it that you KNOW that makes you so certain without any doubts whatsoever that these pilots made such a grossly negligent decision? Please tell us - without relying on speculation to get there!

JB

[BOAC]

I am also intrigued by the concept of taking 'extra care' with 'VIP's on board. The converse is quite frightening! When carrying 'important people' I have never considered taking more than the usual 'care' regardless of WHO is on board. (Mind you, some pax might encourage me to make a noble sacrifice.....)