The Airworthiness of ZD 576
For reasons which Walter knows I will not join in the debate as to whether a STF for the ARS-6 was installed in ZD 576 on that fateful day - except to say that if it could be proved that it was then regardless of whether any "unofficial" trial was also taking place it would "blow a major hole" in the BOI's evidence and hence the findings. However, I believe that Nigel should be supported in his comment on the airworthiness failures - failures that have come back to "haunt" MOD in so many ways since then. This is a long thread and people will have forgotten, so it may be worth reminding them that the document below was personally handed to the then SofS by Lord Chalfont in, as I recall, late 2003 - it has never generated, to my knowledge, any response from MOD. Since that paper was written we have, of course, seen further information which confirms that the Chinook Mk2 fleet in general, and ZD 576 in particular, were operating against the advice of the RAF's own flight clearance authority - perhaps by necessity in terms of real operations, but certainly not a wise decision, even without the benefit of hindsight, in terms of a high profile passenger sortie. Jonathan Tapper undoubtedly recognised this when he asked to keep a Mk1 in theatre for this sortie - but, as was confirmed in the BOI evidence, his request was refused.
Airworthiness Summary
In making its early decision to “eliminate as possible causes: major technical malfunction or structural failure of the aircraft prior to impact” and to focus “on the crew’s handling and operation of the aircraft” the Board, including the Review process not only ignored taking potentially significant evidence but also failed to follow up evidence showing potential airworthiness, engineering and maintenance issues that was placed before it. As such, either by direction or of its own volition, the Board behaved in a partial and inconsistent manner and their findings were heavily biased in favour of a verdict that ensured that the RAF themselves were not questioned on their decisions and shortfalls in their processes.
Even with these limitations on their investigations the Board did not find any human failings in either pilot with their only criticism being an error of judgement by Flt Lt Tapper in terms of the attempted climb over the Mull (but the Board never explains why, with the waypoint changed, they assumed that they planned to overfly the Mull at all). The change in verdict to Gross Negligence by the Senior Reviewing Officers, could not have been justified if the available evidence had been correctly analysed and followed up. Such actions would have shown that the airworthiness status of the Chinook HC2 fleet at that time, potentially coupled with a major technical defect on ZD 576 itself, was a plausible alternative cause for the accident.
JSP 318 (Regulation of Ministry of Defence Aircraft) defines “Airworthiness” as “the ability of an aircraft or other airborne equipment or system to operate without significant hazard to aircrew, groundcrew, passengers (where relevant) or to the general public over which the airborne systems are flow
The Board’s Terms of reference do not specifically task the Board to look at whether the aircraft was “airworthy” in terms of MOD’s own definition of airworthiness, despite the fact that the “problems” of the Chinook HC2 fleet at that time were well known to supervisors and commanders. However the Board is specifically tasked to assess the equivalent “Human Failings”.
The Board, including the Reviewing Officers, does not mention “airworthiness” at any point, and the Board, including the Review process, does not consider the central question of whether, either as a result of the MLU design, Release to Service process and/or the defect history of the aircraft, the “airworthiness chain” was still intact for ZD 576. There is clear, and unused, evidence that it was not, and that there is at least one more plausible explanation for the accident. It is also clear that the RAF’s decision to operate the HC2 at all, against the recommendations of A&AEE, and with the introduction to service problems it had at the time, as well as the choice of the HC2, and ZD 576 in particular, for a high profile but non-operational, passenger flight should be called into question.
The bottom line is that even though we will never know whether, like the DC10 cargo hold door, this was the airworthiness accident waiting to happen, the Chinook HC2 was, in airworthiness terms, totally unfit for purpose as far as its use for this sortie was concerned. This should have been known to all levels of RAF management, as it clearly was to the crew, and as well as having major faults in the procurement processes of this project MOD failed in its duty of care on this particular sortie, and then tried to cover this up by putting blame on the pilots.
JB