ZA 721 was a terrible loss 30 years ago, taking 10 lives with it. It was also a terrible harbinger of even worse to come some 7 years later, when ZD 576 took 29 lives on the slopes of the Mull of Kintyre. All these years later the similarities are striking; inconclusive BoIs that were severely throttled from above, a hamstrung AAIB input, and a cover up of now well known scandals. As we pay tribute on Monday in memory of those who died whilst doing their duty, perhaps we might dwell upon the need to ensure that Military Air Accident Investigation is not so compromised in future by being made independent of the Operator (the MOD) and the Regulator (the MAA), which in turn must be similarly independent of the other two. Of all his posts on this thread, I choose tucumseh's #40 as a summary of the problems posed by the events of 27th February 1987:-
MoD investigations never dig and ask the next obvious question. In this case, a thorough overhaul of an obviously unfit for purpose QA/QC system would have provided a fighting chance of preventing recurrence. In Aug 1992 the CHART report by the RAF's own Inspector of Flight Safety cited ZA721 as an airworthiness related accident. That speaks volumes, given the official line was Cause Unknown. Was this an oversight or IFS making a point to the Chief Engineer and ACAS? Given the rest of the report, the latter. MoD's reaction? Withhold CHART from all concerned. My point is that there is a clear and unbroken chain of evidence from these 1980s failures to Haddon-Cave and then Lord Philip.
One small example - in 1998 new Chinooks were being delivered with similar serious assembly defects. At Boscombe a starboard avionics rack (about 6 feet high, 3 feet wide and crammed with black boxes) came loose and fell on a contractor, just after the aircraft had landed upon initial delivery. (On the pan outside RWTS hangar). The fixing bolts had been over-torqued and crushed the honeycomb bulkhead so that something weighing hundreds of pounds was literally hanging by a thread. In control runs, split pins had not been split. One part fell off and hit the pilot on the head as he was walking out the back. It had secondary bonding that consisted of a rolled up ball of 24awg equipment wire stuffed behind Nav systems. Nav problems? Always check bonding first. It matters not that these were not actuator problems - they were serious QC failures and indicative of a very poor ethos. MoD's reaction was exactly the same. Boeing are a protected species and nothing was done, except each defect (not fault) was quietly fixed as and when it was spotted. Except, the problem is that a defect (as opposed to a fault) indicates contractor liability arising from a poor design. That is, we were content to fire fight instead of getting to the root cause.
Haddon-Cave agreed that there were savings at the expense of safety, but what of pandering to a contractor on the basis of preserving relations, but knowing this places aircrew lives at risk? The next question would be who benefited from this.