Yak 52 down Nr Boscombe 8/7/2016
Ecce Homo! Loquitur...
https://www.theguardian.com/uk-news/...port-alex-parr
A damning report into the death of one of the RAF’s top test pilots said the aircraft he crashed in had “significant equipment defects” before it took off. Flt Lt Alex Jay Parr, a 40-year-old father of three, died in July 2016 when a Yak-52 he was piloting suffered engine failure and crash-landed on farmland. Parr was thrown from the plane and his body was found several feet from the wreckage.
A report by the Ministry of Defence has strongly criticised the RAF and the defence firm Qinetiq for a string of failings which contributed to the accident. These include the fact the plane, used in instruction flights to train test pilots, took off with broken flight instruments, out-of-date parachutes and worn-out seat harness straps. A separate inquiry by the Air Accident Investigation Branch is being carried out, but MoD investigators discovered that the aircraft, built in Romania in 1993, did not have an engine overhaul in 24 subsequent years of flying.
The plane took off from an airfield at Boscombe Down, Wiltshire, in July last year. The military base, operated by Qinetiq on behalf of the MoD, is the home of Empire Test Pilot School, where elite pilots from Britain and the rest of the world, including the US, are trained to become test pilots. Several Nasa astronauts have honed their skills at the school. It is widely regarded as one of the world’s leading flight schools and the report will be a deep embarrassment to the MoD.
Air Marshal Richard Garwood, head of the Defence Safety Agency, last year told MPs on the parliamentary defence committee investigating the safety of military training, that the MoD and the RAF in particular, had “far better [safety] processes in place” since a 2006 incident in which a Nimrod aircraft exploded over Afghanistan killing 14 crew members. An inquiry into the Nimrod explosion later found “systemic failings” by defence officials and manufacturers were compounded by the MoD sacrificing safety to cut costs.
The report into Parr’s death concludes there was a failure to carry out due diligence to ensure a safe flight, that there was inadequate supervision, a lack of risk assessment and that the plane took off with “significant defect failures” including no gyro compasses, a broken altimeter, and failed engine gauges. “These failures would have denied the crew critical information during the emergency and likely caused distraction and confusion,” says the MoD report.
Investigators said parachutes on the aircraft “appeared out of date”, seat harness straps were “significantly weakened” and the pilot was not wearing a helmet.mThe plane was privately owned but sub-contracted to defence contractor Quinetiq. A second pilot, who survived the crash, was “inadequately prepared” for the training flight, having only logged one hour in the aircraft in the previous 12 months, investigators said.
“Overall, no stakeholder grasped the reality of a sub-sub-contractor operating a borrowed airplane. This led directly to [training school] personnel flying in an aircraft that was unfit for purpose and operating in contravention of the Air Navigation Order,” the report says.
Before the crash, the aircraft had been operating training flights at MoD Boscombe Down for a week “without either the aircrew, engineers or supervision picking up on what was clearly an unprofessional and deteriorating situation. We need to ask ourselves why this could happen under the gaze of the world’s premier test pilot school”.
Air Chief Marshal Sir Stuart Peach, describing Flt Lt Parr’s death as a tragedy, paid tribute to him as an “outstanding husband, father, Royal Air Force officer, pilot, test pilot and friend. Clever, witty and warm, he will be missed by many.”
A damning report into the death of one of the RAF’s top test pilots said the aircraft he crashed in had “significant equipment defects” before it took off. Flt Lt Alex Jay Parr, a 40-year-old father of three, died in July 2016 when a Yak-52 he was piloting suffered engine failure and crash-landed on farmland. Parr was thrown from the plane and his body was found several feet from the wreckage.
A report by the Ministry of Defence has strongly criticised the RAF and the defence firm Qinetiq for a string of failings which contributed to the accident. These include the fact the plane, used in instruction flights to train test pilots, took off with broken flight instruments, out-of-date parachutes and worn-out seat harness straps. A separate inquiry by the Air Accident Investigation Branch is being carried out, but MoD investigators discovered that the aircraft, built in Romania in 1993, did not have an engine overhaul in 24 subsequent years of flying.
The plane took off from an airfield at Boscombe Down, Wiltshire, in July last year. The military base, operated by Qinetiq on behalf of the MoD, is the home of Empire Test Pilot School, where elite pilots from Britain and the rest of the world, including the US, are trained to become test pilots. Several Nasa astronauts have honed their skills at the school. It is widely regarded as one of the world’s leading flight schools and the report will be a deep embarrassment to the MoD.
Air Marshal Richard Garwood, head of the Defence Safety Agency, last year told MPs on the parliamentary defence committee investigating the safety of military training, that the MoD and the RAF in particular, had “far better [safety] processes in place” since a 2006 incident in which a Nimrod aircraft exploded over Afghanistan killing 14 crew members. An inquiry into the Nimrod explosion later found “systemic failings” by defence officials and manufacturers were compounded by the MoD sacrificing safety to cut costs.
The report into Parr’s death concludes there was a failure to carry out due diligence to ensure a safe flight, that there was inadequate supervision, a lack of risk assessment and that the plane took off with “significant defect failures” including no gyro compasses, a broken altimeter, and failed engine gauges. “These failures would have denied the crew critical information during the emergency and likely caused distraction and confusion,” says the MoD report.
Investigators said parachutes on the aircraft “appeared out of date”, seat harness straps were “significantly weakened” and the pilot was not wearing a helmet.mThe plane was privately owned but sub-contracted to defence contractor Quinetiq. A second pilot, who survived the crash, was “inadequately prepared” for the training flight, having only logged one hour in the aircraft in the previous 12 months, investigators said.
“Overall, no stakeholder grasped the reality of a sub-sub-contractor operating a borrowed airplane. This led directly to [training school] personnel flying in an aircraft that was unfit for purpose and operating in contravention of the Air Navigation Order,” the report says.
Before the crash, the aircraft had been operating training flights at MoD Boscombe Down for a week “without either the aircrew, engineers or supervision picking up on what was clearly an unprofessional and deteriorating situation. We need to ask ourselves why this could happen under the gaze of the world’s premier test pilot school”.
Air Chief Marshal Sir Stuart Peach, describing Flt Lt Parr’s death as a tragedy, paid tribute to him as an “outstanding husband, father, Royal Air Force officer, pilot, test pilot and friend. Clever, witty and warm, he will be missed by many.”
Air Marshal Richard Garwood, head of the Defence Safety Agency, last year told MPs on the parliamentary defence committee investigating the safety of military training, that the MoD and the RAF in particular, had “far better [safety] processes in place” since a 2006 incident in which a Nimrod aircraft exploded over Afghanistan killing 14 crew members.
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Please excuse my intervention into what is clearly NOT my field, but having spent the last hour or so reading the SI [and comprehending much of it] I find the whole sad saga deeply depressing.
Setting aside the numerous failings, including unreported instrument failures and inadequate checks [excuse my loose terminology] ... has the system now submerged itself in so much convoluted paperwork and 'yuck-speak' that simple common-sense been removed from the equation?
Ignoring numerous other factors, with several cockpit instruments u/s I cannot understand why anyone at ETPS considered the aircraft fit to fly, let alone continue operating it for a week without anyone seemingly bothering to snag it. I wouldn't really want to drive a car in that state.
Setting aside the numerous failings, including unreported instrument failures and inadequate checks [excuse my loose terminology] ... has the system now submerged itself in so much convoluted paperwork and 'yuck-speak' that simple common-sense been removed from the equation?
Ignoring numerous other factors, with several cockpit instruments u/s I cannot understand why anyone at ETPS considered the aircraft fit to fly, let alone continue operating it for a week without anyone seemingly bothering to snag it. I wouldn't really want to drive a car in that state.
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looked like a classic "familiarity breeds contempt " case ie if it had suddenly turned up like that no-one would have touched it but it had been there for ages and people just accepted the gradual deterioration in the aircraft
But it was only there for a week... what were they thinking of?
But it was only there for a week... what were they thinking of?
the MoD and the RAF in particular, had “far better [safety] processes in place” since a 2006 incident in which a Nimrod aircraft exploded over Afghanistan killing 14 crew members.
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tecumseh ... I guess that's my simplistic, non-aviator, point. Generating even more mountains of paper, processes, Regulations and MBA-speak scribble doesn't help anyone if people don't THINK!
In my ATCO days, as Supervisor, Training Officer or Local Examiner, I expected people to think. Yes, obviously comply with the rules, but also exercise their brains occasionally. When, for example, examining someone on Director for a Certificate of Competency endorsement, I would sometimes lean over and put their radar display on standby (obviously watching proceedings on the adjacent display). Many of them would just freeze, without thinking of all the other resources available to them.
If people don't THINK, and instead just try occasionally to wade through 183kg of regulations and forms, we do the people a disservice. Our Danny42C had to think, in his flying and ATC careers, without innumerable volumes of bumf... and he functioned effectively, without sitting on the output of several hundred MBA's worth of incomprehensible typescript..
In my ATCO days, as Supervisor, Training Officer or Local Examiner, I expected people to think. Yes, obviously comply with the rules, but also exercise their brains occasionally. When, for example, examining someone on Director for a Certificate of Competency endorsement, I would sometimes lean over and put their radar display on standby (obviously watching proceedings on the adjacent display). Many of them would just freeze, without thinking of all the other resources available to them.
If people don't THINK, and instead just try occasionally to wade through 183kg of regulations and forms, we do the people a disservice. Our Danny42C had to think, in his flying and ATC careers, without innumerable volumes of bumf... and he functioned effectively, without sitting on the output of several hundred MBA's worth of incomprehensible typescript..
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If they really want to use basic airframes they should have borrowed the BBMF's Chippy; at least it will be thoroughly, comprehensively and professionaly well-spannered and documented, etc etc
Last edited by Green Flash; 6th Aug 2017 at 16:53. Reason: spelling
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The Chipmunk has been out of regular RAF/FAA/AAC service now for about 20 years, so it would count as an unfamiliar type now, I would have thought.
A dreadful accident and what seems to be an appalling series of oversights with some quite absurd convolutions discussed in that SI.
My basic safety thought - What happened to the KISS principle, chaps?
(And so well said 'MPN 11' - It's important that people THINK!)
My basic safety thought - What happened to the KISS principle, chaps?
(And so well said 'MPN 11' - It's important that people THINK!)
MPN11
Agreed.
The MAA won't admit why it is writing these new regs. It is because MoD has been dumbed down. To someone of my age and background, understanding and implementing them was something you did in the 4 or 5 grades before you became a project manager. Today, most skip those grades, and there is no one left to train them when parachuted into the minefield. Industry and MoD's technical authors realised this many years ago, and started having to rethink how they wrote publications. They could no longer assume the previous levels of competence.
One aspect of this case proves my point. The report recommends aircraft publications should be in English, not Russian. In 1992, the RAF Director of Flight Safety recommended they be in English, not Argentinian. 25 years!
Agreed.
The MAA won't admit why it is writing these new regs. It is because MoD has been dumbed down. To someone of my age and background, understanding and implementing them was something you did in the 4 or 5 grades before you became a project manager. Today, most skip those grades, and there is no one left to train them when parachuted into the minefield. Industry and MoD's technical authors realised this many years ago, and started having to rethink how they wrote publications. They could no longer assume the previous levels of competence.
One aspect of this case proves my point. The report recommends aircraft publications should be in English, not Russian. In 1992, the RAF Director of Flight Safety recommended they be in English, not Argentinian. 25 years!
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I am only halfway through the report, but I keep wondering... if the YAK52 is such a good tool for the job, why didn't QQ just buy one, get it airworthy, and charge accordingly?
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Because it would then become a 'familiar' type on the QinetiQ books! Maybe the Harvard switch positions should have had the facility to be changed over to Cyrillic (I'm being ironic). I know, the Harvard has now been sold and there's no chance of QinetiQ buying a Chippy or a Yak.
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1.6.7 The organisational aspects of this accident demonstrated that the lessons identified by previous internal audits and formal staff assurance reports had not been learnt.
Air Chief Marshal Sir Stuart Peach, describing Flt Lt Parr’s death as an avoidable tragedy, paid tribute to him as an “outstanding husband, father, Royal Air Force officer, pilot, test pilot and friend. Clever, witty and warm, he was let down by the system and will be missed by many.”
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D Flying/Flt Test Div etc
Whilst not wishing to say 'I told you so', this breakdown in oversight and assurance was highlighted as a risk when D Flying was subsumed into the MAA and effectively broken up.
Many a meeting were held with the Ops 2* and the 3* Head and also rigorously documented, but the MAA hierarchy did not believe it to be an issue.
Had D Fg still been in existence, would the accident have happened? One cannot say for sure. However, I strongly believe the numerous swiss cheese holes would not have had the ability to line up/been there in the first place.
Crawling back to a happier place as this break up of Flt Test oversight back in 2011/12 got me going then and appears to have done it again...
Many a meeting were held with the Ops 2* and the 3* Head and also rigorously documented, but the MAA hierarchy did not believe it to be an issue.
Had D Fg still been in existence, would the accident have happened? One cannot say for sure. However, I strongly believe the numerous swiss cheese holes would not have had the ability to line up/been there in the first place.
Crawling back to a happier place as this break up of Flt Test oversight back in 2011/12 got me going then and appears to have done it again...
Last edited by MOA; 7th Aug 2017 at 13:26. Reason: Get the VSO ranks right
