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Inquest - Corporal Jonathan Bayliss RAF

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Inquest - Corporal Jonathan Bayliss RAF

Old 11th Oct 2021, 08:33
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Inquest - Corporal Jonathan Bayliss RAF

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The inquest into the death of Corporal Jonathan Bayliss will resume on 2nd November 2021 -

Council Offices - Shire Hall Street, Caernarfon.

Full Inquest scheduled for four days.

Hawk XX204 Service Inquiry

...

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Old 29th Oct 2021, 08:07
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Who speaks for the Dead ?

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Who speaks for the Dead ?


The inquest resumes next Tuesday, Nov 2nd - with four days scheduled.

The separate interest groups will likely include -
  • MoD, who will not be keen for the inquest to consider the long list of repeat failures identified in various SIs and other inquiries, which despite frequent assurances at events like this, seem never to have been fixed. MoD will likely have instructed their barrister to steer everyone away from that sort of embarrassing stuff.
  • The pilot, who appears to be legally represented.
  • The family of Corporal Bayliss, who so far seem not to be legally represented, and who would be better served if this were an Article 2 Inquest - which might also have triggered legal aid.
  • The Public Interest
One hopes the coroner will have summoned a suitably qualified and responsible witness, senior enough to answer questions and tell the truth about the Hawk Mk1 Safety Case etc, and senior enough not to feel threatened by a disciplinary.
'Etc.' includes for this purpose, answering questions about the multiple shortcomings and unimplemented SI recommendations from inter alia, the Valley (2018) and Scampton (2011) accidents.
It will also include answering pointed questions about the relevant Risk Register and any possible more recent assessment of the Risk to Life and Duty of Care, both historical and post March 2018, in particular for the back seat carriage of ad hoc joy-riders and ground engineers who have been chosen to be trained as members of the Reds 'circus.'

That presupposes there will be anyone attending the inquest who will know the right questions to ask, and with enough clout to extract truthful answers.

Or will the coroner have to settle for well rehearsed assurances by some uniformed (or did I mean uninformed ?) lackey, that these accidents have already been fully investigated and lessons have been learned and she doesn't need to worry her PLH about technical details ?

That brings us to the question of Article 2 Inquests. It would seem from press reports of the pre-inquest hearing in May 2021, that the MoD barrister successfully argued against an Article 2 Inquest. He has probably been briefed to avoid anything more complicated. I think he said previously something simple like 'the aircraft stalled - that's it.' Well he would say that, wouldn't he ?

Is the inquest likely to become adversarial ?

If the MoD claims that the MoD, the procedures and the Risk Assessment are not to blame, who does that leave ? Fate ? Bad luck ? Corporal Bayliss ? The pilot ?

Whatever the outcome, Jon Bayliss didn't stand much of a chance on 20th March 2018.

LFH
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Old 29th Oct 2021, 12:17
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Between your post and comments elsewhere, you've pretty much nailed it Flashy. The Coroner's been misled, and MoD doesn't want their past form examined. I wasn't sure what "article 2" meant so had a look see. She must have been high. Is she really saying there is no possibility of MoD having breached their duty of care? Even the service inquiry report admits it.
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Old 29th Oct 2021, 12:58
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Is there any possibility that a Barrister who understands the issues could be found to represent the family on a Pro Bono basis?
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Old 30th Oct 2021, 05:34
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Seems like a case for 'crowd funding' a legal eagle. Where's Gilbert Blades and his clan when you need them? (I expect Blades senior is counsel to St Peter by now)

O-D
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Old 30th Oct 2021, 06:50
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Originally Posted by WB627 View Post
Is there any possibility that a Barrister who understands the issues ?
This, I think, is a key issue. Very few do, which has been all too evident at many a military Inquest, with them unable to pick up when MoD has lied under questioning. Hercules XV179 is the obvious example in England.

One of the deceased was Australian, where government policy is to fund legal representation for the bereaved. The family QC was superb. He had his experts on speed dial for advice during recesses. Even so, when the porkies came thick and fast it was difficult. It was only after the event that the evidence of one senior officer could be dissected, and proven entirely wrong. By then it's too late. And, of course, MoD arranged for one potential witness, a retired C-130 pilot, to be detained on the steps of the courthouse by security forces. Not dissimilar from the Cunningham case, when Mr C was physically dragged away when he tried to speak to those who were there to help. It's not just lack of representation that's the problem. It's the system tolerating this level of interference with due process.

Hopefully, Mr Bayliss and his family have expert help next week. One of the odd things (in my opinion) is that the well-known firm who usually provide a solicitor pro bono to the bereaved, are representing the pilot. That narrowed the family's options, but they were still initially represented. This abruptly ceased after the ruling that it was not to be an Article 2 Inquest, and they were not represented at the Pre-Inquest Hearing earlier this year.

EDIT: Apologies, but I should make it clear that I think the senior officer at the XV179 Inquest was misled by briefings into misleading the court. The main lie was that, earlier in the proceedings, MoD denied ever knowing about Explosion Suppressant Foam, despite it being called up in mandated airworthiness regulations. Two MoD ESF specifications from 1971 were provided by a witness to the Coroner and Oz QC. Coroner David Masters accepted this evidence. tuc.

Last edited by tucumseh; 30th Oct 2021 at 11:14.
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Old 30th Oct 2021, 08:34
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tuc :-
What price the military covenant?
Indeed, tuc. Here we see all the safety nets that might assist in helping to search out the truth; various Service Charities, Article 2 Inquests, Informed Pro Bono lawyers, all seemingly unavailable to the family of Cpl Bayliss. They are left at the mercy of the RAF/MOD, which will be merciless unless checked in its tracks by the Coroner (who confirmed that Article 2 would not feature, I understand). This situation could be repeated ad infinitum unless the attitude of the Establishment changes.

In short, your loved ones could be treated with the same lofty contempt if you are currently serving.
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Old 30th Oct 2021, 10:09
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The Enemy IS the State

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The Enemy
IS the State ......

Corporal Bayliss should not have died. His death was wholly avoidable. Under the circumstances, he didn't stand a chance.

MoD through their barrister, persuaded the relatively inexperienced coroner that it should NOT be an Article 2 Inquest. One aspect of that decision seems to be that the coroner is thereby limited to the bare facts of the death and unable to apportion blame or civil or criminal liability .... though a narrative verdict can be delivered.

In the case of an Article 2 inquest, the coroner can consider 'system neglect.' This is sometimes referred to as a 'Middleton Inquest.' That is where we should be at.

Is the inquest likely to become adversarial ?

Regardless of any procedural limits on the coroner, I feel sure that won't prevent the MoD barrister pointing fingers - and you can be sure he won't be pointing fingers at the MoD who pay him.

MoD will know that if it were an Article 2 inquest, it would be MoD under scrutiny.

A 'defendent' who hoped to be found not guilty, would be unwise to admit guilt even to their defence counsel. Thus MoD has probably made great effort to limit what their own barrister knows about the case.

Jon Bayliss paid the ultimate price, which cannot be refunded. Whether or not MoD has paid, or will pay anything to the 'family' possibly under NDA, that can't replace their loss.

It would be difficult, but in the feverish atmosphere of the coroner's court, not impossible, to point a non-aviation no-holds-barred finger at Jon, sowing only tiny seeds of suggestion that 'he might have realised ....' You only have to consider what rubbish can appear in the national press about aviation matters. If the family are not represented, that would only leave the coroner to speak up.

So if MoD has it's way, that really only leaves the pilot. It might even be to the benefit of the pilot for this to be an Article 2 Inquest. He may be just as much a victim - of the rotten system that rules his flying, if the MoD barrister has been instructed that in extremis, he is to do a hatchet job. I think he said previously something simple like 'the aircraft stalled - that's it.' He would then ask 'Who stalled the aircraft ?' You can see where this might lead.

Article 2(1) of the ECHR states: “everyone’s right to life shall be protected by law”. That places two substantive duties on member states:

1. A negative obligation to refrain from taking life

2. A positive obligation to take appropriate measures to safeguard life.

It seems in this case that substantive duties under Article 2 (point 2 above) have been breached. That is why it should be an Article 2 Inquest. It is not too late.

However, switching to Article 2 would require a substantial adjournment to be declared next Tuesday, Nov 2nd. That would be terribly inconvenient for some of the parties who want this out of the way, before it gets any worse. .... The coroner has been quoted as saying she would keep it under review. It is within her power. It is not too late.

LFH
...

Last edited by Lordflasheart; 30th Oct 2021 at 16:30. Reason: spelling
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Old 1st Nov 2021, 18:10
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Risk Assessment and Duty of Care

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Risk Assessment and Duty of Care - Big Cheese Holes and the Big Cheese


Corporal Bayliss should not have died. His death was wholly avoidable. Under the circumstances, he didn't stand a chance.

From the SI - He did not receive some of the listed training expected for newly selected circus members which elevated the risk. Such that the SI recommended the DDH should mandate a formal training syllabus. Under the circumstances, that issue probably made little or no difference to the fatal outcome.

From the SI - The pilot was distracted by certain issues beyond his control, including a simulator ride at Valley between flights, being required to carry out flight manoeuvres that arguably were incompatible with a shakedown flight for a prospective circus member, misjudging the flight path, losing control and ejecting. Under the circumstances, those 'overwork' issues probably made no practical difference to the fatal outcome.

The path leading to Jon Bayliss' death was laid down many years earlier. Someone would eventually come to grief.

The foundation was the systemic, blind belief that the risk involved in routine and frequent carriage of any non-aircrew in the back seat of a Hawk T1 (especially with the elevated risk associated with certain flight activities) could be passed off as Low and Tolerable and ALARP.

In principle, it's a little bit like building V-Bombers, where only certain crew members were provided with ejection seats. Was the risk deemed to be Tolerable and ALARP or whatever it was called in those days ? Or was it passed off as "Rien ne peut être fait. C'est la guerre froide" ?

Many relatively minor shortcomings in technical and training records, administration and oversight were listed in the XX 204 SI. More serious shortcomings were identified in the SI for XX177 (like absence of a valid Safety Case and the length of time taken to locate and obtain important documents from the multitude of agencies with fingers in the Hawk Pie. Similar issues for other Hawk crashes. And as regularly mentioned and warned, even to the NW Wales Coroner, a long list of serially ignored recommendations, while lying to successive inquests, inquiries, courts etc., that 'lessons have been learned and all recommendations have been implemented.'

Among all the fancy risk assessment data, including as shown in the risk register at the time of XX177 ten years ago, and doubtless up to XX204 in 2018, I could find nothing that discussed or questioned the fundamental issue of why any passenger or supernumerary crew member must be seated in the back (as opposed to anywhere else.) Nothing even to suggest that the seat-specific risk had been considered or had achieved the magic words 'Low and Tolerable and ALARP.'

Everyone in the Hawk and Red Arrows world should know about the command ejection system as fitted to the Hawk T1. Hawk T1 was designed as a trainer, where the command pilot ie the Instructor, would be the GiB, and command ejection could only be initiated 'from the back.' If the command pilot is in the front (as for most Hawk T1s these days, command ejection must be switched off. You can't currently switch 'command' from back to front. Neither can you allow an unqualified back seater the ability to initiate ejection for both seats.

That leaves the back seater to make his/her own 'in extremis' decision to eject, whether ordered or not. What happens when the front seat command pilot of a doomed Hawk T1 shouts "Eject ! Eject ! Eject !" and the back seater doesn't go ? .... How long would you give it ?

**************************************
......................................................
Why did this specific risk assessment (if any) apparently stop where it did ?

With XX204, the SI begins to open up that discussion at last.

Recommendation 1.5.6 Page 1.5 - 2

f ) "RAFAT DDH should ensure that Circus are only employed as Supernumerary Crew on sorties that are directly associated with their primary role and not exposed to potentially hazardous flight profiles .... "

Analysis conclusion 1.4.477. Page 103

"... "Simulations indicated that if a front seat-initiated command eject system had been in place then both individuals might have vacated the aircraft before ground impact."

1.4.482. Two Aggravating Factors. (page 103)

a. The engineer's lack of experience to independently initiate his own ejection.

b. The lack of a front seat-initiated Command Ejection system.

1.5.2 Recommendations - "AOC 22 Gp should ....

e. Assess the feasibility of the incorporation of a command eject capability into the Hawk T Mk1 that would allow aircraft commanders to initiate the ejection for occupants from either cockpit seat."

And from the Convening Authority Comments - dated April 2019

NB The Convening Authority DG DSA post holder in March 2018 was Maj Gen Felton. Since March 2019, DG DSA is AM Gray. I have no knowledge of which DG wrote the comments to SI XX204. Bear in mind the comments were written when it was believed Hawk Mk 1 would be in service until 2030. You can see how the landscape might be changing ...

1.6.11. " ... The rationale for engineers to be Supernumerary Crew and deliver engineering support away from RAF Scampton is clear. Nevertheless, their employment in such a capacity should only be on sorties that are directly related to their primary role."

1.6.12. "... With aircraft commanders in all 3 main Hawk T Mk1 squadrons predominately occupying the front cockpit seat, it is appropriate to assess the feasibility of a command eject capability that could also be initiated from that position. Alternatively, Defence may have to assess if the risks associated with carrying passengers in the rear cockpit of the Hawk T Mk1 are tolerable.

Two years later the Defence Command Paper announced the surprise premature retirement of C-130, BAe146, Typhoon Tranche 1, E-3D Sentry and Hawk T1. In the latter three cases a clear about face from fairly recent positive statements on out-of-service dates and arguably, for all five types, resulting in an unwelcome capability gap. Perhaps Hawk T1 is going early because MoD refuses to pay for any general mitigation. Has RAFAT managed to head off any big changes to current Circus procedures ?
**********************************
,,,......................................................... ....
I seems to me entirely possible that the new DG DSA has had time to review a number of safety matters and has found them wanting. Furthermore it is entirely possible she has done what her predecessors seem to have avoided, grasped the nettle and tried to rope the sacred cow. .... Consider this -

"... Alternatively, [ without front seat command ejection] Defence may have to assess if the risks associated with carrying passengers in the rear cockpit of the Hawk T Mk1 are tolerable."

As it stands, a proper assessment of risk to life and duty of care for Hawk T1 rear seat passengers, could not possibly justify a claim of Low and Tolerable and ALARP. ... Jon Bayliss' death seems to support that argument. You would have to look further for an acceptable safety assurance.

If Circus has to travel, why not in the front seat ? If that is unacceptable to RAFAT, rather than pandering to the sacred cow, declare that it is equally unacceptable to continue with the current arrangements and another safer mode of travel will have to be found. Perhaps that discussion has already taken place. If so, what was the outcome ?

Other notable national aerobatic teams use support air transport as a matter of course, albeit many because their aircraft are single seaters. MoD knows this well because last year they sold a spare C-130J to the US Navy for their Blue Angels, (to be flown by the USMC in pretty Blue Angels colours and Marine Corps markings.

MoD has several C-130s and BAe146s for disposal. Re-cycling one or two of these might be cheaper in the long run than having a more expensive repeat of XX204.

However, there is no public indication (since 2018 and even now) that anything has actually changed (or is about to change) in terms of Red Arrows Circus seating or command ejection or alternative travel arrangements.

If no change is envisaged, that would be to publicly abandon any pretence of safety concern for this particular issue. That might suggest that DG DSA has either followed the laissez-faire or lost the battle.

If I were the NW Wales Coroner, in the Public Interest I would declare the Bayliss inquest to be Article 2. I would also summon the DG DSA, the Big Cheese herself, who might even welcome the opportunity to spill the beans in public, though it might put a damper on her career.

Jon Bayliss should not have died. His death was wholly avoidable. Under the circumstances, he didn't stand a chance.

Immediate Action to prevent a repeat would deliver a measure of justice for his family and for his memory, and would clearly be in The Public Interest.

Who Speaks for the Dead ?

LFH
...

Last edited by Lordflasheart; 1st Nov 2021 at 18:33. Reason: speling
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Old 1st Nov 2021, 19:37
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If Circus has to travel, why not in the front seat ?
Not possible in a Hawk T1.
Although the rear cockpit has enough controls to land a Hawk,only the front cockpit has the LP Fuel C0ck,Parking Brake and other stuff such as the Main Flap controls,electrical switches and some Radio (?) controls.
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Old 1st Nov 2021, 20:24
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Originally Posted by longer ron View Post
Not possible in a Hawk T1.
Although the rear cockpit has enough controls to land a Hawk,only the front cockpit has the LP Fuel C0ck,Parking Brake and other stuff such as the Main Flap controls,electrical switches and some Radio (?) controls.
​​​​​​That's not the reason not to, all that can be fixed with modifications, some very extreme; such as correcting the command eject, so the rear goes with the front. I suspect a very small modification, uncostly for 13 aircraft though.

I sense it's all down to £££.
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Old 1st Nov 2021, 21:52
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Not a small modification for the cockpit controls Moi,changing the command eject system would possibly have been more viable.
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Old 2nd Nov 2021, 13:16
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Did BAe offer MoD a Hawk Command Ejection Mod ?

...
Thanks Ron and Moi -

That would make sense - similar for the Gnat before. It really limits the options to command eject Mod or not at all.

I wonder if British Aerospace ever offered MoD the option to modify Hawk T1 for command ejection from either seat ? ... If not, why not ?

Did MoD refuse what would have been a sensible offer, using the same pathetic excuse that they used to refuse Martin Baker's proposal for fitting the Gas Shackle to Hawk ejection seats ? ... While taking it for Tornado ?

Deaths inevitably follow every case of inappropriate or plain daft decisions (like so many others) made in the safety of the office.

LFH
...
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Old 2nd Nov 2021, 19:20
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Bayliss Inquest now Article 2

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From North Wales Live - Amelia Shaw - this evening

https://www.dailypost.co.uk/news/nor...thing-22038712

"At the pre-inquest hearing earlier this year Ms Sutherland came to the decision that article two of the European Convention on Human Rights - the right to life - had not been engaged.

But today she said that, following further disclosure from the Ministry of Defence, the "low threshold has been met for article two" to be engaged due to "breaches in duties".

Excellent start. I wonder what she will turn up next ?

LFH
...
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Old 3rd Nov 2021, 12:41
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Telegraph article

https://www.msn.com/en-gb/news/uknew...out&li=AAnZ9Ug
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Old 3rd Nov 2021, 13:10
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"Katie Sutherland, the coroner, said the inquest - which is expected to last four days - would look .... what recommendations were made following other air crashes involving the Red Arrows in 2011."

Seen that link to the Flt Lt Cunningham case posted here on PPRuNe a few times over the past 2 or so years. BZ


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Old 4th Nov 2021, 15:07
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Did BAe offer MoD a Hawk Mk 1 'switchable' Command Ejection Mod ?

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Did BAe offer MoD a Hawk Mk 1 'switchable' Command Ejection Mod ?


According to the multitude of media reports from the inquest yesterday, there was lot of stuff about the lack of command ejection from the front seat.

But nothing to say if MoD had been offered and rejected the 'switchable' command ejection mod for Hawk Mk 1 ? I imagine if it was the other way round, we would have been told LaC by now. So far, silence.

The issue was commented on by the DG DSA herself in Part 6 of the XX204 SI, so I would be disappointed if the question had not arisen.

Will anyone at the inquest ask ?

LFH
...
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Old 4th Nov 2021, 17:58
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Arrow

How about the Hawk T2? We’re any changes to Command Ejection made to that version?
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Old 4th Nov 2021, 18:32
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As I understand it, Martin Baker are the DO for the seats on the TMk.1 under contract from the MoD, so BAE Systems are not directly involved in any mods until they get actioned and the installation changes (wiring/switches) need to be designed. The TMk.2 seats are under a different contract arrangement.
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Old 4th Nov 2021, 20:55
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How about the Hawk T2? We’re any changes to Command Ejection made to that version?
The command ejection system on the T2 (which remains an MBA system) is unchanged from other Hawks. The only seat change was the introduction of arm restraints at the MoD's specific request and cost (having been assessed as unnecessary by both MBA and BAES). The use of arm restraints were raised in a much older T1 Service Inquiry with the RAF never showing an appetite to fit them on the T1 fleet preferring to then highlight the discrepancy by fitting them to the T2.

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