Source · Prevention of Future Deaths

Peter Barnes

Ref: 2016-0001-wp25050 Date: 4 Jan 2016 Coroner: Andrew Harris Area: London Inner South Responses identified: 2 / 3 View PDF

Inadequate planning policies for tall buildings around the London Heliport fail to ensure safety, lacking in-depth consultation with the Heliport and official safeguarding measures, despite clear risks to flight paths.

Date 4 Jan 2016

56-day deadline 29 Feb 2016 est.

Responses identified 2 of 3

Other related deaths

Coroner's concerns

AI summary

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the course of the inquest the evidence revealed that
1. London Tall Buildings Policy, implemented after planning permission for St George's Wharf was approved, required reporting of any buildings over 1000 ft, which is the appropriate consideration for Heathrow and Airport flight paths_ In a previous application to development on the site the CAA responded that 575ft would not impact on integrated airspace management and advised consultation with the Heliport: There is no equivalent policy of reporting considering the flight paths to the Heliport:
2. The Head of Safety at Department of Transport advised that aerodrome licence holders should conduct an in depth consultation with local planning authorities about any proposed developments that may affect the of air setvices. No in depth consultation did take place between the Heliport and planning authority about the construction of St George'$ Tower, to which was attached the crane: A retired official from the Civil Aviation Authority had expressed the view that the London Heliport should be a safeguarded aerodrome. The Head of Safety in Department of Transport advised that in an official safeguarding regime one can be sure that such consultation takes place, which one cannot in an unofficial process, where it depends on the local system and players_
3. The Heliport manager was concerned that the erection of St s Wharf would affect passing air traffic on helicopter route H4. He stated that there was an apparent conflict between maintaining en route standard altitudes and complying with Rule 5, especially in reduced cloud base. He had some informal discussions with the CAA, but the local planning authority did not respond to his concerns He did not take the matter further as the proposed building was just outside the area designated in the map of his local plan. It is not clear whether this local plan or the local process is adequate to assure safety He remained of the view that the tall building created a risk a8 it was more difficult to operate helicopters in poor visibility:
4. Captain who was called as an independent expert pilot; gave an opinion that establishing a minimum altitude would assist pilots and promote safety and that the H4 route required review, to make it safer; to reduce future deaths Other pilots testified to the challenges of flying the Thames with the proliferation of tall buildings in less weather;
5. The Air Accident Investigation Branch of the Department of Transport (AAIB) made a Safety Recommendation 201430 in August 2014. It read: It is recommended that the Department of Transport implement measures that enable the Civil Aviation Authority to dssess, before planning permission is granted, the potential implications of new en route obstacles for airspace arrangements and procedures During City safety George along good

The Senior Inspector of Air Accidents (Operations) AAIB said that if this recommendation was not implemented lives would be put at risk The Head of Airspace, Air Traffic Management and Aerodromes at the CAA supported this recommendation, saying it would be a safety back up. The Department of Transport has not implemented this recommendation, and reported in December 2014 that it was consulting, which was still the position a year later: This was explained by the Head of Aviation Safety Policy at the Department of Transport as initially due to lack of resources He said that there was not an intention to implement this recommendation, in particular noting that it may be contrary to government proposals the planning process. Despite a safety record; it would seem that the relevant bodies in relation to aviation safety the Thames need to expedite a specific review of H4 and consider any need to alter flying rules, to assure the public of on going safety given the current concerns of pilots about the difficulties of flying the Thames. It is not clear that helicopter aviation considerations for the Heliport o more widely for flights the Thames are adequately considered in the planning processes for tall buildings. It appears that little O1 no progress been made in considering the need to safeguard the heliport or implement AAIB Recommendation 2014-30, which the court heard would potentially save future lives. ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and I believe that the Department of Transport and Civil Aviation Authority and London Heliport have the power and expertise to address and reduce the risks of future deaths_ YOUR RESPONSE You are under a to respond to this report within 56 days of the date of this report; namely by Monday 29rh of February 2016.1, the coroner; may extend the period, Your response must contain details of action taken Or proposed to be taken, setting out the timetable for action. Otherwise YOu must explain why no action is proposed. If you require any further information about the case, please contact the case officer, If you require further information about the process of responding to this report my clerkE to whom your response should be sent_ for good along along along has duty

Responses

2 respondents

Peterwood

23 Feb 2016 PDF

Action Taken

• The London Heliport has continued its correspondence with both CAA and DfT in order to provide information to progress consideration of official safeguarding of the London Heliport and assist them with implementation of AAIB report recommendation 2014-30. • The DfT will treat the email as a formal application for official safeguarding whilst asking for further documentary evidence to support the application. • The DfT will consult the CAA and the Department for Communities and Local Government to determine what other measures, if any, are available to ensure that local planning authorities give due regard to safeguarding concerns the London Heliport when granting planning permission. (AI summary)

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The London Heliport 23rd February 2016 Clerk to Senior Coroner Inner South District of Greater London The Coroner's Court 1 Tennis Street London SE1 1YD For the attention of Andrew Harris, Senior Coroner; London Inner South Response to Regulation 28 Report to Prevent Future Deaths Peter Barnes & Matthew Wood 16/01/13 Since the inquest the London Heliport has continued its correspondence with both CAA and DfT in order to provide information to progress consideration of official safeguarding of the London Heliport and assist them with implementation of AAIB report recommendation 2014-30. On 4th January 2016 Abimbola Alli from DfT responded to my email of 10th November 2015, which formed part of the inquest documents was asked to comment on during my witness testimony, by stating that the email; originally sent by way of providing information to support the London Heliport enquiry concerning consideration for an application, would in fact be treated as a formal application for official safeguarding whilst asking for further documentary evidence to support the application: The DfT for their part of the assessment have set out the current guidance for official safeguarding of aerodromes and also general arrangements for safeguarding whether official or not and also stated that they will need to understand the existing consultation/communication process between the London Heliport and the relevant local planning authorities. also consult the CAA and the Department for Communities and Local Government (the department with lead responsibility on planning policy) to determine what other measures, If any, are available to ensure that Iocal planning authorities give due regard to safeguarding concerns the London Heliport when granting planning permission: Ata meeting on 29th January with the London Heliport designated CAA Aerodrome Principal Inspector and in subsequent correspondence have set out current requirements and guidance for notification to the London Heliport of planning applications, This process consists ofan annotated map and accompanying guidance letter sent to all planning departments of the Local Government authorities which fall within the London Heliport safeguarded area in 2009, A pre-planning consultation arrangement is in place with the Port of London Authority for any works or development in the River Thames within 250 metres of the London Heliport landing platform which extends on concrete piling from the river wall over the tidal waters_ have also provided to CAA information on the level of pre-planning consultation made by developers under current arrangements and the number actual planning applications upon which the London Heliport has been required to make comment or raise objections since the local authorities were advised in 2009. There have been 10 major projects during this time; including tall buildings, large-site projects with multiple buildings of mixed height, river piers and a modification to the Cremone railway bridge involving a cantilevered foot-bridge addition. All of these projects have been concentrated in the vicinity of the heliport and its air traffic circuit which extends approximately 1 kilometre in either direction the River Thames from the London Heliport: The London Hellport Ltd, Brldges Court, Battersea, London, SW11 38E Registered Oftice: 4t Floor Millbank Tower, 21-24 Millbank, London SWIP 4QP Registered In England & Wales: 04546128 the They would from along

The London Halport The most in depth work to date in 2015 on a development (now approved) at 12-14 Lombard Road ofa 90 metre tall building around 300 metres the heliport located on the southern riverside. Due to its size and proximity to the heliport and its approach and climb-out areas along the river objection to the project involved insistence on in depth wind-tunnel, reflected glare and technical (including building lighting and impairment of radio communications) assessments at the additional expense of the developer since the planning application included only desk-based assessments. Due to the unofficial safeguarding status of the London Heliport there was no mechanism for referral of the planning application and heliport objection to the CAA who were also therefore unable to make comment Following an extended consultation process the development was approved by the planning authority and the London Heliport made final comment that this building and others of similar height would have a cumulative effect on the operation to the obscuration of line of sight between aircraft in the air and the heliport: Consultation on the obstruction lighting scheme is underway and yet to be completed. There have also been adhoc consultations on schemes for obstruction lighting on tall-building projects mostly in the Vauxhall/ Nine Elms area as well as notifications of cranes across a wide area of London about once a week since early 2013 following the 16th January Vauxhall crash: have also discussed with CAA how the safeguarded area, currently centred on the London Heliport Air Traffic Zone with the main focus on the immediate approaches and climb-out area the river front within the heliport "circuit" , might be developed to reflect better important routes where heliport traffic approaches and departs the London Heliport Air Traffic Zone. This could involve extending the coverage to include not only to the east and west along the heli-route structure where it coincides with the course of River Thames through London including the increasingly high-rise Vauxhall/ Nine Elms area but also away from the river directly to the north and south of the heliport As part of this process have also asked National Air Traffic Services to provide radar-plotted information which could assist with highlighting current traffic patterns and also asked to speak to the responsible department within National Air Traffic Services for safeguarding low-level air traffic over London understand there may be a concern registered by the DCLG that if the safeguarded area for the London Heliport becomes too extensive it may view this as too onerous a responsibility in terms of notification and consideration; Whilst understand this concern would suggest there must also be a wider responsibility to protect users of the airspace other than London Heliport customers who use the same routes, have stated our view that whilst the London Heliport itself does not wish to take on an excessively onerous safeguarding burden it is seeking to find a suitable balance in order to work with CAA, DfT, NATS and DCLG to find a solution: In addition to liaising with CAA on the subject have also set out in recent email correspondence with DfT at their request consideration with regard to the London Heliport application for official safeguarding in relation to current guidance. Areas covered included: Strategic Importance for routine government; diplomatic, military and Police and Air Ambulance use use in case of major emergencies (e-g: London bombings 2007, Marchioness Disaster) for Air Ambulance, Police, Military Security Services as a forward operating base for Police Air Support when Central London is a venue for state visits, ceremonial and public events which entail additional security or restrictions on use of airspace: The London Heliport Ltd, Bridges Court, Battersea, London, SW11 38E Registered Office: 4th Floor Millbank Tower, 21-24 Millbank, London SWIP 4QP Registered in England & Wales: 04546128 began from due ` along the

The London Helport Technical safeguarding As a landing site in inner London the London Heliport has the capability if required for technical support to the wider aviation community as an essential local link to National Air Traffic Services radar coverage for the local management of low-level helicopter air traffic in London: At the same time the London Heliport is also currently considering options for upgrade of its meteorological reporting capability under a Meteorological Office project to provide semi-automated online meteorological data available not only to aircrew of low- level air traffic across London (not currently available) but also as part ofthe same project to assist with London-wide fog forecasting for London Heathrow (and City) airports_ Physical Safeguarding Given its location in Central London the main areas for safeguarding London Heliport should cover: much of the Central London heli-route structure including areas at or beyond the limits of the London Heliport ATZ (e-g. Nine Elms/ Vauxhall); keeping in mind the tall-buildings zoning policies for any of the inner and central London boroughs including of London Corporation especially where their boundary is river-facing since there are many tall riverfront (or near riverfront) buildings either consented or under construction in Central London (e:g."Nol Blackfriars" on south side of Blackfriars Bridge) the London Heliport Local Flying Area (LFA) which operates a5 an autonomous (from NATS) extension to the south ofthe heliport ATZ_ a zone of similar dimensions to the LFA but running to the north which although currently overseen by combined NATS and RAF Northolt radar services could also become a second semi-autonomous LFA To this end we are currently under discussions with NATS to put in place contingencies in case of failure of the NATS radar service which have in the past either closed the London Heliport or severely limited its freedom to operate: Whilst would not argue that the London Heliport becomes solely responsible for the onerous task of safeguarding such a large area, believe it would be a logical area within which CAANATS and London Heliport could work together with the DLGC to protect London-wide low-level helicopter and other fixed air traffic (since not all of it uses London Heliport) focus for the London Heliport would be the area within and immediately adjacent to its ATZ, with a wider "on-route" and "off-route" responsibility passing increasingly to NATS and CAA further away from the London Heliport ATZ Current List of officially safeguarded aerodromes This list includes many privately-owned important regional airports, including one which is currently closed and unlikely to ever re-open (Plymouth) and others such as Blackpool and Coventry which have come close to closure: Another; Carlisle currently has no commercial air transport operators. Also listed is Penzance which is now closed having the only dedicated heliport facility on the list; it served the Scilly Isles until closure and transferral of the scheduled helicopter service to Lands' End Airport before this ceased to operate: There is a precedent therefore for safeguarding of a heliport in the public interest for commercial air transport operations (albeit not scheduled services) rather major aerodromes.
5. Future safeguarding arrangements under European Aviation Safety Agency (EASA) A form of official safeguarding will happen through the statutory provision of aerodrome data which is part ofthe increasing scope of EASA law concerning all airports of a certain size and complexity which in time may also include heliports within its scope (this currently only The London Hellport Ltd, Brldges Court, Battersea, London, SW11 3BE Reglstered Oftice: 4t Floor Millbank Tower, 21-24 Millbank, London SWIP 4QP Registered in England & Wales: 04546128 key City wing The- been

The London Heliport applies to aerodromes with a certain level of passenger throughput; runway length which also use radar): Given the pace of development of Central London and the number of tall buildings either under development or at the planning stage it seems expedient to not wait for this to become law in order to secure the future ofthe heliport facility and meet the recommendations of the coroner report into prevention of future deaths following the inquest into the Vauxhall helicopter crash on 16th January 2013. A unique facility The London Heliport is the only licensed Heliport in London: It was the foresight of Westland Aviation (now part of Finmeccanica-Agusta Westland), who as custodians ofthe post Second World War helicopter manufacturing industry; founded the London Heliport in 1959to prove the viability of an urban business heliport: Thanks to its unique design combined with the flexibility of operation of helicopters and their continuing technical and developments, including new designs and technologies, the London Heliport remains a relevant; viable operation after 55 years of operation: Review of current official safeguarding arrangements Although the official safeguarding system may have been established after the Second World War when certain aerodromes were identified as being important for the national transport system, the process has now been extended to other sites, such as Airport so it cannot be right to treat London Heliport differently and be excluded: The London Heliport has similarities in strategic importance with other aerodromes albeit in some case for slightly different reasons due to its specialisation as a facility for helicopters_ In conclusion the London Heliport remains committed to pursuing an officially safeguarded status and working with the aviation regulator (CAA/ EASA); local government (DCLG) and the on-route air traffic service provider (NATS) for the safeguarding of the London Heliport and the wider network of routes in the London area used by helicopter air traffic The London Heliport Is currently awaiting a response from the DfT to the case made above for official safeguarding

Peterwood

24 Feb 2016 PDF

Action Planned

• The Flight Operations team is conducting a review of the safety of onshore helicopter operations in the UK this year. • The review will include a post implementation review of the Standardised European Rules of the Air (SERA). • The CAA will work with the helicopter community to consider whether there are any recommendations or industry best practice that could be incorporated into regulation or regulatory guidance material. (AI summary)

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Dear Sir IN THE MATTER OF AN INQUEST TOUCHING THE DEATHS OF PETER BARNES AND MATTHEW WOOD (DIED 16.01.13) (BATTERSEA HELICOPTER CRASH JOINT INQUEST) CIVIL AVIATION AUTHORITY RESPONSE TO REGULATION 28 REPORT TO PREVENT FUTURE DEATHS Thank you for your Regulation 28 Report to Prevent Future Deaths dated 4 January 2016 relating to the Joint Inquest into the deaths of Peter Barnes and Matthew Wood. The Civil Aviation Authority ("CAA") has carefully considered the matters of concern raised therein and have been asked by Andrew Haines, Chief Executive, to respond on behalf of the CAA. Details of the actions to be taken by CAA in order to help address your concerns are set out below. H4
1.1 The first matter of concern that you raise is the need to expedite specific review of H4 including consideration of need to alter the flight rules, in order to assure the public of on-going safety
1.2 As you know, the London airspace is highly regulated and has good safety record: Nevertheless the CAA routinely conducts on-going regulatory oversight and, as part of this role, the Flight Operations team ("Flight Ops") is in the process of conducting a review of the safety of onshore helicopter operations in the UK this year. This follows the recent review of offshore helicopter operations. The review will include a post implementation review of the Standardised European Rules of the Air ("SERA") which came into force in the UK on 4 December 2014
1.3 The CAA will work with the helicopter_community in_order to_consider_whether there are any recommendations or industry best practice that could be incorporated into regulation or regulatory guidance material, in order to enhance the safety of the UK airspace An initial meeting was held on Wednesday, 20"h January 2016. Helicopter pilots represented Clvll Aviation Authority CAA House K5 45-59 Kingsway London WC2B 6TE WMMWY.caa.CO.Uk Telephone 020 7453 6160 Fax 020 7453 6175 kate staples@caa.co.uk the any

by the British Helicopter Association were invited to raise any areas of concern and to propose operational improvements_
1.4 The review will consider the safety of the London airspace, including H4, in order specifically to address your concerns_ It is appropriate_for H4 and the flight rules to be assessed as part of this wider review for {he following reasons: (a) the flight rules apply to the UK airspace as a whole, are not specific to H4 or the London airspace; (b) low level Visual Flight Rule ("VFR") helicopter flights that take place in the vicinity of tall structures are not unique to London; within the London airspace, the low level VFR obstacle environment; situated below the extensive Instrument Flight Rule commercial air traffic for London Heathrow and London City airports, is not unique to H4 or indeed the heliroutes: most helicopters transiting the London Control Zones are now twin-engine and do not fly on the heliroutes; and (d) H4 is only one of a number of VFR helicopter routes within the London Control Zones which are subject to detailed requirements and operating provisions Consequently, any potential changes to the use of H4 or the applicable flight rules are likely to have wider applicability andlor implications and must be considered both in the context of the wider UK and the other portions of the London airspace.
1.5 This review is scheduled to be completed by 30 September 2016.
1.6 In sum, the review will enable the CAA to identify and assess whether there are any high-level safety issues common to all onshore UK helicopters and (i) any more specific safety issues affecting the London airspace, including, but not limited to, H4.
1.7 In considering whether to implement any changes as a result of this review; the CAA must act in accordance with its statutory duties Whilst the CAA's primary duty in relation to its air navigation functions is to maintain a high standard of safety in the provision of air traffic services, it must also have regard to the following duties (amongst others)?: (a) securing the most efficient use of airspace consistent with the safe operation of aircraft and the expeditious flow of air traffic; (b) satisfying the requirements of operators and owners of all classes of aircraft; and (c) taking account of the interests of any person (other than an operator or owner of an aircraft) in relation to the use of any particular airspace or the use of airspace generally_
1.8 Compliance with these statutory duties requires the careful exercise of judgment to strike a balance between potentially competing interests. Thus by way of example; in relation to the suggestion that it would enhance safety if higher minimum altitude (above 500ft) across London were implemented, the CAA must carefully assess the fact that this could generate a new safety hazard by compressing VFR traffic into a narrower vertical band of available airspace below the controlled airspace above, potentially increasing the likelihood of VFR conflictions Furthermore, the CAA is obliged to be mindful of the fact that this could significantly restrict helicopter operations over London since it would reduce the The British Helicopfer Association is non-profit trade organisation that represents the UK's civil helicopter industry. See Section 70 of the Transport Act 2000 they

available airspace below the Instrument Flight Rules traffic routing in and out of London Heathrow and London City airports. This could adversely impact helicopter operations in general and could restrict access to the London Heliport Planning
2.1 The second matter of concern that you have identified is as follows: "It is not clear that helicopter aviation considerations for the Heliport or more widely for flights along the Thames are adequately considered in the planning processes for tall buildings. It appears that little or no progress has been made in considering the need to safeguard the heliport or implement AAIB Recommendation 2014-30.
2.2 The CAA supports the London Heliports application to the Department for Transport ("DfT") to become officially uarded. The CAA is currently providing support to the DfT in order to assist with the preparation of an official safeguarding map for the Heliport 2,3 We note that in relation to this accident; the Heliport would not have been consulted even if it had been officially safeguarded as St George Wharf is not situated in the relevant area: it is too far away from the London Heliport:
2.4 Consequently, as the CAA explained in the course of evidence, it agrees that implementing the AAIB's Recommendation 2014-030 would enhance safety. As you will recall; the CAA actively encouraged the AAIB to include recommendation of this kind in its report: Recommendation 2014-030 states as follows: "It is recommended that the Department for Transport implement measures that enable the Civil Aviation Authority to assess, before planning permission is granted, the potential implications of new en-route obstacles for airspace arrangements and procedures
2.5 Obstacles such as St George Wharf that are located outside of safeguarded areas are known as "en-route obstacles" If this Recommendation is implemented it will mean that the impact of all obstacles (i.e. any building or works extending 30Oft or above) on airspace arrangements will be assessed either by an aerodrome operator or by the CAA at the pre- planning stage.
2.6 We understand that the DfT is also keen for _implementation of Recommendation 2014-030 to be progressed. An initial meeting took place on 8lh February 2016 between the DfT and the Department for Communities and Local Government ("DCLG") to this end, The CAA will actively engage with and support the DfT and DCLG in this regard,
2.7 The CAA will keep under review, both when implementing the outcome of Recommendation 2014-030 and when considering, on a case by case basis, pre-planning applications and as part of the on-going review of onshore UK helicopter operations whether it becomes necessary to implement an equivalent to the London Tall Buildings Policy in order to maintain safe access routes for helicopters approaching London aerodromes and for those transiting the London (City) and London (Heathrow) Control Zones. Safety Culture
3.1 The CAA is mindful of all the findings of your jury, including the conclusions that Mr Barnes should not have attempted the flight, lost situational awareness and was to have felt under pressure to land at Battersea_ In addition to conducting the review discussed above the CAA is planning to hold seminar later this year on safety culture for the commercial safeg likely

helicopter industry: This subject is also addressed by the Corporate Aviation Safety Executive through its onshore helicopter section We trust that the above is of assistance_ Please do not hesitate to contact either myself (Kate.Staples@caa co.uk) or Serena Lim (Serena Lim@caa,co.uk) should you have queries_

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Report details

Reference: 2016-0001-wp25050
Date of report: 4 January 2016
Coroner: Andrew Harris
Coroner area: London Inner South

Responses identified

Responses identified 2 of 3

1 response not yet linked

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 29 Feb 2016 (estimated).

Sent to

Civil Aviation Authority

Department for Transport

London Heliport

Source links

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Data: judiciary.uk under OGL.