On 8 November 2011 Flt Lt Sean Cunningham was stationary on the ground at his Lincolnshire airbase when his seat inadvertently ejected him, propelling him 200 feet in the air. Whilst parts of the ejector seat system deployed and inflated correctly, the main parachute failed to deploy causing Flt Lt Cunningham to fall to the ground and suffer fatal injuries.
Investigations had found that two RAF engineer technicians had conducted a routine inspection of the Red Arrow's Hawk a number of weeks prior. However, during the reconnection of two shackles, they tightened the nut onto the bolt too tightly and it was this over tightening which stopped the main parachute deploying.
During the investigations conducted by the HSE, it was discovered that there had been numerous failings made by MBAL which materially contributed to Flt Lt Cunningham's death. MBAL had failed to issue the RAF/MOD engineers with updated guidance or warnings in relation to the over tightening of the nut, despite doing so in other jurisdictions, and the warnings they did issue contained incorrect information. They had also been on notice of potential issues with the ejector seat system as early as 1990 when McDonnel Douglas (US military aircraft manufacturer and defence contractor) and BAE systems wrote to them with their own concerns. It was submitted that MBAL failed to properly grapple with these concerns despite the risk of non-deployment of the main parachute specifically being raised.
MBAL pleaded guilty to breach of s.3(1) and s.33(1)(a) of the Health and Safety at Work etc. Act 1974 on 22 January 2018.
The Judge determined that the breach was of a serious nature and the categorisation of harm was at the upper end of Category 2 of the Sentencing Guidelines. She noted there were numerous failings within the company. This included the inconsistency in timing and destination of the distribution of updated guidance and the failure to properly act on concerns raised, both of which suggested a lack of attention within MBAL to the detail and significance of the issues. As a result, it was held that MBAL had exposed a significant number of pilots (and passengers) to the risk of serious harm and potential death from 1990 onwards.
The Judge concluded the appropriate starting point for the fine was £1.45m. This was reduced to £1.25m following mitigation arguments that the company was credible, had a good health and safety record, showed genuine remorse and regret and had fully cooperated with the investigation. For a late guilty plea, the Judge allowed a further reduction of 12% reducing the final sentence to be imposed to £1.1m.