The Nimrod Review - Official Documents

The Nimrod Review
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Causation
24. If the IPT had done its job properly, there was a good prospect that Hazard H73 would have been
properly assessed and addressed, and XV230 would not have been lost.
Criticism of individuals
25. The following three key personnel within the IPT bear substantial responsibility for the failure of
the NSC to capture the risk which led to the loss of XV230 and are open to significant criticism:
QinetiQ
Group Captain (now Air Commodore) George Baber (IPT Leader).
Wing Commander Michael Eagles (Head of Air Vehicle).
Frank Walsh (Safety Manager).
26. QinetiQ also bears some share of responsibility for the failure of the Nimrod Safety Case.
General failures as ‘independent advisor’
27. QinetiQ failed properly to carry out its role as ‘independent advisor’, in particular, QinetiQ: failed
to formalise QinetiQ’s appointment as ‘Independent Safety Auditor’ or otherwise to clarify its
role at any stage; failed to check that BAE Systems sentenced risks in an appropriate manner, i.e.
using appropriate data; failed to check that BAE Systems included risk mitigation evidence in its
Reports; sent someone ill-prepared to the critical Customer Acceptance Conference; failed to read
the NSC reports or otherwise check BAE Systems’ work; failed to advise the IPT properly at the Sixth
Platform Safety Working Group meeting or ask any intelligent questions; subsequently ‘signed-off’
or supported the ‘sign-off’ of BAE Systems’ Nimrod Safety Case reports in circumstances where it
was manifestly inappropriate to do so: (a) without even having read any of them; and (b) in the
absence of an Independent Safety Auditor audit report, contrary to Joint Service Publication (JSP)
553 and Defence Standard 00-56.
Lax and compliant
28. QinetiQ’s approach was fundamentally lax and compliant. QinetiQ failed at any stage to act as
the independent ‘conscience’ of the IPT. As a result, the ‘third stool’ in the safety process, namely
independent assurance, was effectively missing from the Nimrod Safety Case process.
Causation
29. The outcome could have been different if QinetiQ had performed its role properly.
Criticism of individuals
30. The following personnel bear primary responsibility for QinetiQ’s failures:
Martyn Mahy (Task Manager).
Colin Blagrove (Technical Assurance Manager).