Category: Travel

Future of Aviation: Enhancing Safety and Resilience

The aim is clear. A safe, secure, sustainable and resilient international aviation system. I’d add to that list an ambition to continuously improve.

And that’s in the face of the challenge that was recognised 30-years ago. With an aviation system that knows how to archives a high level of safety, even incremental improvement is challenging. Factor in projected air traffic growth that’s unabating. What we know is that that continuously improving the global accident rate requires active interventions. 

Since here I can only highlight the key priorities, I’ll choose three aspects of active intervention. Back to what I said earlier in my talk. Aviation is still climbing that maturity ladder.

Digitisation has facilitated a growth in proactive work. Initiatives and plans identify actions aimed at solving known aviation safety problems. But the next step remains some way off. It’s that ability to anticipate safety problems before they occur. To predict.

We have the notion of safety intelligence. There are Big Data projects that are gathering large quantities of aviation safety data. Today, what might be called prognostics continues to depend on expert judgement. That’s not negative. In fact, that augmented by objective safety intelligence is a route to the next step in maturity.

In my view, here’s the three categories that must be addressed now and, in the next decade.

  • One is a foundation stone of aviation safety work. It’s the capability and will to react in a timely manner to events. Not just accidents and serious incidents but any event that elevates aviation safety risks above acceptable levels.

Top operational risk that are likely to need immediate actions are those involving loss of control and those concerning runway incidents.

To take timely corrective action the results of investigation need to be readily available. As pointed out by the industry, across the globe, there’s much scope for improvement here. Timeliness matters.

  • My next category is that of systemic risks. System wide safety risks. People, organisations, processes, procedures, the human factor and human performance issues.

Much is being done to ensure the effective implementation of safety management systems (SMS). The four pillars of SMS have proven to work – safety policy, risk management, safety assurance and safety promotion.

The elimination or mitigation of risks is not an act that begins on one day and stops on the next. Digitation can help but there’s always the dangers of the needle in a haystack or even a problem sitting in plain sight.

What’s often weak is the communication of what’s discovered. Believable, understandable straightforward communication to decision makers is vital.

  • Thirdly, what’s ahead of us is an order of magnitude more complex than what’s gone before. And a rate of change that mindboggling.

I’m calling this emerging aviation safety risks. The question arises; are we ready for advanced leaps in technology? Hydrogen, hybrid propulsion, machine learning, quantum computing, complex airspace networks and robotics. Humans as executive manager whilst retaining control only in emergencies.

It’s a famous quote; data is the new oil. We are ushering in extremely large and complex datasets that will be essential to the workings of automated and autonomous systems. Could data be the new quicksand? This is a huge issue in dense airspace where crewed and uncrewed aircraft must share the airspace.

Another emerging aviation safety risks, that industry and regulators are starting to address is the fact that safety and security have become inseparable. In the past, these disciplines were addressed as silos. That’s no longer viable.

Another emerging aviation safety risk is that of the workforce. Aviation has attracted dedicated professionals who acquire experience and train to a high level of competence. A safety culture is embedded. In this respect the fundamentals of safety remain constant.

The rapid growth of technology is a two-edged sword. Now, there are many opportunities for future generations, but aviation may not be at the top of the list of choices. As it was in the past. There’s a serious aviation safety risk if investments are not made and people are not motivated and able to gain the competencies needed by a rapidly changing industry.

To sum up. Everything I’ve spoken of can only be addressed in partnerships. In the past, the aviation industry and its regulators have proven themselves to be imaginative, resilient and forward looking.

The challenges ahead, dare I say, are even greater. Levels of integration, interdependency and rapid technology adoption are off the charts. Yet, I believe we can continually improve global aviation safety. We can step up.

Current State of Aviation Safety: Data-Driven Insights

The present day. Today. There will be Press Releases galore at this air show. I expect ambitious and upbeat predictions. More orders. More growth. More developing markets. Demands for more skilled people, more performance, more pressure for the early adoption of rapidly changing technologies.

My subject is safety. Where are we with aviation safety in the present day? There’s a sound legacy. Afterall aviation has a long tail. What we have now, and if I look at the Farnborough Airshow catalogue of ten years ago[1], is digitisation. The ambition to be data-driven. A continuing drive to exploit data of all kinds. Extracting information from ever increasing sources in aviation.

This desire for actionable safety intelligence is not new. On my desk I have a coaster celebrating the UK CAA’s MOR Scheme[2]. That’s been alive for 50 years (1976-2026). Occurrence data has been, and is being, used to construct all sorts of safety performance indicators. These indicators can be useful but it’s not always so. They are fuel for safety management systems.

I used the word “actionable” with purpose. Today, making the results of safety data analysis useable by front-line actors and responsible managers has been a challenge we wrestle. I’ve often heard it said – that’s great but what do I do about it? Too many “greens” on a chart and complacency can set in. Too many “reds” and everyone goes into panic mode.

I have been fortunate to work with a number of safety initiative. One called the Commercial Aviation Safety Team (CAST) in the US. To match its work, on this continent, I set up a European version; ECAST in 2006. The focus was on data-drive analysis. There’re safety teams for Rotorcraft and General Aviation too.

These initiatives came about a reactive way. Reporting in 1997, the Gore Commission, was a reaction to dilemmas that is still with us. What to do in the wake of catastrophic accidents. And more pertinent to this talk; what to do when the global accident rate curve looks flat at the same time as predictions are for a significant growth in global air traffic. Reading this report now, the predictions were horrifying. Predictions of one large aeroplane fatal accident every week by now. Luckily, commercial air transport didn’t suffer that fate.

I should NOT say “luckily”. Current safety performance is down to an enormous amount of work done by thousands of aviation professionals over a sustained period. Not only this but shocks, whether they be financial crisis, volcanic eruptions or global pandemics, have tested our industry severely.

Taking on board what was learned over the decades, safety management has developed and matured. Incorporated in aviation’s safety regulatory framework, it’s now practiced across the whole industry. Almost. We don’t just react. We now have Safety Plans. Lists of actionable tasks aimed at continuous safety improvement. On the scale mentioned earlier we are proactive.

Let me stop. This is not a utopia. I’d say at least half the global aviation industry is struggling with the need to be proactive. So, the road we are travelling on remains a long one. We don’t just need the capability to do better; we need to maintain the will to do better.

[1] 50th Farnborough Air Show in 2016.

[2] https://www.caa.co.uk/about-us/make-a-report-or-complaint/report-something/mor/occurrence-reporting/

The Evolution of Aviation Safety: A Historical Overview

A quick tour of the history of aviation safety. In a couple of minutes.

As powered aircraft took to the skies it quickly became apparent that, of all the means of transport, aviation was less forgiving than others. Moving at speed in four dimensions, with the necessity to take-off and land safely, has inherent risks. By no means does this mean that flying is an dangerous activity. What it does necessitate is an exercise of sound engineering, preparation, and proficiency. When these are missing, and in cases of misfortune, accidents and serious incidents happen.

In the days between the two world wars, aviation moved from the military and a circus-like amusement to a viable means of public transport. Progressively, more passengers had the opportunity to experience the wonders of flight.

Today, it’s not the early days of flight I want to focus on, but we do owe the engineers and aviators of that time a great debt. Much was learned as aeronautics matured. Since the end of the second world war the production, promotion and application of standards has embedded what had been learned. This has established the way that civil aviation works.

One simple expression of the stages we’ve been through is Patrick Hudson’s[1] maturity model. This model describes five distinct levels of cultural maturity. The steps are pathological, reactive, calculative, proactive and generative.

This sits alongside the steps in the development of technology that has been a hallmark of aviation safety. Different categorisations exist. Helpfully AIRBUS[2] have one that is easily understood in terms of generations of civil aircraft.

First are the “classics” of the 1950s and 60s. Next, the second generation starts down the road of more electronics. More safety critical systems. Third generation starts flying in the early 1980s when automation becomes the norm (early fly-by-wire, glass cockpits, flight management systems). The fourth generation introduces safety systems, which address the major causes of fatal accidents, namely Controlled Flight Into Terrain (CFIT) and Loss Of Control In-Flight (LOC-I). That’s the early 1990s. When I made that transition from industry (design and production) to an aviation safety regulator.

Now, I’d say we are well into fifth generation aircraft, with composite structures and integrated modular avionics. In fact, we are well into speculation about what the sixth generation may look like. Machine learning, single pilot operations, hybrid powerplants, aircraft as a node on a network.

Because aviation is a learning industry, and a conservative one, the expectation is of a progressive improvement in maturity throughout the aviation system and innovative technology applied to enhance safety.

This is not to say that the potential for error, missteps and recklessness don’t exist. They do. I expect continuity in a way that takes full advantage of advanced methods without scarifying the legacy of an astonishing good global aviation safety achievement.

Later, to cover a lot of ground in a short time, I’m going to condense all the above into three distinct categories. But before that, I’ll talk about the present and a vision of the future.

POST: UK Farnborough Air Show on Thursday 23rd July 2026.

Time: 13:00-13:15 BST. Location:  Hall 3 Stage.

Session title Where Next for Aviation Safety?

[1] https://www.sciencedirect.com/science/article/abs/pii/S0925753507000227?via%3Dihub

[2] https://d10x.airbus.com/generation-of-jets/

Seasonal Changes

When summer is at its peak, winter is easily forgotten. The reverse is true too. When winter is at its peak summer is a million years away. That’s the experience we have here on the British Isles.

So, it is to live on a spinning planet with an incline. That variation in seasons is the clock by which we live. The slowly shifting path of the Sun as it appears to move with the seasons. Of course, the Sun doesn’t move relative to the Earth. It’s our planet’s inclined rotation that makes the difference. How that came about we will never know beyond some good theories.

I might say something that an expert will say is nonsense. Can you imagine Stonehenge being bult in a people who live on the Equator? A place where the Sun spends much of its time high in the sky. At our Northern latitude, its movements maybe more significant than any other fact.

I wonder if seasonal variations and their impact go wider than dictating the weather? The British Isles is a pace where we are attuned to variations. Rarely extreme variations.

The sentence I started with alludes to an almost schizophrenic attitude to wide ranging variations. Normal would be a summer-winter cycle between say; plus 25 and minus 5 on the Celsius scale. Going outside those moderate thermal bounds causes a lot of heads scratching and newspaper column inches.

Britan’s story is a full one. Look deeply and so much is seasonally dependent. Even wars were shaped by the passing of the seasons. Yet, overall, much is built assuming moderation. It’s one reason air-conditioning is a rarity in a domestic setting. Structures are more designed to keep the wind and rain out than other considerations.

Now, we are experiencing unusual heat. Records are falling by the wayside. Once lush green lawns are looking like brown dirt, concrete hard, parking spaces. That is unless their owners sprinkle oceans of water over them on a regular basis.

Here’s the odd bit. It’s more socially acceptable to save a lawn than it is to own an air conditioner. True, portable air conditioners and fans are flying of the shelves. However, the general attitude is that these are to be used in exceptional conditions. They will be returned to a corner of a garage, to gather dust, after just a few days use. Thus, considered to be a luxury.

A hosepipe doesn’t fit into this category. Commonplace. Certainly, no luxury. Watering equipment of infinite variety is prominently placed in every DIY store. When it happens, a hosepipe ban feels like an afront to personal freedom.

Our habits and behaviours are conditioned by an experience of decades of relative moderation. The idea of building houses with shutters or generous ventilation still fit the bill as being usual. Something done in other, hotter countries.

Our reaction to climate change is fascinating. Hardly surprising in that the normal human reaction to change should tell us a lot. A fair degree of denial is nothing unusual. Put aside those who react early, the inevitable inertia deep in our society takes its toll. Whatever attitude to the causes of climate change may prevail, adaptation is a wise course of action. That said, wisdom is often in short supply.

The builders of Stonehenge knew how to adapt to the seasons. Possibly taking note of their variations. Dare I suggest a modern henge as a symbol of our recognition of the need to adapt?

Traveling Through Time

My first trip to America goes back 45 years ago. Our PanAm flight departed London Heathrow on 25th August 1981. We were booked on a Fly / Drive package on our way to Seattle.

This was the country where Ronald Reagan had taken up the Presidency, earlier in the year. For nerds, like me, it was the start of a revolution that eventual touched us all. The IBM Personal Computer (IBM PC) was launched on the world in August 1981. It became a standards setter for everything that followed.

What was state of the art then is now described as “classic”. The PanAm Boeing 747 we flew on across the Atlantic was of the first generation of that massive passenger aircraft. Still, at the time, an object of wonder. My traveling companions and I were completely wide-eyed about America. There was definitely a feeling that we were leaving a depressed, rebellious, troubled country to visited one that was huge, just like the jumbo jet, full of adventure, optimism and possibilities. The old world to the new world.

The four of us had planned our trip meticulously. Sharing the driving, a couple of days here then a day there, constantly on the move from motel to motel. In the end we did over 6000 miles up and down the West Coast. Getting to know Interstate 5.

What of the America today in comparison with the Amecia of 45 years ago? For one, I don’t have to go far to find a Starbucks anymore. Coffee shops in Seattle were once special to that city, now there are everywhere. Then gambling was the specialisation of cities like Reno and Las Vegas. Now, the internet is festooned with gambling of every conceivable kind.

Those folk easily classified as the nerds of their time, started small businesses in Silicon Valley with an aim to change the world. Guess what, they did.

Some of the grandest, most awe-inspiring aspects of West Coast America haven’t changed. The immense landscape. Mount St Helens, The Rocky Mountains, Crater Lake, Death Valley, San Francisco Bay and even the freeway sprawl of Los Angeles.

There were lots of comedy sketches about Ronald Reagan and his background as an actor. Now, when listening to several of his well-crafted speeches, appealing presentation, and humour, the distance of time sheds a different light on him. The loss of professionalism that marks 2026 is a great shame. It doesn’t matter which side of the political divide.

Today we talk about the world being more dangerous than it has been in decades, at least a couple of decades. What we conveniently forget is that the Cold War was in full swing in 1981. Now, I live near Greenham Common. Back 45 years, that was a site for American nuclear missiles. The site of a legendary peace camp too. Maybe there are inevitable cycles in history. We are destined to repeat the mistakes of the past. Or more accurately old men are destined to repeat the mistakes of the past.

What have we learned? In politics, it does matter what you say. In business, innovation and optimism win out over caution and pragmatism. In conflict, nothing much changes.

In travel, wanderlust never dims.

Happy July 4th.

Will Andy Burnham Lead a New Era?

It’s not so unbelievable. With the volatility of politics in the 2020s, that a leadership role flips from one person to the next in the blink of an eye. The man tipped to run the country has won one constituency in his hometown. Now, lots of people envisage him in the biggest of jobs, sweeping aside the wows of recent years.

One view of this change is that the decades of past allegiances, that we almost took for granted, have now dissolved. The way we view others in our society has become far more complex.

British comedy is littered with these stereotypes. Comic strip characters. Property owning, upper middle class, broadsheet newspaper reader equates to a Conservative. Open toed saddle, tweed jacket owning teacher who goes on improving camping holidays, a Liberal. Football supporting, factory worker, from a generation of factory workers almost certainly a Labour supporter with Socialist friends. At the margines, long retired colonel who inherited a large countryside mansion and estate may even be a Fascist. These animated cartoon images persist. What’s different is that there are dwindling numbers of them in society at large.

Initialled AB, Andy Burnham, comes to us as a smiling face. Down with the people in a way Sir Keir Starmer found incredibly hard. AB has charm and a warm accent that suggest a relaxed demeaner. He talks with enough wriggle room for a wide swath of people to think that he’s on their side. A good skill to have to be successful in politics. As it is, what he stands for when push comes to shove isn’t so easy to discern.

In know the spelling is different but it’s out there in social media land. The fictional Birnam Wood, a forest near Dunsinane Hill in William Shakespeare’s Macbeth. A place of prediction.

[That was one of the texts our teachers chose for us in my school days. Maybe they imagined troubled times ahead. Or wanted to warn us of power’s potential corrupting effect].

Three witches appeared to assure Macbeth that he was a winner. Only seemingly impossible events would defeat him. The message was critic. Bit like the Oracle of Delphi in the ancient Greek world. Nothing like recycling a good idea.

The British media’s prophecy is that Burnham will quickly step into the job of UK Prime Minister and restart the Labour Government with fresh vigour and new imagination. Not to mention better public communication. The constituency who thinks he’s a potential saviour is much bigger than the consistency who thinks he’s a devil in the making.

Will ambition and power’s potential corrupting effect take a hand. Or will the man with the name: “King of the North” have accumulated the knowledge and experience needed to shape history to the country’s benefit. A good sprinkle of luck will no doubt be needed too.

Despite what has passed in our post-Brexit land. UK PM’s coming and going, will Burnham be a force for good? I wouldn’t say past performance is any predictor at all. Making the buses run on time in Greater Manchester is a far cry from being a political party leader and UK PM.

I, as do so many, wish him a fair wind. Let’s hope he and his team can get to grips with the need to adapt, change and even be disruptive where it’s warranted. I hope he will not shy away from big decisions or be cowed by either his own side or the perfidious British right-wing media.

Reflecting on a Decade Post-Brexit: Lessons Learned

The clock has clicked. The pages of the calendar have flipped. Crises have been and gone. And in the UK’s political turmoil continues to exasperate one and all. A decade has passed since UK voters backed a proposal to leave the European Union (EU). The surprise result of the 23 June 2016 vote and the tiny majority for change still haunt the whole country.

Voters were told this and that would not happen, prosperity and a lowering of the cost-of-living were just around the corner. We now know that lie after lie piled-up. The mouths of the advocates of the vote to leave spouted pure undiluted nonsense. Yet, the noisy ones show no remorse or shame.

The pace of change can be overwhelming. Over the last decade the world has moved on with increasing speed. It’s self-evident that the 21st Century is becoming an era of accelerating change. Sadly, in adopting the worst kind of Brexit transition the UK has become a lesser influence. A spectator in the world that has changed dramatically.

The first 10-year anniversary of the Brexit referendum is a time to take stock. To be mystified in reflection of the maddening goings on of the years past. I will not repeat pages and pages of analysis that others have provided. A simple conclusion is evident. The nation is poorer by a substantial amount.

I’m not in favour of endless navel gazing. We are where we are and it’s not a good place to be. What must be plotted in a way forward that increase prosperity, builds resilience and unseats defeatism. Political polarisation and the slide to appease the far-right is proving to be disastrous. The warnings of history should be heeded.

The future of the UK-EU relationship has the potential to be better one than ever before. At least we now know that there was good sound reasoning behind our past membership of the EU. Facing global challenges together is a far better way to face the future. Rapidly advancing technology, social upheaval and geopolitical shocks are not going away. The means by which we collectively respond to these challenges will be critical.

This is not a time to relitigate the Brexit referendum. Let the past be the past. We have learned from that past. It’s far better to ask what a better future looks like. Europe has common challenges. It’s an interconnected, interactive and interdependent region. We share a common cultural heritage.

Discussions over the future will never abate. But there’s a need of it to be put on solid and sound reasoning. Not by equating independence with isolation. Weve found that doesn’t work.

The UK and EU must forge a new closer relationship. It’s a win-win scenario.

Perceptions of Aviation Professionals

Let’s see what aviation stereotypes look like. There’s a wide selection of free images on-line. There’s a typical view of the crew of an aircraft. It didn’t take long to find one.

I can point out the obvious gender related features of such images, but what first caught my eye were the aircraft engines. They were way to far out on the wings. I suspect our good friend artificial intelligence may have generated such a colourful image.

Now let’s go for an Air Traffic Controller. The image that came up did have plus points. It did give an impression of what a controller’s job is about, at least as much as a simple graphic image can. I did expect to see a radar screen with dots on it as part of the image. A controller sitting at a desk with buttons to press and a window to look out of sums up the basic picture.

Next my on-line search was for an aircraft mechanic. Now, I started this search with low expectations of what might come up. The picture I got was of a hanger with two large aircraft to the left and right. Standing in the middle of this scene was a man in overalls moving an aircraft engine on a trolly. Proportions were off, in that the engine diameter was half the hight of the mechanic. Yes, the stereotype of a workingman with a spanner persists.

So, what have I discovered? Not much really. Or not much that didn’t fit the title of time-honoured stereotype. Images that pigeonhole jobs as done by people who dress in a particular way and are surrounded by the equipment of their trade. Roles, age, race and gender are fixed in a traditional pattern. I do draw the conclusion that, for all the daily hype, artificial intelligence is not going to do anything original when faced with a simple question about specific job.

This isn’t good. If the latest advance in technology is locked into classical and predicable images from the archives, then it’s not so advanced at all.

Why does this matter? Well, there’s a great deal of concern about where the next generation of professional in aviation are going to come from. Our wish to fly is affected by lots of social, environmental, and economic factors. Overall, the trend over coming decades is in one direction – up. More flights, more aircraft, and the need for more people to operate the system.

If the generic images of the professional roles in aviation are stuck in the past, then that’s not going to help. It’s off-putting. There are those young people who may find the traditional professional stereotypes appealing. My guess is the majority are unlikely to think this way.

In an on-line environment where artificial intelligence regurgitates the past this technology may drive us backwards. Not for one moment does the image of a workingman with a spanner need to be demoted. What needs a touch of imagination is a portrayal of images more akin to reality. A changing reality too.

[Yes, the title image is an appropriately prompted artificial intelligence generate one provided by WordPress].

Brexit Documentary Review

Firstly, a reaction to the BBC documentary that’s telling the story of Brexit. They called it “Brexit: A Very British Civil War[1].” A corny title that plays on titles “A Very British Scandal,” the drama about Liberal MP Jeremy Thorpe and “A Very Royal Scandal.”

The “Civil War” analogy is out of place. Ten seconds of reading about any real civil war would have sunk that illusion. The events of 2016 were more a battle for the future. Battles continue to rage as the advocates of Brexit have merely changed their colours and rebranded.

Yes, I agree. The stage was set by the choice that voters took in 2015. In fact, if blame must be allocated then its as much the fault of liberal minds as it it’s the reactionary forces that pounded away at their ambition. The political idiocy of promising a national referendum in a country that rarely, if ever, has referendums was a critical folly. The UK is not Switzerland. UK voters have no idea what it’s like to be that sort of federal democracy.

David Cameron won a majority and his hand were tied. He did have choices, but he plodded along with all the imagination of a dull public-school boy in fear of rejection by his peers. Cameron didn’t see the bus that was about to hit him. Having been pounding away for decades the rag tag but monied pushers of a referendum wasted no time in campaigning. Cameron wasted every opportunity.

Aside from the story that the BBC chose to document is the image of a modern European country run by a strange herd of mostly Tory men, living a privileged life. It’s a searing display of a political crisis made by a few for the interests of a few.

I know it is said by both left and right in UK politics, but what more does anyone need to convince themselves that there’s a chasm between the people in Westminster and the people of the nation. Demographic trends were likely to shape the outcome of a national referendum. It proved to be so in the numbers. An older age group favouring Leave and a younger one favouring Remian. Populism had taken root in the Leave campaign.

The dim-witted organisers of the Remain campaign ran a campaign as if they were changing the name of a chocolate bar with diminishing sales. As if they were stereotypical comic depressed bowler hatted businessmen from the 1950s, Cameron’s crew ignored the analysis and lumbered on. He took a politically suicidal path.

The likes of Boris Johnson and Michael Gove dithered with only their own political ambitions tugging at them to eventually decide as to which way to go. Again, my reflection amounted to – what a bizarre way to run a country. Especially one with the history and traditions of the UK.

I understand the notion that Cameron may have seen this political path as a way of resolving a self-evident Tory split once and for all. Ironically, the outcome is a Tory split the like of which couldn’t have been imagined ten years ago.

Deciding whether to back Leave or Remain wasn’t the real question. Capturing the future political agenda was the aim. 2016’s national referendum was not a war; it was a battle. The battle continues.

[1] https://www.bbc.co.uk/programmes/m002xhvj

Lessons from Operational Events

For an aviation industry that takes pride in learning lessons from experience and taking timely corrective action, a series of operational events is surprising to say the least.

Today’s large aircraft do look much the same. The tricycle undercarriage has become universal. A set of steerable wheels at the front and a heavy set of landing gear, each side, to the rear. When parked, a nose gear collapse or inadvertent retraction on a large aircraft is not catastrophic. The aircraft can be recovered, inspected, and repaired. This undesirable event can be dangerous for anyone in the vicinity. It has the potential to be fatal. Fortunately, so far, there has been no fatalities.

For an aircraft operator such an event at an airport gate is a massive expense. Putting an in-service aircraft out of action for a considerable time.

To date, several damaging nose gear collapse (and alike) events have occurred to large aircraft[1]. Detailed analysis of these events exists and corrective actions are proposed.

One conclusion is to say that this is about people not following procedures. That is the instruction is to put a pin in one place but instead it gets put in the wrong place. So, this dramatic unintended event is written up as a maintenance error. It’s an outcome that no one intended. That’s fine. There’s no doubt that an error was made. Accepting that an error occurred is not a reason to blame. That is if there are no signs of negligence.

The trouble is the simple question – how easy was it to make that error?

Then we get into that grey area of the gap between aircraft design and operations. In a design office it may be reasonably assumed that a procedure will be followed in an almost robotic manner. No need for the people in operations to think beyond taking the same action day-after-day. This would surely become widespread practice.

As we know the actual environment of aircraft operations can be more demanding than the original equipment manufactures might imagine. Pressure to turn around an aircraft can be high, working conditions can be poor and fatigue can play a part.

There are lines of communication between the aircraft design and operations organisations, and such difficulties are regularly discussed.

Faced with an event categorised as maintenance error then what next? Redesign the aircraft? Change a procedure or require more training? Those are three of the options, there are more.

This is where the possible discussion gets reactive. Now, it would be extremely costly to redesign an aircraft for the sake of an event that is rare or for which the consequences are minor. It is possible to put numbers on each of these. The rarity, the cost, and the impact.

Modifying or rewriting a procedure, on the other hand, can be less costly and it may be quite sufficient as a corrective action. That said, any procedure that can be written can be subject to error. In fact, the original procedure may have been straightforward and well thought out.

Then there is the fall-back position. Give the people in aircraft operations more training. The assumption being that more training means less errors. It is a crude assumption because this is not a linear relationship. So many other factors come into play.

Discussions surround the above possibilities can become protracted. There’s a call for more analysis and more data. There’s the proposal for a study to be conducted. Once in that loop a year can go by as if it was a month.

There’s always the argument that highlights dozens of aircraft operators haven’t had this event occur and therefore the finger is pointed at those who have. This argument gets an outing, but it is foolish. It’s like saying – I haven’t had an accident yet, and therefore I’m safe. Foolish.

There are a lot of detailed discussions and a million and one opinions. Taking the big picture, this is a problem that is solvable[2]. What is surprising is the reoccurrence of the problem.

[1] https://www.gov.uk/government/news/aaib-special-bulletin-g-zbjb-inadvertent-nose-landing-gear-retraction-during-pre-flight-maintenance

[2] https://www.federalregister.gov/documents/2019/12/12/2019-26734/airworthiness-directives-the-boeing-company-airplanes