Investigation Summary
The aircraft, G-ACPM, was the first production Dragon Rapide and had been delivered to Hillman's Airways only two months prior. On the morning of the accident, weather conditions over the English Channel were poor, with a cloudbase as low as 300 feet and patchy rain. Despite advice from the airline's Chief Pilot to climb to 3,000 feet to fly above the clouds, the pilot, Walter Robert Bannister, chose to remain at low altitude to maintain visual contact with the ground. During the flight, the pilot struggled with radio communications, partially due to leaving a generator switched on which caused interference. He requested multiple radio bearings from Croydon, but by the time he attempted to turn south to regain his course, he had lost sight of land. While there were no visual witnesses to the impact due to the thick mist, the crew of the German vessel SS Leander provided auditory evidence, reporting a sudden roar of engines at full power immediately followed by the sound of impact. The investigation concluded that the pilot's lack of a navigator's license and his inexperience in 'blind flying' led to a loss of situational awareness over the calm, featureless water.
Final Conclusions
The Air Ministry investigation determined the cause to be pilot error. The pilot failed to follow professional advice to fly above the weather and lacked the necessary skills in navigation and instrument flying to safely operate in the prevailing conditions. The calm sea state created a 'glassy water' effect, making it difficult for the pilot to judge his height while flying low in the mist.
Video Analysis
No video analysis linked for this case file yet.
Systems & Failure Modes
Wireless Telegraphy (W/T)
The aircraft was equipped with radio for navigation bearings, but interference from an onboard generator and heavy traffic at Croydon delayed the delivery of a precise position fix.
Navigation Instruments
The investigation noted the pilot failed to use a direct compass course above the clouds, instead attempting visual navigation at low altitude in poor visibility.
Interesting Facts
- 01This was the first hull loss and fatal accident involving a de Havilland Dragon Rapide.
- 02The aircraft involved was the first production model of the DH.89 Dragon Rapide, carrying manufacturer serial number (MSN) 6251.
- 03The pilot did not possess a navigator's license or significant experience in instrument flying.
- 04The crash occurred at high speed, as evidenced by the condition of the recovered wreckage and victims.
- 05The sea was calm at the time, which likely contributed to the pilot's inability to distinguish the water's surface.
Safety Actions & Advisories
Air Ministry Investigation Findings
Source ↗The investigation highlighted the critical need for pilots to possess navigator licenses and instrument flying experience when operating scheduled services in poor visibility, leading to increased scrutiny of pilot qualifications for commercial cross-channel flights.