The government agency responsible for safety at sea says it is changing its practices after it failed to detect issues with journey planning that led to a serious crash involving the ferry currently commissioned by Scots ministers as an emergency vessel for lifeline ferry services.
It comes as investigators found authorities had repeatedly failed to spot that MV Alfred had been routinely passing too close to land - before it crashed causing injuries to 41 passengers and crew.
The Marine Accident Investigation Branch (MAIB) found that the vessel's "inadequate passage plan" had been in place since Alfred entered service in 2019, that it was a "significant safety issue" and that it went "undetected" by annual company audits and surveys by the Maritime and Coastguard Agency (MCA), the publicly funded official UK Government agency responsible for safety at sea.
Now the MCA has confirmed in the wake of the crash that will ensure its surveyors, when they visit vessels, specifically check and seek assurance from the crew on proper passage planning.
READ MORE: Scots £1m-a-month emergency ferry previously crashed after master fell asleep
Ten suffered serious injuries that meant they were unable to work for 72 hours or more in the wake of the crash off Swona, the uninhabited privately owned island in the Pentland Firth off the north coast of Scotland which are part of the Orkney archipelago.
The found that a master of the Pentland Ferries vessel, MV Alfred, had "almost certainly" fallen asleep a matter of seconds before it crashed in July, 2022.
The investigation identified that Alfred’s passage plan was inadequate and that its Electronic Chart Display Information System, which was the ferry’s primary means of navigation, was not being used effectively to support safe navigation and warn of danger.
MV Alfred, once described as the most environmentally friendly ferry in Scotland, had 84 passengers and 13 crew on board when it partially ran aground on the Isle of Swona, the more northerly of two islands in the Pentland Firth between the Orkney Islands and Caithness on the Scottish mainland.
RNLI lifeboats were called to evacuate the Vietnam-built £14m catamaran – with one person being rushed to hospital with a fractured shoulder.
Dozens were feared to have suffered mental trauma and physical injuries including fractures, sprains and soft tissue damage.
CCTV imagery showed passengers and crew being violently thrown to the deck and others somersaulting over benches.
The ferry has since been brought in by Transport Scotland as an 'emergency vessel from April, 2023 with Pentland Ferries operating the services on behalf of the state-owned ferry company CalMac.
But it has emerged that the MAIB was also concerned that among the safety issues the accident raise included that it was allowed to "routinely" pass too close to land.
It said that the vessel master's "significant experience" on the route and the highly repetitive nature of Alfred’s schedule between Gills Bay and St Margaret’s Hope "had probably desensitised him to the risks of transiting close to the shore".
MV Alfred on a recent return to Troon
The MAIB said that "given that passage planning and the correct operation of bridge equipment are critical to the safe operation of every vessel, it is essential that these are subject to assurance during the survey and audit processes".
The MAIB say that it was not until the MCA’s post-accident general inspection that the vessel’s passage planning and other issues "were found to be deficient".
In the wake of the crash they issued a "major non-conformity because the Pentland Ferries safety management procedures for bridge manning and passage planning were not being followed.
The MCA has told the Herald that it will also be ensuring that surveyors when the visit vessels during checks that assurance is received over the correct operation of bridge equipment.
An MCA source said: “The MCA places the highest importance on the safety of passengers and crew. As well as the Alfred being inspected by MCA surveyors after the incident, another Pentland Ferries vessel was inspected incognito during a voyage to check safety lessons had been learned by the company.
“The MCA has accepted the MAIB’s recommendations and will do what is required to ensure ferries continue to operate to high standards so passengers can have confidence in their safety.”
Orkney Islands Council Harbour Authority, which is responsible for safety in the harbour area, created what are described as vessel traffic services (VTS) guard zones just over half a mile from the coast around the islands of Stroma and Swona.
The purpose of a VTS is to "contribute to the safety of life at sea", improve the efficiency of vessel navigation and mitigate the development of "unsafe situations" through providing timely and relevant information that may influence ship movements and assist onboard decision-making. It is also there to monitor and manage ship traffic to "ensure the safety and efficiency of vessel movements.
The system automatically alerts the VTS operator of a vessel entering the zone.
According to investigators, the system gives the operator the chance to warn the vessel’s crew of the development of what it called "unsafe situations".
And according to the MAIB, MV Alfred’s track "routinely triggered" the VTS guard zones around the islands of Stroma and Swona.
It did too before the crash, but the VTS operators did not call the ferry.
An Orkney Council spokesman said: "We’ve considered and accepted the findings of the MAIB investigation. Since the grounding incident, a number of improvements have been implemented, including improved communication with all local ferry companies on their passage plans , an improved auditing process around this and an improved PEC revalidation process."
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