MAIB report reveals fatal flaws in wheelchair-accessible boat accident 

The Marine Accident Investigation Branch (MAIB) has uncovered a series of critical failings that led to a tragic accident at Roadford Lake, Devon, resulting in the deaths of two wheelchair users and one seriously injured. The incident occurred on 8 June 2022 due to the capsizing of a 5.3-metre aluminium open boat – Wheelyboat 123 – designed for wheelchair accessibility, owned by The Wheelyboat Trust.

The report outlines that inadequate maintenance and improper handling of the boat that was carrying six people, including residents and carers from the local Burdon Grange care home, were key factors in the tragedy.

Chief inspector of marine accidents, Andrew Moll OBE, expresses concern over the lack of risk assessment and oversight that contributed to the accident: “The condition of the wheelyboat had been allowed to deteriorate so water could enter it, and on the day no-one recognised the implications of carrying vulnerable people who were strapped into heavy motorised wheelchairs around a lake in an open boat. In short, no one had their eye on the risk, and tragically Alison Tilsley and Alex Wood lost their lives.”

Moll further highlights a worrying lack of oversight in such charitable activities: “Charitable activities such as this seem to fall into a grey zone with no organisation or authority in a position of oversight. This meant that no one stepped in to question what had become custom and practice.” He suggests that addressing this may only be possible with changes in legislation.

The MAIB report states that the boat was last hired in October 2019 and outlines how the activity centre had misplaced crucial instruction and guidance documentation for operating the boat safely. Furthermore, senior management did not effectively oversee the operation and maintenance. 

Both the activity centre and care home assumed the other had knowledge about managing activities for wheelchair users. Moll emphasises that while such trips can be beneficial for the well-being of care home residents, proper risk assessment is crucial. “No one had taken time to properly consider the risks associated with taking wheelchair users afloat, either before the accident or on the day itself,” he notes.

In response to the accident, The Wheelyboat Trust has issued a safety notice to all operators about the need for proper maintenance and warning of the dangers of water accumulation. The MAIB has made recommendations to the South West Lakes Trust concerning the operation and maintenance of boats used by wheelchair users and The Wheelyboat Trust. As a result, The South West Trust has immediately withdrawn all of its existing wheelyboats from use. 

Earlier this year, The Wheelyboat Trust launched two wheelchair-accessible boats on the Thames and in Manchester, on Gorton Reservoir. The Trust continues to rely on donations to fund the acquisition and maintenance of its fleet. 

MIN regularly reports on MAIB’s marine accident conclusions.

Further details about Wheelyboat 123 are available to read and download online.