31 October 2024
On 8 June 2022, two wheelchair users drowned when the open boat they were travelling in capsized on Roadford Lake, Devon, England.
The two people were part of a group of residents and carers from a local care home who had hired Wheelyboat 123 from the lake’s activity centre for a trip around the lake. The two residents who drowned were strapped into their motorised wheelchairs and rapidly sank to the bottom of the lake when they were thrown into the water during the capsize, and could not be rescued.
Wheelyboat 123 capsized due to a loss of stability caused by an accumulation of water on the deck. The water had entered the boat during the trip because the watertight sealing arrangement on the bow door was ineffective, and the boat’s loading caused it to adopt a bow down trim in the water. The bow trim increased as the water accumulated in the port forward corner and, as Wheelyboat 123 made a turn to port, water freely flooded over the port bow. The driver stood up to see what was happening, adding to the heel. The motorised wheelchairs then slid over the tipping deck as the boat capsized, throwing all the occupants into the water.
The investigation found that Wheelyboat 123 had been inadequately maintained, allowing the bow door seal arrangement to degrade and water to ingress. Also, that the instruction and guidance documentation for operating Wheelyboat 123 had been lost and that staff at the activity centre did not understand how to operate the boat safely, particularly for wheelchair users. The driver training did not have sufficient regard to the boat’s operation with wheelchair users and did not ensure the driver had the capability to recognise and deal with emergency situations.
There was no effective oversight of Wheelyboat 123’s operation and maintenance by the activity centre’s senior management or by external agencies, including Wheelyboat 123’s owner, The Wheelyboat Trust, and the unsafe operation of the boat had continued unchecked.
Since the accident, The Wheelyboat Trust has issued a safety notice to all operators of Wheelyboats about the need to maintain them in line with instructions and warning of the danger of allowing water to accumulate on deck.
Recommendations have been made to the South West Lakes Trust concerning the maintenance regime and operation of boats used by wheelchair users. Recommendations have also been made to The Wheelyboat Trust on the safe operation of wheelyboats and their use and to Burdon Grange care home about risk assessments for external activities. The Local Government Association has been recommended to bring this report to the attention of local authorities and to consider the role of local government in overseeing charitable waterborne activities.
A link to the full report can be found here: MAIB investigation report 14-2024: Wheelyboat 123
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