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Air Travel and Health (Science and Technology Committee Report)

There is a tradition in this House of declaring interests. Mine is distant, but, for clarity, I should say that I was involved in the aviation industry for 22 years until 1988. I was everything from an airline pilot to a BALPA shop steward to a senior executive at British Airways and chief executive of a small airline. First, let me say how pleased I am to be here and to be able to participate in this debate. I should particularly like to thank the noble Lord, Lord Sutherland of Houndwood, for bringing this report to the House. In 2000, the committee’s report was a milestone in raising the profile of aviation health. However, shortly after came the 9/11 attack on the World Trade Centre and passenger security became the top priority for Ministers and the aviation industry. Nevertheless, looking back, I can say confidently that the Government, the Civil Aviation Authority as the UK’s aviation regulator, and airlines have responded actively to the committee’s recommendations. The extent of progress was recognised in the committee’s report, Air Travel and Health: An Update, published in December 2007. In February 2008, the Government responded and, in May, the committee published that response. I wanted to put those milestones on the record for two reasons: first, it sets out where we are as background to this debate; and, secondly, the UK has a very good story to tell in aviation health. As the committee observed, "““the Government have responded positively to our recommendations””." Noble Lords know that the UK has a commercial aviation safety record which is second to none. It is a hard won reputation and we will do nothing to jeopardise it. We are also, as far as we know, the only country with a specific duty to safeguard health on board aircraft. The Civil Aviation Act 2006 charges the Secretary of State with, "““the general duty of organising, carrying out and encouraging measures for safeguarding the health of persons on board aircraft””." The functions of the CAA were amended to include the health of persons on board aircraft. This change is a world first as far as we know and was welcomed in Parliament. In direct response to the report’s recommendations, we set up the Aviation Health Working Group, which has brought industry, trade unions and government agencies closer together, not just through meetings but by embedding day-to-day contact as part of the working culture. The AHWG has adopted an approach based on information gathering to underpin policy. This has found wide favour among stakeholders. As the noble Lord, Lord Sutherland, noted, in December 2003, we established the Aviation Health Unit in the CAA to act as a focal point for aviation health issues. I mention these important structural changes to show the permanent place created in government for aviation health issues. I also want to touch on some of the initiatives the UK is engaged on in this field, but, first, I am sure your Lordships will understand when I stress that government departments do not have infinite budgets for all the things that they or others would like to see done. Every use of resources has to be proportionate to the problem it seeks to address. Let me illustrate that by mentioning briefly three important initiatives which the Government have taken. We funded major work on deep vein thrombosis, which was co-ordinated by the World Health Organisation. We have begun innovative research work to investigate concerns about potential contaminants in cabin air, which, again, is a world first. The Aviation Health Unit has made substantial progress on improving information for passengers and GPs on air travel and health, in accordance with the committee’s recommendation. The UK was instrumental in setting up the large, international research project known as the WRIGHT project to investigate travel-related DVT. We contributed substantially. The Department for Transport and the Department of Health made €1.8million available. The rest was funded by the World Health Organisation and the European Commission. We were the only individual nation to back it, although the knowledge gleaned is of global application. The WRIGHT project was carried out by a consortium of medical research experts. Publication of the final report by the World Health Organisation took place in June 2007, although the Department for Transport had already published summary results to provide earlier help to the travelling public. The most important finding—and one that is now widely recognised—is that one’s personal risk of DVT, which varies with medical history and age, is increased three or fourfold on any journey over four hours, not just air travel. So the risk appears to be predominantly the result of prolonged immobility rather than anything specific to air travel. Indeed, in terms of numbers, such blood clots are, of course, found among patients in hospitals. Nevertheless, the absolute risk was found to be low, about one case in every 6,000 flights. As regards cabin air, the committee recommended in the 2007 update report that the research to identify the substances produced during a fume event should be completed urgently. I am pleased to report that this work is actively in hand and is progressing well. The Department for Transport has secured the interest of five airlines to participate in this groundbreaking research, and other countries are watching it closely. I express my warm thanks to those airlines that have made their aircraft and their pilot and management time available to the research effort. It is no exaggeration to say that without this help this work could not have progressed, as sadly was the case in the USA. However, I assure the Committee that the research is entirely independent of industry and is Government funded. Cranfield University, the project manager, is actively engaged in the cabin air sampling programme, and about 40 of the planned 100 flights have now been tested by a scientist on board. Samples are being taken by named individuals who have received special briefing by Cranfield to ensure a consistent methodology and secure chain of custody for delivering the samples to the laboratories for analysis. It is likely that this phase of the research will last until the spring. The logistics are complex and it cannot be done sooner. The findings will then be peer reviewed before being published as a whole. I hope that this will prove possible as soon as practicable. The House will understand that we are filling a gap in knowledge. Fume events are unpredictable and can last less than a minute. There are no published studies of air sampling during fume events. There has been alarmist talk from some quarters about cabin air. I want to assure everyone that it is not a proven fact that cabin air harms health. The Committee on Toxicity, an expert committee of toxicologists, said that it was not possible to prove or disprove a connection between pilot ill health and cabin air on the evidence available. The only way we can resolve this matter is through top quality science of a standard which will, if necessary, influence aviation regulators around the world to take action. I am confident that Cranfield University will give us the best scientific picture of what is in a fume event. Any regulatory action on aircraft types would have to be taken by the European Aviation Safety Agency, and there is no prospect of this happening without robust and convincing scientific research, preferably done by one or more member states of the EU. My third example is in the field of passenger information. Those who have specific medical conditions should, and do, take advice from their GPs or from specialists who can advise them on travelling. We can help by providing the public and doctors with information. That is why I am encouraged by the excellent progress the Aviation Health Unit has made on improving information about air travel and health. Only last month the CAA published an excellent booklet, Travelling Safely, which gives updated health information. The Aviation Health Unit works closely with airlines and other key stakeholders to do this. Part of its website, targeted at a GP audience, has a section with professional medical information which can be downloaded. This website, with its ““Frequently Asked Questions”” and recent guidance to GPs on assessing fitness to fly has been very well received and is generating lots of hits and inquiries to the Aviation Health Unit. It is already proving to be a useful tool to help GPs disseminate appropriate information to those of their patients who may be intending to fly. Since 2001, the internet has developed as the main way of getting advice to travellers, but older methods work well, too. Those without access to the internet can request information by telephone and relevant documents can be printed and posted. I hope this gives noble Lords an idea of the work that we are doing in this important field, and how seriously we take the duty conferred on us. I turn briefly to one or two of the questions that were raised in the debate, addressing first those put to me by the noble Lord, Lord Sutherland. The European Aviation Safety Agency’s competence with respect to air operations and flight-crew licensing took place in February 2008 in Regulation 216/2008. We are confident that the organisation is competent to take over those responsibilities. He also asked about the whole issue of air-passenger duty. As noble Lords know, this has been out for consultation. The consultation has now closed and the matter is now one for the Chancellor of the Exchequer. Noble Lords may find out more, if I can put it that way. Aspirin has been discussed with the working group as a measure to mitigate or ameliorate the incidence of DVT. Research shows that taking aspirin does not help as much as exercise, and of course there are risks attached to taking aspirin. On pilot fatigue, which takes me back because I helped to implement the first Bader recommendations, I should say first that the airline industry is a competitive environment and because of that, companies seek to maximise the utilisation of their crews. Nevertheless, I can state with confidence that safety in aviation is a top priority in the UK. We have one of the best records in the world and we intend to keep it. The law requires all operators of public transport flights to limit the hours that pilots work through adherence to the flight time limitations scheme approved by the CAA. The authority works closely with airlines, including the low-cost sector, and has already identified a number of initiatives such as monitoring the outcome of rostering and training measures to counter fatigue. The CAA will continue to keep this important area under review. I was asked whether we spend enough on research. As I said earlier, we have spent €1.8 million on DVT. On cabin air quality, we have spent €200,000 so far and will probably spend a similar sum over the coming year. We have to recognise proportionality, because many demands are being made on a limited budget. For example, one of the Department for Transport’s key targets to achieve by 2010 is to reduce the number of children killed or seriously injured in road accidents by 50 per cent compared with the period 1994-98. That is clearly another call on resources. The privilege and burden of being in government is always to balance priorities. On the points made about passenger information, as I said, we have produced a new booklet. The established airlines—a high proportion of flying is with such airlines—particularly the long-haul operators, have good facilities for advising passengers. However, on top of that the website of the Health Protection Agency has some useful links, as does the CAA website. In the final analysis, the Aviation Health Unit is supporting GPs to become more competent in this area, and we think that that is happening at the appropriate rate. Turning to the point made by the noble Lord, Lord Patel, about our preparedness for a pandemic, we believe that some of the new developments in aeroplanes, particularly the high-efficiency filters that are now fitted, have a considerable contribution to make to infection within an aircraft. We believe that the position we are at is about right. We think that wipes are a matter for the airlines, but the point is noted. On preparedness for an outbreak, the head of the Aviation Health Unit attended a number of meetings of the Co-operative Arrangement for Preventing the Spread of Communicable Diseases through Air Travel, most recently in Bangkok in 2008. As a result of this approach, which is co-ordinated by ICAO, the international rulemaking body, a number of positive outcomes have been achieved including a new procedure for the commander of an aircraft to notify air traffic control that there may be passengers with pandemic flu on the aircraft in order that a message can be transmitted more rapidly to the landing airport, allowing more time for preparation for the aircraft’s arrival, and the breaking down of silos in order that countries’ national plans link to the aviation plan. This has happened in the UK, and the latest document was presented to the most recent meeting of the Aviation Health Working Group in October 2008 by the Department of Health. Having been involved in emergency planning and knowing the thoroughness with which it is conducted in this country, I believe that we have proper processes in place. The noble Lord, Lord Broers, touched on a number of issues about fume events. I hope that what I have said goes some way to meeting some of his concerns. On the matter of space, within the limitations likely on a practical aircraft we do not feel that space is a health problem. As to space and comfort, airlines are in the comfort business and it is a matter for them, their passengers, their fares and the marketplace. It would not be appropriate for us to intervene. We have no evidence that space within the practical constraints of today’s aviation is a health issue. We are concerned that evacuation requirements can be met, but we believe that, with the present practical applications, they are adequately met. The noble Lord, Lord Haskel, perceptively pointed out that politics has crept into aviation health. I share that view. When politics—with a little ““p””—creeps into anything, one sometimes regrets it, but I sometimes argue that when more than two people meet there is politics. We said it would be good if the Aviation Health Working Group were chaired by the head of the Aviation Health Unit, but the airlines and BALPA asked the Government to retain the chair because it is industry-funded and they felt that the Government are perceived by some as more neutral. Noble Lords will be disappointed by that, but success in this area is by consent, and we must respect that. We think that the unit has a higher profile than people believe. The website is increasingly seen as a point for aviation health medicine. Hits on the website doubled between last year and this. The unit has relaunched its Travelling Safely booklet, which has raised awareness considerably. More than 80,000 copies have been distributed and another 95,000 are available. The unit is looking at ways to do some market research to gauge how well it is known as an organisation so that it can improve its marketing. The noble Lord, Lord Tyler, is clearly not happy with what the Government are doing so far, particularly on fume events. We think that we are doing the right thing. We are the only country in the world doing anything about it, and we believe that we are taking an evidentially based route. We thank the committee for its support in this general direction. The Mackenzie Ross study that reported to the Committee on Toxicity was a small one without a control group and the subjects came forward as patients. The committee arranged for an independent review of it by Professor Robin G Morris, Professor of Neuropsychology at the Institute of Psychiatry at King's College Hospital, London. Professor Morris's report said that the association between flying and neuropsychological abnormality should be interpreted with great caution because of the small sample used. The logical first step in the research is to examine the potential exposure, as recommended by the Committee on Toxicity, which is underway. The committee said that epidemiological research would be best done on an international basis. The scale of pilots and control group needed for reliable results would be large. We are also aware that it would be difficult to recruit pilots who in the UK would be legally obliged to report any health impairment to the CAA, which licences them.