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Dr. Ian Gibson (Norwich, North): It is a pleasure to be the third speaker from Norfolk, following the hon. Member for North Norfolk (Mr. Prior) and my hon. Friend the Member for Norwich, South (Mr. Clarke). That is surely a notable event in the history of this Palace.
Public health and safety are live issues in people's minds and in the media, and are high on the political agenda. Genetically modified crops, depleted uranium, the measles, mumps and rubella--MMR--vaccine, stem cells and bovine spongiform encephalopathy have all evoked a strong public response. The views of the public, which are often gained from the media and from personal experience, are much more important in policy decisions than they were five years ago. Many organisations, including government, have yet to get ahead of the game and see such issues coming so that they can react more proactively.
My subject is airlines and health, which has been the subject of an investigation and subsequent report by the House of Lords Select Committee on Science and Technology. The report, entitled "Air Travel and Health", was published in November 2000. The media have recently piled into the debate, providing useful-- and less useful--data to enlighten the public. Over the past few days, serious accusations have been levelled against some of the airlines. Sadly, much of the available information is anecdotal. In the absence of a well-funded research programme carried out by independent researchers--for which the Committee asked--we have to rely on that level of data.
I am convinced that deep vein thrombosis is a problem on long-haul flights and that research into other modes of transport, such as cars and buses, is also necessary. My hon. Friend the Member for Norwich, South and I travelled down here with our knees together on the Anglia rail service. Although the journey takes only two hours, the effect on one's knee joints can be penetrating, and it is necessary to get up and walk around.
Eminent consultants at the Ashford hospital, which is the nearest hospital to Heathrow, have claimed that deep vein thrombosis causes about one death a month, although that figure is disputed. In the past few months, fit athletes on their way to the Olympic games have suffered from the problem. Speaking from personal experience, my wife developed a stabbing pain in her back five days after we had returned on a 12-hour flight from a cancer conference in New Orleans. Many people die on the aeroplane itself or just afterwards, but some suffer the effects five days to two weeks later. That means that the problem is not recorded as such in the data of the national health service; it appears as a pulmonary embolism.
Five days after the flight, my wife found that she could not breathe properly and was rushed into Norfolk and Norwich hospital's accident and emergency unit. The senior house officer's first question was, "Have you been on a long-haul flight?" It was clear that such symptoms are common knowledge among the hospital profession. Indeed, the house officer told me that she had seen at least 12 other cases over the past year. The blood has to
Happily, my wife survived the experience. She does not want to make it a big issue by going to court. She wants to get on with her life but remember the experience, so that she knows the tactics to prevent it from happening again. The problem is not confined solely to economy class, but in economy seats--most people have experienced them--one person's knees are in the back of the next person, so when the seat in front comes back, one has less room to move around.
Deep vein thrombosis is not age related. Sadly, young women have died, while people of all ages have experienced clotting. The clot does not always move to the lungs or brain; it may dissolve itself without effect. Nevertheless, it forms during the initial phase when the legs begin to swell.
What advice is received by Ministers, who travel frequently due to the nature of their jobs? Indeed, I inquired at the parliamentary travel office to discover what information it has received on that subject. One high-profile event could spark a major problem, perhaps even a panic, which we do not want. I suspect that the problem is common, but we must collect more data.
Dr. Ashok Kumar (Middlesbrough, South and Cleveland, East): My hon. Friend mentioned the report by the House of Lords, which states that if there is an increased risk of DVT from flying, it is small. We must do more research to link DVT conclusively with flying.
Dr. Gibson : Although it is true that the risk is small, it is incongruous to say that we need new data to prove that. We do not know how many people have contracted a thrombotic effect by flying, because we have anecdotal evidence only. Until we collect all the data from NHS hospitals, we shall not know the risk. It may be a small risk, but one death is one too many. There have been many anecdotal cases, and the report by the House of Lords includes 12 pages of such evidence, some of which was contributed by hon. Members.
Economy class syndrome is a misnomer, as this is a problem for the entire transport industry. That seems to deflect the issue towards other forms of transport, which I acknowledge may share the problem. The spokesman said:
A lot depends on a passenger's lifestyle and previous medical history. Our in-flight managers give passengers important information about the need to exercise on long flights. Yesterday, I met the official spokespersons for the airlines, and asked them what information passengers were given. The answer is that two thirds of the way through the in-flight document, which is stored in the backs of seats, there are three lines about possible health hazards.
Yesterday, I received a letter from British Airways expressing concern about this issue, and stating that passengers should think about their health and take precautionary measures before they fly. However, the briefing note that accompanied the letter betrays a whiff of complacency, and I wonder whether British Airways will adopt that tone in the document that it has agreed to send with tickets. The briefing note states:
(http://britishairways.com/health), our 24-hour medical helpline, and the "Well Being" sections of our in-flight magazine, High Life and a video demonstrating the in-flight exercises.
I understand why airlines are reluctant to accept that a cabin environment could lead to an overall increase in the risk of DVT, and I accept their argument that travel by other means could contribute to the development of thrombosis. However, they must take the issue seriously and do much more to inform the public. We need to indulge in preventive activities, and put an end to the patronising attitude that comes through in some of these documents. In terms of information, design and cabin services procedures, airlines and their associates must reappraise current air cabin practices, so that these problems can be dealt with. For example, when cabin staff explain emergency procedures, why do they not spend a few minutes pointing out that remaining immobile could lead to problems--whether sleeping on an overnight business class flight, or sitting with one's legs propped up trying to sleep in economy class? Why do they not make it fun? Why do they not get rows of five people at a time to get up at regular intervals to do exercises? Why do they not keep the aisles open so that people can move about and dodge the trolleys that are serving drinks?
As I am sure we all know, drinking is, in any case, bad for people when flying. Because one is worried about plunging out of the sky into the Atlantic, one tends to over-indulge. The airlines encourage that, while at the same time saying, "Don't drink alcohol--you'll get dehydrated. Drink lots of water." Although one can get plenty of water in the first or business class cabins, if one tries to get up to find water in economy, the cabin staff immediately say, " Go back to your seat, sir. We are in a pocket of air." It is difficult to deal with that sort of cabin procedure and some of the forceful staff. They are only doing their job, but practices need to be reconsidered if health problems are to be taken seriously.
I do not want to talk about the aspects of ventilation examined in the Select Committee report, because other hon. Members may want to talk about the fresh air problems and so on. The House of Lords Select Committee was not heavy on any of those issues and, while recognising that they needed to be looked at, it did not make a strong case.
Smoke odours and smells are also a problem in airliners. There are about 180 incidents a year when a puff of smoke comes through the cabin and passengers are told, "It is nothing, sir. We will sort it out in a minute." When that happens in the air, one tends to put one's head down because there is not much one can do about it, unless one has a parachute and has had the
During flights, medical emergencies can occur. Hon. Members will remember the fantastic story about an operation being performed with a coat hanger. In that instance, the right consultant happened to be on the right plane to save the person's life. Although it is not possible to have a consultant or a doctor on the ever-increasing number of flights, there can be ground contact--a sort of NHS Direct to the friendly skies, as they are called, from the ground--so that information and medical advice can be relayed to those in the air.
What, then, should passengers be doing? I have already mentioned some actions that can be taken. Some people may be more at risk than others from the duration of a flight, immobility, limited leg room, seating procedures and low humidity. Personal factors such as smoking, obesity and height are involved and somebody somewhere will no doubt find a gene that makes one prone to risk. I do not care about genetics; I would rather tackle the environment to make it safe, so that such a gene does not express itself and cause a blood clot.
It is important that the public know about the risk, whatever its extent. We are told that we should drink water, get up and walk in the aisles. We are also told to take an aspirin before flying, although medical advice should be sought about that because there can be problems with stomach ulcers. If I fly, I shall take aspirin the previous day and again a few hours before to thin the blood--as will my wife. Some types of elastic stockings can also be used. I shall fight my way past those trolleys of drink, not imbibing as I go. I shall flex my legs, tiptoe around, duck and dive and weave to make sure that I get exercise every so often. I shall not smoke or drink too much coffee or tea and I pledge not to drink any more alcohol on flights--although I might take just a tipple for the bravery required for landing. Alcohol on flights is not there to help; it is a displacement activity to make one feel better and to counteract the fear of plunging from the sky.
Mr. John Smith (Vale of Glamorgan): I congratulate my hon. Friend the Member for Norwich, North (Dr. Gibson) on securing this debate on a subject of exceptional importance. I congratulate him, too, on the way in which he delivered his speech. He is a scientist. He has a much-deserved reputation in the House for bringing matters, particularly public health matters, to its attention. He has done well to do so today.
Last June, a local policeman, 30-year-old John Anthony Thomas from Flemingston in my constituency, went on a dream honeymoon to Hawaii, a marvellous, once-in-a-lifetime opportunity. This chap was at the prime of his life. He had just had a rigorous police health check, which gave him a clean bill of health, he had no known history of cardiovascular or thrombotic conditions and, within about two weeks of returning from his honeymoon, he dropped dead. Clearly, that had a devastating effect on his wife, his family and everyone who knew him.
When I was asked by the family to intervene and to look at the case, I thought what a tragedy it was, but these things happened and a one-off tragedy such as that did not necessarily mean that there was a problem. Then I discovered a few defining characteristics of the case, some of which my hon. Friend has already alluded to.
Had the pathologist not mentioned that he thought that there might be a connection between pulmonary thrombosis and air travel, the family would not have had a clue. There would have seemed no need to look at the matter; they would not have made the connection automatically. However, the pathologist not only asked whether Mr. Thomas had been on a long-haul flight recently, but expressed the personal view that as many as 20 per cent. of DVTs treated by the national health service could be--I stress "could be"--associated with long-haul air travel.
That was when for me, as a lay person, the alarm bells started ringing. That is the difference between a one-off tragedy, no matter how horrendous and traumatic, and a public health problem. The gap between the flight and the tragic death suggests to me, as a lay man, that hundreds or thousands of undiagnosed deaths from pulmonary and other thromboses could be connected with long-haul flights. We simply do not know. That is the issue.
We have heard varying accounts of the numbers that might be involved. We have already heard about the number of deaths in Ashford, Middlesex, where it is estimated that one person a month dies. We have seen reports in the press suggesting that the number could run into thousands. We now discover that research has been carried out over the past 60 years. The first research into DVT connected with immobility was done in bomb shelters in the second world war, but who knew about that research? Did the airlines know about it? Has it been common knowledge that there is a direct correlation between immobility, especially in aircraft, and those potentially fatal conditions? I have concluded that there is a correlation.
Let me give a couple of small examples, although, sadly, they are anecdotal. I have not yet spoken to a doctor since we have been investigating the condition who does not take precautions before going on long-haul air flights, including taking an aspirin, wearing compression stockings, drinking large quantities of fluid and avoiding excess alcohol. It is not just one doctor, but every doctor to whom I have spoken. I recently took
That situation concerns me greatly. It is why I gave Mrs. Ada Thomas, the mother of that young policeman, an undertaking that, as her Member of Parliament, I would do all in my power to prevent any other mother having to go through what she went through as a result of a problem associated with long-haul travel. Not that she can be compensated for her loss; I assure those who meet her or members of her family that that cannot be done. However, we can, and will, discover once and for all what is behind what I believe to be a major public health problem.
I agree with my hon. Friend that we do not definitely know what causes the problem and we must find out. We must take action now to find out. The track record on investigating public health problems connected with hidden hazards is not a good one. A number of examples are frankly scandalous--I need mention only the production of asbestos. It took 60 years to establish a link between the production and handling of asbestos and mesothelioma. That tells us that we need to do something about the problem.
I intend to use Standing Order No. 23 to introduce a Bill to require airlines that carry British passengers and use British airports to provide all the available information to passengers, so that they are aware of the potential problems. There should be a legal requirement regularly to update that information for passengers and, importantly, to facilitate the gathering of any research or additional information, particularly national data, to ensure that air passengers are fully aware of the potential problems. That is key and the only way in which to speed up the collection of data to carry out the research to discover the background to the condition. There must be a legal requirement to produce information and to facilitate research on the issue. I hope that we get the widest possible support for that in the House so that no one else has to go through the trauma and tragedy experienced by my constituents. We must carry out the research as quickly as possible.
We do not yet know the extent of the problem but there is every indication that Mr. John Thomas was not the only example in Wales. There have been many high-profile cases of deep vein thrombosis connected with long-haul flights. They involve people of all age groups, both genders and completely different backgrounds. What is the connection?
Why do more people die in Wales than in other regions of the United Kingdom? It has been suggested to me that the reason is that Wales has the highest incidence of strokes and cardiovascular disease. The House of Lords Select Committee report suggests a direct correlation between those conditions and deaths after long-haul flights. The problem is that people are not told about the risk; airlines do not bring it to their attention. We must do everything that we can to make that information available.
It is my understanding that the Civil Aviation Authority has responsibility for the safety and welfare of passengers, but may not have responsibility for their health. Will my hon. Friend the Minister deal with that matter when he winds up the debate? I am grateful for having been called and for the opportunity to speak on the issue.
Mr. Paul Tyler (North Cornwall): I, too, am grateful for the opportunity to speak briefly. I sincerely congratulate the hon. Member for Norwich, North (Dr. Gibson) on raising this extremely important issue. If I may say so to him and to the hon. Member for Vale of Glamorgan (Mr. Smith), I very much support the idea that new measures must be taken, by legislative means if necessary, to make certain that the current complacency--it is complacency--in the industry is dispelled as quickly as possible.
I entirely agree with what both hon. Members said about deep vein thrombosis. The hon. Member for Norwich, North may recall that I raised the issue on the Floor of the House on 28 July. However, I want to spend a few minutes dealing with some other issues that affect the health of air passengers and, indeed, aircrews. I will contrast the apparent complacency from which the industry suffers, not only nationally but internationally, with the growing concern among the public.
I give credit to the Department of the Environment, Transport and the Regions, which seems to share the concerns of the public and of Members of Parliament. I am delighted to have had an increasingly responsive reception in the past few months when making representations to the Department. I pay particular tribute to the Minister for the Environment--I hope that the Minister present will convey this to him--for the positive way in which he has responded to my concerns, expressed in this and the main Chamber, on air quality in the aircraft cabin and cockpit.
Hon. Members present will acknowledge that, although the health and safety of passengers is extremely important, the health and safety of the whole aircraft may be in the hands of a small number of professional pilots and aircrew. I am therefore particularly concerned about the air quality that they may suffer during flight. I approach this issue as chairman of the all-party organophosphates group, of which the hon. Member for Norwich, North is a distinguished member. I was alerted to the problem of air quality by an incident in Sweden about 18 months ago. It was alleged--we still have no definitive report on
I shall not go into the technical details, as I want to leave the Minister time to respond in full. Suffice it to say that organophosphates used as lubricants in jet engines, and oil seals used in the maintenance of those engines, can be crucial factors affecting air quality in the cabin. If the problem of oxygen supply in different parts of different aircraft is added, a potentially fatal cocktail emerges.
Organophosphates in toxic fume form are extremely dangerous--obviously in the short term, but also in the long term. It is still unproven whether the chronic effect of low-level exposure to OPs over a long period can be damaging to health, but it remains a matter of concern. The British Association of Air Line Pilots has done much to identify such problems among pilots and other aircrew and much valuable international work has also been done.
Some increase with time is to be expected due to the combined effects of an increase in airline traffic and the growing profile of cabin air quality issues. He referred specifically to incidents occurring in aircraft known as the BAe 146. That aircraft is used, incidentally, by the Queen's Flight, which explains the high-profile interest in its performance. As the manufacturers and operators of the BAe 146 have rightly emphasised, the problem is not exclusive to that particular aircraft: others share the same problem.
I shall make two points about the overall context in which the debate is taking place and its importance. I understand that of the 1,000 deaths in flight and on board worldwide, more are due to heart attacks than to accidents. I do not think that the general public recognises the significance of that. It is far more likely that one's health will be affected by the quality of the air, the conditions in the cabin and the way in which we are herded together than that one will be the victim of any form of accident. It is also important to recognise--this came out in the contributions from the hon. Members for Norwich, North and for Vale of Glamorgan--that certain people are more susceptible to ill health. For example, those who have any sort of respiratory problem are much more likely to be affected by air flight. The experience of the Lufthansa medical director, Dr. Luntz Bergkau is extremely relevant. He pointed out:
The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Mr. Chris Mullin ): I thank my hon. Friend the Member for Norwich, North (Dr. Gibson) for initiating the debate and for the responsible way in which he did so. I was sorry to hear of his wife's experience and I am glad to hear that she has now recovered. I was particularly sorry to hear of the tragic case described by my hon. Friend the Member for Vale of Glamorgan (Mr. Smith).
The health aspects of air travel are of considerable importance and the debate is timely. Not only is it a matter of substantial public concern, but the House of Lords Science and Technology Committee has recently published its report on air travel and health. We are giving detailed consideration to those recommendations that are addressed to Government and we hope to publish our response soon.
My hon. Friend the Member for Norwich, North is a scientist, and I am sure that he would agree that it is important to keep a sense of perspective on this issue. It might be helpful if I referred briefly to the wholly irresponsible article on the front page of the Daily Express this morning, which is based, as far as I can see, on the comments of a Mr. Farrol Khan. To our knowledge, Mr. Khan has never produced any firm evidence for his claims. He was one of those interviewed by the House of Lords Select Committee, which carried out a careful study, as hon. Members have noted. Other medical experts reported in the article dismiss Mr. Khan's proposals. The House of Lords Select Committee used words like "nonsense" and "carelessness with facts" when describing his evidence and added that
In spite of his evident enthusiasm for his cause, sadly we have not found him to be a reliable source of scientific and medical information. I do not want to make too much of it, but front-page stories based on evidence from Mr. Khan should be accompanied by the health warning of the House of Lords Science and Technology Committee, not mine or that of any other Minister.
My hon. Friend the Member for Norwich, North and others referred to several different types of health risk that might be posed by air travel, and I shall take each in turn. First, the possibility that travelling by plane increases the likelihood of deep vein thrombosis must be, and is, treated extremely seriously. Air travel, in common with some other means of transport, can involve long periods of immobility, which has long been known to increase susceptibility to DVT. However, it is important to establish whether factors specific to the aircraft cabin environment increase that risk. The hon. Member for North Cornwall (Mr. Tyler) referred to the smaller amount of oxygen available at height. At present, there is no definitive answer to the question; much research information is available but the findings often conflict. In practice, it is extremely difficult to identify how many cases of DVT are attributable, wholly or in part, to air travel. Given that lack of clarity, I support the House of Lords recommendation that research be carried out to establish with certainty whether the aircraft cabin environment increases the risk of DVT and, if so, to what degree.
The Government-funded study that I announced when giving evidence to the Committee last June will draw together and assess existing research on the subject and make recommendations on how further research can best be targeted. In the light of that preliminary work, the Government will initiate whatever research is necessary to obtain a clear picture of the relationship between air travel and DVT. The parameters and structures of that further research will depend on the outcome of the present study, but the aim will be to clarify the links between DVT and the cabin environment. When the research is complete, we should be able to take decisions backed by a genuine understanding of the risks and contributory factors, rather than on the basis of speculation. In the meantime, the industry and the Government are focusing on ensuring that information and advice are made available to passengers before and during flights and that that is as consistent and authoritative as possible, given the existing knowledge.
I am aware that United Kingdom airlines are pursing strategies to inform their passengers. Last week, British Airways announced that it would issue a leaflet to all its customers. A welcome effect of the flurry of media attention and of debates such as this is the increased awareness that they produce in the travelling public. The Government are contributing to that process by expanding their information leaflets. The most recent pamphlet on health advice to travellers, which is being revised to take account of what we now know about air travel, had a print run of 12 million. If my hon. Friend the Member for Norwich, North had difficulty in finding a copy, it was not for want of trying. The document is being revised and a new version will be published shortly, which gives far more attention to the matters that we are discussing. We are anxious that all parties should have a consistent message on which to draw.
The hon. Member for North Cornwall mentioned air quality. First, I thank him for his generous tribute to my right hon. Friend the Minister for the Environment. The hon. Gentleman expressed concern that the air that circulates on board aircraft may be hazardous to health in several ways. Among the issues raised at different times are ventilation, filtration, humidity and the possibility of transmitted infection. I shall not go into each of those, although any added risks that are specifically attributable to flying clearly need to be isolated.
The House of Lords Committee made some helpful recommendations in that regard. A good deal of detailed work is going on throughout the world to test air quality on board aircraft and suggest improvements or better standards. We and the industry are following that work closely. The study to which I alluded should identify any gaps in existing knowledge about air quality and guide us on whether to promote further research, or whether any regulatory changes are needed.
On organophosphates, one aspect of air quality referred to by the hon. Member for North Cornwall as a particular concern is related to reports that fumes from aircraft engine lubricating oil leak into the air conditioning system, posing a risk to the health of passengers or crew. In this context, I note the comment in the House of Lords report:
I have already referred to information on DVT. I have described the steps that we are taking to provide passengers--both before they book their ticket and during flights--with information and advice to help them make their own decisions and minimise the risks. If it emerges that regulation on health grounds is necessary, we will not hesitate to act, but a trade-off between price and comfort is not an appropriate area for regulation.
Many people are prepared to put up with some discomfort if it means that air fares are within their financial reach. For some passengers, air travel is a far more stressful and worrying activity than it is for others. The key aim is that people should have adequate information available to them so that they can make the choices that best suit them. However, I take on board what my hon. Friend the Member for Norwich, North said about, for example, exercises that can be performed at one's seat. We are subject to various other bits of information during flights. Why should that information not be given too?
The House of Lords report set in motion a valuable debate on a wide range of health issues. The Government have a role to play. We will endeavour to disseminate information, to help to close the gaps in our knowledge that currently hamper action in this area and to work with industry so that it provides passengers with the standards of safety and comfort that they are entitled to expect. Where necessary, we will regulate, although our preference is to avoid regulation where we can achieve the same effect by other means.
I accept that there is an issue of joined-up government. We need to create a suitable structure to deal with an issue that spans several parts of the Government. For that reason, we intend to establish a standing inter-departmental group, which will take forward the House of Lords recommendations on which the Government are to act, steer the current research project to which I referred earlier, monitor other developments on air travel and health and provide advice to Ministers on the way ahead. When I gave evidence before the Lords Committee, I did so accompanied by my hon. Friend the Minister for Public Health, so some joined-up government was present from the outset. The group to which I referred will consist of officials in my Department, the Department of Health, the Civil Aviation Authority and the Health and Safety Executive. It will work closely with the airlines and other parties with an interest in air travel and health.
I should say something about the role of the airline industry. It is important for the Government to play their part, but airlines must accept that they have the principal role, both in minimising risk and in providing effective information to their passengers before they fly.
In his speech late last year, when he launched the Government' s consultation document "The Future of Aviation", my right hon. and noble Friend the Minister for Transport set out a number of challenges for United
This is an important issue and hon. Members are right to stress that there are no grounds for complacency. However, I hope that they will accept that we must keep the matter in perspective. No form of travel is risk free and, as my hon. Friend the Member for Vale of Glamorgan said, knowledge of the problem has existed since the second world war, before the days of mass air travel. The key problem is prolonged periods of immobility, and during the war that arose in bomb shelters underground.
Mr. John Smith : I accept that and I accept that more research is necessary into cabin atmosphere to discover whether it is a contributory factor. However, there is a qualitative difference between air travel and other forms of travel in which the opportunity to take exercise and to relieve discomfort is greater. We should not lose sight of that fact.
Mr. Mullin : I entirely accept that. All parties, including the Government, regulators, airlines and passengers, have a role in assessing and minimising the risks involved in air travel. I am a journalist by profession, and the media also have a responsibility to report the matter with accuracy and balance, which has not always been the case. There is a pressing need to obtain and disseminate accurate and comprehensive information, and my hon. Friends can rest assured that the Government will play their full part in the process.