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Deep Vein Thrombosis

12.59 pm

Mr. John Smith (Vale of Glamorgan): Let me start by saying how much I welcome the opportunity to speak about the important subject of flight-related deep vein thrombosis. This is the first debate to be dedicated solely to the issue, although it follows on from an excellent debate in January 2001 on the health issues associated with flying. That debate was initiated by my hon. and distinguished Friend the Member for Norwich, North (Dr. Gibson), and I am delighted that he is here today. Some considerable time has, however, elapsed since then.

My hon. Friend's debate followed on from a significant report by the House of Lords Select Committee on Science and Technology, which drew attention to several flight-related health issues, including, for the first time, deep vein thrombosis. The Committee made several sensible and important recommendations, and I am glad to say that the Government have taken up many of them. The most important was that they should commission a major epidemiological study into the incidence, causes and extent of flight-related deep vein thrombosis. We do not know for definite the full scale of the problem, although my view is that it is potentially a major public health hazard.

Since that distinguished report was published nearly two years ago, several significant, albeit small, research studies have been carried out. The Committee did not have them at its disposal when it considered the issue, and I believe that they prove beyond all doubt that there is a theoretical link between air travel and deep vein thrombosis. Indeed, all serious scientists working in this area around the world accept that, although they are not sure about the extent of the relationship or the exact cause of the problem.

The other findings from the key bits of research that have been undertaken since the report was published suggest that the problem is much bigger than we first imagined. For example, research by Gianni Belcaro suggests that as many as 5 per cent. of those who fly long haul contract blood clots in their lower limbs simply because they are sitting in cramped spaces for long periods. Their blood pools and stagnates in their lower limbs, feet and ankles, which, in cabin conditions, causes clotting. In the last year for which records are available, 133 million passengers flew abroad from Britain alone, so an enormous number of people might be affected if the 5 per cent. figure is right. I am not saying that it is right, but as an indication of the proportion of those who might be affected, it suggests that we are talking about more than 6 million people.

Since the publication of the distinguished House of Lords report, our own leading expert in Britain, Professor John Scurr, whom the report mentioned, has carried out further research. Although he used a small sample of slightly more than 200 people, his research shows that as many as one in 10 passengers who fly long haul develop blood clots in their lower limbs. If that is right, huge numbers of people may be affected by deep vein thrombosis. Professor Scurr's report also noted that no less than 40 per cent. of the 10 per cent. of people who develop blood clots went on to develop a deep vein

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thrombosis, which could, without treatment, cause a pulmonary embolism and, in many cases, death. That is the major problem that we have with this public health issue: we are dealing with a stealth disease.

The vast majority of cases of flight-related deep vein thrombosis in this country go undiagnosed, because it can take from four to nine days for the blood clots, which are often without symptoms, to develop into a deep vein thrombosis and then up to several weeks before the thrombosis moves from the lower leg to the heart or lungs and kills the person. That is a major problem, and because we do not, and possibly cannot, record the incidents of DVT that are related to air travel, we do not know the full extent of the problem.

My interest in the subject is well established. A constituent of mine died in tragic circumstances two years ago yesterday. John Anthony Thomas, a 30-year-old policeman in the prime of his life, was not just fit and healthy, but athletic. He returned from a once-in-a-lifetime honeymoon holiday in Hawaii, and in a couple of weeks he was dead. He was buried in the same church as he had been married in several weeks earlier, which is a tragedy in anyone's imagination. I went to see the family, but I must admit that my initial reaction was that it was just one of those tragedies. It was a very sad event, but I saw it just as a one-off act of God.

Before speaking to the Thomas family I had no reason to believe anything else. Mr. and Mrs. Thomas told me that they only made the connection by accident after the consultant pathologist asked them whether their son had recently been on a long air journey. It did not appear on the death certificate, but it was almost certainly the preventable cause of that boy's death, which makes this a real tragedy. If he had been more aware of the condition, as many people in this country now are after the Government's good work of the past 18 months, his unnecessary death could have been avoided.

That is what created my interest in the issue, which was strengthened when we discovered that one of the clinicians involved in the case expressed the view that as many as one in five of all deep vein thromboses treated in the national health service could be related to air travel. That was qualified as a personal opinion based on anecdotal evidence, but 25,000 people are treated for DVTs by the national health service in England alone. If that physician is even remotely right, we are talking about large numbers of people. Incidentally, that view has been reinforced since the House of Lords report by research carried out by Emile Ferrari, which suggests that as many as 25 per cent. of all DVTs treated by health services, not only in the UK, could be directly attributable to travellers' thrombosis. We are talking about very big numbers, and it is a matter of great public concern. It is a stealth disease, because we do not see it coming. People are dying or being seriously injured, but we have no idea how many are affected.

I must place on record that the Government have done an enormous amount of work. Indeed, I believe that they lead the world in taking up the travelling health risks related to deep vein thrombosis. They are the leading player in the World Health Organisation research and are offering up to 2 million euros towards the research funding that was agreed last year and commenced last month. They are the first Government in the world to issue health warnings to certain

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passengers of the risk of DVT. Our airlines now offer advice and issue warnings, but two years ago, when I had never heard of the problem—I heard about it only when it affected my constituent—that was unheard of.

Many strides have been made but, as I said, the most important recommendation from the House of Lords report 18 months or so ago was that we should commission a major epidemiological study of DVT. My fear, which I place on the record, is that we are probably no nearer to achieving that most important goal than we were when the Lords first reported, despite all the good work that has been and is being done. For example, following a recent meeting with the Minister responsible for aviation, it was indicated that, in the aviation White Paper to be published later this year, a Minister in the Department for Transport may well be given a clear responsibility for air passengers' health.

For those who do not know, let me explain that there is no protection as regards health for passengers who fly anywhere in the world, because under the Warsaw convention, there is liability only for their safety, not their health. However, as a result of my meeting, I believe that the Minister is considering—and the Government support—the recommendations of the Joint Aviation Authority on increasing seat spacing, not only to provide greater comfort and safety of egress in an emergency, but to look after the health and well-being of passengers, albeit under the auspices of the JAA. That means that all our European neighbours will introduce the same standards.

According to the reply to a question that I put to my right hon. Friend the Prime Minister last November, it was decided to go for the World Health Organisation international research. That is perfectly understandable. I see where the Government are coming from in recommending that. The WHO is a distinguished body, and the world's leading experts will be involved. If the findings identify, as I am sure they will, the correlation between this condition and certain aspects of air travel, and discover its full extent, it will be much easier to make recommendations to the aviation industry worldwide, rather than perhaps penalising the British industry by introducing rules here alone.

That is all well and good, and I congratulate the Government on what they have done, but there is a problem. Sadly, the WHO has not raised adequate funding to carry out a major epidemiological study. Despite the support of the British Government and others, the study is likely to be quite limited. Indeed, just this week, one of the world's leading experts on air travel-related DVT, Professor Ross Baker of Griffith university in Australia, has said publicly that, although the limited studies to be carried out will be useful in their own right, we will be no nearer the truth at the end of them than we were at the beginning. The studies will be incomplete and inconclusive.

My concern is that, while we await the outcomes of the research, and the large randomised and epidemiological studies that we need to get to the bottom of the problem, people may die unnecessarily. That is the point. This public health issue is different from others that we have had to face, because we could take action now that might prevent those deaths. I am talking about action that is low-cost and, in some cases,

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involves no cost, but that would protect the British public while we wait to find out the definitive results on the full scale and nature of the problem.

In the past, we have failed to take such action. Going through the records recently, I noticed that the danger of BSE in cattle being transferred to humans and creating a major public health problem was flagged up in a debate in the House 10 years before any action was taken. Much of the argument at the time was that we should wait until we got the science right before we made any decisions.

Dr. Ian Gibson (Norwich, North): Can my hon. Friend say something about suing the airlines? Have there been any successful cases, or are there many going through the courts now?

Mr. Smith : The only successful case had nothing to do with the health of passengers, but involved the comfort and well-being of someone who paid to go on a holiday and found themselves cramped in the most unfortunate conditions on an aircraft.

One of the reasons why many airlines in this country give warnings and advice to their passengers is not to protect their health and well-being, but in case they are sued for negligence at some future date. They have a vested interest in providing warnings and advice as it could be used in evidence to protect them. It is difficult to sue a company because of the protection of the Warsaw convention. It is an area that needs re-examination for two reasons. First, far more people fly now and, secondly, far more people fly longer journeys to places abroad where they did not fly to before.

What action can we take now? My hon. Friend the Member for Stafford (Mr. Kidney) has a Bill before the House, which would place a legal requirement on all airlines to provide warnings and up-to-date and accurate information to passengers. Most importantly it would force them to co-operate with the sort of research that needs to be carried out to prevent any more injuries and deaths from this dreadful condition. I lay down a challenge to the UK-registered airlines. If they are so damn sure that there is no connection between air travel and deep vein thrombosis, let them sponsor the research to prove the case once and for all. That would be the end of the matter.

If the airlines are so confident that there is no problem, they should co-operate and provide the independent research that we need. They might perhaps make a contribution to the WHO to allow that to happen. I fear, however, that they will not. I fear that the airlines, not only in this country, but throughout the world, realise that there is far more to this than meets the eye. They have known about it for quite some time. My hon. Friend's Bill is before the House. The Government could look at it carefully and consider adopting it or introducing guidelines. They are looking at guidelines for the British airline carriers. They have set up a health committee with the airline carriers within the Department for Transport and it is working well. Again, those are great strides in the right direction.

When I met my constituents I gave them a solemn undertaking that I would do all in my power to prevent any other parent—I am the father of a child of a similar age—going through the same trauma as theirs. The

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debate today is part of meeting that commitment. I am doing what I can. Because of the progress that we have made over the past 18 months, I am convinced that the time will soon come when no air passenger will board a plane until they are satisfied that their health, welfare and well-being are the carriers' top priorities.

1.19 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears) : My hon. Friend the Member for Vale of Glamorgan (Mr. Smith) has been a tireless campaigner on this issue. I congratulate him and all the members of the all-party group who have been campaigning on these issues for some time. They have helped to raise awareness of travel-related deep vein thrombosis. As my hon. Friend said, a couple of years ago the matter was not widely known. They have been instrumental in pushing the issue up the agenda quite dramatically.

I welcome my hon. Friend's comments in support of the Government's work on this issue. In responding, it may be helpful if I set out some of the background and some of our thinking about how these issues will develop. Deep vein thrombosis occurs in about one in 1,000 of the general population, leading to around 25,000 NHS admissions each year. A small proportion may be related to air travel, but DVT is associated with a number of factors, such as immobility after surgery, being over 40 years of age, pregnancy, hormone treatments, inherited clotting factors, a family or history of DVT, and cancer, whether treated or not.

My hon. Friend rightly said that in November 2000 the House of Lords Select Committee on Science and Technology published the findings of its inquiry into air travel and health. That comprehensive and, in many ways, ground-breaking work has set the agenda for aviation health, both here in the UK and internationally. My hon. Friend said that we are world leaders in this field. The inquiry paid particular attention to the issue of deep vein thrombosis. It identified the need to address the gaps in our scientific understanding and recommended that research be undertaken as a matter of priority.

In responding to the agenda established by the House of Lords inquiry, we recognised the need to have an integrated approach to the issue, so we set up the aviation health working group. The group is chaired by the Department for Transport, and the other permanent members include my Department, the Health and Safety Executive and the Civil Aviation Authority. In addition, industry, consumer and medical representatives are regularly invited to participate in the work of the group. It is a good example of joint working.

The Government's approach has been twofold. First, we have sought to ensure that passengers have access to the best available information to enable them to make an informed choice about air travel. Secondly, we have vigorously pursued the means to meet the gaps in our understanding of whether, and if so how, flying can increase the risk of deep vein thrombosis.

In November last year my Department issued information and advice to the airlines and the public on travel-related deep vein thrombosis. That included practical advice for passengers on long-haul flights on how to minimise the risk of DVT, including simple in-

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seat exercises. It also advised passengers, where it was safe to do so, to take regular walks out of their seats and to minimise their intake of alcohol, which can lead to immobility and dehydration. It also identified certain groups who may be at a higher risk and advised them to see their GPs before travelling so they could have a one-to-one consultation about the likely risks.

To maximise access for the public to that information it was distributed to health services and UK airlines, published on the internet and given to NHS Direct. Anyone seeking telephone advice from NHS Direct can be given that good, practical advice. Further information on travel-related health issues is available in two publications: the booklet T6, entitled "Health Advice to Travellers", is available free from the health literature line. It also contains form E111, which is helpful to passengers who might need to recover costs for treatment should anything go wrong when they are travelling in the European Union. The booklet "Health Information for Overseas Travellers" also offers practical advice. It is aimed mainly at providing travel information for doctors and health care workers so that they can advise their patients. It is important to ensure that the health service is fully up to date on the latest scientific developments in this area. The information is also available on Ceefax. People can get this information from many different outlets.

We have closely monitored the use the airlines have made of that material. It would be pointless for us to issue it if the airlines did nothing with it. The British Air Transport Association has made a statement that all UK long-haul airlines are providing health information on DVT. We want to monitor that to check that it is happening. In my limited experience it is. The information is provided in a number of ways including in-flight magazines, leaflets, videos and announcements. My hon. Friend said that there is much more widespread knowledge of these issues than there was just a couple of years ago.

As far as we know, the UK is the only country that has published this kind of advice. Despite that, we recognise that more research is needed. That is why the UK Government agreed to fund up to £1.2 million towards the World Health Organisation's research into air travel and DVT. The WHO announced the launch of the study, which is also receiving funding from the European Commission, just a few weeks ago on 14 May.

The research involves the collaboration of several European universities and will be the first large-scale study to focus on the issue. The proposals include research aiming to determine the frequency and causes of travellers' thrombosis, analysis to identify those at greatest risk and, most importantly, studies to examine the effectiveness of preventive strategies. The question is not only why it is caused and what happens, but what can be done to maximise prevention. As the lead funding body, the UK Government will closely monitor the work as it progresses.

As my hon. Friend suggested, it is disappointing that other countries have not committed resources to this valuable work, but with the UK and European Commission funding, at least the first phase of the research can now get under way. I am pleased to confirm that negotiations are continuing with other member states, Governments and the Commission to attempt to secure funding for the second phase. My hon. Friend is

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right to say that a wide-ranging epidemiological study is needed, as well as studies on preventive strategies and on what factors inside airline cabins might lead to increased risk of DVT. We intend to continue rigorous negotiations with other Governments to bring them on board for this research. Public awareness might well be greater in the UK than in other member states, but the research could act as a catalyst for raising awareness in other countries. I hope that that will put further pressure on Governments to participate in the studies in the second phase.

The first phase will address the critical issues, including the possible link to air travel and analysis of risk factors. As I said, we intend to use the launch to encourage others to participate. We will be actively involved in examining all phases of the research. As my hon. Friend rightly said, we must spread the knowledge that comes out of the research. I understand that the WRIGHT forum, dealing with World Health Organisation research into global hazards of travel, will be established. It will be an annual meeting at which the project's progress will be reported and new data emerging from the research will be discussed and disseminated across all member states. A scientific executive committee will attempt to assess information strategies and ensure that, as the research emerges, the widest possible group of people will gain knowledge and take practical steps to minimise the effects on families. My hon. Friend has described the tragic consequences of deep vein thrombosis and my sympathies go out to all families that have lost a loved one as a result of DVT. I know that my hon. Friend has maintained close contact with many of those affected.

In concluding this debate I would like to pay tribute to these families' hard work in campaigning on this issue. Families and parliamentarians have been equally active. Genuine progress has been made since the House of Lords inquiry. It is fair to point to the now widespread public awareness of the disease. The public now has much greater access to advice, which should enable them to make well-informed judgments about minimising risks. For the vast majority of passengers, travel by air has no effect on their health. Although no human activity can be made entirely risk free, by using easy-to-follow advice and taking sensible precautions, all passengers can minimise their level of risk.

Deep vein thrombosis is not just an issue for the UK. In taking forward the recommendations of the House of Lords inquiry, we can claim to be leading the way internationally. All involved, including my Department, the Department for Transport, the Civil Aviation Authority, the Health and Safety Executive, industry and groups such as the all-party committee, have come a long way. We must keep up the momentum, and the World Health Organisation's research will help to provide the impetus. I am sure that my hon. Friend will continue to press the Government to do even more to ensure that we avoid the sorts of tragedies that he highlighted today.

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