CHAPTER 8: WIDER
ISSUES
Poor recognition of fitness to fly issues
8.44 Lord Graham of Edmonton
(QQ 74-78) drew attention to the lack of knowledge amongst the
public about the aircraft cabin environment and its relationship
with health. Others (Appendix 4) confirmed the general points
that most intending flyers are unaware of cabin environment health
questions. PPP Healthcare (p 267) made the important point that
most general practitioners are also unaware of the health implications
of flying. The Royal College of Anaesthetists (p 275) and the
Academy of Medical Sciences (p 197) were of the same general view.
8.45 People who are recovering from recent serious
illness, surgery or injuries, or who have serious long-term medical
conditions, are generally under professional medical care. If
people in any of these groups intended to fly, they would doubtless
expect appropriate advice from their carers - as they would if
they wished to know whether they could, for example, drive or
take up sport again. If the carers were unable to give appropriate
advice, they would, for the reasons discussed immediately above,
have difficulty in finding appropriate sources to provide it.
In practice, many would contact airlines direct, or would advise
the patient so to do. Many professional carers are aware of the
MEDIF system (see paragraph 7.46) and advise their patients accordingly,
particularly if pre-boarding or in-flight assistance is needed.
However, when a primary practitioner such as a GP or practice
nurse has cleared a patient as fit to fly, problems may still
arise. The airline may disagree and refuse boarding - or, as the
Royal College of Nursing pointed out, a health insurance company
might retrospectively reject a claim if a particular medical condition,
which was not covered, subsequently caused illness (p 277).
8.46 The vast majority of
intending air travellers are people who either are healthy or
have no reason to think that they are not. They are unlikely to
seek professional health advice before embarking on their journeys
- and we agree with the Minister for Public Health that most people
have no need to do so (Q 550). Some intending air-travellers will,
however, have conditions which might cause them to be adversely
affected by flying. While most of these will not experience any
health problems arising from travel within the aircraft cabin
environment, they are at risk, and some may develop problems from
associated factors such as hypoxia in those who have diminished
respiratory function and barotrauma in those with ENT disorders.
8.47 The fundamental problem
is the general lack of recognition by the public and their primary
health advisers that fitness to fly is a serious matter. We consider
that this is due to a lack of knowledge about the possible health
risks in the aircraft cabin environment amongst not only the public
but also the health professions. Neither doctors nor nurses are
taught about these matters during their basic training (pp 198
& 277) and, although some airlines make substantial efforts
to educate health professionals on the medical aspects of air
travel (QQ 315 & 317), such opportunities are only likely
to be taken up by those already aware of their need for such further
education. Intending flyers need to be aware of fitness to fly
issues so that the small minority of them who need advice can
identify themselves and, in seeking advice, stimulate demand from
health advisers for better and more accessible guidance.
8.48 The booklets from DoH,
Health Advice for Travellers, and from AUC, Flight Plan,
should be important sources of health information and advice for
intending passengers. As their publishers accept (see paragraph
8.26), the current editions fall well short of what is required,
and we were pleased to note the plans for appropriate revision.
We recommend that priority be given to refining the advice in
Flight Plan: "If you have any concerns about your
fitness to fly, talk to your doctor before you book your flight".
We understand and share the Minister for Public Health's concern
not to add needlessly to the burden on doctors or to the general
hassle for intending passengers (Q 550). However, the existing
advice is far too vague and, to help both groups, needs to be
made much more specific.
8.49 We find that CAA also
publishes a leaflet, Travelling Safely, which is sometimes
issued with airline tickets. This focuses on safety, although
some of the advice also has health implications. We recommend
CAA to revise its Travelling Safely leaflet, at least to
cross refer to the revised Health Advice for Travellers
and Flight Plan. We also recommend DoH, CAA and AUC to
consider whether the combination of their three leaflets as currently
conceived best serves the travelling public's information needs.
8.50 The Minister for Public
Health acknowledged a case for more targeted information for people
at risk, but noted that not enough was currently known about the
target groups and what advice they should be given (Q 548). The
former should be clarified in the new research initiated by DETR
and DoH (see paragraph 8.3). On the latter, the Minister made
a good start by noting in her evidence to us four particular groups
of people who might need advice about health risks of flying
(Q 551), namely:
- those who might be actually unfit or unsuitable
to fly (which might mean women who were more than 36 weeks pregnant,
or people with severe respiratory or cardiac conditions);
- those who should consider delaying a flight (perhaps
because they had recently undergone major surgery);
- those who might be at particular risk of DVT;
and
- those who were on medication.
8.51 Alongside the revision,
further thought needs to be given to the way the information is
brought to the attention of intending flyers. We note the Minister
for Public Health's view that the message may be too complicated
for a public information campaign (Q 548) but there needs to be
some way of raising the profile to kick start the desirable process
noted in paragraph 8.47. We make our own suggestions in paragraphs
9.5ff.
Airlines'
handling of the travelling public
GENERAL
ISSUES
8.52 DETR noted that, in
the air travel market, the usual rule of "buyer beware"
applies (Q 2, p 1). This was also one of the general thrusts of
the airlines' evidence. It is therefore vital that sufficient
information is available at the point of sale to enable the purchaser
to make an informed choice. In our view, airline ticket selling
does not satisfy this need, particularly for those intending air-travellers
who are concerned about their health and wellbeing - and those
who are not concerned, but should be.
8.53 Airlines and their agents must accept that although
they may feel strongly that the cabin environment does not present
additional hazards to health for the vast majority of their customers,
a significant number of the latter do not agree. Even though some
of those perceptions may be ill-conceived, they should not be
ignored. Much good could be achieved in setting minds at rest
(or alerting those potentially at risk who need to be alerted)
by more attention, at and around the point of sale, to concerns
about health and comfort. The active provision of sound and user-friendly
information and advice at this stage would certainly help consumers
to make informed choices.
8.54 As noted in the section on seating in paragraphs
6.33ff, seating and space limitations have been major subjects
of adverse criticism concerning comfort and wellbeing by many
witnesses. The lack of prior knowledge and choice of what is being
purchased was seen as a major shortcoming of this process-driven
system. Most passengers have no idea of what the seating configuration
of the aircraft is, where in the cabin they will be seated and
what their seat space will be, until they check in and board the
aircraft - by when it is too late to do anything about anything
found to be unsatisfactory.
8.55 Even at the check-in
stage, passengers have found that they are often treated as commodities.
If they try to enquire about conditions on board, or get seats
or groups of seats that they particularly want, they are, in the
telling phrase used by Dr Murray Wilson, made to "approach
the check-in desk as supplicants rather than partners to an equal-sided
contract" (p 255). It appears to us that consumer choice
is unacceptably limited in some aspects by the airline business
being driven by the process itself rather than by the consumer.
8.56 We hope that the European
Commission's initiative, noted in paragraph 3.15, will lead to
legislation to improve the information available to passengers
to make well-founded choices, to create new rights for passengers
and to improve the balance of contracts in their favour. Further,
we hope that airlines' actions before then will render such legislation
redundant.
COMPLAINTS
PROCEDURES
8.57 BATA provided some evidence
of favourable customer feedback on UK airlines (p 124) but this
seems likely to be only part of a range of opinion. Given the
massive number of passengers, there are bound to be some formal
complaints. We did not, at the outset of our Inquiry, intend to
include an examination of airlines' systems for dealing with complaints
about the aircraft cabin environment but, as summarised in Appendix
4, we received evidence that gave us concern about such arrangements.
8.58 Our witnesses' main problems seemed to be that
either they never received responses at all from the airlines,
or that the responses they did receive amounted to denial by the
airline concerned of any responsibility for whatever circumstance
had given rise to the complaint. When pressed further, the airlines
seemed quickly to hand over complaints to their lawyers or insurers
and took no further interest in the concerns. When complainants
made what they thought were helpful proposals that might have
benefited others in the future, they were even more disappointed
by the airlines' apparent lack of interest or concern. As might
be expected, no-one who received satisfaction of a complaint wrote
to us. In any case, it would not be appropriate for us to deal
with individual witnesses' grievances.
8.59 Airlines and their agents
need to be aware that the implementation of our recommendations
for improving the aircraft cabin environment and the public's
awareness of health issues will lead to increased dealings with
their customers. To the extent that these are not handled well
at the normal stages of ticket purchase, check-in and flight,
they may lead to an increased number of complaints.
8.60 Whether or not this
proves to be the case, we recommend airlines to review their
systems and procedures for dealing with concerns and complaints
so that passengers do not feel that they are being forced to deal
with lawyers and insurers from the outset. This review should
include considering the case for an independent "ombudsman".
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