| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Lord Clinton-Davis: My Lords, I thank the noble Lord for giving way. I know of a number of people who have a phobia of flying. They get very worked up by virtue of the fact that they fly at all. Would such people pre-eminently come within the definition which the noble Lord has given? So far he has not mentioned them at all.
Lord Winston: My Lords, the issue surely is that stress changes all kinds of processes in the body. It changes catecholamine secretion and it changes various processes which go on in the brain, such as the production of endorphins. That may actually have an effect on the whole body's response. It also changes white cells and it changes the viscosity of the blood. Therefore, stress might have a very important part to play in deep venous thromboses; it is not yet known.
My third point is that the position may be different for the crews of aircraft. Crews on the whole do not experience this kind of stress. They have a completely different relationship with the work environment. But crews may have other problems. Unfortunately, in spite of what my noble friend Lord Clinton-Davis said, one of the problems was that we asked for evidence from the crews but they were not very forthcoming. Both BALPA and BATA were given the standard inquiries, but were very reluctant to take part. That did not help us very much.
We are worried about certain issues. There is, for example, strong anecdotal evidence that air crews suffer from infertility. Indeed, many infertility clinics
around the London area find that they have a high number of patients who are members of air crews. We do not know whether infertility is due to time change, to the fact that they are away from their families for longer periods than average or whether they can hit the right time of the menstrual cycle. But there is a feeling, certainly among crews, that air travel may be a contributory factor both to infertility and to miscarriage as well.What I am saying comes back to the point made by the noble Lord, Lord Colwyn. The evidence that we have at the moment is very anecdotal. Of course, stories hit the newspapers and, of course, people tell us that they have had deep venous thrombosis. However, one point is clear from our report: more research is needed. What we do not want is the kind of research that was initially suggested to us during the course of our taking evidence. When we first spoke to Ministers, they said that they intended to commission research to see whether further research was needed. I want to emphasise to my noble friend on the Front Bench that that would not be adequate for us. We need to ensure that proper research, probably case controlled, is carried out into the problems of passengers . That is very difficult to do.
Deep venous thrombosis is essentially a silent disease. There may be noble Lords sitting in the Chamber who have a deep venous thrombosis but do not even know that they have it. In fact, as the noble Baroness, Lady Platt, pointed out, it is rather more likely now than it was at eleven o' clock when we commenced our proceedings.
It is only through extensive research in hospitals, as we found during our inquiry, that deep venous thrombosis will be detected. Therefore, if we are to research subjects after coming off an aircraft, it will be necessary to look at them immediately, and then probably a week, two weeks or even three weeks later, and to use various quite sophisticated methods that are relatively costly. It would need to be done for the high-risk groups that have been mentioned--the pregnant, people on the pill, people having hormone replacement therapy, the obese, people who have a previous history of this problem, and people who have had, for example, an abdominal operation in the previous six months. On the whole, that will be a complex and difficult exercise
The issue of acute illness on aircraft needs more resolution. The truth is that there are widely differing practices between different carriers. As a doctor, I know from personal experience that an illness on a plane can reveal that the training of different crews has been widely different. Sometimes it has been excellent and other times it has been rather poor. Sometimes one is asked whether the aircraft should turn round. On one occasion I was asked by the pilot whether the aircraft should land. Fortunately, my patient woke up during the course of the discussion and my potential differential diagnosis was proved to be wrong. The patient was not actually dead.
With regard to aids in the Chamber, I want to point out that the noble Lord, Lord Graham of Edmonton, might have been out of order. In order to test that
hypothesis, when I next speak on science and technology I intend to set up a screen on the Steps of the Throne and project slides during my speech.I have a final point. Reports like ours are important; the actions taken on such reports are important as well. However, we have to recognise that there may be, and almost certainly will be, some degree of trade off. There is no doubt that air travel has been a great liberating influence in our society. It has meant a huge difference to people. It has meant that we have contact with relatives and friends. We have an opportunity of seeing the wonders of the world that we could never have seen first hand before. That is tremendously important and socially liberating. We should not curtail that freedom except after very careful consideration.
The trade-off is between, on the one hand, the key problem, which is the issue of lack of space and thus being cramped in a confined environment, and on the other hand, the inevitable raised costs. Clearly, if more space is given to passengers, pressure will be exerted on fares, which at present are remarkably cheap in many instances. Those low fares enable people to travel to places which they could not have afforded to visit in the past.
In conclusion, this is an excellent report. It demands that action is taken, in particular as regards research. Then, when we come to discuss this issue again, we shall have a clearer idea of exactly what are the risks. The problem at the moment is that we do not know precisely what are the risks of deep venous thrombosis and other conditions such as infections. We need much more accurate information.
Lord Monson: My Lords, perhaps I may put one point to the noble Lord, Lord Winston, before he sits down. At the beginning of his speech he stated that air travel was in many ways comparable to train or coach travel. However, is there not one important difference? There is no train or coach in the world where one could be seated in the middle of a row of five seats with two people sitting to the left and two to the right, all fast asleep. On a night flight, the seats directly in front may also be tilted back. One may be totally trapped and unable to get up to stretch one's legs, however much one wants to do so.
Lord Winston: My Lords, I completely accept that point, which has been well made by the noble Lord.
3.46 p.m.
Lord Jenkin of Roding: My Lords, I should like to add my words of thanks to my noble friend Lady Wilcox for what I can only describe as her brisk and efficient chairmanship of the sub-committee. It was a joy to serve with her.
I found this to be a fascinating inquiry, not least because, as a fairly regular flyer, I was able to identify with much of the anecdotal evidence we received. I am over six feet tall and, as a pensioner, I find the cramped economy seating in which we travel extremely uncomfortable. Even on flights as long as four hours one is given what is known as a 28-inch seat pitch. It is hardly possible to move at all.
We now know beyond peradventure that for some people such conditions are not only uncomfortable but downright dangerous, unless they follow the advice given to the sub-committee--which needs to be made available to all passengers--namely, that they can take steps to reduce the risk.
At this stage of the debate I wish to raise only three issues. First, the main impression I gained from all those involved in the initial stages of the inquiry--other noble Lords have referred to this in their contributions--is how low in the order of priorities came passenger health. At one stage, some of the design engineers flatly denied that there was any problem at all. I well remember putting a question to an engineer sitting before the committee. I asked him whether, in the light of all the evidence that we had received, and which I was sure he had studied, he would like to rephrase that statement. The question caused a certain amount of mirth in the public gallery.
As I have said, it appeared that, at least initially, no one was willing to accept responsibility for this problem. The CAA made it clear that it was not its baby. When we interviewed government witnesses on the first occasion, 2nd May, no department admitted to overall responsibility. However, by 27th June, when we saw the Minister responsible for aviation issues, Chris Mullin, I think the Government had by then recognised that that was not a sustainable stance. Mr Mullin conceded at once that the buck stopped with the Department of the Environment, Transport and the Regions.
I have had a chance to read the government response, which arrived just in time for this debate. One of the main planks of that response was to set up the standing inter-departmental Aviation Health Working Group, to which my noble friend Lady Wilcox referred. It is to be chaired by the DETR. The first question I should like to put to the Minister, and to which I hope he will be able to respond briefly and positively, is this: is it still clear that the buck stops with the DETR? One can read the Government's response in its entirety and nowhere is that specifically stated. Mr Mullin said it; will the Minister repeat it from the Front Bench today?
My second point concerns the Government's response. It is true, as we said and as the response repeats, that air travel does not pose significant health risks for the great majority of passengers. I was rather keen that that should be in our report because it is very important; it is true. However, as the evidence unfolded before us, I was left with the concern that for a minority of passengers it does impose such risks. That minority do not know who they are. Hitherto, they have had virtually no information from airlines, travel agents or the authorities to help them to identify the risks. Their doctors, at best, have only partial guidance on linking risks to particular conditions.
Warnings about the dangers of foreign travel have concentrated almost wholly on the risk of contracting disease in foreign countries, not on the question of becoming ill while travelling. Until our report came along, no one much seemed to care; that is the clear
impression that we formed at the outset. It is true that the so-called Aviation Health Institute was sounding alarm bells, but, as we had in the end to say in our report, Mr Farrol Khan, the proprietor of the institute, turned out not to be a reliable witness, preferring sensation to serious research.Our report is the first authoritative report to examine these risks across the board. The charge that the risks have not been identified, or where identified have been addressed only partially, is in fact a true bill.
For the minority of vulnerable passengers there is now a known risk. We may not be able to quantify it for the reason that we need more research, but we do know that the risks can be reduced by sensible advice, sensible precautions and proper information. Nevertheless, the risks are still there. Perhaps I may say to my noble friend Lady Platt that, knowing this was going to be a long day and that we would be sitting for a long time, I have on my support stockings. Our report, in measured terms, has now spelt this out--particularly where not enough is known to quantify the risks of flying or to take action to minimise them.
When I read the Government's response last night, I found it lacking the sense of urgency that the situation calls for. Yes, more research is planned--but, as the noble Lord, Lord Winston, said, it does not seem to be aimed in the right direction. Clearly even the setting up of our inquiry was needed to goad the authorities into action. To read the Government's response to our Recommendation 2, which concerns the interdepartmental working group--I shall not read it out because of time constraints--is to recognise that they have no sense of urgency about this issue, a point made by my noble friend Lady Wilcox in opening.
Of course, hitherto--I have no quarrel with this--the main emphasis on safeguards has been on the safety of aircraft, passengers and crew, with little or no emphasis on health. But now that we have this report and this evidence, surely there is a case for a greater sense of urgency than the Government's response displays. These health issues now need to be vigorously and swiftly addressed, but what do we find in the response? The impression is given that it is far too difficult; that it requires international agreement and that inevitably the pace has to be the pace of the slowest.
There has been some progress--a number of noble Lords have mentioned the new BA leaflet, The Healthy Journey--but the measure of the cultural change necessary is still not recognised. The leaflet contains the headline "During the flight". Beneath that it states:
- "Be a mover. Try not to sit still for too long. When convenient, get out of your seat and move around the cabin. Stand up and stretch your arms and legs every couple of hours"--
- "and carry out the recommended exercises".
Perhaps I may be permitted one piece of anecdotal evidence. My wife and I returned from India at the beginning of October on a very full BA flight from Delhi to Heathrow. As we waited on the tarmac, the captain made an announcement over the intercom: as every seat
was occupied, would passengers please remain firmly in their seats unless they had to get up to go to the toilet. That is what we were told.Happily, I had "stuck my neck out", and my wife and I had seats at the tail-end of the aircraft, where they were two abreast, not three abreast. As a result, I was able to walk about and get some exercise. But to have been told only last October by a senior BA pilot that we should not move about, and now to have the BA leaflet saying that we should, leads us to ask what BA is doing to train aircraft crews to make sure that passengers do move about during a flight. A cultural change is needed. Perhaps I may coin a phrase which the Minister may like to use: "DVT is much more important than Duty Frees!".
My third point concerns costs and fares. I raised it during the committee's inquiry. I accept that if we are to have more leg-room--and there is much evidence of the need for that--it will have a cost. If we are to have more on-board monitoring of air quality, for which we have asked, that will have a cost. Lower re-circulation of air and more fresh air will have a cost. More record-keeping to allow cases of cross-infection to be identified will have a cost; as will more on-board equipment to deal with emergencies. More research will have a cost. I believe that the industry, not the taxpayer, should pay for much of that research.
Yet the airlines are mainly concentrating their advertising and marketing on ever lower fares, as an incentive to more and more people to fly. There must, therefore, be some doubt whether, in spite of the research, the costs of reducing health risks will be regarded as a high priority, let alone as being inevitable, as I believe them to be.
My noble friend referred to the chart relating to the growth in air travel. The figures are spelt out in Box 1 under paragraph 2.4 of the report. The following paragraph states that,
- "Development seems bound to continue";
Of course, I recognise and understand that the British Government do not want to put British airlines at a competitive disadvantage. That carries the implication that the Government will be slow to impose new costs on the airlines. Yet it is no kindness to passengers to lead them to seek ever lower fares at a continuing, or perhaps rising, risk of falling ill.
There must come a time when the regulators must change their priorities. It is to be hoped that the growing threat to airlines of being sued by passengers who fall ill may persuade them that it is in their interest to do something to deal with the problem. If they do not, the regulators must step in and impose minimum standards. At the same time, the body politic--the public--must accept that the price of reducing health risks must be to reduce the growth in air travel. That can afford to be done without reducing too dramatically the opportunities referred to by the noble Lord, Lord Winston.
As research quantifies the risks, the re-ordering of priorities will become essential. That is the real message of our report. I hope that all concerned--the industry, the regulators and the government--accept that. I believe that the report is a beacon document. I was glad to be involved in its production. I hope that the Government will now inject a greater sense of urgency into what is happening.
4 p.m.
Lord Newby: My Lords, I join all noble Lords who have spoken in congratulating the noble Baroness and the committee on this report. It combines great clarity in its analysis of a number of extremely complicated issues with a set of recommendations that should now be implemented. I believe that it has provided a great service to all air travellers. I must declare an interest as a trustee of the Aviation Health Institute.
I begin by commenting briefly on the criticisms made in the report by Farrol Khan. Mr Khan is a zealot in the cause of aviation health. Like many zealots, he can, and does, exaggerate to make a point. Neither I nor my fellow trustees would excuse this. However, in a situation where both airlines and regulatory authorities have been dilatory, I believe that Mr Khan has done more to raise public attention to issues of air travel and health than any other individual. As the report makes abundantly clear, there are serious issues that need urgent attention.
As we have heard, the current situation is unsatisfactory. We know that there are a number of risks associated with flying. But, as the noble Lords, Lord Winston and Lord Jenkin, as well as other speakers, made clear, we do not know the extent of those risks. Until recently, air travellers in the generality assumed that there were no health risks attached to flying. They might have thought that there safety risks, but they did not believe that there were health risks.
I believe that we are now in danger in certain respects of going almost in the other direction. In the case of DVT, hardly a day passes without extensive newspaper reports appearing in which we read about some celebrity or another who has suffered from the condition. It is always assumed that it has arisen as a result of "economy class syndrome". One recommendation made by the committee that is certain not to be followed is that relating to the use of the phrase by tabloid newspapers and others to describe some of the problems associated with deep vein thrombosis.
Following the high-profile case of Emma Christopherson last September, we found in January that a number of British Olympic coaches had suffered from DVT and attributed this to their use of air travel. Moreover, within the past fortnight, we have heard about Pamela Nimmo (the Scottish squash champion) and, within the past day, we have heard of the experience of Sergeant Paul Ridout. Both have suffered from DVT, the result, it is assumed, of air travel. I strongly agree with the noble Baroness, Lady Platt. We must hope that the degree of alarmism spread by the coverage of such cases will not be fuelled to a great extent by the tabloid newspapers.
Both individual testimony on DVT--we heard from the noble Lord, Lord Graham, most eloquently earlier--and much other evidence have now built up a conclusive case that long-haul flights can increase the chance of someone suffering from DVT. But there is still a need for research in order to give us a better sense of the scale of the problem and to guide us on how better to avoid and prevent it.
However, research on DVT is only one area where the report identifies the need for much further work. Other areas include seat size; noise; demography; air quality; blood-oxygen levels; the interaction of different aspects of the cabin environment and of the experience of flying; and the question of medical records of aircrew concerning the long-term effects of exposure to the aircraft cabin environment.
In my view, the fact that so much basic research is needed on one of the most popular forms of transport is nothing short of scandalous. Indeed, the report underlines on virtually every page the complacency and, until recently, inaction of both the airlines and of the regulatory authorities in respect of health and air travel. As we heard, the first studies on the health risks of immobility were undertaken in 1940, yet airlines have only very recently begun to explain to passengers how they can reduce risks to their health. As we heard earlier, the advice is not always capable of being followed or, indeed, actively encouraged.
Whether it is seat sizes, the distance between seats, air filtration, or the provision of straightforward information, airlines are open to the charge that they have not given a high enough priority to the health risks of flying.
It was interesting to hear what the noble Lord, Lord Winston, said about the difficulty of obtaining evidence on risks from BALPA and other flight crew associations. For example, since the report was published, it has come to my notice that one unacceptable but relatively common practice of stewardesses, stewards and flight crews on long-haul flights is to take a whiff of oxygen if they feel a little groggy. That puts them right. The practice has been commonplace in many of the world's best airlines for many years. Until I heard about it recently the matter had not been drawn to my attention, or to the attention of the committee. I suspect that a number of such practices regularly take place and are not widely known. That is alarming. It illustrates the fact that aircrews feel groggy. No doubt many passengers feel groggy but do not have access to the emergency oxygen supply to enable them to recover.
I understand the commercial pressures which have been mentioned under which all airlines operate but their track record in terms of the health of their crews and passengers is much less impressive than their track record on flight safety. It is difficult not to be extremely critical of them. I am sorry that no Member of your Lordships' House involved in the airline industry is present to give the airlines' side of the story and to explain what they are doing in this respect. That would have been beneficial.
But if the airlines must do better in this regard, the same certainly applies to the regulatory authorities. The report describes the current situation as chaotic. We now have the benefit of the Government's response to the Select Committee report. It is to be commended in one respect at least in that it deals with all the recommendations in some detail. That has not been the case in respect of other government responses to Select Committee reports which have been considered in recent weeks by your Lordships' House. However, the document starts off pretty weakly by implying that government inactivity until extremely recently was justified on the basis that the Government were not faced with sustained concerns about aviation health problems. That is an insight into the bureaucratic mind if there ever was one. People may have been dying unnecessarily but as not many of them complained about it there was no urgency to do anything. Therefore, we must be grateful that something is now being done.
Like many noble Lords, my heart sinks slightly when the principal response to a matter is to set up an interdepartmental group of officials with an impressive but long title. However, at least that is an improvement because lack of co-ordination and lack of lateral thinking have been a major deterrent to action in this area. One can only hope that the views expressed in your Lordships' House and outside will encourage the Government to impose political clout and pressure on their civil servants to make quick progress.
As a number of noble Lords have said, the Government's response could go further in a number of areas. As the noble Baroness, Lady Wilcox, said, it does not agree that the HEPA filtration system should be mandatory. Simply to state that airlines will be requested to install it; that is, to ask, "Would you mind awfully putting in this kind of stuff?" is not acceptable. Frankly, I do not believe that that will make the airlines quake in their shoes or take any serious action. The response also pulls back from implementing a number of recommendations on the ground that it would be unacceptable to impose burdens unilaterally on UK carriers. I can understand that view, but, as the Government accept, pushing through change at the ICAO or JAA is a long and tortuous process. But the issues covered by the report are too urgent to wait until everyone signs up to change.
The report concludes, and in their evidence the Government accept, that there is nothing to prevent the UK Government acting unilaterally on air travel health matters. In view of the seriousness of these matters--the deaths and illness being caused on a regular basis as a result of simply taking a plane--the Government must act now on all the recommendations of the report and, if necessary, alone.
4.10 p.m.
Lord McColl of Dulwich: My Lords, I, too, would like to pay tribute to our splendid chairman, my noble friend Lady Wilcox, who carried out her duties with such charm and efficiency. She was well able to slap down any noble Lords who spoke out of place or for too long. I should also like to pay tribute to our Special
Adviser, Dr Michael Davies, whose expertise and good humour were much appreciated; and for the hard work, efficiency and style of our Clerk, Roger Morgan. It was much appreciated.Much of what I had planned to say has been said, so I shall not repeat it. However, I wish to mention one or two aspects. The retrospectoscope is a wonderful instrument. It is so easy to be wise after the event and to criticise airlines for failings about which they were completely unaware. It is always tempting to make exaggerated claims about the dangers of air travel. Those exaggerated claims attract publicity. I was astonished to read in the Official Report of 16th January that a Member of another place had said that DVT is a public health problem on a major scale and that it could be a greater problem than asbestosis; it could even be a greater public health problem than BSE. I should have thought that that Member needed what is called counselling.
One of the main themes which ran through our inquiry was the forced immobility of passengers. I have been interested in this subject for many years. When I flew across the Atlantic I often worked out the average time available for each passenger to go to the loo; it was called the mean available loo time. With the gangways blocked with trolleys for drink, food and duty-free goods, sometimes that is a pretty critical time, especially if one has a lot of elderly men with prostate trouble.
That emphasises that it is difficult to keep people mobile; hence the danger of DVT. We found no evidence whether air travel per se contributes to the risk, but that does not mean that it does not do so. I would not mind betting that the low partial pressure of oxygen has some effect on the clotting mechanism. As the noble Lord, Lord Graham of Edmonton, and others have said, we need more research into this important subject.
All noble Lords have mentioned seats and not having enough room. I shall not go into that again. However, one problem has not been mentioned. If one is very tall, there is not enough room to assume the brace position in an emergency. That must be a serious factor too. As has been mentioned, we must have more room. If we are to have more room, there will be fewer passengers and the fares will undoubtedly increase; and so be it.
The good news is that British Airways has produced this very good document, The Healthy Journey. It gives advice on anti-malarial medication and the need for any passenger to take in his hand luggage the drugs he regularly takes. There is also a useful website about health when travelling. There is useful information about eating and drinking. I often think that so-called jet-lag is more to do with eating large meals at the wrong time and consuming far too much alcohol.
Perhaps there could be greater emphasis on the need to keep swallowing. Sweets are handed out on take-off and landing. The real problem is landing, when the pressure changes are much more rapid. Greater emphasis could also be put on the need to feed babies on the descent to prevent them getting severe earache. That is easy to do.
My noble friend Lord Colwyn mentioned the prophylactic use of aspirin, which is well established. It is worth emphasising that the dose is not the usual 300 to 600 milligrams, but a much lower 75 milligrams. The use of elastic stockings should also be emphasised--not only in the Chamber but on planes.
I think that the noble Lord, Lord Winston, said that pilots do not have the same amount of stress. I am afraid that the pulse rate of an experienced pilot doubles on take-off and landing. They are under considerable stress at certain times during the flight.
In conclusion, I hope that the Minister will take up the suggestion to inject a real sense of urgency into getting the recommendations implemented. How much money will he make available to do the research that has been suggested?
4.16 p.m.
Lord Burlison: My Lords, I congratulate the noble Baroness, Lady Wilcox, on initiating this interesting debate. I join others in thanking her for her excellent work in chairing the Science and Technology Committee's inquiry into air travel and health. The committee's excellent report was published in November. I admire her stamina, because she has sat through and spoken in both of today's interesting and exciting debates. The noble Baroness, Lady Platt, and the noble Lords, Lord Jenkin and Lord Winston, have also spoken in both debates. I have enjoyed listening to all their comments.
I am pleased to say that the Government have now published their response and laid it before the House. It has been referred to several times.
My noble friend Lord Graham has unfortunately had personal experience of DVT on a long-haul flight from Australia. Those of us who know the noble Lord know that he is no shrinking violet. His representations were in no small measure instrumental in getting the inquiry under way. I notice that he has been drinking water during the debate. As usual, he sets a good example to the House, as well as making an excellent contribution to our debate. I always accept his advice. For some reason, I am charmed by his accent. I shall be happy to respond to the dossier that he has prepared for us.
The health of air travellers is a subject of considerable importance that has generated significant public concern. The report and the Government's response are timely. The Government have given detailed consideration to the recommendations and accepted their main thrust in our response, published yesterday. There are undoubtedly some real concerns, although the issue has also been the subject of much speculation and, in some cases, ill-informed comment, which has unfortunately recently received a high public profile. The noble Baroness, Lady Wilcox, and the other members of the committee must therefore be congratulated on the perspective that they have brought to this complex area of health.
During the debate, the noble Baroness, Lady Wilcox, and other colleagues described a number of different health risks which may be related to air travel. I shall address those now, but I also refer noble Lords to the extensive government response laid before the House.
The possibility that travelling by plane increases the likelihood of the occurrence of deep vein thrombosis, or DVT, must of course be treated extremely seriously. Deep vein thrombosis is a serious condition which occurs in approximately one in 1,000 of the general population and leads to some 25,000 National Health Service admissions each year. We know that some of those--by all accounts, a small proportion--may be related to air travel, but we do not know how many.
However, we know that DVT is associated with a number of factors, such as immobility after surgery, being over the age of 40, pregnancy, hormone treatments, inherited clotting tendencies, a family or past history of DVT, and cancer, whether treated or not. Air travel also appears to be one of those factors. Most experts advise that, in common with some other means of transport, air travel, especially on long-haul flights, may involve long periods of immobility.
Immobility has long been known to increase susceptibility to DVT. It was mentioned that, even during the Blitz, people who remained immobile for long periods in air shelters were found to develop DVT. The noble Baroness, Lady Wilcox, is certainly right to say that Professor Keith Simpson noted the relationship long ago. However, only in recent years has immobility during long-haul air travel been linked to DVT. Patients who are kept immobile in bed for long periods, especially after surgery, commonly developed DVT. But I believe that new approaches to surgery--in particular, early mobilisation--have reduced the risk significantly.
However, as the Select Committee suggests, it is important to establish whether or not other factors, specific to the aircraft cabin environment, may add to that risk. Quite simply, at present there is no definitive answer. A good deal of research information is available, but the findings are far from clear.
In addition, it is extremely difficult to identify exactly what proportion of all DVTs that occur in this country is attributable, wholly or in part, to air travel. We simply do not have that information. Given that lack of clarity, I fully support the committee's recommendation that research be carried out to establish with greater certainty whether or not the aircraft cabin environment increases the risk of DVT, and, if so, to what degree.
I turn to the government-funded study announced by Ministers when they gave evidence to the committee last June. I cannot tell the noble Lord how much money will be available for that study, but I hope that by the time I reach the end of my submission I can throw some light on it. The study will draw together and assess
existing research, and recommendations will be made as to how further research will be best targeted.In the light of that preliminary systematic review, the Government will work with the air travel industry in setting up the necessary research to obtain a clearer picture of the relationship between air travel and DVT, and will provide the best information on DVT for those who travel by air. The parameters and structure of the further research will depend on the outcome of the present scoping study or systematic review. However, the aim will be to clarify the links between DVT and the aircraft cabin environment.
I agree with the emphasis given by my noble friend Lord Winston to the need for research. I have already said that new research will be commissioned. However, we must be sure that it is well targeted. For that reason, a scoping study is currently being carried out. My noble friend also gave us some good advice. I am sure that proper research with regard to passengers is vitally important, and I certainly take on board that particular point.
The noble Lord, Lord Colwyn, always makes constructive contributions to health debates. I cannot go to my local dentist without him singing the praises of the noble Lord in this and other areas.
When the research is complete, we should be in a position to make decisions that are backed up by a genuine understanding of the risks and contributing factors, and not have to do so on the basis of best guesses and consensus. In the mean time, the Government and the industry are focusing on ensuring that the information and advice that is made available to passengers before, during and after flights is consistent and as authoritative as possible, given the existing state of knowledge.
I know that airlines are pursuing a range of strategies to inform their passengers. British Airways is to issue a leaflet to all of its customers. That was mentioned earlier. One of the welcome effects of the recent media attention to this health area and of debates such as this is the increased public awareness that they create. The Government are contributing to that process by improving their own information leaflets and ensuring that they all provide a consistent message and by widening access to that important information.
Very importantly, I emphasise our support for the committee's recommendation that the term "economy class syndrome" is a misleading phrase. That point was made by several noble Lords, including the noble Lord, Lord Newby. It does not reflect the fact that, on current information, immobility appears to be the key factor in developing DVT. Immobility--and, therefore, DVT--carries a risk factor for all passengers no matter which class they choose to fly. That point was made by the noble Baroness, Lady Wilcox.
I say to the noble Lord, Lord McColl, that I have difficulty with many medical terms--I do not have a medical background--and that he threw me a little with his reference to a retrospectoscope. As usual, he made a
good point, especially about safety in the braced position. Not being a big fellow, that point had not struck me previously.The noble Baronesses, Lady Wilcox and Lady Platt, expressed concern that the air that circulates on board aircraft may be potentially hazardous to health in several ways. Among the issues that have been raised at different times are ventilation, filtration, humidity and the possibility of transmitted infection. I shall not go into each of those concerns specifically because they are addressed in the Government's response. However, there is clearly once again a need to isolate any added risks that are specifically attributable to flying.
The noble Baroness discussed air quality on the flight deck. I am told that there was a misunderstanding about the evidence from the witness from the Joint Aviation Authorities. Air crews must receive a minimum proportion of fresh air, but there is no requirement for them to receive fresh air exclusively.
The committee made several helpful recommendations in this area. There is a good deal of detailed work going on around the world testing air quality on board aircraft and making suggestions for improvements or better standards. We and the air travel industry are following the situation closely to identify gaps in existing knowledge about air quality, to clarify what further research might be needed and to decide whether any regulatory changes are needed.
The noble Lord, Lord Clinton-Davis, made a strong case on behalf of the trade unions in the industry. On the point that the noble Baroness, Lady Wilcox, made about HEPA, the Government believe that regulation with regard to those standards would not be proportionate. The vast majority of passengers who travel do so on aircraft that have HEPA standard filtration. Only a tiny minority of the older UK aircraft do not meet HEPA standards. Regulation of course still remains a possibility and a last resort if we cannot make progress by consent in this regard.
The health issues that I have described are only some of those which have recently been linked to air travel. The House of Lords report is compellingly comprehensive in addressing those issues and I do not propose to go into any more detail. But if there is one message above all coming loud and clear from the committee it is that passengers should have better access to authoritative information which is as precise as possible to allow them to make informed choices before travelling. I entirely endorse that message.
I have referred already to the question of information on deep vein thrombosis. I have described the steps that we are taking to provide passengers--before they book their ticket, during their flight and, indeed, after--with information and advice to help them reach their own decisions about travelling and help them minimise any risks. However, my mind boggled somewhat at thinking about the noble Lord, Lord Jenkin, rushing around in his support stockings. If our research suggests that regulation on health grounds is necessary, we shall not hesitate to act.
This important and wide-ranging report has set in motion a valuable debate on health and air travel. The Government will work with the air travel industry to develop the current knowledge base relating to health and safety; ensure evidence-based safety standards for air passengers; disseminate the best available health information relating to air travel; and improve access to that information for the public and air travellers.
The noble Lord, Lord Jenkin, asked whether the DETR has the final responsibility within the Government for air travel and health. Who am I to go against what my right honourable friend in another place says? I can confirm that that is the case. That is where the authority lies.
There is an issue of joined-up government here. Therefore, we need to create a suitable structure to deal with an important area of public responsibility which spans several government departments. For that reason, we intend to establish a standing interdepartmental group on air travel, to which a number of noble Lords referred. In the first instance, the group will take forward those recommendations made by the committee on which the Government are to act: steering the current systematic review; monitoring other developments on air travel and health; and providing advice to Ministers on the way ahead.
The group will be made up of representatives from the Department of the Environment, Transport and the Regions, the Department of Health, the Civil Aviation Authority and the Health and Safety Executive. The noble Baroness, Lady Wilcox, asked for information on that group. Its first meeting will be held within the next few weeks. Initially, the group will meet every two months and will meet more regularly if that is necessary. The group will work closely with the airline industry, the airline regulatory authorities and, importantly, patient representative groups in overseeing that work.
It is important for the Government to play their part in this area of health. We recognise that fully. But even more importantly, the airline industry must accept that it has a primary role to play, both in terms of minimising risk and in providing effective information to their passengers before they fly.
In his speech late last year, launching the Government's consultation document The Future of Aviation, my right honourable friend the Minister for Transport set out 10 challenges to UK airlines to improve standards of service provided for passengers. One of those challenges is for airlines to,
- "provide better information on health issues".
I know that the noble Lord, Lord Newby, referred to those noble Lords who have airlines experience being missing from the debate. I am quite certain that once they pick up Hansard and tune in to what has been said in this debate, they will become involved in the issue in the future.
The Minister of Transport will be meeting with the airline industry and other interested parties next Tuesday to hear their response. Noble Lords will join
me in urging our travel industry to take up the health challenge wholeheartedly.Once again, I thank noble Lords for this valuable and timely debate. The subject of air travel and health is now clearly on the Government's agenda; not just on that of the Department of Health but that of the DETR, the regulators, the airline industry and, indeed, airline passengers. We all have a role to play in assessing and minimising the risks to health involved in travelling by air. We are determined to support that work. In the words of the noble Baroness, Lady Platt, I am sure that we have not worked in vain.
There will be many points which I have not been able to answer. However, I shall read Hansard carefully and respond accordingly to those I have missed. I am a little reluctant to accept that the Government's response does not show a sense of urgency. I think that there is urgency with regard to this issue within the Government. I have no hesitation in recommending to noble Lords the Government's response and the constructive strategy we have set out.
4.36 p.m.
Baroness Wilcox: My Lords, I rise to thank all who have taken part in the debate. In particular, I thank the noble Lords, Lord Jenkin and Lord Winston, and the noble Baroness, Lady Platt, who have already taken part in another big and exciting debate today. It has been something of a day for science, society and the airline-travelling public. It would be remiss of me not to mention the noble Lord, Lord Graham of Edmonton, for his special contribution. All the way through our research he came and gave evidence to us. He has been a great supporter. The speech he made today was unique and one we shall not quickly forget.
It remains for me to thank the noble Lord, Lord Burlison, for his reply on behalf of the Government. I thank him for answering some of the concerns which I and other noble Lords expressed on the new interdepartmental group, when it will start business and how effective it will be. We shall watch the matter urgently.
On Question, Motion agreed to.
- House adjourned at twenty-three minutes before five o'clock.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |