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The report rightly recommends that a proper epidemiological study of the pilots and cabin crew affected should be undertaken. Surely the Minister accepts that this is now urgent, and the committee must insist that the evidence from Dr Sarah Mackenzie-Ross—both her written submission of 7 June 2007

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and her subsequent oral presentation on 10 July 2007—must be followed up immediately, before the trail goes cold.

Members of the Committee will recall the Independent Pilots Association’s findings, based on research by the Global Cabin Air Quality Executive, that 86 per cent of 242 pilots—past and present—who had been responsible for BAe 146 flights had experienced contaminated air events, 57 per cent reported various adverse effects, 25 per cent reported medium or long-term health effects, and 8.5 per cent appear to have been medically retired or had their medical certificate withdrawn by the CAA. This is quite common; it is not really such a tiny situation as Ministers have suggested in the past.

I emphasise again that ill health among occasional air passengers is serious, but how much more serious is acute or chronic illness among those who are regularly and consistently responsible for the safety of our aircraft? The airlines and aircraft manufacturers have shown that they insufficiently protect the safety of crews and passengers. Only Ministers, not the industry, are accountable to the public. If anything went seriously wrong, they would be blamed, and rightly so.

While this problem still exists in some aircraft, some of the worst offenders—notably some of the BAe 146 aircraft—have been withdrawn from service, and more responsible carriers such as Flybe, which is based at Exeter, have disposed of them, partly on account of their deleterious effects on the air quality outside. However, their engines’ impact on air quality inside could be even more serious. Incidentally, I wonder what has happened to the Department for Transport’s own comments on the committee’s recommendation that the JAA should reconsider,

This seems to have disappeared.

How far has the Government’s Aviation Health Working Group or the AHU got with advice for those dealing with victims of serious air contamination events? I understand that Dr Robert Harrison of the Division of Occupational and Environmental Medicine at the University of California published only in August 2008 a document entitled Management of Exposure to Aircraft Bleed-Air Contaminants Among Airline Workers—A Guide for Health Care Providers. Surely the very least that our Ministers should do is to read that carefully and see whether it applies to our situation, too.

People’s lives and livelihoods have been very seriously affected by these problems. I am sure that I do not need to remind either Members of the Grand Committee or members of the Select Committee that there have been near disasters as a result of these contamination incidents elsewhere in Europe, notably in Sweden, with pilots and co-pilots incapacitated. Too many experienced flight officers have been forced into early retirement by consequent ill health. Simply phasing out specific aircraft or specific ventilation systems is not enough.

In the mean time, what of those who have been so adversely affected? We have seen in research into the illness suffered by veterans of the first Gulf War what

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delays can do to undermine the quality of research. Should not the Government establish fully what the toxic effects of tricresyl phosphate are and how toxic it is compared with other chemicals? Ministers have drawn a blank on this issue in Written Answers to me in this House. The GCAQE, led by Captain Susan Michaelis and Tristan Lorraine, submitted substantial evidence on the toxicity of these chemicals and their various isomers. It is unclear why the committee was unpersuaded by their expert submissions.

Dr Sarah Mackenzie-Ross, whose excellent research at UCL is well known, has referred to the possibility of a synergistic effect occurring when chemicals such as tricresyl phosphate are mixed. There may also be a serious risk from the processes of disinfection, when cabin crews have to carry it out in advance of landings in and from tropical climates. Each of the individual chemicals is said to be safe, but very little work has been done on analysing the effects of what for some proves to be a lethal mix of different chemicals. The regulatory approach so far seems to be equivalent to proclaiming that electricity and water are safe on their own, without bothering to point out the grave dangers that can arise if both are used in the same environment.

Fume events of various kinds that threaten not only the long-term health of airline staff but the immediate safety of all on board a given aircraft are currently not reported adequately. There are clear signals from within the industry that the consequences for pilots of reporting such events can be dire. Licences can be lost and careers ended. If these issues, many of which are complex, are ever to be resolved, we must address that fundamental issue.

In his response, I hope that the Minister will be able to answer some key questions. When will the Cranfield research be published? What steps are being taken to ensure that it commands the confidence of campaigners on this issue? For example, has the GCAQE been consulted on the methods and scope of the research? Will the Minister now, on the basis of this report, refute the conclusions of the Committee on Toxicity that an epidemiological study is unnecessary? It is manifestly necessary, and has been for some 10 years, which has been reinforced by our own committee.

What action is the Aviation Health Working Group taking to investigate the effects of mixing chemicals in a cabin air environment? How sure is the Minister that benign individual chemical ingredients do not together amount to a toxic recipe? Finally, what steps will the Government now take to ensure that every fume event is reported? Is legislation now required to compel airlines to manage this process effectively? The pilots, cabin crew and passengers affected by contaminated air events suffer in the long term.

The Government have at last begun to recognise the problem, and the recent court ruling in relation to Georgina Downs’s separate case on pesticides, including organophosphates, being used near people’s homes is also a welcome development. But failure to act on a problem that Ministers now recognise is almost a more callous betrayal of passenger and staff interests than the total blindness that preceded it. This is a very serious issue. I am delighted that our committee it has

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returned to it again; and I hope that this debate, as well as its report, will stimulate more action from the Government.

5.56 pm

Earl Attlee: I am grateful to the noble Lord, Lord Sutherland, and his committee. This is a useful and timely report, and I found it very informative reading over the weekend. His introduction was as witty and clear as any that I have heard.

The 2000 Select Committee report to your Lordships’ House had a significant effect. Much has happened since and most of it is good. The noble Lord, Lord Sutherland, asked about the competence of EASA. When does the Minister think that it will be competent? I hope that he can give an update on the progress, and I would be surprised if he were not well prepared on that point.

The noble Lord, Lord Sutherland, made an interesting point about the control of infectious diseases, as did the noble Lord, Lord Patel, and I look forward to the Minister’s response about contingency plans for pandemics. Your Lordships are very good at differentiating between hope and a proper plan.

The noble Lord, Lord Patel, made important points about hand hygiene, food and bodily functions. He is right. My humble military experience in the Middle East, demonstrated how important that is. Where we had good hand-washing hygiene, we had low rates of infection, but of course the converse was true. The noble Lord, Lord Broers, talked about what I would call “fit-to-fly” issues. I share the committee’s concern about the availability of fit-to-fly information. Information is available on the internet, but there are two problems. First, some people hate the internet and others have no access to it, particularly the old, who are flying in increasing numbers. Secondly, there is a problem with accuracy and reliability. I read in the report that even the BBC travel health section gave completely wrong advice, which the report charitably described as nonsense.

I was surprised what did and did not contraindicate flying. For example, I was surprised that a 10 day-old baby could fly. It is clear that some work needs to be done on disseminating medical advice and, as ever, that is a cross-departmental issue. The Minister needs to push that.

The noble Lord, Lord Haskel, talked about the Aviation Health Unit, the AHU. The committee is right to suggest that the AHU handles passenger complaints, and I am concerned that the airlines’ complaint machinery will fall into the trap of minimising and mitigating complaints. The noble Lord, Lord Haskel, gave an example of how that might occur. No matter how passenger-focused the airline is, if the airline receives one or two complaints of a similar but obscure nature, the temptation must be to bat it off. But if the AHU received eight complaints of a similar nature but about the same aircraft, this would be significant and it would surely take action.

The committee expressed concern regarding insufficient research, and many noble Lords talked about this. The government response to the report lists three projects, but their relevance was a little tenuous and fortuitous.

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Is the Minister convinced that sufficient research is being undertaken? What research is being conducted overseas? Have we got visibility of that? I know that we would not start a research project without checking whether the research had already been undertaken overseas, but are we examining what is being done overseas?

Many noble Lords talked about what I would call the 30-minute rule. I am not yet convinced that the committee has got the correct answer. The committee slightly gave the game away when it said in the report:

“The issue of spread of disease by contact with infectious passengers is high in the public’s mind”.

That statement is absolutely right, but it does not mean that regulation is the right answer. Indeed, the Government do not accept the recommendation in their response. On the whole, I do not like giving power without discretion. The proposed 30-minute rule is predicated on the increased risk after a period of 30 minutes without air conditioning. However, there may be risks associated with disembarking the passengers. They could include logistical problems at the airport or a known risk of crime or terrorism at the airport, or there could be a greater risk of infection from the airport rather than staying in the aircraft. Finally, not being ready to taxi to take-off could result in a lost slot opportunity, and that would have knock-on effects and could mean that the passengers do not get to fly that day at all.

It is a matter of judgment for the aircraft captain, who needs to balance the risks. It is absolutely vital that all members of the crew of the aircraft, from the captain downwards, recognise the risk of being on the ground in excess of 30 minutes without the air conditioning working. The committee suggests an alternative of making a delay of more than 30 minutes reportable,

to which I would add, “and the captain”. I suggest that we need to give further thought to this matter and not rush into it.

I enjoyed dipping into this subject by reading the report and listening to noble Lords’ comments. Following on from the comments made by the noble Lord, Lord Haskel, on the attractiveness of the Science and Technology Committee, perhaps when I get out of my short trousers I might be honoured with a place on the committee. I look forward to listening to the Minister’s comments.

Lord Tunnicliffe: The noble Earl came to a conclusion rather more rapidly than I had anticipated; please forgive me.

Earl Attlee: I can get my researcher’s speech out if the noble Lord would like.

6.05 pm

Lord Tunnicliffe: There is a tradition in this House of declaring interests. Mine is distant, but, for clarity, I should say that I was involved in the aviation industry for 22 years until 1988. I was everything from an

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airline pilot to a BALPA shop steward to a senior executive at British Airways and chief executive of a small airline. First, let me say how pleased I am to be here and to be able to participate in this debate. I should particularly like to thank the noble Lord, Lord Sutherland of Houndwood, for bringing this report to the House. In 2000, the committee’s report was a milestone in raising the profile of aviation health. However, shortly after came the 9/11 attack on the World Trade Centre and passenger security became the top priority for Ministers and the aviation industry.

Nevertheless, looking back, I can say confidently that the Government, the Civil Aviation Authority as the UK’s aviation regulator, and airlines have responded actively to the committee’s recommendations. The extent of progress was recognised in the committee’s report, Air Travel and Health: An Update, published in December 2007. In February 2008, the Government responded and, in May, the committee published that response.

I wanted to put those milestones on the record for two reasons: first, it sets out where we are as background to this debate; and, secondly, the UK has a very good story to tell in aviation health. As the committee observed,

Noble Lords know that the UK has a commercial aviation safety record which is second to none. It is a hard won reputation and we will do nothing to jeopardise it. We are also, as far as we know, the only country with a specific duty to safeguard health on board aircraft. The Civil Aviation Act 2006 charges the Secretary of State with,

The functions of the CAA were amended to include the health of persons on board aircraft. This change is a world first as far as we know and was welcomed in Parliament.

In direct response to the report’s recommendations, we set up the Aviation Health Working Group, which has brought industry, trade unions and government agencies closer together, not just through meetings but by embedding day-to-day contact as part of the working culture. The AHWG has adopted an approach based on information gathering to underpin policy. This has found wide favour among stakeholders. As the noble Lord, Lord Sutherland, noted, in December 2003, we established the Aviation Health Unit in the CAA to act as a focal point for aviation health issues. I mention these important structural changes to show the permanent place created in government for aviation health issues.

I also want to touch on some of the initiatives the UK is engaged on in this field, but, first, I am sure your Lordships will understand when I stress that government departments do not have infinite budgets for all the things that they or others would like to see done. Every use of resources has to be proportionate to the problem it seeks to address.

Let me illustrate that by mentioning briefly three important initiatives which the Government have taken. We funded major work on deep vein thrombosis, which was co-ordinated by the World Health Organisation. We have begun innovative research work to investigate concerns about potential contaminants in cabin air,

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which, again, is a world first. The Aviation Health Unit has made substantial progress on improving information for passengers and GPs on air travel and health, in accordance with the committee’s recommendation.

The UK was instrumental in setting up the large, international research project known as the WRIGHT project to investigate travel-related DVT. We contributed substantially. The Department for Transport and the Department of Health made €1.8million available. The rest was funded by the World Health Organisation and the European Commission. We were the only individual nation to back it, although the knowledge gleaned is of global application. The WRIGHT project was carried out by a consortium of medical research experts.

Publication of the final report by the World Health Organisation took place in June 2007, although the Department for Transport had already published summary results to provide earlier help to the travelling public.

The most important finding—and one that is now widely recognised—is that one’s personal risk of DVT, which varies with medical history and age, is increased three or fourfold on any journey over four hours, not just air travel. So the risk appears to be predominantly the result of prolonged immobility rather than anything specific to air travel. Indeed, in terms of numbers, such blood clots are, of course, found among patients in hospitals. Nevertheless, the absolute risk was found to be low, about one case in every 6,000 flights.

As regards cabin air, the committee recommended in the 2007 update report that the research to identify the substances produced during a fume event should be completed urgently. I am pleased to report that this work is actively in hand and is progressing well. The Department for Transport has secured the interest of five airlines to participate in this groundbreaking research, and other countries are watching it closely. I express my warm thanks to those airlines that have made their aircraft and their pilot and management time available to the research effort. It is no exaggeration to say that without this help this work could not have progressed, as sadly was the case in the USA. However, I assure the Committee that the research is entirely independent of industry and is Government funded.

Cranfield University, the project manager, is actively engaged in the cabin air sampling programme, and about 40 of the planned 100 flights have now been tested by a scientist on board. Samples are being taken by named individuals who have received special briefing by Cranfield to ensure a consistent methodology and secure chain of custody for delivering the samples to the laboratories for analysis. It is likely that this phase of the research will last until the spring. The logistics are complex and it cannot be done sooner. The findings will then be peer reviewed before being published as a whole. I hope that this will prove possible as soon as practicable.

The House will understand that we are filling a gap in knowledge. Fume events are unpredictable and can last less than a minute. There are no published studies of air sampling during fume events. There has been alarmist talk from some quarters about cabin air. I want to assure everyone that it is not a proven fact that

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cabin air harms health. The Committee on Toxicity, an expert committee of toxicologists, said that it was not possible to prove or disprove a connection between pilot ill health and cabin air on the evidence available.

The only way we can resolve this matter is through top quality science of a standard which will, if necessary, influence aviation regulators around the world to take action. I am confident that Cranfield University will give us the best scientific picture of what is in a fume event. Any regulatory action on aircraft types would have to be taken by the European Aviation Safety Agency, and there is no prospect of this happening without robust and convincing scientific research, preferably done by one or more member states of the EU.

My third example is in the field of passenger information. Those who have specific medical conditions should, and do, take advice from their GPs or from specialists who can advise them on travelling. We can help by providing the public and doctors with information. That is why I am encouraged by the excellent progress the Aviation Health Unit has made on improving information about air travel and health. Only last month the CAA published an excellent booklet, Travelling Safely, which gives updated health information.

The Aviation Health Unit works closely with airlines and other key stakeholders to do this. Part of its website, targeted at a GP audience, has a section with professional medical information which can be downloaded. This website, with its “Frequently Asked Questions” and recent guidance to GPs on assessing fitness to fly has been very well received and is generating lots of hits and inquiries to the Aviation Health Unit. It is already proving to be a useful tool to help GPs disseminate appropriate information to those of their patients who may be intending to fly.

Since 2001, the internet has developed as the main way of getting advice to travellers, but older methods work well, too. Those without access to the internet can request information by telephone and relevant documents can be printed and posted. I hope this gives noble Lords an idea of the work that we are doing in this important field, and how seriously we take the duty conferred on us.

I turn briefly to one or two of the questions that were raised in the debate, addressing first those put to me by the noble Lord, Lord Sutherland. The European Aviation Safety Agency’s competence with respect to air operations and flight-crew licensing took place in February 2008 in Regulation 216/2008. We are confident that the organisation is competent to take over those responsibilities. He also asked about the whole issue of air-passenger duty. As noble Lords know, this has been out for consultation. The consultation has now closed and the matter is now one for the Chancellor of the Exchequer. Noble Lords may find out more, if I can put it that way.

Aspirin has been discussed with the working group as a measure to mitigate or ameliorate the incidence of DVT. Research shows that taking aspirin does not help as much as exercise, and of course there are risks attached to taking aspirin. On pilot fatigue, which takes me back because I helped to implement the first

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Bader recommendations, I should say first that the airline industry is a competitive environment and because of that, companies seek to maximise the utilisation of their crews. Nevertheless, I can state with confidence that safety in aviation is a top priority in the UK. We have one of the best records in the world and we intend to keep it. The law requires all operators of public transport flights to limit the hours that pilots work through adherence to the flight time limitations scheme approved by the CAA. The authority works closely with airlines, including the low-cost sector, and has already identified a number of initiatives such as monitoring the outcome of rostering and training measures to counter fatigue. The CAA will continue to keep this important area under review.

I was asked whether we spend enough on research. As I said earlier, we have spent €1.8 million on DVT. On cabin air quality, we have spent €200,000 so far and will probably spend a similar sum over the coming year. We have to recognise proportionality, because many demands are being made on a limited budget. For example, one of the Department for Transport’s key targets to achieve by 2010 is to reduce the number of children killed or seriously injured in road accidents by 50 per cent compared with the period 1994-98. That is clearly another call on resources. The privilege and burden of being in government is always to balance priorities.

On the points made about passenger information, as I said, we have produced a new booklet. The established airlines—a high proportion of flying is with such airlines—particularly the long-haul operators, have good facilities for advising passengers. However, on top of that the website of the Health Protection Agency has some useful links, as does the CAA website. In the final analysis, the Aviation Health Unit is supporting GPs to become more competent in this area, and we think that that is happening at the appropriate rate.

Turning to the point made by the noble Lord, Lord Patel, about our preparedness for a pandemic, we believe that some of the new developments in aeroplanes, particularly the high-efficiency filters that are now fitted, have a considerable contribution to make to infection within an aircraft. We believe that the position we are at is about right. We think that wipes are a matter for the airlines, but the point is noted.


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