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Charges for Oxygen (Airlines)

Volume 495: debated on Tuesday 30 June 2009

It is a pleasure, Mr. Jones, to serve under your chairmanship. I wish to declare an interest; I am a trustee of the Pulmonary Hypertension Association, as listed in the Register of Members’ Interests.

I wish to bring to the attention of the House the fact that some airlines charge large fees to those who need to use supplementary oxygen when flying. I am grateful to the 218 right hon. and hon. Members who signed early-day motion 1,444, in which I called on airlines to scrap those charges. I am also grateful to the Pulmonary Hypertension Association, the British Lung Foundation and the Muscular Dystrophy Campaign for their detailed advice and information.

Pulmonary arterial hypertension—PAH—causes high blood pressure in the pulmonary arteries, which carry blood from the right side of the heart to the lungs. The condition causes those arteries to thicken and narrow, which restricts blood flow in the lungs. The resulting symptoms are breathlessness, chest pains, angina, fatigue and fainting spells. PAH is relatively rare, but sufferers from other breathing conditions such as chronic obstructive pulmonary disease and muscular dystrophy can experience similar symptoms, and require supplementary oxygen to help get sufficient oxygen into their blood. Along with medication, those symptoms can be managed with extra oxygen, which can be obtained from a cylinder or an electronic concentrator. Oxygen from either source eases breathing difficulties, allowing patients who otherwise could not undertake even gentle activity to regain mobility.

Oxygen is as indispensable to sufferers as the wheelchair is to those with walking difficulties. Unfortunately, that fact is not recognised by many airlines. It is hard to imagine a company refusing to allow people the right to bring a wheelchair into a building and then charging them to use a centrally provided one. However, that is what is happening to many oxygen users who want to fly. Many airlines refuse to allow patients to keep their oxygen with them on flights. Instead, they insist that affected passengers should buy oxygen directly from the airlines, sometimes at huge cost.

The Pulmonary Hypertension Association conducted a secret shopper exercise. It found that of the 22 airlines surveyed, only five allowed people to bring their own oxygen cylinders on board, and only nine allowed the use of oxygen concentrators. Some notable exceptions aside, almost every airline that refused permission told the secret shopper that she could be supplied with oxygen by the airline throughout the flight—for a fee. The charges mostly range from £55 to £250, but in some cases are much higher.

The British Lung Foundation became involved in the case of Mr. Palmer, who suffers from PAH. He was told by the Emirates airline that he would have to pay an extra £1,972 to be supplied with oxygen on his flight to Australia. In another case, the same airline told a sufferer from idiopathic pulmonary fibrosis that he would be charged £2,800 to use oxygen on a flight from Manchester to Dubai. In both cases, the airline backed down when the passengers called in the British Lung Foundation. However, not all airlines back down, and many people are told to pay up or lose out.

One PAH sufferer said:

“I have just had to cancel my holiday to Singapore and Australia. I have been on the phone to Singapore Airlines for an entire week. I have my own travelling concentrator, and this one is pictured on the airline’s website to be OK to use on board, but only if you pay 1st class! I think I have been discriminated against.”

That was not justified on the grounds of either security or safety; the airline was prepared to allow the device on to the plane, but only if the passenger could come up with a huge premium.

Another lady described the bureaucratic nightmare of trying to access oxygen on Ryanair. She said:

“When I was due to fly to Spain I faxed off my fit to fly letter and then phoned to pay my £100. They said I was not now allowed to fly with them as I need 2 litres per minute flow, but they only provide 4 litres per minute. Their safety officer said that 2 litres per minute was for children only, even though my doctor had said that was all I require. Also they can only provide oxygen for 2 hours. I flew BA in the end, but the whole thing was so stressful.”

The Guardian quoted one passenger as saying:

“With many of the airlines it’s a catch-22 situation. You can’t take your own oxygen on board but they charge you a fortune for the privilege of using theirs…Disabled people have to fight constantly for things I feel should be made available to us when we need it. Oxygen is a necessity that is keeping me alive and healthy.”

Although some financial help is available from charities for those who need help in paying the charges, it can be an unnecessary drain on the charities’ resources. The Pulmonary Hypertension Association has told me that in the past seven years the charity has paid about £50,000 in grants to cover the cost of airline charges for its members. The association said:

“This is money that could be spent on something beneficial, such as respite weekends for children, or a specialist nurse, not subsidising airlines.”

Ultimately, the high charges mean that airlines are at risk of pricing oxygen users out of the air travel market.

Emirates has announced that it will scrap the charge altogether in response to “feedback from customers”, but not many airlines have followed suit. The fees that they continue to charge amount to a tax on the disabled. That practice needs to end. I shall read on to the record the names of airlines that charge and those that do not. I list first those of the 22 airlines surveyed that no longer charge. British Airways, easyJet, Flybe and Virgin Atlantic do not charge; and after the campaign by the three organisations that I mentioned earlier, Cathay Pacific and Emirates no longer charge.

I now list the airlines that charge. Air Canada charges 150 Canadian dollars. Air France charges €182. Alitalia charges the cost of a second seat. BMI charges £100. El Al charges £75. First Choice charges £150 for short-haul flights and £250 for long-haul flights. Iberia charges £124. KLM charges €100. Lufthansa charges €150 for short haul and €300 for long haul. Ryanair charges €148. South African Airways charges £150. TAP charges €150. It is pretty much a lottery, particularly for those travelling on longer-haul flights, who seem to be charged most.

All airlines should allow people who are dependent on supplementary oxygen to travel at no additional charge, if they have medical clearance to do so. There seems to be no reason why that cannot be achieved. Legislation establishing the principle that disabled people should not be discriminated against when travelling is already in place. European Union regulation 1107/2006 obliges airlines to carry passengers’ medical equipment free of charge. Airlines that charge interpret oxygen cylinders as not coming under that category, but stronger guidelines could oblige them to change their view.

The Equality and Human Rights Commission told me that it

“questions whether airline companies’ refusal to carry passengers’ oxygen cylinders and concentrators without charge—or at all—is within the law.”

It says that it is

“seeking to clarify the regulations so that airlines do not inappropriately charge people who require oxygen”.

The Department for Transport’s code of practice “Access to Air Travel for Disabled Persons and Persons with Reduced Mobility” advises that air carriers may approve the carriage of small gaseous oxygen or air cylinders for medical use, and recommends that portable oxygen concentrator devices should normally be allowed if they are battery operated. The Department clarified that guidance in response to inquiries from the British Lung Foundation, stating:

“The Code of Practice makes clear that airlines should consider portable oxygen cylinders as medical equipment which passengers should have a right to take on board free of charge in addition to standard baggage allowance.”

That is quite clear. The code of practice states that air carriers can make a charge to provide passengers with oxygen. However, the Department has also told the British Lung Foundation:

“We do not believe that the EC Regulation requires airlines to provide oxygen free of charge, but we would encourage airlines to offer this service at their discretion”.

Airlines can thus be in no doubt that the charges that they are currently levying run contrary to the spirit of the rules. It is clear that stronger guidance—or legislation, if necessary—is needed if the practice is to be stamped out permanently. In the USA, the Air Carrier Access Act came into effect on 13 May 2009 and requires all airlines on flights that depart from, or arrive in, the US, and US airlines wherever they are in the world, to allow passengers to use their own portable oxygen concentrators free of charge, as long as they have been tested and labelled as meeting federal airline administration requirements. The United States believes that there should be no charge.

Airlines will, of course, need to follow security procedures, but if some airlines currently allow passengers to take their cylinders or concentrators on board, and if airlines are obliged to carry concentrators in the USA, the necessary security procedures clearly exist already and could be made compulsory in the UK and throughout Europe. To refuse patients the right to carry medical equipment that has been certified as safe, and then to charge large sums for alternative provision, is outrageous. Some airlines have responded to the campaign and changed their charging policy, but it is still a lottery. I trust that the Department will work with its European partners to produce crystal-clear guidance to airlines stating that they should not be charging for the service. I hope that the Minister will respond positively to end this blatant discrimination by some airlines against disabled passengers.

It is a privilege to serve under your chairmanship, Mr. Jones. I congratulate my hon. Friend the Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) on securing this debate. I also congratulate the British Lung Foundation, the Pulmonary Hypertension Association UK and the Muscular Dystrophy Campaign on their work to raise the profile of this issue in many ways and with many parliamentarians, including those who have signed early-day motion 1444.

This debate gives me the opportunity to respond to some of the points raised and to set out the current position. After that I shall turn to the position of airlines, in particular, UK airlines—the point of immediate concern—and then expand on how we might proceed. By definition, aviation is an international business. Many of the airlines to which my hon. Friend referred are international companies based in other parts of the world—not just in Europe, but beyond—and the issues that arise are common across the world. Furthermore, a substantial body of international law governs the operation of airlines. That legislation, whether created by the International Civil Aviation Organisation or, for European states, the EU is designed to support and help aviation consumers, whoever they might be.

Rights of disabled people and those with reduced mobility, from whatever cause, are established under European regulation 1107, to which my hon. Friend referred. The regulation is fully supported by the UK Government and enforced through statutory instrument 2007/1895. However, as he will know, the regulation does not impose specific obligations on airlines to carry or provide oxygen in the cabin. However, to help the UK air transport industry to comply with its obligations under the regulation, the Department published a revised code of practice entitled, “Access to Air Travel for Disabled Persons and Persons with Reduced Mobility”. Section 7 of the latest edition of the code, published in July 2008, includes a section on oxygen advising that air carriers may approve the carriage of small gaseous oxygen or air cylinders—not exceeding 5 kg gross mass—required for medical use, but notes that carriers will wish to ensure that these do not pose a risk to security.

I quoted the charges, but I also have a list of the airlines that do not allow patients to take on board their own oxygen cylinders. That list consists of the majority of airlines that I quoted as charging for alternative provision. It is clear that the majority of airlines in this survey are not abiding by those guidelines.

I think that my hon. Friend is talking about the list that he read into the record earlier. However, many of those airlines fall outside the jurisdiction of the EU, let alone the UK. He is right about the range of options. Some carriers might charge for supplying their own oxygen or allow passengers to bring on their own oxygen cylinder. He is also right that a number of those 22 airlines do not permit the latter, but do allow—I was just coming to this point—portable oxygen concentrator devices to be brought on board. But some airlines do not allow those either.

The code of practice issued by the UK Government notes that as an alternative to oxygen cylinders, passengers could use their own portable oxygen concentrator devices. It recommends that airlines should normally allow such devices to be carried, if they are battery powered and not dependent on the aircraft’s power supplies. Although air carriers are not required to do so under EC regulation, some might decide to supply medical oxygen to passengers on request. The code acknowledges that it would be possible to charge for that service to cover the provision of oxygen. It will be apparent, therefore, that European law, which cannot legislate for airlines such as Emirates or Singapore Airlines, aims to strike a balance between the needs of particular groups and airlines’ commercial requirements. However, there are further considerations, including those raised by the campaign to which my hon. Friend referred, which has raised awareness of this issue.

The Department wants to encourage airlines to make clear their conditions of carriage, so that passengers considering travelling on a particular airline are aware of its policy and can make an informed choice when they purchase their tickets. Indeed, I took on board my hon. Friend’s comments about the stress through which people can be put to try to find out that information. That is why I went online to check out a number of airlines. I typed in “medical oxygen” and “oxygen supplies” to see what would come up. Although some websites were better than others, all of them carried the necessary information. We must continue to work with the transport industry—not just the airline industry—to ensure that it provides accessible information and meets people’s requirements.

My wife uses oxygen, so I have been listening carefully to my hon. Friend the Minister. Earlier, he talked about stress. I have found that stress is not restricted to the airlines. We took cylinders with us when we travelled on Eurostar. I was kept behind in Paris for an hour because the officials thought that I was going to blow up the bloody plane. People feel stressed with hotels and trains. My wife has a card, which should enable her to get some assistance. However, we have found that company officials do not know anything about how to obtain oxygen. As has been wonderfully demonstrated by my hon. Friend the Member for Carmarthen, West and South Pembrokeshire (Nick Ainger), it is an issue that is not sufficiently well known.

As I was saying, there is still a long, long way to go. My hon. Friend recognises that a person has to reassure themselves with regard to both safety and security, and that the right processes are in place. That may even include taking a short blast from the gas that is in the cylinder. Unfortunately, we live in a climate in which we must check everything. My hon. Friend raised a very important point about awareness training for staff who are operating both public and private transport systems.

Earlier this year, I considered accessibility planning and awareness training for people who plan transport systems within our towns and cities, which is a very important role. Let me draw the attention of my hon. Friends to the code of practice concerning aviation to which I referred. The first item in section 7 says:

“All cabin crew, including the flight crew, must receive disability awareness training. For cabin crew, this should be refreshed in line with training in safety procedures.”

Although the guide refers specifically to cabin crew, it equally applies to others operating in the field. So, the ability to understand all the issues must apply across the board. Individual companies probably need to undertake further work in that regard. My understanding is that that is what UK airlines have tried to do on their sites.

Earlier, the Minister mentioned that he had visited a number of airline websites to establish what information was being made available to patients to enable them to make a choice. In certain circumstances, however, patients cannot exercise a choice because they are considering a specific route. They may be looking at a budget airline route to a relatively small airport. BMI and Ryanair are both guilty in my book. Moreover, charter flight airlines, such as First Choice and Monarch, also make charges. When a person books their holiday, they have no alternative but to fly with that particular airline. Therefore, they cannot exercise a choice in such matters.

I recognise that there are some limitations, but the picture is pretty good for UK airlines. British Airways, Virgin Atlantic, easyJet and Flybe allow passengers to use free of charge their own oxygen and their own portable oxygen concentrators. However, I accept that other UK carriers make certain charges. My hon. Friend mentioned that Monarch charged £80 and that First Choice differentiated between short and long-haul operations. [Interruption.] Someone from a sedentary position has mentioned Ryanair, but that is an Irish carrier.

Yes, BMI is another carrier that charges. My hon. Friend raised questions over a number of airlines. He was right to say that Emirates was charging £1,100 and has now dropped its charges. He also referred to Singapore Airlines. Mention was made of £2,800 being charged from Manchester to Dubai, but I did not catch the airline. Emirates and Singapore are not UK airlines and they are not governed by the EU regulation 1107. It is up to the individual companies to justify their charges.

Let me turn to the American situation. My understanding is that it is a little more complex than it appears on first glance. American Airlines will not accept oxygen cylinders on planes. It will accept the portable oxygen concentrators to which we have referred, but they have to come from the seven companies approved by the Federal Aviation Administration, which is part of the US Government. The kit is expensive and comes from American companies, so there are limitations. I did another quick check this morning and I noticed that one company and a number of the other sites had the FAA approved logo. The regime, therefore, is tight, which may limit some opportunities.

In conclusion, I am aware that the British Lung Foundation is jointly campaigning with the Pulmonary Hypertension Association UK and Muscular Dystrophy campaign to end additional charges for people travelling with oxygen and to ensure that all airlines offer the same level of service. I suggest that that can be best achieved through an international forum to ensure that we get standard provision across the board. I understand that the British Lung Foundation has been in touch with my office to discuss this matter further, and I am certainly considering ways in which we can find a way forward.

Can the matter be associated with landing rights? The Minister has set standards for UK companies, and we can put pressure on them. Landing rights are UK rights.

When looking at an overall package, we need to consider the issues that arise.

Let me now turn to the issue of the carriage by aircraft of medical oxygen as part of a medical kit. That is not a requirement of regulation 1107. The Commission is due to review the regulation in 2010, but as this is new European law I would not want unduly to raise expectations that it is likely to be changed quickly. However, it will give interested parties a chance to make representations.

Today’s debate takes us another step forward. Raising public awareness about the companies that charge and those that do not will help to focus minds. We need to ensure that information is available for travellers so that they can make an informed choice. We need to continue our dialogue with the industry and await the EC regulation review in 2010.