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Personal Oxygen (Public Transport)

Volume 507: debated on Wednesday 17 March 2010

Motion made, and Question proposed, That this House do now adjourn.—(Mr. Watts.)

I begin by declaring an interest. I am a trustee of the Pulmonary Hypertension Association.

I am grateful to have the opportunity to raise this important subject, on which the Pulmonary Hypertension Association, the British Lung Foundation, the Cystic Fibrosis Trust and other lung health organisations have been campaigning for some time. Disabled passengers, like anyone else, should have the right to access public transport, but people who need extra oxygen face poor customer service from transport providers and unfair extra fees. They are sometimes refused access to transport altogether. Airlines remain among the worst offenders, but buses and taxis have also turned those disabled passengers away. That is unacceptable and needs to change.

Oxygen is a necessary medication for people with many different lung conditions. Pulmonary arterial hypertension is an incurable and life-threatening condition that causes high blood pressure in the pulmonary arteries. It can result in breathlessness, chest pain, angina, fatigue and fainting spells; it can also result in heart failure. Left untreated, half of sufferers would die within two years, but new and effective treatments can give patients much longer, fuller lives. Extra oxygen can help to ease breathing difficulties and greatly improve mobility for people who would not be able to walk or move around at all without it.

Oxygen used to be supplied only in large, bulky cylinders, which could be stored in a patient’s home but not moved around. Now, it is available in much smaller, portable cylinders, or through electronic oxygen concentrators. There are different models of concentrator available, but they are roughly the size of a large laptop computer or a small suitcase. These innovations have given valuable freedom and mobility to pulmonary hypertension patients and sufferers of other lung disorders such as chronic obstructive pulmonary disease, cystic fibrosis and muscular dystrophy, allowing them to continue to work and travel in a way that previously was not possible. However, that mobility and freedom are being restricted by transport companies that refuse to carry their equipment.

The problem often results from a lack of awareness and misguided safety fears. The Department for Transport has issued guidance on the transportation of dangerous goods, and it includes a section on the carriage of oxygen cylinders on public transport. It states that

“there should not be a problem”

in non-smoking areas. Nowadays, of course, all areas of public transport are non-smoking areas. The guidance notes that some carriers apply different policies on oxygen, but it clarifies the matter by stating:

“Any restrictions concerning the carriage of oxygen cylinders for private use on public transport will be that of the carrier.”

That is very clear. If carriers refuse to allow oxygen on board, it is their own choice. There is nothing in law to prevent bus, train or plane companies from allowing oxygen cylinders or concentrators on board.

However, over-cautious carriers are still ignoring that guidance and refusing to allow oxygen users access to their services. Stagecoach recently refused to allow a mother in Lancaster to board one of its buses with her young son, who requires oxygen. The company stated that it was not allowed to carry oxygen, as it was a “hazardous product”. The baby’s father said:

“He has to travel in a specially adapted pushchair that we have had provided, but we didn’t realise we couldn’t use public transport. We just feel penalised by the system, and it’s like we’re trapped in our own home sometimes because it stops us from being able to take him out.”

The parents now have to push their son into town with his oxygen for him to attend regular hospital appointments.

Stagecoach stuck to its policy when challenged by the local press, and a spokesman for the company said:

“The law regarding passenger carrying vehicles prevents any hazardous products—including oxygen—from being carried on board. We are unable to take anything that’s potentially dangerous. It’s very unfortunate and if we were able to do anything to help then we would do so.”

Stagecoach is wrong. The Department for Transport’s guidance is clear: carrying oxygen is not a problem, and it is not potentially dangerous. I hope that the Department will contact Stagecoach to make it crystal clear that the company cannot hide behind the guidelines.

Sadly, that is not an isolated incident. The British Lung Foundation heard from one passenger who was told by Arriva that she was a fire risk, and other patients have also been turned away on so-called safety grounds. In some instances, refusals are bus company policy, but in others, patients have found that they were allowed on the bus one day but turned away on the next by a different driver. Inconsistencies are rife, and uncertainty for patients is the result.

People refused access to the bus or the tube might want to take a taxi, but a patient in Birmingham who was travelling on business reported to Air Products Ltd—one of the suppliers of the NHS home oxygen service, which runs patient forums for oxygen users—that several taxi firms refused to take her booking when she told them she was carrying oxygen equipment. In the end, she had to conceal her cylinder in her bag in order to hire a taxi.

The situation is totally unacceptable. Disabled people should not have to fight, complain or hide their equipment in order to get what they are entitled to. I feel that the Department for Transport must work to raise awareness among carriers both in headquarters and among front-line staff so that people who use oxygen can exercise their right to use public transport along with everyone else.

Bus and taxi firms could learn from Transport for London, whose staff also turned oxygen users away in the past because of byelaws preventing passengers from carrying inflammable substances on the tube. However, Transport for London has now agreed that medical oxygen should be exempt and it is actively working to ensure that front-line staff are aware of that policy change. It is considering issuing letters or “oxygen passports” to patients who use the tube regularly, which could be shown to any staff who express concern. That is an admirable scheme. I hope that it will be introduced soon and that it is adopted by bus and taxi providers across the country.

Bus and taxi providers need to improve, but the worst offenders are still the airlines. On 30 June last year, I raised this matter in a Westminster Hall debate; the Under-Secretary of State for Transport, my hon. Friend the Member for Gillingham (Paul Clark), responded to that debate, too. I drew to the House’s attention the airlines’ practice of refusing to allow passengers to bring their own oxygen on board and then charging them between $50 and many hundreds of pounds for oxygen from the plane’s supply.

On some airlines, passengers are refused assistance from the time they book to the moment of boarding the plane. The European Commission has issued guidance on the provision of oxygen, stating that

“airlines should always be in a position to give passengers who have requested it accurate information about this specific service, including costs, before booking”.

It also states that legislation aims to

“protect persons with reduced mobility against discrimination, and to ensure that they receive assistance.”

However, evidence shows that that is not happening.

A secret shopper survey of 71 airlines by the Pulmonary Hypertension Association, published in its “Breathe Freely” report, showed that passengers spent an average of 20 minutes on hold, sometimes at a premium rate, speaking to three different customer services advisers, yet sometimes still not getting the information they needed on the airline’s oxygen policy. Some advisers promised to call back, but did not, while others gave incorrect information, sometimes allowing passengers to book flights only to tell them later that they would not be allowed to fly. An example is Jet2, which refused to refund a passenger who had to cancel her booking when it emerged that the airline had changed its policy and would no longer allow her to travel with a concentrator.

Shockingly, some airlines refuse to reveal their own policy and charges before a booking is made, yet the ticket is no longer refundable. Qantas requires a booking number before it will agree to calculate the fee that a passenger will be charged for oxygen. That gives passengers no chance to compare prices or make an informed choice between airlines.

Assistance is often poor during the flight as well as during the booking process. One passenger who liaised with Ryanair in advance to book her oxygen and who had already paid her £100 fee was told, after she had boarded the plane, that the oxygen could not be provided, so she would have to get off. She was left standing on the tarmac with her suitcase and was not even escorted back to the terminal. She said:

“The captain came to me and said that I would have to get off the plane as they didn’t have the oxygen. The steward and the captain were so rude and not at all compassionate; all they wanted was to get me off so they could take off. The fact that I had booked and paid for the oxygen was apparently irrelevant.”

We need much better enforcement of existing rules to protect oxygen users, who are not currently being given the information and assistance to which they are entitled. We should also consider changing the rules to eliminate loopholes that allow airlines to charge unfair fees to people requiring oxygen. Regulation (EC) No. 1107/2006 requires airlines to carry medical equipment free of charge, but does not require them to allow the equipment in the cabin. 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 required for medical use”,

and recommends that portable oxygen concentrator devices should normally be allowed if they are battery-powered. However, those regulations are not binding, and ultimately the code of practice permits carriers who wish to provide passengers with medical oxygen to charge for the service. It allows airlines to flout the spirit of anti-discrimination law by refusing passengers permission to bring either their concentrators or their cylinders on board, and then charging significant fees for centrally provided oxygen. That, in my view, should not be allowed.

Currently, although most airlines allow designated concentrators on board, only a third of them allow cylinders, and the vast majority charge fees to people who need to use the airline supply. According to the secret shopper survey, six airlines did not allow either a concentrator or a cylinder on board but charged to provide the oxygen: Aer Arann, which charges £72 per sector, LOT Polish Airlines, which charges £136 per sector, Malaysia Airlines, which charges £400 return, Qantas, whose charge varies according to flow rate and distance, and Alitalia. Alitalia charges the cost of a second seat, which could amount to many hundreds of pounds. That is clearly outrageous.

Over the past eight years the Pulmonary Hypertension Association, a relatively small charity, has had to spend £60,000 of its own limited resources on grant to enable patients to pay additional airline charges for oxygen. Besides the ones that I have already mentioned, many European airlines charge: Aer Lingus, Air France, Austrian Airlines, Brussels Airlines, Cyprus Air, Czech Airlines, KLM, Lufthansa, Ryanair, Scandinavian Airlines, Swiss International Air Lines, and Thomas Cook Airlines. They charge different rates, but many run into at least three figures.

I welcome the decision by Thomson Airways, one of the major charter airlines, to drop its charges. Long-haul scheduled airlines such as British Airways, Cathay Pacific, Virgin Atlantic and Emirates have already scrapped charges, as have budget airlines such as EasyJet and CityJet and charter airlines such as Thomson Airways and First Choice. If those airlines can provide the service free, so can others. However, far too many airlines are refusing to back down.

The rules need to change to stop that practice. At European level, the United Kingdom Government must make strong representations on the review of regulation 1107/2006, which is due to take place later this year, so that the requirements can be tightened to require carriers specifically to allow certified concentrators to be carried in the cabin on all flights landing or taking off from an airport in the European Union. That is the law in the United States of America, so there is no reason why it could not work here. An added advantage would be that all airlines, not just those based in the UK, would have to comply.

The code of practice “Access to Air Travel for Disabled Persons and Persons with Reduced Mobility” should also be revised to prevent airlines from charging to provide oxygen if they do not allow a passenger to bring their own. If some airlines can operate without charging their disabled passengers extra, all can; and if they will not change their policies voluntarily, guidelines must become obligations. When advances in treatments and technology give back the chance to work and travel to people who would otherwise have been housebound, carriers must not be able to take that away.

Given the growing momentum of the campaign for oxygen concentrators to be provided to patients free of charge on the NHS, I hope that carriers will see more and more mobile oxygen-using patients looking to use their services. Now is the time to get the rules in order. I trust that the Department for Transport will look closely at what action it can take to raise awareness, enforce guidelines and improve the regulations so that this problem can be eliminated.

I congratulate my hon. Friend the Member for Carmarthen, West and South Pembrokeshire (Nick Ainger) on securing this debate; it is his second debate on this issue in the past nine months. I recognise his commitment, and also the hard work of the British Lung Foundation, the Pulmonary Hypertension Association, of which he is a trustee, the Muscular Dystrophy Campaign and the Cystic Fibrosis Trust. They are rightly determined to raise the issue on behalf of the travelling public, and in particular those who require this service so that they have the freedom to travel and are not constrained within the four walls of their home when the technological developments to which my hon. Friend has referred now allow a degree of portability and freedom that could only have been a pipe dream just a few years ago. I welcome this opportunity to respond to the points raised by my hon. Friend.

First, let me address aviation. I hope my hon. Friend will not be disappointed to learn that the position is still essentially the same as when we last debated this matter in June; the law is the same as it was nine months ago. My hon. Friend’s remarks, and the names of the many international airlines he has read into the record, highlight the fact that this is an issue for the international community. It raises matters that need to be dealt with across the sector through the international law that the International Civil Aviation Organisation has put in place to support and help aviation consumers, and through the European Union for EU states. EU regulation 1107/2006 establishes the rights of those persons who are disabled or have reduced mobility for whatever reason. It is fully supported by the UK Government and has full applicability in UK law under our statutory instrument 2007/1895.

While it is true that this regulation does not impose specific duties on airlines to carry or provide oxygen within the cabin, in order to help the UK air transport industry comply with its obligations under the regulation, the Department for Transport has issued a code of practice, to which my hon. Friend referred: the “Access to Air Travel for Disabled Persons and Persons with Reduced Mobility” guidance. The latest edition of the code was published in July 2008 and it includes a section on oxygen. It advises that air carriers may approve the carriage of small gaseous oxygen or air cylinders which are required for medical use, but that carriers must also be able to ensure that they do not pose a risk to security. Indeed, advice given by TRANSEC, the body that provides the security advisers in the sector who monitor such matters, recognises that in all usual circumstances, they should not cause a problem.

I hear what the Minister is saying. However, there is something I cannot accept, and which the PHA and the British Lung Foundation certainly cannot accept. A number of airlines already accept small oxygen cylinders in the cabin for the personal use of patients. Why on earth can we not say that, if it is good enough for those airlines, it applies across the board? The practical issue of security and so on has clearly been overcome by those airlines. Why can this not apply to all airlines?

Regarding the code we issue to assist airlines and to enable interpretation, we are clear that that is possible, but that code is based on the EU regulation so it would be difficult to go beyond that for the UK only. Indeed, in the cases that my hon. Friend listed, many UK-based airlines have a good record in meeting the needs of those who require this service.

We should recognise that since the last discussion of this issue in the House, Thomson Airways and First Choice have come on board. I pay tribute to my hon. Friend and to all the organisations that have raised this issue and kept it in the public domain. There has to be an international solution and international regulations, but the work that has been undertaken has convinced airlines to rise to the challenge, which is why such movement has happened. Today’s debate helps in that process of focusing minds.

I accept everything that the Minister is saying, but EC regulation 1107/2006 is being reviewed. Is that not an opportunity to use the regulation itself, or an addendum to it, to make it absolutely clear that airlines are expected to allow people to bring on board their own personal oxygen cylinders or concentrators for use in the cabin? Surely that is an issue that can be cleared up this year.

My hon. Friend is absolutely right that the current regulation is due for review. I am sure that all interested parties will clearly express their views as to its shortcomings, and we as a Government will put our own experiences on the record as well.

This is a relatively new regulation—2006—and I would not want unnecessarily to lead the House to believe that great changes may happen because it is relatively new. Having said that, I absolutely agree with my hon. Friend that this is an opportunity that should not be missed, and I am sure that he and the organisations to which we have referred will take every opportunity to press the case at European level at the right time. Equally, the Government will ensure that these issues are recognised.

The European law as it stands seeks to strike a balance between the needs of the particular group of consumers and the commercial requirements of the airline. We urge all airlines to be clear about charges and provisions, so that when people make their purchases and decisions they have an informed choice about the services and so on that they can rightly expect. Many of the UK-based airlines are leading the way and are showing other European-based carriers the way forward, as well as doing so on a wider international stage. The Malaysia Airlines example just reinforces the fact that further work is required at an international level so that we ensure that people have the freedom to travel as far and as widely as possible.

My hon. Friend raised issues relating to other forms of public transport. On the use of personal oxygen on trains, the decision as to whether cylinders can be carried is down to the individual train operating company, but all operators are likely to allow passengers carrying portable personal oxygen supplies to board. The conditions of carriage may vary between different companies and, therefore, we always recommend that passengers who may need to transport oxygen cylinders first contact the relevant operator to check what restrictions may apply. Contact details are available via the national rail website. I should say that some of the train operators make things clearer and set out in their conditions of service that they will allow this—Southeastern, which runs services in my patch, is very clear that this is permitted. Some passengers may require physical assistance in boarding and alighting, and that can be booked through the assisted passenger reservation service. That can be accessed through the same sources—for example, the national rail web portal—and 24 hours’ notice should usually be allowed so that arrangements can be put in place.

We are talking, again, about relatively small cylinders and concentrators. Transport for London is proposing that there should be a proviso whereby somebody should have a letter or other confirmation to show that their cylinder or concentrator is kosher and has been checked for security purposes. In such circumstances, why should people have to give 24 hours’ notice to use a train? If we are really saying to these people that they will be treated the same as other people—the same as people who use a wheelchair, for example—surely they should be able to buy their ticket and walk on in the same way that anybody else does.

I accept what my hon. Friend is saying. Perhaps I should make it clearer that the assisted passengers reservation service was introduced to help people with physical disability—those in wheelchairs, for example—rather than to address issues about portable oxygen supplies and so on. Having said that, I must add that our “Access for All” programme to improve railway stations the length and breadth of the country is trying to make sure that that is not a necessity, so that those people have the same freedom to move about as any one of us in this Chamber. That work continues and we continue to make that investment in the transport infrastructure so that they have access at any time, like everybody else.

In respect of buses—I shall discuss my concerns about Stagecoach in a moment—it is fair to say that the issue is one of safety. The carriage of oxygen tanks on buses and in taxis would not normally be considered hazardous in the small quantities that we are talking about for personal requirements. That is covered by the Public Service Vehicles (Conditions of Fitness, Equipment, Use and Certification) Regulations 1981, which are very clear. Obviously, no person should use a public vehicle with something that might be highly inflammable or otherwise dangerous. Provision is set out in those regulations, but my hon. Friend was right to say that our guidance makes it clear that there should be no such problem regarding the quantities that we are talking about. I am distressed to hear of the incident to which he referred that involved a mum and son being turned away from a bus, run by Stagecoach in that case. I believe that he also mentioned a story involving Arriva. I certainly give him an undertaking that I will take up that issue and I shall correspond with him accordingly. That incident should not have happened and we want to ensure that people in such a position have the opportunity to move as freely as anyone else.

Finally, on the subject of ships and ferries, I am not aware of any difficulties that have arisen in using personal oxygen on board ferries or on cruise ships. Indeed, passenger needs are often met efficiently. On ferries, passengers who require medical oxygen may carry a limited quantity of up to 60 litres, provided the passenger has a letter from a doctor. I am not aware of any such issues. As this debate affords me the opportunity to do so, I shall put on the record the fact that if there are similar cases of people being turned away on such a basis—particularly from those forms of transport that make up the backbone of our transport system, with buses in particular being involved in some 5 billion journeys a year, or from ships and ferries—we would be grateful to receive that information. We will continue to ensure that UK-based operators recognise the code, use it and work with it, and we will continue to work with our colleagues who work in the charities on this matter. They have done a sterling job in raising its profile. My hon. Friend can rest assured that we will continue to work on that basis.

I now have to announce the results of the Divisions deferred from a previous day. On the first motion relating to children and young persons, the Ayes were 253 and the Noes were 188, so the Question was agreed to. On the second motion relating to children and young persons, the Ayes were 252 and the Noes were 189, so the Question was agreed to. On the motion relating to representation of the people of Northern Ireland, the Ayes were 303 and the Noes were 139, so the Question was agreed to. On the motion relating to Northern Ireland, the Ayes were 301 and the Noes were 138, so the Question was agreed to.

[The Division lists are published at the end of today’s debates.]

Question put and agreed to.

House adjourned.