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Air Travel And Health: Select Committee Report

Volume 622: debated on Friday 16 February 2001

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2.30 p.m.

rose to move, That this House takes note of the report of the Science and Technology Committee on Air Travel and Health (5th Report, Session 1999–2000, HL Paper 121).

The noble Baroness said: My Lords, I am delighted to introduce this debate on the report from the Science and Technology Committee on air travel and health. As the one who had the privilege of chairing the sub-committee which undertook the inquiry, I am glad to be able to bring renewed attention to bear on an area of public health which we found to be woefully neglected.

Before turning to the substance of our findings and commenting on the Government's recently published response, I should like first warmly to thank the other members of the sub-committee for their invaluable contributions to the conduct of the inquiry and the consequent report. I am delighted to see so many members in their places today and I look forward to hearing their contributions. As noble Lords will see, the report is wide-ranging. It covers medical, technical and regulatory information and consumer issues, as well as the interplay between them. Because the subcommittee was so broad-based, I believe that it is obvious from the report that we were able to bring substantial expertise to bear on these matters.

On behalf of the whole sub-committee, I should also like to pay tribute to our specialist adviser, Dr Michael Davies, OBE. The range and depth of his knowledge were invaluable in helping the sub-committee to focus on the key issues. My particular thanks go to our Clerk, Mr Roger Morgan, who not only whipped in witnesses from across the globe, some of whom were initially reluctant to attend, but also helped the subcommittee to produce a concise report written in plain English so that it attracted the widest possible readership and response. I thank him for that.

I suspect that some people were rather surprised when we began this inquiry. They could not see that there would be sufficient substance in it. However, we shall explore today how wrong we discovered those doubters to be. Air travel is big business. Quite staggering numbers of people fly both for business and pleasure. At any one time, around half a million passengers are in the air somewhere in the world. Each year, airlines carry some 2 billion people, the equivalent of one-third of the world's population. The substantial growth of air travel over the past 50 years has been steady rather than explosive and, without anyone really noticing, things have changed out of all recognition.

People from almost any circumstances of life and almost any age may now find themselves travelling by air over very long distances, as did my brother, his wife and teenage boys as they travelled to Vienna for my son's marriage on Saturday. They then travelled back here and are due to return to Australia tomorrow.

No longer can there be an assumption that air passengers are necessarily fit or even in the prime of life. Alongside changes in the volume and nature of air travel, an awareness has developed of the effects of environmental factors on health. In initiating the inquiry, our aim was to see whether the design and use of aircraft had kept pace with the understanding of those environmental factors. To the extent that risks remained, were passengers able to take properly informed decisions about whether to fly in their particular circumstances? Furthermore, were they aware of how best to avoid any health problems when they did fly? It is understandable that at least some people, and probably many more who would not care to admit it, are still scared of flying. Their concerns are fed by occasional horror stories and we determined to take a careful look at the whole area to separate the fact from the fantasy.

To position ourselves we first reflected on the regulatory structures within which airlines operate. No one could possibly object to those dealing extensively with safety. But we were astonished to find that the health of passengers and crew receives no mention at all. What provision airlines do make on health-related matters is left very much to their own discretion. That seemed wholly unacceptable. We therefore welcomed the somewhat belated recognition in June when Ministers gave evidence that the Department of the Environment, Transport and the Regions has the lead on such health matters. We strongly recommended the Government to recognise and exploit that lead, both nationally and in the international setting, so that these health matters can have the profile they deserve.

The main themes of our report became the identification, management and communication of health risks in air travel. We were disappointed to find a great deal less than we had expected. This was not only in relation to the communication of risk to the travelling public, but the Government, the regulators and the industry could and should do much more in managing those risks—and, indeed, in identifying them for us in the first place.

I welcome the Government's generally positive tone about our report's recommendations in their recently published response, but I do not get any particular sense of urgency from the response, which passes a great deal to a proposed new standing interdepartmental aviation working group. I should be grateful if the noble Lord, Lord Burlison, will say in his reply when the group will begin business. How often will the group have regular meetings? What status and resources will it have? When will the travelling public begin to see some tangible results?

On the international front, the Government will,

"continue to work with like-minded countries to try to ensure that health issues are on the international aviation agenda".

Can the Government not upgrade this aspiration to an explicit target of getting these health issues on the international agenda?

When we began the inquiry, the bulk of expressed concerns, in particular from the general public, related to the quality of air in the aircraft cabin. There are two main issues: does the air provided deal adequately with respiratory needs; and is it sufficiently free of contamination?

To use fuel efficiently, aircraft cruise at very high altitudes—typically between 30,000 and 40,000 feet, where the air is too thin and too cold to support human life. The ideal would be to pressurise the aircraft cabin so that sea-level pressures were maintained throughout the flight. However, structures strong enough to withstand such forces would be impracticably heavy.

The compromise is that pressure within the cabin is maintained at the pressure found at around 6,000 to 8,000 feet. Such conditions would be similar to those experienced during skiing or other mountain holidays. Particularly as passengers are generally at rest, we found suggestions that conditions are intrinsically harmful to be misconceived—although we also noted that for the most serious case of respiratory difficulty, flying may be possible only with supplementary oxygen.

The biggest concern about gaseous contamination involved—I cannot say this word—triorthocresyl phosphate (TOCP). In concentrated form, this chemical is extremely toxic, but it is found in lubricants in very small concentrations. Even in the worse case scenario of all—an engine's oil being lost into the pressurised air directed into the cabin—we did not find that safety levels would be breached. Moreover, there is no possibility of even that level of contamination catching people unawares because the air would be thick with nauseating oily vapours.

Other contamination concerns related principally to the transmission of infection, particularly following the practice since the 1960s of re-circulating half of the cabin air. This efficiency measure obviously holds out the prospect of re-circulating germs that may be in the air. However, it has long been the practice to filter the air before re-circulation. The latest high-efficiency particulate air—or HEPA—filters are designed to be extremely good at this.

We found no reason to doubt the design claims for such filters, but we were, however, astonished to find that filtration was not required. We asked the Government and the regulators to make filtration to best HEPA standards mandatory in re-circulatory systems. The Government's response to this is disappointing. They accept that HEPA filtration is key, but then say only that the yet to be established aviation health working group,

"will continue to promote the use of HEPA standard filtration".

Will the noble Lord, Lord Burlison, who is to reply, please tell the House why the remaining small minority of UK aircraft cannot now be required to meet that standard?

A predominant theme among the complaints we received from the general public related to air quality in the aircraft cabin. People were concerned that it was stuffy and somehow bad, and in particular that they were more likely to catch infections. We found no evidence that air quality was bad; however, we were disappointed to find that airlines have no routine monitoring arrangements that would quell any continuing disquiet among the general public.

I am pleased to note the Government's acceptance that research into general air quality is a priority. I am pleased, too, that the Government accept our recommendation for action in the light of ASHRAE's present work to clarify and extend air quality standards. It is, however, disappointing that the Government continue to rely on a voluntary approach to the committee's recommendation for a complete ban on in-flight smoking.

On general ventilation matters, I am again pleased to note that the Government are acting on the committee's recommendation to resolve the present muddle over the JAA and FAA standards. I must, however, take issue with the Government's rejection of the committee's recommendation as regards revisiting the JAA's requirements for only fresh air to be supplied on the flight deck.

Paragraph 18 of the Government's response states that the recommendation in 5.17 of the report is based on a misunderstanding. If so, it is a misunderstanding that is shared by the authoritative JAA witness from whom we took the evidence. I draw attention to his reply to Question 363, which appears on page 144 of the volume of evidence supporting the committee's report. Can the noble Lord, Lord Burlison, throw a little more light on this matter in his reply?

So far as concerns the transmission of infection, there are understandably no data on minor infections—I refer, for example, to coughs and colds. However, we found remarkably few documented cases of the transmission of major infections. If the systems can contain infections such as TB, it is not unlikely that they are effective also for minor infections.

We must not be complacent about disease transmission; however, a sense of proportion has to be maintained. It seems likely that the air quality in aircraft cabins is among the best that people will encounter. It is probably substantially better than the quality of air that people experience in crowded circumstances on their way to and from the airport. Indeed, the air quality in this Chamber is unlikely to be as good as that in an aircraft cabin.

Any problem is, of course, reduced if those who are likely to infect others are dissuaded from flying in the first place. I am pleased to note that the Department of Health will be considering how to broaden the dissemination of health advice for intending airline passengers.

Long before the publicity surrounding the sad death of Emma Kristofferson last September from the consequences of a deep vein thrombosis (DVT) following a flight from Australia, we were clear that the risk of DVT was the principal issue arising from the inquiry. I should emphasise that in general the risk is only a small one. This is no occasion for some of the more alarmist commentaries. But the risk is real and serious, particularly for certain categories of people. Moreover, it is not difficult to deal with.

There has been much debate about whether specific aspects of the aircraft cabin environment, such as lower oxygen levels or reduced pressure, might have some bearing on DVT risk. We found insufficient evidence to form a judgment about that. Indeed, we were astonished to find that so little work has been done on what are, for some people, life and death questions.

Putting any additional risk from the aircraft cabin environment to one side, there is no doubt about the risk associated with prolonged immobility. This has been known since the 1940s, when Professor Keith Simpson found a surprising increase in DVT-related deaths in those who had sat in deckchairs overnight while sheltering from air raids. It is clear that the circumstances in which people might sit immobile for long periods occur commonly in air travel. That reminds me of the debate that took place earlier today in the House. The medical profession has had this information since the 1940s. It has taken a very long time for the general public to get to know that this information is available.

I am pleased to note that the Government accept our recommendation about the need for urgent research to answer the important questions about the incidence of travel-related DVT. Pending the eagerly-awaited outcomes, our report assembled—as far as were aware, for the first time—the existing medical knowledge about the risk factors for DVT, together with advice on suitable precautions for individuals in various risk categories. We recommended that these be used to provide the guidance that intending passengers need.

Strongly associated with DVT risks is the question of seat size. We were amazed to find that minimum seat space is regulated only from a safety point of view. The minimum standard is set to allow an aircraft to be evacuated in 90 seconds. No account is taken of the health or the comfort of the passengers in the aircraft. During the course of our inquiry research was being undertaken to review the changed size and shape of the average passenger to ensure that minimum standards remain adequate. I am glad to note the Government's acceptance of our recommendation of the urgent need to capitalise on this research to devise a set of unambiguous definitions for seat space.

Point 13 of the response also endorses our recommendation against the use of the seriously misleading phrase, "economy class syndrome". Although seating is less spacious in economy class, sitting immobile in a business or first-class seat can equally lead to DVT. In any case, the risk does not come from immobility alone. Individuals can do a great deal to alleviate their risk by avoiding alcohol and caffeine, both of which encourage dehydration. They can also drink more water than usual and flex their leg muscles from time to time.

My final comments relate to the treatment of airline passengers. These are the customers on whom the airlines depend, although that reliance is not always evident from the treatment that passengers receive. I am glad to say that our inquiry dented the apparent complacency among the Government, the regulators and the industry about air travel health issues. I look forward to real advances in the information made available not only at check-in and around the time of take off, but also at the time of ticket purchase. That early information is vital so that, as necessary, timely medical advice can be sought by those who should be concerned about their fitness to fly. I encourage the Government, and others, to attach a high priority to these points—in particular, to the development of effective means of both encouraging intending passengers to consider whether they are fit to fly and of meeting the demand placed upon them.

Occasionally things will go wrong. We were concerned at the difficulties that passengers seemed to have in getting airlines to deal adequately with their complaints. Accordingly we recommended that airlines should review their systems and procedures for dealing with concerns and complaints. We suggested that they might, perhaps, consider introducing an independent ombudsman. As that recommendation, like some others, was not addressed to the Government, it is not covered in their response. But here, as elsewhere, I believe that the Government ought to take some interest in the totality of the arrangements for the proper safeguard of passenger interests. I hope, therefore, that through the aviation health working group, and otherwise, the Government will help steer the whole industry to a service that is properly focused on the customers.

The committee was obviously delighted by the extensive coverage received by our report on its publication. However, the topic deserves more than a day's good headlines. These matters impinge on the lives of millions of people every day in this country, and elsewhere. I look forward to listening to the contributions from other noble Lords today and, indeed, to the Minister's response. I beg to move.

Moved, That this House takes note of the report of the Science and Technology Committee on Air Travel and Health (5th Report, Session 1999–2000, HL Paper 121).—( Baroness Wilcox.)

2.49 p.m.

My Lords, I congratulate the noble Baroness and also the committee on their work. I congratulate the noble Baroness, even if she was occasionally caught out by some of the abbreviations that were used!

Over the past year I have suffered a stroke. I hope that the House will be sympathetic towards me on that score. First, I declare an interest as president of the British Airline Pilots Association (BALPA). I only wish that I could speak with the same fluent expertise with which that body addressed the sub-committee, albeit in writing.

I have not had an adequate opportunity to consider the views of the Government which were communicated to the House of Lords late in the day. Most of my comments are sympathetic to the committee's views. However, I resent and rebut the criticisms of airline trade unions which have been recorded by the Select Committee and also by the Government at paragraph 4 of their response. It is for regulators and airlines, of course, to make their own reply to the points which have been made. However, as far as BALPA is concerned, the criticisms are not worthy of the committee.

Let me say at the outset two things. First, BALPA was requested to keep its submission short. Accordingly, it omitted certain points which it considered important but which had been dealt with elsewhere. For example, it is misleading to suggest a lack of attention on the part of airline trade unions to the health of aircrews. That is a principal raison d'être of the trade unions concerned. Indeed, it is one of the principal matters which BALPA, and I as its president, have to contribute to the safety of air passengers. I think that the airline trade unions, and my own union in particular, thought that this was an issue which was, and should be, taken for granted. For that reason I give emphasis today to the fact that a strong view had been taken by the airline unions on preventive and regulatory medicine. Pursuant to that, BALPA, unlike the Select Committee, takes the clear view that general practitioners are in a better position than the regulators to oversee preventive medicine.

It is not the role of the CAA—even if it is provided with additional funding—to do that. It is for employers to take all necessary steps to ensure a healthy working environment. The CAA should be responsible for staff on the flight deck and the Health and Safety Executive should be responsible for passengers beyond the flight deck. That view has always been taken by the union which I represent.

Airlines do a certain amount to alert the travelling public to some of the risks that they take. But they do not do enough to alert the public to all the inflight health risks, perhaps for obvious reasons. It appears that, so far as can be ascertained, the numbers affected are very small. Nevertheless, I might stress that the research is ongoing. It is only recently that those associated with the industry have become more aware of what is at stake. More should now be done in the way of prevention, in particular as regards long-haul flying. For example, passengers could he advised to drink large quantities of water and to monitor their blood pressure prior to flying. There could be provision of inflight exercise programmes which, notwithstanding the comments that have been made, are, I think, very important. Many of the major airlines currently do so.

Fortunately, the air crews do not face the same risk from deep vein thrombosis because they do not remain stationary during the flight. Dr S A Goodwin, who advised BALPA on this issue, said:
"There has been a suspicion of an increased risk of Deep Vein Thrombosis (DVT) from flying. It has been labelled 'economy class syndrome' though"—
this the noble Baroness underlined—
"in fact it can occur in first class or indeed any other form of long-distance transport involving long periods of sitting still. Any extra risk from flying because of decreased cabin pressure or available oxygen or low humidity has not yet been proved … DVT is the formation of a blood clot, usually in the veins of the lower leg, possibly precipitated by prolonged pressure on the vein from the edge of the seat. In some cases the clot may become detached and travel up the body to lodge in the lungs, a condition known as pulmonary embolism … which may be fatal".
But the fact remains that,
"BALPA has no record of pilots suffering from DVT without clear predisposing cause unrelated to the flying".
I have taken a special interest in that subject.

"Anecdotally some pilots have suffered. Half-hourly flexing and rotating the ankles for a few minutes is recommended as is getting up from the seat at regular intervals on long-haul fights or between sectors on short-haul. 'Heavy' crew would be safer sleeping in bunks than in chairs".
The drinking of water or non-caffeinated soft drinks when dry or thirsty is also recommended.

"Some factors may increase the risk of DVT in pilots. There is a minor risk with increasing age over 40, the very tall, short or obese"—
I do not refer to any Member of this place—
"previous or current leg swelling, recent minor leg injury, minor body surgery, varicose veins".
Those are all matters which can contribute to the problems to which I have referred. In those cases it may be worth wearing support stockings. I shall listen with interest to what the Opposition Front Bench have to say. Why have we not received more comment on the issue from the airlines or other interested parties? It is important to pay proper attention to this.

The report also raised several other issues. Air crews deserve similar protection to that received by the rest of the working population from the regulations on noise at work. I may have missed it, but the Select Committee ought to have referred to that.

The committee referred to in-flight medical emergencies. Every long-haul passenger aircraft should be required to ensure that medical emergency kits such as defibrillators are readily available. Air-toground access to professional medical advice should also be available.

The committee recommended that aircraft should be fitted with ozone converters. That would minimise the health problems associated with ozone plume. BALPA has also recommended that the Meteorological Office should look into providing ozone plume forecasts in advance so that the phenomenon can be avoided altogether.

After an 18-month inquiry, the Australian Senate concluded that it was,
"convinced that there was sufficient evidence before this inquiry to justify further examination of the following factors—the effects on human health of the introduction into the aircraft cabin and cockpit of engine oil, by-products of engine oil combustion and other compounds as a result of leaking seals and bearings".
I do not understand how the Select Committee concluded that there was no risk to passengers and crew from the contamination of cabin air by toxic fumes. In that respect, the committee has misled itself. It came to that conclusion without research into what may be abnormal operating conditions, such as the leaking of an oil seal. Does the Select Committee agree that the effects of such abnormal operating conditions should be researched?

Finally, I shall deal with cosmic radiation. There is a DETR radiation group under the new legislation. The Select Committee report says:
"The matter does not require further comment or recommendations".
I agree. Why should it be so surprised that, in the light of what it has already said, in its submission BALPA makes no mention of cosmic radiation?

I have spoken for long enough. BALPA always has looked, and in the future always will look, to whatever opportunity is available to enhance the safety of the travelling passenger and the air crew. It has no greater duty than that.

3.5 p.m.

My Lords, I, too, congratulate the committee on its interesting and stimulating report, and I thank my noble friend Lady Wilcox for the way in which she opened the debate this afternoon. I picked up my copy of the government response to the report as I entered the Chamber and admit that, as yet, I have not had a chance to read it.

I have no particular qualifications for contributing to the debate, other than an interest in health and the way that it can be maintained naturally. I also have some experience of helping during three or four in-flight emergencies over the past 20 years.

The last of those occurred approximately a year ago on a flight with the Emirates airline, when I helped to dispense glycogen to a passenger who had lapsed into hypoglycaemic coma owing to a very delayed take-off and, I assume, a long delay in the provision of suitable refreshment. That must be a fairly common problem for diabetics. In this case, the airline should be congratulated on the high standard of its emergency medical kit. I hope that the committee's recommendation to,
"upgrade the required minimum provision by UK carriers for medical emergencies to current best practice levels in relation to both crew training and medical emergency kits—which should include automatic external defibrillators",
will be implemented as a matter of priority by the CAA and JAA.

I am sure that the airlines are aware of the existence of new medical technology, especially tele-medicine links, which can make the management of emergencies much easier. Communication with experts should be possible within minutes. People like me are often quite capable of carrying out instructions in an emergency but do not always have sufficient experience to make medical decisions in life-threatening circumstances, other than those which might be expected during a normal working day. In the emergency which I have described, I remember discussing with a young doctor whether the drug should be administered intramuscularly or intravenously.

The committee has not shown much concern for the problems of cabin relative humidity. I should have thought that in-flight dehydration would be one of the most serious hazards of long-haul flight. Many passengers fly infrequently, and the tendency to drink alcoholic or caffeinated beverages before or during a flight, resulting in an abnormal production of urine, can lead to central dehydration.

A recent survey by Boeing showed that relative humidity can fall to between 5 and 10 per cent. As recommended levels for comfort in buildings are between 30 and 70 per cent, that represents a dramatic reduction. However, the committee received evidence that low humidity is beneficial for the aircraft structure and equipment in that it reduces moisture and condensation, thus limiting corrosion and opportunities for bacterial and fungal growth. However, I believe that passengers should be warned of possible problems and, as the noble Lord, Lord Clinton-Davis, said, actively encouraged to drink plenty of water.

Together with my noble friend Lady Wilcox, I was surprised not to find any reference to the health problems of cabin crew. It is not clear to me whether or not those crews gave evidence. During the speech of the noble Lord, Lord Clinton-Davis, my attention was drawn to paragraph 4, and I am delighted that, in their response, the Government were also surprised at the lack of attention to the health of air crew by regulators, airlines and air crew trade unions.

I expected to hear from those groups as I believed that the incidence of sickness among crew was relatively high throughout the world. Because of the nature of their work, flight attendants breathe significantly more oxygen than do passengers. They are also exposed to significantly more toxicity. Many airlines require random drug tests for crews and insist that cabin air is not a factor. Yet complaints from pilots are rare. But, of course, they are provided with separate, purer, oxygen-rich air in the flight deck. I am delighted that pilots are treated well, but low oxygen and low humidity strain the respiratory tract.

A recent series of tests which measured oxygen saturation of the blood showed that a progressive lowering of oxygen saturation levels occurs during long flights. I do not have the exact figures but I use similar measurements while working on some of my patients with sedative drugs and have learnt that a drop from 98 per cent saturation of oxygen to 92 per cent requires dramatic action. Pesticide residues and toxic chemical vapours that originate from hydraulic spills could well be involved. Vaporised hydraulic fluid is a known neurotoxin and it is possible that hazardous oil fumes may react with other chemicals to cause ill health.

My noble friend reminded us that there is no fresh air in aeroplanes. All air is processed through engines, where it can become laced with toxic chemicals. It is also likely that any chemical spills or leaks from the aircraft could be close to air intake doors. I am sorry that the report made no mention of the "sick aircraft" syndrome, which is widely known in the United States. Minor problems are fixed on a temporary basis and any fluids that have leaked during a flight are routinely topped up and the aeroplane is kept in the air. Sadly, it is more important to maintain departure times than to deal permanently with such defects when they are discovered.

Health problems related to toxic chemical poisoning are often delayed and time released. Low-level exposure results in burning eyes, nausea, headache, fatigue and flu-like symptoms. How many passengers do noble Lords know who say that they always contract flu or respiratory problems after long flights?

Finally, I turn to deep vein thrombosis. There is a mass of evidence to show that it is a problem, and that it is brought on by many factors, including dehydration, toxicity and the lack of exercise. The noble Lord, Lord Graham of Edmonton, will later tell us of his experiences. Perhaps he is lucky to be here this afternoon.

My family, friends and I have routinely taken aspirin before long flights for more than 20 years. I cannot remember why I do so; many other travelers have not. It is a cheap, essential and life-saving preventive measure that should be used routinely on long flights, and predominantly by passengers over 40. However, in view of recent reports of problems with younger people, it might be wise to extend that simple preventive measure to them.

I look forward to the speeches of other noble Lords and to the Government's response. I commend the report.

3.12 p.m.

My Lords, I join other noble Lords in expressing appreciation to the noble Baroness, Lady Wilcox, for the excellent way in which she summarised a year of very hard work. When I was privileged to attend her committee, I was enormously impressed by the width of experience that was available—it helped her to compile the report. Time and again, it is clear that Members of the House comprise men and women who have been, and often still are, heavily engaged at the chalk face and who deal with major problems. I pay tribute to the noble Baroness.

All that I had hoped the committee would achieve is contained in the report. I am a layman in this regard. As the noble Lord, Lord Colwyn, pointed out, perhaps I am lucky to be here. My luck depended on the service provided by Whipps Cross hospital, which is not unknown to the noble Lord, Lord Jenkin. He had the privilege of being the chairman of the relevant trust for some time and he knows about the quality of the work carried out at the hospital. When I developed difficulties, my local GP immediately sent me there, and I was treated.

I congratulate the committee on the range of matters that are covered—I had not appreciated how many were involved. I was affected because I had deep vein thrombosis. I ask the House to bear with me later when I explain the experiences of many people. My attention was drawn to them through the ongoing study.

I shall begin by discussing the Government's response to the report. Under the heading, "Deep vein thrombosis", at paragraph 1.16, the report states:
"It is imperative that the current paucity of data on deep vein thrombosis … be remedied. We recommend that an epidemiological"—
my pronunciation of that word is as good as the noble Baroness' earlier efforts—
"research programme of the case-control type be commissioned by the DoH as soon as practicable".
Another recommendation, as an interim measure, pending the development of more authoritative guidance, is that,
"we recommend airlines, their agents and others with consumer interests to repackage the summary indicative and precautionary advice on DVT in Box 4, together with the summary information on predisposing and risk factors in Boxes 2 and 3, and make widely available to the general public".
I felt—I was going to say a real clot, but I shall change the word—a real ninny when it happened to me. I spoke to so many people, one of the whom was the noble Lord, Lord Colwyn, who pointed out that there were measures that I could have taken on a long-haul flight which I had not appreciated at all; for example, taking an aspirin, making sure that I avoided drinking too much alcohol, although not all alcohol, drinking lots of water and taking exercise. Those are all general steps which I could have taken.

However, what I want—and I believe it is now on its way—is that every doctor's surgery should carry information; namely, a card with "dos" and "don'ts" of what can be done to avoid the problems.

I am delighted to see the recent initiative of British Airways in recommending to passengers what they should avoid doing if they are travelling long-distance. I am not gunning for the airlines or anybody else, because that is an exercise in futility. As the noble Baroness said, we have had 40 or 50 years of warnings in relation to these matters. Now we have a catalyst, and that catalyst is the noble Baroness's report. The phrase that comes to my mind is that things will never be the same again. Its impact has been to make people sensitive to the issues. The general public realise that they have responsibilities in this regard, as well as the airlines. But above all, the Government have a responsibility. The Government, the committees and the inter-departmental committees must all be seen to be working and effective. I do not believe that Ministers will now be able to say to me, as they did three years ago when I first raised the issue, "There is little evidence of this."

The evidence of Dr Edgerton comes straight to my mind. There was no facility at Heathrow to deal immediately with his wife who had suffered a DVT. He was told that there was a hospital at Ashford 30 minutes away, which deals very efficiently with such problems. That is no good a 30-minute journey away. Such a facility needs to be at Heathrow. I raised that matter with my noble friend Lord Whitty who told me that an investigation had taken place. There is now an alertness, which did not exist before, as to ways in which we can avoid those dangers.

I simply want to draw to the attention of the House one or two matters which have come to my notice. I hold up this simple cushion which is like a honeycomb. The company which makes them is called Roho International and is located in Belleville, Illinois. The cushion is designed to spread the load and to spread the weight, which in my case is considerable. It is an aid. I do not know whether it is therapeutic or whether it will be really effective. But that is something that has been drawn to my attention.

My Lords, perhaps my noble friend will give way. He may recall that during my first week in the House, I withdrew a mobile phone from my pocket to demonstrate the importance of having a mobile telephone. I wonder whether the noble Lord is out of order in showing us a cushion in this debate.

My Lords, I wonder whether my noble friend was in his place when I went to the Clerk at the table and asked whether it was in order to do so and he told me that it was. It ain't what you do, it's the way that you do it. I am grateful to the noble Lord.

Another product which has been drawn to my attention is a simple cushion which, when inflated, one uses to exercise the ankle. That seems very useful. However, perhaps the most interesting product I received was from a firm called Bio Electronics in New Zealand. Its letter states:
"You may not be aware that electric stimulation of the lower legs has been used in hospitals for many years to prevent thrombosis in patients who are unable to be ambulatory after surgery or during prolonged illness".
The letter continues:
"As early as February 2001 we will be releasing a personal use miniature version of these hospital machines that will enable passengers to receive static exercise of the calf muscles during long flights even when asleep…A mere 55 mm by 36 mm by 15 mm. 25 grams weight, powered by a watch battery these stimulators attach to self adhesive applicators and are controlled by simple 'remote control' type buttons. They will operate for 10 hours on the internal battery".
I can see the idea. People who are travelling long distances and become a little tired are sometimes advised to get into the aisles and have to avoid the drinks trolley and gift trolley. However, with this product, the calf is exercised while one is sitting down. I do not say that it will work. However, it should be investigated.

One friend who wrote to me asked why aircraft do not have tip-up seats instead of static seats. One of the problems with static seats is that if you are sitting in the middle of a row of four or five people and want to get up, everyone has to get up. In a tip-up seat it is much easier to get in and out. I believe that there is a range of measures which the industry, consumers and manufacturers can take which would produce great benefits.

I recently saw a newspaper advertisement from African Safari Airways for non-stop flights to Mombasa offering "31 inch seat pitch". That is the first time I have ever seen in an advertisement a seat pitch of 31 inches being given as a "come-on" for customers. Those who have studied the matter know that a pitch of 26 inches is the minimum. Many airlines offer 28 inch or 30 inch pitches. Before it is thought that the advertisement does not refer to economy class, it states that club and VIP upgrades are available.

I have a great deal more to say. However, I am conscious of the time. I feel sorry for the great many people whose comments I said I would introduce to the House. I have a dossier, parts of which may be familiar to the Minister and his advisers. I know that the Minister will be agreeable to accepting it from me after the debate for his officials to look at and for it to be considered at inter-departmental committee level.

There is a great deal of concern, not panic, about this subject. It is right and proper for this issue to be examined by Members of this House, the Secretary of State for Health, the noble Lord, Lord Jenkin, the noble Lord, Lord McColl, with his eminence, and the noble Lord, Lord Winston. They will not be panicked by it. They will have lived with the problem for a great deal of time. However, I believe that they would do the House, the country and the flying public a great service if they get a move on and ensure that the evidence which has been garnered for the past 12 months is put to good use.

3.20 p.m.

My Lords, as an aeronautical engineer employed immediately post-war by British European Airways, I found this inquiry fascinating. I am grateful to my noble friend Lady Wilcox for her friendly and spirited chairmanship of the committee and to our Clerk and Expert Adviser.

Times have changed since those days with BEA. Many more people fly today. They cover a wide age span and include women and children. The question of fitness to fly is therefore of greater importance.

Peter Masefield, deservedly since knighted, arrived as our new chief executive at British European Airways and said, "The passenger is not an interruption of our work; he is the reason we are here". After that, our motto became "The customer is always right".

Air safety was paramount, as it must be today. That was where my work lay. However, courtesy and consideration for passengers, who in those days were more nervous, were also uppermost in staff training, and we made a profit. In those days, that was less common. We took great pride in our airline.

That customer consideration needs to rank higher in airlines' mission statements and staff training at all levels. At the back of our report are some of the many customer complaints we received, including airline reaction, much of which is cavalier, as the noble Lord, Lord Graham, said, and lacking in any consideration of customer care.

Cabin staff and air crew are usually very polite and kind, which is essential, but management needs to give the subject of customer care far more consideration. Small modifications can reduce their anxieties. I give as examples not treating passengers as supplicants at the check-in desk; enabling passengers who are very tall or have other specialist needs to book premium seats with longer leg room in economy class; issuing passengers with boiled sweets on climb or descent to prevent ear pressure; giving ear plugs to those who are noise sensitive; providing individual cool-air nozzles so that passengers feel more in control of their personal comfort; and encouraging passengers to drink water rather than alcohol.

All those comparatively inexpensive modifications would reduce passenger stress, which is often still an underlying factor in flying. They contribute to customer satisfaction, which is fundamental to the future prosperity of any airline and can contribute considerably to their popularity in the market.

Millions of people travel safely by air every day. While we speak, about half a million people are flying in commercial aircraft world-wide. It is therefore most important that the media should not exaggerate the dangers of flying and increase people's fears of what is to them a strange environment.

There have been many articles about the risk of cross-infection and lack of oxygen while flying. When the Chamber is full, or when travelling in crowded trains, buses or the Underground, we are at similar risk of cross-infection. Aircraft cabins are pressurised so that oxygen availability is the same as at 8,000 feet. As we know, many people live their whole lives above that height. At the height at which aircraft fly—that is, about 35,000 feet—the outside air is much colder and the pressure is much less. There is therefore less oxygen. The responsible airlines therefore recirculate half the air supply, passing it through high efficiency particulate air filters (HEPA) in order to provide acceptable air at reasonable cost. The air is changed throughout the cabin every two to three minutes, which means an average entire exchange of cabin air with fresh air 10 to 15 times an hour. We were satisfied by expert witnesses of the sufficient availability of oxygen and of the removal of contaminants, emphasising the importance of properly installed and maintained HEPA filters.

We recommend that the ICAO should require a smoking ban and that filtration to best HEPA standards should be made mandatory world-wide. I believe that the ICAO must be stronger. It was a strong organisation when I was involved in the aircraft industry and we did as we were told. It is about time that all countries did the same. Travel is world-wide and passengers are international. Therefore, every nation has a responsibility in that direction. We also recommend that airlines collect, record and use basic cabin environmental data that are already' monitored to provide a better basis for public confidence and to refute the genuine anxieties of passengers. That is set out in detail in Chapter 5.

Deep vein thrombosis has been found to affect a number of people while travelling or soon after flight, particularly long-haul. Sitting still in a cramped position can contribute to it—having sat here all morning, perhaps I am suffering from DVT. However, DVT does not develop only in economy class. As my noble friend Lady Wilcox said, it was first found in people who sat in deckchairs while sheltering deep in the Underground during the war. It is clear that some people are more at risk than others. Predisposing factors are listed in Box 2 on page 46 and risk factors are listed in Box 3 on page 48. Precautionary advice is provided in Box 4 on page 49.

At the back of the BA flight magazine, passengers are given advice on regular exercise to be taken during flight. We know that it is very difficult to walk about, but continuous leg and foot movement is strongly advised. However, for those at risk it is no good reading on board the aircraft that taking an aspirin or wearing support stockings may help, or that it is inadvisable to fly soon after an operation, while pregnant or taking oral contraception or oestrogen hormone replacement therapy. One needs to know the risks before one flies so that one can, perhaps with the advice of a GP, take sensible precautionary measures. We also recommended user-friendly information for professionals, GPs and practice nurses. We are pleased that the Government are revising existing advice and intend to republish it early this year.

I wrote the next part of my speech earlier this week. It would be a good idea if GPs posted notices in their surgeries listing features that might reduce fitness to fly. Today I received from British Airways a poster that is to be sent to every GP which does exactly that. There is also a pre-flight British Airways publication, The Healthy Journey. Therefore, we have not worked in vain; things are happening.

One of our most important recommendations is that clear advice on fitness to fly should be given by airlines and their agents before passengers fly, not to create over-anxiety but to warn them of the increased risk and enable them to make sensible pre-flight arrangements. Before take-off, in addition to safety advice, airlines should give a short health briefing. We have recommended more research in a number of fields. We were surprised by the major gaps in knowledge, which are listed in paragraph 143. With increased knowledge, ICAO, JAA, FAA and CAA—the international regulators—and government will be able to decide, on much more firmly-based data, where the risks lie and, where necessary, regulate accordingly. That will be necessary, and it should happen.

We are glad that, prompted by our inquiry, the DETR and DoH are initiating new wide-ranging research into air travel and health. We recommend that for the very few in-flight medical emergencies government should upgrade the requirements for medical emergency kits and associated crew training, including the provision of automatic external defibrillators at least on long-haul aircraft. In addition, as in America, contracted ground-based expert medical advice should be made available by long-haul airlines.

The vast majority of passengers travel by air safely, but we hope that our report and its recommendations will assist those at increased risk also to travel safely. We also hope that those airlines which adopt wholeheartedly the need for greater customer care find that their passengers want to fly with them again and, therefore, will prosper accordingly.

3.35 p.m.

My Lords, as I rise to speak for the second time on a Friday afternoon, I shall try to be brief. I cannot but observe that it is a unique privilege for the chairman of a parent committee to thank on the same day two chairmen for performing so outstandingly.

The noble Baroness, Lady Wilcox, was a stupendously good chairman. The noble Baroness had just the right qualifications for the inquiry. The verve, wit, charm and determination that she showed during the inquiry was appreciated by us all. She was a great asset to the Select Committee, for which we are very grateful. In consequence, I believe that we have produced a valuable and topical report.

I should like to point out that the health risks on aircraft should be fairly similar to those experienced on other methods of travel. Immobility is not unique to aircraft. It occurs on trains, on coaches and on long car journeys.

One of the important and interesting questions, but one which is unresolved because there has been virtually no research at all, is whether or not other compounding factors may make a difference; for example, a closed environment; the time changes involved with long-haul flights; the alterations of diet encountered with aircraft diets; the changes in pressure; the changes in oxygen tension; and, particularly, the interesting area of hydration. In spite of what the noble Lord, Lord Colwyn, observed, the evidence we received was that the changes in hydration are actually very small: that we lose only about 100 millilitres of fluid on a long-haul flight. That may be true. None the less there are some open questions, such as whether or not, given the other changes in the environment, this becomes more important. I do not believe that we have any evidence one way or the other to answer that question.

Nor were we able to consider the important factor of stress which, for most passengers, is unique to air travel—for example, attending an airport, going through Customs, queuing up for various reasons and checking in one's baggage. All these actions are uniquely stressful. As a regular long-haul traveller, I find them stressful. I am sure that people who go on flights less often must also find them stressful.

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.

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.

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.

My Lords, I completely accept that point, which has been well made by the noble Lord.

3.46 p.m.

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"—
I should be delighted to see the noble Lord, Lord Monson, doing that from the middle of his five-across seating—
"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 t o 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";
that is, at 5, 6 or 7 per cent a year, which is double the growth in the economy.

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.

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.

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.

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, al though 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 mini mum 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 a re 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.

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.