MRS DAWN PRIMAROLO, MR JIM FITZPATRICK, MRS SANDRA WEBBER, DR RAY JOHNSTON

17 JULY 2007

  Q280  Lord Colwyn: Do you think there is a case for standardised guidelines for carrying ill or vulnerable passengers across all airlines and, if you do, who do you think should take ownership for the responsibility?

  Jim Fitzpatrick: We have covered some of this territory earlier on, your Lordship, in the proceedings, but it is our view that freedom of passage and personal mobility is obviously very important and we do a great deal to encourage and facilitate it. Of course, all travellers must exercise personal responsibility. I would like, if I may, to refer to two examples of the facilitative role that we undertake. First, on disabled passengers, new regulations concerning the rights of disabled passengers and persons of reduced mobility when travelling by air are being introduced to bring aircraft in line with the Disability Discrimination Act 1995. These come in next week, if I am correct. They will give disabled people new rights for travelling by air in Europe and will ensure that no person can be refused carriage on a commercial flight starting and finishing within the European community on the basis of their disability or reduced mobility. The regulation was an important achievement of the UK's Presidency of the EU in 2005. Secondly, on pregnant passengers, the Gender Directive will make it an offence to discriminate against passengers on the grounds of pregnancy. We are consulting with the Royal College of Obstetricians to make sure that we have a workable position for passengers and airlines. Of course it would not be sensible for people who are clearly too ill to travel to do so. That is why, for example, the European Passenger Restricted Mobility Regulation includes provisions for the refusal of carriage in specific circumstances on the grounds of legitimate health and safety concerns. Those who have specific medical conditions should, as we discussed earlier, and do generally take advice from their GPs or from specialists who can advise them on travelling. On balance, we do not think there is a need for standard guidelines. We want to enable air travellers to make informed and responsible decisions themselves on whether or not to travel, although, notwithstanding that we believe the current system operated by airlines works well, we obviously have the comments from Dr Johnston earlier on about particular guidelines which might be more appropriate.

  Q281  Lord Colwyn: I do not think I fly enough to have personal experience on this but the guidelines on pregnancy or people who have recently undergone surgery - and another problem that is often forgotten is people who are going to have surgery—it is very important that they know about the problems of flying. Should the government or the CAA look into this and try to standardise it?

  Dr Johnston: It is an individual assessment. The earlier suggestion of bringing together the disparate specialties and breaking down the areas of competencies would be a way forward. There are standard guidelines produced by the Aerospace Medical Association, the BMA and other individuals and they are very similar. Another thought that I have is to try to bring these together in one focus in the aviation health unit on the website. The point you make about having appropriate advice in one place is difficult because if it is only in one place and the individual does not know about that one place they are almost disadvantaged. The spread of information is useful at the moment and, having reviewed all that information, the correlation between the information is fairly close. One always says in research, "Triangulate the data for good evidence." Bringing these competences together would certainly be a way forward in that respect.

  Q282  Lord Patel: If next November there was a report of an outbreak of pandemic 'flu in the United States, what action would that trigger in the aviation industry?

  Jim Fitzpatrick: Much work is being done to ensure preparedness for a possible 'flu pandemic or for other contagious diseases such as SARS. The Department for Transport has worked closely with airlines and airports and other modes of transport operators to ensure they have preparedness plans in place and contingency planning exercises have taken place also. The international aspect of preparations is very important. In addition to our own preparedness, the International Civil Aviation Organisation, ICAO, in conjunction with the World Health Organisation and the International Air Transport Association, has introduced a standard for contracted states to establish a national aviation plan in preparation for an outbreak of communicable disease. There is a lot of work going on, as you know, within government generally to prepare in respect of a 'flu pandemic which is a health issue but obviously transport will have an important role in our response and this is a matter which is under active consideration within the Department.

  Q283  Lord Patel: At this stage you do not know what action that would trigger in the aviation industry?

  Jim Fitzpatrick: It would be very difficult to anticipate fully all the potential actions which may be required. There are guidelines in place in respect of certain aspects. There are recommendations from the World Health Organisation in terms of countries' preparedness but we are working up a more definitive statement of policy. Indeed, I think we have a meeting coming up next week which Mrs Webber might be able to give a little more information on.

  Mrs Webber: If your question was what specifically is in these preparedness plans, I do not think we are at the stage of giving the detail at the moment because it is still an active project. Obviously that is something that airlines, shipping and other international transport operators know they have a role in, providing information to the health authorities and protecting people who look ill when they are on board.

  Q284  Lord Patel: One of the key facets of the overall plan for pandemic 'flu was containment of the pandemic in the area where it first occurs. Therefore, movement of people out of that area will be important. What you are saying is at this stage we have no plans for what the aviation industry would do because that is the industry that would be responsible for moving people around.

  Mrs Webber: I do not think it is fair to say we have no plans. The plans are being developed and refined but if something happened tomorrow the planning as it has got to—

  Q285  Lord Patel: November was my target date.

  Mrs Webber: There will be plans in place but in terms of talking of containment there will be stages, depending on the level of the threat. Clearly, cancelling all flights is the last resort, not the first resort. There will be levels of activity depending on the risk assessment at that stage.

  Q286  Lord Patel: You already have a plan that says that one of the things in any pandemic, particularly pandemic 'flu, would be to try and contain that into the area where it first occurs to minimise its effect or allow us even a few days to prepare for that pandemic. If there are no plans for people moving out of that area and arriving here, then we cannot contain that.

  Jim Fitzpatrick: If there was a suspected person on board, there is a clear process in place whereby that individual passenger and the fellow passengers would be monitored. There is a process for isolation to take them to the appropriate port health authority for dealing with them. If there is a 'flu pandemic that develops there will be conflict because there will be citizens in different parts of the world who will be desperate to return to their home country. This will be a matter that will be judged dependent upon the circumstances that apply at the time. The government has well laid plans laid down and corporate exercises have been taking place for some time now to make sure that, wherever the pandemic occurs and breaks out, there will be an appropriate government response. We are refining the Department for Transport's response in terms of dealing with our responsibility there too.

  Q287  Chairman: I could not help but notice, flying into Hong Kong a few weeks ago, that they are still monitoring the temperature of everybody arriving in Hong Kong. That strikes me as not an unreasonable thing, especially if there was a state of high alert. Do we have equipment to do that? I know all doctors tell me that people can be infectious before they have a temperature but if you take a population of people with a high fever and without you are more likely to find infected people with a high fever, are you not?

  Dr Johnston: I would concur with your friends and colleagues who have notified you about temperature.

  Q288  Chairman: I do not accept their argument for one moment. If you take 50 people who are running a fever of 104, it is far more likely that more of those are infectious than if you took 50 people who were not running a high fever.

  Dr Johnston: Absolutely. With the incubation period in pandemic 'flu, being different from SARS, the temperature screening has a limited value. It may have some value but health screening in terms of a questionnaire before someone left an area—you alluded very astutely to containment. Screening can be more than temperature measurement. It can be a simple questionnaire on one sheet of A4 asking about their wellbeing before they get on the aeroplane. All these methods are not without failings because if someone is desperate to leave area "A" they may well say they feel well. If they are in the early stages before they become ill with a high temperature, they will leave anyway. I do take your point that temperature screening may have a role but I think it might not be the most vital role in a pandemic 'flu epidemic.

  Q289  Lord Colwyn: The filters on these aircraft are obviously effective against molecules. Are they not effective against viruses?

  Dr Johnston: The HEPA filters we talk about are 99.97% effective in removing bacterial viruses. The problem is, in infection, on the route of spread. One can become obsessed by droplet spread but it is often droplets on the hand and touching so good hand hygiene has been shown by many experts to be highly effective. If one is travelling for example to Heathrow and cannot afford the Heathrow Express and travels on the tube, one's respiratory tract and hands are close to total strangers and you do not know their history either. The whole journey, because you are with a large number of people, can be a risk rather than just the aircraft per se. The flow patterns on the aircraft would mean two rows in front, two rows behind of any suspect case so the HEPA filters are a highly effective method of removing bacteria and viruses.

  Q290  Lord Colwyn: My medical colleague has just reminded me that 'flu of course is a bacterium.

  Dr Johnston: It is a virus, with respect.

  Q291  Lord Patel: My question was very specific. It was not about transmission of infections on an aircraft. It was about if there was a report of a 'flu pandemic in the United States in November. What action would that trigger in the aviation industry—ie, are we going to stop flights to contain the disease where it is or are we going to allow free movement of people and allow the disease to come here?

  Jim Fitzpatrick: We are not in a position to give a definitive answer on that. It would very much depend on the circumstances. There are preparedness plans in place for the industry. The Department is working closely with the airlines to make sure that they have their plans in place. It may very well be that that would be a consequence but I could not say this morning that that is what we would do.

Chairman: How big is the 'flu virus?

Lord Patel: Pretty small.

Chairman: I know the polio virus is only 15 nanometres in diameter and that is likely to pass through a HEPA filter.

  Q292  Lord Patel: The answer that Dr Johnston gave is that the majority of the viruses will be caught by a HEPA filter, but not all of them.

  Dr Johnston: The figure of 0.3 microns comes to mind.

  Q293  Lord Patel: If it is H5N1.

  Dr Johnston: Yes. Who knows? It may change again before the pandemic occurs.

  Q294  Lord Colwyn: It is still widely felt that if you go on an aircraft and someone at the other end has a cold you are going to get a cold a couple of days later, is it not? Is that an old wives' tale?

  Dr Johnston: If I can address that particular point and consider the passenger journey. If there is a person at the front of the aircraft, who may be in first class, and you are sitting at the back of the aircraft and it was a coaching departure, the respiratory tract of the first class passenger might have been in close proximity to that of an economy passenger—so it is the entire journey that is important. We become focused on the aircraft but the journey from starting and finishing, round a baggage hall and waiting for your bags to arrive etcetera. In statistical or any other research the effect of confounding must be clarified.

  Q295  Lord Haskel: On the question of toxic air, we have had a number of people tell us that they are concerned—also the Pilots' Union has told us—about fume events on aircraft. What action is the government taking to meet these concerns?

  Jim Fitzpatrick: There are occasional bad smells or fume events during flights and these have been reported particularly on the Boeing 757 and the BA 146. Second, some pilots who have experienced these events do report a variety of short or long term symptoms or ill health. However, no link has been established between these two facts to a standard which has convinced any government or regulatory authority, bearing in mind that aviation is global. The campaigners attribute their health symptoms to organophosphates in mist from heated engine oil or hydraulic fluid which has leaked into the cabin because of design or maintenance faults. Your Committee looked into this in 2000, particularly the organophosphates and tri-ortho-cresyl-phosphate, known as TOCP, which I will refer to it as, and concluded that the very low levels of TOCP that would be found even in the highly unlikely worst case of contamination from oil leaking into the air supply lead us to conclude that the concerns about significant risk to health of airline passengers and crew are not substantiated. Nevertheless, your Committee also recommended sampling of cabin air during both normal and abnormal operations. Since 2000 there has been further research on cabin air quality during normal operations and the quality is found to be very good. Taking air samples during fume events did not turn out to be, if I can quote your report last time, "a simple and inexpensive exercise". We have just begun a ground breaking research project, a world first, using experimental technology. There are three reasons why it has taken so long to reach this point. Typically, cabin air is exchanged every two to three minutes and cockpit air every minute, so you need sampling equipment which can pick up transient contaminants. Also, the equipment must not interfere with flight safety either mechanically or by distracting the crew during a fume event. Finally, fume events occur in perhaps half to one per cent of flights so we would need equipment on many flights to maximise the chance of capturing the fume event. Cost is a consideration in terms of the devices, the space they occupy and the analysis. We have begun testing various sampling devices. These include solid phase micro-extraction devices, SPMEs, photo-ionisation detectors, PIDs, and a grab sampler being developed by the BRE, the former Building Research Establishment. The tests involve creating a fume event on the ground and seeing what substances the equipment records. The tests may also determine where best to place sampling equipment on aircraft. Once we have identified effective equipment, it is intended to sample around 1,000 flights using more than one sampling device, more than one laboratory to analyse the results and an independent project manager from the academic world. Crew will be asked to record whether they detected any smells. We shall use the BA 146 and the Boeing 757, including specific aircraft where fume events have been reported in the past. We are grateful, if I may say so, for the help of the airlines, BALPA and the Advisory Committee on Toxicity.

  Q296  Lord Haskel: That certainly is a very impressive project and I am sure it will throw up a lot of new information, but meanwhile we have been hearing from for instance Dr Sarah Mackenzie Ross that some pilots are presenting symptoms consistent with organophosphate poisoning. Should this aerotoxic syndrome be classified as an occupational disease while all this work is going on?

  Jim Fitzpatrick: My brief says that Sarah Mackenzie Ross's study was a small one without a control group and the subjects came from patients ie, they were not randomly selected. The Committee on Toxicity arranged for an independent review of it by Professor Robin G Morris, professor of neuropsychology at the Institute of Psychiatry, King's College Hospital in London. Professor Morris's report said that the association between flying and neuropsychological abnormality "should be interpreted with great caution because of the small sample used." He concluded that the study "cannot suggest a link and equally it does not rule out a link. In order to establish a link there is need for a much larger study taking a randomly selected epidemiological sample. There are practical difficulties in designing such a study." We are not discounting Sarah Mackenzie Ross's study but we are saying that we need far more evidence upon which to base our conclusions.

  Q297  Lord Haskel: You are not going to classify it as an occupational disease?

  Jim Fitzpatrick: I do not think we are in a position to draw conclusions at this stage until we get adequate evidence on which we can make decisions.

  Q298  Lord Haskel: Another thing that we have been told is that some of the airlines have told pilots not to report these events. In some phases of flight, people say that they are normal. What is the view of the government and the regulator about this matter?

  Jim Fitzpatrick: From the information I have in front of me about the claim of severe under-reporting of fume events to the CAA, it is our view that the UK has one of the best aviation safety records in the world and that the CAA's mandatory occurrence reporting scheme is part of our successful safety regime. The CAA receives approximately 10,000 new reports every year. The definition of a reportable occurrence is any incident which endangers or which, if not corrected, would endanger an aircraft, its occupants or any other person. The EU also now requires all Member States to have such a scheme under Directive EC2003 42 which is essentially based on the UK scheme. The CAA chairman assures the confidentiality of reports and provides that the CAA will not take any action, punitive or otherwise, against an individual as a result of a report, except in cases of gross negligence. The CAA encourages and expects employers to act accordingly. We do not believe that there is under-reporting. We believe that there is every encouragement given to professional pilots to be able to record anything which they think is appropriate. The fact that there are reports clearly indicates that pilots are prepared to come forward and make those reports to the authorities.

  Q299  Lord Haskel: You have every confidence in the integrity of the CAA statistics?

  Jim Fitzpatrick: We are confident in the statistics because of the information I have just given but also because there are two other avenues to report if an individual wishes to bypass an employer, which may be a natural concern for anybody. One, there have been no air contamination incidents reported by flight crew via the individual confidential pathway to the CAA so, although the procedure exists for people to report it without having to go through their employer or their line management, no such reports have taken place. Because of the reports which are being received through formal procedures, it tends to suggest that we are getting reports. Secondly, the number of air contamination incidents sent to the confidential Human Factors Incident Reporting Programme is small, 22 in total to date, nine from flight crew, ten from cabin crew and three from others. The programme is seen as an alternative reporting approach for an individual to report concerns without their employer being involved so we are confident in the reporting systems.