Select Committee on Science and Technology Fifth Report


Poor recognition of fitness to fly issues

8.44 Lord Graham of Edmonton (QQ 74-78) drew attention to the lack of knowledge amongst the public about the aircraft cabin environment and its relationship with health. Others (Appendix 4) confirmed the general points that most intending flyers are unaware of cabin environment health questions. PPP Healthcare (p 267) made the important point that most general practitioners are also unaware of the health implications of flying. The Royal College of Anaesthetists (p 275) and the Academy of Medical Sciences (p 197) were of the same general view.

8.45 People who are recovering from recent serious illness, surgery or injuries, or who have serious long-term medical conditions, are generally under professional medical care. If people in any of these groups intended to fly, they would doubtless expect appropriate advice from their carers - as they would if they wished to know whether they could, for example, drive or take up sport again. If the carers were unable to give appropriate advice, they would, for the reasons discussed immediately above, have difficulty in finding appropriate sources to provide it. In practice, many would contact airlines direct, or would advise the patient so to do. Many professional carers are aware of the MEDIF system (see paragraph 7.46) and advise their patients accordingly, particularly if pre-boarding or in-flight assistance is needed. However, when a primary practitioner such as a GP or practice nurse has cleared a patient as fit to fly, problems may still arise. The airline may disagree and refuse boarding - or, as the Royal College of Nursing pointed out, a health insurance company might retrospectively reject a claim if a particular medical condition, which was not covered, subsequently caused illness (p 277).

8.46 The vast majority of intending air travellers are people who either are healthy or have no reason to think that they are not. They are unlikely to seek professional health advice before embarking on their journeys - and we agree with the Minister for Public Health that most people have no need to do so (Q 550). Some intending air-travellers will, however, have conditions which might cause them to be adversely affected by flying. While most of these will not experience any health problems arising from travel within the aircraft cabin environment, they are at risk, and some may develop problems from associated factors such as hypoxia in those who have diminished respiratory function and barotrauma in those with ENT disorders.

8.47 The fundamental problem is the general lack of recognition by the public and their primary health advisers that fitness to fly is a serious matter. We consider that this is due to a lack of knowledge about the possible health risks in the aircraft cabin environment amongst not only the public but also the health professions. Neither doctors nor nurses are taught about these matters during their basic training (pp 198 & 277) and, although some airlines make substantial efforts to educate health professionals on the medical aspects of air travel (QQ 315 & 317), such opportunities are only likely to be taken up by those already aware of their need for such further education. Intending flyers need to be aware of fitness to fly issues so that the small minority of them who need advice can identify themselves and, in seeking advice, stimulate demand from health advisers for better and more accessible guidance.

8.48 The booklets from DoH, Health Advice for Travellers, and from AUC, Flight Plan, should be important sources of health information and advice for intending passengers. As their publishers accept (see paragraph 8.26), the current editions fall well short of what is required, and we were pleased to note the plans for appropriate revision. We recommend that priority be given to refining the advice in Flight Plan: "If you have any concerns about your fitness to fly, talk to your doctor before you book your flight". We understand and share the Minister for Public Health's concern not to add needlessly to the burden on doctors or to the general hassle for intending passengers (Q 550). However, the existing advice is far too vague and, to help both groups, needs to be made much more specific.

8.49 We find that CAA also publishes a leaflet, Travelling Safely, which is sometimes issued with airline tickets. This focuses on safety, although some of the advice also has health implications. We recommend CAA to revise its Travelling Safely leaflet, at least to cross refer to the revised Health Advice for Travellers and Flight Plan. We also recommend DoH, CAA and AUC to consider whether the combination of their three leaflets as currently conceived best serves the travelling public's information needs.

8.50 The Minister for Public Health acknowledged a case for more targeted information for people at risk, but noted that not enough was currently known about the target groups and what advice they should be given (Q 548). The former should be clarified in the new research initiated by DETR and DoH (see paragraph 8.3). On the latter, the Minister made a good start by noting in her evidence to us four particular groups of people who might need advice about health risks of flying (Q 551), namely:

  • those who might be actually unfit or unsuitable to fly (which might mean women who were more than 36 weeks pregnant, or people with severe respiratory or cardiac conditions);
  • those who should consider delaying a flight (perhaps because they had recently undergone major surgery);
  • those who might be at particular risk of DVT; and
  • those who were on medication.

8.51 Alongside the revision, further thought needs to be given to the way the information is brought to the attention of intending flyers. We note the Minister for Public Health's view that the message may be too complicated for a public information campaign (Q 548) but there needs to be some way of raising the profile to kick start the desirable process noted in paragraph 8.47. We make our own suggestions in paragraphs 9.5ff.

Airlines' handling of the travelling public


8.52 DETR noted that, in the air travel market, the usual rule of "buyer beware" applies (Q 2, p 1). This was also one of the general thrusts of the airlines' evidence. It is therefore vital that sufficient information is available at the point of sale to enable the purchaser to make an informed choice. In our view, airline ticket selling does not satisfy this need, particularly for those intending air-travellers who are concerned about their health and wellbeing - and those who are not concerned, but should be.

8.53 Airlines and their agents must accept that although they may feel strongly that the cabin environment does not present additional hazards to health for the vast majority of their customers, a significant number of the latter do not agree. Even though some of those perceptions may be ill-conceived, they should not be ignored. Much good could be achieved in setting minds at rest (or alerting those potentially at risk who need to be alerted) by more attention, at and around the point of sale, to concerns about health and comfort. The active provision of sound and user-friendly information and advice at this stage would certainly help consumers to make informed choices.

8.54 As noted in the section on seating in paragraphs 6.33ff, seating and space limitations have been major subjects of adverse criticism concerning comfort and wellbeing by many witnesses. The lack of prior knowledge and choice of what is being purchased was seen as a major shortcoming of this process-driven system. Most passengers have no idea of what the seating configuration of the aircraft is, where in the cabin they will be seated and what their seat space will be, until they check in and board the aircraft - by when it is too late to do anything about anything found to be unsatisfactory.

8.55 Even at the check-in stage, passengers have found that they are often treated as commodities. If they try to enquire about conditions on board, or get seats or groups of seats that they particularly want, they are, in the telling phrase used by Dr Murray Wilson, made to "approach the check-in desk as supplicants rather than partners to an equal-sided contract" (p 255). It appears to us that consumer choice is unacceptably limited in some aspects by the airline business being driven by the process itself rather than by the consumer.

8.56 We hope that the European Commission's initiative, noted in paragraph 3.15, will lead to legislation to improve the information available to passengers to make well-founded choices, to create new rights for passengers and to improve the balance of contracts in their favour. Further, we hope that airlines' actions before then will render such legislation redundant.


8.57 BATA provided some evidence of favourable customer feedback on UK airlines (p 124) but this seems likely to be only part of a range of opinion. Given the massive number of passengers, there are bound to be some formal complaints. We did not, at the outset of our Inquiry, intend to include an examination of airlines' systems for dealing with complaints about the aircraft cabin environment but, as summarised in Appendix 4, we received evidence that gave us concern about such arrangements.

8.58 Our witnesses' main problems seemed to be that either they never received responses at all from the airlines, or that the responses they did receive amounted to denial by the airline concerned of any responsibility for whatever circumstance had given rise to the complaint. When pressed further, the airlines seemed quickly to hand over complaints to their lawyers or insurers and took no further interest in the concerns. When complainants made what they thought were helpful proposals that might have benefited others in the future, they were even more disappointed by the airlines' apparent lack of interest or concern. As might be expected, no-one who received satisfaction of a complaint wrote to us. In any case, it would not be appropriate for us to deal with individual witnesses' grievances.

8.59 Airlines and their agents need to be aware that the implementation of our recommendations for improving the aircraft cabin environment and the public's awareness of health issues will lead to increased dealings with their customers. To the extent that these are not handled well at the normal stages of ticket purchase, check-in and flight, they may lead to an increased number of complaints.

8.60 Whether or not this proves to be the case, we recommend airlines to review their systems and procedures for dealing with concerns and complaints so that passengers do not feel that they are being forced to deal with lawyers and insurers from the outset. This review should include considering the case for an independent "ombudsman".

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