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Lord Winston: 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.

Lord Graham of Edmonton: 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

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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

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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.

Baroness Platt of Writtle: 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.

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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

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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.

Lord Winston: 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.

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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.


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