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I begin by declaring an interest. I am a trustee of the Pulmonary Hypertension Association.
I am grateful to have the opportunity to raise this important subject, on which the Pulmonary Hypertension Association, the British Lung Foundation, the Cystic Fibrosis Trust and other lung health organisations have been campaigning for some time. Disabled passengers, like anyone else, should have the right to access public transport, but people who need extra oxygen face poor customer service from transport providers and unfair extra fees. They are sometimes refused access to transport altogether. Airlines remain among the worst offenders, but buses and taxis have also turned those disabled passengers away. That is unacceptable and needs to change.
Oxygen is a necessary medication for people with many different lung conditions. Pulmonary arterial hypertension is an incurable and life-threatening condition that causes high blood pressure in the pulmonary arteries. It can result in breathlessness, chest pain, angina, fatigue and fainting spells; it can also result in heart failure. Left untreated, half of sufferers would die within two years, but new and effective treatments can give patients much longer, fuller lives. Extra oxygen can help to ease breathing difficulties and greatly improve mobility for people who would not be able to walk or move around at all without it.
Oxygen used to be supplied only in large, bulky cylinders, which could be stored in a patient's home but not moved around. Now, it is available in much smaller, portable cylinders, or through electronic oxygen concentrators. There are different models of concentrator available, but they are roughly the size of a large laptop computer or a small suitcase. These innovations have given valuable freedom and mobility to pulmonary hypertension patients and sufferers of other lung disorders such as chronic obstructive pulmonary disease, cystic fibrosis and muscular dystrophy, allowing them to continue to work and travel in a way that previously was not possible. However, that mobility and freedom are being restricted by transport companies that refuse to carry their equipment.
The problem often results from a lack of awareness and misguided safety fears. The Department for Transport has issued guidance on the transportation of dangerous goods, and it includes a section on the carriage of oxygen cylinders on public transport. It states that
"there should not be a problem" in non-smoking areas. Nowadays, of course, all areas of public transport are non-smoking areas. The guidance notes that some carriers apply different policies on oxygen, but it clarifies the matter by stating:
"Any restrictions concerning the carriage of oxygen cylinders for private use on public transport will be that of the carrier."
That is very clear. If carriers refuse to allow oxygen on board, it is their own choice. There is nothing in law to prevent bus, train or plane companies from allowing oxygen cylinders or concentrators on board.
However, over-cautious carriers are still ignoring that guidance and refusing to allow oxygen users access to their services. Stagecoach recently refused to allow a mother in Lancaster to board one of its buses with her young son, who requires oxygen. The company stated that it was not allowed to carry oxygen, as it was a "hazardous product". The baby's father said:
"He has to travel in a specially adapted pushchair that we have had provided, but we didn't realise we couldn't use public transport. We just feel penalised by the system, and it's like we're trapped in our own home sometimes because it stops us from being able to take him out."
The parents now have to push their son into town with his oxygen for him to attend regular hospital appointments.
Stagecoach stuck to its policy when challenged by the local press, and a spokesman for the company said:
"The law regarding passenger carrying vehicles prevents any hazardous products-including oxygen-from being carried on board. We are unable to take anything that's potentially dangerous. It's very unfortunate and if we were able to do anything to help then we would do so."
Stagecoach is wrong. The Department for Transport's guidance is clear: carrying oxygen is not a problem, and it is not potentially dangerous. I hope that the Department will contact Stagecoach to make it crystal clear that the company cannot hide behind the guidelines.
Sadly, that is not an isolated incident. The British Lung Foundation heard from one passenger who was told by Arriva that she was a fire risk, and other patients have also been turned away on so-called safety grounds. In some instances, refusals are bus company policy, but in others, patients have found that they were allowed on the bus one day but turned away on the next by a different driver. Inconsistencies are rife, and uncertainty for patients is the result.
People refused access to the bus or the tube might want to take a taxi, but a patient in Birmingham who was travelling on business reported to Air Products Ltd-one of the suppliers of the NHS home oxygen service, which runs patient forums for oxygen users-that several taxi firms refused to take her booking when she told them she was carrying oxygen equipment. In the end, she had to conceal her cylinder in her bag in order to hire a taxi.
The situation is totally unacceptable. Disabled people should not have to fight, complain or hide their equipment in order to get what they are entitled to. I feel that the Department for Transport must work to raise awareness among carriers both in headquarters and among front-line staff so that people who use oxygen can exercise their right to use public transport along with everyone else.
Bus and taxi firms could learn from Transport for London, whose staff also turned oxygen users away in the past because of byelaws preventing passengers from carrying inflammable substances on the tube. However, Transport for London has now agreed that medical oxygen should be exempt and it is actively working to ensure that front-line staff are aware of that policy change. It is considering issuing letters or "oxygen passports" to patients who use the tube regularly, which could be shown to any staff who express concern. That is an admirable scheme. I hope that it will be introduced soon and that it is adopted by bus and taxi providers across the country.
Bus and taxi providers need to improve, but the worst offenders are still the airlines. On
On some airlines, passengers are refused assistance from the time they book to the moment of boarding the plane. The European Commission has issued guidance on the provision of oxygen, stating that
"airlines should always be in a position to give passengers who have requested it accurate information about this specific service, including costs, before booking".
It also states that legislation aims to
"protect persons with reduced mobility against discrimination, and to ensure that they receive assistance."
However, evidence shows that that is not happening.
A secret shopper survey of 71 airlines by the Pulmonary Hypertension Association, published in its "Breathe Freely" report, showed that passengers spent an average of 20 minutes on hold, sometimes at a premium rate, speaking to three different customer services advisers, yet sometimes still not getting the information they needed on the airline's oxygen policy. Some advisers promised to call back, but did not, while others gave incorrect information, sometimes allowing passengers to book flights only to tell them later that they would not be allowed to fly. An example is Jet2, which refused to refund a passenger who had to cancel her booking when it emerged that the airline had changed its policy and would no longer allow her to travel with a concentrator.
Shockingly, some airlines refuse to reveal their own policy and charges before a booking is made, yet the ticket is no longer refundable. Qantas requires a booking number before it will agree to calculate the fee that a passenger will be charged for oxygen. That gives passengers no chance to compare prices or make an informed choice between airlines.
Assistance is often poor during the flight as well as during the booking process. One passenger who liaised with Ryanair in advance to book her oxygen and who had already paid her £100 fee was told, after she had boarded the plane, that the oxygen could not be provided, so she would have to get off. She was left standing on the tarmac with her suitcase and was not even escorted back to the terminal. She said:
"The captain came to me and said that I would have to get off the plane as they didn't have the oxygen. The steward and the captain were so rude and not at all compassionate; all they wanted was to get me off so they could take off. The fact that I had booked and paid for the oxygen was apparently irrelevant."
We need much better enforcement of existing rules to protect oxygen users, who are not currently being given the information and assistance to which they are entitled. We should also consider changing the rules to eliminate loopholes that allow airlines to charge unfair fees to people requiring oxygen. Regulation (EC) No. 1107/2006 requires airlines to carry medical equipment free of charge, but does not require them to allow the equipment in the cabin. The Department for Transport's code of practice "Access to Air Travel for Disabled Persons and Persons with Reduced Mobility" advises that
"air carriers may approve the carriage of small gaseous oxygen or air cylinders required for medical use", and recommends that portable oxygen concentrator devices should normally be allowed if they are battery-powered. However, those regulations are not binding, and ultimately the code of practice permits carriers who wish to provide passengers with medical oxygen to charge for the service. It allows airlines to flout the spirit of anti-discrimination law by refusing passengers permission to bring either their concentrators or their cylinders on board, and then charging significant fees for centrally provided oxygen. That, in my view, should not be allowed.
Currently, although most airlines allow designated concentrators on board, only a third of them allow cylinders, and the vast majority charge fees to people who need to use the airline supply. According to the secret shopper survey, six airlines did not allow either a concentrator or a cylinder on board but charged to provide the oxygen: Aer Arann, which charges £72 per sector, LOT Polish Airlines, which charges £136 per sector, Malaysia Airlines, which charges £400 return, Qantas, whose charge varies according to flow rate and distance, and Alitalia. Alitalia charges the cost of a second seat, which could amount to many hundreds of pounds. That is clearly outrageous.
Over the past eight years the Pulmonary Hypertension Association, a relatively small charity, has had to spend £60,000 of its own limited resources on grant to enable patients to pay additional airline charges for oxygen. Besides the ones that I have already mentioned, many European airlines charge: Aer Lingus, Air France, Austrian Airlines, Brussels Airlines, Cyprus Air, Czech Airlines, KLM, Lufthansa, Ryanair, Scandinavian Airlines, Swiss International Air Lines, and Thomas Cook Airlines. They charge different rates, but many run into at least three figures.
I welcome the decision by Thomson Airways, one of the major charter airlines, to drop its charges. Long-haul scheduled airlines such as British Airways, Cathay Pacific, Virgin Atlantic and Emirates have already scrapped charges, as have budget airlines such as EasyJet and CityJet and charter airlines such as Thomson Airways and First Choice. If those airlines can provide the service free, so can others. However, far too many airlines are refusing to back down.
The rules need to change to stop that practice. At European level, the United Kingdom Government must make strong representations on the review of regulation 1107/2006, which is due to take place later this year, so that the requirements can be tightened to require carriers specifically to allow certified concentrators to be carried in the cabin on all flights landing or taking off from an airport in the European Union. That is the law in the United States of America, so there is no reason why it could not work here. An added advantage would be that all airlines, not just those based in the UK, would have to comply.
The code of practice "Access to Air Travel for Disabled Persons and Persons with Reduced Mobility" should also be revised to prevent airlines from charging to provide oxygen if they do not allow a passenger to bring their own. If some airlines can operate without charging their disabled passengers extra, all can; and if they will not change their policies voluntarily, guidelines must become obligations. When advances in treatments and technology give back the chance to work and travel to people who would otherwise have been housebound, carriers must not be able to take that away.
Given the growing momentum of the campaign for oxygen concentrators to be provided to patients free of charge on the NHS, I hope that carriers will see more and more mobile oxygen-using patients looking to use their services. Now is the time to get the rules in order. I trust that the Department for Transport will look closely at what action it can take to raise awareness, enforce guidelines and improve the regulations so that this problem can be eliminated.