HEALTH REGULATIONS (AIRCRAFT AND SHIPS)

HC Deb 03 April 1978 vol 947 cc173-203

10.1 p.m.

Dr. Gerard Vaughan (Reading, South)

I beg to move, That an humble Address be presented to Her Majesty, praying that the Public Health (Aircraft) (Amendment) Regulations 1978 (S.I., 1978, No. 286), dated 28th February 1978, a copy of which was laid before this House on 10th March, be annulled.

Mr. Speaker

I understand that it will be convenient to take at the same time the second Opposition Prayer, That an humble Address be presented to Her Majesty, praying that the Public Health (Ships) (Amendment) Regulations 1978 (S.I., 1978, No. 287), dated 28th February 1978, a copy of which was laid before this House on 10th March, be annulled.

Dr. Vaughan

If that would meet the convenience of the House, Mr. Speaker.

Mr. Robin Maxwell-Hyslop (Tiverton)

On a point of Order, Mr. Speaker. Does that give us three hours rather than one and a half hours?

Mr. Speaker

It is 11.30 p.m. in any case.

Dr. Vaughan

We have asked that these two regulations should come before the House because we regard them as extremely important for the health safety of this country. I am not at all sure that the significance of these regulations has been fully and generally understood by people. I hope that the Government will take our view very seriously.

Today everybody has heard about rabies and has heard about lassa fever and has even heard about marburg disease, because we have had a series of crises in recent years when it was feared that cases were wandering about at large. There have been alarms of various kinds. One does not need to be a doctor to know that these are extremely serious diseases. They are difficult to diagnose—sometimes very difficult. They are certainly extremely difficult to prevent spreading once they are in the country and they are very difficult to treat. Therefore, some of the cases under these categories are fatal.

Up to now in this country we have been relatively safe, I would suggest, because we have had quite efficient and fairly thorough—by international standards—checks on people coming into the country. Even so, the situation is changing. With increasing ease of travel, particularly air travel, it is now quite a major problem to control the various kinds of disease coming into the country, so that many tropical diseases which we thought had gone from our shores for ever are now seen relatively frequently. The whole pattern of preventive medicine has had to be changed in order to take these diseases into consideration. From that point of view alone—the ease and the greater numbers of people involved in travelling—the risk is increasing.

There is also a strong case for a full medical physical examination of new entrants to the country. There is a view, to which I subscribe, that all people wishing to come here as immigrants should be fully examined. There are now quite large numbers of cases of tuberculosis, for example, and malaria in this country, but particularly tuberculosis, when we thought that tuberculosis generally was dying out. So there is another kind of risk.

It is well known that rabies is spreading steadily, if slowly, across France and we are expecting it shortly to reach the other side of the Channel. Quite rightly, there are great anxieties. We are anxious to prevent rabies from entering the country, let alone on a large scale. That is another health hazard against which it is important to be alerted.

Logically, on all those counts we should not only continue our present standards of care and supervision but, if anything, we should increase them. There is a very strong case for having more careful checks rather than less careful checks than we are having today.

But that is not what the Government are proposing. In these regulations, both at our airports and at our shipping ports, just at a time when these risks are increasing generally throughout the country, the Government are deciding to do exactly the opposite. They have quietly decided to relax the controls at the point of entry. We—and I assure the House that this is not on a party political basis at all—consider that that is not only irresponsible but, frankly, when one looks into it, totally incomprehensible. Why should it be done now and in this way?

We have recently had a whole series of regulations of one kind and another. The most extreme recent example was the regulations on the Medicines Act concerning prescriptions by chemists. It then turned out that the Government had not conducted full consultations with the people involved and had not understood the full implications of the changes they were making. In the end, the Government, wisely—though it was a disaster from their point of view—put in a transitional period before the implementation of the measure. But now we have another case, and one can only think that here again the Government have not consulted adequately and properly with those concerned.

Mr. Maxwell-Hyslop

Before my hon. Friend leaves that point, may I ask whether he is aware that the Government have not even consulted their own Departments? In answer to a Question on 23rd March about the enforcement of the animal health regulations, the Minister of State, Ministry of Agriculture, Fisheries and Food said: It is not intended that representatives of my Department should undertake this task, which will continue to be carried out as an agency function by HM Customs."—[Official Report, 23rd March 1978; Vol. 940, c. 645.] But the chairman of the Board of Customs and Excise, Mr. Lovelock, has written to me: We have no statutory obligation in this area and there will be no change in our practice. The enforcement of livestock controls is the responsibility of the police, who act on behalf of the Ministry of Agriculture, Fisheries and Food. Customs involvement is limited to notifying the appropriate police authorities … and so on. In other words, it is not just that the Government have not consulted the public. Clearly, there is no correlation of consultation among HM Customs, the Department of Health and Social Security and the Ministry of Agriculture, Fisheries and Food.

Dr. Vaughan

That is a very helpful intervention, and it goes further on exactly the kind of anxiety that we feel, because the more we look into this matter the more uncertainty and confusion and lack of consultation we find.

The position is that, up to 1973, every ship that came to this shore that was thought to be a particular risk—for example, if it came from Africa, Asia or South America—was automatically boarded by a doctor. Ships which came from other parts of the world where the risk was thought to be less were inspected by HM Customs.

Then, in 1973, the situation was changed. I am dealing particularly with ships, but all this applies also to aircraft. Ships that came from countries at risk were still inspected by a doctor, but other ships, instead of having HM Customs on board, were put into radio contact and had to make a report before they arrived.

All that has again been changed under these regulations. No inspections are now to take place and, what is more, the whole of the responsibility for making a declaration is to be put on the ship's captain. He does not have to say "My ship is clear from infection". All he has to decide is whether he has someone—or an animal—on board who is a danger.

It has been put to me very strongly that a busy captain, perhaps in a difficult situation, such as fog, is certainly not going to give first priority to making a health announcement about those on board. We think that this is a very serious and, frankly, a stupid step to take. All the captain has to do is to make a report if he thinks that there is a dangerously ill person on board.

I know that the Minister had a deputation today from the Port of London Authority. He should tell us frankly what the deputation told him. I will tell the Minister what I believe the members of the deputation told him. I believe that they said that it was ridiculous to expect a ship's captain, who has had no medical training, to take a query list of medical signs and symptoms and then decide whether someone has a serious disease. As a doctor, that certainly seems to me to be medically ridiculous. Some of these diseases are very difficult to detect in the early stages.

I believe that the deputation would also have made the point that the captain is very busy and would not bother about this, and that the fines proposed are so ridiculous that in some cases it would be to the captain's advantage, from the company's point of view, to overlook a possibly serious condition.

The Minister may argue that by making these changes we are merely following what is being done currently in some other countries—for example, in the United States of America. He is quite right. But in America there are very high penalties indeed—even imprisonment—for failure to carry out health regulations of this sort. There has been a change of responsibility but this has been accompanied by a very high penalty if the captain does not exercise his responsibility properly.

The Minister may tell us that by including animals under the rabies section he is introducing an extra precaution. I would not disagree with that, but to suggest that we can allow a rabid animal to come into this country provided that afterwards we take action against the captain of the ship seems to me to be the height of irresponsibility.

Lastly, the Minister may tell us that some trial studies have been done at different ports in this country. Will he tell us how they were carried out and what is in the reports? He may not know that one of the ports that is quoted did not even make a report, and yet its experience is put forward as evidence in favour of these changes. Another port nominated some special ships which were using the port regularly and were well known. These were special cases and provided anything but a fair trial of a change of this kind. Another port limited the trial to tankers going to controlled jetties. They were not ordinary ships but special tankers going to special jetties. Yet as a result of these trial studies, we are told that everything will be safe and that this provision can be extended to the rest of the country.

The trials were also restricted to begin with, I understand, to ships from Common Market countries, so that there was no risk of lassa fever or of marburg disease, although, understandably, there was a slight risk of rabies. What happened? It was decided to extend it to other ships, but because of a misunderstanding between the port health authority and the pilots, the whole thing became a shambles. That is the kind of study on which the Minister is placing his weight as evidence that this could be made a general provision for this country.

I suggest to the House that when we look into it we can only find that it is farcical. The Government are once again being persuaded to rush into something which they have not thought through properly, and of which they do not understand the full implications. It needs only one very serious case to get into this country to produce a serious outbreak. If that happens, there will be much hand-wringing and many apologies, no doubt.

I put it to the House, not on party political lines at all, that the Government are ma king a serious mistake here. They are reducing the safety of this country's health cover, and they are doing it for administrative reasons which do not stand up to examination. The Government should be increasing the cover at points of entry, not decreasing it in this way.

My advice to the Government is to leave the situation as it is. If they cannot do that, or are unwilling to admit that they have made a mistake, I suggest that there are four things they should do. First, they should not ask the captain to try to be a lay doctor. It should be frankly understood that the captain is not in a position to ascertain medical signs or symptoms, because that is what he is being asked to do.

Dr. M. S. Miller (East Kilbride)

The hon. Gentleman must be aware that on many ships that do not carry doctors the captain bears the exact responsibility of which the hon. Gentleman speaks.

Dr. Vaughan

I am very well aware of that fact, but in these regulations we are asking the ship's captain to decide whether the ship's passengers can come into this country and whether they are free from infection. The captain must make that medical decision and the hon. Member for East Kilbride (Dr. Miller) as a medical Member will know that. In other words, we are asking the captain to make a medical judgment in our ports when we know that there are medical officers of health who are capable of carrying out that task far more efficiently.

My second suggestion is that the captain should report by radio before he comes into port whether he has anybody on board who has been ill within the previous month. Thirdly—and this is very important—I would ask the ship's captain to sign a document to say that his ship is free from infection because by these regulations he has to take action only if he thinks that he has infection on board. If he has a difficult seamanship problem on his hands, I suggest that there is nothing to remind him that he must take this further step when he comes into one of our ports.

Fourthly, I believe that there should be major penalties for breach of this responsibility so that they will act as a real deterrent if the captain does not carry out the duties laid upon him. We ask the Government to admit once again that they have made an error, to look to the safety of the nation, to abandon their personal worries about how this matter came up in the Department, and to admit that a mistake was made. We believe that the Government should take back both sets of regulations and return them to the House in a better, safer form in future.

10.18 p.m.

Mr. Robin Maxwell-Hyslop (Tiverton)

These two orders are part of the tip of the iceberg. They are allied to the non-statutory action by an organisation that is subservient to the Treasury—namely, the Board of Customs and Excise. Treasury Ministers are constitutionally responsible to this House for the actions of that board. The board has decided among other things, that whereas in past years every incoming ship has been boarded, that will no longer happen in the future.

Together with my hon. Friends the Members for Totnes (Mr. Mawby) and Christchurch and Lymington (Mr. Adley), I visited on 16th March the chairman of the Board of Customs and Excise, who received us very graciously, and we had a most useful discussion. Following that visit, the chairman wrote me two letters. I am particularly concerned with the animal health side of the matter. The animal health regulations are very extensive—to such an extent that the master of a tramp steamer must radio ahead to say that he has on board a mouse suffering from diarrhoea. [HON MEMBERS: "Oh."] Yes, that is specifically provided for.

Of course, the more germane matter in this debate concerns rabies, of which this country is free and it is my fervent hope that it will stay so. The House will note that no Member from the Liberal Party, the SNP or Plaid Cymru is present. Presumably, they have no interest in this subject. We in the Conservative Party are most concerned that rabies should not be admitted to this country.

The chairman of the Board of Customs and Excise, following our meeting of 16th March, wrote to me saying: We have no statutory obligations in this area and there will be no change in our practice. The enforcement of livestock control is the responsibility of the police who act on behalf of the Ministry of Agriculture, Fisheries and Food. Customs involvement is limited to notifying the appropriate police authority and the MAFF when the presence of livestock on board vessels is brought to our attention. We shall continue to perform this function. Masters will continue to declare details of livestock on their arrival documents, which under the new arrangements, will either be presented to the Customs officer on boarding, or if the vessels are not boarded, lodged at a dockside point designated for this purpose. That incidentally is up to 12 hours after arrival.

However, the Ministry of Agriculture said something totally different. Whereas every merchant ship to date has been boarded by a Customs officer, henceforth only in those small ports where the Customs officer is also the immigration officer will every one be boarded. The chairman of the Board of Customs and Excise said that it is nothing to do with it. Customs officers will still board vessels which they have boarded before and they will continue to do so.

What I want to ask the Minister is what about the vessels that they do not board at present but which they used to board. Where there is an immigration officer they will not in future board every vessel, only a few selectively. Who does what the Customs officer used to do? The Minister might say that it will be the immigration officer. But that is not what the Ministry of Agriculture said.

In a priority Written Question on 23rd March I asked the Minister of Agriculture what action he is taking to ensure that a representative of his Department boards all incoming merchant ships which prior to 1st April would have been boarded, but which will not as a matter of routine be boarded after that date, to ensure that the master is aware of and has complied with all the animal health regulations, particularly those prohibiting the landing of pets which might carry rabies. The Minister of State said: It is not intended that representatives of my Department should undertake this task, which will continue to be carried out as an agency function by H.M. Customs."—[Official Report, 23rd March 1978; Vol. 946, c. 645.] But it will not, and it is not. That arrangement is now cancelled. The Customs says that it will be the Ministry of Agriculture, the Ministry of Agriculture says that it will be the Customs, and the Customs says that it will not be boarding vessels where there is an immigration officer, except selectively.

The Ministry of Agriculture is denying what the chairman of the Board of Customs and Excise has said. The Treasury Minister here is responsible to the House for what Customs and Excise says, and since, astonishingly, there is no Minister on the Government Front Bench from the Ministry of Agriculture or the Scottish Office, the Minister who is here must explain to the House why the chairman of the Board of Customs and Excise is saying the opposite to that said by the Minister of State for Agriculture, Fisheries and Food.

Where does that leave the Minister who is to reply to the debate, except with the task of saying that he will withdraw the regulations? He is shaking his head. Can he then explain why the Ministry of Agriculture says that this task will be carried out by the Customs, while the Customs say that it will be carried out by the Ministry of Agriculture? Who will do it?

I am not talking about the small ports where Customs officers will still board ships, under the agency arrangement, as immigration officers. I am talking about the ports where there is an immigration officer who, according to the Ministry of Agriculture, will not perform this task because the Customs will perform it. But the Customs say that they will not perform it because they will not board every vessel. I shall willingly give way to allow the Minister to reply to this point because it would save a lot of debate.

Can he tell us who is wrong? Is the chairman of the Board of Customs and Excise wrong in saying that the Ministry of Agriculture will do it, or is the Ministry wrong in saying that the Customs will do it? There is no other possibility.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I have listened to the hon. Gentleman's case with great interest, but the regulations before the House do not deal with animal health regulations. I shall make sure that the hon. Gentleman's remarks are drawn to the attention of my right hon. Friend who can answer his points.

Mr. Maxwell-Hyslop

It seems that the Minister has not read Statutory Instrument No. 287 which we are debating. That refers to the insertion after Part IV of Schedule 4 to the principal regulations of:

"PART V—LASSA FEVER, RABIES, VIRAL HAEMORRHAGIC FEVER OR MARBURG DISEASE

Infected ships and suspected ships

(1) The medical officer may—

1. (a) place any suspect on board under surveillance…
2. (b) require the disinfection of the baggage…

(2) If there is any rodent on board, the authorised officer may require the ship to be deratted in a manner to be determined by him" …

How does an authorised officer know whether there is a rodent on board if he does not go on board?

Mr. Moyle

The hon. Gentleman had better wait for me to make my speech on the whole of the two sets of regulations. Perhaps the correct relationship between rabies, rodents and the regulations will become clear to him.

Mr. Maxwell-Hyslop

I hope that it will become clear why Customs officers are not to do this job, although the Ministry of Agriculture says that they will, and why Ministry officers are not to do the job, under the orders of their Minister, although the chairman of the Board of Customs and Excise say that they will.

Unless the Minister is disclaiming responsibility for the Board of Customs and Excise, he is impaled on the horns of a dilemma which will not go away unless he withdraws the regulations and unless the arrangements for the Customs are restored to the status quo of yesterday until the matter is satisfactorily resolved.

10.29 p.m.

Mr. Peter Viggers (Gosport)

My hon. Friend the Member for Tiverton (Mr. Maxwell-Hyslop) has dealt with this subject with the care we expect of him and I congratulate him on the research he has conducted into this matter. I am facing a Minister who has not yet explained the way the regulations are shaped and we await his comments with interest because it is difficult to defend the Government's proposals.

The commercial pressures on the master of a large commercial vessel are so great that the temptation must be upon him to ignore the regulations that the Minister is seeking to impose. The turn round times for enormous vessels—oil tankers and roll-on roll-off container ships—are all about one day. The pressure upon a master not to bother the medical authorities with a marginal case must be almost overwhelming in commercial terms.

The definitions which a master is expected to fulfil are very strict. He is expected to know, for instance, whether one of the people on board his ship has been suffering from a temperature in excess of 38 degrees Centigrade for more than 48 hours. As one who is married to a doctor, I know for certain that my wife does not know whether I am suffering from a temperature in excess of 38 degrees Centigrade for more than 48 hours. We do not even have a thermometer in the house. It is not reasonable to expect the master of a ship to know these things or to put that pressure upon him.

The cost which may be saved by the Government in bringing forward these regulations may be miniscule and completely without relevance to the cost in both financial and human terms should there be a spread of disease within this country. Anyone visiting a marina or shipping centre knows of the strain that is already imposed on the authorities to ensure that rabies and other fevers do not spread within this country. The cost, not in financial terms, because that is miniscule, but in human terms should rabies ever reach these shores in recent years is so great that any Government who are responsible for a diminution of regulations would have a heavy strain to bear in this respect.

Anyone who deals with safety regulations knows that it is necessary to have a fail-safe regulation. Earlier today we debated the Royal Air Force. I was a pilot. Therefore, I know that when landing an aeroplane one has three or four separate mechanisms to ensure that a mistake is not made. The pilot has a buzzer in his ear, a light coming on and the tower telling him when to put his wheels down and a few other things. We are legislating for the opposite to fail-safe. We are legislating for the master to decide whether there is a risk and whether it is necessary for further checks to be made. I regard that as unsatisfactory.

My hon. Friend the Member for Tiverton talked about merchant vessels. I notice from the definition in the Act that a ship is included as "any vessel", not necessarily a larger or merchant vessel. To what extent do these regulations apply to yacht marinas and other areas which increasingly bring in people from the Continent who may have a lax attitude towards regulations or those who, because they are weekend sailors—good luck to them—pop across to Cherbourg or Le Havre and have no real reason to study the regulations? What pressure is there upon such people to ensure that they do not fall in breach of the regulations?

Finally, a minor, but significant point. Proposed Regulation 2(i) provides that after paragraph (5) of regulation 2 there shall be inserted the following paragraph— '(6) For the purposes of these regulations a ship shall not be regarded as having met another ship or offshore installation unless in the course of the encounter a person has boarded one ship or installation from the other.'. It may sound a facetious point, but I ask that the Minister and his advisers note that if an animal should have boarded one ship or installation from the other it would not be regarded as a meeting. If, for example, animals were transported from one ship to another, that would not be regarded as having been a meeting for the purpose of the master taking decisions on certain matters. That appears to be a slip, and—without making a major point of it—I wonder whether the Minister will consider whether an amendment is necessary.

10.35 p.m.

Mr. Peter Brooke (City of London and Westminster, South)

I am grateful to my hon. Friend the Member for Gosport (Mr. Viggers) for pointing out the turn-rounds that ships' masters face in present economic conditions. It is a happy coincidence that this debate should be following the debate on the RAF. One of the splendid sights at the Spithead Review last year was the moored tanker around which the review circulated. That showed vividly how important is timing in these medical decisions by ships' masters.

I am grateful to the Minister who will be replying for the generous way in which he received a deputation, about the regulations, from the Port of London. I think that I speak on behalf of the delegation, which I was lucky enough to accompany, when I say that everyone was impressed with the care and thoughtfulness that he devoted to the points made by the City Corporation on behalf of the largest port in the country.

The Port of London is unique in this respect. My hon. Friend the Member for Reading, South (Dr. Vaughan) paid it an unwitting compliment, when he ascribed to the whole nation things which have happened in the last five years primarily in the Port of London alone. It was only in the Port of London that five years ago the Customs and Excise withdrew these health services. But the rest of the country now faces the same problems. The Department has chosen to answer this problem differently from the way in which my constituents responded.

Local authorities which administer these regulations are bound to pay attention to Circular 78/5, which accompanies the regulations and which, although having no legislative effect, seems to me as a junior Member to serve the same function as the explanatory memorandum of a Bill. The circular says that the regulations, prompted by the coincidence of the withdrawal of Customs and Excise services, relate to changes in the incidence and control of infectious disease and in the means of transfer, together with the level of hygiene and sanitation in the United Kingdom.

Regarding infectious disease, only two significant things have happened in the period just ended. The first is that smallpox, which seemed to have been eradicated in the late 1950s and early 1960s, but which then re-erupted, now seems really to have been eradicated. But equally during that period we have seen the arrival of such virus diseases as lassa fever which we were not contemplating in the late 1950s and 1960s. In that sense in terns of the phrase of the local authority circular changes in the incidence and control of infectious disease we have a stand-off in terms of certain diseases increasing and other decreasing.

The means of travel are referred to in the local authority circular. But they have scarcely changed. Sea and air travel—Concorde apart—are exactly the same as they were in 1974 when these regulations were last changed.

The high level of hygiene and sanitation in the United Kingdom is irrelevant to these regulations; unless the Government are basing the regulations on the theory that our high standards here mean that it does not matter if we allow infectious disease in because we shall be able to control it once it is here. That is a hazardous and dangerous philosophy.

Dr. Vaughan

Does my hon. Friend agree that the truth is quite the opposite These diseases are very difficult to manage once they are in this country. They present a very serious risk, however high our standards of sanitation and hygiene and however effective our general control of infection may be.

Mr. Brooke

I am grateful for that comment. We are particularly conscious of this point in the Port of London. We have 180 miles of coastline within the port and it is difficult to effect control once sailors come ashore. With the rapid turn-round that my hon. Friend the Member for Gosport referred to, the sailors come ashore immediately a ship berths. The feeding back into the hinterland is difficult to control.

The argument of the Department—and I seek to be charitable and generous—is, I assume, that the new regulations, which seem to me to be prompted by the coincidence of an attitude towards Customs and Excise, will be more economical to operate and more cost-effective in terms of the sort of quality control that exists in other walks of life. I am in no position to say, because I do not have the knowledge possessed by other hon. Members who have spoken this evening, whether that kind of quality control sampling is as appropriate in health matters as it is in an industrial context.

I intervene in this debate purely as a layman. I am apprehensive that we should have adopted regulations which would seek to give a result on the basis of a series of experiments which, as my hon. Friend the Member for Reading, South said, seemed to be somewhat inadequate as a scientific basis on which to proceed.

I should like to amplify what my hon. Friend said, not least in order to give the Minister of State the opportunity to correct me if I am wrong. As I understand it, the experiments which led to these regulations were, as the local authority circular says, conducted at three ports. At the first port they were limited to vessels which had been previously nominated by the port health authority. The ships which were chosen had regular runs into the port and were well known to the port health authority. They were all required to submite a maritime declaration of health and a pro forma.

Under the regulations that we shall now have, that presentation of a maritime declaration of health will no longer apply, in the manner in which my hon. Friend the Member for Reading, South described. Therefore, speaking again as a layman, the first case does not seem to me to have proved anything in terms of how well these arrangements might work in the future.

The second case did not apply to ordinary ships using the port casually. I am slightly hesitant about this, given the number of ships that come into the Port of London annually. The Port of London was not used as one of the experimental ports. The experiment was limited to ships that were all tankers that were going on what I would describe as preordained voyages, about which everyone knew in advance, and they were going to places that were agreed, understood and expected in advance.

As a consequence of that, the people who were supervising the jetties concerned were able to supervise those particular journeys and to be able to be satisfied that the formalities were being adhered to. But as my hon. Friend said, in the first instance they used only Common Market ships or ships that belonged to the partial agreement area. Later, they managed to extend it to other ships from non-endemic areas, but due, apparently, to a foul-up in communications between the port health authority and the pilots, they were not able to extend it to ships from endemic areas and, of course, it is ships from endemic areas that constitute the principal anxiety that is being expressed from the Opposition Benches tonight.

The third scheme was conducted at a port where most of the trade was continental and was not from endemic areas. As part of the experiment, three firms that were running ships into container berths were asked to provide the port health authority with the names of the ships coming in during the next 12 months, and the firms were asked to agree to the experiment. At the end of the day, I agree, the ships nominated were from endemic areas.

The port health authority wrote to each master, set out the scheme and asked for his co-operation. Co-operation was given. There was not any trouble, but there was not any sickness, so at the end of the day we are still left wondering what is the result that flowed from those experiments.

I speak in a sense of all fairness to the Government. If there are more cost-effective ways of conducting these arrangements, I am in favour of reaching them. But unless the evidence has been misrepresented to me, I must feel the gravest uneasiness about how these experiments were conducted. It seems that we are proceeding to what the Government may seek to justify on scientific grounds as being a good way of managing affairs in the future from a basis which was fundamentally unscientific in terms of the build-up of evidence.

Dr. Vaughan

I apologise for interrupting my hon. Friend again, but will he also confirm that it was our understanding that it was one of these three—Milford Haven—where no written report at all was made on this great scientific study on which all these observations are based?

Mr. Brooke

As I understand it, no written evidence emerged in the Milford Haven case.

I comprehend that the Government may choose to defend what they are proposing to do through these regulations on the basis that it has been tried in the United States and it has worked. I can only say that I hope that the Government have taken care to ensure that the controlled circumstances of American experience are directly comparable to our own, because, as my hon. Friend said, one has the impression that: the powers that the American port authorities and American health authorities can use are considerably more strenuous than those that we enjoy here. I understand why the penalties that can be imposed are limited. It is because they have to apply to so many other offences as well.

Mr. Maxwell-Hyslop

Will my hon. Friend correct what I think was possibly a slip of the tongue? Surely his first priority is not that the measures should be cost-effective, but that they should be effective; not that the cost per lassa fever detected should be lower, but that the people with lassa fever should be detected before they enter this country even if the cost is somewhat greater.

Mr. Brooke

I am extremely grateful to my hon. Friend, because he is correct. He detected an error in what I said, and which I hope I should have corrected before I sat down. My hon. Friend is correct to have made the point that he has made.

I appreciate that I am speaking from particular experience of the Port of London which has had a different experience over the last five years from that of the rest of the country, but I want to come to the situation in which my constituents in the Port of London find themselves, in that they are being asked to take a much more relaxed view, given the circumstances of 1978, than they have been taking over the last five years. As my hon. Friend the Member for Tiverton has been quick to point out, over the last five years my constituents have taken a strenuous attitude towards lassa fever.

The disadvantage of the local authority circular, which the Minister is free to point out does not have legislative power, is that it imposes on the local authority certain standards and criteria with which it would have to deal in coping with, apart from anyone else, the district auditor if it was felt to be incurring expenditure which was not laid upon it by the Government.

In my concluding remarks I come back to my constituents in the Port of London because I am endeavouring to respond to the Minister in the cost-effective coin which I understand to have underlain the recommendations of the regulations. At the present time, with the 180 miles of coastline that we have in the Port of London, with regulations that existed before 1973, and which, with admirable adaptability, the Port of London has used from 1973 onwards when the method of implementing them passed from Customs and Excise to itself, it has relied on a single boarding point for doctors within the port. That will no longer be justifiable under the arrangements which the Department is bringing in.

That system has been possible in the past because the number of ships being boarded justified having that single boarding point. We are now to move to a situation in which, as it is no longer justifiable for the Port of London to have that single point, it will rely upon doctors up and down this 90 miles of coastline on either side of the river. I say with all sincerity that I hope it has been verified that the medical resources will be available to respond to that need under the new regulations.

The second consideration that flows from that is that historically, particularly during the last five years, the port health authority in London has taken responsibility, through its cadre of doctors, for handling non-infectious acute illness throughout the port, for individual accidents on ships, and for major accidents causing casualties on the river. The authority has no statutory obligation to provide these services, and if its cadre of medical service is to be dispelled as a consequence of these regulations, as at present it will be, that obligation will immediately be transferred back on to the NHS off the health authority.

The most serious matter of all—I hope that I am summing up the Opposition's views—is that if a serious case occurs, as a consequence of these new regulations the responsibility will be thrown back—whether the Department likes it or not—on the port health authority. The port where that case occurs will be held responsible for that case having occurred. Yet it is being asked to do it when it has no power, other than the good will of the ship's master, to prevent its happening. That is a serious obligation that the House would be imposing.

Dr. Vaughan

My hon. Friend referred exclusively to local authority Circular 1978/5, paragraph 4(a) of which contains a definite instruction: Routine clearance of all ships should therefore cease. As I understand it, there is no legal support for that instruction.

Mr. Brooke

We are moving into areas where the Minister may be able to help my hon. Friend more than I can. But my hon. Friend is correct in the quotation that he has just given.

What worries me is that under the new regulations, if a serious accident and a serious infectious disease occur, all the obloquy will go to the local port health authority, yet it will have been powerless to prevent it, unless the ship's master drew its attention to it in the first place.

10.57 p.m.

Dr. M. S. Miller (East Kilbride)

I did not want to intervene until I realised that what we were talking about referred entirely to ships.

Dr. Vaughan

And aircraft.

Dr. Miller

I understand that both orders are being taken together, but everyone has been talking about ships. As far as I can gather, nothing has been said about aircraft. I ask my hon. Friend the Minister to confirm that the number of people at risk who land from ships nowadays is infinitesimal compared with the number of passengers who arrive at airports. I have not heard one word about how the regulations put forward by Opposition Members will apply to aeroplanes.

Mr. Maxwell-Hyslop

How often has the hon. and medical Gentleman seen an aircraft's dog or cat pop ashore, or rats and mice pop down from aircraft? This is a frequent occurrence from ships. Is not that the whole point?

Dr. Miller

I think that my hon. Friend answered that point when he indicated that that is not what we are dealing with, but that he will pass that matter on to my right hon. Friend the Minister of Agriculture, Fisheries and Food to deal with.

Dr. Vaughan

We are discussing, in the Port of London Authority alone, about 6,000 vessels and last year nearly 60 patients. That is quite a large number of cases for one port alone.

Dr. Miller

The hon. Gentleman must know that ships carrying a certain number of people—I think that it is now 100—have a doctor on board in any case. I was not saying that this was not important from a shipping point of view. What I was saying was that if hon. Members want regulations to be extended. I do not see how they could be extended in an area in which that is absolutely impracticable—in the air. What must be done is to ensure that regulations in respect of the possibility of bringing disease into this country will act where they are much more likely to bring about the result that we want.

Dr. Vaughan

May I try to help the hon. Gentleman again? Other countries have very careful screening tests. In Canada, for example, there is a full medical screening of immigrants coming into the country by air—far greater than we have here.

Dr. Miller

That is another point. I am not suggesting that that should not be done; I am dealing with the regulations before us. I am not saying that there should not be some kind of screening of people who enter the country—not just immigrants, because other individuals may be involved, too.

I am pointing out that it is much more likely that a disease will be detected on board a ship before the person lands than will be the case in air travel. As the hon. Gentleman knows, people flying from one area to another will finish their journey long before the incubation period of the disease is over. Generally speaking, that does not happen in travel by sea.

The hon. Member for Reading, South (Dr. Vaughan) knows that at present on board ships which do not have a doctor responsibility is placed on the captain or chief officer to deal with minor ailments which develop and sometimes even responsibility for the detection—not necessarily the diagnosis—of more serious illness.

I return to the point which I made earlier. As far as I can see, hon. Members opposite are directing their attention to regulations which they see as not entirely satisfactory but which apply to a much smaller field, namely, maritime travel, whereas I think that everyone regards as much more important—

Mr. Brooke

Unless I am greatly mistaken as regards current convention, if an aircraft is coming from an area where a disease is endemic and there has been a recent outbreak, every passenger on the aircraft will be identified as he goes through the airport control. Under the arrangements now proposed for ships, if a ship comes from an area where a disease is naturally endemic, he will not even have to report to the port health authority that he has arrived in the port.

Dr. Miller

As I said, the chances are that any condition which a person may have picked up will have become evident during the voyage. That is much more likely than it is in the case of air travel. Hon. Members have been making a case directed to one specific instance, the Port of London Authority, and I think that they are in all probability trying to use a sledgehammer to crack a walnut.

11.3 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

As my hon. Friend the Member for East Kilbride (Dr. Miller) has said, most hon. Members who have spoken in the debate have directed their attention primarily to the situation as it affects entry into this country by sea, although we are dealing with both sets of regulations, and in reply I shall adopt the same general line, except that I shall refer from time to time to entry by aircraft as it illustrates the general position. This has been a useful debate because there is obviously a great deal of misconception to be corrected.

The regulations provide for the public health control of ships arriving at of leaving ports in England and Wales, and they reflect provisions of the International Health Regulations 1969. They also maintain a balance providing the maximum security against international spread of diseases with minimum interference with world traffic.

I ought first to clear up one misapprehension—that these changes are being made in consequence of changes in boarding procedures by Customs and Excise officers. This is not so. Though at most ports Customs and Excise officers have in the past carried out the routine work of collecting maritime declarations of health and of giving clearance to heathly ships, these officers may not always be available to do so from 1st April 1978.

It is administratively convenient for the amending regulations to come into force on that date. But the simplification procedures are something which we have had in mind for some time and the principle of the amendment regulations stands on its own. Customs and Excise officers will continue, when boarding, to remind masters of ships of the public health requirements.

In doing all this we are following what has become accepted international practice. For example, Canada and the United States of America adopted some time ago the system we are adopting in these regulations and so far they have reported no operational difficulties in following them through.

Dr. Vaughan

Both those countries have very much higher penalties for failure to carry out instructions.

Mr. Moyle

I shall come to that point later. The hon. Gentleman asked me to deal with the points raised by the Port of London Authority when its representatives came to see me, and I will deal with that point in that context.

What will the amendment regulations do? What is the present position? At present the master of a ship arriving from a foreign port is required to notify the presence on board of, in the wording of the regulations, a person who is suffering from an infectious disease or who has symptoms which may indicate the presence of infectious disease or when there are on board a ship before arrival any other similar circumstances requiring the attention of the port medical officer". Where the ship has a radio transmitter, the notice must be given before arrival. Otherwise the notice must be given immediately on arrival. Even when he has nothing to report the master must complete a maritime declaration of health and maintain restrictions on boarding or leaving the ship until he has received health clearance, although ships coming from most ports in Europe are excepted from the arrangements. Thus, in almost all cases port health control rests on the master of the ship giving notice.

All that the amendment regulations do is to dispense with this routine completion of the maritime declaration of health and to lift the requirement to maintain boarding and leaving restrictions where the master has nothing to report. That is the major change between the new system and the old one. In other words, under the new system, masters are relieved of making nil declarations, although port authorities can still make a sample check to determine that there is nothing to report in circumstances where the medical officer decides that a check should be made.

A port medical officer or an authorised officer may inspect any ship on arrival or already in the port health district. We have proceeded with great caution. We are satisfied that changes in the incidence and control of infectious diseases and in the means of travel, together with the high level of hygiene and sanitation in the United Kingdom, mean that certain routine procedures are no longer useful. Here I touch on the debate which took place following an interjection by the hon. Member for Reading, South (Dr. Vaughan).

One of the great advances in public health since the system of control of entry into this country was first instituted has been in the control of communicable diseases. It is no longer necessary or economic to maintain the same level of port health measures as when these diseases were rife and frequently imported. The hon. Member for City of London and Westminster, South (Mr. Brooke) mentioned smallpox, an example of a disease which has been almost entirely eradicated. The Horn of Africa is the only area where the disease might persist. For example, the spread of cholera in this country would be severely retarded by the vastly higher standards of hygiene here compared with many years ago. I know that the hon. Member is not entirely convinced about this, but it is a fact that he must take into consideration.

The international health regulations envisaged that a health administration may dispense with the declaration of maritime health altogether, whether positive or negative. We have not gone that far. The other possibility is to impose it on ships coming from certain areas or ships having positive information to report. We have adopted the last-mentioned procedure; in other words, ships which have something positive to report are to be required to do so. A similar simplified system has been in operation at airports for some years. As my hon. Friend the Member for East Kilbride said, airports are the main source of entry of people into this country.

Infectious diseases have incubation periods, usually of several days—here again I am reinforcing the point made by my hon. Friend—and the vast majority of the people arriving in this country from places where dangerous infectious disease is endemic come in through airports within 24 hours of leaving such countries. About 30,000 international travellers arrive each day at Heathrow alone, without counting our other international airports. Commanders of aircraft report any incident of a passenger showing signs that might be those of infectious disease, but there is no written declaration at all; nor, where there is nothing to report, are their boarding or leaving restrictions.

In the case of ships—and we must remember that continental ferries are already exempt—the numbers are relative to those I have been talking about, very small—that was another point made by my hon. Friend—and the disease is more likely to become apparent during passage and the need of the individual for treatment more obvious. It is also a fact that larger ships, with over 100 persons on board, carry a ship's doctor. Aircraft, however large their passenger-carrying capacity, do not.

However, application to the ports was preceded by some tests over an extensive period and by extensive consultation, contrary to what the hon. Member for Tiverton (Mr. Maxwell-Hyslop) said. We did pilot studies at Southampton, Immingham and Milford Haven. They were pilot studies, and were not totally comprehensive. All three ports reported on them, although Milford Haven reported orally rather than in writing. As the hon. Members for Reading, South and the City of London and Westminster, South raised the point, I should explain that initially the studies were based on ships of reputable lines, but they were subsequently extended to other ships. One of the ports predominantly used tankers—I presume that that was Milford Haven.

The tests were carried over a period exceeding two years, which is a fairly extensive period for testing, and later they were extended to ships which were regularly arriving from ports in endemic areas, as the hon. Member for City of London and Westminster, South eventually agreed. That was the extent of the tests. There were no operational problems and the simplified procedures were welcomed by all concerned at these ports. But, in the light of this experience, proposals for changing the system of health clearance were then put to interested organisations, including the Association of Sea and Air Port Health Authorities, the Environmental Health Officers' Association, the General Council of British Shipping, and interested Government Departments.

In December 1976, we circulated draft regulations, and again in August 1977, on the same basis. A final version was sent round in January this year. So a very considerable period has been spent, first in testing the concept of these new regulations, and then, whatever anyone says, in very extensive consultation. I cannot assume that everyone understood what they were being consulted about, but I am confident, on the basis of what I have said, that if there was misunderstanding it was, broadly speaking, not the fault of the Department. No effort was spared to conduct extensive consulations before promulgating the regulations.

The consultations resulted in amendments in detail but no changes in substance, and the principle of the amending regulations was generally welcomed as unnecessary work for ships and port health authorities.

Mr. Brooke

I totally acknowledge the dialogue which took place on consultation, but inevitably, when the regulations eventually emerged, they were read with a fine toothcomb by those who would have the responsibility for implementing them. There was a belief, on the basis of the regulations which existed before the local authority circular, that it would still be possible for local authorities to implement and execute them in a way which was consonant with the local traditions which had been maintained.

That belief was shattered by the local authority circular, which gave the impression that they would not be allowed to do so.

Mr. Moyle

I will come to that shortly, if the hon. Gentleman will bear with me The only objections which have been made to the regulations were by the port health authorities of London and Newhaven.

London has a very thorough inspection procedure and I appreciate its concern to maintain its excellent record of health surveillance. I am sympathetic to that point of view. I am very conscious that the changes may involve some difficulty for the Port of London Authority. First of all, therefore—this was the point raised about medical manpower—I am asking the City and East London Area Health Authority, in the discussions it is having with the Port of London Health Authority, to ensure that the latter is provided with the necessary medical manpower. I understand that there is now agreement between the port health authority and the area health authority on the procedures to be followed and the way forward, by which it is hoped that that problem can be solved.

As was mentioned by the hon. Members for Reading, South and for City of London and Westminster, South, I met a deputation from the Port of London Health Authority—including also the executive of the City of London, I believe—and four points were put to me by the members of that deputation. They said that the ship's master should not attempt a diagnosis. I entirely agree with this. Diagnosis is a process of deducing symptoms from the presence of a particular disease or condition, and that is a matter for doctors and not laymen.

Mr. Maxwell-Hyslop

The Minister surely means deducing disease from the symptoms, not deducing symptoms from the disease. It is the symptoms which are observable, surely.

Mr. Moyle

That is right. Deducing from symptoms the presence of a disease was what I intended to say, if I did not say it. This is a matter for doctors and not for laymen. I have every confidence, therefore, that I can give the assurance that the City of London wants on this point.

What has to be accepted is that the master of a ship has always had to make a judgment whether there is a disease. In times past, when he has made a judgment that there is not a disease, he has filled in a nil return. We do not now want him to make that particular return, but he still has to exercise the same sort of judgment. What we are doing, in order to strengthen his position, is to give the master some specific guidance. We are saying, quite simply, that if someone on board a ship has a temperture of 38°C, and it is accompanied by a rash or a glandular swelling or jaundice, or has persisted for more than 48 hours, the captain should make a report. He should also make a report if anyone on the ship has had diarrhoea severely enough to interfere with work or normal activities, and, if he has any cases of doubt, the captain should make a report.

What we are saying is not that the master should report infectious diseases—he is not capable of doing that—but that he should make the same sort of judgment that he has always made, and we are now giving him guidance which will help him by making clear what are the sorts of matters that he ought to report.

Mr. Brooke

I am sure that the Minister is aware, in terms of the gap between what is being proposed and what is current practice, that all those ships which are coming into the Port of London from endemic areas—from Africa, Asia, and Central and South America—are currently being boarded by a doctor, so that the questions which are being asked, and the inspection of the symptoms which is taking place, are medically derived. It is only in the cases where the ships are from non-endemic areas that, by a system of radio clearance, the ship's master is being asked to make a declaration such as the Minister is describing.

Mr. Moyle

If the hon. Gentleman will contain himself, I am coming to that point.

The second point is that masters should be required to report any illness on board during the four weeks prior to arrival. I am advised that there is nothing positive in the new regulations to prevent the Port of London Health Authority from making such requests in the future as it has done in the past.

Mr. Brooke

I am sorry to intervene yet again, but how will the Port of London Health Authority make that request under the present regulations?

Mr. Moyle

That will be a matter for the authority to arrange, it has the power so to do.

The third point is that a nil declaration should be required when the ship is berthed. I have already explained our attitude on that matter, and I am afraid that I cannot meet the port health authority on that. The port medical officer has a wide power in the regulations to direct, if he so wishes, that masters of ships should complete declarations. Therefore, that again will be helpful to the Port of London Health Authority.

The authority also mentioned the matter of penalties, which, in its view, were inadequate. The penalties, given the capital value of ships and their running costs, do not appear to me to be large, but the point I made—a point which I think the Port of London Health Authority now accepts—is that these penalties are part of a pattern of penalties that extend right across the English legal system and that these regulations are not an appropriate vehicle in which to alter the penalties. They are not high, they are part of a general pattern, and these are no appropriate regulations by which to change the penalties, but if the Port of London Health Authority makes representations to me about the adequacy or inadequacy of the penalties I am prepared to receive those representations and to consult about them. I cannot give a guarantee that new penalties will be promulgated because there will be a large number of people with interests in these matters who will want to let me know what they think about them. I am prepared to give that undertaking.

Mr. Brooke

The four points put to the hon. Gentleman were a summary which was produced in response to the regulations, but we are still left with the essential difficulty that there is no way under the new regulations by which the Port of London Health Authority can communicate with incoming ships to ask the kind of questions which the Minister has just said they are free to continue to ask.

Mr. Moyle

I shall take note of that point and look into it, but we are not removing means of communication in the PLA. It is up to that authority how best to judge how to use the powers in the regulations.

Apart from the question of penalties there is another aspect of the matter namely, that ships are very expensive vehicles, with very high running costs. Although there is a pressure on masters for a quick turnround, there is also pressure on masters to return to a particular port. If masters have defaulted on regulations and if they are discovered and return to this country, they would be subjected to some extensive delays as a result. The sampling inspections which could be applied to ships will be applied to the ship which has committed that sort of offence. Masters will be well aware of the situation and therefore they will exercise their duties under these regulations very responsibly indeed.

Dr. Vaughan

We accept what the Minister has just said about the implications for masters of ships. He has made an important statement about penalties. It is his responsibility to ensure that the penalties are adequate for the purposes that he wishes to be carried out. Will he give an undertaking to make representations on this point to the Home Office?

Mr. Moyle

No. I shall await representations from the Port of London Authority. If it wants to see me, I shall undertake to give the matter consideration. I will not go any further than that.

Mr. Maxwell-Hyslop

Is the Minister seriously saying that the penalties that he has written into the regulations for which he is responsible to the House are amendable only if the PLA asks for it? What about the rest of the United Kingdom, and what about his duty to the House of Commons as the responsible Minister? Will he defend the penalties that he puts in here, or undertake to alter them, instead of simply saying that he is just a bit of blotting paper, waiting for the PLA? It is his responsibility, not the PLA's.

Mr. Moyle

I do not believe that the hon. Gentleman is as obtuse as he makes out. I have given an undertaking to the House, and I stand by it. I have not given an undertaking that, even if the PLA makes any representations about the penalties, they will be altered. I have given an undertaking in the terms that will appear in Hansard and that is the one that I shall follow.

I do not think that there is anything in the regulations to prevent the Port of London Health Authority from boarding the same proportion of ships as hitherto. There is, however, the local authority circular which indicates that only in exceptional circumstances will ships be boarded. I accept that, because of the case put forward by the PLA, a substantially higher percentage of checks will be necessary in the case of London than is suggested by the circular which the Department has issued giving guidance about how the regulations should be applied. That undertaking will be sufficient to enable London to escape the full rigours of the circular, and will remove, from London any worries about questions by the district auditor if it substantially exceeds the number of spot checks recommended in the circular.

I turn to the question of rabies. I take second place to nobody in this House in trying to ensure that this country remains protected from rabies. I was the Minister who took the Rabies Bill through the House and placed the Rabies Act on the statute book. The principle regulations are primarily concerned with communicable diseases in human beings, and not with animal health. That is not their main purpose. The principal regulations at present provide for controls of rodents on ships since these can carry plague. At the request of the Ministry of Agriculture, we have in the amendment regulations extended these provisions to require that the masters of ships, report the presence of animals and captive birds of any species on board, or illness or mortality among such species.

If this has any bearing at all on rabies, it is to strengthen our defences. We may not be going as far as the hon. Member for Tiverton wants, but we are certainly going further to protect the country against rabies than we have up to now. It is a modest but additional strengthening of our defences, and I hope that this reassures the hon. Member.

There are other provisions relating to offshore installations. Ships arriving from such installations are brought under control. There are also provisions for sampling food and water and new post-notification control measures for lassa fever, viral haemorrhagic fever, and mar-burg disease.

The regulations do not deal with immigrant health, as my hon. Friend the Member for East Kilbride has pointed out. They make a sensible and useful change in public health control of ships.

In praying against the regulations Opposition Members are trying to prevent an improvement in the turnround of ships—

It being half-past Eleven o'clock, Mr. DEPUTY SPEAKER put the Question pursuant to Standing Order No. 4 (Statutory Instruments etc. (Procedure)).

Question negatived.