1. Medical standards and medical examinations Tim Carter

2. 2010 revisions Most changes are working well ADs empowered to take more discretionary decisions Some problem areas: -Vision -Hearing -Obesity -Asthma

3. Vision Standards clear Problems in interpretation Quality of assessment – charts/plates, lighting, conditions of use, accountability MCA lanterns – limitations of CAM, servicing of Holmes Wright B, access to testing, future use of screen-based methods

4. Hearing Use of test methods: timing, choice, application. Whisper, audiometry, RNID Sound cards in NHS computers Practicality of use Interpretation of results

5. Hearing case study Results from one AD who tested all seafarers seen RNID tested: 82 First ENG 1: 9, all normal Subsequent ENG 1 –Tested: 73 –Normal: 62 –Possibly below normal: 10 (3 normal on re-test) – Below normal: 1 Referred to GP and for retest at next ENG 1: 8

6. Obesity Hawks and doves Use of framework as in standards Decisions based on capability – assessed where needed. BMI as a guide to need for assessment Practicalities of assessment Doing deals Failure to meet agreed targets

7. Asthma Text in MSN 1822 and in ADG Presentation at 2009 Seminar Few difficulties if no recent episodes and no continuing treatment or if poor control Considerable number of people on continuing treatment that is effectively suppressing any symptoms Risk of exacerbation at sea Provoking factor: respiratory infection

8. MCA APPROVED DOCTORS AUDIT PROGRAMME AUDIT VISIT SUMMARY 200520062007200820092010 New508923 Routine25353315238 Non routine 340105 TOTAL33394225 16

9. AUDIT VISIT RESULTS 200520062007200820092010 No follow-up required 12131610 6 Minor non- conformities 152423482 Major / multiple non-conformities 4121177 Change in approval status 211001 TOTAL33394225 16

10. Common shortcomings identified… Admin Confusion between old and new manual Using new pad of ENG 1 certificates before old one has finished Not adhering to standard restrictions ENG1 certificates not stored in locked cupboards Clinical information recorded on ENG 1s ADs giving practice / general email address as main point of contact for MCA must ensure that staff are aware of this and see all emails MCA send Clinical Soundproofing arrangements for consultation rooms Inability to access RNID test from NHS computers Making seafarers aware of chaperoning arrangement before ENG 1 Unsuitable near vision test cards ENG 2s completed incorrectly Carbon copies of ENG 1s and ENG 3s are illegible Poor lighting for visual acuity and colour vision testing

11. Key points from 2010 audits Although a smaller number of audits have taken place over the last year, the proportion of findings requiring major or multiple non-conformities is significantly larger. This could be due to the change in medical standards that occurred at the beginning of the year. However, it is still the case that appropriate vision testing facilities are not available. Chaperonage policies are not always followed. Sometimes certificates have been issued in accordance with company wishes rather than MCA standards.

12. International dimensions Selling UK approaches! IMHA working group on medical fitness criteria ILO Maritime Labour Convention Revised IMO Convention on Standards for Training, Certification and Watchkeeping IMO/ILO medical examination guidelines Possible handbook for medical examiners Project on QA and accreditation for doctors/clinics

13. 2011 activities Deficit reduction DfT to find 15% reduction over 5 years –33% on administrative functions MCA budget not yet known for 2011-12 and onwards but will be reduced Implications for seminar Possible cost recovery on MCA service functions Revision of Ship Captains Medical Guide and MSN on medical stores – EU and international links