1. Maritime Health Seminar 2011 Fitness and Fairness

2. Fitness and fairness Difficult decisions – who can work at sea without risk to themselves or to others? Balance between: - public safety risk - personal risk - loss of employment opportunities. Role of MCA Role of AD

3. MCA: fitness and fairness Provide standards: MSN 1822 and AD Manual guidance. Appoint, advise and train ADs Audit work of ADs Manage referee system Involve social partners in development and changes to standards.

4. AD: fitness and fairness Perform medical in accord with requirements. Ensure that true and fair view on any medical condition is taken – history, examination, reports, investigations. Apply discretion within standards to decide on fitness Discuss and engage seafarer in decisions.

5. Legal overlays UK equality/disability law. EHRC. Applies if recruited or substantially employed in UK. Public safety justification. ILO Maritime Labour Convention 2007– ratification. Decent working conditions IMO STCW 2012. Safer ships. Both ILO and IMO have medical requirements that UK has to align with.

6. ILO/IMO medical examination guidelines Major task for me – special adviser Meet requirements of MLC and STCW. Agreed by maritime authorities, unions, employers – medicine and politics! Very similar to MCA approaches! Text agreed – one year to get ILO and IMO endorsement. Dream of whole world being consistent!

7. MCA and AD performance MCA – social partner support but challenges to standards: IDDM, monocular vision etc. 80/2,000/50,000. Referee cases/restrictions/examinations. Few complaints AD consistency/audit findings.

8. AUDIT VISIT RESULTS 2005200620072008200920102011 No follow-up required 12131610 61 Minor non- conformities 15242348216 Major / multiple non-conformities 41211777 Change in approval status 2110010 TOTAL33394225 1624

9. Audit: fitness & fairness issues Clinical information on ENG1 – employer discrimination. Non-standard restrictions – incomprehension so not employed Not checking/using current standards Shortcomings in vision and hearing testing Not following standards: BMI, physical fitness testing, warfarin Not seeking supporting medical evidence.

10. Summary Performing well Area of continuing change: medical, social, employment International dimensions. Developed/developing world Explanations of reasoning essential.