Summary of medical examinations of seafarers conducted by approved doctors - 1 January – 31 December 2023

Required in accordance with The Merchant Shipping (Medical Certification) Regulations 2010

1. Summary of approved doctors’ decisions

Fitness Cat.	Result	Validity Period	Form Issued	Number Issued
Cat 1	UNRESTRICTED	2 years	ENG 1	43073
	UNRESTRICTED	Less than 2 years – non medical reasons e.g. under 18 years	ENG 1	411
	UNRESTRICTED*        U(TL)	Less than 2 years – medical reasons	ENG 1	4606
Cat 2	RESTRICTED*             R	2 years	ENG 1 + ENG 3	1209
	RESTRICTED*             R(TL)	Less than 2 years – medical reasons	ENG 1 + ENG 3	1500
Cat 3	TEMPORARILY UNFIT* TU	Any	ENG 3	1878
Cat 4	PERMANENTLY UNFIT* PU	Permanent	ENG 3	93
TOTAL	52770

Chief Medical Advisor’s

COMMENTARY

Each year all MCA Approved Doctors (ADs) complete a return that lists the number of medical examinations performed, how many medical certificates have been issued in each category (fit for service worldwide and fit for restricted duties whether for two years or a limited time), and how many seafarers and fishermen are made temporarily or permanently unfit. The medical reasons for all restricted certificates and decisions of unfitness are anonymously noted. The MCA then analyses these returns and produces this summary report.

In previous years all this information was collected from paper records and so only limited analysis was possible. It did however enable the pattern of illnesses to be noted and any major trends to be highlighted. During 2022 the MCA began the role out of a new, Approved Doctor Information System (ADIS) that enables ENG1 medical examinations to be documented on an electronic system with the appropriate certificate issued once a decision has been made. This role out was completed within 2023 and as of January 1st, 2024, all ENG1 certificate will be issued within the system. Certificates issued and completed by hand are no longer accepted.

For the 9 years prior to the pandemic, the total number of medical examinations had been remaining relatively steady between approximately 51,000 and 54,000 but this number dropped during the pandemic with 38,567 examinations done in 2021. All Covid restrictions were lifted in early 2022 and that year saw an increase in the number of examinations to 47 808. We believe that 2023 saw a return to pre pandemic numbers of ENG1 certificates, with 52 770 examinations completed.

Since 2019 UK fishermen working on larger vessels have been included in the medical examination process, following the implementation of the Work in Fishing convention 2007 (ILO 188). Fishermen on smaller vessels that meet certain parameters required a medical certificate before November 30th, 2023, although many on smaller vessels chose to apply for the ML5 certificate instead. A policy on Grandfather Rights for existing fishermen who had worked safely with stable medical conditions prior to the introduction of the medical certificates was developed to minimise the impact on industry and continued throughout 2023, even after the November deadline to not penalise seasonal fishers. A total of 1539 fishermen attended for ENG medical fitness examination this year, increased from 1051 in 2022. 1269 (82%) were fit without restrictions and only 2 were made permanently unfit. Grandfather rights were not applied in any cases.

Regional figures continue to be reviewed annually to ensure that any significantly high or low numbers are considered when renewing appointments or appointing new ADs. The number of medicals performed overseas decreased slightly in 2023 to 37%. This is down from over 40% in the pre pandemic years. The majority of these are done in areas associated with yachting with the exception of the Philippines, where many seafarers work in the cruising sector. Figures in the former areas are continue to increase back towards the numbers seen in 2019 although more ENG examinations were done in the US than ever before. Numbers in the Philippines dropped by 20% in 2023 although it is not immediately clear why this should be the case.

Seafarers or fishermen who either fail or are issued with a restricted certificate are entitled to seek a review of the AD’s decision by an independent medical referee if they have reservations about the initial decision. The results of the referee reviews are also presented. Fuller details of the procedures for ADs and referees can be found in MSN 1883, MSN 1886, MSN 1887 and in the MCA Approved Doctors’ Manual, July 2020 Edition which can be found on line at https://www.gov.uk/government/publications/the-approved-doctors-manual.

An Executive Agency of the Department for Transport Referrals to referees had remained stable at between 30 and 50 reviews each year but dropped in the two years prior to the pandemic and were stable at 18 per year, no doubt due to the lower number of medicals performed. The increased number of examinations seen in 2023 was reflected by an increase in referrals to 36 which may be due to the many more complex cases involving multiple medical conditions, an increase in the diagnosis of mental health issues within the general population. Decisions were altered in 28 out of the 36 cases reviewed, but it should be noted that a change in decision may represent a different restriction, and does not necessarily mean that the end result was more lenient.

Analysis of the type of certificate issued showed 91% Category 1 Unrestricted certificates, 5% Category 2 Restricted certificates, and 4% temporarily or permanently unfit. These percentages remain relatively stable year on year. The total number of ADs varies during the year with ongoing retirements and new appointments. Data was collected from 204 ADs in total, most of whom are on the general list and able to perform medicals for any seafarer, while 22 performed medicals only for one or more named companies, data being collected separately for each company.

On reviewing the conditions underlying a decision of a restriction, or of temporary or permanent unfitness, the majority were caused by endocrine disease (mostly obesity, but also diabetes) followed by cardiovascular disease (mostly hypertension but also history of a cardiac event). This is a change from last year when cardiovascular disease was the most common reason for a restriction or decision of unfitness. Sensory issues, mostly visual acuity but also hearing, are again a significant number of these outcomes, as are mental, cognitive, and behavioural disorders where over 70% are a diagnosis of minor or reactive mood affective disorders. This is a significant increase to previous years.

Although every condition noted for each seafarer is recorded, one seafarer may have several

different conditions leading to their fitness decision. It is not possible to report whether specific conditions were linked, although it is likely for instance that hypertension was seen with other diagnoses such as obesity or diabetes. Since the introduction of Colour Assessment and Diagnosis (CAD) testing as a supplementary test for deck candidates failing the Ishihara screening test for colour vision, statistics around the pass rate have been gathered. The pass rate for this test is low, at only 2% in 2023. It is consistently less than 5%. This is similar to the low pass rate for Holmes Wright B Lantern testing and illustrates the fact that most of those who fail the Ishihara test do indeed have defective colour vision.

2023 was the last year that the report is compiled from returns submitted by hand and electronically and we look forward to the opportunity for more detailed analysis in years to come.

Dr Sue Stannard

Chief Medical Advisor

UK Maritime and Coastguard Agency