Research and analysis

Annual report: ML5 Medical Assessments 2022

Published 9 January 2024

Important notice

The ML5 certificate does not comply with the requirements of the Maritime Labour Convention (MLC), Work in Fishing Convention (ILO 188), or other international conventions and so may not be accepted during vessel inspections outside the UK. If you need certificates that are MLC or ILO 188 compliant, crew members must have an ENG1 performed by an MCA approved doctor, or hold a recognised equivalent certificate issued by another maritime authority.

The ML5 system

Masters of small commercial vessels and crew members of certain classes of vessel within this group have the option of periodic fitness certification by the means of the ML5 system rather than the ENG1 system of medical examinations for merchant navy seafarers performed by doctors who are approved by the MCA. As of 30th November 2023 all commercial fishermen will also be required to hold a valid medical certificate and for those on vessels under 24 metres, operating on voyages of less than three days and less than 200 miles from the UK coastline this may be a ML5 rather than an ENG1.

The ML5 form includes information and instructions for both doctor and applicant and is available online.

Applicants should download the form and may then request any GMC registered doctor with a licence to practise to complete the form giving information on their health. The ML5 form is designed so that if there are no boxes ticked indicating ill health or condition the doctor may complete a certificate that indicates that the applicant may work on the designated classes of vessel. If one or more of the boxes indicates the presence of illness or condition the medical report must be referred to one of the four Medical Assessors appointed by the MCA. Referral for Boatmasters will be via the MCA Marine Office, and for holders of RYA commercial endorsements, referral will be made via the RYA.  Referrals for fishers should be made via the MCA Medical Administration Team. The Medical Assessor will review the medical report and may contact the individual for further information. Based on what is reported and any additional information supplied, the Assessor will make a decision on fitness and issue an appropriate certificate.

Data sources

The MCA Assessors summarise their findings at the time of the assessment in a structured way on a database. The results presented here are from this source. Each year a clinical review meeting is held between the MCA and the Assessors at which the summary data for the previous year is presented and specific case work and policy issues are considered in order to assure the quality of the system.

As this information only relates to the cases referred to the Assessors, the overall numbers of RYA, Boatmasters or fishermen applicants are not available. As a result it is not possible to access total numbers with regards to age, gender and the class of license or endorsement applied for, and incidence and prevalence rates for different conditions cannot be analysed. As only 6% of applicants are female these have not been analysed separately and the results presented are for both male and female.

Key results for 2022

A total of 758 referrals were made, 334 being applicants for Boatmasters licenses, 404 for RYA commercial endorsements for yachtmasters and powerboat operators and 20 fishermen. This represents a significant increase in both RYA and BML referrals which is no doubt due to the removal of pandemic restrictions  in February 2022.

	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
BML	253	253	265	298	323	320	318	357	205	259	334
RYA	414	343	373	388	333	362	392	409	313	380	404
Fishing	-	-	-	-	-	-	-	-	-	-	20
Total	667	596	638	686	656	682	710	766	518	639	758

Reason for referral

Analysis of the reasons for referral shows that figures are relatively consistent, with the highest number of referrals continuing to be related to Endocrine and Metabolic, Cardiovascular and Sensory conditions. The prevalence of Respiratory conditions referred for assessment has reduced since the redesign of the form to avoid referral for more stable asthmatics as noted previously. It should be noted that many referrals are for more than one reason, and in the more complex cases are for a number of different conditions.

%	Cardiovascular	Endocrine and Metabolic	Psychiatric	Sensory	Respiratory
2016	17	21	10	19	16
2017	19	19	11	17	17
2018	17	21	10	19	16
2019	18	25	13	19	8
2020	21	25	11	17	9
2021	21	24	13	16	9
2022	17	22	11	18	10

Outcomes

The percentage found fit, unfit, or restricted varies slightly year on year, but as demonstrated below, no specific trends have been identified. 2% were found unfit, 38% were able to obtain a restricted certificate and all others assessed (60%) were found fit without restriction.

As before, the MCA has not been made aware of any significant incidents arising because of health related impairment in those using the ML5 system as the means of certifying fitness to work at sea. This demonstrates the value of this simpler method of assessment for those pursuing careers in inland waterways or in certain limited sea areas.

Quality assurance of the system is achieved by discussing different aspects of certification for specific conditions with the Assessors, the detail of a number of different cases selected by both the Assessors and the MCA Chief Medical Advisor, and also by comparing the number of failures and restrictions for each Assessor in order to ensure that decisions are being made fairly.

Dr Sue Stannard Chief Medical Advisor

Maritime and Coastguard Agency 2023