Annual report: ML5 Medical Assessments 2023
Published 20 December 2024
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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. Fishers may also have the option of using the ML5 system, please see MSN 1883, as amended.
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 decide 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 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 licence or endorsement applied for, and incidence and prevalence rates for different conditions cannot be analysed. As only 3% of applicants are female these have not been analysed separately and the results presented are for both male and female.
Key results for 2023
2023 saw a 120% increase (888) in the number of referrals made with a total of 1646 referrals for the calendar year. This is considered to be largely due to the requirement for all commercial fishermen to hold a medical certificate which came into force on November 30th 2023, meaning that 724 referrals for fishermen were received. With the subsequent announcement by the Secretary of State to exempt existing fisherman working on vessels of 10 metres and less, this is not expected to be sustained. There was also a significant increase in the number of Boatmaster Licence referrals (470) and a small increase in the number of RYA commercial endorsements for Yachtmasters and powerboat operators. It should be noted that the figures are not directly comparable to those from 2022 due to differences in data collection.
| 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BML | 253 | 265 | 298 | 323 | 320 | 318 | 357 | 205 | 259 | 334 | 470 |
| RYA | 343 | 373 | 388 | 333 | 362 | 392 | 409 | 313 | 380 | 404 | 452 |
| Fishing | - | - | - | - | - | - | - | - | - | 20 | 724 |
| Total | 596 | 638 | 686 | 656 | 682 | 710 | 766 | 518 | 639 | 758 | 1646 |
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 with the percentage of the first two increasing significantly. This may reflect disease prevalence in the general population. 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 several 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 |
| 2023 | 22 | 28 | 10 | 17 | 7 |
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, 34% were able to obtain a restricted certificate and all others assessed (64%) were found fit without restriction.
Following feedback received from industry MCA also reviewed the duration of the ML5 certificates issued by the assessors. Certificates for the maximum duration of 5 years (under 65 years of age) were issued in 30% of cases whilst 70% of cases were time limited, most commonly (49% of all certificates) to 1 year. Time limited certificates enable monitoring of ongoing health conditions to ensure that the applicant remains fit to work on a vessel. Please note that the maximum validity period of a ML5 certificate issued to an applicant above the age of 65 years is one year.
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. Over the next 12 months the ML5 form and process will be reviewed, and all feedback is welcomed by email to [email protected].
Dr Sue Stannard
Chief Medical Advisor
Maritime and Coastguard Agency
2024