House of Commons Hansard Debates for 15 Dec 1994

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redress. It is a charter principle that when things go wrong in the public services, they should give an apology, a full explanation and an effective remedy.

Under the citizens charter, the Government are actively encouraging a greater awareness of the complaints procedure. That is partly why the amount of work going to the ombudsman is increasing. As has been said by hon. Members, we are empowering the users of public services and giving them more information. My hon. Friend the Member for Brentford and Isleworth (Mr. Deva) said that we are making sure what service the public should get and how they can complain if they do not get that service.

Another point made by the hon. Member for Leeds, West and picked up by the hon. Member for Cannock and Burntwood and by my hon. Friend the Member for Brentford and Isleworth is the complex matter of whether there should be inclusions to a list of jurisdictions, or whether we should simply exclude those areas where we do not want the parliamentary commissioner to operate. The Government are prepared to consider carefully whether the Parliamentary Commissioner Act 1967 could be amended as proposed. As the purpose of the Committee's proposal was primarily to reduce confusion, however, we will first explore whether publicity could describe the position more clearly. We are still studying the matter and considering ways in which to clarify which bodies come within the PCA's jurisdiction. I hope that members of the Committee in particular will recognise that this is not a simple matter and that most hon. Members may not think it appropriate for the security intelligence services, the Cabinet secretariat and nationalised industries to come within the commissioner's jurisdiction.

The hon. Members for Cannock and Burntwood, for Glasgow, Central and for Hall Green argued that the ombudsman should be in the same position as the Comptroller and Auditor General. The Government agree and that change will happen when we have an opportunity to legislate. I was grateful to the hon. Member for Leeds, West, when he said that the Opposition will give all the Bills in this Session a swift passage through the House to enable time to be made available for that specific legislation. I am sure that the business managers also took note of that assurance. We all recognise the difficulty in finding time in the parliamentary timetable, but when an opportunity presents itself, we will legislate to make that change.

The hon. Members for Cannock and Burntwood and for Glasgow, Central asked whether the parliamentary commissioner should have the power to initiate investigations. It is not clear to me why that is necessary. The PCA can, if necessary, take up a deserving case with a member of the Select Committee. As for the question of the "MP filter", I believe that hon. Members should take a case to the ombudsman only after they have taken it through the appropriate stages. I am not sure that the power to initiate investigations would add anything to the ombudsman's role.

I agree with my hon. Friend the Member for Suffolk, Coastal, who complained about the use of initials, acronyms and jargon. That drives us all absolutely mad. In common with other hon. Members present, I spent some time in local government and it is awful when people talk in a language completely incomprehensible to anyone not part of the same organisation. It is not just local government which is guilty of that. According to the

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Treasury and Civil Service Select Committee, the way in which we have changed the whole structure of government through the next steps initiative has been the most successful reform in recent decades. I accept, however, that we could have come up with a clearer name than "next steps". If we intend to put examples of what the parliamentary commissioner has said at the disposal of people, I wonder whether calling them epitomes is the most clear way of describing them.

The hon. Member for Glasgow, Central raised the difficult case of court staff in Scotland. He recognised the constitutional difficulties, but he will know that my right hon. Friend the Secretary of State for Scotland wrote to the Chairman of the Select Committee on 8 December to say that he has decided to review the position and is consulting the Scottish judiciary. He will contact the Committee again in due course.

The hon. Member for Leeds, West and my hon. Friend the Member for Taunton spoke about commercial and contractual matters. The Government believe it appropriate to continue to exclude them from PCA jurisdiction, other than those concerning the compulsory acquisition of land or the disposal of surplus land acquired compulsorily. I will write to the Chairman of the Committee and hon. Members about that specific matter in more detail.

The points that hon. Members have made about the health service are extremely important and they have been noted by the Under-Secretary of State for Health. He has already made it clear today that the Government will respond soon to the Wilson report. Hon. Members will appreciate, however, that 600 responses have been received and it is important to ensure that they are considered carefully.

The debate has revealed our common belief that the parliamentary commissioner plays an important role in assisting Parliament to protect the individual citizen against the effects of

maladministration. Sometimes he plays a crucial role in issues of national importance, but sometimes he plays a role in putting right a problem for an ordinary citizen which, to him or her, is equally important.

I express what I believe is the sense of the House: that Parliament has been well served by those who have been appointed ombudsmen, those who serve him on his staff and hon. Members on both sides of the House who serve on the Select Committee.

It being Ten o'clock Madam Speaker-- proceeded to put forthwith the Questions which she was directed by paragraph (5) of Standing Order No. 52 (Consideration of Estimates) to put at that hour.

SUPPLEMENTARY ESTIMATES, 1994-95

Class XIII, Vote 4

Resolved ,

That a supplementary sum not exceeding £45,825,000 be granted to Her Majesty out of the Consolidated Fund to defray the charges that will come in course of payment during the year ending on 31st March 1995 for expenditure by the Department of Social Security on administration, for agency payments, the promotion of Government policy on disability issues, and for certain other services, including grants to local authorities and voluntary organisations.

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VOTE ON ACCOUNT, 1995-96

Class XIX, Vote 4

Resolved ,

That a sum not exceeding £4,277,000 be granted to Her Majesty out of the Consolidated Fund, on account, for or towards defraying the charges for the year ending on 31st March 1996, for expenditure of the Office of the Parliamentary Commissioner for Administration and the Health Service Commissioners for England, Scotland and Wales on administrative costs.

It being after Ten o'clock , Madam Speaker-- proceeded to put forthwith the Questions which she was directed by paragraphs (1) and (2) of Standing Order No. 53 (Questions on voting of estimates etc.), to put at that hour .

SUPPLEMENTARY ESTIMATES, 1994-95

Resolved ,

That a further supplementary sum not exceeding £1,230,882,000 be granted to Her Majesty out of the Consolidated Fund to defray the charges for civil services which will come in course of payment during the year ending on 31st March 1995, as set out in House of Commons Paper No. 3 of Session 1994-95.

ESTIMATES 1995-96 (VOTE ON ACCOUNT)

Resolved ,

That a further sum not exceeding £95,393,674,000 be granted to Her Majesty out of the Consolidated Fund, on account, for or towards defraying the charges for defence and civil services in Classes I to XVIII, Class XIX, Votes 1 to 3 and 5 to 7, and Classes XIX, A and XIX, B for the year ending on 31st March 1996, as set out in House of Commons Papers Nos. 4, 5 and 6 of Session 1994-95.

Ordered ,

That a Bill be brought in on the foregoing resolutions: And that the Chairman of Ways and Means, Mr. Chancellor of the Exchequer, Mr. Jonathan Aitken, Sir George Young, Mr. David Heathcoat-Amory and Mr. Anthony Nelson do prepare and bring it in.

CONSOLIDATED FUND BILL

Sir George Young accordingly presented a Bill to apply certain sums out of the Consolidated Fund to the service of the years ending on 31st March 1995 and 1996; And the same was read the First time; and ordered to be read a Second time this day and to be printed [Bill 7.]

Orders of the Day

CONSOLIDATED FUND BILL

Order for Second Reading read .

Question , That the Bill be now read a Second time, put forthwith pursuant to Standing Order No. 54 (Consolidated Fund Bills) , and agreed to.

Bill accordingly read a Second time.

Question , That the Bill be now read the Third time, put and agreed to .

Bill accordingly read the Third time, and passed .

Motion made, and Question proposed, pursuant to Standing Order No. 54 (Consolidated Fund Bills) , That this House do now adjourn.--[ Mr. Wood. ]

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Employment Rights After Manic Depression

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Wood.]

10.1 pm

Dr. Jeremy Bray (Motherwell, South): I am grateful to you, Madam Speaker, for putting at the top of tonight's agenda the subject of employment rights after manic depression.

Each kind of disability has its own problems, challenges and opportunities but of none is that more true than of manic depression. I mean nothing but encouragement for concerns about other kinds of disability and for disability in general in raising this much-neglected part of the subject.

The Government's consultation document on disability said that a workable employment right should be based on a definition that, in principle, covers physical, sensory and mental impairments. I hope that the promised Bill, code of practice, notes of guidance and national disability council will deal more fully with mental illness than did either the consultation document or the Minister's statement on 24 November.

In the index of the House's proceedings I can find no record of the House of Commons having had a debate specifically on manic depression, or any aspect of it, in the past 10 years. More broadly, on mental illness, including depression, a recent Gallup survey showed that the general public believe that people with mental illness, including depression, should be at the bottom of the national health service priority list.

There is much straight ignorance. In still too many cases people are discharged from hospital without their families being told of the nature of their illness or even the necessary continuing drug regime. Neighbours and social workers unschooled in the symptoms of mental illness put outrageously anti-social behaviour down to avoidable malice. But, mercifully, many ordinary people are extraordinarily understanding, forgiving and helpful.

Attitudes are changing. In the past generation, there has been a much greater acceptance into the community of the mentally handicapped, who are more easily recognised than the mentally ill. In my constituency experience --first in a constituency on Teesside and later in Scotland--the changed attitude to mentally handicapped people has owed much to Catholic influence.

Mental illness is less easily recognised, but attitudes to it also appear to be changing. The younger generation show greater understanding and support than their elders. The sight of so many homeless people sleeping rough on our streets after discharge from psychiatric hospitals has been a great shock, giving the sense of, "There, but for the grace of God, go I."

It is more widely appreciated that mental illness is as genuine as physical illness, and that it is not malingering. Indeed, evidence is accumulating on the possible physical causes and symptoms of different types of mental illness. During a visit last week to the Institute of Molecular Medicine at Oxford, as part of the inquiry into human genetics by the Select Committee on Science and Technology, it was interesting to speak to researchers who are applying the ideas and methods currently being

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pursued in developing somatic cell therapy for principal physical diseases such as cancer and cardiovascular diseases, to mental illnesses and handicap.

In addition to a normal distribution of human attributes generally, manic depression often appears to carry with it a heightened sensitivity and awareness, which has a wider function in day-to-day society and in the family, the community, the work group, business, democracy, committee, Parliament or football team. Employers take advantage of the energy, vitality, productivity and enterprise of people vulnerable to manic depression when their condition is under control. They may be qualities that we all need, but they can get out of hand in a manic depressive. Those are matters not only for objective medical and psychiatric research but for social accommodation and public understanding and for campaigning and organisation, of which we need to take account in framing social policy.

One per cent. of the population will suffer from manic depression during their lives, and another 1 per cent. from schizophrenia. Many more people suffer from acute, disabling depression, without manifesting the full symptoms of the manic depressive. About 20 per cent. of women and 10 per cent. of men can be expected to suffer from depression at some time during their lives.

Suicide is overwhelmingly associated with depression. Each year there are more than 100,000 attempted suicides in this country, of which 4,000 are fatal. That figure compares with 3,500 road deaths. Christmas is an especially difficult time for mentally ill people, when so many activities and services are closed.

The experience of each sufferer from manic depression is unique, but between the swings into manic elation and acute depression, manic depressives behave like anyone else. Their wish is to be accepted in society and to contribute to it fully, in every way, in work, at home and in their wider social life; often they succeed.

The characteristics of manic depression are frequently not noticed by people who already have a difficult enough job coping with normal problems- -social workers, housing and social security officials, personnel managers, employers and trade union officials. I confess that it was many years before I learnt some of the obvious signs of mental illness myself, when constituents in trouble came to see me. According to the Royal College of Psychiatrists and the Royal College of General Practitioners, who can be expected to be objective about those matters, surveys show that 50 per cent. of those people suffering from clinical depression do not visit a doctor at all, and of those who do a further 50 per cent. are not diagnosed. The cost of not treating depression has been estimated by the Office of Health Economics at about £3 billion per annum--nine times the £333 million cost of treating depression.

In his statement on 24 November, the Minister for Disabled People said:

"Greater employment opportunities are at the heart of enabling disabled people".--[ Official Report , 24 November 1994; Vol. 250, c. 741.]

On 26 November, the Manic Depressive Fellowship held a useful forum on employment, which I attended. I shall tell the House about some of the things that were said and points that were made, there and elsewhere, by people who have suffered from manic depression.

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Some people have to live with episodes of manic depression throughout life, but others are able or enabled to control it. They suffer from only a temporary incapacity, but they remain vulnerable. Care can be effective, but mental illness is not a high priority for community care in many parts of Britain. Manic depression is an illness that begins in adult life or late adolescence, so appropriate continuing and adult education is as necessary as appropriate school education is for other disabilities. Strategies for completing studies and achieving a professional or vocational qualification are important.

The perception of manic depressives is that if they go along to the jobcentre and say that they have had an episode of manic depression they will be steered towards low-paid, unskilled work. That is a common experience of graduates, accountants, lawyers, teachers, business managers and other professionals. Their true capabilities are not recognised or thought to be recoverable.

What specific practical help is offered to manic depressives under the access to work programme? It is good that the Department of Employment is willing to spend money on the disabled who need easily identifiable physical aids, but what will it do to boost the skills, performance and self-confidence of those whose productivity has been undermined by mental illness?

The Government's talk of civil rights education for the disabled makes no reference to the existing battery of legislation on mental health. Episodes of illness can provoke irresponsible behaviour which can endanger the safety of the patient and of others. Fortunately, patients can recover from manic depressive episodes, and from a medical and psychological point of view those people are fully able to resume their usual responsibilities. Unfortunately, much of society and some aspects of the law presume that once a person has gone mad, he will always be mad. People are awaiting the new mental health Bill with keen interest. I trust that its scope will be wide enough to accommodate the debate needed and to enact the conclusions that are reached.

If manic depressives are honest about their illness to their employers, or in seeking work if they are out of work, they find that the only work options that they will be offered are jobs well below their capabilities. To overcome that prejudice, many patients lie or tell less than the full truth. Consultant psychiatrists and general practitioners actively encourage manic depressives to do that. The practice has helped a good many manic depressives to very senior positions. Suggestions are made now about how to fill in gaps in curriculum vitae with less than the full truth.

Is it not right that people should have the right to say nothing of a long past episode of mental illness? If a discharged prisoner can legally keep silent about his record, why should not a discharged mental patient? Any legal requirement to tell people of mental health records should not extend back further than five years.

As long as the patient does not become ill in the workplace, the practice of lying or omitting to tell the truth can prove satisfactory to the employee and to the unwitting employer. However, if a patient becomes ill at work, or his psychiatric case history becomes known some other way, problems may occur. Neither the employee nor the employer would have made contingency plans to cope with the event of a mental health

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emergency, and the employee would have committed a breach of contract by lying or by telling only part of the truth.

We need a clear legal framework that is fair to employees and to employers, but the industrial tribunal may not be the best place to resolve a dispute regarding a psychiatric patient. Industrial tribunals are pretty traumatic for those who are mentally stable. They would be horrendous for a psychiatric patient. Who would want their psychiatric case history to be laid before the tribunal, let alone read out in open court? There needs to be some legal remedy against employers who use the illness to discriminate. The mutual responsibilities of employer and employee are not clear and the lack of clarity acts as an effective artificial bar to the labour market. The manic depressive is vulnerable in other ways. Far from easing someone who has been ill for a long time back into employment, the social security benefit system makes re-entry both difficult and risky. It is often better for someone who is getting over an episode of manic depression to re-enter the employment market gradually and cautiously. The possibility exists of retreat back to benefit should the move be premature or too stressful. If such people fail to hold down a job, they should not have to face all over again the barriers, delays and humiliations that the benefit system inflicts. The means should be found to provide people who are prepared to try entering employment after a long and severe illness with a safety net-- that they will be able to return to invalidity benefit without waiting six months and going on the much lower income support.

In theory, the disability working allowance should offer a well-supported route upwards into employment but with a safety net for those people whose illness recurs. In practice, however, few manic depressives claim the allowance. Severe problems are connected with it. Its receipt depends on the understanding of the employer. That may be fine if a person is in a wheelchair or suffers from Down's syndrome but, as I have already said, the mentally ill are faced with major problems in relation to what to tell employers. The number of manic depressives entering employment via the allowance route is minuscule. People who take that route are often no better off financially than they were when on benefit. Someone who has been covered for six months by a doctor's sick note should be on invalidity benefit and can do therapeutic, part-time work--for example, for a charity- -and earn up to £15 per week pocket money without losing benefit. That would bring the disposable income of a single person up to £79 in round figures. In addition, one would be entitled to housing benefit and council tax rebate, both of which are valuable benefits.

If people on the allowance begin to work again, at most they will be only £1 to £2 better off than they were on invalidity benefit. The problems of the combined effects of tapers and clawbacks are well known, but they are especially crippling to vulnerable people. They amount to a 97 per cent. tax on additional earnings of more than £50 per week. It is small wonder that only 3,500 people with all kinds of disability are on the allowance. About the only thing that can be said in favour of the allowance is

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that, if people on it cannot sustain a job, it provides a safety net. They can go back immediately to the benefits to which they were formerly entitled.

Those problems have been argued for many years in relation to many sorts of disabled people, but fresh problems exist in the Social Security (Incapacity for Work) (General) Regulations, which were laid before the House on 24 November 1994 and which, no doubt, we shall debate soon under the affirmative procedure. The regulations omit people with severe mental health problems from the list of persons with a severe condition who are to be treated as incapable of work, despite an undertaking given to a number of organisations that persons with severe mental illness would not be subjected to the work test.

The effect of the regulations as drafted will be that persons with severe mental problems will be subjected to a work test, regardless of their mental state. The questionnaire that will be used to assess them has been widely criticised as inappropriate. Administering the questionnaire is likely to cause extreme distress to many severely ill patients. I cannot believe that the Government would allow the regulations to be the last word. I look forward to what the Minister has to say.

Good practices and pioneering projects on employment operate in many parts of the country and in many different fields. They play an invaluable role for those recovering from mental illness. Counselling and staff support schemes are now operated by some employers, offering confidential support to help individuals in employment to deal with problems that may be affecting their performance at work. The cost of mental health problems to British employers is enormous. The Health and Safety Executive estimates that sickness certificates attribute 30 to 40 per cent. of absences from work to some form of mental or emotional disturbance. The Scottish Association for Mental Health has reviewed the experience of the counselling and staff support schemes. Obviously, such schemes can play an important role in keeping people well and productively employed.

Many employers in Scotland operate staff support schemes in all or some of their establishments. They include British Telecom, United Distillers, Scottish Mutual, BBC Scotland and Marks and Spencer. The Working Well trust in Tower Hamlets supports employment and training in printing, clothing manufacturing, office services and shops and is now branching out with a new project in Bath. The Mental After Care Association runs a wide range of activities nationwide, some of which are directed at employment and training.

Another route that many manic depressives find useful is the voluntary work that is available in a wide variety of organisations. It offers them a start on the road back to regular employment. It is often not the content of the work but the availability of a supportive working community that is important.

Those who have been mentally ill want to return to a normal social and working life. They do not want to be stranded in a ghetto. The contracting- out revolution has made work insecure for a great many people and the mentally ill are not the only ones who suffer. However, on the way back into employment, the contracting-out revolution makes it possible for some people gradually to re-enter the labour market in some skilled and

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professional areas. Good employment practices for contracting out services by the fully fit require clear task setting, milestones, delegated responsibility and an interest in and encouragement of progress. Those are doubly important for those who have been mentally ill.

Perceptive and enterprising practices are not limited to large firms. One of the best worked-out schemes that I have seen is in Context, the firm that is recording for posterity on compact disc our proceedings in the House. The employment offered by some firms is not undemanding. Some firms in the market for new high-tech skills realise that people who have had a breakdown can learn fast and perform well.

The Royal College of Psychiatrists and the Royal College of General Practitioners, in their current comprehensive defeat depression campaign, are seeking to raise awareness at work, to promote health education for employees, to address the organisational forums that create stress and to provide effective occupational health services. The Government should join forces with all those and other firms and agencies, many of whose activities they are already supporting in one way or another, to create a pilot scheme or schemes geared directly to the needs of manic depressives and their employers. They have done that with particular groups of the physically disabled. The evidence and experience gained can provide the basis for a national scheme that can be backed up with the proposed legislation and code of practice. It needs to be run by a multidisciplinary team and, of course, implementation should be done by those already active in and responsible for educating, training and re-establishing the manic depressives in employment. In that way, employers can get back-up when they need it and of the kind that they need.

The scope of individual schemes needs to be considered. At the point of delivery in a firm, a scheme covering a wider field--covering depression and mental illness generally--would have a wider scope and be more often used than a scheme for specific mental illnesses such as manic depression. The treatment needs of different illnesses differ greatly and it would be necessary to be able to call on those able to deal with the special needs of each of them.

In the guidance notes and in implementing the Government's code of practice, there would be scope for those several different kinds of people, who are all called disabled but whose particular problems, challenges and opportunities need to be addressed separately, to be served by a coherent set of schemes. Manic depression would be a good place to start because it has been neglected, because there is a potential to be realised and because there are people throughout the community who have a deep understanding of the condition that is so near to the centre of each of us.

10.25 pm

The Minister of State, Department of Employment (Miss Ann Widdecombe) rose --

Mr. Ian McCartney (Makerfield): Would the Minister like to speak first? I do not mind, it is near Christmas.

Miss Widdecombe indicated dissent .

Mr. McCartney: First, I congratulate my hon. Friend the Member for Motherwell, South (Dr. Bray) on his success in the ballot. I congratulate my hon. Friend not

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on the lucky draw but on the subject that he selected. For many years before I became a Member of the House, I was a voluntary advocate for people suffering from mental illness and stress. Indeed, in my family today, through my wife, that role of working with people who suffer from mental stress continues.

I welcome this opportunity, therefore, especially as this is my first speech in my new portfolio as spokesperson for employment. Previously, I had been spokesperson for health. I did not expect my first debate in my new capacity to be so directly related to my previous portfolio as Labour party spokesperson on occupational and mental health. Although it is late in the evening and few other hon. Members are here to support either the Minister or me, I welcome a debate in which we can have a dialogue on the serious issues that my hon. Friend raised.

It is important to set a background to mental stress at work and what has been happening during the 1980s and 1990s. We now know from various reports that upwards of 1 million British workers suffer from work-related stress as a direct result of Government activities and the labour market changes in the 1980s and 1990s. Employees in full-time work are now working harder and longer hours than ever before. Redundancy, short-term working, part- time working, temporary or part-time and temporary low-paid jobs produce a sense of a loss of security and an overwhelming sense of insecurity at work. That has led to--it is continuing--increased stress at work, including manic depression.

That is the view of not just the Labour party, the trade unions, the advocacy groups representing people at work with a mental illness, the Royal College of Psychiatrists, the Royal College of Nursing and the Health Select Committee; it is shared across a range of activities. Interestingly, a recent report, highlighted in The Times , was produced by Professor Cooper of the university of Manchester's institute of science and technology on behalf of the Health and Safety Executive--an organisation directly responsible to the Government, which advises them on stress at work and on health and safety issues in general. Professor Cooper, in his report to the Health and Safety Executive, said:

"the situation was probably worse in Britain than in America as the country had gone through greater change."

That relates to the Labour market changes imposed by the Government. He said:

"The Thatcher era had been marked by technological and economic change and the country was also facing substantial social changes. The incidence of work-related stress had increased markedly in the past 20 years and more people were taking sick leave because of anxiety . . .

`Those on the shopfloor work till they drop while senior managers take a few days off every now and then'".

That report was produced by an eminent professor, on behalf of the United Kingdom's most eminent independent Government-related body dealing with health and safety.

Last year, citizens advice bureaux in the United Kingdom answered 882,257 queries about employment problems. That is an astonishing figure for a voluntary organisation, and it does not count those who consulted trade union or other employment organisations or sought the help of their doctors, the Royal College of Psychiatrists or advocacy groups. It suggests the existence of a deep-seated, underlying problem in the British economy: people's sense of insecurity is manifesting itself in stress and mental illness.

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Again, that is the view not just of the organisations that I mentioned. A recent report in The Guardian by Tim Radford stated that in Britain workers were suffering the worst levels of stress in Europe. It stated:

"British white-collar workers have the lowest `feelgood' factor in Europe, according to a survey of office workers".

The survey was carried out throughout the world, but Mr. Radford referred particularly to Europe. He said:

"More than half claim stress has increased in the past two years, and 16 per cent. admit it has caused them to take time off. Thirty-seven per cent. do not feel appreciated at work, against a European average of 29 per cent. Confidence in management ability is 53 per cent., against 69 per cent"

in other European countries.

British workers felt that their jobs were less safe--they felt less secure about being able to remain in employment--than their European counterparts, which led to increased mental stress at work. The Policy Studies Institute's survey of 1993, which I am sure the Minister read, revealed two startling facts. About one in three employees reported significant stress levels owing to working conditions, while 54 per cent. felt that their level of stress had increased over the past five years. The Department of Health and the CBI estimate that sickness absence related to stress and mental disorder is costing the United Kingdom economy a staggering £56 billion per annum. That does not count on-costs such as medication, benefits, high staff turnover and poor judgment leading to bad decision making.

The Department of Health also states that mental illness is one of the main three causes of certificated sick leave, with a consequent loss of 91.5 million working days in the British economy. In 1993, the number of working days lost through strikes was 649,000. Those, too, are staggering figures.

The situation has become so acute that the International Labour Organisation, which brings together union, employer and Government representatives, has said that

"the time has clearly come for a shift in attention in occupational health prevention activities away from a `physical hazards only' perspective to a focus which includes full attention to psychosocial hazards".

In layman's terms, that points to a large increase in the number of people suffering from mental illness and stress in the workplace. We need to ensure that organisations such as the Health and Safety Executive, and indeed the Government, bear in mind the key subject of mental stress when making policy: it is as important and damaging in the workplace as accidents and other forms of illness. The Trades Union Congress and its general secretary, John Monks, have identified occupational stress as one of the top five health and safety priorities. Mr. Monks and various trade unions have a team to advise them on how to tackle the problem through the development of prevention strategies.

A research review of occupational stress by Professor Tom Cox for the Health and Safety Executive reported that there was too strong a focus on caring for or curing individuals and that

"only a minority of organisations appeared to be directly and deliberately addressing the management of occupational stress." Professor Cox, on behalf of the Health and Safety Executive, said that there was a need for intervention policies in industry, involving employers and employees,

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