House of Commons - Work and Pensions

Select Committee on Work and Pensions Fourth Report

15 OCCUPATIONAL HEALTH SUPPORT

242. In oral evidence, the Minister emphasised the importance of ensuring good information and advice was out there to support employers in protecting employees from occupational health risks.[409] In other EU countries, legislation requires employers to use some form of occupational health and/or safety specialists to assist them in their provision of a safe and healthy working environment. Such provision is further endorsed as a key requirement of the EU Framework Directive (89/391) in which employers are required to manage the work environment according to a set of prevention principles, together with workers or representatives and with the support of either internal or external prevention services.[410] A number of key issues came up in the course of the Committee's inquiry. These included: progress in improving the coverage of occupational health and safety support since the publication of Securing Health Together; the extent to which employers are required to use such support; and the importance, from the employee's point of view, of having access to services which are independent of the employer.

Progress since Securing Health Together

243. Revitalising contained a commitment to encourage better occupational health support.[411] The Government's long-term occupational health strategy, Securing Health Together[412], published in July 2000, aimed to ensure appropriate mechanisms were put in place to deliver information, advice and other support on occupational health. It was to do this by identifying the support needed; setting up suitable frameworks and delivering them to the right people and raising awareness of the existence of these frameworks and what they can deliver.

244. Despite this, evidence suggests that coverage of occupational health support is low. HSE research found that 3% of all firms were covered by occupational health activities (defined as including training, job engineering, risk measurement and health monitoring). 15% were covered by a minimal service (including risk identification, risk management and information).[413] One witness raised a question as to whether provision was so low as to make the UK vulnerable to challenge in the European Court[414].

245. In the absence of such provision, Mr Simon Pickvance described primary care as having to act as a 'default occupational health service.' However, he argued that it was ill-equipped to pick up this role. GPs and nurses have too many other priorities to be in a position to offer the full range of occupational health advice. Furthermore, there is 'no secondary referral service for occupational health problems from primary care.'[415] Patients are referred to consultants who are able to deal with symptoms but are not trained to look for causes and whether there are factors at work that caused something to happen. Dr Kit Harling told us that previous attempts to get occupational health training into schools of nursing and medical schools had not been very successful.[416]

246. The literature review conducted for HSC/E to provide an evidence base for the strategy, concluded that there was significant scope for improvement in the provision of occupational health and rehabilitation advice and support in the UK.[417] HSC's current strategy explains that it will explore ways to promote access to and take-up of, authoritative health and safety advice and guidance, and press for the provision of nationally available advice and support, initially focused on occupational health. [418] HSC aims to develop the provision of such support through innovative partnerships in the public and private sectors. [419] It recognises the need, at the same time, to raise awareness and stimulate demand for these services.

247. Three pilots are currently planned or under way to test a model for occupational health support, developed collaboratively by HSE and stakeholders.[420] General features of these programmes include free advice on various occupational health issues directed to both employers and employees and collaboration of HSE with partners in the health sector.[421]

248. In oral evidence, HSC/E highlighted occupational health support as a priority for extra spending.[422] It further explained that an additional spend of £25 million over 3 years would enable it to use innovative partnerships to pilot occupational health, safety and rehabilitation support regionally, locally or by sector, to evaluate what works best in changing behaviour and to assess how much difference such support makes in improving health and reducing sickness absence.[423] It will then be able to evaluate the benefits of further investment to roll out support across the country .

249. Evidence suggests that, in any case, provision will take some time to develop. The Royal College of Nursing suggested that a lack of suitably qualified staff may be an obstacle to the provision of occupational health services. However, Dr Kit Harling argued that the gap between need and supply would drop if occupational health physicians did not do activities for which they are over-qualified[424]. The important thing was to focus on what needed to be done and then look at the 'competencies' needed to do this.

THE EMPLOYMENT MEDICAL ADVISORY SERVICE

250. A number of organisations giving evidence to the Committee make critical reference to the loss of the post of Chief Medical Officer and the reduced staffing of the Employment Medical Advisory Service (EMAS)[425]. This is designed to help reduce risk and protect people at work by providing advice and guidance on how to comply with the law, inspecting workplaces, investigating disease and illness complaints and taking enforcement action where necessary. EMAS supports all HSE's front-line activities and provides occupational health advice directed to employers and employees. The Committee was told that HSE now employs just 15 doctors/occupational physicians and 27 nurses compared to 120 staff (split roughly evenly between doctors and nurses) 12 years ago.[426] Mr Timothy Walker, Director General of the HSE, reported that EMAS staff considered their staffing levels were correct for the role they had to play, which was to provide guidance.[427] Both TUC and Prospect call for proper resourcing of EMAS in order to enable it to drive forward occupational health in Britain.[428] Prospect argues that the proposal to set up a new organisation, using partners (as is being explored in the pilots), is very likely in any case to require considerable public funding.

251. The Committee is disappointed at the plans and progress to date to establish national cover of occupational health services. It recommends that this is given higher priority than it has received to date and that HSC/E is provided with the necessary resources to enable it to make progress towards the 2010 targets on occupational health.

Competencies

252. It is a key requirement of the EU Framework Directive 89/391 that employers are required to manage the work environment according to a set of prevention principles, together with their workers and with the support of either internal or external prevention services. Great Britain pursues a largely voluntary system in which employers still have maximum discretion over the extent to which they choose to involve occupational health and safety specialists. Employers in Great Britain are required to appoint a 'competent' person to assist them in complying with health and safety requirements. However, there is a lack of clarity of the meaning of competence. EEF, the manufacturers' organisation, told the Committee that employers often only find out that they have failed to meet the required standard in the course of litigation[429]. Mr Simon Pickvance of Sheffield Occupational Health Service argued that the requirements of occupational health services, including definition of competence, could be clarified in an Approved Code of Practice.[430]

253. The Committee recommends that the HSC should, by 1 October 2005, develop and publish an Approved Code of Practice defining the standards of competence employers are required to use to ensure they comply with health and safety requirements.

A SERVICE FOR EMPLOYEES

254. Several witnesses pointed out that employees suffering from work-related illness do not have employment security, which may influence the identification and the treatment of the illness.[431] Employees do not want to talk about their health problems with their employer if they are potentially work-threatening. There is a need for a third party advice for both employees and employers. People should feel that can get clear, honest advice that is not tainted one way or another. We endorse the suggestion of NHS Plus that the NHS is ideally placed to provide third party occupational health advice to employees and employers. This does not mean that they would provide all the service, but they could "serve as honest broker". [432]

409 Volume II (Ev 148 Q564) Back

410 Commission of the European Communities, Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions, on the practical implementation of the Health and Safety at Work Directives. Brussels, 05.02.2004. COM (2004) 62 final Back

411 HSC (2002), Revitalising Health and Safety. Strategy Statement. June 2000. Wetherby:DETR Action point 29 Back

412 HSC et al (2000), Securing Health Together. A long-term occupational health strategy for England Scotland and Wales. Sudbury: HSE Books Back

413 Pilkington A et al (2002), Survey of use of Occupational Health Support. HSE Contract Research Report 445/2002. Sudbury: HSE Books Back

414 Volume II (Ev 100, Q386) Back

415 Volume II (Ev98, Q376) Back

416 Volume II (Ev 98, Q375) Back

417 Wright M et al, Building an evidence base for the Health and Safety Commission Strategy to 2010 and beyond: A literature review of interventions to improve health and safety compliance, Report Report196 page 76 Back

418 HSC (2004), A strategy for workplace health and safety in Great Britain to 2010 and beyond. Sudbury: HSE Books Back

419 HSC (2004), A strategy for workplace health and safety in Great Britain to 2010 and beyond. Sudbury: HSE Books Back

420 Volume II (Ev 141) Back