Examination of Witnesses (Questions 900-919)
LORD HUNT
OF KINGS
HEATH, MR
GEOFFREY PODGER,
DR JOHN
STATHER AND
DR ALASTAIR
MCKINLAY
17 MAY 2006
Q900 Dr Harris: Because
we have not had that from the UK representative even though they
had every opportunity to tell us, "we are on your side; we
are on the side of the people who wanted to remove it"; and
indeed we heard from an MEP with a particular interest in this
that in the presence of—that the UK had refused to support
a proposal to take out MRI from the directive.
Mr Podger: That is not my understanding.
Q901 Dr Harris: Can you
provide us in writing with some evidence of the point at which
the UK did seek to remove MRI completely from the directive during
that negotiation, if it was then, because that is not clear? Minister,
the other thing you said which was a little surprising was that
the UK effectively opposed the directive as best it could. I understand
that some of these things are inevitable with qualified majority
voting, but we did hear from Mr Biosca—and it is in the
transcript of evidence that I hope you have had a chance to see—that
"your comment" on the HSE saying they could find no
benefits from the implementation of this directive—"your
comment is very surprising when the UK authorities supported the
directive in council". That must have jumped out at you,
and you must have already instigated a process of correction or
written to say, "no, that is wrong". He was there.
Lord Hunt of Kings Heath: Can
I ask Mr Podger to answer the specific detail.
Mr Podger: It certainly jumped
out at me when I read that transcript, and I thought it was a
very disingenuous comment by the Commission, if I may say so.
The point, as the Commission are well aware, is that it is normal
practice for any Member State to object to something in principle
and find that they are outnumbered, to essentially indicate a
willingness to go along with the principle of the measure, while
seeking to amend it in a way that makes it more acceptable to
them. I am quite clear that the Commission understood throughout
that period that that was the UK's position. Hence, while it is
entirely true as a matter of fact that the UK did not say "we
will vote against this" the Commission understood perfectly
well what the preference of the UK would have been and the reason
why it was following this particular course. As I say, it is perfectly
normal in Brussels negotiations, as you all know.
Q902 Dr Harris: I accept
that. My final point is that he then said: "How about the
report of the NRPB in the UK on proposals for limiting exposure
to electromagnetic fields?"—which he then described
as "proposals for setting limits to exposure"—and
it covered the public and workers as well. Do you recognise what
he is referring to?
Lord Hunt of Kings Heath: We may
have to check that back and write to the Committee but my assumption
is that he was referring to the original NRPB guidelines, which
were in existence in this country, which I think departs not a
lot, if anything, from the UKREP guidelines. Our position is very
simple. We felt that there was no need for the directive because
we already have these guidelines. We already have the legislation,
the parent Health and Safety at Work legislation. We thought that
that was sufficient for this country, and that is why we could
see no health and safety benefits by adopting the directive.
Dr Harris: That is very clear.
Q903 Chairman: Mr Podger,
I am now a little confused about something you said earlier, and
I have just gone back through my notes. You said that in terms
of the static fields, that was the main thrust of your argument
through the Commission to have that area removed, and you were
not so bothered about the variable fields.
Mr Podger: No, I think, with respect,
what I was seeking to say was that HSE's impression from the other
stakeholders with which it was dealing was that once the static
fields had been removed, once that had been agreed, that there
was not a significant outstanding problem in relation to MRI.
That was what was understood by us at the time. As events have
subsequently shown, this was erroneous. To try to answer Margaret
Moran's earlier question, that was the reason why we did not engage
in further consultations on the specific issue.
Q904 Chairman: What surprises
me about this—and perhaps the information we got from Dr
Keevil needs to be amended—is that from July 2004 the HSE,
despite the fact that static fields were removed from the directive,
had been stating that they should not have been removed, and that
the HSE would seek to enforce it in the UK, because it is in the
NRPB guidance. Even as late as 6 June 2005, the HSE will seek
to include a 2-tesla static field limit in UK legislation. In
other words, HSE, despite having got this out with the Commission,
in terms of static fields, is now seeking to put it in as far
as Britain is concerned. In other words, we are going to gold-plate
this directive when it is not even needed—so can you clarify
that?
Mr Podger: Certainly—and
I had anticipated this question having been provided with the
written evidence!
Q905 Chairman: That is
why I provided you with it!
Mr Podger: We are not intending
in any way to gold-plate this directive, which the Committee will
have well understood by now is not a favourite of the HSE. In
particular we are not proposing to in any way re-introduce the
static field issue. I have to say to you, Chairman, to be entirely
honest with you—and I understand this comment was made by
somebody from HSE and is accurately reported in the evidence we
have received—that it is not our policy.
Chairman: It is important to put that
on the record, and we are very grateful to you.
Q906 Mr Flello: Lord Hunt,
in terms of variable fields, has any attempt been made to amend
the exposure time for time variable fields, given that this was
raised, I gather, by the medical community back in mid 2003?
Lord Hunt of Kings Heath: I think
I will refer you back to the answer that Mr Podger has given.
It seems from what I have read of what happened that we, the Government,
were of the view that the issue was in relation to static fields,
and it was thought that with the removal of those levels the problem
had been dealt with. As it has transpired, in the view of the
Commission we have seen that this is not the case. The intention
in the negotiations—one of the fears in the negotiations
is that the Commission would adopt even harder levels than was
in the ICNIRP guidelines, so that the position that this country
took was to try and ensure that the Commission did not go for
levels other than the ones in the guidelines. That is the position
in terms of the negotiations we were involved in.
Q907 Mr Flello: Would
it be perhaps fair to say that even though three years ago the
clinicians were saying that there was an issue around the time
variable fields, it was almost all or nothing; the thrust was
put in trying to get rid of the whole issue around MRI scanners
at all, and it was only late in the day when they realised it
would not happen, and people started looking at the other issues?
Lord Hunt of Kings Heath: I am
not sure I have enough knowledge of the to-ings and fro-ings of
the negotiations at that period, but the sense that I have is
that although a number of countries wished to remove MRI altogether
from the directive, the general feeling around the table was that
it having been agreed that the static field levels would be removed,
the problem had been dealt with. As far as I am concerned it was
only last autumn that I became aware that clinicians had a major
problem with what had been agreed. From that, we have taken various
actions to see what we can do to sort this problem out.
Q908 Mr Flello: Do you
feel that the whole consultation around this issue was badly handled?
Lord Hunt of Kings Heath: Can
I say that my general experience of the way the HSE handles consultations
is very extensive. I know from work that I have been involved
in around the Noise at Work Regulations and the Working at Height
Regulations, where they have got heavily engaged with stakeholders
who have had concerns about various aspects of regulations, where
they have very extensively worked with them to look at the practicalities
of the regulations, to make sure that the advice that runs alongside
those regulations is practical. So I believe that the general
way of working of the HSE is commendable in terms of the way they
deal with stakeholders. However, when it comes to the issue of
the people they consulted a few years ago, I would say that the
glaring omission from that were the medical royal colleges. You
will know that my background is the Health Service, so that is
the thing that strikes me. With the benefit of hindsight, it would
have been better if HSE had had a more extensive consultation
with the medical royal colleges. If they had done, I would hope
that these issues would have been raised then rather than last
autumn—but again this is with the benefit of hindsight.
In general, the Health and Safety Executive is, I believe, good
at consultation.
Q909 Mr Flello: Is it
fair to summarise that as being 99 per cent of the time they get
it right but this one has gone badly wrong?
Lord Hunt of Kings Heath: Clearly,
something has happened over the last few years, which has meant
that the issue- you have heard from clinicians—has not been
fully considered by the Government, and clearly something went
wrong with the process. It may well be—and you asked the
clinicians that question—that the colleges might have been
more active. My experience of the medical royal colleges is that
they are not slow in coming forward, and gain ready access to
Government departments. It may be that they could have done more
as well, but I am not seeking to hide behind that. I do think
that the HSE should have consulted more widely with the medical
field, yes.
Q910 Mr Flello: Mr Podger,
you seem to be nodding in firm agreement.
Mr Podger: I want to put on the
record that I entirely agree with what Lord Hunt has said. That
is clearly the case.
Q911 Dr Iddon: With nuclear
magnetic resonance we have a static magnetic field, and we have
concentrated on that this morning throughout this meeting; but
we have to sweep the patient with an alternating radio frequency.
You do not seem to have commented on the health aspects of that.
Is anything known about the alternating radio frequency affecting
the health of a patient in a static magnetic field?
Dr Stather: There is not that
much information on epidemiology of patients exposed to MRI. As
an organisation we have asked for work to be done on a number
of occasions over the last ten years. There is not that much concrete
evidence. Of course, our advice is about exposure of people not
just particular patients, but people as a whole—including
people whose work brings them into contact with electromagnetic
fields.
Q912 Dr Iddon: The research
seems to be being done on the strength of the magnetic field and
not the effect of the sweeping radio frequency, which is also
necessary to flip the spins of the nuclei, the atoms.
Dr Stather: The advice we produce
obviously reviews static and time varying fields to the extent
that information is available from epidemiology, but not particularly
patients exposed to MRI.
Q913 Dr Harris: Dr Stather,
the British Institute of Radiology say they wrote to you in August
2003—indeed, they were advised to write to you expressing
their concern about the new guidance; and in our evidence they
said they never got a reply. Have you had a chance to look at
that assertion in their evidence? Why did they not get a reply?
Dr Stather: That was in relation
to the document we put on our website for consultation (in May
2003) about what we were saying about the guidelines. We did not
write to individuals; we got many comments that came in but we
did not respond to individuals. We put a response document on
our website which included the points made by the medical community
on MRI. I have a copy I can leave with you, if you wish.
Q914 Dr Harris: That would
be helpful. I am grateful for your acceptance that HSE did not
consult widely enough. On 25 October 2005 you were asked about
this specifically by Lord Oakshott, and your response was: "I
assure the noble Lord that the HSE has consulted medical people
on a number of occasions during the progress of the directive."
Were you unaware of the paucity of the consultation—
Lord Hunt of Kings Heath: That
answer was true because HSE can supply you with a list of medical
organisations. Clearly, in preparing for the Select Committee
I looked very closely into the medical organisations that were
invited, and my conclusion, as I said to you, is that I think
we should have invited the medical royal colleges. I believe my
answer to that question was accurate in the House of Lords.
Q915 Dr Harris: I am not
suggesting it was not accurate. Can I turn to the precautionary
principle. You will have heard the discussion we had in the previous
session. I guess the easiest thing to ask you is whether you have
any comment to make particularly in respect to Government policy
on the precautionary principle. Do you think the precautionary
principle played a part in the evolution of this directive and
that an extreme or too-firm version of that has led to some of
these concerns? Second, regardless of that, do you think there
is work to be done on the precautionary principle even in terms
of the way it guides UK policy and negotiations, or at least at
EU level?
Lord Hunt of Kings Heath: On the
first question, as we learnt, the directive is based on the ICNIRP
guidelines so I guess the question that one has to pose is: are
the ICNIRP guidelines based on the precautionary principle and—
Q916 Dr Harris: Whatever
that is!
Lord Hunt of Kings Heath: Whatever
that is. I read the evidence that David King gave to you a couple
of weeks ago, which I thought was very helpful in making clear
his view that it was an approach rather than a principle. He said
that it is an approach in which risks are analysed as best we
can; and he said we cannot freeze ourselves into total inaction
on the basis of unknowns which prevent us from doing anything
new with science and technology. That seemed to me to be a reasonable
description of the approach that had been taken. Whether there
needs to be more work in this area as far as the UK Government
is concerned—clearly, the advice of the Committee will be
extremely helpful in that regard. One of the problems of course
is that the more precise you make it, you may be boxing yourself
in. It seems that there is a trade-off here between a degree of
flexibility and a very precise description of what the precautionary
principle should be. As far as Europe is concerned, what I particularly
would wish Europe to consider is the broader impact of what it
is they may be introducing. For instance, what is the trade-off
between introducing the directive in this regard if the impact
is as the Commission say and you are no longer able to use the
procedures in the way you wish to do it—if the alternatives
produce more risk for patients and staff, how do you take that
into account? The question is, as to whether Europe is in a position
to take that into account. I am not sure at the moment if it is
sufficient.
Q917 Dr Harris: The Commissioner
said when we raised this that you cannot talk about third parties
when you are dealing with the protection of workers. That is their
view, but you have to deal with the risk benefit in isolation
for the workers and it is unfair to subject a worker to risk simply
because there may be some benefit to a third party, even though
it is a human.
Lord Hunt of Kings Heath: I do
not think I necessarily share that view. I think it is much better
that we make decisions in the round where you balance off the
risks to the various partners in any transaction.
Chairman: To be fair, Mr Spidla is coming
back from that hard-line view as well, so hopefully there will
be some movement.
Q918 Dr Harris: Dr McKinlay,
did you have something to say about ICNIRP's approach on the precautionary
principle?
Dr McKinlay: Yes. ICNIRP did not
invoke the precautionary principle or precautionary approach in
respect of its guidelines. I stated before that it adopted a cautious
approach in the interpretation of the science. This is quite different.
In fact, we attempted to spell out the HPA's policy and NRPB's
policy in this review in 2004. It was referred to earlier—we
separated the known adverse health effects. The known adverse
health effects in the context of the ICNIRP guidelines were referring
to those health effects where we understood what the mechanisms
were. The unknown health effects, if you like—to put the
converse—is really the issue of carcinogenesis, the issue
of cancer. We spelt out very clearly on this—because that
is a major concern still in the community as to whether electromagnetic
fields can cause cancer; it is one of the major issues with mobile
telephony, for example, and rightly so; it has been rigorously
examined. This approach in terms of advising the Government that
they should consider the need for the precautionary aspects of
policy really came about because of the epidemiological evidence
on childhood leukaemia from power lines, and it is a very sensible
separation of the precautionary approach, the interpretation of
the scientific data and the cautionary aspects which I think are
policy, and quite rightly the aspect that government should be
dealing with. That is ICNIRP's view certainly, and I think the
HPA's view.
Q919 Margaret Moran: What
specific outcomes of the meeting held on 5 January with MR stakeholders
have emerged, and what further work or research is needed as a
result of that; and is the Government prepared to support that?
Lord Hunt of Kings Heath: Yes,
the sequence of events is that I met with the Royal College in
October. That then followed on with a stakeholder meeting at the
beginning of January, between HSE and various clinicians with
an interest. I subsequently met the college again, and am due
to meet them very shortly. They have agreed a series of work programmes,
really looking to see what research is available in the areas
of concern, and looking at some of the practicalities—the
question of whether in fact, if the directive was implemented,
to what extent it will be impossible for clinicians to use the
techniques they want. It is looking to see what evidence is available,
what research needs to be commissioned, and what the practicalities
are. At the same time, we encourage the clinicians to talk with
their colleagues within Europe. I hope that the result of this
work, which is being done together, will produce the evidence
base that will then enable us to come to a firm conclusion. As
you will have seen from your own considerations and the witnesses
you have received, at the moment we are still faced with a disagreement
between that expressed by the Commission officials and the clinicians.
Everything we do in this area has to be evidence-based.
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