Memorandum submitted by Professor Anthony
Seaton CBE, MD, DSc, FRCP, FMedSci
Occupational diseases are an
important cause of ill health and even death.
Their recognition and management
is difficult, a matter for trained medical specialists.
The HSE used to have, but no
longer has, such a nation-wide body of specialists. This loss
has occurred over some 20 years and appears to represent a failure
to recognise the importance of medical expertise to the organisation.
An alternative resource is not
available elsewhere in the UK and this causes serious difficulties
for the generality of doctors in dealing with suspected occupational
disease and thus preventing it in other workers.
Matters have recently been exacerbated
by diversion of HSE resources to sickness absence management,
an essentially non-medical management matter.
Lack of special medical and
other scientific expertise in the HSE threatens the ability to
enforce legislation and can be seen as pandering to those who
denigrate "Health and Safety" as an obstruction to business.
1. Occupational diseases remain an important
cause of ill health in the United Kingdom. They may be difficult
to diagnose and delays in diagnosis may lead to two important
consequencesthe condition becoming intractable and other
exposed workers suffering the same fate. Occupational asthma and
skin allergies and occupational cancers are well-recognised problems;
less so are the influence of occupational exposure on development
of chronic obstructive lung disease or on mental deterioration
and chronic neurological disorders such as Parkinson's disease.
2. The prevention of occupational disease
is the primary responsibility of the HSE. However, the detection
of occupational disease in individuals is dependent on the ability
of hard-pressed general practitioners and consultants to suspect
an occupational cause. It should be recognised that the primary
roles of clinical doctors are to make a diagnosis and to plan
a course of management for individual patients and that in the
normal run of practice investigation of causation is of secondary
interest. The education of medical students and of young doctors
in this issue of aetiological diagnosis is patchy in the UK and
often is dependent on voluntary efforts by committed doctors offering
their services to Medical Schools rather than a formally funded
part of the curriculum. There is thus a likelihood that a patient
with an occupational disease will go for a prolonged period without
such a diagnosis being made.
3. In the event of a doctor recognising
a possible occupational cause of his/her patient's condition,
the primary concern is to manage the condition in a way that allows
the patient to recover. Inevitably, this involves intervention
in the workplace. This is an area of work in which only occupational
physicians have expertise. When I started teaching undergraduates
and postgraduates occupational medicine in the late 1970s, the
advice I gave was simple, thus: "There is a national body
of trained occupational physicians, skilled in the diagnosis of
occupational disease and in the investigation of workplaces, who
have the authority to enforce action if necessary and who can
therefore prevent other people getting the same condition. Pick
up the phone and speak to your local EMA." This doctor was
used to seeing occupational diseases and knew how to deal with
them. He or she was in every way analogous to the consultant in,
say, cardiology to whom colleagues would refer a patient suspected
of cardiac disease.
4. This body of doctors with such expertise
no longer exists. The local substitute is usually an Inspector
with little or no medical knowledge or a nurse with some theoretical
knowledge of disease but no practical experience of diagnostic
investigation. Neither, in my experience, really understands the
medical implications of the issues they are addressing. To whom
can a doctor turn? Local consultants in the relevant specialty
may, or may not, have relevant diagnostic experience but will
rarely be familiar with the methods of workplace investigation.
Local occupational physicians will have little practical experience
of diagnosis of occupational diseasetheir job is to prevent
itand their experience is likely to be in only one sector
5. I have observed a progressive side-lining
of occupational medical expertise in the HSE over some 20 years.
In the 1980s and early 1990s it was possible to recommend to my
postgraduates that a few years spent at the "coal face"
in EMAS was the best way of getting hard experience of the discipline
at its core, the prevention of occupational disease. Many did
this, working with experienced practitioners, seeing the day to
day consequences of poorly controlled hazards and learning the
practical problems of diagnosis and prevention. This invaluable
method of training is no longer available, a consequence of the
reduction of resource available and of a failure by HSE to recognise
the value of medical expertise.
6. More recently, the HSE seems to have
become involved in management of sickness absence. This is of
course of great economic importance, but is only distantly related
to its central role in prevention of work-related illness. Prevention
of occupational disease will make a very small impact on sickness
absence, since most absence is related to other causes. In contrast,
involvement in absence management (essentially a management issue
rather than a medical one) leads to diversion of resources from
disease prevention. This appears to be exacerbating the chronic
problem of "dumbing down" the HSE's role in occupational
7. The UK led the world in causing industrial
disease, but also led the world in recognising and preventing
it. The pattern of disease has changed with the changing pattern
of work in UK, but the old hazards remain and new ones are recognised
or suspected. The history of legislation and, especially, enforcement
of that legislation in Britain is a proud one dating back to the
19th century. We have however become complacent; powerful voices
deride the "Health and Safety Culture" and the "Nanny
State". In some countries, good legislation is totally ineffective
because of failure of enforcement. Such countries (of which I
have some personal experience) may gain economically in the short
term, but this is at the expense of the health of their workers.
I fear that this is a path down which we are heading. I am sure
it is not one that Parliament would wish us to continue to walk.
This evidence has been written from the point
of view of someone who has been a consultant physician in the
NHS successively in Cardiff, Edinburgh and Aberdeen since 1971
and who trained in medicine in England and USA before that. I
have taught occupational medicine to postgraduates and medical
students since 1978 and was Director of the Institute of Occupational
Medicine, Edinburgh, from 1978 to 1990. I was responsible for
transforming the Institute from a British Coal organisation to
a self-funding charity in 1990. I was then professor of Occupational
and Environmental Medicine in Aberdeen from 1988 to 2003. In retirement,
I continue to research and consult in environmental health issues
and have an emeritus chair in Aberdeen University and an honorary
consultancy at the Institute of Occupational Medicine. I have
chaired and served on a number of relevant Government committees
and currently chair a Scientific Advisory Committee for the Natural
Environment Research Council.
My main research interests have been in the
causes of the rise in asthma, the cardiac effects of air pollution,
the epidemiology of pneumoconioses and the neurological effects
of commonly used chemicals such as solvents and pesticides.
Professor Anthony Seaton