Select Committee on Work and Pensions Written Evidence


Memorandum submitted by Professor Anthony Seaton CBE, MD, DSc, FRCP, FMedSci

SUMMARY

    —    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 consequences—the 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 disease—their job is to prevent it—and their experience is likely to be in only one sector of industry.

  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 disease prevention.

  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.

MY INTERESTS

  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

January 2008





 
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