Memorandum submitted by the Institute
of Occupational Medicine
EXECUTIVE SUMMARY
— We acknowledge the vital role
fulfilled by HSE (and HSC) as lead organisations with the mandate
to ensure the health and safety of workers in Great Britain. We
believe that these bodies take a balanced and mature approach
to risk management in the workplace, and that they display a laudable
commitment to partnership working.
However:
— Given its mission, we question
whether it is appropriate for HSE to have a PSA target based on
working days lost to absence. This has led to an increased focus
on sickness absence and incapacity, at the expense of the control
of risks at work and the protection of workers from exposure to
hazards. Together with reductions in real terms in its overall
budget, it means that HSE is under-resourced to meet its core
responsibilities.
— We believe there has been a
significant weakening of HSE's specialist expertise, particularly
in the medical arena, coupled with a net reduction in the resources
available for enforcement. The consequences are that HSE is less
able to provide clear, authoritative advice and guidance, and
less able to carry out an effective enforcement programme.
— There has been a shift in approach
towards encouraging companies to carry out qualitative risk assessments,
as opposed to the collection of hard data and the expert interpretation
of such data.
— There are some unfortunate perceptions
of health and safety. Workplace health in particular is not widely
perceived as an important issue, either by politicians or the
general public. Occupational disease is often (wrongly) considered
to be a thing of the past. In the worst case, workplace health
and safety can be caught up in the media-led ridiculing of the
general health and safety culture and the notion of the nanny
state. These perceptions do not make HSE's job any easier.
— There is ambiguity over the
role of the Health and Safety Laboratory, which on the one hand
is the in-house laboratory of a government body, and on the other
hand is a publicly-funded provider of commercial services. We
believe that this has led to unfair competition in the market
for commissioned occupational health science.
— The shift in emphasis towards
the management of sickness absence, the weakening of HSE's specialist
expertise and enforcement capability, the move towards subjective
risk assessments and away from data gathering, and the low public
and political profile of occupational health have, we believe,
contributed to a "dumbing down" of occupational health
and safety, particularly health.
— Many of these same factors are
contributing to a narrowing of the science base in occupational
health, and the unfair competition created by the activities of
the Health and Safety Laboratory is resulting in an additional
threat to the future security of the science base.
— Our recommendations are intended
to redress these difficulties.
THE INSTITUTE
OF OCCUPATIONAL
MEDICINE (IOM)
The Institute of Occupational Medicine (IOM),
a self-funding charity, and its subsidiary IOM Consulting Limited
were formed with the primary aim of carrying out research, consulting
and services to help make workplaces safer and prevent ill-health.
Though our activities are international and include environmental
as well as occupational risks, our main activities are focused
on the health and safety of workers in Great Britain.
Overview comments
1. We see the health and safety of workers
in Great Britain as very important, and something that needs to
be safeguarded to a high standard, for ethical and for economic
reasons.
2. We look on the HSC and the HSE as the
lead organisations mandated to help ensure the health and safety
of workers in Great Britain. Consequently, we are firmly in favour
of a strong and effective HSC/E and we welcome the integration
of the Health and Safety Commission and the HSE, for the reasons
given in the initial consultation about the proposal to merge
them. We hope these comments will help in some way towards strengthening
health and safety in Great Britain. (Throughout the body of this
response we use the acronym HSE and so do not distinguish between
the Commission and Executive.)
The changing context in which HSE operates
3. The need to protect the health and safety
of workers is unarguable. However, there are a number of unfavourable
aspects of the overall context in which this needs to be done
at present. We highlight three.
4. There is a problem of perception. Although
occupational health and safety is taken very seriously by many
of the individual politicians, workers, professionals, managers
and members of the public that we encounter, there is a wider
public perception that it is an old-fashioned subject, and no
longer very relevant. In contrast, protection of the environment
has (properly) become an issue highlighted among politicians and
in public debate. There is, from time to time, major focus (sometimes
in the form of panics) on food safety. Nutrition, physical activity
and obesity have become topics of major importance. There is some
ongoing focus on the conditions of those workers overseas, especially
those in poorer countries, who produce, under conditions of exploitation,
cheap raw materials, goods and services for the UK market. However,
apart from short-lived responses to occasional fatal accidents,
the health and safety of workers in Great Britain is not perceived
as an important issue among the wider body of politicians or the
general public. This is particularly true where health rather
than safety is concerned. There is a perception that occupational
disease is a thing of the past, and that the well known occupational
diseases have been eliminated. There is little understanding that,
in proportion to the numbers of workers exposed to risk, the chances
of developing even old-fashioned but fatal disease still constitute
a significant problem. Moreover, there is little understanding
of the contribution exposure to occupational hazards makes to
the risk of developing a wide range of diseases not thought of
as primarily occupational, for example lung and other cancers,
and chronic obstructive pulmonary disease (COPD).
5. In fact, the situation is worse than
this. It has become fashionable within the popular media to attack
the notion of safeguarding health and safety. Partly this is a
ridiculing of occasional instances (either real or mythical—"Myth
of the Month" on HSE's website is informative as well as
amusing) where health and safety precautions have clearly been
taken to extremes; and though often these apply to safety of children,
not workers, the attack becomes an attack on the "health
and safety" culture as a whole. Partly it is an attack against
the whole notion of affording protection to workers and others,
on the grounds that this is a further example of the so-called
"nanny state". Either way, it puts under attack the
concept of protecting the health and safety of workers, and it
puts the essential work and role of the HSE on the defensive.
The current treatment of health and safety in popular culture
is like the ridiculing of European legislation which was in vogue
about 20 years ago—interestingly, this has largely subsided
in recent times.
6. There is a problem of resources. While
there have been real increases in public spending on areas such
as healthcare and education, there have been cutbacks in other
areas. These include the DWP, of which HSE is a part. We understand
that, in real terms, HSE's budget has been cut in recent years
leading to reductions for example in the numbers of inspectors
available for enforcement.
7. Resources mean not only numbers, but
knowledge and skills. We understand that increasingly, HSE inspectors
may lack the solid grounding in science or engineering that is
necessary for understanding many issues of occupational exposure
and its control, and for making good judgements on-site. We recognise
the importance of inspectors having good inter-personal and other
skills, for example in winning co-operation; but core skills in
health and safety must not be compromised.
8. A related element is the downgrading
of HSE specialist knowledge, for example in occupational hygiene
and notably in HSE's medical capability—what remains of
the Employment Medical Advisory Service (EMAS). This means that
front-line inspectors do not necessarily get the specialist back-up
they need, in a job which of its nature is a multi-disciplinary
one. From a medical point of view, the NHS doctor who suspected
occupational disease in a patient used to have a ready local source
of occupational medical advice and experience in the local EMAS
physician. This allowed discussion of the case on a confidential
basis, and confidence that the medical issues that affected the
specific patient and, importantly, his or her workfellows, would
be investigated and resolved. For at least a decade this has no
longer been the case, and such issues may well go unresolved and
workers may suffer as a consequence. The extensive experience
and understanding of occupational medical problems that existed
in HSE's medical inspectors no longer exists. The decline in EMAS,
and the expert knowledge therein, has significant implications
for the future of occupational health in Great Britain.
9. There is a problem of an explicit or
implicit change in role for HSE. It seems that increasingly, HSE
is under pressure to help the economy, by managing outcomes such
as sickness absence and incapacity, rather than focus on its central
mission, of ensuring that risks at work are controlled properly.
Of course the latter remains important to HSE; but we perceive
a change in emphasis. This may be consolidated by the culture
of target-setting and management to targets. While two of HSE's
three headline Public Service Agreement (PSA) targets focus on
reducing respectively (i) work-related fatalities and injuries
and (ii) work-related disease, the third focuses on reducing days
of sickness absence, whether work-related or not. We consider
the first two to be appropriate targets for HSE, given its mission—to
protect people's health and safety by ensuring risks in the changing
workplace are properly controlled. The third is, however, about
the overall effective management of businesses, rather than the
control of risks at work, and the associated protection of workers
from work-related hazards to health and safety. (Disease and injury
caused or exacerbated by work is a relatively minor determinant
of the amount of sickness absence from work).
10. There are other changes, eg the changing
nature of British industry, with the long-term decline of production
and growth of services; changing demographics of the workforce,
with an ageing workforce and more immigrant workers; new hazards,
for example from asthma-causing chemicals and possibly from manufactured
nanomaterials. But these might be looked on as "business
as usual" changes, of the kind that HSE might under any circumstances
expect and be expected to respond to. Those we have highlighted
earlier are contextual changes of a different kind.
HSE's response to that context and some implications
11. HSE has made many changes in response
to this change of context. Generally, we think the broad thrust
of HSE's response has been good. For example,
(a) HSE has, correctly, judged that it cannot
deliver its PSA targets in isolation, that it needs partnership
working to do this. This is a good move, in that it places HSE
at the head of a movement to control risks in the workplace, rather
than as a body acting in isolation.
(b) HSE puts forward a balanced attitude
to risk; it accepts that some risk is inevitable, but emphasises
that risk can and should be controlled and reduced.
(c) HSE has streamlined its organisation
and activities to deliver its PSA targets. This includes developing
and publishing its strategy for achieving them, and monitoring
progress. This is good—though we do not think that having
a target on sickness absence is appropriate.
(d) Also, we think that HSE has handled well
the fact of devolved administrations in Scotland and Wales. Our
direct experience is with the situation in Scotland, where we
see effective co-operation between HSE and the Scottish Government,
in ways that respect the planned distribution of responsibilities.
However, some other aspects of HSE's response
have had what we assume are unexpected or unintended consequences.
12. HSE's focus on partnership working has
some drawbacks (none of them intrinsic). One is that HSE seems
to be trying to do too much by co-operation and persuasion, at
the expense of its role in giving strong and clear direction,
and in strong enforcement. This is a consequence also of scarcity
of resources—of not having enough inspectors to make enforcement
a real threat. From our many contacts with industry we get the
impression that many companies think that HSE is without teeth—that
the chances of an inspection are small and, if something untoward
is found, then there will be a lenient timescale for correcting
it. This means that the `threat' of HSE enforcement is not seen
as a real one, and so is not seen as a motivator for better practice.
It is possible to have co-operation as a main model, without compromising
enforcement. This may mean more resources but it is also a question
of viewpoint, of the balance between direction and persuasion.
13. Another aspect is that HSE looks to
companies to carry out health and safety work themselves, for
example through risk assessments. This is good insofar as some
risk assessments get done which otherwise would not, and—for
routine hazards and risks—the quality of the assessments
may be sufficient to help manage the risks effectively. There
are however many situations where measurement is needed to properly
evaluate a situation, and we note a trend in industry to back
off from measurement in favour of subjective assessments. Also,
there are situations where access to in-depth knowledge and specialist
skills is needed in order to deal effectively with more difficult
problems; and this may be overlooked by somebody less experienced,
especially if the risk assessment is being done as a formality
rather than as a real exercise in risk management and reduction.
We think HSE could and should emphasise more strongly that "lay"
assessments need to be underpinned by measurement and by specialist
knowledge.
14. A third aspect is that some HSE guidance
is vague, and leaves it too much to companies to assess for themselves
what changes to make and when to make them. This would work well
if companies (i) saw good health and safety practices as intrinsic
to good management, rather than something to be done minimally;
and (ii) had sufficient access to and use of specialist knowledge.
There are many situations where these two desirables are not in
place. As it stands, more authoritative guidance could be beneficial.
15. This progressive weakening of HSE's
expertise and enforcement roles, together with a focus on managing
sickness absence, has contributed to a kind of dumbing-down of
health and safety knowledge and expertise, to the point where
the demand for specialist knowledge is far short of the need,
and the science base in occupational health and safety is in danger
of being seriously compromised. We believe this is particularly
true for occupational health, though we re-emphasise that in our
work, we meet many capable and committed health and safety professionals
working effectively to control risks, and getting help when needed.
16. HSE, through its Chief Scientist, Dr
Patrick McDonald, recognises there is a problem with erosion of
the science base. We support the work he is doing, with others,
to try to rectify it. We are not convinced, however, that HSE's
own unintended part in this erosion is properly recognised.
17. The situation is added to by HSE's policy
of placing its commissioned science work, as far as practicable,
with its own Health and Safety Laboratory (HSL). This is an understandable
response to the high costs of the new building that HSL occupies
at a time when HSE's overall budget is simultaneously being cut
in real terms. The policy does not however guarantee best value-for-money
in relation to the specific projects that HSE needs to commission;
and, together with the policy of supporting and in effect subsidising
HSL to gain 3rd-party funding, in competition with other providers
of research, consultancy and services, it creates unfair competition,
and risks further narrowing of the overall science base in occupational
exposures and health. We think it is inadvisable and inappropriate,
that the regulator should also aim to become the principal provider
of commercial services in this area. These comments reflect an
element of self-interest on the part of IOM in that we compete
with HSL for this type of work, but the view expressed in this
paragraph is widely held in the British occupational health community
and we make the comment in the spirit of trying to ensure that
the whole arena of workplace health and safety in Great Britain
should work well.
18. HSE signed up to three headline PSA
targets. As noted above, we think two of these are fully consistent
with its mission, while the third is not. These targets have informed
HSE activity in recent years. However, the associated push for
quick gains in reducing work-related injuries and disease has
led to a focus on situations where the adverse consequence is
more-or-less immediate, at the expense of areas where there is
significant latency before serious disease becomes manifest. We
see signs that HSE is finding ways of re-asserting the importance
of traditional occupational diseases which may take many years
to develop. (The current PSA targets discourage this focus.) We
support the moves to re-focus on traditional long-term issues
to complement the recent emphasis on seeking immediate gains.
RECOMMENDATIONS
19. Our primary recommendation is that HSE—without
reduction in its resources—be allowed and encouraged to
return to its original mission, ie "to protect people's health
and safety by ensuring risks in the changing workplace are properly
controlled". This implies a greater focus on reducing work-related
disease and injury, and a reduced focus on managing sickness absence
(except insofar as this is work-related, or an early return to
work might imply unacceptable risks). Relieving HSE of what we
see as an unwarranted responsibility for workplace sickness absence,
without loss of resources, would we think bring with it a resolution
of many of the other difficulties noted above.
20. A less satisfactory alternative is that
HSE keeps its current targets, including that for sickness absence;
but gets substantially more resources to deliver them. These resources
would logically come from Departments (DWP, BERR, maybe Health)
who gain from HSE taking on this work, which in our view is really
outwith its core role. We consider this way forward less satisfactory
because the associated expansion of HSE's role is confusing with
regard to HSE's core mission. We think it better if HSE could
focus on that mission, without distraction.
21. We recommend that HSE's complements
its policy of encouraging companies to move forward on health
and safety issues with in-house and possibly lay expertise, with
a policy of emphasising the need for companies to underpin this
work by drawing on specialist expertise.
22. We recommend that HSE re-builds its
own specialist expertise, particularly medical, in its traditional
role of providing authoritative advice and guidance to inspectors
and other practitioners, and not as a commercial service.
23. We recommend that HSE removes the ambiguity
in the role of HSL, between that of an in-house laboratory providing
services to a government body, and that of a publicly-funded commercial
service provider.
24. Finally, we recommend a greater emphasis
on effective enforcement. This would mean more inspectors, and
so more resources. It need not compromise effective partnership
working.
|
