Select Committee on Work and Pensions Written Evidence


Memorandum submitted by Professor Raymond Agius

1.  EXECUTIVE SUMMARY OF THE MAIN POINTS MADE IN THE SUBMISSION

    —  Although more resource may be needed for the HSE to fulfil its roles, there is evidence to suggest that the HSE has not used its research budget in the most efficient manner.

    —  The research needs of the HSE are best procured through fair and transparent competition open to Universities and others on a "level playing field basis".

    —  The effect of health on the capacity to work, and the influence of work on health are two sides of the same coin. The HSE should therefore be resourced to do more to achieve vocational rehabilitation. However others, such as GPs, have an important role to play in vocational rehabilitation and should be provided with the training to engage in this.

2.  A BRIEF INTRODUCTION TO THE SUBMITTER, EXPLAINING THE AREA OF EXPERTISE AND INTEREST

  2.1  I am the Professor of Occupational and Environmental Medicine at the University of Manchester. I have held this position for the last seven years. The University of Manchester admits about 150 doctors and scientists for postgraduate courses leading to University degrees, Diplomas or other qualifications in Occupational Hygiene or Medicine every year (probably more than the total of the other Universities in these fields in the UK). It is one of the foremost centres in the UK undertaking research in occupational and environmental health.

  2.2  As part of the same job package I am the leader of the Occupational and Environmental Health Research Group http://www.medicine.manchester.ac.uk/coeh/ in the School of Translational Medicine of the Faculty of Human and Health Sciences at The University of Manchester. I am also an honorary consultant in the Central Manchester and Manchester Children's Hospitals NHS Trust and at South Manchester University Hospitals NHS Trust.

  2.3  My previous appointments have included being a Senior Lecturer in Occupational and Environmental Health at the University of Edinburgh (1990-2001) and prior to that: Director of Medical Services at the Institute of Occupational Medicine, also in Edinburgh.

  2.4  My research interests have ranged widely from occupational to environmental ill health including respiratory and cardiovascular disease, stress and back pain, and audit and quality in the delivery of occupational health services. I have a special interest in education in occupational medicine especially utilising the Internet and other innovative approaches. My book Practical Occupational Medicine is now in its second edition.

  2.5  I am a Fellow of the Royal Colleges of Physicians of London and of Edinburgh, a Fellow of the Faculty of Occupational Medicine of the Royal College of Physicians of London and an Honorary a Fellow of the Faculty of Occupational Medicine of the Royal College of Physicians of Ireland. I have served on various national and international committees, governmental and non-governmental bodies, and am a past president of the British Occupational Hygiene Society.

  2.6  I have lectured widely and my invited "eponymous" lectures or orations include the Donald Hunter lecture (Faculty of Occupational Medicine, Royal College of Physicians of London), the Smiley lecture (Faculty of Occupational Medicine, Royal College of Physicians of Ireland), the Ferguson Glass Oration (Australasian Faculty of Occupational Medicine, Royal Australasian College of Physicians), and the Heijermans Lecture (University of Amsterdam).

  2.7  My vested interest in this is that as an Occupational Health professional for about 22 years I am keen for the UK workforce to have the benefit of an effective and efficient Health and Safety Executive and Commission. Moreover I have had financial support for my research from the HSE intermittently over the last 20 years, and have extant project funding awarded from the HSE for my research at the University of Manchester of about £1 million, essentially in support of parts of the University's research programme entitled The Health and Occupation Reporting Network (THOR) http://www.medicine.manchester.ac.uk/coeh/thor/.

  2.8  Further information about me is in the public domain: http://www.agius.com/raymond/

3.  FACTUAL INFORMATION BEING OFFERED

  3.1  Experience of dealing with HSE's inspectors, with workers and with employers suggests that, especially in relation to the Employment Medical Advisory Service (EMAS), the reduction in staffing resource over the last two decades has had adverse consequences. When workers are worried as to whether their health has been, or might be, adversely affected by their work, their medical attendants (GPs or consultants) are often not best able to address these concerns. Moreover even when the doctors believe that ill health may be work related they are usually not in a position to follow up their suspicions with appropriate workplace investigations and actions—these being functions of the HSE. I have found an increasing need and demand for such medical advice over the years "pari passu" with the shrinkage of the medical advisers/"inspectors" in EMAS. Whilst I and other NHS based occupational physicians have gladly assessed such workers when requested (usually by their GPs, sometimes by consultants) our capacity to deliver this service is limited, and we do not have access to the workplace and to the means of improving it in the same way that HSE inspectors have. More investment of resource is needed to support HSE's medical advisory functions, within its field operations.

  3.2  Most or all of the HSE's objectives rely in the first instance on high quality information, a great part of which requires specific research, and cannot be obtained by statutory means alone. For example the Reporting of Injuries Diseases and Dangerous Occurrences Regulations (RIDDOR) is acknowledged by HSE as being notoriously poor at collecting information about work related ill health. In fact HSE no longer uses its own RIDDOR data to provide statistics on its website about work related ill health. However, it is important that the HSE has access to high quality information on the incidence of common disorders such as work-related musculoskeletal disease, and mental illhealth. It also needs to be able to monitor less common hazards or illness but which may present a high risk in specific sectors such as by identifying new causes and incidence of asthma and dermatitis in hazardous occupations (eg the chemical industry) as well as in other sectors such as in health care and in hairdressing. It also needs to monitor the economic cost relating to work days lost. Since the statutory means offer an incomplete picture, engagement with stakeholders such as medical practitioners (be they GPs or specialists) and support of appropriate networks which these doctors trust is essential. The Health and Occupation Reporting network (THOR) run by the University of Manchester http://www.medicine.manchester.ac.uk/coeh/thor/ and with a provenance dating back to the Surveillance of Work-Related and Occupational Respiratory Disease (SWORD) scheme in 1989, is such a UK network of about 2,300 doctors. The "THOR" research conducted at the University of Manchester provides very useful information for HSE both on the incidence of common ill health, and on novel causes as well as on sickness absence. Its value is attested by the HSE's website and by several peer-reviewed publications. It has secured funding from HSE competitively through tender bids, as well as support from other sources. So long as such valuable work fulfils its objectives (eg in helping the HSE monitor trends in illhealth) through competitive and high quality research, resources need to be provided to maintain it.

  3.3  There is evidence that HSE might not have allocated its research budget in the most efficient possible way. The HSE has a research budget to the order of £40 million per annum. Between five and 10 years ago HSE seemed to have abandoned its previous policy of considering research proposals through an open competition of ideas. This meant that new research needs identified by forward thinking academics and others, together with proposals for addressing them no longer have a forum within a Government body, nor prospects for Government funding unless the HSE successfully "second-guesses" the issues and concepts that the researchers would identify. This change in policy as well as other factors (indicated below) result in a weakening of the UK's academic base in occupational health which, although small when compared to a number of other developed countries in the EU and elsewhere, undertakes research and education of an international standard. A weakening of this academic bedrock in occupational health may result in a reduced capacity for the UK to measure the risks of health to its workers and to maintain a healthy and productive working population.

  3.4  Between five and 10 years ago HSE embarked on a costly plan funded through a Private Finance Initiative (PFI) to build new "Health and Safety Laboratory" (HSL) premises and facilities in Buxton (contract finally signed in 2004). More or less in parallel with this, the HSE adopted a policy whereby HSL, ie their own internal "supplier", would automatically and as a general rule be the provider of choice for all HSE's research needs. Information stated in, or inferred from, the HSL's annual reports indicates that the HSL property is worth about £57 million and costs the taxpayer more than £8 million per annum in the lease charges and the various PFI service costs (yet the Buxton premises do not belong to the taxpayer unlike the Crown property in Sheffield did before it was transferred to the PFI consortium as part of the deal). The HSL receives more than £29 million per annum from the HSE even though it provides HSE with services explicitly worth less than this amount. This suggests that the channelling of a large proportion of the HSE's research budget in a non-competitive manner to HSL (and thence a large proportion of that to the PFI consortium) is not the most efficient stewardship of taxpayers' money.

  3.5  The HSL does have high quality research capabilities, and arguably some of its facilities and activities are unique. In these areas it need not fear, and indeed should relish, open competition in seeking and obtaining public funding. However, in many other research areas where an alternative entity eg a University department can best meet the HSE's research needs and can demonstrate this through open competition, and through its track record and results, then it is important that the most effective provider should do so. Unfortunately whether for reasons of the manner in which HSE had chosen to manage its research budget or for other reasons, this principle of procuring the best quality research competitively, has not been consistently pursued. There are instances where external academic providers had, as per past HSE policy, on more than one occasion secured research funding competitively from the HSE. They have gone on to deliver to specification, on time and at or below budget. They have in their specific area achieved a quality of stakeholder involvement and of statistical results unarguably better than that which the HSE had achieved with the full force of the law behind it. In at least one of these instances HSL had originally submitted a tender to do the work but did not succeed in the competition against the external academic provider. Yet in 2006 a strategy proposed from within HSE in regard to this research work was as follows: "The overall strategy... would be that over time there would be a gradual transfer of a large proportion of the work... to HSL... Under the above strategy,... the only possibility of further funding would be from HSL resources.... this might involve some staff transferring to the HSL payroll... However, the longer-term aim would be for the majority of the staff... to be located at HSL". In other words, in spite of compelling reasons for the external academic provider to continue to do the work, it was posited that taxpayers' money would nevertheless go to HSL instead, and if HSL did not have staff with the competencies or experience to do the work the staff from the external academic department would be transferred to HSL. One is hopeful that under senior management more recently appointed to HSE the attitude in research procurement results in an ethos in the whole organisation that is not so anti-competitive. Indeed there are highly welcomed indications that this more recent new blood at senior level values the need for open, fair and transparent competition, to achieve high quality research procurement.

  3.6  No specific "evidence" can be offered regarding the HSE on the subject of removal of its crown immunity. Nevertheless, the perception of a different set of weights and measures when it comes to matters of health and safety can only be harmful by undermining confidence and engendering cynicism.

  3.7  When, about three and a half decades ago, HSE, and in particular EMAS, was founded, the provision of specialist advice regarding vocational rehabilitation was an explicit responsibility of the latter. With time, and shrinkage of resources, the function of EMAS to advise on rehabilitation in the workplace dwindled away to practically nothing. Recently various laudable initiatives have arisen from DWP and elsewhere to foster workplace rehabilitation. However, it should be borne in mind that the management of the influence of health on work and of the effects of work on health are "two sides of the same coin". The competencies needed for the former are inextricably linked with the understanding of the workplace and credentials that are required by the latter. The HSE should therefore be resourced to do more to embed vocational rehabilitation in the workplace both at a strategy/policy "macro" level and at the "tactical" level of providing the expert staff and resources, to work in tandem with other stakeholders. Historically EMAS, within the HSE, used to provide excellent postgraduate training opportunities for aspiring specialists in Occupational Medicine competent both in the prevention or management of work related ill health and in the rehabilitation of workers back to work. For several years now EMAS/HSE offers no such jobs and instead relies on attempting to attract doctors with prior postgraduate training in private industry or in the NHS, without itself contributing to expanding the limited pool of such trained doctors.

  3.8  However, vocational rehabilitation is unlikely to be satisfactorily achieved by the HSE or by other Government bodies alone, nor even simply by agencies or other companies paid to address this issue. Employers and their advisers eg occupational health professionals have an important role to play. However, the involvement of medical General Practitioners is crucial. They need to be provided with the training, motivation and resources to fulfil their role in supporting vocational rehabilitation.

  3.9  The information offered above has been limited mainly to my specific academic or professional interests. Nevertheless it is recognised that all stated aspects of this enquiry are important, and more could be said about some of the others not specifically addressed here.

4.  MAIN RECOMMENDATIONS FOR ACTION WHICH THE SUBMITTER WOULD LIKE THE COMMITTEE TO CONSIDER FOR INCLUSION IN ITS REPORT TO THE HOUSE

  4.1  The HSE ought to be stimulated to get the best value for the taxpayers' money committed to its research budget by adopting as a general rule the policy that its research requirements should be met by an open, fair and transparent competitive process. The HSL would be welcome to compete too, but on a "level playing field basis". The competing applications for research funding by HSE should be submitted to external peer review, and with a clear demarcation between those parts of HSE involved in commissioning the research and the HSL in the event that it also bids to do the work.

  4.2  Advice on vocational rehabilitation should be more firmly embedded as a function of the HSE and especially of EMAS, with appropriate provision for training and employing staff.

  4.3  Both for research needs and for training purposes, partnership between HSE and external stakeholders such as academic institutions and networks of relevant health care professionals (as well as employees and employers) is essential.

  4.4  Correspondingly, further resource needs to be provided de novo or vired to permit the above to be fulfilled.

Professor Raymond Agius

January 2008





 
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