OCCUPATIONAL ALLERGIC DISORDERS
3.9.Obtaining accurate data on the prevalence of
work-related allergic disorders is particularly difficult because
occupational illnesses can have many causes, not just allergy.
Allergy to flour causes Bakers' Lung in bakery workers, but Professor
Anthony Newman Taylor, Chairman, Industrial Injuries Advisory
Council pointed out that other occupational asthma, such as that
caused by "an irritant chemical, such as chlorine or sulphur
dioxide" is not allergy-related (p 92).
3.10.The Health and Safety Executive (HSE) collects
data on occupational diseases through a range of sources. Their
lead source is usually the survey of self-reported work-related
illness, but this fails to give "reliable estimates"
of the prevalence of occupational lung and skin disease (Q 58).
The HSE also co-ordinates the Reporting of Injuries, Diseases
and Dangerous Occurrences Regulations 1995 (RIDDOR) which requires
employers and self-employed people to report cases of occupational
illness. Professor Raymond Agius, Director of The Health and Occupation
Reporting (THOR) network, claimed that RIDDOR suffered from "substantial
under-reporting" (p 93) because, as the British Occupational
Health Research Foundation (BOHRF) commented, "patient consent"
was required to report a case of occupational illness (p 340).
Mr Rob Miguel, Health and Safety Officer at Amicus the Union,
added that employment law in the United Kingdom deterred people
from reporting disease because "if a worker is deemed not
to be able to do his job then he can be laid off" (Q 264).
3.11.For occupational asthma and contact dermatitis,
the HSE therefore relies "quite heavily" on data produced
from THOR network, run by the Centre for Occupational and Environmental
Health at the University of Manchester (Q 58). The THOR network
includes a number of occupational health surveillance schemes
which collect information from occupational specialists who voluntarily
report cases of work-related illness. Of relevance to allergic
disorders are the EPIDERM project, which monitors occupational
skin disorders, and the Surveillance of Work-related and Occupational
Respiratory Disease (SWORD) scheme, which collects information
about respiratory disorders.
3.12.However, some witnesses criticised the accuracy
of the THOR data. Professor David Gawkrodger, Honorary Treasurer,
British Association of Dermatologists, told us that there was
"a core group of reporters who report every single case of
occupational skin disease that they see" but another sampling
group only reported for one month every year. He added that "you
only have to have suspicion" that an allergen is involved
to report it, and pointed out that verification by occupational
allergen testing was not required. Furthermore, general practitioners
(GPs) were "not educated sufficiently" to recognise
occupational skin disease, so the numbers produced by the THOR
schemes were "an estimate not a firm figure" (Q 635)
because, as Professor Newman Taylor pointed out, "only about
12 per cent of the workforce" can access an occupational
physician (Q 265). The BOHRF felt that their "voluntary"
nature also accounted for the under-reporting of these schemes
(p 340).
3.13.Mr Patrick McDonald, Chief Scientist and Director
of the Corporate Science and Analytical Services Directorate at
the HSE, described an extension to the THOR scheme, THOR GP, which
is "based on GPs who have had occupational health training"
(Q 58). But Dr David Orton, Consultant Dermatologist, Amersham
Hospital, Buckinghamshire pointed out that allergens causing dermatitis
were "not only found at work" but also in "people's
domestic environments" so diagnosis required expert interpretation
of the results of skin tests. Similarly, Professor Newman Taylor
pointed out that investigations into occupational asthma also
had to be carried out "in specialist centres" (Q 304).
In an attempt to improve data capture, the HSE is contributing
to two European Union (EU) working groups, the European Statistics
of Accidents at Work project and the European Occupational Disease
Statistics group, which are trying "to standardise the position
for work-related illness and injury" (Q 66).
3.14.Professor Agius told us how the THOR schemes
compensate for factors that lead to underreporting (Q 298), but
described their funding as currently under threat. Although the
GP reporting scheme had been granted HSE funding until November
2008, the specialist schemes were relying on reserve funds and
charitable support. He noted that "the HSE provided us with
a commitment in principle 10 months ago to fund specialist schemes
for a further five years, but they tell us that they are under
severe financial constraints and so far that commitment has not
been made good into a contract, which we seriously need because
we have good staff leaving" (Q 302).
3.15.Mr Ivan Lewis, Parliamentary Under Secretary
of State for Care Services, told us that there were "ongoing
contractual negotiations" (Q 836) to "guarantee funding
of data collection within the THOR GP scheme until 31 December
2010 and the THOR Specialist scheme until 31 December 2011"
(p 320). However, Professor Agius told us that the HSE's latest
offer would only fund around a quarter of the full economic costing.
The University of Manchester had suggested another option to the
HSE where "with their agreement, we could save money on extant
work that we are doing for them and thus reduce our costs for
the extension of the THOR schemes even further" but this
would still leave a "substantial gap" (p 111).
3.16.We welcome the involvement of the Health
and Safety Executive in EU working groups to standardise the collection
of data on occupational illness. The use of common standards in
the diagnosis of occupational allergic conditions would allow
international comparisons of disease incidence, and enable the
evaluation of disease reduction strategies. We recommend that
the Health and Safety Executive should fund The Health and Occupation
Reporting network with the full economic cost of its surveillance
programmes, and we urge the Government to ensure support for this
work in the future.
