86. Occupational safety is concerned with preventing accidents at work and is addressed, in essence, by physical improvements to the working environment. Occupational health, on the other hand, is more difficult to define and to manage. It concerns taking care of the economically active section of the population and involves managing the impact of work on people's health; managing the impact of health on people's work; health promotion; and environmental impacts.

87. While there has been some success in controlling traditional occupational diseases such as heavy metal and toxic chemical poisoning as well as the lung disorders traditionally associated with mining and quarrying, attempts to prevent and manage the long term effects of working with asbestos, organophosphates or occupational allergens to lung or skin, for example, have been less successful. Furthermore, increasingly the attention of occupational health practitioners is turning to a third group of problems: illnesses which may occur in the population anyway but might be caused or exacerbated by work. These include musculo-skeletal disorders (for example, repetitive strain injury, back pain) and psychosocial disorders such as occupational stress.

88. Several witnesses accused the HSE of neglecting occupational health. When it was established, health was not an original focus for the HSE and it consequently has continued to receive less attention than it should. The TUC claimed that the HSE's record is better on safety than it is on health[143] and RoSPA described health as "the Cinderella part of health and safety".[144] The Government conceded that previously this area had been neglected[145] and told us that each year 25,000 people give up work never to return due to occupational health problems. The scale of the problem may be even greater: a Labour Force Survey in 1995 found that 2.2m people are affected each year by occupational health problems.[146] We are concerned about the numbers of people affected and the resulting personal and economic cost.[147]

89. However, we recognise that this is a difficult area to regulate since problems often have a long gestation period and scientific evidence that occupations cause ill-health is often elusive. This may explain why such problems may not have been addressed as effectively as other workplace diseases, or unsafe working practices. The lack of 'proof' has also been a source of friction between employers and employees. The CBI expressed concern that any proposed action on occupational health needed to be "based on sound science rather than speculation or unfounded public concerns".[148]

90. In contrast, the TUC was worried that a lack of scientific proof was simply being used as an excuse for inaction. It told us that "people will always be requiring more evidence and we will never actually get round to the action".[149] The TUC believes that there already exists sufficient evidence to warrant action on some of the major occupational health problems. We agree with this view and believe there is a danger in delaying responses to some of the less straightforward occupational health disorders. As has been the case with asbestos related diseases, there can be dire consequences in waiting for definitive scientific proof to become available. We agree with the views of Bradford Hill quoted in 1965:

"All scientific work is incomplete—whether it is observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer on us a function to ignore the knowledge we already have, or to postpone action that it appears to demand at a given time".[150]

91. We are therefore pleased that the HSE has adopted occupational health as one of its five 'strategic themes' in its Strategic Plan. It aims to 'raise the profile of occupational health', to try to reduce the extent and severity of work-related and occupational health problems.[151] The HSE has already produced a draft long term occupational health strategy[152] which sets out a number of targets to be achieved by 2010.[153] This is likely to be finalised by spring 2000. The Minister also gave us assurances that the Government considered occupational health to be a priority[154] and it features strongly in its review document, Revitalising Health and Safety.

92. Several witnesses, primarily on the trade union side, were concerned about the lack of provision for occupational health.[155] A number of them suggested that more needed to be done and that dedicated provision was the best way forward. UCATT suggested the setting up of Regional Construction Occupational Health Centres, to deal specifically with the many occupational health problems associated with that sector.[156] We discussed some of these problems—for example, vibration white finger and contact dermatitis—on our site visits. The TUC put forward a similar suggestion proposing the establishment of a "comprehensive community occupational health service".[157] This would cover all sectors and would be based in GP surgeries, plugging the gap caused by the provision of private occupational health services by the larger companies and no service at all in small firms.

93. We believe that it is currently very difficult to address occupational health problems within the mainstream health service. Incidence is likely to increase and we are concerned that HSE's strategy and associated targets, while welcome, may not be ambitious enough. We therefore recommend that the Government and the HSE develop the idea of an occupational health advisory network based around primary care groups. The resource implications of such a plan would need to be considered, but we believe that primary care groups and trusts could well act as a valuable and relevant population based focus for initial advice and help on occupational health and safety matters. Referrals on to specialist units would be feasible in the current public and occupational health infrastructure.

143  Q107 Back

144  Q82 Back

145  Q404 and HSC Annual Report 1998/99  Back

146  Jones JR, Hodgson JT, Clegg TA et al, 1998, Self reported work related illness in 1995 HSE Books Back

147  The Minister estimated that the economic cost of occupational health problems was over £2 billion a year (Q440) Back

148  HSE17, para9 and see Q4. The CBI also strongly argued that HSE activity should continue to be focussed on workplace health and safety rather than embracing "lifestyle issues or public education". Back

149  Q123 Back

150  Bradford Hill, A, 1965, The Environment and Diseases: Association or Causation? Proc. Roy. Sco. Med. pp 295-300 Back

151  HSE25, para 10 Back

152  HSC Healthy work, healthy at work, healthy for life A new long term occupational health strategy for England, Scotland and Wales Back

153  These are: a 20 per cent reduction in the incidence of work-related ill health; a 20 per cent reduction in ill health to members of the public caused by work activity; a 30 per cent reduction in the number of work days lost due to work related ill health; 100 per cent of all individuals who have been ill, will be given the opportunity to be assessed for rehabilitation back into work, and as appropriate rehabilitated. HSC Healthy work, healthy at work, healthy for life, a new long term occupational health strategy for England and Wales - DRAFT Back

154  Q404 Back

155  see HSE02, HSE18, HSE23 Back

156  HSE23 Back

157  HSE18, para5 Back