Occupational Health Scheme

NATIONAL HEALTH SERVICE REORGANISATION BILL [Lords] – in the House of Commons at 12:00 am on 12th June 1973.

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Within five years of the coming into force of this Act the Secretary of State shall lay before Parliament his proposals for providing an occupational health scheme for all industries which employ in total more than two hundred and fifty thousand persons.—[Mr. John Silkin.]

Brought up, and read the First time.

4.20 p.m.

Photo of Hon. John Silkin Hon. John Silkin , Deptford

I beg to move, That the clause be read a Second time.

It is 14 years, I think I am right in saying, since the Government of the day accepted the ILO Convention and agreed to the development of occupational health services. Time has gone by, Government have succeeded Government—I make no party point of this—and every Minister of Health there ever was has always told those of us who would like to have an occupational health service established, "You are knocking at an open door". Some of us began to think that it is time not only for that door to be opened but for us to be invited inside.

The reasons for an occupational health service, I should have thought, are self-evident. We live in an age in which industry is the predominant occupation of the overwhelming majority of workers in the country. Most of their waking hours are spent in the work they do in factories and industries which they run. It is there, and there above all—in their employment—that they are most exposed to the hazards of the age in which we live. All of us are beginning for the first time to take some notice of the effects of pollution. It has an effect upon employees in addition to the effect on their work when they may be injured at work. That is an obvious hazard which they have to face. Yet all these things fade into insignificance beside the enormous stress of modern life, a stress which occurs so markedly in the work in which people are engaged.

There is not only the stress in the work in which people are engaged but even the effect on their very fitness mentally and physically to do the work they are supposed to do. All these things cause a greater degree of illness and injury in the actual occupation than happens in the home. For this reason, the idea of an occupational health service is something which has been in mind, at least as to lip-service, among most hon. Members throughout these years. What has not followed, however, is appropriate Government action to meet the point.

I have talked about injuries at work and illness, but of course there is another factor. I suppose that we are all very much aware that prevention is better than cure. It was not necessarily so recognised in the past, and people did not perhaps realise it when the National Health Service was set up, but all of us are very much aware of it now, none more than the Under-Secretary of State. I will quote his golden words, spoken in Committee on the Bill: Modern chemo-therapy and modern sanitation have virtually cleared up all the cruder manifestations of ill-health, and we shall make a leap forward only if we really get cracking on prevention. It is certainly the purpose of the Bill to secure that"—[OFFICIAL REPORT, Standing Committee G. 12th April 1973, c. 142.] Those of us who favour the implementation of an occupational health service have been waiting with baited breath for the Under-Secretary to tell us when he will "get cracking". Alas, so far there has been only an ominous and prolonged silence.

We have been told under both Governments that the Employment Medical Advisory Service has been allowed to get under way and that, because of its scope of employment and health hazards, in dealing with this situation it will be sufficient—but of course it will not. I remember that the Under-Secretary said—I cannot quote the reference—that he agreed that the EMAS was only a temporary matter and a question of timing. As his predecessors, he said that we might move to an occupational health service in legislative form under the National Health Service. Of course if it is only a temporary thing, if the whole of the EMAS is to remain with the DEP for the time being, we are discussing only the question of timing.

One of the tragedies of legislation in this country is that, however well-merited legislation may be, there is always someone to tell us that now is not the right time and that it should be another time, perhaps. Then the years go by, but it is never quite the right time. I can understand how the argument developed in the past. First there has been the idea that the setting up of an occupational health service would be very costly and substantial financial resources would be devoted to it when they could be better employed in other areas of the Health Service. There have been many Cinderella parts of the Health Service, as we all agree. We have seen how the long-stay hospitals have deteriorated from bad to worse, as have the geriatric wards, mental hospitals and so on. All these certainly are deserving of care. But we have to bear in mind that prevention is not only better than cure, particularly for those who require eventual cure, but it is also in the long run a more economic method. For that reason, occupational health services have been engendered by large companies here and there throughout the country, to their credit. It must be admitted that they have been effective.

We are proposing by this new clause to see that the Government act on the right lines, to give them time to prepare a good occupational health service. We have limited it to industries which employ 250,000 people. I would not argue about 50,000 either way, but one must make a start somewhere. I see that if one applied this to industries with a smaller number than a quarter of a million one might create difficulties, but I do not think that such difficulties would occur in industries with round about that total of workers.

Another factor is that we have given the Minister and his successors five years in which to prepare for a total occupational health service. That is a good long time. I should have thought that even if this Government went on their shambling course to the last humiliating day of their term, which I work out as two years, one month and 12 days—it may be 11 days—in that period there would certainly be time to receive the results of all the surveys the Government are making, or could make.

It cannot be said that we are exactly rushing the Government. We are saying that, after all the talk since 1959 about a comprehensive global occupational health service, let us get on with it. Five years is sufficient time. We are not hurrying the Minister or the Department or anyone. We are preparing the ground for what could be a most revolutionary step forward in the health and prevention of sickness of our people.

Photo of Mr Timothy Raison Mr Timothy Raison , Aylesbury

The right hon. Member for Deptford (Mr. John Silkin) spoke in his usual sweetly reasonable way, as he did many times in Committee on the Bill, but I wish to import a discordant note into what has been said and to try to raise the question whether even the principle of an occupational health scheme is all that it is cracked up to be.

I wish to look at the new clause in terms of three aspects. The first is whether as it stands the clause is sufficiently clear to make sense. I am not immediately cleat about whether the clause is referring to one scheme for the whole of industry or one for each industry. That obviously is a point of detail, but I think that before one could accept the clause one would have to look hard at industries which are heavily fragmented. The Opposition have plucked the number 250,000 out of the air—and the right hon. Gentleman said that it might be 50,000 either way. I assumed that he was speaking about industries one could get one's hands on, as it were, but what about the retail industry? Does that qualify? Are we to set up an occupational health service for the retail industry covering thousands of little shops throughout the country?

The principle of an occupational health service is either right or wrong. If one believed that it was right, one would say that it should be made available for all industries, or at least all industries which could be shown to need the service, and not on the principle of an arbitrary figure.

4.30 p.m.

There is, secondly, the question of resources. I firmly believe that there are many higher priorities in medicine today than this. There is no need to produce a catalogue of priorities, but hospital waiting lists need a great deal of attention. We would agree that the disparities between the different regions in terms of medical provision is something else which needs attention. I do not believe that occupational health rates as highly as these other things.

I come to the question whether the principle of an occupational health service is the right one. I know that it has been sanctified by the ILO and I know that previous Governments have said that it is a good thing. I suspect that it is one of those things which people automatically say is a good thing without thinking hard about it. They accept the argument that people spend a great deal of their time at work and that people have illnesses connected with work or meet accidents at work. But I do not think it necessarily follows that, because of that, an occupational health service is the right answer.

There may be industries in which there are special hazards and in which some sort of occupational health service makes sense. That is a case that can perhaps be made. If we consider an industry such as coalmining, I should be surprised if doctors operating in those areas were not fully conversant with the special problems created by coalmining.

As a general principle my objection to the occupational health service—and this is a point on which a decisive argument has not been made—is simply that it conflicts with the notion of the family-based health service, which is what I want to see. If we take the analogy of social work, we can consider the introduction of the Seebohm Report and its subsequent implementation. There was a great fragmentation of social work. The Seebohm principle was to concentrate social work on the family services, as is done to a great extent in respect of health. I do not believe that, because a person incurs an illness while at work, that illness should necessarily be treated at work. It seems preferable for it to be treated by a person's family doctor.

The truth is that if there is an occupational health service and a family service running in parallel, many people will use the occupational health service because it is rather more convenient to see the doctor or the nurse, to pick up prescriptions and so on, while at work.

Photo of Hon. John Silkin Hon. John Silkin , Deptford

Is the hon. Gentleman advocating—and this must be the logic of what he is saying—the abolition, for example, of appointed factory doctors?

Photo of Mr Timothy Raison Mr Timothy Raison , Aylesbury

I accept that there is some limited scope for the provision of medical health in the factory. Equally, I believe fundamentally that the goal which we should have in mind is a family-based service. The best person to treat a patient is the family doctor, who has all the knowledge, who knows the family context and who can tie up the whole of a person's medical treatment in one bag.

We all know the problems of split treatment. We know of the problem where one person is treating a patient at one moment but does not know what other treatments are taking place at another moment. That can be avoided by making it the normal thing for a person's health, and I include preventive work, routine testing or anything else, to be the responsibility of the family service. I hope that my right hon. Friend will resist this new clause on the grounds both of expediency and of principle.

Photo of Dr David Owen Dr David Owen , Plymouth, Sutton

I wish to support the new clause but from a slightly devious stance. The clause is very modest. If we believe that something is to be done five years is far too long and I would much prefer the two-year time-scale recommended in the Labour Party's policy document. The time needed for a survey is the minimum period necessary before decisions are taken. I do not agree with the remarks of the hon. Member for Aylesbury (Mr. Raison) about the delineation of these particularly large sections of industry. If it is thought that an occupational health service is necessary, it is needed overall. The way it is implemented overall is something which has to be considered industry by industry, area by area. There is a need for an overall policy which would operate within small factories, which can be some of the most dangerous places.

The nub of the question comes down to the two points raised by the hon. Gentleman, resources and a family-based service. I agree with the argument he put against it although I disagree with his conclusions. Let us deal with a family-based doctor service. I too think that this is an essential element of a national health service.

I wonder whether the hon. Gentleman has spoken to family doctors in areas where there is a group occupational health service or where there is an industry-based occupational health service. I believe he will find, with few exceptions, that general practitioners in such areas strongly welcome the occupational health services. He will also find that there is an extremely good relationship between the doctors and, more important perhaps, the doctors and the occupational nurses working in those industries.

By constant communication there is no overlap of responsibility. It is possible to retain the element of the family-based service and yet save the family doctor a great deal of time, enabling him to give a more effective and efficient service. Before the hon. Gentleman adopts this stance he should make sure that the GPs in his area agree with his criticisms. I think he will find that they do not.

The hon. Gentleman should question why practically all doctors' organisations support the introduction of an occupational health service. An organisation such as the BMA often supports all the different claims of its constituent elements without necessarily looking at overall resources. There is the problem of resources. We know that the Department of Health and Social Security in its evidence to the Robens Committee on accidents and safety which looked at occupational health services, although somewhat cursorily, said that it could not possibly have an occupational health service in under 10 years.

I hope that the Minister will produce some of the evidence on which that statement was based. We well know that Sir George Godber and the various advisers of successive Ministers of Health have opposed an occupational health service, mainly because of the resource allocation question. I do not think it is necessary to have so many doctors in an overall national occupational health service as many people believe.

By using ancillary help and occupational nurses a great deal can be done. Why is it that other countries have an occupational health service, and why is it that many of us believe this to be an urgent priority? To put the Robens Report in perspective, and its recommendations were largely concerned with accidents, of the 314 million working days lost through sickness absence in 1970–71 only about 7 per cent. can be accounted for by industrial accidents. In 1970–71 31 million working days were lost through absences due to mental health disorder, which form 10 per cent. of all sickness absences. That is 50 per cent. more than the total absences due to industrial accidents.

For every day lost by strikes 10 days were lost by industrial disease and injury, and for every day lost by strikes 100 days were lost by ordinary illness. Yet this House and successive Governments spend hours discussing how to reduce the number of strikes. We also spend a good deal of time looking at the problem of industrial accidents. Yet we spend little or no time trying to produce better health for the worker in his place of work, using the access and availability of the worker which is one of the essential ingredients of an occupational health service. We cannot afford to go on ignoring this large, captive patient-group, which spends the vast majority of its working week at its place of work.

If we are serious about preventive medicine we need to look more seriously at occupational health. The Department of Health and Social Security must justify its stance. The Secretary of State nodded at every word the hon. Member for Aylesbury said. He clearly thinks that occupational health has a very low priority. It would be better for him to spell out exactly why he thinks it has a low priority than to pay lip service to the need for an occupational health service and do nothing about it. Not only is it desirable, but there is an overwhelming case for it to be given much higher priority.

The Robens Committee recommendations on occupational health are a considerable disappointment, but if the evidence which was given to the committee—as Mr. Robinson, the trade union member of the committee, said—was that it could not be contemplated for 10 years, it is not surprising that the committee embraced the second best, the Employment Medical Advisory Service. In the Second Reading debate on the Employment Medical Advisory Service Bill I urged the Government to consider occupational health when they were considering the reorganisation of the health service.

Medical officers of health will now come into the National Health Service, with responsibility as community physicians attached to area health boards. They are doctors with considerable experience in preventive medicine but who have not yet had experience in occupational health. They could take as one of their responsibilities occupational health, and they should be given a mandate to cover occupational health in their area.

The Employment Medical Advisory Service contains only 100 doctors, a great many of whom are tied up with inspection. Professor Wood—another member of the Robens Committee—said that occupational health was equally as important as the prevention of accidents and in future will become more important. The Secretary of State may scoff-off other people's remarks, but presume- ably he will not scoff off the views of Professor Wood.

The Secretary of State should explain to the House why he gives such low priority to occupational health and why almost everyone who looks at occupational health comes to the conclusion that something should be done urgently. There was the Dale Committee in 1951 and the Portia Committee in 1952, and we have had successive debates in the House, yet once Governments get into power they become susceptible to the arguments used by the Department of Health and Social Security against an occupational health service. A small group of men in the higher reaches of medicine have consistently blocked any advance in occupational heath. They cannot go on blocking it in silence. They need to produce evidence and justification.

If it is said that resources are not available, perhaps the Minister will say how many doctors and specially trained nurses are needed for an occupational health service. The Labour Party policy is an evolutionary, gradualist approach, trying to highlight areas where there are deficiencies, moving in after a period of regional study and putting in an occupational service by degrees. It is not a proposal for instant money-spending which will stretch resources, but a carefully worked-out proposal after a two-year period of survey and then a phased introductory period. We are not advocating a block occupational service such as the initial introduction of the National Health Service.

Most people accept that industries with an occupational health service should be able to carry on with their existing service. We have to evolve a structure which uses area health board facilities, group occupational service schemes and industrial occupational health schemes. There should be a tripartite approach to the problem of providing a national occupational health service.

This is a major and important issue. I have consistently argued that higher priority should be given to a national occupational health service ever since the Labour Party was in Government. Two years is the minimum period that should elapse between the decision to go for an occupational health service and the implementation of that decision. I hope that it will be a shorter time.

Photo of Hon. John Silkin Hon. John Silkin , Deptford

There is nothing in the clause to say that it cannot be done more quickly.

Photo of Dr David Owen Dr David Owen , Plymouth, Sutton

If we were given the opportunity as the result of a General Election to introduce an occupational health service earlier, I hope that we should act within the period of five years by a handsome margin.

My plea to the Labour Party and to the House is to give occupational health and the ill health that affects the worker in his work place—not always as a result of his work—far higher priority and accord to it just a fraction of the time, effort, energy and resources that we give to reducing the number of strikes and accidents in industry. We shall receive a significant return for that investment.

4.45 p.m.

Photo of Mr Christopher Mayhew Mr Christopher Mayhew , Woolwich East

I agree profoundly with my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen). I agree with his reservations about the clause. The fact that we intend to initiate an occupational health service in advance of five years is a good reason for not putting five years in the clause. I agree—and I think I am here agreeing also with the hon. Member for Aylesbury (Mr. Raison)—that, rather than improving the occupational health service in industries employing more than 250,000, it would be better to aim at an overall occupational health service, starting with the industries where it is most needed. That seems to be a more practical approach.

I wish to argue in favour of this concept because of the contribution it can make to the great and growing problem of stress at work about which my hon. Friend spoke. This is primarily not a medical problem but a management problem, and it is a problem to the solution of which an occupational health service could make a great contribution.

As I see it, the problem is the feelings of anxiety, inadequacy and frustration at work which are partly or wholly caused by bad psychological environment. Stress at work is hard to pin down and quantify. Because it is produced by so many variable factors people are encouraged to think that it is not widespread, that it does not cause great suffering, that it is not important and that nothing practical can be done about it. All those opinions are wrong. Noise, radiation, dust and fumes can be measured and quantified, but the emotional environment cannot, certainly not yet. As a result, the size and importance of this whole problem have been neglected. It is extremely important and many practical things could be done to relieve it. This real suffering creates an unacceptable level of absence from work and sometimes leads to serious mental breakdown.

I should like to put on record a notable speech made by the Chairman of the 101st annual Trades Union Congress, Mr. John Newton, who said: Where work gives little or no satisfaction to the worker, where there is no freedom to exercise talent or skill, where men and women do not determine how they do their work, where they have become merely components in the production system, they have during their working lives lost their identity as individuals. This they feel, and underlying many strikes is a protest against this unnatural environment.If the society in which they live does not provide them with compensation for this loss of identity, there were social consequences as well. And until we have an occupational health service committed to a study in depth of the psychological consequences of modern production methods, unrest will continue. Indeed, in the absence of these remedies, strikes are likely to continue in the process of mental and physical re-adjustment.Nobody who has not experienced the effects of years of confinement within the walls of mass production, without apparent means of escape, can understand the debilitating effects on the mind, the vocabulary, on the spiritual capacity of human endurance. Nobody, without this experience, can really understand why men down tools, when on the surface there seems to be only a pretext, to escape momentarily from the monotony of an unnatural existence.

Photo of Mr Timothy Raison Mr Timothy Raison , Aylesbury

I entirely accept the force of these arguments. I accept that stress and the organisation of work are extremely important matters. As the hon. Member for Woolwich, East (Mr. Mayhew) said, it is within industry, in management, that important decisions about how to remove these difficulties can be made. Would it not be far better to see this as being the clear responsibility of the Department of Employment—perhaps the Department of Trade and Industry as well—rather than putting it under the National Health Service, which will not have the same power to twist the arm of industry?

Photo of Mr Christopher Mayhew Mr Christopher Mayhew , Woolwich East

It is a clear responsibility not only of management but of the trade unions, and indeed of everybody concerned in industry. I am arguing that in addition the medical profession can make a contribution. I have in mind physicians who could treat people as individuals but with a knowledge of a person's working environment. Such a physician would be particularly well-placed if he had special training in this subject.

My hon. Friend the Member for Sutton drew attention to the extent of the problem. The Mind campaign has calculated absences from work through phychosis, neurosis, debility and headaches at nearly 37 million man-days in 1969–70, far more than the number of days lost through industrial disputes. This excludes things which are increasingly recognised as symptoms of stress, such as dyspepsia, skin complaints and muscular aches and pains. This is a growing problem. The total of absences through certified sickness rose 22 per cent. in the 15 years up to 1970, but the absences through neurosis and psychosis rose by 152 per cent. for men and 302 per cent. for women.

This is a fast growing problem which will require serious effort before it can be overcome. Research into it has hardly begun. I was glad to see in the recent Labour Party policy document at least one line calling for more research into the problems of stress at work. Perhaps the subject was not adequately and fully dealt with in that document, but it was at least a move forward.

The Mind campaign gave its evidence to the Robens Committee in support of an occupational health service to combat this problem, among others. It emphasised the danger of over-promotion—in other words, giving to a man a job which it is beyond his capacity to undertake—and also emphasised the danger of under-work, which can be pleasant for a time but eventually leads to loss of confidence and self-respect, tension and sometimes illness. There is also the danger of inadequate job definition when a worker has no idea whether he is responsible for certain tasks which worry him. There is also the danger of lack of effective consultation and communication which may cause people to suffer needless fears about sudden changes in their employment, fear of redundancy and all the rest. Finally, there is the danger of financial insecurity, which is endemic in many parts of industry.

In our evidence to the Robens Committee we recommended an occupational health service covering all the working population not already provided for by industrial health schemes. The occupational health scheme would consist of physicians, nurses, welfare officers and social workers working closely with general practitioner services. They would help in the early identification of stress symptoms related to the working environment and would be able to advise the management in preventing and minimising these consequences. It was a great disappointment to all concerned with an occupational health scheme that the Robens Report entirely neglected this side of the problem. The terms of reference given to Robens include concern for health in industry, but there is no reference in the Robens Report to the subject of stress at work, nor is there any reference to the evidence given by societies, organisations and individuals concerned with this important subject.

We have in this country at present only 600 full-time occupational physicians. It is worth looking at what is happening in other countries. In Sweden every firm with more than 500 employees has at least a nurse and a personnel adviser. Every firm with more than 2,000 employees has in addition an occupational physician; every firm with more than 4,000 employees has, in addition to a personnel adviser and an occupational physician, a social worker; and every firm with over 10,000 employees has in additional a psychologist.

I wish to emphasise that this is not just a medical problem. Industrial physicians can provide an immediate service to the individual based on an understanding of the individual and of his working environment, and they can communicate expertly with individual general practitioners. Subject to the medical code, these physicians can also explain to senior management the kind of circumstances which help to produce this kind of illness.

This situation is also the responsibility of management and of trade unions, and I am glad to see some mental health element being injected into management courses run by the British Institute of Management and also into courses for shop stewards run by the TUC. However, all this activity still falls far short of what is needed. Everybody with responsibility in industry should have education and training to cope with the challenge of stress at work, to cope with crises and breakdowns when they occur and to help with the recovery and rehabilitation of persons affected.

The subject of stress at work provides a vast field of research, but, even given our restricted knowledge of causes and cures, it also provides a vast field for practical remedial action now. The time has come for a national campaign against the evil of stress at work and the mountain of avoidable misery that it causes. We should welcome the new clause for many reasons, but particularly because it is an important first step in the right direction.

Photo of Mr Ken Lomas Mr Ken Lomas , Huddersfield West

My hon. Friend the Member for Woolwich, East (Mr. Mayhew) always brings to these debates a knowledge of mental problems, and the right sort of emphasis was placed on this subject in his speech. I agree with my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) that this is a major subject to be considered.

The hon. Member for Aylesbury (Mr. Raison) asked whether the principle sought in the clause was the right one. In my opinion the principle has already been established and the clause seeks an extension of it. We already have the National Health Service, and we want to improve it. We already have industrial doctors and nurses operating in factories, and we want to extend their services. Therefore, the principle has already been well established.

Is the clause clear? My right hon. Friend the Member for Deptford (Mr. John Silkin) said that there was nothing to stop an incoming Government bringing in an occupational health service within the five-year period, and I hope that this will be done. I regard the figure of 250,000 persons as too high, but it is a matter which can be further studied in debate and no doubt can be resolved.

We must then turn to the subject of resources. Have we enough money to provide an occupational health scheme? It would appear that we are already spending a great deal of money on many subjects which overlap one another and are not being properly co-ordinated. If those activities were brought under one umbrella instead of being allowed to overlap, as is happening at present, we would save a good deal of money in the long term and could use it for the purposes set out in the clause.

We have been told by the Government only recently that such a scheme would conflict with the family doctor service. t believe that the opposite would happen and that the scheme would be complementary to the family doctor service and in many ways would assist it. For that reason in particular I support the idea behind the clause.

Over the past 30 or 40 years there have been calls under both Conservative and Labour Governments for an occupational health service. With a working population of over 25 million people such a service is vital in determining the standard of personal health, and any consideration which does not include an occupational health service is unrealistic. A sick mind in a sick body acts as a drag on the individual and his work. If a man is unwell he cannot do the job he is paid to do and the productivity in the labour force of which he is a part suffers.

5 p.m.

My hon. Friend the Member for Woolwich, East emphasised the increase in stress and mental illness. I wish to mention another ailment which creates as much absenteeism as, if not more than, mental illness. I refer, of course, to migraine. Recently the Under-Secretary gave the all-party group some interesting information about it.

Migraine could be treated in an occupational health service. It is responsible for a considerable amount of absenteeism, bearing in mind that roughly 10 per cent. of the population suffer from it. That means that about 2·5 million working people are off work because of it. If migraine sufferers could obtain treatment when they had attacks at work they would be helped a great deal. The Minister has the power to set up headache and migraine clinics under the National Health Service. Unfortunately, however, London has only five and there are very few in the provinces.

An occupational health service is not a luxury but a necessity for the safety and health of people at work, and everyone in work is not only his own keeper but his brother's as well.

We often hear about the millions of days which are lost through strikes. Very many millions more days are lost because of sickness and injuries. For every penny which has been lost through strikes over the years, 99p has been lost because of illness and injuries at work.

Many people will say that we do not need an occupational health service because employees are protected by the provisions of the Factory Acts, and so on, which take care of many problems. However, there are many anomalies and many things wrong with the set-up under the Factory Acts. We have to look at them again. For example, employees in hospital staff canteens are covered, whereas those in patients' canteens are not. Hospital laundry workers are covered. Hospital boiler workers are not. Men building a bridge are covered under the Factory Acts. Men maintaining a road are not.

The functions of an occupational health service were agreed as long ago as 1950 by a joint committee of the ILO and WHO which said: Occupational health should aim at the promotion of the highest degree of physical, mental and social wellbeing of workers in all occupations; the prevention among workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the planning and maintenance of the worker in an occupational environment. That is saying, in other words, that what is important is the adaptation of work to man and of each man to his job.

To make that effective it has to be done on a national scale under one command. This is where I go further than my right hon. Friend the Member for Deptford. We have a situation where local health authorities have their own inspectorates relating to sanitation, general environment, and so on, in factories. The Department of Health and Social Security runs pneumonconiosis, mining, pottery, asbestos and sandstone panels. The Treasury appoints doctors to examine civil servants before they take up employment and, after illness, to assess their fitness for work. The Ministry of Defence has an industrial medical service for its factories. Then there are the Armed Services and other public bodies all with their own services. Perhaps the mining industry has the most highly developed of these services, including legal provisions, full-time medical officers and financial rewards for developing new safety methods. There is still a long way to go, however, and this is why we need to combine our resources into an occupational health service both for research purposes and to help those who deserve it most.

A large number of big enterprises already employ nurses with industrial nursing certificates, but nearly 90 per cent. of the doctors inside our factories are part-timers. We ought to have people who specialise in this work for the benefit of those in industry.

The Department of Employment has its Industrial Health Committee. The Factories Inspectorate has a number of medical inspectors and conducts certain research. I could give many more examples, but I think I have proved the need for them to work together. There is a tremendous overlap, and what we should be looking for is an occupational health service which can take the place of the old Factory Acts system and the industrial health service. We want a true occupational health service which will take care of people at work and ensure that they can do their jobs more efficiently and effectively. By that means we can enrich the lives of people in industry and increase the well being and health of the nation.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West

The powerful case made by my hon. Friend the Member for Woolwich, East (Mr. Mayhew) emphasised what is already known to the Under-Secretary, that, bearing in mind the responsibility that his Department has for all aspects of health, the most serious growth in ill health arises from stresses and the resulting mental illness, and that these are matters which need to be tackled urgently.

My hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) challenged the statement by the hon. Member for Aylesbury (Mr. Raison) about the relationship with the family-based service which we believe to be the very front line of defence. In my constituency I have the Central Middlesex Industrial Health Scheme. It is an experiment where the Department of Health and Social Security provides the consultants, where the local authority provides certain services, where Messrs. Guinness provides the land and buildings and where local industrialists provide the money required to employ industrially qualified nurses.

The hon. Member for Aylesbury tried to make a difference between the family doctor and the resources used for family-based medicine and medicine based on the hospitals. He asked whether we ought not to put more resources into reducing waiting lists. If the hon. Gentleman cares to come to Central Middlesex I can provide him with statistics showing that this happens.

The industrial medical service has meant far less referral to out-patients departments. For general practitioners it solves one of their great problems. In all medicine, doctors, whether domiciliary or industrial or working in the hospital service or in local communities, seek not to treat symptoms but to find and eradicate causes. A general practitioner with 2,500 patients on his list and six minutes for each patient finds it relatively easy to get at the symptoms. It is much more difficult for him to get at the causes. Bearing in mind that more often than not those causes arise during a man's working life, clearly this is a service which general practitioners in my area welcome, as I am sure most doctors do.

This is a short debate, and all of us would like to say a great deal more than time allows. However, my right hon. Friend the Member for Deptford (Mr. John Silkin) reminded us of the lip service which is paid to the idea of an occupational health service such as that proposed by the ILO convention of 1959. Nowhere does that occur more than in this Chamber. I remember Prime Minister Macmillan 10 years ago resisting pressure which I put on him for an occupational health service in the Palace of Westminster. Today we still have only a first aid box and the services of any available hon. Member who happens to be medically qualified. We have about 800 workers, quite apart from 600 or so Members and the Members of the House of Peers. At this time of the year some 2,000 people are in the Palace. It is true that we have an arrangement with Westminster Hospital, which gets an ambulance here quickly if it is required. However, probably no section of the community is more subject to stress than hon. Members sitting in the Chamber at the moment.

The concept of the emergency medical advisory service is already an outdated and narrow one. It does not touch even the fringe of the argument put forward by my right hon. and hon. Friends when talking about an occupational health service. Secondly, there is already a strong base from which we can work. There are 70 whole-time and 1,000 part-time medical officers in industry. The clause would make it possible to move towards a career structure and adequate training for grope qualifications in industrial medicine not only for doctors but for State-registered nurses.

We must be able to see ahead. The clause refers to five years. With a Labour Government it would be less than five years. I think that my right hon. Friend had in mind that with a Conservative Government it will probably take five years. If the clause were accepted, we could get moving now all the necessary organisation to back up what needs to be done. Indeed, as I said, we have a base from which we could start.

The Under-Secretary will know from the documentation which has been prepared by industrial medical officers over the last three years that a lot of research has been carried out. Indeed, there is more than many people realise. Post-graduate training has been going on at three university departments of occupational medicine—Newcastle, Manchester and London, the latter incorporating the TUC Centenary Institute of Occupational Health—and at three other university departments of social medicine which have a commitment to occupational medicine. The Medical Council, which I had the privilege to serve recently, has undertaken research at a number of units: the Environmental Physiology Unit, the Industrial Injuries and Burns Unit, the Applied Psychology Unit, the Pneumoconiosis Unit, the Toxicology Unit, and the Unit on Occupational Aspects of Ageing. Therefore, the idea of starting with a blank sheet is not right. We have something. However, over the last 10 to 15 years we have neglected the opportunities open to us. This is the meaning of the clause.

The Robens Report, which the House has not yet had an opportunity to discuss, is totally inadequate. It does precisely what the Opposition have been objecting to throughout the debate. It looks at treatment and vaguely at accident prevention, not the complete health of the individual. Implementation of the Robens Report will leave untouched the present apathy. We need the clause to give a shove, an impetus, some meaning and direction.

Despite the argument about resources, it is well known that there will never be sufficient resources. But, by the intelligent use of the resources that we have, I feel certain that we could build a fourth wall to the National Health Service. At the moment it has three walls which cater for community, domiciliary and hospital medicine. The fourth wall is completely open to the elements. It needs that wall to be built. The clause will enable that to be done.

Photo of Dr Anthony Trafford Dr Anthony Trafford , The Wrekin

I should like to make a brief intervention. It was disappointing to me that the right hon. Member for Deptford (Mr. John Silkin), in moving the clause, did not define what he meant by "occupational health". This has become even more apparent as other Opposition Members have spoken. The hon. Member for Woolwich, East (Mr. Mayhew) directed his remarks to one small, though not unimportant part of a total service.

There was considerable confusion in what the hon. Member for Plymouth, Sutton (Dr. David Owen) said about what appeared to be a sphere of preventive medicine, research and industrial medicine and what amounted to a sort of glorified form of first aid.

This degree of confusion in the aims and objectives of the clause is far too woolly. If we knew what the right hon. Member for Deptford and his hon. Friends were proposing, it might be capable of what I might call sustained analysis. As it is, it seems to have comprised a series of non sequiturs from various hon. Gentlemen opposite and a considerable confusion as to what the clause means. The right hon. Gentleman does not appear to have thought out the consequences of accepting a full occupational health scheme on a national basis. My hon. Friend the Member for Aylesbury (Mr. Raison) mentioned just one, but I can think of many others.

The hon. Member for Willesden, West (Mr. Pavitt) referred to a number of units—the Industrial Injuries and Burns Unit, and so on. These cannot come under the sort of occupational health scheme about which the hon. Member for Woolwich, East was talking. They are matters of great importance, but they do not come under the same scheme. They arc not on the same wavelength. The whole concept, as expressed by the Opposition, is very woolly. For that reason, without going into the philosophical questions of the overall value of an entirely different concept and of resources, the clause is far too woolly to be either understood or accepted in its present form.

5.15 p.m.

Photo of Mr David Crouch Mr David Crouch , Canterbury

The debate has taken a certain shape. My hon. Friend the Member for The Wrekin (Dr. Trafford) has brought us to the nub of the question; namely, that the Opposition have put forward a clause which is far too woolly to be added to the Bill.

I have great sympathy with the intentions enshrined in the clause, which is directed towards stress resulting from certain operations in industry. However, we must be clear what we are talking about when we refer to an occupational health scheme. There seem to be two sides. One aspect concerns the health of an individual as he performs his job; that is, his treatment if he should be injured or taken ill at work. The other aspect is the study of the causes that might produce illness over a relatively long period.

Yesterday I visited the Ford factory at Dagenham. One of the first things I was shown was the medical centre in the engine plant. That medical centre was essentially for taking care of people who had knocked, cut, or bruised themselves or had perhaps fainted. A resident doctor and nurses were present. The facilities were excellent, as one might expect. However, I am sure that that doctor has not been consulted by the management about the repetitive nature of the work being done by the men on the assembly line.

Photo of Mr David Crouch Mr David Crouch , Canterbury

I agree. I have had considerable experience of work in factories, though not on the assembly line. I believe that a great deal of thought must be given to this matter. We cannot neglect it.

Is an occupational health scheme the right method and mode? Should we pass this matter over to the Department of Health and Social Security for supervision? Is not this a matter for industry? Is it not for the TUC and the CBI, the management of both sides of industry, to study these problems?

For example, when I asked one manager yesterday how many different jobs a man did on the assembly line in manufacturing a car, the answer was "One job." I said "I thought you varied the jobs so that there was an opportunity for a man to do a different job from day to day." He said, "Good heaven, no. That would slow up production, and they do not want to do more than one job."

Management is ruling according to production. Management is making decisions in industry according to the achievement of the greatest possible production for the greatest possible economy. It is not necessarily listening to the doctors. Therefore, the establishment of an occupational health scheme will not improve that situation. We can improve it by introducing the idea of stress problems caused by what a man is doing at work into the whole management study.

I know of some industries where the medical profession is closely consulted about this problem. For example, wherever there is toxicity in industry the doctors are consulted. For example, in a paint shop there are the Factory Acts and regulations regarding the protection of workers.

What the right hon. Gentleman is suggesting is that we should go beyond this and find out the effects of work itself, rather than just of toxicity, on a person's health. I go along with him on this, but if we introduced this woolly clause, this blanketing phrase about establishing an occupational health scheme, implying that the problem would thereby be taken care of, we should do more harm than good. I would therefore recommend that the House does not accept such a woolly suggestion.

At the same time, however, we cannot push aside the requirement for management and shop floor to take into account the real problems which exist in industry and can attack a person's health.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

I think it was the hon. Member for Willesden, West (Mr. Pavitt) who last used the phrase—it may have been used also by the hon. Member for Plymouth, Sutton (Dr. David Owen)—about our paying lip service to the relevant ILO convention. We utterly refute this allegation. We in the Government, and, above all, in my Department, pay more than merely lip service to the notion of occupational health.

We are broadly, indeed actively, in sympathy with the concern expressed by the right hon. Member for Deptford (Mr. John Silkin)—I cannot say in full agreement with the terms of his clause, but in the associated exposition of the clause for doing everything possible to sustain, improve and develop the health and well-being of people in their place of work. Indeed, as I shall hope to show, we have not been slack or inactive in seeking to carry this cause forward.

But it would be a great advantage for the House to follow the line suggested by my hon. Friend the Member for The Wrekin (Dr. Trafford) and be a little more analytical than many hon. Members have been about the notion of an occupational health service. It has not been sufficiently analysed and there is some muddled thinking about it. The Robens Committee gave a useful lead when it said: The rôle of occupational medicine can be understood only against the background of the general structure of health services in this country. The main element is the personal and mainly curative work of the National Health Service, which is centred on the individual and the family and not in the place of work.

The second broad division of the health service is the environmental and preventive or public health service provided for the community as a whole. In occupational health, the working environment is of predominant importance, and it is engineers, chemists and others, rather than doctors, who have the expertise to change it.

I want to ask the House to reflect for a moment on the mainly curative personal health services which we deliver at present on the basis of the free general practitioner services, leading through to the free hospital provision associated with general practitioner referrals. I must agree with my hon. Friend the Member for Aylesbury (Mr. Raison) that there can be no question but that the personal family curative medical treatment, especially of personal health, is properly based at present as a priority in the family context and the general practitioner services.

It is arguable that a strong case could be made for extending and developing this, so that personal curative medical treatment was provided in other places as well as the family context. But what is beyond dispute is that there can be no justification for making a switch of emphasis from the present family-based structure of these personal curative services towards putting them into the places of work. We could not conceivably duplicate them, and in the absence of the power to duplicate them we must lay the primary emphasis for this aspect of personal curative treatment on treatment by the general practitioner in the family.

There are other aspects of this question than just the personal curative medical aspect. There are other things which doctors can, should and do do in an environmental or occupational way. Let me remind the House of what the Tunbridge Committee specified as the sort of activities that doctors and others might do in the proposed occupational health service for our own National Health Service.

Paragraph 8 of the Tunbridge Committee's Report says that an occupational health service for hospital staff might include the following activities: pre-employment medical examinations other routine medical examinations examination and advice on resettlement where necessary after sick absence maintenance of immunisation records maintenance of staff health records advice on environmental health and safety conditions, including planning of new buildings health and hygiene instruction research into health factors, sickness patterns, wastage, etc.". These are all very proper and necessary aspects of an occupational health service, but they are not elements necessarily including the personal curative medical treatment for which priority must, we believe, be given to the family-based general practitioner service.

At the same time, we have not only paid lip service to the notion of the occupational health service in the terms that I have specified in that quotation; we have committed ourselves actively to promoting this service in the National Health Service. The hon. Member for Sutton talked about the evolution of the Labour Party's proposals in this field, but we are at least as committed as the Labour Party to the evolution of a pattern of occupational health service, in respect of this single NHS occupational health service.

Indeed, to quote from the circular that we sent out in 1971 in respect of the NHS occupational health service: The recommendations"— of the Tunbridge Committee, that is to say—— are far reaching and the pace of their implementation will have to be governed by the limitations of finance and manpower resources, on which there are many competing demands. There is also the need, which the Joint Committee emphasises, to test the practical effect of their proposals before a service of the kind recommended is introduced generally. So there is nothing between us on this.

We think that there is a key and cardinal place for the notion of an occupational health service, not necessarily a personal curative medical régime, but the sort of activities outlined in the quotation I read; all we say is that we are bound to hasten slowly because resources are at stake here.

As to what sort of resources are at stake, I believe I am right in saying that about a third of the firms in industry have some sort of medical practitioner associated with them in some way, perhaps full time, perhaps part time. We were advised in 1966 that if we were to try to increase the extent to which medical practitioners were active in industrial firms so as to cover the whole range of industrial firms—in other words, the other two-thirds as well—the cost would have been £20 million and the number of extra doctors needed would have been at least 2,000. That was in 1966.

5.30 p.m.

The House can calculate that the cost will be immeasurably greater today, certainly in financial terms and almost certainly in terms of medical manpower if we are to lay a proper emphasis on the basic family personal curative medical service. In order to expand the occupational health service with doctors doing slightly different kinds of medical work, of the sort that I have suggested, enormous increases in expenditure will have to be considered and very large transfers of medical practitioners into industry will have to be envisaged, or the attempt to recruit further doctors from overseas or other sources.

The practical difficulties cannot be ignored. With the best will in the world, we are bound to evolve in this direction. We are committed to evolving in our National Health Service, but we shall evolve slowly, unavoidably, because the proper priority must rest with the family doctor health service.

I think that the hon. Member for Woolwich, East (Mr. Mayhew) appreciates the priorities which my right hon. Friend postulated in the latest White Paper on public expenditure, in which he said: There will continue to be special emphasis on services for the elderly, the mentally ill, the mentally handicapped and the physically disabled including the younger disabled requiring long-term care; and additional emphasis will be given to services for alcoholics and homeless single people. It is also intended that family planning services provided under the National Health Service should be substantially expanded in order to reduce the distress caused by regretted pregnancies. I could continue ad infinitum reminding the House of all the other claims that there are upon the 2,000 doctors who might have to be moved into industry so that all firms are covered by a doctor.

Whatever claims there are on this expenditure of over £20 million and on over 2,000 medical practitioners, there is yet a further subdivision which one could make in the notion and content of the phrase "occupational health service". This is the aspect which comes into view when we consider the Employment Medical Advisory Service; that is, the kind of work connected with the surveillance of workmen and workwomen to determine whether they are affected by their work.

We are deeply in sympathy with the point made by the hon. Member for Woolwich, East. The surveillance of workers at work, be they men or women, and the effect upon them of their conditions and environment and the character of their work, is of enormous and vital importance. We make no bones about this. We are entirely in sympathy with the point of view that the hon. Gentleman expressed. This is associated in the EMAS with such undertakings as the definition of criteria for safe working, advice on placement in work to ensure efficiency, and so on. Here again, we are more than in sympathy with what the hon. Member has brought forward in this notion of stress at work.

I can again give the House some reasonable grounds for encouragement here. The EMAS is very much a bipartisan measure. Both sides of the House are associated with it. It was a Labour Party measure in origin. We have implemented it. The Act received Royal Assent on 11th May last year, so it has only just got off the ground. But in this context there is a considerable number of doctors already employed or inherited from the former Medical Inspector of Factories, known as medical advisers. The EMAS inherited about 50 full-time staff. We propose to increase this to the equivalent of about 100 full-time doctors. So on this specific but rather narrow EMAS activity of the sort with which the hon. Gentleman is concerned—for example, the surveillance of stress—we have taken steps not only to implement the Act but to double the number of doctors we are proposing to employ in industry for this purpose.

It is estimated that when the service is fully operational there will be about 78 full-time doctors and 42 part-time doctors. That is virtually a trebling of the number of medical personnel deployed through the EMAS. In addition to the doctors there will be a number of nurses and supporting administrative and clerical staff.

This is no paying of lip service to the notion of an occupational health service. Not only have we provided for such a service within the National Health Service, but we are determined to go forward as fast as we can. In the EMAS we are proposing to treble the number of doctors employed. However, we are very much in sympathy with my hon. Friend the Member for Aylesbury that the overriding priority must still rest with curative personal medical work associated with the family. This priority must remain.

Photo of Dr Shirley Summerskill Dr Shirley Summerskill , Halifax

Will the hon. Gentleman say whether the Government intend to retain the EMAS indefinitely under the Department of Employment? In December 1971 the Under-Secretary of State for Employment said when the National Health Service was reorganised, which we are in the process of doing at present, the proper home for the EMAS would undoubtedly have to be looked at again by the Department concerned. Are the Government looking at it again?

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

We are considering it. Subject to a correction which I shall have to give to the House on Report if I make a mistake, the present intention is that the EMAS should stay with the Department of Employment because many of its activities go wider than the employment of medical staffs. There are features associated with this aspect which overlap into the non-medical specialties, such as the work of chemists, physicists, engineers, and so on. If I am wrong in that I shall take action to correct it, but the present intention is that the EMAS should be part of the Department of Employment.

For these reasons we entirely refute the notion that we pay lip service to the idea of an occupational health service. On the contrary, we are not only trebling the number of doctors but setting up a service within the National Health Service.

Photo of Dr David Owen Dr David Owen , Plymouth, Sutton

Does the hon. Gentleman agree that the Government have reduced the number of doctors envisaged for the EMAS in the original Labour Party Bill? Did the Government say in evidence to the Robens Committee that they could not introduce an occupational health service within 10 years?

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

As far as I am aware, the evidence that we gave to that committee has not been published. I should not comment on that. I am not sure of the extent to which it is right that the hon. Gentleman should comment on that evidence. We never made any bones, nor do we today, about stressing that we believe in an occupational health service for the National Health Service. As was suggested in the departmental circular that I have read, we are hastening forward as rapidly as possible, in the same style as the hon. Gentleman has prayed in aid for the Labour Party's policies.

There is a very considerable measure of underlying agreement here, certainly in the realities of what we are trying to do. Very little divides us. We want an occupational health service and we are doing a great deal to provide one. But in terms of the words of the clause, I am bound to echo the fears expressed by my hon. Friend the Member for Canterbury (Mr. Crouch) that its drafting is rather woolly. I cannot recommend to the House that it should, by any stretch of the imagination, accept the clause. It is not clear from the words of the clause whether it is the Secretary of State who is to set up the extended occupational health service or whether the responsibility is to be laid upon industry. Certainly no powers are provided by which we could require industry to set this up. The clause does nothing more than urge us to do what we are doing already.

Photo of Hon. John Silkin Hon. John Silkin , Deptford

Perhaps the Under-Secretary will just take a little time to re-read the clause. I rise only to answer the "woolly" argument, because it was a woolly criticism. All that one is asking the Secretary of State to do, as the clause says very clearly—because we have at present a Conservative Secretary of State—is to take five years to look at what proposals are necessary in order to lay an occupational health scheme before Parliament. A Labour Government would do it in two years.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

That exposition of the nature of the clause may clarify some doubts about who is to be responsible for laying proposals, though it does not make clear who is to be responsible for implementing proposals.

The clause would impose no obligation upon the Secretary of State to implement proposals. It would merely require him to lay proposals. I am not sure that that would achieve very much in view of the amount that is already being done.

There are other defects. For example, the notion of industry as used in the clause is somewhat unsatisfactory. It is obviously borrowed from the standard industrial classification which has been used for quite different purposes than that of providing a proper structural basis for an occupational health service. We are limited to industries with at least 250,000 workers.

What might be sensible would be to provide an occupational health service within, say, a reasonable sized manufacturing town. This would be a rational and practical basis, perhaps, for providing an occupational health service, where there might be representative firms of half a dozen industries. Unfortunately, the clause would not enable us to make provision for an occupational health service along those lines. We could make provision for an occupational health service in only one of those firms—say, an engineering firm—in such a town and in another similar engineering firm in a town 10 miles away. That might be an entirely impracticable and irrelevant way to set about it.

It might be much more sensible to lay stress upon an occupational health service in a quite small firm connected with the manufacture of a toxic product. However, if such a firm were in a manufacturing or chemical industry below a certain size it would be excluded. For example, shipbuilding and marine engineering would be entirely excluded because of the provision as to the minimum number of workers, for those industries have only 183,000 workers. The clothing manufacturing industry could have an occupational health service because just by chance it has a greater number of employees.

Photo of Hon. John Silkin Hon. John Silkin , Deptford

There is nothing in the world to prevent the Secretary of State from going lower than that figure if he wishes. The purpose of the clause is to say that in the case of industries in which the total number of workers exceeds that figure he must act.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

That is a lame explanation for putting a specific term in the clause, expecting the House to adopt one law for industries which happen to be above a certain size and an entirely permissive practice for industries which happen by complete chance to be much smaller.

The clause as presented is clearly unacceptable in drafting terms and, indeed, is nonsense when viewed analytically. However, I do not want to dwell upon that. I want to dwell on the common ground. The right hon. Gentleman expressed it with some eloquence. This is the concern we all have for the health and wellbeing of people—be they men or women—at their place of work, for it is a vital national interest.

In so far as resources permit, huge priority should be given, as indeed it is given in the Employment Medical Advisory Service, to promoting the specialist medical facilities which an occupational health service requires. We are committed to this in the National Health Service occupational scheme and we shall continue to try to expand these facilities as fast as resources permit.

Nevertheless, we must stress the overriding priority we are bound to give in present circumstances to the personal curative medical treatment provided by medical practitioners in the family context and in association with hospitals. Given that priority, we are bound to hasten perhaps slowly in an evolutionary way. In that we follow the tone and note of evolution which is so suitable to both sides of the House on this occasion.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West

The hon. Gentleman has made a strong case about the family-based medical service. What argument is there against transferring the conservation and treatment of teeth from the present system into an occupational health service? What more would it cost? What extra manpower would it require? None.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

As the hon. Gentleman no doubt knows, there are many dentists already employed in private manufacturing concerns. They may even be employed in the nationalised industries, but I cannot speak with authority on that. In view of the criticism we are receiving about the extent to which dental practitioners are opting out of practice with the National Health Service, we should be greatly at risk of intensified criticism if we were to decide to encourage the redeployment of yet more family dental practitioners deliberately into manufacturing and commercial undertakings. I do not think that proposition is any more of a starter than is the transfer of family doctors into industry.

5.45 p.m.

Photo of Mr George Thomas Mr George Thomas , Cardiff West

The Under-Secretary has disappointed us. We listened to him in Committee on many occasions. When he had a thin case he managed to make the most of it and fill up the time. This afternoon he filled up the time but did not make the most of it. The Under-Secretary has revealed the wide gap there is between us. Taking away all the flannelling around those words, the essential point is that the Government decline to agree even to produce a plan within five years for an occupational health service.

The Under-Secretary adopted a very different attitude from that adopted by his hon. Friends. My hon. Friends, who presented impressive statistics, revealed without exception a tremendous knowledge of the National Health Service and advanced a positive case. There was just hostility to the idea of an occupational health service from the Minister's hon. Friends.

The hon. Member for The Wrekin (Dr. Trafford) was the most hostile of all. His approach was entirely negative. He had not one kind word to say for an occupational health service. I understand that the hon. Gentleman is engaged in the world of medicine. One would have expected at least a little more understanding of what an occupational health service means to workers from a man whose responsibility it is to care for the sick when he is not in the House.

Photo of Dr Anthony Trafford Dr Anthony Trafford , The Wrekin

The right hon. Gentleman could not have been listening to what I said. I was not in any way hostile to an occupational health service. I said briefly that the proposition contained in the clause was too woolly and that the right hon. Gentleman's hon. Friends had revealed that they had very differing concepts of an occupational health service. If the right hon. Gentleman likes to tell us—if he knows what he is talking about—precisely what is entailed, we will listen with the greatest of interest, but it is nonsense for him to say that we are hostile when he has not told us precisely what it is that is intended.

Photo of Mr George Thomas Mr George Thomas , Cardiff West

The hon. Gentleman has been in the House just as long as it will take us to introduce an occupational health service—just over two years. He made a great mistake this afternoon. He had nothing constructive to say. I believe that he was asked to speak so that there should be a speaker from the Conservative benches. The hon. Gentleman spent his time saying that the clause is woolly, that it is nothing more definite than a call on the Secretary of State to produce within five years his plan for an occupational health service. There is nothing woolly about that. If the hon. Gentleman cannot understand that, I can only say that it looks to me as if he will make a similar contribution in the House to that of his predecessors in that constituency. I could hardly be more unkind.

Photo of Mr David Gibson-Watt Mr David Gibson-Watt , Hereford

Will the right hon. Gentleman give way?

Photo of Mr George Thomas Mr George Thomas , Cardiff West

Is it a contribution on this subject or an answer to my comments to the hon. Member for The Wrekin?

Photo of Mr David Gibson-Watt Mr David Gibson-Watt , Hereford

May I ask the right hon. Gentleman a question? Was the right hon. Gentleman referring to my hon. Friend's Labour predecessor or a Conservative Member who came before?

Photo of Mr George Thomas Mr George Thomas , Cardiff West

I was referring to the Arab. We all know who that was. I certainly was not referring to any Labour man, and I am grateful to the Minister of State for giving me the chance to make that clear. I was thinking back to that oddity. However, let us leave that.

It was difficult to gather from the Minister's speech this afternoon that the British Medical Association and the Trades Union Congress have asked for the proposal that we are putting forward. It was hard to judge from speeches from the Conservative side that the medical profession does not think this proposal woolly or that it will damage the rest of the health service. My hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) is a distinguished member of the medical profession and he indicated that the general practitioner could be greatly helped by an occupational health service. The efficiency of the family service will be improved because the family doctor who is unable to probe into the causes of complaints with which he has to deal will be helped by those who devote themselves as experts to this task. Although the occupational health service is far more than just an accident-at-work service, we in Wales, as the Minister of State will know, have a special cause for hoping for a national occupational health service. Wales has 5 per cent. of the United Kingdom population, but 9·4 per cent. of injury benefit and 12·7 per cent. of disablement benefit are paid in Wales. This is largely owing to the heavier industries and to the more dangerous nature of much of the industry there.

The Under-Secretary in opposing the clause did not present many convincing arguments but he said that he was in favour of the general idea but was unwilling to give a date or time for producing a comprehensive plan for this service. All that the Under-Secretary and the Government can do today is to delay the matter. When we have a Labour Government we shall introduce this scheme, and within two years we hope we shall have had the reports of working parties which we shall set up in every region. Employers and workers will he represented on these working parties, which will also include representatives of the health service, the local authorities, the medical profession and especially those concerned with the care of people at work. We shall undertake a complete survey so that comprehensive plans can be presented to the House indicating the

ways in which we can make the most effective use of our resources.

My right hon. and hon. Friends have made one point which the Minister did not attempt to answer. I hope that the survey which we propose of every region and of every industry in every region will help us to find the fields of research that are an essential part of an occupational health service. Many of my right hon. and hon. Friends have been engaged in industry, not in the board room or in the manager's office, but at the bench as skilled craftsmen. I am not speaking for myself, because I served in the classroom as everyone knows. I only wish that I had the chance to teach the Minister of State something, but that was his misfortune as well as my——

Photo of Mr George Thomas Mr George Thomas , Cardiff West

Thank you. My right hon. and hon. Friends have served in industry as skilled craftsmen, as miners and as railwaymen, and we therefore see this problem in a different light from the Government. We therefore, commit ourselves to increasing the amount which will be spent on research into health hazards for people at work. We all know that these hazards have increased, are increasing and will continue to increase and so we see this as a major issue.

My right hon. and hon. Friends will have no hesitation in going into the Lobby in support of our belief that an occupational health service is a natural development in the National Health Service. The Bill seeks to reorganise the whole of the National Health Service after 25 years. It has now been proved that millions of workers in industry require this service on grounds both of efficiency and personal happiness. The Government may stop us today but once we are returned to power an occupational health service will be introduced.

Question put, That the clause be read a Second time:—

The House divided: Ayes 249, Noes 270.

Division No. 147.]AYES[6.00 p.m.
Abse, LeoAshley, JackBarnes, Michael
Allaun, Frank (Salford, E.)Ashton, JoeBarnett, Joel (Heywood and Royton)
Archer, Peter (Rowley Regis)Atkinson, NormanBaxter, William
Armstrong, ErnestBagier, Gordon A. T.Beaney, Alan
Benn, Rt. Hn. Anthony WedgwoodGrimond, Rt. Hn. J.Orme, Stanley
Bennett, James(Glasgow, Bridgeton)Hamling, WilliamOswald, Thomas
Bidwell, SydneyHannan, William (G'gow, Maryhill)Owen, Dr. David (Plymouth, Sutton)
Bishop, E. S.Hardy, PeterPadley, Walter
Blenkinsop, ArthurHarrison, Walter (Wakefield)Paget, R. T.
Boardman, H. (Leigh)Hart, Rt. Hn. JudithPalmer, Arthur
Booth, AlbertHattersley, RoyPannell, Rt. Hn. Charles
Boothroyd, Miss B. (West Brom.)Healey, Rt. Hn. DenisPardoe, John
Bottomley, Rt. Hn. ArthurHoram, JohnParker, John (Dagenham)
Boyden, James (Bishop Auckland)Houghton, Rt. Hn. DouglasParry, Robert (Liverpool, Exchange)
Broughton, Sir AlfredHowell, Denis (Small Heath)Pavitt, Laurie
Brown, Hugh D. (G'gow, Provan)Huckfield, LesliePeart, Rt. Hn. Fred
Buchan, NormanHughes, Rt. Hn. Cledwyn (Anglesey)Perry, Ernest G.
Buchanan, Richard (G'gow, Sp'burn)Hughes, Mark (Durham)Prentice, Rt. Hn. Reg.
Butler, Mrs. Joyce (Wood Green)Hughes, Robert (Aberdeen, N.)Prescott, John
Callaghan, Rt. Hn. JamesHughes, Roy (Newport)Price, William (Rugby)
Campbell, I. (Dunbartonshire, W.)Irvine, Rt. Hn. Sir Arthur (Edge Hill)Probert, Arthur
Cant, R. B.Jay, Rt. Hn. DouglasRadice, Giles
Carmichael, NeilJeger, Mrs. LenaReed, D. (Sedgefield)
Carter, Ray (Birmingh'm, Northfield)Jenkins, Hugh (Putney)Rees, Merlyn (Leeds, S.)
Carter-Jones, Lewis (Eccles)Jenkins, Rt. Hn. Roy (Stechford)Rhodes, Geoffrey
John, BrynmorRoberts, Albert (Normanton)
Castle, Rt. Hn. BarbaraJohnson, Carol (Lewisham, S.)Roberts, Rt.Hn.Goronwy (Caernarvon)
Clark, David (Colne Valley)Johnson, James (K'ston-on-Hull, W.)Robertson, John (Paisley)
Cocks, Michael (Bristol, S.)Johnson, Walter (Derby, S.)Roderick, CaerwynE.(Brc'n&R'dnor)
Cohen, StanleyJohnston, Russell (Inverness)Rodgers, William (Stockton-on-Tees)
Coleman, DonaldJones, Barry (Flint, E.)Roper, John
Concannon, J. D.Jones, Dan (Burnley)Rose, Paul B.
Corbet, Mrs. FredaJones, Gwynoro (Carmarthen)Ross, Rt. Hn. William (Kilmarnock)
Cox, Thomas (Wandsworth, C.)Jones, T. Alec (Rhondda, W.)Rowlands, Ted
Crawshaw, RichardKaufman, GeraldSandelson, Neville
Cronin, JohnKelley, RichardSheldon,Robert (Ashton-under-Lyne)
Crosland, Rt. Hn. AnthonyKinnock, NeilShore, Rt. Hn. Peter (Stepney)
Crossman, Rt. Hn. RichardLambie, DavidShort, Mrs. Renée (W'hampton,N.E.)
Cunningham, Dr. J. A. (Whitehaven)Lamborn, HarrySilkin, Rt. Hn. John (Deptford)
Dalyell, TamLamond, JamesSilkin, Hn. S. C. (Dulwich)
Darling, Rt. Hn. GeorgeLatham, Arthur
Davidson, ArthurLawson, GeorgeSillars, James
Davies, Denzil (Lianelly)Lee, Rt. Hn. FrederickSilverman, Julius
Davies, G. Elfed (Rhondda, E.)Leonard, DickSkinner, Dennis
Davies, Ifor (Gower)Lewis, Arthur (W. Ham, N.)Small, William
Davis, Clinton (Hackney, C.)Lewis, Ron (Carlisle)Smitn, cyril (Rochdale)
Davis, Terry (Bromsgrove)Lipton, MarcusSoref, Harold
Deakins, EricLomas, KennethSpearing, Nigel
de Freitas, Rt. Hn. Sir GeoffreyLoughlin, CharlesSpriggs, Leslie
Delargy, HughLyons, Edward (Bradford, E.)Stallard, A. W.
Dell, Rt. Hn. EdmundMcBride, NeilSteel, David
Dempsey, JamesMcCartney, HughStewart, Rt. Hn. Michael (Fulham)
Doig, PeterMcElhone, FrankStoddart, David (Swindon)
Dormand, J. D.McGuire, MichaelStonehouse, Rt. Hn. John
Douglas, Dick (Stirlingshire, E.)Machin, GeorgeStrauss, Rt. Hn. G. R.
Driberg, TomMackenzie, GregorSummerskill, Hn. Dr. Shirley
Duffy, A. E. P.Mackie, JohnSwain, Thomas
Dunn, James A.Maclennan, RobertThomas,Rt.Hn.George (Cardiff,W.)
Dunnett, JackMcMillan, Tom (Glasgow, C.)Thomas, Jeffrey (Abertillery)
Edelman, MauriceMcNamara, J. KevinThorpe, Rt. Hn. Jeremy
Edwards, Robert (Bilston)Mahon, Simon (Bootle)Tinn, James
Edwards, William (Merioneth)Mallalieu, J. P. W. (Huddersfield, E.)Tomney, Frank
Ellis, TomMarquand, DavidTope, Graham
English, MichaelMarsden, F.Torney, Tom
Evans, FredMason, Rt. Hn. RoyTuck, Raphael
Ewing, HarryMayhew, ChristopherVarley, Eric G.
Fernyhough, Rt. Hn. E.Meacher, MichaelWainwright, Edwin
Fisher,Mrs.Doris(B'ham, Ladywood)Mellish, Rt. Hn. RobertWalden, Brian (B'ham, All Saints)
Fletcher, Raymond (Ilkeston)Mendelson, JohnWalker, Harold (Doncaster)
Fletcher, Ted (Darlington)Mikardo, IanWallace, George
Foot, MichaelMillan, BruceWatkins, David
Ford, BenMiller, Dr. M. S.Weitzman, David
Forrester, JohnMilne, EdwardWellbeloved, James
Fraser, John (Norwood)Mitchell, R. C. (S'hampton, Itchen)White, James (Glasgow, Pollok)
Freeson, ReginaldMolloy, WilliamWhitehead, Phillip
Galpern, Sir MyerMorgan, Elystan (Cardiganshire)Whitlock, William
Garrett, W. E.Morris, Alfred (Wythenshawe)Williams, Alan (Swansea, W.)
Gilbert, Dr. JohnMorris, Charles R. (Openshaw)Williams, W. T. (Warrington)
Ginsburg, David (Dewsbury)Morris, Rt. Hn. John (Aberavon)Wilson, Rt. Hn. Harold (Huyton)
Golding, JohnMoyle, RolandWoof, Robert
Gordon Walker, Rt. Hn. P. C.Oakes, Gordon
Gourlay, HarryO'Halloran, MichaelTELLERS FOR THE AYES:
Grant, George (Morpeth)O'Malley, BrianMr. Joseph Harper and Mr. James Hamilton.
Grant, John D. (Islington, E.)Oram, Bert
Griffiths, Eddie (Brightside)Orbach, Maurice
Adley, RobertGardner, EdwardMills, Peter (Torrington)
Alison, Michael (Barkston Ash)Gibson-Watt, DavidMiscampbell, Norman
Allason, James (Hemel Hempstead)Gilmour, Ian (Norfolk, C.)Mitchell, David (Basingstoke)
Amery, Rt. Hn. JulianGlyn, Dr. AlanMoney, Ernie
Archer, Jeffrey (Louth)Godber, Rt. Hn. J. B.Monks, Mrs. Connie
Astor, JohnGoodhart, PhilipMonro, Hector
Atkins, HumphreyGorst, JohnMore, Jasper
Awdry, DanielGower, RaymondMorgan-Giles Rear-Adm.
Baker, Kenneth (St. Marylebone)Grant, Anthony (Harrow, C.)Mudd, David
Baker, W. H. K. (Banff)Gray, HamishMurton, Oscar
Balniel, Rt. Hn. LordGreen, AlanNabarro, Sir Gerald
Barber, Rt. Hn. AnthonyGrieve, PercyNeave, Airey
Batsford, BrianGriffiths, Eldon (Bury St. Edmunds)Nlcholls, Sir Harmar
Beamish, Col. Sir TuftonGrylls, MichaelNoble, Rt. Hn. Michael
Bennett, Sir Frederic (Torquay)Gummer, J. SelwynNormanton, Tom
Bennett Dr. Reginald (Gosport)Gurden, HaroldNott, John
Benyon, W.Hall, Miss Joan (Keighley)Onslow, Cranley
Berry, Hn. AnthonyHall-Davis, A. G. F.Oppenheim, Mrs. Sally
Biffen, JohnHamilton, Michael (Salisbury)Orr, Capt. L. P. S.
Biggs-Davison, JohnHannam, John (Exeter)Page, Rt. Hn. Graham (Crosby)
Blaker, PeterHarrison, Brian (Maldon)Parkinson, Cecil
Boardman, Tom (Leicester, S.W.)Harrison, Col. Sir Harwood (Eye)Percival, Ian
Body, RichardHaselhurst, AlanPike, Miss Mervyn
Boscawen, Hn. RobertHastings, StephenPink, R. Bonner
Bowden, AndrewHavers, Sir MichaelPounder, Rafton
Bray, RonaldHawkins, PaulPowell, Rt. Hn. J. Enoch
Brown, Sir Edward (Bath)Heseltine. MichaelPrice, David (Eastleigh)
Bruce-Gardyne, J.Higgins, Terence L.Prior, Rt. Hn. J. M. L.
Hiley, JosephProudfoot, Wilfred
Bryan, Sir PaulHill, John E. B. (Norfolk, S.)Pym, Rt. Hn. Francis
Buchanan-Smith, Alick(Angus,N&M)Hill, S. James A. (Southampton, Test)
Buck, AntonyHolland, PhilipQuennell, Miss J. M>
Bullus, Sir EricHolt, Miss MaryRaison, Timothy
Burden F. A.Ramsden, Rt. Hn. James
Butler, Adam (Bosworth)Hordern, PeterRawlinson, Rt. Hn. Sir Peter
Campbell, Rt.Hn.G. (Moray & Nairn)Hornby, RichardRedmond, Robert
Hornsby-Smith,Rt.Hn.Dame PatriciaReed, Laurence (Bolton, E.)
Carlisle, MarkHowe, Rt. Hn. Sir Geoffrey
Carr, Rt. Hn. RobertHowell, David (Guildford)Rees Peter, (Dover)
Chapman, SydneyHowell, Ralph (Norfolk, N.)Rees-Davies, W. R.
Chataway, Rt. Hn. ChristopherHunt, JohnRenton, Rt. Hn. Sir David
Chichester-Clark, R.Hutchison Michael ClarkRhys Williams, Sir Brandon
Churchill, W. S.Iremonger, T.L.Ridley, Hn. Nicholas
Clark, William (Surrey, E.)Irvine Bryant Godman (Rye)Rippon, Rt. Hn. Geoffrey
Clegg, WalterJames DavidRoberts Wyn, (Conway)
Cockeram, EricJenkin, Patrick (Woodford)Rodgers, Sir John (Sevenoaks)
Cooke, RobertJessel TobyRossi, Hugh (Hornsey)
Coombs, DerekJohnson Smith, G. (E. Grinstead)Rost, Peter
Cooper, A. E.Jones Arthur (Northants, S.)Royle, Anthony
Cordie, JohnJopling, MichaelRussell, Sir Ronald
Corfield, Rt. Hn. Sir FrederickJoseph, Rt. Hn. Sir KeithSt. John-Stevas, Norman
Cormack, PatrickKaberry, Sir DonaldSandys, Rt. Hn. D.
Costain, A. P.Kellett-Bowman, Mrs. ElaineScott, Nicholas
Critchley, JulianKimball, MarcusScott-Hopkins, James
Crouch, DavidKing, Evelyn (Dorset, S.)Shaw, Michael (Sc'b'gh & Whitby)
Dalkeith, Earl ofKirk, PeterShelton, William (Clapham)
d'Avigdor-Goldsmid, Sir HenryKitson, TimothyShersby, Michael
d'Avigdor-Goldsmid,Maj.-Gen.JackKnight, Mrs. JillSimeons, Charles
Dean, PaulKnox, DavidSinclair, Sir George
Digby, Simon WingfleldLamont, NormanSkeet, T. H. H.
Dixon, PiersLane, DavidSmith, Dudley (W'wick & L'mington)
Dodds-Parker, Sir DouglasLangford-Holt, Sir JohnSoref, Harold
Douglas-Home, Rt. Hn. Sir AlecLe Merchant, SpencerSpeed, Keith
Drayson, G. B.Lloyd,Rt.Hn.Geoffrey(Sut'nC'field)Spence, John
du Cann, Rt. Hn. EdwardLloyd, Ian (P'tsm'th, Langstone)Sproat, Iain
Dykes, HughLoveridge, JohnStewart-Smith, Geoffrey (Belper)
Eden. Rt. Hn. Sir JohnMcAdden, Sir StephenStodart, Anthony (Edinburgh, W.)
Edwards, Nicholas (Pembroke)McCrindle, R. A.Stokes, John
Elliot, Capt. Walter (Carshalton)McLaren, MartinStuttaford, Dr. Tom
Elliott, R. W. (N'c'tle-upon-Tyne,N.)Maclean, Sir FitzroySutcliffe, John
Emery, PeterMcMaster, StanleyTapsell, Peter
Eyre, ReginaldMacmillan,Rt.Hn.Maurice(Farnham)Taylor, Sir Charles (Eastbourne)
Farr, JohnMcNair-Wilson, MichaelTaylor, Edward M. (G'gow.Cathcart)
Fenner, Mrs. PeggyMcNair-Wilson, Patrick (New Forest)Taylor, Frank (Moss Side)
Fidler, MichaelMaddan, MartinTaylor, Robert (Croydon, N.W.)
Finsberg, Geoffrey (Hampstead)Madel, DavidTebbit, Norman
Fisher, Nigel (Surbiton)Marples, Rt. Hn. ErnestTemple, John M.
Fookes, Miss JanetMarten, NeilThatcher, Rt. Hn. Mrs. Margaret
Fortescue, TimMather, CarolThomas, Rt. Hn. Peter (Hendon, S.)
Foster, Sir JohnMaude, AngusThompson, Sir Richard (Croydon, S.)
Fowler, NormanMaudling, Rt. Hn. ReginaldTilney, John
Fox, MarcusMawby, RayTrafford, Dr. Anthony
Fraser,RtHn.Hugh(St'fford & Stone)Maxwell-Hyslop, R. J.Trew, Peter
Galbraith, Hn. T. G. D.Meyer, Sir AnthonyTugendhat, Christopher
Turton, Rt. Hn. Sir RobinWard, Dame IreneWoodnutt, Mark
van Straubenzee, W. R.Warren, KennethWorsley, Marcus
Vaughan, Dr. GerardWeatherill, BernardWylie, Rt. Hn. N. R.
Vickers, Dame JoanWells, John (Maidstone)
Waddington, DavidWiggin, JerryTELLERS FOR THE NOES:
Walder, David (Clitheroe)Wilkinson, John
Walker, Rt. Hn. Peter (Worcester)Winterton, NicholasMr. John Stradling Thomas and Mr. Kenneth Clarke.
Walker-Smith, Rt. Hn. Sir DerekWolrige-Gordon, Patrick
Walters, DennisWoodhouse, Hn. Christopher

Question accordingly negatived.