Occupational Health Scheme

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

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Photo of Dr David Owen Dr David Owen , Plymouth, Sutton 12:00, 12 June 1973

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.