of group industrial health services (Slough was a well‐known example) to which small companies could subscribe according to the number of their employees, or the ‘leasing’ of spare capacity in a large organisation to other employers in the locality.
The Health and Safety Executive (HSE) in 1982 published a booklet entitled Guidelines for Occupational Health Services, which gave practical guidance on the functions, staffing and operation of OH services. This stressed that each organisation has its own needs. The number of employees, the number of locations, the number and severity of potential hazards, any statutory requirements for health surveillance, and the availability of and distance from NHS facilities must all be taken into account.
In 1983 the Select Committee on Science and Technology of the House of Lords, chaired by Lord Gregson, reviewed the future provision of occupational health and hygiene services. It defined occupational health as the physical and mental well‐being of the workers and occupational hygiene as the control of physical, chemical and biological factors in the workplace which may affect the health of the worker. The Gregson Committee perceived the main aim of an occupational health service as the promotion of the health and safety of those employed at the workplace. Occupational medicine was described as ‘a branch of preventive medicine with some therapeutic functions’. No full survey of occupational health services had ever been undertaken, but what research had been done revealed that at that time (1976), full‐time medical and nursing personnel were concentrated in large industries, as might be expected. Many large companies relied on part‐time medical advisers who might be local general practitioners (GPs). Few of these had special training in occupational medicine: 87.6 per cent of firms, employing 36 per cent of the workforce, had no medical service apart from first‐aiders (Occupational Health Services – The Way Ahead (1978)).
The Committee concluded that more provision was needed in small firms. They put considerable emphasis on preventive medicine:
Early detection of hazards of work and the timely adoption of preventive measures will not only alleviate individual suffering: they will lighten the financial burden which sickness imposes upon the State. There are also sound business reasons for ensuring that a workforce remains healthy. A healthy worker is a more efficient worker: absenteeism is lower and productivity higher.
The costs of the service should continue to be borne by the employers in reflection of their general duty under the Health and Safety at Work Act. However, Gregson was not in favour of imposing a legal obligation to provide an occupational health service. The Committee thought that a non‐statutory Code of Practice should be drawn up and monitored by the Employment Medical Advisory Service (EMAS). Tax incentives could be conferred on those who implemented the Code, and insurance companies might take it into account in fixing premiums. General practitioners should be encouraged to extend the occupational health side of their activities and to acquire additional qualifications. Occupational health nurses should be the first point of contact between the patient and other sources of referral. Trade unions and employees should be given more opportunity to have a voice in the management of occupational health services.
So far, there has been no significant move towards either a voluntary or a statutory Code of Practice. Meanwhile there have been international developments.
International developments
As long ago as 1962, the European Commission recommended that a statutory obligation to provide an occupational health service should be introduced at least for large employers (as has been shown, this would not represent much of a change in this country where most large concerns already have such a service). In June 1985, the International Labour Organization (ILO) adopted a Convention (No. 161) and a supporting Recommendation (No. 171) on Occupational Health Services. The Convention defines occupational health services as:
services entrusted with essentially preventive functions and responsible for advising the employer, the workers and their representatives in the undertaking on:
1 the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work; and
2 the adaptation of work to the capabilities of workers in the light of their state of physical and mental health.
It should be noted that the Convention covers occupational hygiene and ergonomic services as well as medical and nursing services. Signatories to it will have to formulate, implement and periodically review a coherent national policy on occupational health services and to develop progressively occupational health services for all workers such as are adequate and appropriate to the specific risks of the undertakings. The UK government sought the advice of the HSC on whether the UK should ratify and/or accept Recommendation 171, which is in similar terms to the Convention, but would not, if implemented, carry the same mandatory legal force as the Convention, were the Convention to be adopted here. The HSC advised that no decision should be taken at that stage.
If this country were to ratify the Convention, legislation would eventually be needed. An additional duty would have to be imposed on employers by amendments to the Health and Safety at Work Act whereby they would be compelled to provide an adequate and appropriate occupational health service, as defined in the legislation, or be guilty of a criminal offence. Further legal provisions would be needed to implement specific requirements. The legislation would not have to come into immediate effect, but would commit us to a process of progressive development.
The Recommendation could be accepted only in part; there would be a moral though not a legal obligation to implement any provisions which had been accepted. However, acceptance of the Recommendation would not require any major changes in our law.
As the Convention is under discussion, it may be worthwhile to examine its structure, especially as it demonstrates the trend of the international community’s thinking on occupational health services. Important aspects are as follows:
It employs legal sanctions, rather than the voluntary approach which has so far prevailed in the UK.
It adopts a multidisciplinary approach, regarding the doctor and the nurse as part of a team which also includes the hygienist and the ergonomist.
It contemplates that there shall be recognised qualifications for personnel providing occupational health services.
It requires the involvement of the workers themselves in the management of the service.
It sees the function of the service as essentially preventive; treatment is confined to first aid and emergency treatment.
As has been seen, the movement in occupational health has been away from treatment but towards prevention. If an employer wishes to provide ‘private treatment’ services in addition to the NHS because he thinks them economically worthwhile he may do so, but this is less important than the identification of work‐related hazards and the steps taken to protect the workers against them. A Joint ILO/World Health Organization Committee in 1950 wrote this:
Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and social well‐being 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 placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological equipment.
The UK government’s response to the Gregson report was published in 1984 (House of Lords Select Committee on Science and Technology). It enthusiastically welcomed the conclusion that ‘the responsibility for occupational
