employers’. It doubted whether GPs could provide services as an integral part of primary care without reducing efficiency. The government made clear its determination not to provide occupational health services out of public funds.
At the same time, the HSC agreed that there should be a review of the participation of GPs in occupational health practice. The Commission supported the provision of a training and qualification scheme appropriate for doctors working for only a small part of their time in industry. It recognised ‘the important role of trained occupational health nurses … which is frequently misunderstood and … could be widened in scope’.
In 1986 the HSC issued a statement of policy in response to the Gregson Report. It declined at that stage to formulate a Code of Practice. Instead it initiated a programme of action. This included:
the preparation of guidelines for employers on such matters as the benefits and availability of OH services;
a publicity campaign especially aimed at small firms about the appropriate use of OH services;
the encouragement of new projects by the Industry Advisory Committees (organisations set up within particular industries, under the aegis of the HSE, to make recommendations to the HSC);
the promotion by the HSE of conferences and seminars for the exchange of practical information about the provision of OH services;
liaison with training bodies to promote the training of OH specialists and make managers more aware of health and safety;
the improvement of co‐ordination with the National Health Service;
co‐ordination between the organisations involved in the provision of OH services, including larger employers, public and professional bodies, academic departments, group services and independent consultancies.
Many health professionals working in occupational health criticised what they saw as a lack of resolve in the HSC. However, the ILO Convention did have an indirect effect on the law of the United Kingdom, because it was one of the important influences which led to the European Community’s Framework Directive, incorporated into UK law in the Management of Health and Safety at Work Regulations 1992 (Chapter 5).
Further on the international front the World Health Organization has developed a global strategy on occupational health for all. It published Good Practice in Occupational Health in 2002. In 2007 the World Health Assembly endorsed the WHO Global Plan of Action on Workers’ Health (2008–2017). The Assembly urged Member States to improve the performance of and access to occupational health services as well as working towards full coverage for all workers to basic occupational health services for the primary prevention of occupational disease and injury. The service provider should aim towards establishing and maintaining a healthy and safe work environment, maintaining a well performing and motivated workforce, preventing work‐related disease and accidents, and maintaining and promoting the work ability of workers.
The emergence of different forms of employment like the gig economy and zero hours contracts, discussed in Chapter 7, have serious implications for the protection of the health of the workers. In 2019 Maria Neira, director of public health and environment at the World Health Organization, said this:
Most workers in informal and precarious employment, gig economy, care economy, migrant and domestic workers, don’t have regulatory protection of their health and safety at work, occupational health services, and social security. We want the future of work to close, and not to widen, the gaps between those who have full labour rights, health and safety services, regulatory and social protection and those who do not. The current system of regulations, services and practice of occupational health and safety is a product of 20th century forms of work and organisation of the economy‐standard employment in big enterprises with social protection and regulatory control. The system is not any more suitable for the new forms of work and work organisation – it needs to evolve to ensure no one is left behind. We need a reform of occupational safety and health governance and services. The lack of collaboration between health and labour sectors in countries is a major obstacle for addressing the health and safety challenges from a changing world of work.
Developments in the last 25 years
In the last 25 years there has been a sea change in the attitude of the British government to occupational health. A White Paper, The Health of the Nation, was published in 1992. Successive governments since the inauguration of the National Health Service after World War II had come to realise that spending on health care must be contained. The creation of an internal market by separating the authorities who provide health care from those who purchase it was one strategy to try to secure better value for money. Another was to try to encourage the population to take care of its own health. The White Paper demonstrated the government’s commitment to preventive medicine. It selected five key areas in which national targets were fixed. These were coronary heart disease and stroke, cancers, mental illness, HIV/AIDS and sexual health, and accidents.
The White Paper emphasised the importance of a healthy workplace and proposed the setting up of a task force to examine and develop activity on health promotion in the workplace. It also encouraged the NHS to set an example to other employers to show what can be achieved. The NHS Management Executive set up a task group of NHS managers, Health Education Authority representatives and professionals to review the way in which the NHS promoted the health of its own employees.
Further important proposals were initiated in 1998. A Green Paper Our Healthier Nation proposed a ten‐year strategy for occupational health, to be set out in a consultation paper from the HSC. The Occupational Health Strategy Unit within the HSE’s Health Directorate, set up in 1996, was charged with the responsibility of developing a national ‘vision for occupational health’.
At the same time there was a marked increase in the numbers of regulations governing health and safety at work, particularly those originating in European Community Directives. Many of these were designed to prevent long‐term injury to health, as compared to the prevention of accidental injury. Health professionals with the necessary training and expertise are especially valuable to employers who need advice on the implementation of the regulations and the provision of health surveillance to ensure that the employees are not suffering adverse effects from their work. Perhaps the most important of these regulations are the Management of Health and Safety at Work Regulations 1992, implementing the EC Framework Directive. These oblige all employers, with minor exceptions, to make a suitable and sufficient assessment of the risks to the health and safety of their employees, and to those not in their employment, arising out of the conduct of their undertakings. Every employer shall ensure that his employees are provided with such health surveillance as is appropriate. The Approved Code of Practice (since abandoned) advised that, at least in some instances, this would necessitate the services of ‘an Occupational Health Nurse’ or medical surveillance by ‘an appropriately qualified practitioner’. Taken with the emphasis in the regulations on the need to employ competent persons, it would seem that the employment of health professionals with specialist qualifications in occupational health was at last gaining official recognition. An Occupational Health and Safety Lead Body was established to develop vocational qualifications for health and safety practitioners.
Amendments to the Approved Code of Practice (no longer in force) accompanying the Management Regulations 1999 gave guidance on the appointment of competent persons. Paragraph 49 stated:
Employers who appoint doctors, nurses or other health professionals to advise them on the effects of work on employee health, or to carry out certain procedures,
