providers can offer evidence of a sufficient level of expertise or training in occupational health. Registers of competent practitioners are maintained by several professional bodies, and are often valuable.
Competence does not necessarily depend on paper qualifications, but may also require an understanding of relevant best practice, an awareness of the limitations of one’s own experience and knowledge, and the willingness and ability to supplement existing experience and knowledge, when necessary, by obtaining external help and advice. A British Standard (BS 8800) was published in 1996: Guide to occupational health and safety management systems. BS 8800 is regularly updated. In 2018 a comprehensive International Standard was published: BS ISO 45001.
The Health and Safety Commission expressed one of its priorities as the establishment of the key points of attack in improving occupational health and identifying the extent of occupational ill health, taking appropriate action to exploit the linkages between occupational health and the government’s ‘Health of the Nation’ initiative.
The assessment and management of health risks – the central requirement of the various regulations – are often more complex or involve greater uncertainty than for occupational safety risks. Targeted guidance on assessment and management, and on selecting expert advice, will be needed by employers and employee representatives, as well as by health and safety inspectors, as an essential tool to ensure effective action.
The Commission planned to continue to give high priority to epidemiological research. A successful consultant‐based scheme for the collection of data relating to occupational lung disease was extended to a number of other work‐related diseases. Subsequently some GPs also became involved. This data collection scheme is now known as THOR (The Health and Occupation Reporting Network) and is administered by the Centre for Occupational and Environmental Health of the University of Manchester. More attention was paid to GPs, who may fail to identify the connection between a patient’s work and their medical condition. The Health and Safety Executive in 1992 produced a booklet on occupational health for family doctors: Your Patients and their Work and the Faculty and Society of Occupational Medicine and the Royal College of General Practitioners, supported by the Department for Work and Pensions, produced a joint publication: the Health and Work Handbook.
In 2000 the Department of the Environment, Transport and the Regions published a Strategy Statement (Chapter 5). It set out targets for reducing the number of days lost through illness and injury at work. The role of occupational health was seen as central to achieving this reduction. The HSC’s report, An Occupational Health Strategy for Great Britain (2001), set out a number of objectives. Interested parties planned to work together to achieve the following targets by 2010:
a 20 per cent reduction in the incidence of work‐related ill health;
a 20 per cent reduction in ill health to members of the public caused by work activity;
a 30 per cent reduction in the number of work days lost due to work‐related ill health;
that everyone currently in employment but off work due to ill health or disability is, where necessary and appropriate, made aware of opportunities for rehabilitation back into work as early as possible; and
that everyone currently not in employment due to ill health or disability is, where necessary and appropriate, made aware of and offered opportunities to prepare for and find work.
A Partnership Board was set up to oversee the implementation and delivery of the strategy, and responsible to them was a Programme Action Group to facilitate the delivery of each of the strategy’s five programmes of work (compliance, continuous improvement, knowledge, skills and support mechanisms). Programme 1 (to improve the law in relation to occupational health and compliance with it) was the most relevant to this book. The aim was to encourage the important work of developing standards, or guidance on best practice, and to support occupational health legislation, as well as enforcing the law when appropriate. The priority areas included:
improving the law by introducing agreed new and revised health‐related legislation and/or guidance and by removing unnecessary legislation;
increasing the involvement of health and safety representatives;
increasing fines/sentences and other disincentives to breaches of the law;
increasing information on the economic benefits of addressing occupational health in order to help promote compliance;
raising awareness of the law within priority groups (e.g. small firms);
securing consistent enforcement action on health issues;
increasing the involvement of interested parties (e.g. trade associations) to produce standards; and
raising awareness among employers that reasonable adjustments to working arrangements should be made for employees or job seekers who are, or who become, disabled.
Programme 5 (to ensure that appropriate mechanisms are in place to deliver information, advice and other support on occupational health) was particularly relevant to occupational health professionals. The aim was to give everyone access to appropriate occupational health support. It planned to examine ‘the feasibility of new legislation on the accessibility and availability of occupational health support’ and ‘ensure that support is provided by professionally skilled people when appropriate’. One recommendation was to provide occupational health training for primary care teams.
In 2000, the Report of the Occupational Health Advisory Committee and Recommendations on improving access to occupational health support was published (OHAC Report). It made the point that changing patterns of employment mean that an increasing proportion of the working population are employed in small enterprises where there is no ready access to occupational health advice. The report drew comparisons with the position in other Member States of the European Union: from France where occupational health was very much grounded in occupational medicine, to Finland where all employers must have a multi‐disciplinary service, 50 per cent of the costs of which could be reimbursed through national sickness insurance.
The Committee reported that in the UK public sector almost half the total workforce had access to some form of occupational health advice, but that the picture was very different in the private sector. There was a decrease in the number of people covered by in‐house services. Indications were that smaller companies either did not use occupational health support at all or relied on GPs or nurses, some of whom were not trained in occupational health. EMAS, the HSE and local authority inspectors were a source of information and guidance, but their resources were stretched. Employers of small‐ and medium‐sized enterprises (SMEs) had little awareness of occupational health legislation.
Even where occupational health support was provided by employers, it was often viewed with suspicion by workers who saw it as being concerned mainly with sickness absence monitoring. ‘The fundamental issue is one of recognition that the prevention of work‐related ill health should form an essential aspect of the running of any organisation.’ Attention needed to be paid to tackle health inequalities throughout the workplace. Women, ethnic minorities and the disabled might need different treatment from other workers. There was a need for partnerships at local level. Occupational health support should be linked strategically with NHS and local authority initiatives. One example of such a partnership was the Sheffield Occupational Health Advisory Service which was developing a service to patients through the four Sheffield Primary Care Trust practices. It had created a Manual of Occupational Health in Primary Care. A similar organisation was Health Works in the
