to see the medical adviser is more than compensated by reductions in overtime and travelling expenses for the workers. A second example is a chemical company employing over 1000 people and concerned about absence from work due to muscle and joint disorders. It arranges for a self‐employed physiotherapist to attend three mornings a week. The employer benefits greatly from the reduction in absences from work from sickness and attending for treatment outside the workplace. Easy access to the physiotherapy service also assists early treatment which is often essential to a good outcome. Finally, a company using isocyanates requires health surveillance of the workforce. EMAS advises the company to contact a local GP. The GP notices other occupational health problems, such as skin conditions and stress‐related symptoms. This leads to regular workplace visits which improve the health status of the workforce and benefit manager/worker relationships.
The HSE has published information about the tax and National Insurance treatment of occupational health support. An employer is able to claim a deduction against business profits in providing health‐related benefits to employees, provided the expenditure is wholly and exclusively for the purpose of the business. The benefit of private medical care provided free or cheaply by employers to employees is subject to tax on the employee, though £500 of care per annum recommended by occupational health is now tax free. However, the following benefits are not subject to income tax: medical and other treatment for the consequences of work‐related accidents or ill health, health screening and check‐ups, welfare counselling, equipment and services for disabled workers, employee‐only recreational and sporting facilities. This is as long as the benefits are provided by the employer directly to the employee. If the employee is given money to pay for the benefits he will have to pay income tax.
In 2017 the Society of Occupational Medicine (SOM) published Occupational Health: the value proposition by Dr Paul Nicholson. The SOM report is divided into sections: making the business case, the legal, moral, business and financial imperatives for investing in occupational health, the evidence for investing in occupational safety and health and workplace promotion, and finally the evidence for investing in occupational health services. Nicholson states that legal, financial and moral reasons and reputational risk are the key drivers for employers to invest in healthy workplaces and occupational health and safety. He highlights the burden of sickness absence. Minor illnesses are the commonest reason for absence, but the greatest number of days’ absence is due to musculoskeletal and mental health problems. One employer survey reported that sickness absence was estimated to cost UK business £28.8 billion a year. In addition, long‐term sickness absence is a huge cost to the state in welfare benefits.
1.4 The Employment Medical Advisory Service and Appointed Doctors
In 1833 and 1844 the Factory Acts required child workers to be examined by a local surgeon or physician to assess whether they were under the legal minimum working age (nine). The 1855 Factory Act conferred on these Certifying Factory Surgeons the task of certifying that young people were not incapacitated for work and of investigating industrial accidents. The doctor was independent both of the employer and of the employee, though paid by the factory owner. Later in the century, legislation required the Certifying Factory Surgeons also to investigate cases of industrial disease. In addition, employers were compelled to pay Appointed Surgeons to undertake regular medical examination of those working with specified substances like lead and phosphorus. The first full‐time Medical Inspector of Factories was appointed in 1898.
Part‐time medical practitioners have, therefore, conducted medical examinations in industry for more than a century. They now operate under the supervision of full‐time specialists in occupational medicine, the Employment Medical Advisory Service (EMAS) and are called Appointed Doctors (ADs). Their principal function is to undertake examinations of workers in the workplace and to assess their fitness for work when the employer is bound by statute to carry out regular health surveillance. The ADs are appointed by the Health and Safety Executive through EMAS in respect of a particular company or companies and premises. EMAS is able to ask for evidence of occupational health qualifications and experience when making appointments, though these are not mandatory legal requirements. The ADs are obliged to comply with both the clinical and administrative procedures set by EMAS; they are subject to inspection by Employment Medical Advisers. It is very important that proper clinical records are kept and statistical returns made to EMAS. If the work of the AD is unsatisfactory, his appointment may be revoked without a reason being stated or an explanation given. The employer has to pay fees for medical surveillance required by law.
The functions of EMAS are laid down in section 55 of the Health and Safety at Work Act. It undertakes the following responsibilities:
Advice to the inspectorate on the occupational health aspects of Regulations and Approved Codes of Practice (Chapter 5).
Regular examinations of persons employed on known hazardous operations.
Other medical examinations, investigations and surveys. An Adviser has power to require an employer to permit him to carry out a medical examination of any employee whose health the Adviser believes may be in danger because of his work.
Advice to the HSE, employers, trade unions and others on the occupational health aspects of poisonous substances, immunological disorders, physical hazards, dust, and mental stress, including setting standards of exposure to harmful processes and substances.
Research into occupational health.
Advice on the provision of occupational health and first aid services.
Advice on the medical aspects of rehabilitation and training for and placement in employment.
EMAS employs both doctors (EMAs) and nurses (Inspectors of Health and Safety (Occupational Health)) as well as support staff. It also provides the secretariat for two of the Health and Safety Executive’s Advisory Committees:
1 the Workplace Health Expert Committee (WHEC). This committee was set up in 2015 under the chairmanship of Professor Sir Anthony Newman Taylor. Its remit is to give an independent expert opinion to the HSE on new, emerging and existing workplace health issues and the quality and relevance of the evidence base on workplace health issues.
2 the Advisory Committee on Dangerous Pathogens (ACDP).
1.5 The occupational health physician
The British Medical Association (BMA) defines an OH physician as
a doctor who in relation to any particular workplace takes full medical responsibility for advising those working therein including contractors working on the site on all matters connected directly or indirectly with the work. These may have a bearing on health as it affects work and the effect of work on health including that of the public at large, either in general or as individuals. (The Occupational Physician)
An OH physician must be a registered medical practitioner and hold a licence to practise. There is as yet no strict legal requirement that the OH physician should hold any other qualification than ordinary registration but employers are advised to ask for a qualification in occupational medicine. General practitioners who provide occupational health services part‐time should have the minimum qualification of the Diploma in Occupational Medicine (DOccMed). Those involved more comprehensively in occupational medical practice should obtain in addition Associate Membership of the Faculty of Occupational Medicine of the Royal College of Physicians (AFOM). Further experience and a dissertation enables a doctor to apply for membership of the Faculty (MFOM). The MFOM is a career specialist qualification and entitles the doctor to call himself a specialist or consultant. Specialist training in occupational medicine is prescribed by the Postgraduate Medical Education and Training Board
