§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lawson.]
§ 10.59 p.m.
§ Mr. Laurence Pavitt (Willesden, West)
One of the difficulties which I face in raising the subject of industrial health tonight is that there is a general acceptance of most of the case which I propose to put forward, and there is, behind the Ministry of Labour, a considerable amount of experience in safeguarding the health of people in industry. Nevertheless, what I am seeking to do is to put forward the case that the time has now come when there should be radical changes in the provisions which we make for the health of workers in industry and commerce, and that we need to take the first steps towards establishing a comprehensive occupational health service.
The idea of an occupational health service has been accepted by most people who have anything to do with the health of the nation. We had the British Medical Association's Report in 1961, the Dale Committee's Report in 1951, the Report of the Medical Practitioners Union in 1953, and the Socialist Medical Association has constantly campaigned for an extension of the Health Service to workers engaged in industry. In their White Paper of 1961, the former Government endorsed the recommendation of the International Labour Organisation that all Governments should seek to extend their occupational health services.
For some reason, it is difficult to get any sense of urgency into what is an extremely important problem. There is constant pressure on the public about the importance of production and exports. There is a constant demand for less industrial unrest and fewer disputes. The result is that strikes make headlines and news. In 1963 the total number of days lost through strikes was 1,755,000. In the same period the number of days lost to 1315 industry, and thus to the export drive, through illness was 288,860,000. In other words, the industrial position was affected by 164 days illness for every one day of strike that took place in that year.
Despite these figures, we can get all the personnel departments, the British Institute of Management and so on, all engaged in the problem of how to prevent industrial unrest and spending large sums in so doing, yet little is done about preventing the amount of production time—damage to exports and industrial capacity—lost through illness. If we could make a great inroad into the problem of this enormous amount of time lost through illness, think of the additional days that would be worked and consequent strength to the economy.
The fact that the public notices the one rather than the other is exemplified by the way in which the Press handles industrial news. I was looking back over the news published in the Daily Express last week. I was interested to discover 17 news items about strikes reported in that one newspaper in six days. On Monday items appeared on pages 11 and 17; on Tuesday on page 11; on Wednesday on page 11; on Thursday on pages two, nine, 13, 13 again and 20; on Friday on pages one, 10, 13, 13 again; on Saturday on pages nine, nine again, 15 and 20. There were 17 items about industrial unrest, yet no attention to the fact that for every one day lost to industry through strikes, 164 days were lost through illness.
Because this is so important a subject, I hope that the Joint Parliamentary Secretary will consider a few constructive proposals I wish to make towards seeking to ameliorate what I regard as a national danger. I make no claim for originality in the points I am putting forward, for these ideas are extant in the minds of many people who are interested in occupational health. I cannot mention them all, but to name a few, there are Professor R. S. F. Schilling, Professor of Occupational Health at the London School of Hygiene and Tropical Medicine, University of London, and doctors like Garland of Central Middlesex and O'Dwyer who organises the extremely good Unilever scheme for industrial health.
At present the country has three types of occupational health service. They are, 1316 first, the services provided voluntarily by employers; secondly, the services available to those employed by the nationalised industries, provided under the nationalisation Acts for the coal, gas and electricity industries; and, thirdly, the statutory services administered by the Minister of Labour and the Minister of Pensions and National Insurance. Under the Minister of Labour we have the factory inspectorate and the appointed factory doctors, supervised by medical inspectors, whose main task is to examine young persons and those employed in dangerous trades. In the Ministry of Pensions and National Insurance we have the pneumoconiosis panels. But the whole structure—and I would pay tribute to the work done by these Departments—had grown up primarily before the National Health Service, and there is no doubt that the provisions of the National Health Service have entirely altered the rôle which this service under the Ministry of Labour and the Ministry of Pensions and National Insurance should play in our community. This means that there should be changes in the system they are now operating.
I will not argue the case now but, in the long-term, it is inevitable that the service for health in industry should go to the Ministry of Health. We have not yet reached the stage when this is a viable proposition. In the meanwhile, I would suggest to the Ministry of Labour that it should so reorganise this department as to make it a more complete unit, and more able at a future date to be integrated into the general health system under the Minister of Health.
What is immediately needed is to hive off the whole service that has to do with health, and create a distinct department within the Ministry of Labour to deal with occupational health. It is not just a question of changing the title but also of a need to change the function because, at the moment, the whole system is based on medical inspectors with the idea of enforcing minimum standards decreed by Statute. I suggest that it is time that the medical inspectors became medical advisers, and so get us away from the negative idea of what we will stop to the positive idea of what we will create. The medical advisers in the Ministry should then seek to advise, not only the Ministry but also industry, not just to preserve 1317 minimum standards of safety but to promote maximum standards of positive health.
I suggest that to do this the Ministry needs reorganising by the appointment of a chief medical adviser having the task of co-ordinating and supervising a regional medical organisation with regional medical advisers. It would be the task of the chief medical adviser to control the Central Reference Laboratory which does so much excellent work in the kind of research needed to prevent illness in industry. I envisage that alongside the present trend towards regional government, which is being assisted by my right hon. Friend the First Secretary of State, there would be regional medical advisers whose job it would be to supervise the work of district medical advisers, to advise industrial medical officers already employed in industry and, more particularly, to organise training and educational programmes that would enable industry to cope with its health hazards.
There are at present more than 2,000 appointed factory doctors—usually general practitioners who do a part-time job, generally on Friday afternoons, and mostly engaged in examining young persons entering industry. The position has now been so vastly altered by changing social and economic conditions that the idea that every young person going into industry should be examined no longer holds good. I should like to see those 2,000 appointed factory doctors replaced by 300 district medical advisers, again drawn from the world of general practitioners. That would not only release some 1,700 doctors, who are very hard-pressed at the moment if we are to accept what is said in the general practitioners' charter, but would give a more responsible job to the 300 appointed to be district medical advisers, who would have a more specialised function to perform.
At the present time, the cost to industry of the appointed factory doctors is about £250,000. The appointment of the 300 district medical advisers would cost about the same amount. I suggest that the district medical advisers should have the statutory task of examining workers and their environments; very often we are not so much discussing sick people as sick factories, and we need to be able to diagnose the sick 1318 factories, and make them healthy. We should not examine all young people, but only those with medical records showing need, because of the National Health Service and the services organised in schools through the Ministry of Education, records are available. The people for whom examination would be necessary could be easily designated.
The district medical advisers would also need to examine all dangerous trades without waiting for regulations to be passed by the House. If they were in the rôle not of inspectors but advisers this could be a semi-voluntary operation in which I am sure industry would be only too ready to co-operate. It would be possible for the advisers fo examine conditions and advise employers, for example, in the case of battery manufacturers and others using chemicals and the number of trades where today radioactive substances are used. Managements are not malevolent. They are only too ready usually to help take care of the health of their workers. These medical advisers should also be specially trained to use modern techniques of biological and environmental monitoring.
An attempt should be made and the initiative taken among people who are interested, not among civil servants but among those engaged in health matters generally, so as to avoid splitting the occupational health service into separate disciplines. It might be possible with the co-operation of the Minister of Health to establish an Institute of Occupational Health which would bring together the Association of Certifying Factory Surgeons, the Association of Industrial Medical Officers, the British Occupational Hygiene Society, the Ergonomics Research Society, and other organisations which are at the moment engaged in occupational health therapy.
Reconstitution within the Ministry of Labour is the first step forward. One of the most difficult things in politics is to transfer from one Ministry to another. but we are missing out at the moment because the whole framework of health care is now of a comprehensive character and because, as a result of the vast experience built up in the Ministry of Labour, we have a pocket of people who are still thinking in terms of pre-National Health Service standards. Eventually I hope that we shall not only 1319 consider these things in industry but that it will be possible to extend an occupational health service to agriculture. There is a great need for as complete a coverage for agricultural workers as there is for workers in industry.
I should like to see the Ministry of Labour with its new Department having the power to initiate and be evangelical about joint schemes, like that in central Middlesex where factories at the Park Royal estate pay subscriptions to establish a health centre which serves, through a series of clinics in the area, the health needs of many factories. Large firms like Unilever and I.C.I. are able to operate first-class schemes for their large numbers of employees, but the vast majority of workers are employed in small firms. If they are to have any coverage at all it can be done only by co-ordinating these firms and having a federal system. But at present nobody has the responsibility to see whether firms can be persuaded to join and to get a scheme off the ground.
At present there are about half-a-dozen of these schemes and the Ministry of Health is most helpful in being able from time to time to give the part-time service of a hospital consultant to industrial health schemes. He is paid partly out of the funds of the scheme and partly by the Ministry. Here again, it seems to me that there is an opportunity for collaboration between the Minister of Labour and the Minister of Health in persuading more firms to adopt this kind of idea.
In our present economic circumstances, it is, I know, extremely difficult to envisage the expenditure of more money. Ideally, of course, I should like to see a completely new occupational health service started. I should like the same device to be used, if it were possible, as was used in the Departments responsible for the Colonies and for Commonwealth Relations when they were faced with a similar problem and set up the Department of Technical Co-operation, having a separate Department for the time being with a Minister for a Department of Occupational Health responsible to the House. But I realise that this cannot come in the immediate future.
For the present, I should like the Ministry of Labour to take steps to set up a 1320 health department within the Ministry in the next two or three years, a department so organised that we should get away from mere inspection, get away from the business of merely ensuring that certain standards are observed, and see that positive steps are taken. I acknowledge that it would cost more money, but not all that much more in the immediate future. It is not a question of whether the nation can afford to have an occupational health service. In our present economic circumstances, I submit, the nation cannot afford not to have an occupational health service.
§ 11.17 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Labour (Mr. Ernest Thornton)
I was pleased to learn that my hon. Friend the Member for Willesden, West (Mr. Pavitt) had chosen this subject for debate tonight, because it is one to which the Ministry of Labour has recently been giving increasing attention. I thank my hon. Friend for letting me have a note of certain questions which he intended to raise, questions concerned largely with the organisation of medical services. These matters are important because they raise the question of the rôle of the Government in industrial health in present-day conditions, which, as my hon. Friend said, are so different from those prevailing at the time when the services were started.
I go some way with my hon. Friend, though I cannot agree with all the points he made. I say at the outset that we are perfectly prepared to look critically at the way things are organised at present. In particular, we doubt, as my hon. Friend doubts, that the appointed factory doctor service is at present organised in the most effective way for promoting industrial health.
Before going on to discuss the medical inspectorate and the appointed factory doctor service, I should point out that such appointments are made under the Factories Act. Many of the provisions of that Act and the Regulations made under it are concerned with industrial health. Responsibility for their enforcement rests with the general factory inspectorate throughout the country. On the particular problems encountered in the course of their inspection, inspectors can, of course, call in their specialist 1321 colleagues, including doctors, chemists and engineers. These specialists are based either in London or in the 13 divisional offices and include 19 medical inspectors.
The senior medical inspector, two deputy senior medical inspectors and two other medical inspectors are stationed at headquarters, and 13 are stationed elsewhere, cn the general basis of one in each division. The senior medical inspector is responsible for the work of all medical inspectors throughout the country. Medical inspectors are responsible to him and report to him, but, of course, the out-stationed inspectors work very closely with the rest of the factory inspectorate.
One of the principal tasks of the medical inspector is to advise the general inspectorate in his division on any of the medical aspects of health, welfare and safety in industry. In parenthesis, may I say how pleased I was that my hon. Friend called attention to, and put into perspective, the amount of time lost through industrial illness as compared with the much publicised number of days lost by strikes. The medical inspector visits factories and also studies the health and related problems of local industries in pursuance of special inquiries begun by the medical inspectorate. He also advises factory occupiers on the provision and value of medical and nursing services and first-aid facilities. He maintains contact with the appointed factory doctors and advises the chief inspector through the senior medical inspector on their appointment.
One of the two medical inspectors stationed at headquarters is in charge of the medical laboratory. I am pleased that my hon. Friend paid tribute to the work done here. The purpose of the laboratory is not to undertake fundamental research. That is a matter for the research establishments to which, of course, we have access. The purpose of the laboratory is to provide a number of basic services. These services, with the development of new materials and new or improved diagnostic techniques, are necessary for the day to day working of the Inspectorate.
I have described the present duties of the medical inspectorate. I should make it clear, however, that we are not by any means certain that its organisation can- 1322 not be improved. My hon. Friend has made a number of suggestions to that effect. I am afraid that I have not time tonight to comment on these in detail but I can say that the question of the organisation and functions of the medical inspectorate is at present being reviewed by the Department. In deciding on our future policy we shall obviously have to take into account any changes which are agreed on as a result of the review of the appointed factory doctor system to which I now wish to turn.
§ Dr. Wyndham Davies (Birmingham, Perry Barr)
Would it not help to increase the number of medical inspectors? They are so overloaded with work at the moment that they are not able to do their jobs as efficiently as they would otherwise. If it were possible to increase their number this might be of great help.
§ Mr. Thornton
This is one of the many matters under consideration by the Department at the present time, and I will certainly bear in mind the point raised by the hon. Member.
My hon. Friend emphasised the need to reorganise the appointed factory doctor service and to change the approach from one of examination of fitness to a preventive medical service. With this I am very much in agreement. This is a problem to which we, in conjunction with the Industrial Health Advisory Committee, have been paying close attention recently. At its meeting last November the committee appointed a sub-committee with wide terms of reference—namely, "to review the appointed factory doctor service and to make recommendations."
The sub-committee includes persons from the B.M.A., the Association of Certifying Factory Surgeons, the Association of Industrial Medical Officers and also representatives of the B.E.C. and the T.U.C. It would be premature for me to anticipate the results of its review. But the appointed factory doctor service has a very long history, originating with the certifying surgeons who came into existence as a result of the Factory Act, 1844.
The present position is that those under 18 who start work in factories have to be medically examined within 14 days of starting. They are also required to be re-examined yearly until the age of 18, and on change of employment. In 1963,
1323 the appointed factory doctors carried out more than 500,000 such examinations. As my hon. Friend pointed out, only very few of those examined were declared unfit for their particular jobs or had conditions attached to their work.
The system was last modified in 1948 and was evolved before the National Health Service came into being and before the school medical service was organised. The re-examination currently being undertaken can be expected to assess the need for these medical examinations in present conditions. It will also see how the appointed factory doctor service should be related to the other medical services.
Certainly I agree that we must be satisfied that doctors are not given unnecessary routine statutory duties when their time could be devoted to more constructive purposes in the industrial health field.
Appointed factory doctors carry out a number of other duties which I am afraid I have not time to review tonight. The other main point to which attention will be paid is the question of the structure of the appointed factory doctor service. At present the service is basically in the hands of 1,500—my information is 1,500 and not 2,000 as my hon. Friend said—district factory doctors. It seems to me that it would be a good thing if, more often than at present, the factory doctor could be the local expert on industrial health to whom practitioners, employers, and the factory inspectorate would increasingly turn. The work of the medical branch would also be helped if the appointed factory doctor were able to play a more active part in special inquiries than is possible at present.
It will be apparent from what I have already said that whole we do not claim that the present organisation of our medical services is the best possible one, it does not follow that the right solution is to set up a separate department of occupational health within the Ministry of Labour or to transfer such a department to the Ministry of Health. Questions of occupational health are already dealt with as a special sub- 1324 ject of high importance in the headquarters of the Ministry of Labour. On the administrative side, one branch of the safety, health and welfare department is concerned solely with health matters. Apart from the Medical Inspectorate, one of the deputy chief inspectors of factories is concerned with health problems.
Any further separation of the administration of industrial health questions from that of other aspects of the administration of the Factories Act seems to me undesirable. Let us not forget the day-to-day responsibility for seeing that employers maintain their factories as healthy places to work in lies with the factory inspectorate who make routine inspections.
The suggestion that responsibility for occupational health should be transferred to the Ministry of Health is, as my hon. Friend said, not new. Those who take this view rightly emphasise the importance of co-ordinating industrial health services with the National Health Service and the need to avoid the duplication of facilities.
It is, however, not necessary for the responsibility for industrial health to be given to the Health Departments for these objectives to be achieved. We work in the closest collaboration with the Health Departments. One of the aims of the review of the appointed factory doctor service is to consider its relationship to other health services.
There is another question—the industrial hygiene services. As I told the House in an earlier Adjournment debate, on 26th November, we are carrying out a special random survey of factories to establish the extent and nature of toxic hazards so as to establish how much industrial hygiene services are really needed—
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty-nine minutes past Eleven o'clock.