FACTORY DOCTOR SERVICE

HC Deb 25 November 1966 vol 736 cc1871-80

Motion made, and Question proposed, That this House do now adjourn.—[Mr. R. W. Brown.]

4.3 p.m.

Mr. Nicholas Scott (Paddington, South)

In raising the subject of an appointed factory doctor service on this the first opportunity that I have had to speak on the Adjournment, I hope that it is not entirely inappropriate if I mention the personal pleasure that it gives me that the hon. Lady the Parliamentary Secretary to the Ministry of Labour should be replying to this debate. Our political paths crossed before either of us came into this House, and it is a source of personal pleasure to me that she should fulfil her high office with such competence and charm.

Turning to the subject of an appointed factory doctor service, and in particular to the Report which was published in April of this year, to me the most disappointing factors are the narrow terms of reference of the sub-committee and the narrow nature of the Report when it was finally published. On 1st November last year the hon. Member for Hudders-field, West (Mr. Lomas) asked the Minister of Labour what steps he had taken to set up an occupational health service and the Minister replied that the Industrial Health Advisory Committee would be considering the Report of its subcommittee on the appointed factory doctor service.

It seemed that the Minister saw this Report as a step towards the setting-up of an occupational health service. If this is so, I am at a loss to understand why the sub-committee was given such narrow terms of reference. It is quite clear that, far from being a real step forward, the Report marks time if it is seen in the context of a development towards an occupational health service. I shall return to that point later. Meanwhile, I want to look at the Report and for the time being to confine myself within the limits the sub-committee set itself.

The origins of the appointed factory doctor service lie back in the mid-nineteenth century, with dark satanic mills and the industrial environment of that time. The Factories Act, 1844, authorised the appointment of certifying surgeons to ensure that children working in textile mills were of the physical strength and appearance normal for children of nine years and over. We have come a long way since then and the service has acquired other responsibilities. In 1948 it became known under the term we now use.

In November, 1964, the sub-committee was asked to consider its future, and last April we saw its Report. I understand that for the past six months the Ministry of Labour has had a great number of burdens on its shoulders, not all of its own choosing and perhaps not all entirely to its liking. I nevertheless hope that the hon. Lady will be able to give us the general lines of her thinking on the service's future and on the future development of an occupational health service, even if she is unable to give us specific proposals today.

I asked for the debate because I thought that the Report covered a fairly small subject which is crucial when one looks at the overall question of industrial health. The Report makes clear—and we would all accept this much—that at the moment there is a great deal of waste of medical manpower in the way the appointed factory doctor service works. It is medical manpower that we can ill afford to waste or misuse in any way.

The service was given its present duties before the National Health Service or the School Health Service had developed as they have today. A young person who goes to work in a factory is required to be examined by an appointed factory doctor, yet only months, and possibly weeks before that young person will have been examined by a school doctor, and perhaps given a clean bill of health. Therefore, the first priority is to move away form the general examinations, with their waste and overlapping, and to pay special attention to the small proportion, perhaps 5 per cent., of children who are in need of special attention from an industrial health service.

Thus far I go along with the subcommittee's proposals, because it intends to replace the 1,500 odd appointed factory doctors by a new type of doctor giving more attention to this, concentrating his effort on the 5 per cent., of young people with defects. The committee calls these doctors, rather unimaginatively, "A" doctors. I hope that if this ever becomes legislation some more imaginative name will be found. But there are other duties the Committee envisages being placed upon the "A" doctors, some of which are, indeed, already held by the present appointed factory doctors, who have a responsibility for the medical examination of people involved in hazardous processes. Incidentally, many of the regulations on hazardous processes appear to go back to the beginning of the century, and I would have thought that possibly the time was now ripe for some sort of codification to bring those regulations up to date, and perhaps the hon. Lady will be able to tell us whether this is in the mind of her right hon. Friend at the moment.

The Report goes on specifically to set out its broad aims as, first: the elimination of unnecessary medical examinations, particularly of young people which at present take up a disproportionate amount of A.F.D.s' time. We all agree with that. The second aim is: The redeployment of medical resources to bring about a more compact, integrated, and expert medical service with wider duties over the whole field of occupational health. Of course, this country is committed, under the I.L.O. Convention on occupational health services, to the development of such a service. Elsewhere, the Report envisages also that the service should be able to provide advice to firms on the employment of special cases, the chronic sick, old people or disabled people employed in a factory.

I cannot see how the second aim or the advice aim can be fulfilled by a part-time service. In a recent article in The Times Review of Industry, Lord Taylor and Dr. Elliot, who have been involved in the development of the Harlow industrial health service, estimated that we would need between 300 and 500 full-time equivalents working in the industrial health service to fill this sort of rôle.

Perhaps the answer envisaged by the sub-committee is the best that can be proposed at this time, bearing in mind our tragic shortage of medical manpower, but opportunities for legislation on these matters occur only too rarely, and I hope that the hon. Lady will be able to talk about the long-term aim and let us know how she envisages the future development of an occupational health service. It seems to me that the sub-committee's views were very restricted and went no further than the continuance, albeit in a refined way, of an essentially amateur and part-time occupational health service. They represent no more than an almost imperceptible step forward.

We should have in mind the development as soon as possible of a service manned largely by full-timers, with training programmes and with a career structure in its own right, able to devote a great deal of time to questions of environmental health and preventive medicine in industry. Is this a view with which the hon. Lady agrees? If it is, I hope that she will make clear that she disagrees with the sub-committee's attitude towards the rôle of works medical officers in industrial health. It seems to me that the sub-committee's view was backward-looking and out of date. In paragraph 50 of its Report some rather hopeful signs are given: 'A' doctors with their responsibility for a district will never be able to take the place of a doctor in an individual factory, and there is no reason in principle why works medical officers should not be appointed to carry out particular types of medical examinations, subject to official supervision and direction". In the next paragraph it is said that The new Service should operate under the close direct control of the Medical Branch of Her Majesty's Factory Inspectorate, and should be subject to the guidance and control of the Senior Medical Inspector in all aspects of its work". That was a hopeful sign that the subcommittee was looking with a rather less jaundiced view than the Ministry of Labour has in the past at the rôle of works medical officers in industrial health, but, unfortunately, in paragraph 49 the sub-committee found Some incompatibility between holding an appointment with a private employer and a public service appointment involving a degree of supervision over the same employer". I regard this as a slur on the medical integrity of those who would hold both these jobs, and, in the light of today's circumstances, I can see little justification for it. Also, it seems to me to cast doubt on the effectiveness of the close direct control which the Inspectorate is supposed to have over the operation of the service. If we are to have an effective occupational health service we need every pair of qualified hands that are available to be employed as effectively as possible with no overlapping, duplication or waste. It is important that the hon. Lady should make clear her attitude to the rôle of works medical officers of health in this matter.

There are two other specific questions that I would ask the hon. Lady before I come back to what I think is the crux of the whole matter. First, the main impact of the work of the service should be felt by the 5 per cent. of young people with defects who will need its help and guidance. These are also people for whom the Youth Employment Service has very special importance. Her right hon. Friend has now promised us a statement on the Youth Employment Service before Christmas. I would ask her to bear in mind that we hope that the plans for the Youth Employment Service will be ambitious ones, and also that it will be possible for her to be able to announce the specific proposals regarding the appointed factory doctor service at the same time, or at about the same time, as we get the plans for the Youth Employment Service.

Secondly, I should like to know whether it is intended that the provisions of the new type of service, on whatever lines that is decided, should be extended beyond the boundaries of factory premises. It does not seem to me that there is today any logic in this particular case in distinguishing between factories and other types of work place. Certainly, with regard to what is indicated on the suggested form at the back of the Committee's Report—heavy manual work or lifting, work involving exposure to fumes, work near vehicles, work requiring fine or accurate vision, work requiring normal hearing—any of these types of work can be experienced outside factories in shops, offices and other premises. One would like to know that the Government envisage the extension of the scheme beyond the factory floor.

Finally, I would express the hope that in the future the Ministry will see its way clear to the development of a comprehensive occupational health service. Our signature to the I.L.O. Convention on this permits us to a number of provisions of that Convention on which I should like to list just one or two: surveillance within the undertaking of all factors which may affect the health of the workers and advice in this respect to management and to workers or their representatives in the undertaking; job analysis … and advice to management and workers on the best possible adaptation of the job to the worker having regard to these considerations, participation … in the prevention of accidents and occupational diseases … and advice to management and workers in this respect; surveillance of the hygiene of the undertaking; periodic pre-employment, and special medical examinations … particular surveillance over certain classes of workers, such as women, young persons, workers exposed to special risks and handicapped persons", and others.

I do not see how the service as envisaged by the sub-committee will be able to develop along the lines to which we are committed by our signature to the I.L.O. Convention. So it seems to me that the action suggested by the sub-committee is hardly a leap forward towards the realisation of a comprehensive occupational health service.

In Harlow Lord Taylor and Dr. Elliot have been involved in an extremely interesting venture on a co-operative and non-profit making basis to develop the sort of comprehensive industrial health service available to medium-sized and small-sized firms which, in the first place, offers those firms facilities which previously were available only to the large firm which was able to have its own medical department, and, secondly, shows the sort of pattern which we should most carefully follow in the future, under the supervision, of course, of the medical branch of the Factory Inspectorate, eventually involving the appointed factory doctors or those of them who are prepared to take up full-time work in occupational health in the system. This is the pattern, I think, which, with one other addition—that is, Government support for the development of a proper industrial hygiene service—would enable us to say that we were moving forward towards the realisation of a realistic industrial health service.

The final question I ask the hon. Lady, which she may not be able to answer now, is, if we move towards this comprehensive system, will the Ministry of Labour or the Ministry of Health be the most appropriate Ministry to undertake this work?

4.21 p.m.

The Parliamentary Secretary to the Ministry of Labour (Mrs. Shirley Williams)

I begin by thanking the hon. Member for Paddington, South (Mr. Scott) for raising this question about which he has a great deal of knowledge, and for making so extremely interesting points about it. One of the difficulties in answering the debate is that while consultations are still going on, as he indicated, it is difficult to suggest the specific proposals which will eventually be put forward, but I shall try to assist the hon. Member as much as I can.

First I point out that the Report itself recognised that there was some place for medical manpower in the present factory doctor service, because of the routine medical examinations to which the hon. Member has referred. These routine medical examinations are obligations under existing legislation, under the Factories Acts. Consequently, until there is any amendment of that existing legislation it is not open to the Ministry of Labour to resolve this situation. Any changes made in the factory doctor service bringing in proposals for the "A" doctor service will depend on and have to await the opportunity for legislation.

As the hon. Member rightly pointed out, the main objects as the Committee saw them of the "A" doctor service would first be a concentration on young persons at risk, that is with a medical history of one kind or another which would enable them to be given far more attention, and secondly, the continuing concern with people working in factories subject to occupational hazards of one sort or another.

In answering the question which the hon. Member put specifically, although it is a little unrelated to this debate, it is a little difficult to codify hazardous processes in regulations for the simple reason that new techniques are constantly arising which demand a completely new body to deal with the hazards involved. For instance, the use of lasers in industry presents a completely new type of hazard which is not comprised in existing regulations. There is a constant review of the existing regulations.

I give a couple of examples. Only very recently there was the bringing up to date of the notification of industrial diseases and one or two more diseases were added to those which have to be notified for registration. Also there is the case of the notification of hazards in the use of carcinogenic substances which will shortly be brought up to date and announced in the House, and similarly with lead processes. These involve much of a factory doctor's time and have to be notified publicly. There is a constant attempt to bring these up to date and there would be difficulties in codifying and in trying once for all to settle the problem, because one has to get back to the different dates of the regulations which one has at present.

Turning from that to the main question which the hon. Member raised and which concerns the introduction of an occupational health service, I am very much aware of the excellent work done by Lord Taylor and his colleagues in Harlow. It is very exciting work and work to which the Ministry pays a great deal of attention. The real difficulty, as the hon. Member pointed out, is the shortage of medical manpower. For historical reasons, the factory doctor service was set up very early. To some extent the establishment of the National Health Service and the school health service have been caught up and passed by the factory doctor service. Consequently we are in a situation where there is a fuller health service in many ways than in many other countries but one which is very demanding of medical manpower.

As he quite rightly pointed out, the present situation is that appointments to the factory doctor service are drawn to a very great extent from people who spend little of their time on this work and a lot of their time on other work in the National Health Service and so on. He mentioned 1,500 doctors and asked why they could not all be full-time and said that most of them spent only a small proportion of their time on this work. That is the main difficulty along the lines to the goal which he wishes to see, but I will give him one immediate assurance. We see the possibility of extending the present service to cover non-factory premises. We recognise fully what he said and recognise that it will be essential to try to extend the service to all places where people work as soon as practicable. We also very much support the argument that there should be fewer doctors in the A doctor service and that they should spend a larger part of their time on this service.

He suggested that ideally they should all be full-time, but I hope that he will recognise that in present circumstances it would be very difficult to commit oneself in so many words, because there may be a problem of staffing up with full-time doctors services of this kind. I am certainly in full sympathy with the aims of the improvement of the health of workers in industry and we have recently established the Industrial Hygiene Laboratory under the Factory Inspectorate. This laboratory will be open to the A doctor service for their own use. We also see the A doctor service as having an important rôle to play in terms of preventive medicine and in terms of research into industrial hazards; not simply being concerned with medical inspection, but also ultimately developing into a full-scale advisory service on the whole of the hazards to health involved in industrial processes in premises outside factories as well as inside.

The hon. Gentleman, may recall that recommendation in paragraph 82 of the Report which he mentioned on the subject of works medical officers said: Because of the possibility of incompatability of functions it would, in general, be inadvisable for a works medical officer to be appointed as an A doctor although in some cases such appointment would be appropriate and Works Medical Officers might also be appointed to carry out particular types of medical examinations. This does not come down wholly on one side or the other, but this is one of the matters which is being discussed with the bodies involved and I will give the hon. Gentleman the assurance that the points which he has made will be borne in mind in the conclusions reached about the rôle of works medical officers.

He also referred to the possible training of A doctors. It is fair to say that we recognise that there would have to be some additional training in the particular concerns of occupational health. One particular aspect of this work is the knowledge that doctors in the "A" service would need to have of the legal regulations governing factories and in particular of the hazardous processes, so that it is essential, even though one gets fully qualified medical manpower, that there should be some additional background in the particular requirements of an occupational industrial health service.

In conclusion, may I say that personally I have a great deal of sympathy with the points made by the hon. Gentleman? He was gracious enough to recognise that the main barrier in the way is the shortage of present medical manpower. That shortage in some ways can be made good in the short term only by the employment of part-time doctors, and not least by the return of married women doctors, for example, to the National Health Service and to other parts of the medical services for part of their time.

At the moment we cannot foresee a situation in which it would be possible to give up the use of part-time qualified medical manpower, but we are endeavouring to bring an end to the consultations which are now going on. We are also looking at the various aspects which the hon. Gentleman has in mind and will bring forward legislation which will end the present waste of medical manpower involved in routine medical inspection. We think this would be a step forward towards what the hon. Gentleman wants to see, with the assurance that we will bear in mind sympathetically the extending of the service outside the factories themselves and extending current appointments into more research and into industrial hygiene. We hope that eventually we can move towards the goal which the hon. Gentleman has in mind.

Mr. Scott

Can the hon. Lady give any idea of the time scale which she has in mind for the legislation which she mentioned?

Mrs. Williams

The hon. Gentleman mentioned the Youth Employment Service. I should point out that the announcement about the Youth Employment Service, at least in part, will involve administrative decisions and not decisions requiring legislation. Because any change in this respect requires legislation, timing is not totally in the hands of the Ministry of Labour and will depend to some extent on the exigencies of other legislation now before the House.

Question put and agreed to.

Adjourned accordingly at half-past Four o'clock.