§ Order for Second Reading read.
§ 7.1 p.m.
§ The Under-Secretary of State for Employment (Mr. Dudley Smith)
I beg to move, That the Bill be now read a Second time.
It is comparatively rare for a Minister to find himself in the position in which I am today in introducing, on behalf of the Government, a Measure which was previously put forward by the former Administration and which I welcomed from the dispatch box opposite on behalf of the then Opposition. On that occasion, the hon. Member for Doncaster (Mr. Harold Walker) wound up the debate. He is aware of this legislation since he worked very hard at it during his time in Government.
The Bill is to establish an Employment Medical Advisory Service. It is a short Bill, but it takes an important step forward in occupational medicine, and I hope it will be generally welcomed.
Perhaps I might take a few moments to remind the House of the origins and genesis of the Bill. As long ago as 1844, the Factories Act provided for the appointment of "certifying surgeons" to certify the age of children employed in cotton mills. From this modest beginning evolved the system whereby today young persons who enter factory employment have to be medically examined within 14 days of entering that employment and these examinations have to be repeated at annual intervals, or on their change of factory employment until they reach the age of 18.
These medical examinations are now carried out by some 1,500 appointed factory doctors, the modern name for certifying surgeon, who are appointed to carry out these examinations by the Chief Inspector of Factories. Appointed factory doctors are normally general practitioners. They also carry out certain other duties under the Factories Act, the most important of which is the statutory medical examinations required under regulations for persons employed in certain hazardous trades.
122 There is no doubt that, during the long years of its existence, the appointed factory doctor service has contributed a great deal to the health of our young people. But conditions are now very different from those which obtained when the service first started in 1844.
We have the School Health Service, dating from 1906, a most important development in the medical supervision of children, while the introduction of the National Health Service in 1948 made a comprehensive health service available to every citizen. These two services together now keep a careful check on the health of young persons, and the routine examinations by factory doctors of all young people entering factory employment have ceased to be so important.
It was therefore felt right that the value of the appointed factory doctor service should be reassessed and accordingly, in 1964, a sub-committee of the Industrial Health Advisory Committee, was set up to review the service and to make recommendations. The report of the sub-committee, published in 1966, recommended far-reaching changes. It considered that the requirement for the routine medical examination of all young persons entering factory employment should be abolished and that the medical time thus saved should be used to establish a more integrated and expert medical service, with wider duties in occupational medicine.
The recommendations of this report were accepted by the Government of the day, and this Bill implements and develops these recommendations, so that, with the establishment of the Employment Medical Advisory Service, we are not merely modernising the appointed factory doctor service but setting up for the first time a focus for the development of occupational medicine in this country.
The Bill includes a number of proposals which were not in the 1966 report, but these later ideas which extend the recommendations of the report have been worked out with the help of the same sub-committee of the Industrial Health Advisory Committee. I should like to place on record my thanks for the valuable assistance the sub-committee has given my Department.
The nucleus of the Employment Medical Advisory Service will be the 123 recently formed Medical Services Division of my Department which has taken over the duties of the former medical inspectors of factories, and also co-ordinates on a professional level the work of doctors in Government training centres and industrial rehabilitation units, together with that of the Department's regional medical consultants.
So far as its existing staff resources permit, the Medical Services Division advises the other branches of my Department on any medical problem arising from employment, including fitness for work, placement in work, industrial rehabilitation and mental health. When the Employment Medical Advisory Service is established, there will be added to these duties the medical supervision of young persons in employment and the medical examination of workers in hazardous trades. This will mean bringing together for the first time, in one nationwide organisation, the various categories of doctors employed in industrial medicine.
Perhaps at this stage I should make clear that the new service is not and is not intended to be a comprehensive industrial health service, if by that phrase we mean a service which envisages more doctors in more factories. However, we claim that it represents a new initiative in occupational medicine. We have adopted a selective approach to the problem of man's response to the requirements of his work, and we shall seek to identify and then overcome the causes of disease, fatigue and stress arising from work. In fact, we are instituting a modern medical detective service which can be of the utmost value.
In doing this, the service will work in the closest collaboration with the Factory Inspectorate, and here perhaps I might mention the Industrial Hygiene Unit which is concerned with the detection and measurement of hazards found in the working environment and ways of overcoming them. The E.M.A.S. will also work closely with the industrial rehabilitation services and the psychological services of the Department. It will not, however, provide treatment, which is a matter for the National Health Service.
We intend that the Employment Medical Advisory Service should tap the 124 expertise of many disciplines. To this end, we propose to elaborate the present system of professional advisory panels so that the Chief Employment Medical Adviser can draw on the advice of many experts. We regard this as very important. The function of the panels will be both to advise on the solution of medical problems in industry, and to use medical and other knowledge to predict problems in industry which may arise in the future.
While the new service will spend much of its time on the day-to-day medical problems of industry, it will also undertake surveys and epidemiological studies in relation to both long and short-term hazards. Many of the new hazards to health are not immediately evident, so formalised studies of populations must supplement the clinical examination of employed persons. There will be close co-operation in such work with the other medical and related services, especially with the Medical Research Council. As will be apparent to the House, such surveys and studies can only be done by a nationwide service.
As one of the most important aspects of the service is the change in the arrangements for young persons, perhaps I might say a few words on this.
For some years now it has been the practice of the School Health Service to notify the Youth Employment Service by means of a standard form of those school leavers who are not unconditionally fit for employment, indicating in general terms working conditions which are best avoided; for example, work in dusty places. When the E.M.A.S. is established, this standard form will be sent to the employment medical adviser as well, so that for the first time there will be a direct link between the school medical officer, the employment medical adviser and the careers officer of the Youth Employment Service.
Hitherto there has been no connection between the information passed from the School Health Service to the Youth Employment Service and the activities of the appointed factory doctors in regard to young persons. This new arrangement will make it possible for there to be continued co-operation and consultation between the careers officer and the employment medical adviser during the whole process of advising these pupils and placing them in employment. My 125 Department and the education department are satisfied that the School Health Service will be able to undertake this extra work and are considering the best way of bringing home to school doctors the new importance which their medical examinations and interviews will assume.
I see the hon. Member for Doncaster smiling. I remember that I raised a point on this very aspect when I was in Opposition. I have taken particular trouble in checking with officials of my Department and I have the assurance that the School Health Service is well aware of its duties in this respect. As time goes on everything will be done to improve the service and to make it as efficient as possible.
Before I comment on the individual Clauses of the Bill, there are a few general points which I should like to make on matters which I know are of interest to hon. Members. Firstly, it might be asked whether, while the Committee on Safety and Health under the chairmanship of Lord Robens is sitting, it is right to legislate. We discussed with Lord Robens our proposals to reintroduce this Bill. He has authorised me to say that his Committee sees this reform of the appointed factory doctor service as a constructive measure which would prejudice neither his Committee's recommendations on safety and health, nor possible further development of occupational medicine within the context of the general health services. This in some respects answers an interesting article which appeared in the Lancet last weekend which in part praises the introduction of the Bill but queries whether it is wise to legislate in advance of the Robens Report. Having had this from Lord Robens we can go ahead with a clear conscience.
This leads me to the relationship of the Employment Medical Advisory Service to the National Health Service. It has been suggested either that the establishment of the E.M.A.S. should be deferred until the National Health Service reorganisation is complete, or that the E.M.A.S. should be part of the National Health Service, and therefore included in its reorganisation. This is a matter which has been discussed most fully between the Ministers concerned.
The Government are agreed that responsibility for occupational medicine and in particular for the Employment 126 Medical Advisory Service must, for the present—I emphasise for the present—remain with the Department of Employment as the Department responsible for working conditions in factories, shops and offices and the Department most closely concerned with conditions of employment generally.
But it is equally clear that the subject of occupational medicine must not be dealt with in isolation from other aspects of the health service. We are determined therefore that there should be a very close relationship between the Employment Medical Advisory Service and the National Health Service, and we are exploring with the health departments ways of achieving this.
One particular area in which co-operation has been agreed concerns the laboratory, X-ray and other investigatory facilities which will be an integral part of the work of the service. It is proposed that the National Health Service laboratories should be used for most Employment Medical Advisory Service work and discussions with the health departments are proceeding on the best way of arranging this. This will be an important point of contact between the two services. Another useful point of contact will lie in the employment of part-time employment medical advisers. Many of these will no doubt already be working for the National Health Service whether as general practitioners or in hospitals.
When the National Health Service is reorganised, the proper home for the Employment Medical Advisory Service will undoubtedly have to be looked at again by the Departments concerned, and I can assure the House that there is nothing in the E.M.A.S. proposals as at present drafted which prejudices the issue of what arrangements might be most appropriate in the long term for occupational medicine. I hope that some medical authorities who have raised doubts about this will read these words in HANSARD and accept this assurance as it is a sincere one from my Department.
We feel, however, that it would be folly to defer this long overdue reform of the appointed factory doctor service simply because the structure of the National Health Service itself is under review. We see no reason why the organisation and 127 duties of the E.M.A.S. should not be planned in such a way that if a major change in departmental responsibility is deemed necessary, there will be a well-organised structure for occupational medicine to be transferred.
§ Dr. David Owen (Plymouth, Sutton)
Would the hon. Gentleman confirm that he is not excluding the possibility, when the legislation on reorganisation of the Health Service comes before the House next Session, that it may incorporate such changes to allow occupational health centres under the National Health Service?
§ Mr. Smith
That is possible. As the hon. Gentleman knows, that is not a matter for me because the reorganisation of the Health Service is not for my Department to carry through the House. There is no doubt that there will be continuing consultations between Government Departments who are affected. At present we believe this is the right course. In future, circumstances may change and in that case undoubtedly the Government will introduce whatever legislation is thought appropriate.
Apart from the relationship of the E.M.A.S. with the National Health Service, there is the question of its relationship with works medical officers—doctors who are employed by many firms and large organisations to supervise the health of their employees. It is estimated that about one-third of all employees in factories are covered by full or part-time works medical officers. There are thought to be some 400 full-time works medical officers, and probably considerably more part-timers. In some areas there are group industrial health services.
These are services which provide a works medical officer for firms in the area on payment of an annual fee based on the number of employees in the firm. In contrast to individual works medical services, they are run by a governing body composed of employers, trade unions and medical representatives. The areas covered by such services are Rochdale, Dundee, Slough. Harlow, Central Middlesex, West Midlands and Newcastle-upon-Tyne.
We recognise that works medical officers possess a great deal of knowledge and expertise in occupational medicine 128 and it is our intention that the Employment Medical Advisory Service shall work closely with them. In so far as such services are already doing the sort of things which the E.M.A.S. will be doing, the Department is wholeheartedly in favour of them and there is certainly no intention of allowing the new service to duplicate their activities.
So far as the statutory duties of the E.M.A.S. are concerned, we propose to continue the long-standing practice whereby works medical officers are authorised to undertake the statutory medical examination of employees in their factories, although in future authorisation will be by the Chief Employment Medical Adviser instead of the Chief Inspector of Factories.
The last general point on which I wish to comment relates to the staffing of the service. As Members will have seen from the Financial and Explanatory Memorandum, we propose that the nucleus of the new service shall be the 50 doctors already employed by my Department, in particular the former medical inspectors of factories now medical advisers, and we shall need about the equivalent of 50 more full-time doctors—35 more in the first year, building up to 50 when the service is at full strength, together with supporting staff.
§ Mr. Adam Butler (Bosworth)
I am not sure whether the phrase "equivalent full-time" doctors implies a large number of part-time doctors or whether there is some other significance behind it.
§ Mr. Smith
The emphasis will be on a smaller number of full-time doctors. The vast majority of appointed factory doctors are part time. Many of them are also in general practice. The idea is to reduce the numbers but to make them more expert in the particular line in which they will be engaged. The majority of them will be full time.
Although this is a small increase in the number of doctors employed by my Department, it should be seen in the light of the saving in national medical manpower which will result from the abolition of the universal young persons' examinations, which is estimated to take up the equivalent time of 70 to 80 full-time doctors. This shows that valuable medical practitioners will be released for other medical work.
129 The doctors who will be employed by my Department will have to have the usual secretarial and clerical staff and we are also proposing to bring into the service 12 nurses. The idea of having nurses in the service is a new one, but, when we looked at the duties which the E.M.A.S. would carry out, we felt there would be advantage in this and it will, of course, be more economical of the doctor's time.
We intend to discuss the duties of the nurses with the Royal College of Nursing, but the sort of things we have in mind are that nurses should, for example, undertake and assist in the medical examination of young persons and the periodic examination of workers exposed to toxic hazards. They would also help in the surveys of occupational groups. I am confident that by employing nurses in this way we can do a great deal both to run the service more economically and efficiently.
I should like to comment briefly on the Clauses of the Bill.
Clause 1 deals with the establishment and functions of the Employment Medical Advisory Service and provides for the appointment of employment medical advisers and sets out their powers. These are identical with some of the powers given to H.M. Inspectors of Factories by the Factories Act, 1961—for example, the right of entry to factory premises—and are necessary for the proper functioning of the Service. The powers are given in detail in Part I of Schedule 1, and Part II of that Schedule lists the places and processes which are deemed to be factories under the 1961 Act and to which the powers of advisers extend in the same way as those of factory inspectors. Clause 1(6) deals with the transmission of information from the School Health Service to the Employment Medical Adviser. This is the statutory backing to the arrangements which I have already mentioned whereby the E.M.A. may be fully briefed on the medical history of those school leavers who require continued medical supervision.
Clause 2 abolishes the position and functions of the Appointed Factory Doctors.
Clause 3 is directed to the employer and allows a medical adviser, where he 130 is of the opinion that any employed person's health is or may be affected by his work, to serve a notice upon a factory occupier requiring him to permit the employment medical adviser to carry out medical examinations of any of his employees. The occupier will be obliged to comply with such a notice. These powers are intended only as a last resort in cases in which a recalcitrant employer refuses to let his workers be medically examined. It is most unlikely that there will be many of these, and we do not expect the powers under this Clause to be used frequently if at all. The fallback power is necessary. However, I should add that the Clause does not compel a worker to submit himself for medical examination.
Clause 4 alters the power of suspension in Section 75 of the Factories Act which is concerned with the employment of women and young persons in processes involving the use of lead compounds. At present the appointed factory doctor has power to suspend workers where he thinks continued employment in such a process may endanger their health. Under the Bill, however, the procedure will change and the employment medical adviser will advise the occupier of a factory in writing that he is of the opinion that the continued employment of a worker in a particular process in the factory would involve special danger to his health. The employer will then be guilty of an offence under the Factories Act if he continues to employ that person.
Clause 5 is an important new provision concerned with young persons. As I have explained, we are abolishing the routine medical examination of young persons and substituting instead a more selective system based on the records of the School Health Service. When a young person takes up factory employment the occupier must give notice to the local careers office of the Youth Employment Service of that fact within seven days of the engagement. This is a further check so far as factory employment is concerned to ensure that young persons identified by the School Health Service as not being unconditionally fit for employment are given proper advice about suitable employment. It does not impose an extra burden on the occupier, for at present the factory doctor has to be told of a young person's engagement. 131 In future the notification will go to the careers officer.
Clause 6 provides for the occupier to continue to pay the fees for periodic medical examinations of persons employed in hazardous trades required under the Factories Act. The fees paid for examinations by employment medical advisers are to be paid to the Exchequer and for those by other medical practitioners direct to those practitioners by the occupier.
Clause 7(1) provides that Clauses 3 and 5 shall also apply to other places which are deemed to be factories under the Factories Act, namely, to docks, wharves, quays and warehouses; the processes of loading, unloading or coaling of ships in any dock, harbour or canal—but not including any work by the members of the crew of a ship; any work of specified kinds carried out on ships in a harbour or wet dock; and building operations and works of engineering construction.
That, then, is a summary of the provisions of this modest but not unimportant Bill which I commend to the House. It is an earnest of the Government's intention to do all they can to better the conditions of people at work and as such I believe it is worthy of the support of the House. I hope it will have a fair passage to the Statute Book.
§ 7.28 p.m.
§ Mr. Harold Walker (Doncaster)
I had the feeling during the speech of the Under-Secretary of State that we were participating in a reunion. After looking round the House at the Members present that feeling is strengthened. There was very little in the hon. Gentleman's speech from which I would dissent. It was not what he said but what he failed to say which will perhaps occupy the major part of my remarks.
The Under-Secretary said, rightly, that the Bill was substantially Part I of the Employed Persons (Health and Safety) Bill proposed by the Labour Government. As the hon. Gentleman reminded us, I was the Minister responsible for the original Bill. Therefore, the House will expect me to welcome its belated resurrection, which of course I do. However, for several reasons, I cannot pretend to have the enthusiasm for the present Bill which I had for the original Bill.
132 The Under-Secretary of State said that the Bill was a long overdue reform. Yet it has taken almost two years to bring it before the House. I must first of all comment on what seems to me this extraordinary and unjustified delay, because, after all, the Government inherited a ready-made Bill, one which had been through all the time-consuming preliminaries of consultation, one which the House had approved in principle. In spite of this being a long overdue reform it has taken two years to put before the House again—or the best part of two years.
§ Mr. Walker
Twenty months. Of course, we all know that the Department has been rather overworked and obsessed with other issues. This Bill has been roughly elbowed aside by the determination of the Government to introduce the Measure to curb the unions. The House and the country must make their own judgment on the Government's priorities.
The next thing which cools my welcome for the Bill is the absence from it of anything which deals directly and specifically with industrial safety. In his review of the genesis of this Measure the Under-Secretary failed entirely—I do not know whether it was an oversight or a deliberate omission—to point out that the original Measure was a balanced one which dealt not only with industrial health but with industrial safety as well.
The present Government have deliberately omitted from this Bill what was by far the most important and radical part of the previous Measure, the provision for worker representatives and safety committees. The T.U.C. and the British Safety Council and other bodies and individuals concerned with industrial safety have long held the view that those were useful and constructive steps which could be taken in the short term to diminish the daily toll of life and limb in British industry, but, of course, hon. Members opposite, with a few honourable exceptions, have never concealed their distaste for giving the workers some voice and influence in this crucial aspect of their working lives.
When we last debated industrial safety the Government sought to evade facing this issue by taking refuge behind the Robens Committee. When my hon. Friend the Member for Renfrew, West 133 (Mr. Buchan) presented his Employed Persons (Safety) Bill on 12th February last we were told that we had to await the comprehensive legislation which was likely to flow from the report of the Committee, to which the Under-Secretary referred, and sitting under the chairmanship of Lord Robens. I should have thought, notwithstanding, that the logic of that argument is that it applies equally to the concept of the E.M.A.S.
I am glad that the Government's prejudice against worker safety representatives has not deterred them from bringing this Bill forward today, but I must say that this dichotomy of approach by the Government is illogical and inconsistent, and exposes the former argument of "waiting for Robens" as a shabby sham.
I see from the Order Book of the House that on 4th February next we shall again debate the Employed Persons (Safety) Bill. I want to tell the hon. Gentleman that if we get the same negative reaction from the Government then as we got last time we shall seek to introduce it again and again and again till we get it on to the Statute Book. I await with interest that occasion because I think that by bringing forward this Bill today the Government have in advance invalidated their earlier argument. They will have either to accept that Bill which was presented on 12th February or expose the reality of their true position, and that is that to them workers' safety is subordinated to political ideology and doctrine.
However, it is not only the omission of the safety section of the original Bill that causes me concern. This Bill is totally silent on industrial safety. I should have thought that the Government might have shown some response to the constructive and well-informed speeches in the debate we had earlier this year and to which I have already made reference, but there is no sign here that they were even listening to that debate. Everything has to wait on Robens in the field of industrial safety. I would have hoped that the hon. Gentleman might in his speech have given some indication of when he expects the report from the Robens Committee. We have not heard that. I hope he will refer to that.
§ Mr. Dudley Smith
Certainly one will endeavour later to answer the points made by the hon. Gentleman, but perhaps I can help him now on this point. The latest information I have is, in the early summer of next year.
§ Mr. Walker
That is welcome news, but I hope it will not be followed, when we receive it, by yet another round of consultations, by yet another consultative document, and by a yet further series of stratagems to serve to put off action.
In the meantime there are some obvious reforms which have widespread support and which could have been embodied in the Bill, and not the least of those is to increase the absurdly low level of the maximum penalty provided in the Factories Act—£300 maximum fine for criminal negligence leading to loss of life. That makes a ridiculous contrast with the kind of penalties currently demanded and applied in other areas of the law. I thought we might have heard something today of the Government's reaction to last week's High Court judgment on industrial deafness. It may be too early, but one would expect far-reaching consequences in the light of that judgment. I thought tonight we might have had a very clear statement of what the Government's attitude would be to industrial deafness, because Mr. Justice Ashworth's ruling in the case of Berry v. Stone Manganese and Marine Ltd., that the employer was legally responsible for the plaintiff's deafness and that the deafness was incurred in the course of and arising out of the man's employment, is a significant precedent which the Government cannot ignore. The hon. Gentleman knows that the T.U.C. and others have pressed for many years for industrial deafness to be recognised and compensated under the National Insurance (Industrial Injuries) Act. I think that that High Court decision last week is a very powerful reinforcement of their case and one which, as I have said, calls for a statement eventually on the attitude of the Government.
I turn to the Bill itself and refer to yet another reason for the tepid nature of my welcome for it. I suggested to the House that we had been presented with an emasculated version of the Bill's progenitor, but even what we have is 135 mutilated. I see from the Explanatory and Financial Memorandum that the proposed service will be run on about £850,000 per annum. The original Bill presented in March, 1970, provided for an expenditure not of £850,000 but around about £1 million per annum.
In view of the rip-roaring inflation which the country has endured since March, 1970, I calculate that to keep the value of that £1 million constant the Government ought to have been asking the House to approve not £1 million but £1.2 million—to maintain the value of £1 million which we provided for in 1970. That £1.2 million would be the sum required to maintain the constant value of that £1 million. We see in this Bill that far from there being an increased capital sum allocated it has been chopped to £850,000, which means in real terms a little over two-thirds of the original. Does this mean that we are to have a service which is to be two-thirds of that we originally conceived? I hope that the hon. Gentleman or his hon. Friend in reply to the debate will tell us, where have the cuts occurred? What has been chopped?
The Explanatory and Financial Memorandum itself provides at least part of the answer. I should have thought that when he was talking about the provision for the numbers of medically qualified staff the hon. Gentleman would have acknowledged the contrast between what the present Bill provides and what its predecessor provided. Under this Bill we see provision for 50 full-time and the part-time equivalent of a further 50 additional doctors—a total of 100 doctors or their equivalent. In the original Bill that number was to have been 50 plus 60; that is, 110 full-time doctors or their equivalent. In other words, this would mean a cut of almost 10 per cent. in the number of professional medically qualified staff. It is true that there will be an increase in the supporting staff provided under the Bill, and we were told that this will happen because the service will now make some provision for the employment of nursing staff. Is the hon. Gentleman now substituting nurses for doctors? This was the implication of what he said.
§ Mr. Walker
The fact that the hon. Gentleman shakes his head can only be taken as saying that he is acquiescing in cutting the number of professionally qualified staff—that is to say, the number of doctors involved. This is the reverse of the course urged upon us by the then Conservative Opposition when the Bill was last before the House.
The hon. Member for Carlton (Mr. Holland) said in Standing Committee on the previous Bill that he would like to have seen an increase in the medically qualified staff at the expense of the number of supporting staff.
§ Mr. Philip Holland (Carlton)
I hope that if I have an opportunity to speak a little later in the debate I shall again have the opportunity to question whether the number of staff will be enough. The hon. Member for Doncaster (Mr. Harold Walker) should wait a little longer to hear my contribution.
§ Mr. Walker
I look forward to hearing what the hon. Gentleman has to say. I am sure it will be an interesting and intelligent contribution, and I am glad to have his support. I should not want my earlier remarks to be taken as implying that the hon. Gentleman will in any way perform a volte face. I very much doubt that the hon. Gentleman will do such a thing.
I hope that in his reply the Minister will explain where the cuts have occurred and will say why these changes have been necessary. May we know why the financial allocation has been reduced and what effect this will have on the size and growth of the service when it starts to operate? It may be a little premature to ask at this stage who will head the new service, but it would be of interest if we could be given that information.
§ Mr. Dudley Smith
On a point of clarification, does the hon. Gentleman mean the name of the individual or the title of the office?
§ Mr. Walker
It would be helpful if we could be given both, but it would be quite acceptable if the hon. Gentleman could give only the title.
A number of other minor changes have taken place in the provisions of this Bill as compared with those of its predecessor. It would probably be more 137 appropriate to probe this matter in Committee rather than to take up the time of the House tonight. However, I should like to refer to one substantial change which has occurred in the new Schedule and its relationship with Clause 1(5).
Having looked carefully at the new Bill, I recall the earlier debates and realise that the hon. Gentleman has responded to some of the arguments which were then deployed. Clause 1(5) of the original Bill was severely criticised because of its obscure and labyrinthine language and was described as gibberish or gobbledegook. It was then said that rather than having cross-references to the various powers, the new Employment Medical Advisory Service should be defined and delineated in a Schedule. This probably explains why the hon. Gentleman has responded with the new Schedule. However, it appears that the hon. Gentleman has now given us the worst of both worlds. We still have the complex cross-referencing, which is the bane of most legislation, but the Government have also added a third source of reference, namely, the Schedule.
Instead of merely having to refer to the Factories Acts, we now have to refer also to the new Schedule. In addition, the hon. Gentleman has put the provisions of the Bill in the vulnerable position that they may later be subjected to amendment, which would not necessarily be amendment to the original Factories Acts, and thus the consistency which is so desirable would be lost. No doubt again this is a matter which we can discuss in Committee.
What is clear is that the Government have diluted into a timid little Measure what was a radical and constructive attempt to improve industrial health and diminish the toll of life and limb in industry. However, it is a step in the right direction. The Employment Medical Advisory Service has a potential rôle well beyond that provided for at its inception, and well beyond that of the appointed factory doctor system which had reached its limits in terms of the rôle it could play in industrial health. This is not in any way intended to imply criticism of those doctors who are carrying out this work and who have been doing so for a considerable time. They have made a great contribution towards raising the standards of health in industry, 138 and I have paid tribute to their work on other occasions.
With the creation of the new service we are entering a new phase in our approach to the health and well being of workers in industry. I hope that the E.M.A.S. will have an increasingly important and expanding rôle to play—and by expansion I do not mean empire-building, but rather that they will be given the facilities and resources to research into and advise upon aspects of industrial health which at present receive so little attention.
I think it was the Parliamentary Secretary who urged in our 1970 debate that the new service should be allowed to take into its scope environmental, psychological and behavioural studies; and I am sure he was right. I say this without disrespect to the good work already being done by such bodies as the Society for Occupational Medicine, and National Institute of Industrial Psychology, and others.
The hon. Gentleman referred to the growing interest in, and pressure for, the introduction of an occupational health service. I do not wish tonight to discuss what we mean by such a scheme, but I was struck by his statement that responsibility for occupational health will remain with the Department of Employment. This must necessarily and inevitably imply a limited scope for occupational health provision. If there is to be a response to this growing demand, it surely must be accommodated within the framework, structure and resources of the National Health Service. To say that occupational health will remain with the Department of Employment seems to rule out what hon. Members on this side of the House understand in broad terms by an occupational health scheme. We do not see the E.M.A.S. as a scheme of that sort. We do not see it as a substitute for such a scheme, nor do we believe that the original design was on those lines. This is not an alternative to an occupational health scheme, nor is it intended to be such a scheme.
I shall not go into the merits of seeking to define what is meant by an occupational health scheme. What is broadly understood is so wide and demanding of resources as to involve a thorough-going recasting of the structure of the 139 National Health Service, and would therefore be the primary responsibility, not of the Department of Employment, but of the Department of Health and Social Security.
I reiterate my regret that the Bill does not follow the path of the original Measure and make provision for dealing with the problems we find in industrial safety. By eliminating the original proposals and not replacing them, the Government have shown a surprising apathy and complacency in the face of what must be considered, despite the encouraging trend of the figures—they are improving and we welcome this trend —a disturbing, not to say distressing, toll of human life and limb.
None of us can afford to be complacent when the undertaker must deal twice a day with the consequences of negligence and the result of accident and injury, and when the doctors must deal 1,000 times a day with the consequences of inadequate provision for safety in industry.
Despite my criticisms of the Government and the Bill—and we shall seek to improve the Measure in Committee—I welcome the creation of the Employment Medical Advisory Service and wish it well in its work and future.
§ 7.51 p.m.
§ Mr. Philip Holland (Carlton)
The hon. Member for Doncaster (Mr. Harold Walker) rather churlishly complained that the Bill was here in 1971 rather than in 1970. The reason is surely that the good intentions of the hon. Gentleman and his colleagues were frustrated by the faulty political judgment of his right hon. Friend the Leader of the Opposition in 1970.
The reality of the hon. Gentleman's sound and fury about the loss of the industrial safety part of his Measure in 1970 should have been, and probably was, subconsciously directed at the Leader of the Opposition rather than at the present Government.
In the debate on Second Reading of his Bill in 1970 I congratulated the hon. Member for Doncaster and his right hon. Friends for having brought forward proposals to replace the appointed factory doctor service with an employment medical advisory service. However, in 140 view of the circumstances, I am sure that the hon. Gentleman will allow me to withdraw at any rate some of the congratulations and bestow them on my hon. Friend the Under-Secretary of State, in the belief that, while they were premature congratulations in 1970, they will not be premature to my hon. Friend in 1971.
I said in 1970 that the proposal to reorganise and streamline the industrial health service was timely. I agree with the hon. Member for Doncaster that it is even more timely and welcome now, and perhaps we now have a Measure which will go through all its stages rapidly and be on the Statute Book to improve the industrial health service.
One advantage of debating a proposal which was previously before the House, before there was a change of Government, is that one has on the record what both Front Bench spokesmen said when they were on opposite sides of the House. This is a considerable advantage for hon. Members who wish to take part in the debate. In these circumstances, I draw the attention of my hon. Friend the Under-Secretary to his remarks on 2nd March, 1970, when he made reference to the Society of Occupational Medicine.
He told the House that at first the Society had feared that the concept of occupational medicine within industry was likely to be primarily toxicological and therefore rather limited in scope. He took the view, however, that as the new service was to be advisory, its terms of reference would probably include the environmental, psychological and behavioural, as regards both groups and individuals, as well as the epidemiological and the physiological. If any hon. Member requires a definition of these terms he should apply to my hon. Friend. He used them first.
I hope that the Under-Secretary still takes that view now that he is in office. I hope so not because I have been lobbied by the Society of Occupational Medicine but because I am rather appalled at the growth of what amounts to a new industry which is to some extent parasitic. I refer to the increasing numbers of seminars, conferences, teach-ins or whatever the current "in-word" happens to be for a day spent at ease in a glossy hotel listening to a bright young P.R. 141 boy talking pseudo-knowledgeably about "motivational research" and "job enrichment".
I am not referring to the excellent work that is being done in the training sphere by reputable organisations such as the I.P.M. and the Industrial Society, but there appears to be a rash of new little companies being set up for the purpose of milking industry of a portion of its earnings in return for feeding executives and supervisors a load of academic eyewash about how to enrich repetitive work in a mass-production plant.
I hope that one of the early projects to be undertaken by the new Employment Medical Advisory Service will be research in this sphere to establish exactly what the needs are, and I suspect that in many cases it is arrogance to assume that shop-floor operators want to have their jobs enriched in the way that some of these academics suggest.
What is monotony to one man may be regarded as an opportunity for "money for old rope" to another. Different individuals seek different satisfactions in their work. Some people need to be fully mentally extended. Others seek the satisfaction of earning as much take-home pay as possible, and can best achieve this doing the sort of work that would drive you, Mr. Deputy Speaker, and me into a mental hospital.
But this is all speculation. I should like to see a medically qualified research team carry out a study in depth into this field, and then publish an authoritative report on the subject. This of course raises the further question as to whether the new Employment Medical Advisory Service will have the facilities or adequate number of personnel to carry out this kind of study and publish reports, and not purely private departmental reports, for the general information of all who are concerned with personnel matters in industry.
The hon. Member for Doncaster will have been pleased to hear me raise this point in view of his earlier remarks about me. There is great need for this sort of authoritative report and advice. Perhaps the Under-Secretary will find time when he replies to deal with this aspect.
Of course, if the answer to my question is in the affirmative, then this raises 142 another question: to what extent would this kind of general research project, which could be of great value to industry as a whole, be financed out of fees levied on the companies in which the field-work was carried out on the grounds that, under the provisions of Clause 6, a company's employees had been subject to examination and supervision? The word "supervision" is used in the Bill and, of course, it has a wide meaning.
I understand that the C.B.I. has expressed some concern that there appears to be no distinction between fees to be charged for statutory medical examinations and the financing of research projects which may not be directly related to the establishment in which the fieldwork is carried out.
What concerns me even more is the fact that there does not seem to be any provision in the Bill for financing the Employment Medical Advisory Service to carry out research projects in the behavioural or environmental spheres.
One of the disturbing features of the growth in recent years in prestige of the personnel function has been the rise in charlatanism and gimmickry on the fringe of the subject. I hope that the new service may open a few windows and let in a little of the fresh air of common sense. To achieve this it is clearly desirable for members of the new service to be adequately qualified for the task.
In the 1970 debate my hon. Friend who is now the Under-Secretary drew attention to the fact that Clause 1(3) of the Bill then before the House called for no specialist training or experience for an appointment as medical adviser, other than the customary medical practitioner qualification. I am disappointed, therefore, to note that Clause 1(3) of the new Bill equally requires only that an appointee shall be a registered medical practitioner.
I suggest that when the Bill is in Committee, my hon. Friend may care to amend Clause 1(3) by adding a form of words at the end such asand can furnish proof of specialised knowledge of industrial medicine or occupational medicine.This could be done either by furnishing proof of medical experience in industry or by means of a diploma in occupational 143 health, industrial psychology or some similar qualification.
The drafting of the Bill could be couched in very general terms, but could still insist on there being an additional qualification that particularly fitted the members of the service for the work that they would have to do.
I am glad to have the Under-Secretary's assurance that education authorities will have the capability of fulfilling their obligations under Clause 1(6). Had my hon. Friend not checked on this matter before coming to the House today—a matter that he himself raised, as he said, 18 months ago—no doubt he would have been the target for brickbats from both sides of the House. I am glad that he took the precaution of checking this with my right hon. Friend the Secretary of State for Education and Science.
By the standards of legislation that passes through this House, the Bill may be adjudged a minor Measure. I do not regard it so. Intelligently implemented, it may well prove to be a major step forward in preventive medicine in a field that has been for too long neglected and about which there tends to be at present a good deal of mystique but very little else.
While fully acknowledging the work of the factory doctor service over the years of its existence, and with the strict limitations imposed upon it by its nature and terms of reference, I await impatiently the birth of this proposed Employment Medical Advisory Service. May it be a lusty child and may it grow rapidly to full maturity. I wish it well.
§ 8.2 p.m.
§ Mr. Lewis Carter-Jones (Eccles)
I, too, give the Bill a qualified welcome. I am glad that the hon. Member for Carlton (Mr. Holland) has had a late conversion to the value of consulting educational authorities and, in particular, the teachers, who were left out of our discussions in the last day of our debate in Standing Committee G on the Employed Persons (Health and Safety) Bill.
I am fed up with always waiting for someone. In the theatre we are waiting for Godot. In local government we were waiting for Maud. In this matter we are waiting for Robens. I have no doubt 144 that Robens will produce a first-class report.
In the Second Reading debate on 2nd March, 1970, I said that on the last available figures 254,000 people were injured every year. Since then, over 500,000 people have been injured in factories. Robens will not cure this, but certainly the implementation of the report would help to reduce it. By the time Robens reports, there may be 750,000 accidents and still no legislation on safety. I must take the Under-Secretary to task about this. The Government ought to have brought forward health and safety together, because they go together. For that, the Under-Secretary must be condemned.
There is no doubt that good health is a priceless possession. But all too often factory conditions involve a violation of the person. All too often conditions are uncivilised. A working environment in this day and age ought to respect the dignity and wonder of the human body. This is all too rare in industry today. I sometimes feel that workpeople have their lungs positively raped—I use the word advisedly—in many of our factories and workshops by dust, grit, toxic fumes and objectionable smoke. Still it goes on. All too often workpeople's senses are dulled and blasted by either noise or dull repetitive processes. That is why I welcome an occupational health service, which I hope will at least try to alleviate some of the hardships.
Like my hon. Friend the Member for Doncaster (Mr. Harold Walker) I look forward to the Bill being improved and expanded in Committee. Certainly my hon. Friends, and no doubt hon. Gentlemen opposite, will be putting down Amendments to expand the Bill. I mention in particular the anxiety expressed that the National Health Service will have its work force of skilled people reduced by the Bill. Those of us who have been involved in industrial practice and industrial relations over the years would suggest to the House that the intelligent use of the Employment Medical Advisory Service will result in fewer workpeople having td visit the general practitioner as a result of a deficiency in health caused by working conditions. The intelligent expansion of this service will reduce our general practitioners' work load.
145 I was pleased to note in Clause 1(2) the idea of the establishment of laboratories and research units to investigate problems, and that the Secretary of State may… provide and maintain such laboratories and other services as appear to him to be requisite.I should like to think that the laboratories and the service generally will be concerned with monitoring the adverse effects of new processes before it is too late. At the same time, I hope that they will take cognisance of the need to control the existing hazards to health in factories and, on a rather unusual note, I hope that they will be allowed to report back to the Secretary of State for Employment and the Secretary of State for the Environment on the environmental factors involved in certain processes, such as effluent and smoke emission. But above all, the organisation ought to be independent and ought to have teeth.
I say that with some feeling because I was brought up in a Welsh mining community and I now have a constituency with a very strong mining interest. All too often I have seen my people abused by the evils of pneumoconiosis, and not only the evils themselves but the way in which they were interpreted. The miners knew that they had pneumoconiosis. Their wives and their doctors in our community knew that they had pneumoconiosis. But medical panels and legal committees would argue the niceties and the percentages and would say that it was bronchitis or asthma. But every man, woman and child in the mining community knew, in their heart of hearts, that it was pneumoconiosis. People are still coming to my political surgery with this complaint, having been turned down by the panel.
§ Mr. Holland
In my experience it is often the medical boards and the panels that turn down these applications and, because they are medically and technically qualified, there must be little that laymen can do about reversing their decisions. How does the hon. Gentleman suggest that a further medical panel will change this? I do not follow the argument.
§ Mr. Carter-Jones
The hon. Gentleman jumped the gun a little. I was saying that such people are motivated frequently 146 by a desire to protect the compensation fund. I hope that these new personnel will have sufficient independence to report any new diseases or risks early, thus making it clear that in future a disease will be recognisable and diagnosed and that there will be no beating about the bush as to whether, for instance, a disease is pneumoconiosis or something else: it will be a classifiable and verifiable disease known to diagnosticians. Does that satisfy the hon. Gentleman?
§ Mr. Carter-Jones
I hope that there will be no more industrial diseases, but, if there are, I hope that appeals in connection with industrial diseases will be unnecessary and that workpeople who suffer and widows of those who have died from occupational disease will be protected.
As to the provisions of Clause 1(6), on 14th May, 1970, in Standing Committee G on the Employed Persons (Health and Safety) Bill, the argument raged backwards and forwards as to who should have access to records. I believe that the Employment Medical Advisory Service should have as much information as possible to ensure that young people entering industry will not be prejudiced, because some young people may be medically or psychologically unsuited for the tasks they are taking on.
§ Mr. Dudley Smith
I hesitate to interrupt the hon. Gentleman's interesting speech, to which I am listening with great attention. The employment medical adviser will have access to the school medical records of young people whose health is in doubt. This is part of these provisions. There will be a complete linkup. Confidentiality will apply as between medical person and medical person.
§ Mr. Carter-Jones
Glory be for a late conversion. We are glad to have the Under-Secretary on our side.
Clause 1(9) concerning training for disabled persons causes me alarm. I am not particularly impressed by the performance of the Department vis-à-vis disabled people. There is room for considerable improvement. I hope that the Advisory Service will not become too involved in stopping disabled people from obtaining work.
147 Clause 4(1)—Employment of women and young persons in processes involving the use of lead compounds"—must command our full support. I hope that it will be possible for the Bill to be amended so as to provide—"including all other toxic materials and potentially toxic materials".
I repeat my qualified welcome for the Bill. I hope that we shall be able to improve it in Committee so as to enable it to make a much more substantial and significant contribution to occupational health.
§ 8.13 p.m.
§ Mr. Adam Butler (Bosworth)
It is difficult not to welcome a Bill which is the result of the recommendations of an advisory committee and which has two-party support, although somewhat grudgingly expressed by hon. Members opposite. Our task is to debate the Bill and not last year's or next year's Bill, which is what the hon. Member for Doncaster (Mr. Harold Walker) seemed to want to do.
The mention by the hon. Member for Doncaster of the Government's preoccupation with, as he put it, curbing the unions, or, as I will put it, industrial relations reform, may redound slightly on him, because I am sure that he is aware of what is written in the Draft Code of Industrial Relations about industrial health and safety matters and the obligations which the Code places on employers.
The Bill should be welcomed, not only because of the general support that it commands, but also because State involvement of this type in health and welfare matters is accepted in principle and has become a factor in our industrial history. However, it would be wrong not to examine these proposals fairly closely. I imagine that this is what my hon. Friend the Under-Secretary has been doing over the last 18 months.
We are all aware of the need for the implementation of provisions of this type, or at any rate with the need to achieve the objects which these proposals seek to achieve. I question whether the work which is required can be done in a better way. Perhaps more work could be done by individual companies or by industrial medical group schemes. If so, should 148 such schemes be voluntary, with government encouragement, or should they be made compulsory by legislation?
Another general question is whether the resources are available to achieve what we are trying to do.
My experience has been gained from working in a large group of companies where various health risks or hazards arise from the manufacture of chemicals and their use in yarn or fibre production, and also hazards arising from the noise and eye strain which may be part of the processing of these yarns into fabric and garments.
This group of companies has run a comprehensive medical scheme for some years with a staff of qualified doctors and nurses. Annual examinations have been conducted on certain workers engaged in what might be described as potentially hazardous production processes in the manufacture of yarn. These examinations are being conducted by general practitioners attached to each factory on a part-time basis and not appointed as part of the factory doctor service.
There are plenty of other examples where company schemes operate. Despite what my hon. Friend the Under-Secretary said, and the emphasis he laid on supporting company schemes, I am not sure that the Bill displays real concern for and recognition of the work done by such schemes. The Bill must ensure their continuity and it must make use of them.
The Confederation of British Industry wants qualified staff in companies to be recognised as part-time employment medical advisers. I question that proposal. It might be better for them to be permitted to carry out examinations which would be fully recognised under this legislation. Some supervision of such examinations would be needed to ensure that they came up to the required standards; but, as the people that I am referring to are all professionally qualified, only superficial checking would be necessary.
The contribution of such company schemes and of company medical officers is invaluable. These names will be well known to the experts in the House; but nearly all our knowledge of nasal cancer in the chemical industry is due to Dr. 149 Amor and of bladder cancer in the dyestuffs industry to the late Dr. M. Williams, both employed by I.C.I. They and others of their type have made an invaluable contribution. They, their colleagues and their successors must be dovetailed into the new scheme.
I am led to believe that the experience of those who work in industry in the way I described is that it is not always possible to distinguish between injury or disease which is caused at work or in outside employment or, indeed, at leisure, and I wonder whether, as Clause 3 requires, it is possible to confine the work of E.M.A.S. to situations where health is being or may be affected by a person's work, and by work only. I query this very much from the experience of those now involved in occupational schemes.
Then on Clause 4, where the reference is only to those occupations involved in the use of lead compounds—and there have been suggestions this evening that we should include those occupations, too, where there are hazards from toxic substances—I wonder whether, as a general point, the E.M.A.S. can require individuals to undergo an examination before they are employed on potentially hazardous work and to submit to regular checks.
I am thinking of much more simple situations than those I have just mentioned—situations, for instance, involving noise where it would be wrong to employ those with suspected weak ear drums or, again something equally simple, where the work requires excessively precise eyesight and where there is a strain on the eyes. Is it conceived under this Bill, and will it be possible, for eye tests or ear tests to be carried out before a worker is taken on for a particular job where these hazards exist?
Then, looking at Clause 5, I must agree absolutely that to continue to examine young people regularly on a 100 per cent. basis would be a complete waste of time. They are mostly healthy. But the success of the proposals in Clause 5 depends on this relationship to which my hon. Friend has referred, the relationship between the careers officer, the School Health Service and the E.M.A.S. My hon. Friend spoke with great confidence about the ability of the School Health Service to stand up to this test; but, as 150 I see it, reference will be passed to the careers office when young men or women are taken on, and I presume that the names will be checked against the list held in the careers office for the suitability or otherwise of the employment.
However, this is dependent on adequate records being available from the School Health Service, and I must query from what I have heard whether those records are truly available for immediate checks—because it is no good checks taking weeks—and whether the records are adequate.
As one of my last general questions I posed the point whether the resources were really available for this new service. My hon. Friend has already confirmed to me that there will be a concentration on full-time doctors and staff as far as possible, in order to have a really expert and specialist body. This is right. But where are these 50 additional full-time doctors coming from? I can see that the National Health Service will benefit from the 1,500 or so appointed factory doctors being released back into the National Health Service full time; but they were, after all, only doing a few hours a week each, and, whereas they were involved for the greatest part of their time on conventional work within the National Health Service, the additional 50 will he withdrawn from it, I am also interested in the comments which have been made about the complete restructuring of the National Health Service and the possibility implied in my hon. Friend's opening remarks that the E.M.A. Service might eventually leave his Department.
The fact is, however, that to begin with and under the Bill as proposed, these 50 or so doctors will be withdrawn from the National Health Service. It is generally accepted that the National Health Service is under-recruited. In my area in particular we feel this through delays in consultation and delays in operations after those consultations, and our accident and emergency departments suffer from under-staffing. So can we afford from our over-burdened National Health Service 50 qualified doctors?
Can my hon. Friend, in winding-up, comment on the status and pay of these men? I agree with my hon. Friend the Member for Carlton (Mr. Holland) that 151 they should preferably have extra qualifications and, therefore, they are most likely to be recruited from those who already serve as appointed factory doctors. This would be sensible.
§ Mr. Holland
Or possibly medical officers from industry—not necessarily from factories. I would have thought that was a better experience.
§ Mr. Butler
My hon. Friend is right. Those men will certainly have had a greater experience. Most of the appointed factory doctors do only a few hours a week in industrial work.
I also query what sort of man will this new service attract. It will be a different sort of existence from most of the work carried out within the National Health Service, and I query whether the bright young man is going to be attracted into this service. I wonder whether my hon. Friend has any particular source of recruitment in mind and whether he would comment on my worries about the type of person who might come forward.
Generally, this is a question of priorities. The hon. Member for Doncaster has accused the Government of cheeseparing this service by cutting down on the number of doctors and reducing the amount of money to be spent. This is a question of judgment. There is only a limited number of doctors to go round, and there is only a limited amount of money which can be spent in this way. As I say, it is a question of judgment.
I feel, on balance, that this figure of 50 doctors is probably the right one which, added to the 50 already employed, gives us a round 100. I am not prepared to argue with the hon. Member for Doncaster on this point, but I think it is a quibble on his part and not on mine. The point is that if we withdraw these men from the National Health Service we must be fully aware of the extra strain which is being put on that service.
I have not examined this Bill in depth, but I have run a critical eye, or a stethoscope, over it. No doubt, much will come out in the Committee stage and Amendments will be made. But, in principle, I strongly welcome the Bill, in the light of my own experience of occupational 152 medicine in industry, and I shall just be grateful if my hon. Friend can reassure or enlighten me on some of the points which I have raised.
§ 8.29 p.m.
§ Mr. David Watkins (Consett)
The hon. Member for Bosworth (Mr. Adam Butler) has, as he put it, run a critical stethoscope over the Bill, and, having given it informed scrutiny, has accorded it a critical welcome. I noted, in particular, the question which he raised early on in his speech, which, I think, he took as his main theme: are the resources, not only the resources allocated under the Bill but our overall national resources, sufficient for the objects in mind?
Further, the hon. Gentleman queried whether the Bill's proposals were such that they could be integrated properly with the occupational health schemes operated by some companies. True, there are some very good company schemes, but in a large part of industry such schemes are virtually non-existent. This is, after all, the basis of our need for a Bill of this kind.
It is interesting that all hon. Members who have spoken so far, apart from the Under-Secretary of State, have given the Bill a pretty critical welcome. The hon. Member for Carlton (Mr. Holland), who is always listened to with respect on these occasions, and who speaks from knowledge and experience, gave it a rather critical welcome. For my part, I give it something less than half a welcome, because it seems to me to be something less than half a Bill. The Government have lifted, more or less, the first half of the Employed Persons (Health and Safety) Bill which was introduced by the Labour Government in the last Parliament, and, as my hon. Friend the Member for Doncaster (Mr. Harold Walker) said—these were not his words—they have to some extent fiddled about with it.
The Explanatory Memorandum tells us, among other things, that Clause 1requires the Secretary of State to establish and maintain an employment medical advisory service".By contrast, the previous Bill merely gave the Secretary of State power initially to establish such a service. I welcome this improvement, making it mandatory rather than permissive, but I 153 feel justified in pointing out that all that the Government have done is to incorporate my own Amendment No. 1 from the Committee stage of the Labour Government's Bill, that Amendment having been carried by the Committee.
§ Mr. Dudley Smith
It only goes to show that we pay attention to good, sensible and practical Amendments from whatever quarter they come.
§ Mr. Watkins
A most flattering reception, but the hon. Gentleman must not seek to undermine my critical powers. He will not succeed by flattery.
§ Mr. Harold Walker
My hon. Friend will confirm that there was no Division in the Committee, and I responded to the eloquence with which he moved the Amendment by accepting it on behalf of the Government.
§ Mr. Watkins
My hon. Friend did precisely that. Moreover, he listened to eloquence coming from what the Under-Secretary of State would probably describe as all quarters, and not only on that Amendment but on others he responded in the same fashion.
I welcome the improvement, as I say, with the justified proviso which I have stated. I am glad that the permissive provision in Clause 1 of the previous Bill is replaced by a mandatory requirement. None the less, I feel that the Government ought not to try to claim credit for it, since they are merely taking up something done in Committee on the previous Bill.
It is proposed under the Bill to recruit the equivalent of 50 full-time doctors, and this is to be compared with the equivalent of 60 full-time doctors under the Labour Government's Bill. Also, as my hon. Friend the Member for Doncaster pointed out, there is smaller financial provision in this Bill than there was in the previous one. What the Bill also does is to drop completely the second half of the previous Bill, which introduced the principle of compulsory joint consultation between managements and trade unions on the matter of industrial health and safety, and above all industrial accident prevention. It is for those reasons that I say that it is less than half a Bill and that it deserves less than half a welcome.
154 We are all waiting for Robens. We are usually waiting for somebody or something. My hon. Friend the Member for Eccles (Mr. Carter-Jones) said in theatrical terms that we were waiting for Godot, and at an even earlier stage we were waiting for Lefty. That we are waiting for somebody before something is done about an important problem is an argument much too often reiterated here. What is required is a major Bill combining the Factories Act, 1961 and the Offices, Shops and Railway Premises Act, 1963 and also containing provisions to extend and modernise our whole national approach to the great issue of industrial health and safety. The modern developments in industrial accident prevention in particular are not being applied with anything like sufficient force in industry generally.
It is sad to recall that a start was once made in the House on the road which would have led to such a major Act as I have referred to. With the advent of this Bill, that great start seems to have fizzled out completely. It was in June. 1967, that my right hon. Friend the Member for Southwark (Mr. Gunter), then Minister of Labour, said in answer to a Written Question that he was contemplating such a Bill, and in December of that year he issued a consultative document outlining his thinking on the subject. After a considerable passage of time, in March, 1970 the Employed Persons (Health and Safety) Bill, a much lesser Measure, was introduced and was filbustered out of existence by the then Opposition in Committee.
Now here we are with this little Bill, the proposals of which are derisory in comparison with the magnitude of the problem of injury and disease at work, which it makes a tentative start at seeking to come to grips with. Dropping the principle of joint consultation is an especially retrograde step. It typifies the Government's approach to the whole idea of having working people involved in any way in decision-making in industry and their obvious intention to seek to have working people excluded from such decision-making even on such important matters, where they are so much the potential victims, as industrial health, or lack of health, and injury.
155 In preparation for the debate I have looked back over some of the records, and I have found that consistently over a century there has been similar opposition from the Tory benches. When I say "a century", I am not exaggerating, because the principle which is being dropped from the Bill was initially enshrined in the Mines Regulation Act as long ago as 1872. One of my predecessors, Sir George Elliot, who was then one of two Members in the old Durham, North division, was reported as saying:There was, however, one provision which would be extremely objectionable, and that was, that the men might appoint two or more among themselves, if desirous of so doing, for inspecting the mine.If any hon. Member wants to check that, he will find it in HANSARD of 12th February, 1872, at columns 244–245 of Volume 209 of the Third Series.
Here we are—a century later, all but a few months—considering a Bill in which quite consciously the same principle which Sir George Elliot fulminated against 100 years ago has been deliberately dropped by the Government in a Bill which is a lesser re-hash of one which formerly incorporated that principle. As the rest of the country goes forward into the seventh decade of the 20th century, the Government are still kicking and screaming against the first decade.
Something of the low regard the Government have for this subject in general is measured not only by their delay in introducing the Bill, but by their allocation of only three hours to the Second Reading of a Measure which everyone concedes deals with a vitally important subject.
I welcome the Bill, as far as it goes, because it grapples, although I fear it will prove to grapple rather ineffectively, with a fairly major national problem. I add my voice to the voices of my hon. Friends who have already indicated that in Committee we shall seek by the most detailed and searching examination to remedy the Bill's present inadequacies.
§ 8.41 p.m.
§ Mr. Robert Redmond (Bolton, West)
I thank you Mr. Deputy Speaker for calling me and my hon. Friend the Member for Bosworth (Mr. Adam Butler), 156 because until my hon. Friend rose I began to think that this was a private argument among people who had taken part in previous debates on another Bill —the Employed Persons (Health and Safety) Bill. Now I know that anyone can join in. The previous Bill was killed by the right hon. Gentleman the Member for Huyton (Mr. Harold Wilson), but as this Measure is welcomed by the Opposition I hope that they will speed it on its way, although I gather from the hon. Member for Consett (Mr. David Watkins) that we shall hear about something that happened under the Liberal Government in 1872. I am not concerned about what went on 18 months ago: I want to hasten the Bill on to the Statute Book in its own right.
I am sorry that the hon. Member for Eccles (Mr. Carter-Jones) has left the Chamber because he and I represent Lancashire seats and I thought that he was right in what he said about diseases like pneumoconiosis. I wish I could think that his hope that there will be no more industrial diseases will come true, but new diseases can easily come from new processes, and the Bill is essential if we are to avoid what could be the natural consequences of the new technological advances and processes that are continually being brought into industry.
My hon. Friend mentioned the C.B.I. view that the E.M.A.S. should consult existing staff in factories. I should not think legislation was necessary there, because I am sure that in the interests of good industrial relations employers will never allow the sanction in the Bill to be applied. It is a matter of common sense that all employers should co-operate.
The Opposition's main argument appears to be that the Bill does not do anything about industrial safety. The Bill provides a medical advisory service. Industrial safety is being dealt with by the Robens Committee and we must see what that Committee recommends. That does not make sense. We should get this part of the requirement on to the Statute Book as soon as possible. Why set up a Committee under Lord Robens and then try to anticipate its findings? There seems to be no point in anticipating a Bill dealing with industrial safety at this juncture. It is true that there is a thin line between health and safety. Together they lead to good industrial relations, 157 good productivity, and should be welcomed by anyone. On those grounds I welcome the Bill.
There are three questions I should like to put to my hon. Friend. I am a little worried in another context about the apparent rundown of the mass radiography services which have done so much in recent years to stamp out the incidence of tuberculosis. I am no expert but, as I understand it, the success of mass radiography has led to the removal of the need for such a service to some extent. There may be some industries in which, under Clause 3, the employment medical adviser may exercise his power to carry out a medical examination for suspected T.B. I would suggest that there are some geographical areas where this could be equally necessary, not because of T.B. being caused through any industrial process.
A lot of hot air has been generated on this subject, particularly after that unfortunate article on the centre page of the Sunday Express yesterday. I am sure everyone will recognise that this is not a matter of race prejudice when I say that the incidence of tuberculosis among the immigrant population is higher than we would expect it to be and higher than it is amongst the indigenous population. The mass radiography service could be brought in here and used in areas where the incidence of T.B. is greatest. If the service were to lapse completely, I hope that under the provisions of this Bill it could be revived.
Under Clause 6 employers have to pay for the medical examination. Is it possible to give some idea of what the cost will be? The cost of administering the service is said to be £850,000, set off by receipts of about £100,000. The hon. Member for Doncaster (Mr. Harold Walker) has asked for more to be spent. He suggests that fees for medical examinations will not be very great. I know that many people in the board rooms, particularly of the smaller companies, are frightened by what they regard as any additional tax on jobs such as we have had through the levies from the industrial training boards and S.E.T. I should not like to see anything happening to discourage industry from providing jobs. [Interruption.] Does the hon. Member for Doncaster wish to intervene?
§ Mr. Harold Walker
I was simply suggesting to one of my hon. Friends that I heard echoes of the dinosaurs when I heard the hon. Gentleman suggesting that we ought not to deter employers from providing jobs by charging fees for medical examinations. I take it that was the gist of the hon. Gentleman's remarks. No doubt that was the same kind of argument levelled in this Chamber at Shaftesbury a hundred-odd years ago when he introduced his Ten Hours Bill.
§ Mr. Redmond
It is a pity the hon. Gentleman was reading something else —or appeared to be—when I was speaking. I thank him for enabling me to clear up that point and knock it hard on the head. I would of course, had I been here, have supported the Earl of Shaftesbury who was a good member of the Tory Party. Let us not forget that. But we do not want to go into a history lesson. I was saying that there are employers who are worried about the constant levies upon them for the number of employees they have. I instanced in particular selective employment tax and the levies of the industrial training boards. I also said that I did not think that £100,000 was a great sum of money and indicated therefore that the charges would not be great. But it will be of great help if this can be cleared up. It was really to prevent any argument about what the hon. Gentleman called "dinosaurs" that I mentioned the point, and it is a great pity that he was writing his wind-up speech at the time, for otherwise he would have got the point.
How are we to employ the 12 nurses—or have I got this figure wrong? We are apparently to have 100 doctors—50 full-time and 50 part-time—and if there are only to be 12 nurses between them I do not see how we shall be able to spread the services of the 12 nurses throughout the country on an equitable basis. The number may, indeed, be so small that it may not be worth having. Have I misunderstood the situation? My hon. Friend the Member for Bosworth (Mr. Adam Butler) has fears about the shortage of doctors. I think that there could be a shortage of nurses in this scheme if we are to employ only 12.
I am glad that the new service is to remain under the Department of Employment. It would be a great mistake to 159 put it under any other Department. I could not quite follow the hon. Member for Doncaster in his argument, but I would say that the primary factor in this scheme is that it is an industrial service, and I think it is necessary for the people engaged in it to talk the language of industry and industrial relations. To put the service under the Department of Health and Social Security would be quite wrong. I welcome the Bill and hope that it gets a speedy passage through the House.
§ 8.52 p.m.
§ Dr. David Owen (Plymouth, Sutton)
The problem which the House is discussing is the health of some 20 million working people—people who spend one-third of the 24 hours of each working day in their working environment, people who in various industries are well known to be susceptible to noxious agents and industrial disease. We need to put their health in perspective. For every day lost by strikes, 10 days are lost by industrial injury and disease. But an even more revealing perspective is that for every day lost by strikes 100 days are lost by ordinary illnesses.
Instead of trying to improve the deleterious effect of work on health in industry, I think we now need to take a much greater interest in how we can improve people's health in work. This is an ambitious aim but it is one which has won support on both sides of the House, as well as in practically every single professional body which has ever studied the issue. We should, therefore, judge the Bill on how it measures up to the whole question of providing a comprehensive occupational health service, and by that measure it lamentably fails. It is at best a side-stepping of the central issue. I think that it will prove to have delayed the introduction of a comprehensive occupational health service. I must confess to a great fear that once we have legislated in this very limited and partial manner, the Government—of either party—will use it as an excuse not to tackle the really central issue, which is to provide an occupational health service.
All that is being done in the Bill is to add to the existing 19 medical inspectors of factories a further 50 full-time medical equivalents—in other words, to 160 provide 69 full-time doctors. That is only a fraction of the medical manpower in occupational health services. The hon. Member for Bosworth (Mr. Adam Butler) paid tribute to existing schemes run by industry—for example, by some private companies like I.C.I. and by some nationalised industries—and I readily echo that tribute. They are providing by far the largest percentage of all medical care to people in industry. I believe that the equivalent of 600 doctors are employed full time by these industries. I pay tribute to the Royal Dockyards, the industry which first gave me my interest in occupational health, where many of the medical services are provided by the Royal Navy. They have done pioneering work on asbestosis and the danger to a man's health from working with asbestos. The severity of this as an occupational illness has come to the fore only in the last decade.
Although these industries are already making excellent efforts to meet the demand, they are industries which would not be doing it unless they saw an economic return. I.C.I., for example, would not invest in this if it did not think that there was an overall economic return, quite apart from its moral commitment. Yet, looking at the pattern, one sees that the industries mainly concerned are those with over 3,000 employees. Of the 2,000 or so factories with more than 500 employees, only about 1,300 have the services of a part-time or full-time doctor, and of about 195,000 factories with 100 or fewer employees, only about 1,800 have the services of a full-time or part-time doctor.
I suspect that anyone examining closely the services actually available will often find that they are woefully inadequate. Voluntary provision amongst our major industries has made a great contribution to occupational health in those industries, but one of the sad features is that that voluntary provision in recent years has virtually ceased to expand. For that reason, the Bill must be looked at against the background that, without further stimulus, it does not seem that an occupational health service will be provided on any sort of scale.
We have heard mention of group occupational health services. It may be that they provide the best foundation on which to expand. However, if one looks at the 161 list of the seven existing group occupational health services, one sees no prospect of any major expansion on them. I find that regrettable. I wish that it were possible to take a more optimistic view of the future.
Why is it that this House in 1971 is paying a tribute in certain quarters to this fairly miserable Bill when it is set beside the history of occupational health? In 1949, the Government appointed the Dale Committee to consider the relationship between the National Health Service and the various health services then provided in industry. In its report, the Committee recommended the establishment of a service which made… comprehensive provision for occupational health covering not only industrial establishments of all kinds, large and small, but also … non-industrial occupations.Over the years, we have seen an ever-increasing body of opinion demanding some form of comprehensive occupational health service. In 1959, the Internatioinal Labour Conference adopted a resolution on the organisation of occupational health services in places of employment. That became its Recommendation 112. It was accepted by Her Majesty's Government, who hastily made it clear that it would not apply in this country since we had a National Health Service already.
As for the European Economic Community, Articles 117 and 118 of the Treaty of Rome pay tribute to the essentially preventive character of occupational health services. In the Community countries, there are three recommendations already in existence. We see that in 1946 France established a comprehensive health service. Belgium has something somewhat similar. The Netherlands has produced a health service at which we could well take a close look. Possibly only Germany and Italy do not have a fully comprehensive health service, but even they provide services from which we could learn a goad deal.
In 1961, the Medical Services Review Committee, under the chairmanship of Sir Arthur Porritt, came out in favour of establishing a comprehensive occupational health service as an integral part of a centrally co-ordinated National Health Service. The Royal College of Nursing and the British Medical Association 162 favour such a scheme. It is obvious that the Society of Occupational Medicine also favours such a scheme. A detailed memorandum was presented to the Robens Committee on this subject. I found the statement of the Committee—and presumably it was given with the permission of Lord Robens—profoundly disappointing. It is clear from what the Minister has said that the Robens Committee will not produce any major recommendations for the long-term future of the occupational health service. It sees this as a fringe matter.
There was a chink of light in what the Minister said in answer to my intervention, namely, that in the reorganisation of the National Health Service the Government would not exclude the possibility of legislation covering occupational health. However, I understand that already in the consultation process the Government have told the organisations concerned that they have no intention of introducing an occupational health service in any N.H.S. reorganisation.
The prospect for the production of a comprehensive occupational health service is poor. The Royal Commission on Medical Education appeared to think it would be some time before there were any changes in occupational health. I should like to quote from what was said by a senior medical inspector at a meeting of the European Regional Office of the World Health Organisation:In spite of many claims over many years that medical services in industry save working time, no objective evidence that they do has been produced: even if they do, the present view is that the amount of medical and nursing time deviated from therapeutic medical services (including general and hospital practice) is not justified".That may be his view. It is not my view. It is not the view of private industry, prepared to put money into their own occupational health services. I hope that it is not the Government's view, and I hope that it was not the view of the Labour Government.
The Minister made the usual qualifications of this Bill in order to placate the various organisations putting pressure on him, just as his predecessor did, by saying that this was not a comprehensive occupational health service but that he foresaw the day when it might come and that the Government were not completely closing the door. What is the extent of 163 the commitment to produce a comprehensive medical service? I realise that there are tremendous demands on medical manpower. I accept that a scheme cannot be introduced overnight. I also accept that any scheme which is introduced must run in harmony with existing schemes in industry, whether nationalised or private industry.
But the House and successive Governments have totally failed to grasp the essential problem. I hope that when we become members of the European Economic Community the countries of the Community will put pressure on us to provide an overall comprehensive health service. The Royal College of Nursing has written to the Secretary of State to express… its grave concern that the E.M.A.S. is to remain within the Department of Employment".If one sees the development of an occupational health service purely in terms of an inspectorate or of an external service imposed by Government on industry and paid for by general taxes, it is legitimate to say that it should stay in the Department of Employment. But, viewing it in the wider health context of the man at work, it must logically fall under the Department of Health and Social Security.
It is time that we had a pledge from the Government that they will introduce legislation to provide an occupational health service. There are two major ways in which that could be done. We could have an external service organised for industry by the Government paid for by taxes and as part of the overall National Health Service. Over the years, this has had many proponents, but it is open to grave objection. I do not think it will come about.
A much more attractive alternative is what I will call an internal occupational health service organised by industry under legal compulsion by the Government and with minimum standards controlled by the Government who would probably maintain some executive control of the statutory inspectorate aspect. The latter point will be looked at by Lord Robens and his Committee. It would not surprise me if he decided to take all of the inspectorates together and tried to rationalise the structure under the 164 Department of the Environment—and there is as much logic in that as there is in putting some under the Department of Employment and some under other Departments.
The strongest argument, in my view, for overriding an externally organised occupational health service and in favour of choosing an internally organised occupational health service is that the internally organised service lends itself to be organised on an industry basis and not a regional basis. A chemical worker's occupational health problems are likely to be very similar whether he is working in the North-East or in the South-West; and a coal worker's occupational health problems will be the same whether he works in Wales or in Durham. The managerial involvement is likely to become much stronger if such an organisation is industry-specific and the degree of expertise among occupational health workers, the medical workers and the social workers is likely to be stronger also. For these reasons I would come down in favour of an internally organised service.
§ Mr. Holland
Could the hon. Gentleman amplify a little the sort of structure he has in mind? Would it be something on the lines of an industrial training board which is financed by a particular industry?
§ Dr. Owen
That is the sort of structure one is envisaging. A small factory, for instance, has not necessarily the financial resources to support a full-time doctor or even, perhaps, a full-time nurse. It has been the case in Slough, Harlow, in central Middlesex, and other areas, that firms in different industries have come together in a group and have collectively funded medical help. One would hope that the health team—doctor, nurse and the social worker—would provide a complete service in the area, and that is the kind of development which I would like to see.
What we should try to do is to introduce an overall occupational health service; it should be phased, and have Government money behind it in the introductory period, to get the system running, to get the groupings working. This is what the Nuffield Foundation has been doing over the years besides all the other things it has been doing. One cannot expect the Nuffield Foundation to go on 165 doing more and more indefinitely. Now the Government should put money behind this work and after a period of two or three years, when the system has been running in an area or industry, the Government should say, "Now this is your responsibility and you can choose to run and finance it yourself, or you can subcontract it, so to speak, to an area health board."
This is where reorganisation of the health service becomes of major significance. An area health board could take responsibility for occupational health, just as much as it is now planned it will take the new responsibility for community health, and in areas of high industrial development I believe that an area health board should have a specialist in occupational health to stimulate provision of small groupings in an area and an expert consultative service.
I know that this may be reasonably expensive in terms of manpower, but the Minister himself is thinking of a manpower of 100 doctors. This figure is very inspection-oriented. I am not denying that there is a need for inspection. It may be that that aspect of a statutory obligation would always stay outside the general scheme and stay under the Department of Employment. I do not feel very strongly about that, but what I am asking is that the Government should lift their sights and look at the much more important and a greater problem of providing for healthy workers. One of the problems of medicine anywhere is of access to somebody who is ill; a successful treatment should be speedy and efficient.
I come back to the words to which I referred earlier, of the senior medical inspector, and what may be the Government's view, perhaps, although I only hope it is not, that surely industry itself would not be providing this service if it did not think there was an economic return. Industry does not agree with the senior medical inspector. It thinks it a sound use of existing medical facilities and manpower to provide such a service in the factories. They are increasingly concerning themselves with the wider environmental problems and providing a healthier atmosphere, and psychological medical problems must also be taken into account.
166 I hope the hon. Gentleman in reply will assure the House that this small Bill once on the Statute Book will not be used as an excuse not to produce legislation next year when we come to reorganise the whole National Health Service and at a time when the Robens Committee's recommendations have been absorbed. I hope that we shall not be told, "Let us see how the E.M.A.S. works out. Therefore, let us leave it for a decade." That will be a recipe for further delay, frustration and lost opportunities.
This country already lags woefully behind many of our industrial competitors, all of which have to watch their industrial costs so that they do not price themselves out of the market. This country, having pioneered the National Health Service, cannot go on lagging so far behind in occupational health services.
This Bill does not provide the framework within which to develop an overall occupational health service. I hope the Bill will be improved in Committee. I should like to emphasise the importance of specific occupational health training for the doctors and nurses who are to work in the service. I should like there to be greater examination of how the system will work in harmony with existing schemes conducted by private industry.
My major concern is that the Bill does not have widespread support, and it is an illusion to think that it does. It may have support between both Front Benches, but there is not a single person interested in occupational health who sees this legislation as a very definite advance; indeed many fear that it will be used as an excuse for some years ahead to do nothing substantial.
The first thing that must be done is to convince the Department of Health and Social Security and its senior advisers that there is a need for an occupational health service. There are a number of key people who have held up an occupational health service for long enough. It is time that Ministers gave up listening to those people and, instead, paid attention to the views of the Royal College 0of Nursing, the British Medical Association, the Socialist Medical Association and all the unions involved who want an occupational health service. Their demands can be met, not by starving the 167 health service of doctors, but by sensible allocation of medical manpower in an effort to catch disease in its early stages. That is the challenge, and I hope the Bill will not be used as an excuse not to face up to it.
§ 9.13 p.m.
§ Mr. Peter Doig (Dundee, West)
As a member of the largest trade union in Britain, I welcome this Bill because I believe it will do some good, however little, for the working people of this country. It does not go as far as I should like it to go but, having in mind the old adage that half a loaf is better than no bread, I welcome it.
It will be appreciated that Scotland has its own National Health Service. We have been told by the Government Front Bench that these provisions involve a temporary arrangement and that this system might be incorporated into the National Health Service. If this is the intention, it is surely a mistake that Scotland is to be incorporated in the Bill's provisions. Should there not be a similar Bill, on parallel or similar lines directed at the needs in Scotland Failing this, should there not be a completely separate Bill for Scotland?
We in Scotland in the past have suffered from the fact that a large number of the top administrative jobs have been held in centres in London. We are fortunate that the bulk of the staff of the Secretary of State for Scotland are resident and work in St. Andrew's House and that the Scottish Home and Health Department controls the health service in Scotland. When one remembers that the unemployment rate in Scotland is much higher than anywhere else in the United Kingdom, surely much of the administrative work should be carried out in Scotland.
In Dundee, which I represent, we have today the only unit in Scotland specialising in occupational medicine. There seems every reason to have this service centred in Scotland, remembering that we are far removed geographically from London and that the north of Scotland is more remote still. It is wrong, therefore, that a service such as this should be administered from London, especially when we have the National Health Service already established in Scotland.
168 This unit in Dundee, which I visited recently, provides a service to employers and employees alike. It receives donations from employers as well as charging them for certain services that are provided. I accept that it is wrong that the unit should have to depend on donations from private industry. It should have been properly equipped in the first place without donations being required. However, it is being supplied with money in this way and it is doing an effective job.
The unit in Dundee also provides a service for hospitals in the area. For example, it diagnoses blood and urine samples, and measures noise, dust and fume levels. It also suggests remedies for these difficulties, and this is a particularly import aspect of its work. It is already part of the university and will have a part in the new Nine Bells Hospital which is being constructed in Dundee—that is, if the hospital is ever finished. It has been under construction for so long that we wonder whether it will ever reach completion.
Will the Bill duplicate or replace this service in Dundee? This is an important question, because the unit at present advises the Government on the prescribing of industrial diseases. It does a great deal of research work on, for example, the testing and incidence of deafness and how deafness can increase as a result of excessive noise.
Our main industry in Dundee is based on the jute mills and conditions in this industry have improved vastly in recent years. At one time one could tell a jute mill worker in the street by the loudness of his voice. He or she had to speak so loudly to overcome the noise of the machinery in the jute mills that this level of conversation became a habit.
In addition, an excessive amount of dust tended to enter the lungs of jute mill workers. Fortunately, steps have been taken by managements, possibly assisted by this or a similar unit, to introduce things like dust extractors. These developments have helped to prevent diseases of the lungs. They have also tried to tone down excessive noise levels. These efforts have also helped, but only to a degree. More still needs to be done.
I hope that I have said enough to show that this unit in Dundee should be kept in being. Will it be done away with 169 under the proposed set-up? Will occupational hygienists travel from London to Inverness, Fort William and other parts of Scotland to conduct investigations? If so, why should this be necessary when we already have a unit in Scotland capable of doing—and already doing—this work? Will industry contribute to this service, as it does now to some degree to this Department of Occupational Medicine in Dundee? We have been told that it will contribute in relation to medical examinations. But will it contribute to the other services that an organisation such as this carries out, very often giving advice on how to reduce excessive noise and how to take steps to prevent these things happening? This is very necessary from a worker's point of view.
From where will the employment medical advisers seek help in their laboratory investigations? Will they use the existing laboratories or will environmental tests be referred to the factory inspector at the laboratory in London when we already have one in Scotland? Will they co-operate with the universities, as the present set up does? There is no mention of that in the Bill. Will the university interests in teaching and research be safegarded? Will existing university laboratories be used on an agency basis, as departments of bacteriology are at present? All these matters ought carefully to be considered.
There is nothing worse than seeing the effects of neglect in these matters, which could have been prevented had more money been spent by us a little while ago. Recently I was visited by a woman who brought with her a very young daughter in order to interpret what was being said because the woman was deaf and had learned to lip-read from the child. I realised then the effect of excessive noise in industry and how it accelerates the process of deafness which overtakes these people. In this case there was a cure. The Government gave a deaf aid to this woman. She said that it was useless. The experts pretty well agreed about that. A private firm then offered to lend her a commercial hearing aid. She tried that aid and found it quite effective and that she could work properly with it. I wrote to the Secretary of State for Scotland about this case, giving him all the details and inquiring whether there was any way in which his 170 Department could assist the woman to buy this hearing aid, which cost about £60. The correct price was about £100, but, because it felt sorry for the woman, the firm offered it at cost price. In spite of this, the Department in Edinburgh refused any financial help.
But for the lateness of the hour, I could continue with case after case of victims of this neglect, this failure to provide a service of preventive medicine, where steps could have been taken to prevent these tragedies. When one considers a person who loses his hearing or whose sight is affected, or who has any other disability, such as being unable to walk up a hill without getting out of breath and having to stop two or three times, or being confined to his house because he is unable to go up and down stairs because of dust inhaled during his working life, one realises the necessity for such a Bill. That is why I welcome it. However small it may be, it will at least help someone if it encourages research into preventing this sort of tragedy. They are tragedies to the workers involved and their immediate families.
§ 9.24 p.m.
§ Dr. Alan Glyn (Windsor)
One of the great difficulties facing the House is the general relationship between the facttories doctors and the general practitioner. As I see it, this is a serious difficulty, because the general practitioner is in locus parenti, or has a relation especially towards his patient, where that is not the case with the factory doctor in his capacity as a medical adviser. The hon. Member for Dundee, West (Mr. Doig) brought this out very well when he said that what a factory doctor's job was was to point out the dangers and hazards of a particular industry, and these dangers exist in every industry. The difficulty has always been to secure a proper balance and relationship between the factory doctor and the family doctor whom the patient normally consults. The job of the factory doctor is to become accustomed to and advise on the peculiar hazards that arise in his factory and in his industry. In the old days one great problem was, for instance, silicosis in mining.
There is room for the establishment of a closer liaison between the factory doctor and the general practitioner. This is a sphere in which my hon. Friend the 171 Under-Secretary can help. A close liaison between a medical advisory service in an industry and a family doctor will produce the best possible service for the individual patient. All the knowledge which has been accumulated as a result of years of work by a factory doctor should be made available to the general practitioner so that when he is advising his patient he has available the knowledge accumulated over a period of years.
If the debate achieves nothing else, I hope that it will succeed in establishing a closer liaison between two branches of a profession which are essentially complementary. Together the factory doctor and the family doctor can help the patient to overcome what is for him an extremely difficult problem. About 12 years ago we debated the subject of silicosis, which was a peculiar problem associated with mining. At that time silicosis was not recognised as an industrial disease. As a result of that debate, and following legislation, it is now recognised that silicosis is a disease associated with mining and is a recognised industrial disease.
I repeat that the factory doctor and the general practitioner should always seek to co-operate, in the interests of helping the individual patient and of alleviating any condition of his arising from circumstances peculiar to the industry in which he is working. I am sure that the hon. Member for Doncaster (Mr. Harold Walker) will not disagree that if we get these together working as a team, the interests of the ordinary patient, which is what we are really here to discuss, will be best served.
§ 9.30 p.m.
§ Mr. Harold Walker
With the leave of the House, I should like to make a few brief comments—I assure the House that they will be brief—to help draw to a conclusion this short but interesting, useful, constructive and at times lively debate.
The hon. Members for Bolton, West (Mr. Redmond) and for Bosworth (Mr. Adam Butler) said that they were not concerned, nor should the House be concerned, with the Measures of yesterday, but that we should be concerned with the matter before the House today. The hon. Member for Bolton, West said that we ought not to try to anticipate the 172 findings of a body which had been set up to look into these other important matters. It struck me as rather odd at the time because I had referred to the Government's industrial relations policy, and I could not help recalling that it was based entirely on a document which did not wait for the Royal Commission on Trade Unions and Employers' Associations, the Donovan Commission, but was drafted before that body reported.
I must point out that the original Bill from which this Measure derives was introduced at the same time as my right hon. Friend the Member for Blackburn (Mrs. Castle) set up simultaneously the Robens Committee. I hope the House will not accuse her of trying to anticipate the conclusions of the Committee which she set up when she presented the Employed Persons (Health and Safety) Bill in 1970. If this was a valid argument about one half of the original Bill, it was an equally valid argument in respect of the other half.
I said that the Under-Secretary had already deployed the same argument once before this year in rejecting the Private Members' Measure brought before the House by my hon. Friend the Member for Renfrew, West (Mr. Buchan), but he invalidated his own case by presenting his own Bill. I welcome the fact that he did so, not only because I want to see the employment medical officer service quickly established but also because I think it weakens his argument when we debate the Measure again on 4th February—the safety part of the original Bill.
I think the hon. Member for Bolton, West rather misunderstood me on the question of departmental responsibility for either the E.M.A.S. on the one hand or the occupational health service, for which many people were pressing, including my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen), on the other hand. My hon. Friend's speech reinforced my point. His speech was not inconsistent with but complementary to my own remarks when I pointed out that the employment medical officer service as originally conceived had a limited rôle and indeed must inevitably do so. One sees that that rôle is rightly related to and will continue to be connected with the responsibilities of the Department of 173 Employment. But we never suggested that it is a substitute for or even an alternative to, or a pretence to be, an occupational health scheme. As my hon. Friend the Member for Plymouth, Sutton eloquently and lucidly said, an occupational health scheme is for most people something which goes a long way beyond the concept embodied in the Bill. It seems to me that it is something which not only goes beyond the scope, resources and responsibility of the Department of Employment but would involve a fundamental recasting of the National Health Service, and for that reason be a proper matter of policy and responsibility for the Department of Health and Social Security. That is what I was saying, and I gather that my thoughts on the matter were echoed by my hon. Friend the Member for Sutton.
I understood the point made by the hon. Member for Windsor (Dr. Glyn), but I do not see the service proposed under the Bill as having the resources for providing either treatment or clinical facilities. As the Title and the content of the Bill show, it is to be an advisory service. Its staff will be primarily engaged, one hopes, in research and advice to industry, in prophylactic and preventive advice, and so on.
Notwithstanding all the reservations and criticisms which have been expressed, the Under-Secretary of State can be reassured by the general welcome which his Bill has had. For all my own criticisms, I join in that welcome. I commend the Bill to the House tonight on Second Reading. We look forward to discussing the details in Committee.
§ 9.36 p.m.
§ Mr. Dudley Smith
May I have the leave of the House to reply to the interesting debate which we have had? Some hon. Members have been less than enthusiastic about the Bill, and I really do not understand why. The hon. Member for Doncaster (Mr. Harold Walker), for whom I have a great personal regard, seems to be getting testy in his old age. He was very condemnatory in his opening speech, though rather more placatory in his response just now. I agreed almost entirely with what he said in winding up, though I must dissent from his observation, typical of 174 Opposition Front Bench exaggeration, that the House has been waiting over two years for the Bill. We have been in office for only 18 months, and we have been extremely busy in that time with a lot of important legislation. We have always regarded this as an important Measure, though not of first priority compared with such Measures as the Industrial Relations Act.
The hon. Gentleman pointed out, quite fairly, that industrial safety is not mentioned in the Bill; in other words, that we have implemented only the first part of the Labour Government's Bill. True enough. But, as he knows, my hon. Friends and I maintained in Committee on that Bill that these were two quite separate matters. For the sake of convenience, the last Administration lumped them together in one Bill, but they are two entirely separate themes. We thought it absolutely right that the subject matter of this Bill should be judged and provided for separately, and we have brought it forward in that way.
There have been a number of questions about the safety side of it, and we have been reminded that the hon. Member for Renfrew, West (Mr. Buchan), who was fortunate enough to come top in the Ballot recently has chosen this as the subject of his Private Member's Bill. We shall have an opportunity to debate it for the whole of one Friday in February, and, although we have been over the course a number of times, it will be interesting to hear the latest views on the subject. Irrespective of any arguments about it being a Private Member's Bill, it would surely be wrong at this stage, with that Measure on the horizon and coming up for debate so soon, to incorporate its subject matter in the present Bill. It is sensible for us to tackle the provision of an employment medical advisory service in this Bill in the way proposed.
I come now to the questions put to me. The hon. Member for Doncaster asked about industrial deafness and referred to the recent judgment in the High Court. I can say no more about that now. Damages were awarded, and I understand that there may well be an appeal, so to some extent the matter is sub judice. However, I can say that the subject of occupational deafness has been receiving a good deal of attention within 175 the Department. A special sub-committee of the Industrial Health Advisory Committee has been studying the subject, and I hope that it will shortly be making important practical recommendations.
Meanwhile, the Factory Inspectorate, which is equipped with better instrumentation than it has ever had, is carrying out field surveys of considerable importance to improve its knowledge of the subject. I assure the hon. Gentleman that we are in no way complacent about things and are well aware of the implications of modern noise in industry.
The hon. Gentleman chided us for paring off some of the costs in comparison with the Bill his Administration introduced. The saving is not even mainly in staff. There has been a substantial saving in the cost of laboratory facilities, owing in part to the development of improved methods by the Department's medical laboratory and partly to a revised and more accurate estimate of the number of tests. There will be a saving of staff, and this accounts for about a third of the cash saving. But that is not simply due to a reduction of numbers. There is to be a more economical use of staff. In particular, the introduction of nurses is a change which with a proper deployment of forces we believe will be at once an economy and a strengthening of the arrangements. We do not accept that we have weakened the service by cutting it down. We should not necessarily improve its efficiency by spending more money.
Obviously as time goes on we can consider those matters and even the need for strengthening certain departments. I am sure that the Government and the Secretary of State of the day will be prepared to consider that. We believe that our provision is a sensible and worthwhile one at this stage.
I was asked who will head the Service. I am glad to say that it is expected to be headed by Dr. T. A. Lloyd Davies, the Department's distinguished Chief Medical Adviser. I am sure that the hon. Member for Doncaster knows him and knows that he is a most worthy person to undertake the task.
§ Mr. Harold Walker
May I express my congratulations through the hon. Gentleman 176 to Dr. Lloyd Davies on his appointment and wish him well in his work.
§ Mr. Smith
I am sure that Dr. Lloyd Davies will be grateful for those kind words.
The hon. Gentleman also referred to the new Schedule and the complex cross-references. I agree with what he said, but, as he well knows, it is sometimes very difficult to draft Bills without appearing to be a little confusing. We certainly tried to meet some of the criticisms advanced in Committee on the old Bill. If the hon. Gentleman thinks that there are ways of improving it, we shall be prepared to look at his drafting, but what we did was done in an attempt to be helpful.
The hon. Gentleman hoped that the service would have an increasingly expanding rôle, and we certainly hope so. We believe that that will happen, and that is what we have set about ensuring. I believe that the staffing and the facilities will be adequate.
The service will undertake a number of surveys which could throw light on the relationship between diseases and working conditions. The cost of the work will not come out of the medical fees, which are designed merely to pay for the cost of examinations and tests. Research will be a general charge on my Department.
We heard an interesting speech from the hon. Member for Eccles (Mr. Carter-Jones), who wanted to know whether it is possible to monitor new hazards before it is too late, a point we all take very seriously. That will be done. It is an advisory service, but it is also a preventative service, and the more monitoring that can be done of diseases before they take a serious or fatal hold on individuals, the more successful will be the Service.
One of the three main principles of the Service will be that it will be concerned in quite a big way with disabled people. I am not entirely satisfied with the Department's performance in regard to disabled people over a period of years, and the Department is not satisfied either. We are looking at the matter very seriously. I know of the hon. Gentleman's personal interest in the subject.
I agree with my hon. Friend the Member for Bosworth (Mr. Adam Butler) that 177 works medical officers are most valuable. There will be full co-operation with them in the operation of the Bill. As he said, some works medical officers have done extremely valuable research. I think that school records will be adequate. Indeed, we intend to give those responsible full briefing in advance of the Bill coming into operation so that everyone knows his responsibility and the performances can respond accordingly.
My hon. Friend also asked where these full-time doctors would come from. A number will, we expect, be works medical officers. Some will be ex-appointed factory doctors and some of these have given more than a few hours a week, as my hon. Friend has suggested. They will not be withdrawn from the National Health Service which, on balance, as I said earlier, will I believe gain in medical time from the changes which are being instituted. I do not believe that there will be any paring back of the National Health Service as such.
The pay for the doctors will be the standard salaries for the various grades of medical civil servants. There will be a career structure which should be attractive to good men with an interest in the subject. There is already an indication, I am glad to say, that some very good applicants will be forthcoming. We have no worries about being able to staff the new service satisfactorily.
My hon. Friend the Member for Bolton, West (Mr. Redmond) referred to mass radiography and tuberculosis. These are really matters for the Department of Health and the National Health Service and not really for my Department and the Employment Medical Advisory Service. But, of course, the new service will be interested in radiography where this can make a contribution to the study of occupational diseases in places such as potteries and foundries, where damage to lungs is likely to occur through exposure to dust.
I was interested in the contribution of the hon. Member for Consett (Mr. David Watkins), who is a regular contributor to such debates. But if I may say so without offence, I did not think that he was quite as constructive as he usually is. He was rather more critical, as he is entitled to be. He talked of the need 178 to modernize the Factory Acts, and I agree. But this is what the Robens Committee is all about. I hope that we shall have some radical, comprehensive and useful recommendations early next summer from the Robens Committee. Contrary to the hon. Gentleman, I take the view that these new provisions will grapple effectively with some of the problems which are facing industry. I do not think that this is a weak, puny and ineffectual little Bill. I think that it will be very successful when it goes into operation.
The hon. Member for Dundee, West (Mr. Doig) asked about duplication in the health services. The laboratory services for the new Employment Medical Advisory Service will be provided by its own central laboratory and by designated National Health Service laboratories. It will co-operate with the university departments, such as those at Manchester, Dundee, London and Newcastle, with the Medical Services Division of the Department of Employment and with the Factory Inspectorate.
My hon. Friend the Member for Bolton, West raised the question of fees for employers. For the periodical medical examinations, the fees will be exactly as at present. The fees vary from 75p to £3.45 for examinations. There will certainly not be an additional financial burden on industry as a result of these provisions. There is no extra element of taxation here.
We heard an interesting speech from the hon. Member for Plymouth, Sutton (Dr. Owen), who is a medical man himself. I agree with some of the things he said but they were very wide of the policy we are discussing. As the hon. Member for Doncaster said, some of the points raised by the hon. Member for Sutton are really more suited for consideration by the Department of Health or, in relation to the whole question of health policy, by the Government.
The hon. Member suggested that the Bill is a pretext for not setting up an industrial medical occupational service. With all due respect, this is absolute nonsense. The Measure embodies a well thought out approach to the problem of satisfying the real needs of people in industry while avoiding any overlapping 179 with the facilities available under the National Health Service. Moreover, the new service will enlist the co-operation of doctors now employed in industry by employers, and I submit that the result will be a national centre of intelligence in occupational medicine which will be of help to all doctors in industry while, at the same time, advice on occupational medicine will be available to small employers and to employed persons who have never had it before. There is, therefore, a considerable advance.
The new service is not inspection-oriented, as the hon. Gentleman sought to suggest, but an advisory service which will help the employed person and the employer. It will conduct surveys of a sophisticated character in order to establish the areas where there are risks, and in this way it will be oriented towards prevention; avoiding the exposure of employed persons to serious and often hidden hazards. I appreciate the hon. Gentleman's point, and I know his feeling and that of many other medical men about the need for a comprehensive occupational health service but again, with respect, I do not think that the Bill is the right vehicle for that and I can make it quite clear that it is not intended to be a substitution for it.
We believe, and we probably have the support of many people in saying, that this is the best form of expansion of a service of this type. It is a valuable advance. It may in some ways be a limited advance, but it is an advance which will have an impact. I do not share the pessimism of some hon. Members who have poured cold water on the proposals. I am sure that they will be extremely surprised, once the Bill is enacted and in operation, by its effectiveness. It will be a considerable advance on our present industrial health operations.
We shall certainly be very pleased in Committee to consider any Amendments put forward by hon. Members. As I said, the hon. Member for Consett had one 180 success before, and may have some other success again, because we believe that the Bill has the support of both sides. It is a sensible Measure, and it is appreciated by all who have at heart the best interests of industry, both employees and employers. It is a realistic Bill and one which I am sure will commend itself to the House for the fullest possible support on its way to the Statute Book.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).