HC Deb 08 June 1981 vol 6 cc228-41

9.3 am

Mr. Barry Jones (Flint, East)

I beg to move, That an humble Address be presented to Her Majesty, praying that the Health and Safety (Fees for Medical Examinations) Regulations 1981 (S.I., 1981, No. 334), dated 5 March 1981, a copy of which was laid before this House on 13 March, be revoked. The two main functions of the Employment Medical Advisory Service are helping to prevent ill-health caused by work and advising people with health problems about the type of work that suits them, or that they should avoid on health grounds.

The proposed regulations introduce a change in the structure of charges and increase the fees to cover the estimated full economic cost to the Health and Safety Executive of conducting these examinations. I estimate that each year about 90,000 examinations take place by appointed doctors, and a further 20,000 by the Health and Safety Executive's employment medical advisers.

However, all is not well, and we object to the proposals. These fees should not be increased as a charge on employers. The charges, as increased, could discourage employers from using the service, and could provide an excuse for irresponsible employers to evade using the service, to the considerable detriment of their employees.

There is an alternative case, namely, that the Government should retain the charge to employers at existing levels and subsidise the remaining cost so as to maintain this excellent service at its highest level.

The proposals imply higher costs for industry at a time when redundancies and the recession are getting worse. As the national officer of a leading trade union in heavy industry said to me, the proposals may also lead to demands from employers for a reduction in examinations, with a subsequent increase in risks to workers. The TUC's experienced secretary for social insurance and industrial welfare has expressed a similar view.

The stakes are high. We must never forget that many workers are engaged in dangerous, unpleasant and demanding occupations. They run the risk of either death or disease. There must be a consequential worry and tension among their relatives and dependants. The following statistics may be of interest to the House. In 1978 there were eight cases of aniline poisoning, one case of anthrax, five cases of carbon bisulphide poisoning, 64 cases of chrome ulceration, 23 cases of lead poisoning, three cases of mercurial poisoning and one case of phosphate poisoning.

In addition, the regulations have a direct relevance to skin cancer caused by pitch, tar and oil. They relate indirectly, but importantly, to dermatitis, poisoning by pesticides and the many occupational dust diseases. In 1978 there were reported gassing incidents of 43 by chlorine, four by hydrogen cyanide, 11 by nitrous fumes and 29 by sulphur dioxide. I name but a few.

The Opposition must probe and criticise the Government's proposal. The Government permitted a 540 per cent. increase in fees as recently as 1979. They are now proposing to increase fees by 247 per cent. My hon. Friend the Member for Keighley (Mr. Cryer) is chairman of the important Joint Select Committee on Statutory Instruments. The Committee's report is critical of the decision to raise the fees. It fears that there will be an erosion of the Employment Medical Advisory Service. It emphasises that a discretionary power in delegated legislation—namely, the power to raise fees—is being used to erode an absolute requirement of primary legislation that the EMAS should prevent ill-health at work.

The report is disturbing. By publishing it the Committee has done a service to the House. I want to quote briefly from the minutes when the Committee was examining witnesses. One witness said that: it must be borne in mind that the instruction came from the Government … to increase fees. Another said: I suppose it is possible, if more and more employers use appointed doctors, we (EMAS) would be left to undertake examinations at smaller and more remote plants which could possibly lead to a higher level of fees. I express the fear that if the appointed doctor system continues to grow the EMAS examinations will become even more costly, and ultimately may be eliminated. It is right to fear the erosion of the EMAS. It is a possibility. Clearly, we want assurances about that from the Minister. If my hon. Friend the Member for Keighley catches your eye, Mr. Speaker, he may wish to refer to the Committee's report.

How many appointed doctors are there? How many doctors are there in the EMAS? What is the estimate of the average salary of the appointed doctors who, I presume, are either company or works doctors? Why does the Minister propose a 247 per cent. increase in fees when it is said that fees charged by the EMAS covered only 50 per cent. of the costs?

The Minister consulted widely via the Health and Safety Executive's consultative document. It would be interesting if he were to release the submissions of the British Medical Association and the Royal College of Nursing. Did the BMA dictate the increase in fees? Is this the price for a readiness by doctors to deal with the increase in private examinations? Has the Minister any idea of the total sum involved in terms of fees charged by appointed doctors? Will he confirm that nine out of 10 employers choose the appointed doctor and that the work carried out by the doctors is on not a contractual basis but a statutory basis?

It would help the House if the Minister were to tell us what, in his estimation, leads companies to go for the appointed doctor system by the factor of 9 to 2. Trade officials are frequently unhappy with the appointed doctor. We fear that the Employment Medical Advisory Service will be whittled away. We know that trade union officials prefer the presence of the EMAS doctors. Shop floor workers are uneasy when the doctors who examine them are paid by employers. Managerial wishes might just take precedence in borderline cases, in the knowledge that the appointed doctor is paid by the employer on a contractual basis.

We seek reassurance from the Minister. This is an issue of express concern and we ask for assurances. How stringently controlled is the EMA certification of competence given to an appointed doctor? How thorough and how frequent are the assessments made of the doctors? Do they receive training and guidance so that they may give the best possible protection to employees in many dangerous occupations?

The Health and Safety Executive does magnificent work. The EMAS carries grave responsibility, and it does so well. It performs magnificently. However, we know that the executive is labelled by the Government as a quango. We know that the Government do not like quangos. Monetarism implies fierce expenditure cuts. The EMAS must face such cuts. That is why it is being forced to balance its books by increasing its fees. The monetarist Administration, aided by the Rayner exercise, are seeking to reduce the number of civil servants. That is why to some degree we think that the statutory instrument is paving the way for an expanded private appointed doctor system. Government policy is to enforce manpower reductions in the Health and Safety Executive, and clearly the advisory service is not immune from that exercise. Thus, the EMAS is less likely to cope with the increasing demands upon its services and for the retention of its high quality of service.

It is deplorable that the EMAS will undertake fewer routine examinations of workers at risk. Something had to give in this sector under the current monetarist regime. The public sector is being cut. This could well be a cynical story. First, insist on manpower cuts and expenditure cuts. Note the possibility of a decline in the quality of service. Switch the accent, after raising fees, to the private appointed doctor system. Call this privatisation. It points to the erosion of a fine service. This is how the public sector can be cut. Cynical observers would say that the statutory instrument is promulgated as a result of Government manpower cuts in Whitehall and upon its quangos.

Those who believe that the Government are not behaving cynically should consider another famous quango—the Manpower Services Commission. Currently engaged in helping the unemployed, it is already to suffer a cut of 1,700 staff and £80 million in its budget. The industrial training boards are under threat and are to lose £50 million annual funding.

This morning we are debating a classic compendium of expenditure cuts, manpower cuts and the urge to track down quangos, whilst opening up the way towards privatisation of a prize medical advisory service. The Opposition genuinely fear the erosion of the EMAS.

We say that there is another way open, even to the Government, notwithstanding their current monetarist dogma, namely, to let the Government retain the charges to employers at existing levels and subsidise the remaining costs. By so doing they can step back from the disgraceful tactic of using a discretionary power in delegated legislation to erode an absolute requirement of primary legislation.

Our working-class men and women, who often work in the most demoralising and frequently dangerous conditions, will not benefit under the measure proposed by the Government. Parliament should protect workers from health hazards by opposing the measure.

9.16 am
Mr. Bob Cryer (Keighley)

The Joint Committee on Statutory Instruments has drawn the special attention of the House to the instrument in question—the Health and Safety (Fees for Medical Examinations) Regulations—on a number of bases.

I shall divide my comments into two. I shall refer first to the comments raised in Committee. In the report that the Committee presented to the House it made it clear that it felt that the discretionary power in delegated legislation is thus being used to erode an absolute requirement of primary legislation. The House set up the Joint Select Committee on Statutory Instruments in order to scrutinise delegated legislation and to make sure that such abuse of power is not taking place. The Committee was set up in the 1940s, when it was discovered that by breach of subordinate legislation the National Fire Service had been operating illegally. It was established to draw the attention of the House to various abuses, ambiguities, and so on. It seemed to the Committee that that was an area where an unusual use of powers was being made.

Section 55 of the Health and Safety at Work etc. Act 1974 places an absolute duty on the Minister to maintain an Employment Medical Advisory Service. Subsection (1) says: There shall continue to be an employment medical advisory service, which shall be maintained for the following purposes". After that there is a list of purposes. The Act does not say that the Minister "may" maintain a service, that he shall "use his best endeavours" to maintain a service, or "use all practical means to do so", but absolutely that he "shall" maintain a service. The purpose of the service is then outlined. The Act says that it is so that the Secretary of State, the Health and Safety Commission, the Manpower Services Commission and others concerned with the health of employed persons seeking or training for employment can be kept informed of, and adequately advised on, matters of which they ought respectively to take cognisance concerning the safeguarding and improvement of the health of those persons". It is difficult for an advisory service adequately to advise the Secretary of State and the various bodies on the safeguarding and improvement of people's health if it does not examine people. It can obtain reports from appointed doctors secondhand, as representatives of the Department of Employment claimed in evidence to the Committee, but the legislation lays it down that such an advisory service shall be maintained so that the advice is based on practical, direct experience.

On fees, section 57 of the Act states: The Secretary of State may by regulation provide for such fees as may be fixed by or determined under the regulations to be payable for or in connection with the performance by the authority responsible for maintaining the employment medical advisory service". In other words, the payment of fees is discretionary. It is not an absolute duty. It seemed to the Committee unusual that the Minister should make swingeing increases in fees. The fees had not been changed since 1971, so there was a catching-up exercise, involving an increase of about 540 per cent., which came into force at the beginning of 1980. The increase is now about 247 per cent., making a total of 787 per cent., which should be sufficient to catch up with inflation and a good deal more to boot.

A member of the Committee said that the fees were being increased by an enormous amount, which could lead to a reduction in the use of the EMAS, with employers going to private doctors. In answer to a question, a representative of the Department stated: I suppose it is possible if more and more employers use appointed doctors we would be left to undertake examinations at smaller more remote plants, which could possibly lead to a higher level of fees. That is an admission that the instrument could lead to a further increase in fees because of a diminishing use of doctors employed by the advisory service.

Is it a matter of policy, or is it chance? Representatives of the service are quoted in "Safety" as wanting to move work from the service to private doctors. I shall be interested to hear the Minister's comments. If that is the case, the Department is using an apparently innocuous instrument to increase the fees and carry out a policy not permitted under the primary legislation.

The Health and Safety at Work etc. Act allows the Minister to do a wide range of things, far wider than I regard as reasonable. Although I was on the Committee that considered that legislation, it was my first Committee, and in my view the Minister got away with a good deal more than he should have done. Nevertheless, it does not allow him to erode the provision of the EMAS.

It is clear to me that the director of the Health and Safety Executive, Mr. John Locke, who delivered a lecture on 15 May 1981 to officers of the Institute of Occupational Health, takes a fairly cynical view of the way in which both Ministers and Parliament can be manipulated. Certainly, a cynical attitude comes across in that lecture. It would indeed be a cynical misuse of powers if the Minister were using an increase in fees in order to carry out a policy decision.

The Minister must answer the point that his own employee made in evidence to the Committee. How can he reconcile the absolute duty laid down in the primary legislation with the view taken by his employee that the increase in fees may well lead, or could possibly lead, to a higher level fees through a diminution in the use of the service?

This is repeated again on page 8 of the evidence: It is possible, as you say, that some restructuring might result in more and more employers not using the Service", to the point at which it becomes patently incompatible with Government expenditure. I therefore believe that there is a very strong case for the Government to answer, namely, that this is a very unusual use of powers, because they are implementing policy in an area in which they are not allowed to do so, by way of a discretionary power that is, in effect, eroding an absolute duty.

Under the 1974 Act the Health and Safety Commission and the Health and Safety Executive must have their accounts examined by the Comptroller and Auditor General. It could be argued that if the level of fees were so low that the cost of maintaining the EMAS were extraordinarily high the Comptroller and Auditor General would have drawn the attention of the House to the matter.

In the last published accounts that I could obtain from the Library, however—the accounts for 1979–80—the Comptroller and Auditor General, Douglas Henley, does not draw the accounts to the attention of anybody. He says: I certify that in my opinion the Income and Expenditure, Accounts, Balance Sheet and supporting information give, under the accounting convention stated above, a true and fair view of the transactions of the Health and Safety Commission and the Health and Safety Executive for the year ended on 31 March 1980 and of the state of affairs at that date. I have no observations to make upon them. If the Comptroller and Auditor General had no observations to make upon those accounts, I assume that the level of fees was such that no extraordinary deficits were incurred that he felt should be drawn to somebody's attention. Therefore, yet again, there is the decision that it is a matter of policy that the EMAS should be phased out. That is against the statutory obligations laid upon the Minister.

The second part of my comments concerns the functions of the EMAS and the important role that it plays. I have no doubt that many employees hold it in high regard, because they recognise it as a form of independent assessor in cases where there may be a conflict of opinion about adverse medical conditions arising as a result of a person's occupation or employment.

There is suspicion where a doctor is employed to carry out medical examinations on behalf of an employer and to report to that employer. The Minister may well argue that doctors give purely medical advice. All I can say is that in the reality of the factory workshop, many employees feel that if a doctor is employed the balance will be tilted in favour of the paymaster, to the detriment of absolute medical impartiality. That view is held by many people with whom I have spoken.

The retention of the Employment Medical Advisory Service is important for that reason. If such suspicion exists, the EMAS can be available for use by the employer and employee, thereby generating a feeling of confidence.

There is a conflict of interest between the employer and employee in the operation and enforcement of many of the regulations. The regulations exist not because employers carry out their duties with zeal—be it in respect of the ionising radiation regulations, the chroming regulations and all the other regulations that require medical examinations of one sort or another—but because in the past they have not carried out their duties and obligations with necessary zeal.

The reason for legislation is that people in the workplace have suffered from adverse medical circumstances arising from the product or process with which they are associated. In order to ensure that the regulations were carried out to the full, the EMAS was established to give an impartial assessment. It would be a retrograde step if we eroded the duties of the EMAS in the way suggested.

The Minister has a serious case to answer. I believe that the proposed increase in fees is unnecessary. It represents an application of policy rather than the use of a discretion to cover costs. The Minister must answer the basic point, namely, how he squares this massive increase in fees with the statutory, absolute obligation that the Secretary of State shall maintain an Employment Medical Advisory Service, because the evidence from his own employees is that the proposed increase in fees will probably lead to a diminution in the use of the EMAS.

9.34 am
The Under-Secretary of State for Employment (Mr. David Waddington)

I should like briefly to give the background to this subject. As the House knows, the law requires employers in certain industries where there are potential health hazards to arrange periodic medical examinations of their workers. As has become clear, those examinations can be—and have been for a considerable time—carried out either by local doctors appointed by the Health and Safety Executive or by employment medical advisers of the HSE.

Nine out of 10 examinations—90,000 out of the 100,000 examinations in all—are carried out by appointed doctors, that is, by doctors other than employment medical advisers. Their fees are, therefore, arranged by agreement between themselves and the employer.

In fact, many appointed doctors are salaried employees of the companies concerned. It is highly desirable that there should be an increase in such company doctors, rather than the reverse. I do not subscribe to the view advanced by the hon. Member for Keighley, (Mr. Cryer), that there is something disadvantageous in there being appointed doctors and doctors employed by companies. There is a clear advantage, in that one man has a fine opportunity to become a real expert in the risks involved in the work activities in that business.

Only one out of 10 examinations is carried out by the EMAS. Therefore, in only one out of 10 cases does the statutory fee arise. The regulations provide for increases in the statutory fees. It is correct that I put on record the reasons for the size of the increases.

As has already been said by the hon. Member for Flint, East (Mr. Jones), no change in the charges was made between the coming into existence of the EMAS in 1973 and January 1980. The 1973 charges were already two years out of date, because they were based on fees fixed in 1971 by Department of Employment medical advisers, who were the predecessors of the employment medical advisers.

As hon. Members will readily appreciate, proposals for increases were made from time to time between 1973 and 1979. It must be an open secret that various policy matters intervened. The Government had to cope with incomes policy, and so on. Consequently, fees were not increased to cover costs during those years, although it is on record that it was the policy of the HSE and the Treasury that they should be done.

As a result of increases this year and last year, fees have been increased to cover the full cost to the HSE. Expressed in percentages, the increase provided for in the 1979 regulations and the present increase are formidable—540 per cent. in 1979 and 247 per cent. in the regulations. But the increases have been made on a derisory figure. I am told that according to a majority of the people and bodies consulted during the consultative process leading to the publication of the regulations, the new charges approximate to those that might be charged by a private doctor carrying out an examination on somebody at premises other than his own. That is plain when one considers the sums involved.

In 1971 the charge for the most common examination, which is for exposure to lead, was £1.05 for the first person examined and 35p for each additional worker. In 1980, it increased to £6.75 and £2.25 for each additional worker. I suggest that that is hardly an unreasonable fee. Under the new regulations in 1981 the charge goes up to £9.75 plus extra charges for laboratory tests and X-rays, because it was thought right to put the additional burden where the extra test had to be carried out rather than to impose a flat rate charge which would spread the additional costs over the whole field. Surely it is right to make an economic charge.

Mr. Terry Davis (Birmingham, Stechford)

Will the Minister refer to schedule 2? It is connected with regulation 3, which comes into effect in August. Will that increase the charge from £1.05 to £23.50?

Mr. Waddington

I think that the hon. Gentleman is correct. I have examined the process that the HSE went through to try to arrive at the true cost of X-rays, for instance. We are talking not about the charge for an X-ray plate but about the average charge for the total number of X-rays that have to be carried out on a particular person. I am told that that is the true economic cost.

There is no case for the taxpayer subsidising the employer. No reason was advanced by the hon. Member for Keighley when he said bluntly that the present charges were right and that it was wrong to increase them. He said an increase was unnecessary.

I do not understand how it can be argued that an increase is unnecessary when the present charges do not meet the cost of the service and the taxpayer is paying rather than the employer. There will be an annual review to determine whether an application for an increase should be made so that we do not fall behind in the ridiculous fashion that we fell behind between 1973 and 1980.

Mr. Cryer

Does the Minister accept that one of the reasons for a cheap medical service is to maintain the good health of workers, and that it is more likely to be used if it is cheap? Do not employers make a contribution through their taxes? Many Ministers have complained about that in the past.

Mr. Waddington

The hon. Gentleman's remarks are entirely misconceived. It is not a question of a service being more or less used because it is more or less expensive. The employers have a statutory obligation to ensure that the tests are carried out, whether they are cheap or expensive. If they do not, the factories inspector will close their works. There is no question of employers being able to escape their obligation. There is nothing in the argument that a different scale of charges would affect the number of examinations. The only valid point involves the extent to which higher charges might lead to more use of appointed doctors and less use of employment medical advisers.

Three worries have been expressed. It is said that there would be an excessive burden on employers at a difficult time, that that excessive burden would lead to a lower standard of occupational health care, and that a reduction in the use of the EMAS would be a mistake because one should not contemplate a diminution in its role.

If employers use the medical advisory service they will be asked to pay the true cost. They do not have to use the EMAS. If they do not like the charges, they can go to an appointed doctor.

I have already answered the point about the lowering of standards. Employers are obliged by law to arrange the examinations. They cannot stop having them. There is no reason to doubt the efficiency of appointed doctors if, because of the fees, employers decide to use them instead of the advisory service. The hon. Member for Keighley said that there is a suspicion that when an employed doctor carries out an examination he may not do his duty correctly and may not be truly independent and impartial because he is an employed doctor. Such a suspicion is wholly unwarranted. I am sure that the hon. Member for Keighley, when he hears those ridiculous suspicions voiced, says plainly to those who voice them that there is no justification for them. I fear, however, that this is not the role that he plays. The hon. Gentleman has been unable to quote a single case in which it has been found that an appointed doctor has not reported a matter that he should have reported.

I turn to the case advanced in the report of the Joint Select Committee on Statutory Instruments. The hon. Member for Keighley says that that is a case where there has been not only an unusual use of power but an abuse

of power. The hon. Gentleman says that it is a case where discretionary power in delegated legislation is being used to erode an absolute requirement of primary legislation. If it is parliamentary language, I am prompted to describe the hon. Gentleman's observation as poppycock. It is primary legislation that gives the absolute discretion to make charges by delegated legislation.

The hon. Gentleman argued that the fees could lead to a reduction in the number of those using the EMAS. As a result of the increased charges, more employers may opt to use appointed doctors rather than employment medical advisers. That is a different matter. The purpose of the regulations is not to bring about a transfer from employment medical advisers to appointed doctors. I have stated as clearly as I can that the purpose is merely to see that the true economic cost of an examination carried out by an employment medical adviser is borne by the person who is required by statute to see that the examination takes place.

Mr. Cryer

I must point out that if I use the words "an abuse of power" they represent my view and not those of the Joint Committee. The all-party committee also considered that this instrument was an unusual use of the powers. Will the Minister make it clear that if, as a result of the instrument, the advisory service is diminished, he will seek to maintain his absolute duty under the Act to reduce the fees should any threat to the service arise.

Mr. Waddington

I do not give that undertaking. It is not necessary for me to give such an undertaking. The hon. Gentleman, it seems, is under a misapprehension if he talks in terms of the only function of the EMAS being to visit factories and examine employees. I have looked into this matter. A tiny percentage of the total time of the employment medical advisory service is spent in carrying out this sort of examination. It has very many roles to perform and the House may well think that some of them are very much more important than the role of carrying out rather routine examinations of individual employees.

For instance, if there is a transfer by employers from the EMAS advisers to appointed doctors, the EMAS will have more time to devote to a consultancy service for employers and unions. It will have more time to devote to its work at MSC employment rehabilitation centres and at skillcentres. It will have more time to advise the careers service and Government Departments, and more time to carry out research into occupational health and to monitor hazards.

The truth of the matter is that very little time is now spent on these examinations by the EMAS. That has been true for a number of years and, therefore, it is difficult to see how there can be an unusual use of the powers of the Act in the way suggested by the hon. Member for Keighley, when what may happen, and all that may happen, is that the employment medical advisers will be free to deploy more of their time in research and advice and can spend less of their time carrying out routine examinations.

The statutory instrument has now been in force since 8 April, so the House is debating it a little late in the day as well as a little early in the day. I am informed that the experience of the EMAS since these higher charges were introduced has been that they have made no difference to relationships between the EMAS and employers, and that no representations concerning the impact of the charges have been received from anyone.

I shall deal with the specific points raised by the hon. Member for Flint, East. He asked me how many appointed doctors there were. The answer is 688. He also asked how many doctors there were in the EMAS. The answer is 83. I cannot tell him the average salary for appointed doctors, because the circumstances are so various. Some of them spend a very small proportion of their time performing the role of an appointed doctor and are in private practice. Others are company doctors carrying out multifarious functions.

I was asked what the BMA had to say about the matter. The point being made was that the BMA may have lobbied the Health and Safety Executive to put up the statutory fees so as to increase the remuneration of appointed doctors. In fact, my records tell me that the only observation made by the BMA on the matter was to the effect that it was pleased to note that the EMAS was now relaxing its opinions with regard to non-EMAS doctors being appointed to perform statutory examinations.

I was asked whether I knew why so many employers went to appointed doctors. I do not really know. All I can say is that very many of them went to appointed doctors long before these increases in fees. I can only say that they have a choice, and they have exercised that choice over the years.

I was asked how strictly controlled were the certificates of competence given to appointed doctors to make them so appointed. I am told that the employment medical adviser who interviews the doctor concerned examines his qualifications and then has to base his judgment on the interview and on those qualifications. I repeat, the examinations that are carried out by these doctors are perfectly routine, ordinary examinations, well within the competence of the ordinary medical practitioner. I therefore invite the House to reject this prayer.

9.54 am
Mr. Terry Davis (Birmingham, Stechford)

The Opposition believe that this matter involves health as well as the Department of Employment.

I should like to begin by picking up one of the Minister's points in case an unreasonable interpretation is placed on it. He said that we were discussing the regulations a little late in the day. He will know that the Opposition prayer was not taken in time, because the evidence available to the Joint Select Committee could not be published in time to have it before us when debating the regulations. Therefore, it was agreed through the usual channels that the Government would provide an opportunity for the Opposition to raise the matter when we had all the evidence before us. We did not want to base our opinions simply on prejudice. We wanted to see the facts and what the Minister's civil servants had said to the Joint Select Committee.

In his defence of the regulations, the Minister said that they may affect only the fees paid by an employer for the medical examination of an employee if the examination is done by a doctor employed by the Health and Safety Executive. Of course, that is correct. However, it is also correct—as the report of the Joint Select Committee and my hon. Friends have pointed out—that the regulations increase the fees for such medical examinations by the remarkable amount of 247 per cent.

As my hon. Friends have also pointed out, it is not the first time that the Government have increased those charges. For seven years, from early 1973 to the end of 1979, there was no increase in the fees. For seven years there was stability. For all the complaints about the burdens that the Labour Government allegedly placed on British industry nothing was done to increase those charges. Then the Conservative Party was elected to power. As soon as it came to office the Health and Safety Executive announced that there would be a massive 540 per cent. increase in the charges, effective from January 1980.

There has now been another 247 per cent. increase. It follows that the increase is cumulative much more than was suggested by my hon. Friend the Member for Keighley (Mr. Cryer). If a charge is increased by 540 per cent. and the new charge is increased by 247 per cent., the total is an increase not of 787 per cent. but of more than 2,000 per cent. I intervened earlier and pointed out that it seemed that the increase would be from £1.05 when the Government took office to £23.50 in August this year. That increase supports my calculation. I hope that the Minister will intervene and correct my arithmetic if I have made a mistake.

As the charges are complicted, and as the Government have put them on to a new basis, perhaps the increase amounts—as my hon. Friend the Member for Keighley suggested—to only 800 per cent. However, an increase of 800 per cent. is a big increase even by the Government's standards. Indeed, it is a big increase even by the standards of a Government who have increased prescription charges by 400 per cent. This increase in the fees must be far in excess of any increase in costs. It is so much higher than the general level of inflation that the Opposition must be right to question its effect.

The Minister explained that the increase in fees represented the true cost. Perhaps he will tell us how those costs were calculated. Are the costs simply based on the salaries of doctors employed by the Employment Medical Advisory Service, or is there an element of fixed costs? If so, what does that element of fixed costs consist of? How are the calculations made? The Minister said that the Health and Safety Executive consulted the British Medical Association. If the fees are based on costs, why was it necessary to consult the BMA? I could understand the Government consulting a firm of cost accountants, but I do not understand why they should consult the BMA to establish the true cost of the EMAS.

There is a slight discrepancy between the Minister's description of that consultation and the views expressed by the BMA, and the evidence given by one of his civil servants to the Joint Select Committee. According to the evidence, the BMA had been consulted about the amount of the fee and not about whether it would welcome a relaxation of the Health and Safety Executive's view that more doctors should be employed by the EMAS and that examinations should be conducted by it. In effect, the representatives of the competition to EMAS were consulted to establish what the new fees should be.

My hon. Friend the Member for Keighley dwelt on the constitutional point. I understand the Minister's defence, but it is nevertheless true that a statutory obligation is put on the Government to provide the Employment Medical Advisory Service. The Opposition are not completely reassured. We suspect, as the Joint Select Committee said, that the Government are seeking to destroy the EMAS through the back door. That is a constitutional point.

The most important issue is the health of working people and the possible effects of these fees on those people. The Government believe in financial incentives. The Minister failed to assure us this morning that the Government are not creating a financial incentive to unscrupulous employers to ignore their moral and legal obligations. If these fees are being increased by such a large percentage, surely there should also be an increase in the penalty that it imposed on a rogue employer. However, the Government are not proposing that, either now or in the future.

There is also the effect on industry and the economy as a whole. At a time when the recession bites ever deeper, when more and more people are losing their jobs, and when industry is finding it more and more difficult to compete with foreign manufacturers, surely it is madness for the Government to increase the costs of our own manufacturing industry. Yet that is what they have done with the fees for examinations done by the Employment Medical Advisory Service. The Government weep crocodile tears about increases in rates, largely engineered by the Government themselves, but then they increase the fees charged for medical examinations by as much as 800 per cent., or even 2,000 per cent.

There is also the effect of this increase on the work of the Health and Safety Executive—the effect on the Employment Medical Advisory Service. My hon. Friend the Member for Keighley emphasised the importance of the EMAS. He also referred to its effectiveness. The Minister says that appointed doctors are often employed by the company, and he is right. Many factory doctors, as they are called, conduct these regular, routine but essential examinations on the factory premises. However, not all appointed doctors are company doctors. Many appointed doctors are local general practitioners. When the Minister says that he wants greater emphasis put on appointed doctors who are salaried employees of the company, is he suggesting that it should take place at the expense of the local GPs? I am sure that the medical profession would be interested to know that.

More important is the aspect of impartiality. My hon. Friend the Member for Keighley is right when he says that there are often times when the employee and his trade union representatives ask for what they see as an independent opinion by a doctor who is not employed by the employer. Good employers do not resent that request. They see it as a way of maintaining the confidence of their employees in their own appointed doctor. Usually the second opinion by a doctor of the EMAS confirms the opinion that has been given by the company's appointed doctor. That is an important function of EMAS, and it is valued by good employers as well as by trade unions.

The Minister says that he wants an increase in those employed doctors who are full-time company doctors, because he says that it would give them greater experience, and that the doctor who works full time in a factory—it would have to be a large factory—would have more experience of the risks to which the employees are exposed. I suggest to the Minister that there is a contrary argument. It can be said that it is better to have experience of several companies so that one can compare the conditions of work and the risks to which people in that type of industry are exposed. The argument is not all on one side, as the Minister suggested when he said that it would be beneficial to employees if there were an increase in the number of doctors who were employed only in a particular factory or company. There is the question of the width as well as the depth of experience.

As my hon. Friends said, the employer has two options. The Minister, too, emphasised that fact. The employer can use either the EMAS or an appointed doctor. If he decides to use an appointed doctor, it is done under a private arrangement between the employer and a doctor of his choice. The Minister failed to answer the question what would happen as a result of the increase in fees. Will more employers switch to appointed doctors? What will happen as a result of fewer examinations being undertaken by doctors of the EMAS? Will we see redundancies among them? If there are no redundancies, in spite of fewer examinations, what will be the cost of the service? If the cost remains the same because there are no redundancies and fewer examinations, and therefore fewer fees and lower revenues, what will happen? Presumably we may see an increase in the cost to the Treasury.

The Minster has not given an assurance that there will not be any redundancies among doctors of the EMAS. He rightly said that they have other responsibilities and work. The Opposition do not regard the routine examination as unimportant, but we accept that equally important work is undertaken by the EMAS. Is it the intention of the Health and Safety Executive that, if there are fewer examinations and more of the time of employed doctors is available, that time will be used by the EMAS for other work without reducing the number of doctors employed?

Finally, if there is a switch from medical examinations being carried out by doctors employed by the EMAS to examinations by appointed doctors, it will be one more example of what my hon. Friend the Member for Flint, East (Mr. Jones) called privatisation. Unlike the Government, the Opposition believe in a public Health Service, not a private Health Service.

10.7 am

Mr. Waddington

With the leave of the House, Mr. Deputy Speaker, when I said that the debate was taking place a little late in the day I did not mean to convey to the hon. Member for Birmingham, Stechford (Mr. Davis) that I was in any way blaming the Opposition. I was paving the way for my following remark that no representations had been received since the regulations had been in force.

The £23.50 charge will be levied for examinations taking place as a result of the new Control of Lead at Work Regulations 1980. It is a new obligation and test. I do not deny that it is a substantial charge. I was asked why I consulted the BMA. I did not ask any organisation for its advice on that aspect. All the organisations were written to—for example, the Royal College of Nursing, as well as the BMA—and asked to make general observations. I quoted the specific observation made by the BMA in reply to that invitation.

In reply to the suggestion that the increased charges would provide an incentive to employers to avoid examination, I repeat that rigorous checks are carried out by the inspectorate. The most severe consequences would follow any failure to carry out that duty. It is not simply a question of fines being imposed—eventually HM Inspector could impose a closure order if an employer refused to fulfil his obligations under the Act.

I dealt earlier with impartiality. There is no evidence of there having been any lack of impartiality by appointed doctors. There is no reason why, in special circumstances, an examination carried out by an appointed doctor should not be followed by another examination by a doctor of the EMAS.

I concede that there could be fewer examinations by EMAS doctors because of the increase in charges, but that is not the reason for the increase in charges. It could mean that if there are fewer medical examinations there could be other increases in fees. I am advised that that is less likely to be the cause of any increase in fees than the usual cause, namely, inflation.

Many factors must be taken into account in assessing the economic cost. One of the most substantial elements in the present charge is the travel that is involved. The employer's medical advisor often has to travel a considerable distance from the place where he is based to the factory. That is sometimes forgotten. There is no separate charge for the travelling costs, and the costs are averaged.

I have done my best to assist the House. I hope that the House will feel that in all the circumstances it is right to reject the prayer.

Question put and negatived.