EMPLOYMENT MEDICAL ADVISORY SERVICE BILL

HL Deb 09 March 1972 vol 329 cc224-71

4.0 p.m.

THE MINISTER WITHOUT PORTFOLIO (LORD DRUMALBYN)

My Lords, I beg to move that this Bill be read a second time. This is a short but rather complicated measure and it has, I think, an unusual history, in that it was introduced in another place by the previous Administration as Part I of the Employed Persons (Health and Safety) Bill and was in Standing Committee at the time of the Dissolution of Parliament in June, 1970. It has been reintroduced by this Government and is now before your Lordships for the first time, so your Lordships do not have the advantage that Members of the other place have of having seen the Bill before. Perhaps, therefore, it would be helpful if I first gave a brief outline of the origins of the Bill before making some general comments, and then briefly explained the most important clauses.

The appointment of "certifying surgeons" (as appointed factory doctors were then known was first authorised by the Factories Act of 1844, so that the appointed factory doctor service is one of the oldest public health services in the country. The duties of the service have varied from time to time, but for over a hundred years appointed factory doctors have been responsible for medically examining young persons as to fitness for work on taking up employment in factories. As noble Lords will know, appointed factory doctors now have two main functions. The first is to undertake the statutory medical examination of every young person—that is, under the age of 18—entering factory employment, and thereafter to carry out a further examination every year until he reaches 18. The second function is to carry out the statutory examinations required under the Factories Act 1961 and under regulations for persons working in hazardous processes and trades. Although appointed factory doctors are general practitioners appointed by chief inspectors of factories, they work as independent contractors and are paid fees for their examinations by the occupier of the factory. Any factory which has its own works medical officer may have him appointed to carry out examinations under the specific code of regulations which apply to that factory.

The Secretary of State for Employment is advised on industrial health matters by the Industrial Health Advisory Committee. In 1964 a sub-committee of that Committee was set up to look at the appointed factory doctor service. The C.B.I., the T.U.C., the B.M.A., the Society of Occupational Medicine and the Royal College of Physicians were all represented on the sub-committee, together with other bodies interested in industrial medicine. The sub-committee considered the work of appointed factory doctors in the light of the social conditions of to-day. This Bill has its origin in their report. When examinations by the appointed factory doctors started in the last century, and for many years after that, there was no doubt that they did a great deal of good so far as young persons were concerned, for often the appointed factory doctor was the only doctor whom the young person saw. But now that we have the school health service and the National Health Service it seemed to the sub-committee that it was no longer necessary to examine all young persons entering factory employment. It was considered that a selective system of examination should be evolved instead, under which the school health service would identify those school-leavers who were not unconditionally fit for employment, and that they alone should be given further medical supervision. The other main duty of the appointed factory doctor, the periodic examination of persons engaged in hazardous trades and processes, would of course have to continue. The sub-committee recommended that both the selective medical examination of young persons who were not fully fit and the statutory examination of persons engaged in hazardous trades should be undertaken by a small expert group of doctors and that the appointed factory doctor service should be abolished.

The Bill which we now have before us embodies these recommendations of the sub-committee. It also takes them a step further, as a result of further discussion within the sub-committee. It sets up an employment medical advisory service which will have the duty not only of carrying out the functions recommended in the sub-committee's report but also of advising the Secretary of State for Employment, and anyone else who has an interest in the subject, on medical aspects of all employment problems. This means that the appointed factory doctor service will no longer exist, but we are confident that most of the fine traditions of the service will be carried forward into the E.M.A.S. The nucleus of the E.M.A.S., if I may go on calling it so, will be the medical services division of the Department of Employment, which exercises professional control over the work of doctors employed by the Department. These doctors are the former medical inspectors of factories (now known as medical advisers), doctors in industrial rehabilitation units and Government training centres and regional medical consultants. In numbers they represent the equivalent of about 50 full-time doctors.

Having given this brief outline of the origins of the service, I should now like to comment on two matters which have given rise to some concern in connection with this Bill. The first is one which was mentioned by a number of noble Lords during the debate on the reorganisation of the National Health Service on November 29 last year, namely, the relationship between this new service and the National Health Service. We are determined that the service shall work in close co-operation with the National Health Service. The proposals for this service have been worked out in the closest collaboration with the Health Department. It is because of this determination that we are arranging for the joint use of laboratories to encourage co-operation in the field. In addition we have lanned an extensive publicity programme to come into operation once the Bill receives the Royal Assent. Not only will the programme include publicity specifically directed at the medical profession, but to ensure that all doctors in the health service know of the existence of the E.M.A.S. the Health Departments have agreed to send a special letter about the organisation and functions of E.M.A.S. to all doctors in the Health Service. The letter will stress the need for the closest possible co-operation between the new service and the general medical services of this country. If, at some future date, the Government of the day thought it desirable to transfer E.M.A.S. to the Department of Health and Social Security there is nothing in this legislation to preclude such a transfer. At the moment, however, we think it right that the service should remain with the Department of Employment, as the Department responsible for employment matters.

Secondly, there is the question of the relationship between the service and private works medical officers. Is E.M.A.S. the beginning of a comprehensive occupational health service? First let us define our terms. For most people a comprehensive occupational health ser- vice means more doctors in more factories—doctors who, among other duties, will carry out treatment. E.M.A.S. is not, and is not intended to be, such a service. It is intended to be primarily a medical detective service, which will serve as a focus for the development of occupational medicine in this country. It will not provide treatment. To do so would duplicate the work of the National Health Service. We estimate that at present about one-third of the factory population have their own works medical services. To cover the remaining two-thirds would, we estimate, need some 2,000 doctors and cost about £20 million. The doctors are just not available. However, the service will work in the closest co-operation with private works medical officers, and the sub-committee of the industrial health advisory committee, which I have already mentioned, is discussing the best way of ensuring that the State service and the private services work together in harmony. We see the two Services not as competing but as complementing each other.

I should now like to turn to the Bill itself so that your Lordships can see how the recommendations of the sub-committee have been implemented and the scope of those recommendations enlarged. Clause 1 is the most important clause. Subsection (1) sets out the purpose of the Bill, which is to establish and maintain an employment medical advisory service to ensure that the Secretary of State and others concerned with the health of employed persons and persons training for employment can be kept informed of, and adequately advised on, matters of which they ought to take cognisance concerning the safeguarding and improvement of the health of those persons. Under subsection (9) of the same clause, persons training for employment include persons attending industrial rehabilitation courses and the phrase "others concerned with the health of employed persons" is to include organisations of employers or employed persons and associations of such organisations.

This subsection also gives the Secretary of State power to appoint persons to be employment medical advisers. As I have said, there are already the full-time equivalent of some 50 full-time doctors in the Department of Employment, and it is estimated that the equivalent of about another 50 full-time doctors will be required for the operation of the Service together with about 110 supporting nursing, executive, clerical and secretarial staff. At a rough estimate, we think that when the Service is fully operational there will be some 78 fulltime doctors and 42 part-time, but that must be an estimate. Officials of the Department of Employment are at present discussing what should be the exact duties of the nurses, of whom there are expected to be 12, with the Royal College of Nursing.

The service will be organised in eight regions with a regional employment medical adviser at the head of the team of E.M.A.s at each region. The regional boundaries will be the same as those of the Department's regional organisation. The field organisation has been worked out on the basis of the distribution of industry, the location of Government training centres and industrial rehabilitation units and the spread of the estimated work load.

LORD REIGATE

My Lords, will my noble friend allow me to interrupt? Did he say that the boundaries would coincide with the existing boundaries of his own Department's services? Is there no question of their coinciding with the regional boundaries which will be set up in the National Health Service under the Consultative Document?

LORD DRUMALBYN

My Lords, we have to work with what we have, and this seems to be the best way of organising it at the present time. The full-time advisers will be based on the main centres of industry and population. The less industrialised parts of the country will be covered by part-time advisers. Within this general structure it is proposed that there should be substantial groups of full-time advisers in the major conurbations, that is, Central London, Birmingham and Glasgow. This will allow the development of a degree of specialisation among those advisers which will be of considerable benefit to the Service as a whole.

Subsection (2) of Clause 1 gives the Secretary of State power to commission research and provide laboratories for the purposes of the employment medical advisory service. For the most part the employment medical advisory service will carry out its own investigations into problems connected with its work. But there will also be cases where the best course would be to commission some outside body to investigate a particular problem. As for the laboratories which E.M.A.s will require, the Medical Services Division of the Department of Employment, which is to be incorporated in the E.M.A.s, already has its own laboratory, which will undertake many of the tests for the London and South-Eastern area and act as a central reference laboratory. Other routine work for the E.M.A.s will be carried out in national health laboratories which have been designated for the purpose. We attach the highest importance to these arrangements. They will encourage close working between the E.M.A.s and the National Health Service. That is essential if the service is not to develop in isolation from the main stream of medicine.

While we are on the subject of laboratories, I should mention the Industrial Hygiene Laboratory of the Factory Inspectorate, which carries out environmental tests such as dust counts and is the biggest in Europe. The E.M.A. will be working closely with the Factory Inspectorate, so that medical findings can be related to environmental conditions. Also, there are five university-affiliated occupational hygiene laboratories which undertake both environmental and biological tests. As the industrial hygiene laboratory of the Factory Inspectorate does not undertake routine testing of environment, we see an increased role for university-affiliated laboratories in providing this service for occupiers. So far as biological tests are concerned, the Department will not seek to interfere with private arrangements between occupiers and university-affiliated laboratories. University laboratories have said that they were "greatly reassured" by a discussion between their representatives and officials of the Department of Employment. The powers of the employment medical advisers are set out in subsection (5) of Schedule 1 to the Bill. Noble Lords may have noticed that employment medical advisers will not have all the powers which are given to Factory Inspectors since the Employment Medical Advisory Service, as it names implies, is an advisory service and E.M.A.s should have only those powers which they need to enable it to carry out its statutory duties under the Factories Act.

Subsection (6) of Clause 1 gives statutory backing to the new arrangements which I have already briefly mentioned about the follow-up of young persons who will be identified as in need of further medical supervision by the school health service. The school health service already identifies from records, or by means of interview or examination, school leavers who are not unconditionally fit for all types of employment, and they notify the careers officers of the youth employment service of each of these school leavers by means of a standard form, Y.9, which simply gives in lay terms the restrictions laid down on his employment—for instance, that he must not work at heights or carry heavy weights. In future the school health service will send this standard form not only to the careers officers but to the E.M.A. and to the family doctor. In this way there will for the first time be a direct link between the school health service, the employment medical advisory service and the youth employment service. It is hoped that this form will be completed by the school health service at the beginning of the young person's last year at school. Then it will be possible for the careers officer and the E.M.A. to consult together during the whole process of advising these pupils and placing them in employment. The subsection also empowers the E.M.A. to ask the school health service for such other information relating to a young person's medical history as he may reasonably require for the efficient performance of his functions, but forbids him to disclose such information otherwise than for the efficient performance of his functions, for instance, to the career officers. If disclosure is wanted for any other purpose, for instance to a prospective employer, the consent of the young person must be obtained.

Clause 2 abolishes the position of appointed factory doctor and makes various consequential amendments to the Factories Act. The most important of these is that in subsection (3). Under a number of codes of regulations the chief inspector of factories is at present authorised to approve medical practitioners other than appointed factory doc- tors who may carry out statutory medical examinations for the purposes of the Factories Act and regulations made under it. This subsection enables similar powers to be given to the chief employment medical adviser and his deputy or deputies so that they can authorise works medical officers to carry out these examinations.

Clause 3 looks long and complicated but in essence it is quite simple. Under the Factories Act, medical inspectors are empowered to carry out medical examinations. We shall no longer have medical inspectors and so employment medical advisers must have the power to carry out medical examinations if they think them necessary since an E.M.A. may go into a factory where work not covered by regulations is carried on and where he thinks it advisable to examine some of the workers concerned. The clause is directed towards the occupier and requires the occupier to permit the medical examination of his worker. The workers themselves are free to refuse examination, and there is nothing in the Bill which can force them to be medically examined.

Clause 4 carries into effect the recommendations of the I.H.A.C. sub-committee that a doctor should no longer have the power to suspend a worker when he considers that his work is adversely affecting his health. While the sub-committee considered that the power of suspension was necessary, they thought that it should not be the responsibility of a doctor, since his function is to give medical advice, not to take action in pursuance of that advice. They therefore recommended that, in cases where the E.M.A. came to the conclusion that continued employment in a particular process of a worker whom he had medically examined was inadvisable, he should not have power to suspend the worker but should formally advise the employer and the worker in writing of his conclusion. On receipt of such a notice it will no longer be lawful for the factory occupier to employ the person concerned.

Noble Lords may wonder why this clause deals only with women and young persons employed in any process involving the use of lead compound. The explanation is that all the powers of suspension except one are contained in Regulations or Orders made under the Factories Act and will be dealt with by amendment to the Regulations. The reference to suspension in respect of women and young persons employed in lead compounds, however, is in Section 75(2) of the Factories Act and it has to be dealt with by amending the Act. I should add that the change in the procedure for suspension under the Factories Act will not result in any change in the practical effect; it merely removes the responsibility for suspension from the doctor.

Clause 5 requires the occupier of a factory who engages a young person to notify the careers officer within seven days after he takes a young person into employment. The careers officer will then be able to check these notifications from the factory occupier with the form Y9 which he has received from the school health service and in appropriate cases he can discuss with the E.M.A. whether the notified employment is suitable for the young person. This formal system of notification applies only to factory employment, but the E.M.A. will be willing to advise on the medical aspects of any employment problem. Clause 6 deals with the revised arrangements for payment by occupiers of fees for the statutory medical examination carried out under Regulations. In the past, these have been paid to the appointed factory doctor. In future, the occupier will pay them to the Secretary of State. These I think are the vital clauses of the Bill now before us and I hope that, with that explanation, noble Lords will be willing to accept this Bill. My Lords, I beg to move that the Bill be now read a second time.

Moved, That the Bill be now read 2^a.—(Lord Drumalbyn.)

4.22 p.m.

LORD SHACKLETON

My Lords, we are very grateful to the noble Lord, Lord Drumalbyn, who gave a characteristically thorough and detailed explanation of the Bill, and if I do not follow him in many of the points he has made it is simply because nothing more needs to be said. Certain aspects, some of which raise difficulties, he explained clearly and I shall concentrate on those areas where we still see difficulties. First of all, I think it would be right to pay a tribute to the work that has been done in the past by appointed factory doctors whose services will now he discontinued by the Bill. Many of them have served the employees and the firms very well and we should acknowledge that service. None the less, these new proposals, as indeed the noble Lord himself said, form part of a Bill which, after very thorough discussion, was introduced by the previous Government. Although for the most part it does not raise controversial issues, and therefore we certainly welcome it, there are some important issues, and there are some difficulties. Furthermore, it provides an opportunity to discuss some of the wider matters of industrial health. Such criticisms as I have to make of the Bill are for the most part concerned with detail, and some of them relate to certain changes which the Government have made in comparison to our Bill, which, though small, are not insignificant.

I am bound to say that I still much regret that the Government have not seen fit to include what in some ways was the more important part of our original Bill on the subject of safety. It is quite startling—and I am sure that noble Lords who are interested in this subject will agree—how complacent we all seem to be about the heavy loss, the suffering, indeed the death, that still arise in British industry. Our original Bill made some important provisions, which were strongly backed by the British Safety Council, by the Trades Union Congress and the trade union movement generally, for a proper involvement of workers in this area through worker representation on safety committees.

I would have wished to go into this theme at some length, for we attach great importance to it, were it not for the fact that in another place, only a month ago, a Second Reading was given to the Employed Persons (Safety) Bill which had been introduced by Mr. Hattersley. The importance of this measure, which deals with the particular area I am touching on, is such that I hope very much that the Government will give a fair wind to it, notwithstanding—and this is the answer which I think we may be given—that the Robens Committee are dealing with this subject and will be reporting in due course. I admit that the Government have a logical argument here; but looking at the practice in legislation, looking at the pressure we always have on our timetable, and even bearing in mind that Robens may be reporting this summer, the fact is that it may be two, three, or even more years before we have a comprehensive measure. Meanwhile, more people will be killed and injured; more family life will be disrupted, and great suffering caused to individuals. If the passing of Mr. Hattersley's Bill saves only one life it would be worth while. In my view, it could do a great deal more.

Furthermore, I would say this to the noble Lord. The Robens argument is not entirely valid, because the Robens Committee were set up by the previous Government and notwithstanding that, we decided to press on, not only with a Bill such as that before us to-day—and we are grateful to the Government for proceeding with this matter; they may have been a little tardy, but I am not going to complain about that—but, at the same time, with another matter to which we attach great importance. The noble Lord cannot give us a definite assurance on this, since the Bill I am referring to is not before us. I had indeed even thought of incorporating in it some of the provisions of the old Bill, on the subject of safety and workers' representation, even at the price of delaying a measure which we welcome; but I hope the Government will be willing to give it a fair wind if that Bill comes up to us. A great deal, of course, depends on progress on Committee stage in another place. Although in a sense I am getting dangerously near to being out of order, and certainly in another place I should be out of order, this matter ties in importantly with the Bill now before us, and indeed with our attitude towards this Bill.

Let me comment briefly on some of the provisions of the Bill. As I say, we welcome the proposals, even though they create some awkward interfaces between the medical services which the best firms themselves have and indeed—as was implicit in the intervention of the noble Lord, Lord Reigate—the organisation of the National Health Service. I do not doubt that the noble Lord will have something to say on that, and I hope very much that the noble Lord, Lord Drumalbyn, may be able to comment on it. But the specific points which I should like to draw to the noble Lord's attention, and to which we are likely to return on Committee, are the following. First of all, I am bound to say that the penalties for breach of some of the provisions of the Factories Act, particularly the penalty for obstructing a medical officer in his capacity as an inspector, are inadequate. A penalty of £20 is really absurd to-day. If it was right at the time of the 1961 Act (I do not think it was, and I think perhaps I might admit that my colleagues in a previous Government would express regret that they had not done something about it), it certainly is out of date now by reason of the advance of inflation. It may be argued that this Bill is not the right one for amending the provisions of the Factories Act. It is a self-contained reform. I am glad that the Government have continued with the Bill, despite the rough edges and anomalies which are inevitably created by this sort of measure, and I hope they will be sympathetic when we come to arguing the question of penalties.

There is another point which concerns us and which we should like the noble Lord to answer. As the Explanatory and Financial Memorandum reveals, the Government propose to spend, in real terms, something like 30 per cent. less on this new service than we had originally intended. According to the Memorandum it is going to be £850,000, instead of the £1 million which we proposed two years ago. This is a cut, in real terms, of about one-third. Linked with this there is a proposal to have a smaller number of doctors. Admittedly there is a proposal to provide some additional nursing staff, and having seen nursing staff in industry I would not want to criticise this. I may have missed what the noble Lord, Lord Drumalbyn, said the nursing staff are going to do. He said that the Government would be having talks with the relevant nursing authority, but surely it would have been reasonable for the Government to decide this before they adopted this solution. Perhaps we can be given some more information on this point, and on the particular ultilisation of nursing staff.

I think we are all inclined—the Government and the rest of us—to underestimate the real size of the need. Some of us remember that when the National Health Service was introduced the view of the cost was grossly out of relation to the reality, and I remember Aneurin Bevan pointing out that none of us knew just how great the needs were. What is proposed now is an important development, but perhaps I may give one example of the kind of situation which makes me wonder whether the numbers are right (I am referring to the numbers of qualified personnel, including doctors) and whether it is right to be saving money. We see reported to-day in the Guardian that work on motorway box girder bridges throughout the country may be halted while checks are made of the risks of lead poisoning. Merely taking into account the number of box girder bridges where people will be working makes one wonder whether the 100 in full-time equivalent will in fact be adequate to monitor and carry out the tests. I should be grateful if the Minister would comment on this situation in his reply.

My Lords, these doctors will carry heavy responsibilities, and we certainly wish them all luck; and we wish the new head of the service good fortune. But I suspect that they will have to devote quite a bit of time to further training. This is not a reflection on them: it is the pattern throughout all industry for managers, and certainly for the medical profession, where more and more time is being spent on refresher training on new hazards. Indeed, one hopes they would have the time to learn something about the problems of industrial management and the trade unions. So I make as powerful a plea as I can to the Minister to think again whether the amount of money proposed is enough. I hope that it may be possible to review this and if the numbers are not adequate that at an early stage the necessary recruitment will be done.

There are other matters which some of my noble friends will be raising but I want to deal with a subject which is close to my heart; and in this matter I would draw attention to the views of the British Medical Association and other bodies who have expressed fears that the introduction of this new service will have certain deleterious effects. I do not myself necessarily wish to give credence to these fears, but it will be helpful to have assurances. Anxiety has particularly been expressed that the creation of E.M.A.S.— the employment medical advisory service—under the Ministry of Labour may make more difficult the development of proper occupational health provision. There is a fear that what is proposed here will perpetuate another point that has been made; that is, the isolation of the person valuable to limited occupational health services from the mainstream of medicine. I do not necessarily go along with these criticisms, but they need to be met and therefore I should like to say a few words about occupational health.

My Lords, quite a high proportion of industry has some form of medical service backing, although the quality and extent of it vary a great deal. The best firms have developed it to an extent where it provides not only valuable service to the employees but also valuable help to management. In one way or another such industrial health schemes, paid for by the firm, in my experience pay for themselves; and perhaps I may speak briefly on this matter from my own experience. I make no apologies for referring to my experience when I was on the Board and concerned with personnel management of the John Lewis Partnership, although I may say that I have no connection with that organisation to-day and therefore do not declare an interest.

Partly from principle and partly from the fact that there were no equity outside shareholders, the John Lewis Partnership did not shrink from spending money in fields where they thought it was important to the happiness of the workers, but the important thing is that I am quite sure that the spending of money on medical health added to the profitability of the business. Indeed, I myself found good medical backing essential to good personnel management. Each branch had its own medical sister; the smaller ones were visited regularly, and there was at least one first-class senior doctor (and sometimes two) who was fully integrated and working in the personnel department yet at the same time retained full professional independence. I found that a large number of individual personnel problems at all levels—at management or shop floor level, and including industrial work as well as department stores—had some medical angle. Sometimes it was of a psychological kind, and even when there was no pathological condition the advice of the medical side was absolutely invaluable in particular cases because of the additional communication that it supplied, the fact that the medical and personnel side met regularly, and in some cases daily. While the medical side were strictly enjoined to preserve proper medical confidence, they were always able to give good advice, aided by a certain detachment from direct management responsibility.

So often when an individual's work falls off it is not due just to wickedness but is due to some specific reason, and sometimes the medical side can provide a clue. The falling-off might be due to health reasons; it might possibly be due to the development of some serious and slow-acting chronic condition; it might be due to family reasons. But at least the consultations provide management with the essential information and the worker with an opportunity of protection, provided that there is strict control in management. Another important point that we always had in mind was that people should not be sacked for medical reasons that were not true; nobody should be sacked without a doctor's certifying a true medical reason. This has some bearing on the Industrial Relations Act. Sometimes medical treatment was called for; sometimes it was an extra period of leave; sometimes even a bonus; sometimes a "rocket"—all sorts of things.

May I make this point to the noble Lord? I realise that he was not dealing with an occupational health service, but he slightly implied that an occupational health service, as understood by some people, involved treatment. It will be the minor treatment that it is proper to give on the spot for a minor ailment. But the important thing is the close cooperation that will be possible with the National Health Service. It can be of assistance to the general practitioner, as well as reducing some of the time that is wasted through people having to queue up for some relatively minor ailment. I regard this as a very important field of development. Furthermore, doctors and sisters were able not merely to judge whether there was any "lead-swinging"; they were very often able to judge that a person ought not to be at work at all when he or she was still struggling to stay there. This brings me to another point in the Bill to which we may want to return at a later stage. Some firms have very good sick pay schemes; they pay full rates and take into account bonus and overtime earnings. But there are not many such firms. We may want to look to see whether the existing provisions for compensation for time off are adequate.

I have stressed that such a medical service should not in any way replace the National Health Service; it will be complementary to it. I apologise to the House for taking up time on this aspect, but I have been wanting to say this in this House for a very long time, because in my experience it is a matter of the greatest importance. In some ways I would say that we could press on further within the Government service, and I am bound to say that the Civil Service gets some very fine doctors. It was one of the areas in which, had I remained in office, I was intending to bring more pressure. Indeed, my last act as a Minister was to write a Minute on this point. Some of the causes célebres I had to deal with as a Minister arose from decisions which had been taken many years before. If the right medical advice had been available at the time, it would have avoided endless trouble for particular individuals. In industry, there is, for example, the problem of girls' having illegitimate babies—the sort of case that can be picked up quickly by the medical side and help given. I appreciate that there could be a danger of a degree of duplication, and therefore it would need to be tied in very closely; this again brings in the question of boundaries and correlation with the National Health Service.

I think industry ought to pay for a good part of it, but certainly I hope that such a service would come under the general direction of the National Health Service. The time lost in this area of industrial ill-health is vastly greater, as the noble Lord knows, than anything lost through strikes. I am bound to say that progress in this field would have been infinitely more valuable than the Government's wretched Industrial Relations Act. Fifty to a hundred times the amount of time lost through strikes is lost through ill-health in industry. It is interesting to see from the report of the Office of Health Economics the extent to which this problem also relates to management. Of those never sick, 96 per cent. said that they enjoyed their jobs, while only 46 per cent. of those frequently sick did so; 18 per cent. of those frequently sick said that they disliked their jobs, and only 2 per cent. Of those who were never sick disliked their jobs. This, therefore, is an important issue for management.

It would be tempting to go into the work of people like Herzberg in this field, but I will refrain. I do not, of course, expect the Government to announce a national occupational health service today (and I appreciate that the previous Government decided to go ahead with this small but important measure, and I appreciate that it will call for extra medical services), but I hope very much that they will indicate that the steps they have taken will not preclude the development in due course of a national occupational health service of the kind which is being increasingly recognised as necessary. My Lords, I am sorry to have taken so long, but this Bill is of interest. We certainly hope to see it on the Statute Book, but it is likely that at the Committee stage we shall want to move some Amendments, and I hope that the Government will be sympathetic to them.

4.47 p.m.

LORD AMULREE

My Lords, I, too, should like to thank the noble Lord, Lord Drumalbyn, for the extremely clear way in which he has explained the purpose of this Bill. I should like also to thank the noble Lord, Lord Shackleton, for the very interesting way he has spoken about a great deal in the Bill. He said a number of things which I might have said not quite so well and concisely; so I shall be able to cut down my remarks to your Lordships quite considerably, which is probably an advantage. Before I begin to comment on the Bill I wish to join the noble Lord, Lord Shackleton, in paying tribute to the work of the factory doctors for the very valuable work they have done in the past.

When I read this Bill I was rather disappointed in it, because I was hoping that it might contain something which would lead to the foundation of a comprehensive national occupational health and hygiene service. What I mean by that is I think probably accepted by everybody. Roughly it can be divided into two parts. The service should begin in the supervision of the work environment and study of the effect on health, at the same time—and this is what is done now very well—making an assessment of the individual's fitness to perform certain work without harm to himself or to others. On the supposition that that is accepted, it seems to me rather surprising that the present Bill should set up a service to work under the Department of Employment and Productivity, even though only for the time being, rather than as part of the National Health Service.

I was very pleased indeed to hear that contacts are going to be very close between the two services, but one would have liked to see this become part of the National Health Service. In that event it would be far easier to exchange information about disabled people, sick people and the like than is possible with two separate services. But it is of great advantage that the reports of the school health service will be available to the youth employment service so that they will know what kind of work a disabled person can do and something about his past history. I think that will be very encouraging, and I am pleased to see it. But are we waiting, then, for the reorganisation of the National Health Service before bringing in occupational health? I quite realise that this is not a question for the Department for which the noble Lord is responsible, but I wonder whether he could give me an answer to it, because I have talked to your Lordships on more than one occasion about the existence in various Government Departments of little health services which exist by themselves. One thought when the National Health Service first came into being in 1948 that it would mean that those services would be gradually absorbed, but I do not think they have been.

In commenting on the 50 new doctors, I should like to inquire, with the noble Lord, Lord Shackleton, whether they are going to be given special training—that is, these more or less full-time doctors—before they start their work. I should also like to ask, with the noble Lord, Lord Shackleton, what is going to become of the nurses. What are they really for? Are they going to work by themselves, or are they going to work with the doctors? I wonder whether the noble Lord, when he comes to reply, could say a word about it. What I am not quite sure about—and what I heard a moment or two ago did not make it any clearer—is whether this occupational service will be done on an industry basis, as I should think it surely must, and not on a regional basis. One must get similarity between the services available for the various industries. There may be a difference between the regions, and the various industries there would get a different service.

There are two further points to which I should like to refer. One is post-graduate training. Three universities have departments of occupational medicine and three others use their departments of social medicine for that—and there I thought of the University of Dundee for I saw in The Times to-day that they are engaged in work on a disease called "farmer's lung". I am sure that that is where the occupational health service can become a great preventive factor in medicine, although not for a vast number of people; but it can control a certain number of diseases, and I am thinking particularly of the processes which can lead to cancer. I saw a rather sad thing in a report the other day: 39 new cases of cancer of the scrotum have been notified during the past 12 months. This form of cancer is almost entirely caused in the beginning by contact with hot oil from mule spin-flings. It is a form of cancer which should not occur at all now, and one can say that there were 39 totally unnecessary cancers. One hopes that when this service gets going there will be very tight control on processes that can lead to cancer.

There are just two further points. I see that the C.E.M.A. can carry out surveys. I take it that the employers cannot appeal against paying the costs of the surveys, and that if a medical officer considers that a survey is necessary he will be able to decide when and where the tests are to be carried out. Perhaps the noble Lord could just make that quite clear. Finally, I think that one or two of the sections or clauses of the Treaty of Rome refer to the importance of preventives occupational medical services. One finds that in some of the European countries they have occupational health services. They are not the same as we have, but they do have services which contain factors from which we could learn, and it might be worth while finding out what are the first-class points in the foreign services and adopting them into our own service. Apart from those few words, I am very pleased indeed [...]o support the Second Reading of this Bill.

4.55 p.m.

LORD PLATT

My Lords, I too am very grateful to the noble Lord, Lord Drumalbyn, for his clear exposition of this Bill, and especially for his going into the previous history of what one might call, in the widest sense, industrial medicine, which I had not fully understood on reading the Bill. I understand that in this instance considerable consultation has taken place with the medical profession, both by this Government and by the previous Government, who were planning a Bill of this kind. I understand that, on the whole, the profession is satisfied that the provisions are for the good of the health of the individual in industry.

Having said that, I should like to comment briefly on three matters. In the first place, I would ask the noble Lord, in his reply, to say something about the reaction of the medical profession to the question of confidentiality. I am a little worried, and a little surprised, about Clause 1(6) where it says: It shall he the duty of every local education authority … to furnish, on the application of an employment medical adviser, such particulars of the school medical record … as the adviser may reasonably require … The subsection goes on to say that the adviser may only use the particulars for his own purposes, and that they may not be disclosed to anyone else without the consent of the person concerned. I am a little worried about this, as we are with all aspects of confidentiality at the present time, when records can be so easily kept, maintained and discovered by computer methods, and so on.

All kinds of things may happen to people in infancy, in adolescence, and so forth, which should not follow them for the rest of their lives. I am not merely thinking of delinquency which, after all, is a phase which some young people go through and come out of perfectly well; I am thinking of the kind of person whose doctor once found a murmur in his heart, which probably long ago has been proved to be quite an innocent murmur but which is nevertheless in his records for all time. A quick look through the record would disclose this. Perhaps an entry may be found, "query epilepsy" where the child has had some little attack that nobody quite understands. Is he starting epilepsy? The doctor writes, "query epilepsy", and it is on the child's records for the rest of his life. It can have two ill effects. I have already stated one; that is, that it may influence people where it should really have been washed out long ago. The other is that the more we know that our records may be looked at by other people, the less shall we put down in them. You hesitate to make quite rude remarks about patients—which I have put on their notes from time to time—if you think that they will be made available to all kinds of other people.

LORD SHACKLETON

My Lords, may I interrupt the noble Lord, who is on a very interesting point? I must say that, as one who has been a personnel manager, I would never have expected to see medical records, and would regard it as quite wrong to do so. That is why I hope that the professional standards of the doctors involved will safeguard them.

LORD PLATT

Yes, my Lords. I fully understand that, and I fully understand that my own records will be sent to another doctor if I move away to another district: but that other doctor to whom they will be sent will be a person of my own choice, whose sole business it will be to look after me and my interests. But there is nothing in the Bill to say that the records shall be sent only by permission of the person concerned. It is stated that they cannot be shown to anybody else without permission, but they can be, and must be, supplied if the employment medical advisory doctor asks for them. It may be that I am making too much of this, and I am quite prepared to hear that people think I am, but it seems to me that the Government might look again at the wording. If it were simply stated that the employment medical advisory doctor may request the school medical service to furnish a report on aspects which might influence the employment of a person, that would be a safer form of wording than just asking for the whole of the records to be passed on. That is my first point on which I should like a little clarification, and I should like Her Majesty's Government to think a little more about the wording of that part of the Bill.

Secondly, I should like to add my little praise and compliment to many of the appointed factory doctors of the past, and to inquire whether any kind of compensation will be offered to them for the loss of their jobs. I believe that many of them act only in a comparatively small, part-time capacity and no doubt their loss of income will not be too serious. But others have given a considerable amount of time to the factory service, and I wonder whether the Government have it in mind to provide some kind of compensation for them. My third point, which has been adequately covered by the noble Lord, Lord Shackleton, and the noble Lord, Lord Amulree, concerned what we really need to aim at; that is, a proper national occupational health service closely combined with, and in fact part of, the National Health Service.

5.3 p.m.

LORD POPPLEWELL

My Lords, I should like to extend a general welcome to this Bill, but I regret that it has been divorced from the more comprehensive Bill on general health and safety measures which was presented by the last Government. My welcome goes only so far, because there are quite a number of matters about which we shall want further explanation before this Bill finally passes through your Lordships' House. I hope that the Government will not present any difficulties about getting on the Statute Book Mr. Hattersley's Private Bill, which comprises the second part of the Bill which the last Government proposed and which has now had its Second Reading. May I say at the outset that, if I do not get the 6.20 p.m. train from Kings Cross to York, I shall be very late in getting home, so I hope that I shall be acquitted of any discourtesy if I leave before the noble Lord, Lord Drumalbyn, winds up.

I listened with very great interest to what the noble Lord, Lord Drumalbyn, said about the additional doctors who will be appointed to this service. He said that, including the present 50 doctors under the Factories Act, this Bill will bring the number of full-time doctors up to only 78, with 42 part-time doctors. The Bill gives the impression that there will be at least 50 additional doctors appointed. Of course there will be additional doctors, but the difference between part-time and full-time is very material indeed.

I was also very interested in the noble Lord's definition of the regions. I completely share the approach of my noble friend Lord Shackleton on this matter. If we want properly to safeguard the health of the workers in the type of structure which trade unions and others are bringing about, then this service should definitely be linked up with the National Health Service as a whole. One could see complications when the noble Lord said that the eight regions would coincide with those of the Department of Employment, and not with those of the National Health Service.

He spoke about the close relationship which there will be between the advisory service and the Health Service. It is only in London and the North-East that the present factory inspectorate has its own laboratories, and it appears that the rest of the country will he sharing laboratories with the National Health Service. This appears to be a weakness in the Bill because, according to Clause 1, the main function of the service is to inform and advise the Secretary of State on matters concerning the safeguarding and improvement of the health of employed persons. That clause also enables the Secretary of State to … investigate or assist in the investigation of problems arising in connection with any such matters … and … to maintain … laboratories and other services". When I heard the noble Lord speak in the way he did I recalled how, in the past, when we have tried to interpret various Acts of Parliament, we found escape clauses which did not represent exactly what we thought.

My noble friend Lord Shackleton pointed out that there is a reduction of some 30 per cent. in what we suggested previously, bringing the figure down to £850,000. Offset against that, it is expected that there will be £100,000 coming by way of receipts. That therefore reduces the Government expenditure to a figure of £750,000, which is a quarter of a million less than we had visualised. If one takes into consideration what should be involved by reason of this Bill, one very definitely queries the financial approach of the Government in this matter.

Will this amount be sufficient for the important lines of investigation into pollution and into the other matters that are industrial hazards? For instance, my noble friend Lord Shackleton referred to the box girder bridge trouble that they have down in Bristol at the present moment, at Avonmouth. The union has had to take out an injunction before the Bristol magistrates to prevent any further work taking place on these box bridges until proper breathing apparatus is provided and there are proper means of ventilation. One would have thought that, bearing in mind the development that we were hoping to see, this was the type of thing into which the service itself would have been conducting researches and investigations, through its laboratories and in other ways.

It is mentioned that 110 nurses and secretarial staff will be appointed. I think we are entitled to a little further explanation as to the type and nature of the duties which these secretaries and additional staff are going to perform, because the usefulness of this scheme in itself, in my submission, rests upon additional research taking place into many of the hazards that there are in connection with our industrial life at the present moment. The Schedules to the Bill define certain types of additional developments, as it were, which are covered by the terms of the Bill. I make just two suggestions that may already be covered—and I am subject to correction here. I wonder whether railway shops could be brought within the purview of the Bill. One understands how difficult it is to get the Factories Acts to operate in so far as railway shops are concerned. Some little changes have taken place in recent years with which I am not fully acquainted, but I think that such places as railway shops should be covered. I know there is not so much lead poisoning to-day, with diesel engines, as compared with the days when we had the old steam engines; but in the paint shops and elsewhere there is still the difficulty of lead poisoning, which is covered by these provisions. I would also ask whether lorry drivers will come within the purview of this particular service, because the fumes and so on are very injurious indeed to health.

As to the argument that we should await the issue of the Report of Lord Robens on safety and health at work, I hope that this Bill will not be used to delay the implementation of anything that that Report may ultimately recommend.

One knows that the question of these occupational health services has been very seriously considered, and it is not a matter about which one can expect a Report quickly; but I sincerely hope that this Bill will not in any way jeopardise any recommendations that might be made in that Report. Then there is the question of expenses for employees who have to attend for medical examination. The Bill says that travelling or subsistence allowances or such compensation for loss of earnings will be paid. What might that loss of earnings be? One can understand that the travelling and subsistence allowances may be in accordance with the appropriate scales, but I hope the Government will be a little more forthright in telling us exactly what the payment for "loss of earnings" will be. Will it be base rates, or will it be the gross earnings for the time the person is away on these duties? There is a big difference here, and it is a difference which can arouse quite a lot of controversy in this particular matter.

My Lords, the last point I want to make—and it is an extremely difficult one, I accept at once—is that the Bill lays down a fine of £20 for anyone obstructing an inspector. This is all linked up so very carefully and closely with the Factories Act; and in the other place, when efforts were made to bring more reality to this question of a fine on anyone who obstructs an inspector in this direction, all kinds of excuses were made. I thought it was deplorable when I read that the Minister of State in another place said: In the Fire Precautions Act, the fine for obstructing an inspector is £50; in the Salmon and Freshwater Fisheries Bill, which is currently before the House, the fine for obstructing a water bailiff is £100; in the Agriculture (Safety, Health and Welfare Provisions) Act 1956 it will be £100". My Lords, surely it is not in accordance with your Lordships' desire that a man who is catching salmon or trout and who obstructs a water bailiff should be liable to a fine of £100, and yet in the case of anyone who obstructs the operation of these provisions where a person is seeking such medical attention as is necessary the fine is limited to £20. Surely, in this day and age this House will not agree to that. I suggest that there will be some Amendments coming along here.

If I may digress for just a moment, I remember a case many years ago in which a signalman on the railway, working on a Sunday night—his box closed at 12.30 a.m. and opened again at 3 a.m.—booked off and took the opportunity to go into a plantation and steal a pheasant. He got a pheasant. He was up before "the beaks", and he was sentenced to six months. He appealed, and of course the sentence was quashed. At that selfsame court a few months later, before the same set of magistrates, a farmer was charged with adulterating milk and was fined £2. Here we have a £20 fine for obstructing something intended to prevent a real danger to health, and yet for netting salmon the fine is £100. I see that in the Committee stage in the other place £75 was mentioned so far as a pheasant is concerned. I am certain that justice will be done in this House, and that this anomaly will be corrected. I am certain that we shall have a good deal to say about that point.

I generally welcome the provisions of the Bill. My only regret is that it does not go as far as I should like, but I think it is a step in the right direction. We must pay more attention to the health of people engaged in industry. We all know of the great number of days lost through injuries to workpeople incurred in industrial conditions, many of which are probably inherent, and it is necessary that research should take place to obviate them. We have only to compare public reaction to the (shall I call it?) slaughter consequent upon industrial injuries and compare it with the public outcry and excitement associated with a national disaster such as a main-line railway accident. Surely, in 1972 it is time that we approached this matter on different lines. I generally welcome this Bill.

5.21 p.m.

LORD REIGATE

My Lords, like all speakers before me I give this Bill a welcome, albeit qualified, as the intervention which I made earlier will show and as I hope to show later in my speech. It seems to me that the Bill can be described as a good little Bill, a nice little Bill but not a very revolutionary Bill. It reshuffles some duties and reinforces some powers—and I agree with the noble Lord that the penalties are probably inadequate. It gives a new name for an old service. The only snag I find is that it is introduced (I say this with great respect to my noble friend) by the wrong Minister. I should have preferred to see the noble Lord, Lord Aberdare, introducing this Bill and seeing to it that the Secretary of State, who is not named in the Bill, is the Secretary of State for the Social Services. For the last 22 years the question of occupational health service has been a bee in my bonnet. The bee is quite long in the tooth now, and I have already allowed it out for a flight round your Lordships' House on a previous occasion. You must forgive me if this elderly bee has another run for its money this afternoon.

Perhaps I may remind your Lordships that the Dale Committee on the industrial health service reported 21 years and one month ago and the Report was warmly welcomed in all quarters. If I may, I will quote from that Report. It said: For the most beneficial development of the National Health Service, public health services and industrial health services must be co-ordinated. Twenty-one years and one month later, absolutely nothing has happened except for the setting up in 1954 of the Industrial Health Advisory Committee, referred to by my noble friend, and this little Bill, which I think the doctors would describe as a placebo to keep us quiet for a little time. My noble friend said that there is going to be co-operation, collaboration and co-ordination—I think those were the words he used—with the National Health Services. My Lords, these are three blessed Whitehall words to cover a multitude of sins or nothing at all.

What is really important is the ultimate Ministerial responsibility. The achievement so far is not what the Dale Report asked for. We all know that to-day we do not have an occupational health service; we do not have—and shall not have, as a result of this Bill—a framework, or even a skeleton of one. We do not have the Ministerial backing. In another place the Bill was described as "a focus for the development of occupational medicine". This, like those other words, is a fine phrase which can mean anything or nothing. I think it is a piece of jargon at this stage. But I must make my position clear. No one can expect a nation-wide occupational health service to come about overnight, or even in the course of a generation. We do not have the resources; it will be a long time before we have them. To some extent an occupational health service, as the noble Lord, Lord Shackleton, and other speakers have said, has happened of itself and it will grow of itself.

I would go further and say that there are few firms of any size, standing or repute who do not provide such a service. Why? They do not do it for any other reason than the fact that it is beneficial and profitable—which for me is the best of all reasons, saving the remarks of the noble Lord who seems to think that if you did not have equity shareholders you could not have an industrial health service. I was brought up in a firm which had elaborate occupational facilities. For this reason I wish to see these extended.

LORD SHACKLETON

My Lords, the noble Lord has misinterpreted what I said. I merely pointed out that it is easier to spend money freely on employees if all the money goes to them anyway. I am not attacking the equity principle, nor would I agree that there is anything approaching an occupational health service in most firms.

LORD REIGATE

My Lords, I said most firms "of any size". I realise the difficulties for small firms; but I will willingly withdraw anything that I have said to which the noble Lord takes exception. I only know that in a firm entirely owned by equity shareholders we pursued an occupational health service a very long way. Meanwhile, the E.M.A.S. is all we have. My only complaint is not that it is itself inadequate or inefficient, but that it will never develop further when it is in the hands of the wrong Department.

I studied all the debates in another place, and when the matter was raised there an assurance was given (which my noble friend repeated to-day) that nothing in this Bill prejudices the issue of what arrangements might be most appropriate in the long run for occupational medicine. Then, in a most illuminating passage, we were told that these matters were fully discussed with the Minister concerned. I should have liked to be a fly on the wall during those conversations and to know why the Department of Health has been defeated in taking the responsibility for this Bill—because I am sure that it would like to have it. Is there any reason why responsibility cannot be transferred? It is not a very large part of the Department of Employment and Productivity, and it would be very simple to integrate it into the Department of Health and Social Services at the present time. I would point out that my interruption during the speech of my noble friend was illustrative of this.

There are, I think, 13 or 14 Regional Boards in this country. There are to be 8 under the Department of Employment and Productivity. I have a feeling that the boundaries are not going to be coincident at any stage. We have never been given a good reason why responsibility should not be transferred forthwith. I suppose we shall be told that it must wait until the reorganisation of the National Health Service is complete; but I must remind your Lordships that that reorganisation has been in train for eight years and we have still another two years to go before the necessary Bill is passed. No doubt we shall then be told that the moment is not ripe and that we ought to give the National Health Service time to settle down.

The fact is, my Lords, that under the Consultative Document, and under the Act which will ensue, the National Health Service is going to be revolutionised. If we are to have a revolution we might as well go the whole hog. If your Lordships will look at the Consultative Document you will realise that it is going to set up area health authorities—which is a revolutionary concept, far more revolutionary than anything contained in that rather conservative Act of 1948. We may disagree—some of us do—about the duties and composition of the area health authorities and some of the consequences which may flow from their being set up. Most will accept it in principle as a new concept. The area health authority assumes responsibility for all public health, all general medical services, all hospital services—but not occupational health. This one curious little empire in St. James's Square survives intact; I wish I could find out why. To go back to the area health authorities, I would remind my noble friend that the National Health Service is at the moment the largest single employer in the country. In many of the areas the health authority will be one of the biggest employers. It will have this vast range of health services, but it will not have anything to do with occupational services.

My Lords, if I may digress for a moment, before I heard the lucid speech of my noble friend I thought it might be as well if I found out more about this Bill which does not tell one what it contains in the way of functions and duties. So I furnished myself—not for the first time—with a brief from the Conservative Central Office which I found cogent, lucid and helpful. It sets out the ten main duties to be undertaken by the E.M.A.S. Seven of those already exist; one is a follow-up to the school health service, and there are two apparently new ones, so far as I can ascertain. The first is liaison with general practitioners, hospital staff, works medical officers and others interested in occupational medicine. The other is medical advice to general practitioners in connection with their patients' work. Those two functions, my Lords, are part of the National Health Service, and this makes it the more mysterious to me why the new area Health Authorities are not to have this extra function tacked on to them. It may be that, for some reason about which my noble friend will tell us, it is not the right moment. I might point out that the Department is being examined, I think by McKinsey, the efficiency experts, to see what its duties should be under the new set-up. I should have thought this the right moment to make a categorical declaration that on the appointed day the duties will be taken over by the Department of Health and Social Security. We cannot afford any longer the fragmentation of medical resources which, unfortunately, is implied in this Bill.

5.32 p.m.

BARONESS SUMMERSKILL

My Lords, in following the noble Lord, Lord Reigate, I find myself in the most unusual position of being able to say that I entirely agree with everything he has said. I got a little confused when he embarked on something about equity shares, which I did not realise was relevant to this debate. I am glad that he and I are not enthusiastic about the Bill. Indeed, I regard it as a puny measure quite unfitted to be related to the most important subject which we are discussing; namely, the health of the workers of this country. I regard it as an emasculated version of the Bill which the former Government introduced and it impresses me only because of what is omitted.

My Lords, to-night I shall deal particularly with the provisions which were included in the last Bill, designed to decrease the number of accidents in industry. Other noble Lords, including the noble Lord, Lord Reigate, have talked about safety in industry, and I should like to remind the House that we have had years of propaganda by organisations concerned with accident prevention. Yet this Bill, which purports to be a preventive measure, fails even to provide for safety committees representative of the workers and management. I have always felt that only the workers and management can discuss the details of preventive machinery and defective organisation in their own factories.

Other figures have been quoted, but I want to put on record again that why I consider it a failure not to include safety in the Bill may be judged by the fact that in 1970—these are the latest figures we have—the number of fatal accidents was 556 and the number of notified nonfatal accidents was 304,595. Unhappily, many accidents which are legally notifiable are not notified. It is common for a doctor to have a patient come into the surgery or to have to treat the victim of an accident, and, when he asks whether the accident has been notified, for the patient to say, "No, I cannot be bothered." The only encouraging feature in this ugly picture is the existence of the good employer; and indeed the good employer does exist. In my opinion the factory inspector is gravely inadequate but the best firms set a standard which is unsurpassed in any other country. Therefore, the objective should be to exercise control over the bad employers. It is among the people who run the factory, or manage the mine, or control chemical reactions that we find the guilty men.

I am not speaking simply from academic knowledge. For many years I was the Member of Parliament for an industrial constituency in the North and the factories and the work carried on there are absolutely familiar to me. I should like to draw to the attention of noble Lords from Wales an article which appeared last week in the Western Mail, in which it was stated: Accidents in work which result in absence from work happen at the rate of two every working minute, and many of them can result in a claim for injury or disablement benefit. Investigations by the Consumer Campaign, one of those organisations which devotes itself to investigating these matters, show that getting your entitlement can cause more or as much distress as the accident. Yet, my Lords, the Industrial Injuries Fund amounts to £350 million. We are still dragging our feet over our treatment of these people, for the most part inarticulate, who are injured in our factories. I am glad to see that a noble Lord who hails from Wales is listening to me, for the problem is particularly acute in Wales which has the highest rate for industrial accidents and disease of any region in the country.

This indifference, which other noble Lords have mentioned and which I am stressing, is reflected in this Bill for which we have waited, and which entirely ignores these matters. It does not mention the question of safety or accidents. That inclines me to think that there are those in authority who have the, "I'm all right, Jack", approach. They think, "It cannot happen to me"; and indeed it cannot happen to them. We go on, as one noble Lord has said. Twenty years ago we had a specific Statement on this question and parliamentarians believed then that a measure would soon be introduced. But here we are to-day, my Lords, with this miserable little Bill dealing with this very important subject, and we get no further. What excuse is given? Yes, my Lords, an excuse is given. It is that we must wait for yet one more report, although the shelves in the offices of various organisations up and down the country are crammed with reports on the studies and recommendations on the subject which have been made over the years.

One of the latest and, in my opinion, one of the most important, comes from the researchers at the National Institute of Industrial Psychology and consists of an in depth study of more than 2,000 accidents. This very important Report describes the situation in which accidents are the result of the way work is carried out and the lack of communication between employers and workers. Who will read it? Unfortunately, few people, apart from those concerned in management, will read this important piece of research. They are interested only in keeping on the right side of the law. They will leave the problem of safety at work and the prevention of accidents to some hard-pressed juniors who have little time or inclination to read such reports; and so no doubt to save face this will be introduced into the factory and perhaps put on a shelf where it will collect dust. This apathy concerning the safety of the workers is responsible for the high incidence of accidents—apathy, lack of interest by those who are there on the spot and who should be showing more interest. Yet the penalty for this callous disregard for those in their employment is entirely inadequate: the maximum fine for criminal negligence is only £300. We have heard tonight of the inadequate fines: but that is the maximum for criminal negligence, for risking the life and health—permanent health—of a worker in one's factory.

In this House we have over the years had some interesting debates, generally on Unstarred Questions, regarding industrial accidents and diseases. I remember a most interesting debate, initiated by my noble friend Lord Taylor, on deafness in factories. In the constituency in which I worked, workers came to see me on Friday nights, some of them men of 40 or 45, who could not hear me when I spoke to them in a normal voice. I had to shout at them. I would say, "You should not be deaf at your age", and the answer I received was often to the effect, "Oh, my father went deaf too, and he was employed in the same factory." There was this sort of fatalism. Premature deafness is a serious disability—

A NOBLE LORD

Hear, hear!

BARONESS SUMMERSKILL

—about which most employers are entirely indifferent. I think we should all be glad, and particularly the noble Lord who said, "Hear, hear!", to learn that Mr. Justice Ashworth last week ruled that an employer was responsible for a worker's deafness because that deafness arose out of the man's employment. At last we have heard a voice of authority on the subject. This ruling, I am glad to say, will alert the bad firm more effectively than a hundred debates in Parliament, for the only way to get some employers to protect their workmen is to inflict a penalty which will seriously reduce their profits.

From the Bill I see that economies are to be effected. In this puny little measure they have decided to reduce the number of doctors overall and to introduce 12 nurses—although people disagree about this number. I feel that the medical profession will be very shocked to hear that nurses are to be a substitute for doctors. I am not at all shocked by the substitution of nurses for doctors. If it is necessary to economise in doctors, I would give a few hundred capable nurses a course in industrial medicine and hygiene and let them invade our dirty, inefficiently-run factories, and allow the knowledge, experience and social conscience of these splendid women full rein. The noble Lord talked about training. We already know that under the Bill the doctor in a factory is not there to give treatment. It will be quite possible to teach these conscientious women the kind of things that they should know when they go into these factories. Perhaps we might have a revolutionary change.

It has been said again and again—it was emphasised by the noble Lord, Lord Reigate; and indeed I find it very difficult to understand—that although the Bill is concerned with the health of workers, its provisions are going to be administered by the Department of Employment rather than by the Department of Health and Social Security which possesses a wealth of knowledge and expertise. When I listened to the noble Lord who opened the debate talking about the extra laboratories and facilities which would have to be established in the administration of this Bill, I was astonished. My Lords, they are all there. What a gross waste of public money it is to transfer the provisions of this Bill away from the Health Service to a Service attached to the Department of Employment. I agree with what the noble Lord, Lord Reigate, said about this: what Ministerial or Civil Service brain could sit round a table and suggest such stupidity? If we have a vast National Health Service which is the admiration of the world, to set up another Service and administer it by another Department and expect them to build more laboratories to serve it, is sheer stupidity. It was as long ago as 1961 that the Medical Services Review Committee recommended, as the noble Lord said, a comprehensive occupational Health Service as an integral part of the National Health Service. It is not a question of our debating this only to-day: this has been discussed ad nauseam over the years in committee room after committee room.

My final word about this Bill is this. My fear is that by passing this miserable little Bill and putting it on the Statute Book we are giving those people who are dragging their feet another excuse to prevent the bringing in of a comprehensive medical health service in this country which is what the country urgently needs.

5.47 p.m.

LORD DAVIES OF LEEK

My Lords, it has been a pleasure to listen to this debate. I have enjoyed every speech that I have listened to: they have been very authoritative. May I say to the noble Lord, Lord Reigate, that I agree with everything he said because I know of his experience in this area. Like other noble Lords and the noble Baroness who has just spoken, I welcome the Bill and I like the use of the word "placebo" which has been applied to it, because nothing very much happens when a placebo is used during clinical trials. Nevertheless we shall welcome the Bill and I hope that during the Committee stage this House will work to improve it and to give it some "spikes". Like the noble Lords, Lord Amulree and Lord Platt, who spoke with great authority and professional knowledge, I can omit a number of points from my speech which therefore need not be too long. That will please your Lordships' House.

I hope that we shall not talk all the time about Europe or the Common Market. We had certain commitments particularly in relation to the International Labour Organisation, long before the Common Market, and we were pioneers in industrial and trade union legislation. When I worked as a Minister in the 1964 Parliament, I had first-hand experience of the Industrial Injuries Act and of diseases such as pneumoconiosis, asbestosis and the new types of diseases afflicting workers due to the rapid development of modern technology. It was my duty to go all over the country in connection with these health matters and I visited the marvellous pneumoconiosis centre at Euston. Here, may I pay a tribute to those doctors who have given such devoted service in relation to diseases of the lung.

We have regulations for the factory, but we have to remember that sometimes hazards arise in the kitchen. The housewife is often forgotten. Let me give an illustration to your Lordships. When I was a Minister we had a case of a housewife who died after eight months' exposure to asbestos. Asbestosis is a killer. Her husband was a docker; he had been shifting asbestos in the docks. Her only contact with asbestos was that she had regularly to clean his clothes, his trousers and turn-ups, and that girl died within 18 months from cancer and asbestosis. In other words, there is a job of work to be done here and these hazards have to be watched by the new Factory Inspectorate.

We should push home to the public, and remember it ourselves when we are talking about strikes, that for every day lost through strikes 10 days are lost through industrial injury diseases. For every day lost by strikes, a hundred days are lost through illness. Consequently, as my noble friend Lord Shackleton and the noble Lord, Lord Reigate, indicated, there is an economic credit in forthright progressive firms seeing that they have first-class occupational therapy and first-class doctors working in their factories, because even from the acquisitive point of view there is a return. This Bill—and it was very difficult to get this measure: I do not know why—grew out of a report by a sub-committee of the industrial health advisory committee. This sub-committee was established in November, 1964—you see we are a long way off and a lot of water has gone under the bridge since then.

The sub-committee's terms of reference were to review the appointed factory doctor service and to make recommendations. I will not bore the House by reading masses of the recommendations, because the House is well informed, but it will not hurt to recap a little. They said that the factory doctor service needed polishing. It is true that the medical examinations of young persons are to be looked at to save wastage on the use of doctors. There was also the matter of the medical examination of adults and the duties, organisations and powers of a reform service—we have had some of that in this Bill. The extension of arrangements to premises other than those covered by the Factory Acts were also included in the terms of reference. There was a summary of about 32 recommendations at the end of that sub-committee's report. They had five sittings to produce this report. I wish the Bill that the Labour Government introduced in another place before the Election had had a run for its money and had been brought into effect, because, as my noble friend Lady Summerskill mentioned, it covered the safety aspects.

I want to ask a question about the laboratories. I was delighted that two noble Lords referred to them. There is no natural boundary for the setting up of these laboratories. Some committee should be established to see that money is not wasted by the Department of Employment, building monstrosities that look like match boxes with glass and steel around them, and setting up expensive instrumentation. I know something about the equipment in laboratories because I have an interest in very expensive equipment in laboratories that make pharmaceuticals and drugs. Some of these instruments, and some of these modern machines—and there is a brand new one for measuring the micrograms of lead in human blood—are expensive.

I suggest that we have a good look at this aspect before we talk of building new laboratories. We should support our universities and give them a good sum of money to expand their present buildings and use the material that they have. I am sure that the Government, over a period of time, could save many millions of pounds by using services that are already there and improving them by way of Government grants; and those benefits could be brought into the occupational service. I should like to make an appeal here. I hope that when the Government look into the centres where they are going to establish the laboratories they will have a "double take". I hope that Wales will have one. I notice that Stoke-on-Trent again is left out. There is a first-class university and a first-class hospital there, with marvellous services. The Potteries area is an island of industry in a sea of agriculture. It has steel and coal, and there are many of the industrial diseases in which the medical profession are interested.

There is another point of paramount importance. My noble friend Lord Popplewell pointed out the paucity of the number of doctors in this field; but this work requires a particular kind of training. My noble friend Lady Phillips was saying yesterday that everybody is always looking into the teaching profession and suggesting changes. It is a fact that the gamut of modern medicine is so great—even the electronic engineer comes in now, with the radioactive isotopes that are used in the operating theatre—that an expert in one area may not be expert in another. I will not name the specialist because he would be ashamed, but I knew a dermatological specialist who failed to diagnose measles in his own child. In other words, he became so specialised. This can happen to a man who has dedicated his life—and it is not a laughing matter; it shows the necessity for a first-class general practitioner who is still at the base of the pyramid of medicine. He should be brought in to co-operate fully and be made to know what is going on in his area in factories and elsewhere. I speak as a person who has a "Guinness record" so far as the Houses of Parliament are concerned. I introduced the biggest Private Bill in the history of Parliament—and I am not saying this; it was said in a report on Private Bills which is extant. I introduced a Bill in the other place on the Gowers Report on safety in industry. It started lots of other Bills, although many people did not acknowledge it, and to-day we should be taking a broader canvas than this little Bill.

I should now like to bring out what I think is a point worthy of note. There are some places where healthy conditions for the eating of food are impossible. A collier has to eat his food sometimes stripped, sometimes naked and sometimes sitting in water and in dust and dirt. There is no beautiful white napery for a miner, or those working on haulage or at the coal face. They have to eat where they are. There are no facilities for human needs, no lavatory accommodation; you cannot have that in a mine. No matter what safety measures or what health measures you introduce, there are certain industries in which it is impossible to introduce complete health measures, and one of them is the industry where the man is cutting coal at the coal face.

Hazards are also growing in farming. The modern young farmer also needs a knowledge of engineering; he is using sharp and keen tools. It will be necessary to bring in country general practitioners and town general practitioners about every quinquennium for a sabbatical together with the occupational therapists, and doctors to have a two months' course at a university to keep up with the new acids, the new combines, the new machines and tools that enter into modern technology. I think some things like this could be introduced. The nation would not be wasting money in letting our general practitioners and other medical people attend these symposia. As a layman although I am not always able to follow the medical terms that are used in discussions, I have had the privilege of listening to symposia, and I have never seen a more keen audience than masses of highly qualified specialists and consultants when they are at these general symposia. Money spent by the Government, rather than by private firms, to encourage this kind of thing over a quinquennial period would be money well spent.

Now, having spoken for nearly ten minutes, I will make my last point. It was sad—I do not know whether Private Eye has been mentioned in the House of Lords before or not—that it was Private Eve who drew the attention of the world to the dumping of cyanide and factory waste. This is a side of this Bill for which the factory doctorate and others should have some responsibility. I can think of nothing more socially irresponsible than factory owners, whoever they are, dumping up and down Britain tons and tons of cyanide and other materials which poison and can destroy life. The fines for doing that should be very heavy indeed. During the Committee stage of the Bill in another place one of the doctors there said that Dr. Faulkner-Hudson, the medical officer of the Imperial Smelting Corporation at the Avonmouth works, made recommendations, but he is quoted as saying that they were not taken up for political, administrative and economic reasons. I do not know what authority that gentleman has to say that, but I hope to goodness that factory inspectors will use their powers when things like this happen and will ensure that a court order is applied for so that during the period of investigation the factory can be shut down. We must give this provision "teeth" for it to be really effective.

I was delighted to hear what was said on the question of noise. All of us now suffer with decibels. When my granddaughter puts the radio on I nearly suffer deafness myself with the modern sounds we get on this machine; it is put on every morning when she gets up. This is the price we are paying for modern technology. A last point. It makes me sad when I think the medical profession made a huge mistake in the Willink Report, which years ago I studied deeply. They limited the number of students going to universities. My noble friend Lady Summerskill, herself a doctor, was nodding her head on this point, and I was glad to see it. Many more doctors are needed. The Health Service is being undermined. Hardworking general practitioners are only human-beings and if they have masses of patients their work cannot be done. More people should be allowed to get into the universities; the doors must be opened. In this way we could double the number of people in the medical profession. I am sure that the talent and love of the job are available if people were given the opportunity to qualify. If we want to make a success of this, the small number of doctors can be increased—and it will take at least ten years to get a good doctor out of this system in which we live—only by opening the doors of the universities and the hospitals to enable more young men—

A NOBLE LORD

And women!

LORD DAVIES OF LEEK

I thank my noble friend—and women, who are devoted, to go into this profession. My Lords, with those moderately brief remarks I welcome the Bill; and, of course, I always welcome the excellent way in which that hard-working Minister opposite brings his case to this House.

6.4 p.m.

LORD DRUMALBYN

My Lords, I am very grateful for the noble Lord's last compliment. I feel a bit like a placebo myself now at the Box. The Bill has been welcomed—I am not certain I could say, "with open arms". It has been regarded as too small and not perhaps comprehensive enough. I think it is generally the case that Governments are accused by the Opposition, when the Opposition basically agrees with what they are doing, of not going far enough. So I do not feel unduly depressed by the reception of this Bill. I shall deal with what my noble friend and others said about a much wider conception than this Bill is designed to engender. But may I first of all deal with some of the points raised by the noble Lord, Lord Shackleton. I quite understand his regretting that Part II of the Employed Persons (Health and Safety) Bill was not included. I noted that the noble Lord, Lord Popplewell, associated himself with this. But to judge by some of the speeches we have heard to-day, certainly that of the noble Baroness, Lady Summerskill, if it had been included I think we should have been accused of going not nearly far enough in that particular direction.

The noble Lord, Lord Shackleton, asked me what the Government's attitude was, and I think I cannot do better than quote what my right honourable friend the Parliamentary Secretary said in another place. He said: The Government are favourably inclined to the underlying objectives of the Bill, but, as I have stressed, they have considerable reservations about the wisdom of introducing its provisions at this time. However, this is a Private Member's Measure and it is up to the House to decide how to treat it"—[OFFICIAL REPORT, Commons; 4/2/72, col. 883.] And the House gave it a Second Reading. I do not think I should go further than that because I think exactly the same applies in your Lordships' House. The noble Lord went on to draw to the attention of the House what he described as the startlingly high rate of industrial injuries. He said that it might be two or three or more years before Robens comes into operation. We expect to receive the Robens Report in the summer. As the House will be aware, the noble Lord's Committee have said that the passage of this Bill will in no way interfere with the recommendations that they expect to make and that they regard it as a constructive measure.

The next point the noble Lord made was in regard to the penalty for obstruct- tion—and here again the noble Lord, Lord Popplewell, referred to this. He said that the penalty of £20 in the Bill was absurd. The point here is that the penalty for obstruction, in paragraph 4 of Schedule 1, is the same as that which applies to obstruction of the factory inspector, and as the Schedule contains a quotation from the Factories Act it is not possible to alter it. It would be awkward, to say the least, to have a much larger penalty in respect of obstructing a medical adviser than in respect of obstructing a factory inspector, say, in the same factory. The two services are so closely linked together that it seems only reasonable that the penalties should be the same. I might mention that the penalty in the case of an occupier causing an obstruction to a medical adviser, or for that matter a factory inspector, is at present £60; and that is not altered in the Bill.

The noble Lord, Lord Shackleton, then went on to speak of the cost of the Bill, which he said was £850,000 instead of £1 million. One of the reasons for this is the introduction of the selective system of examining young persons. If I remember aright, the original Bill represented a continuation of the system of examining all young persons entering factories. There is also a saving involved on the laboratory side through better co-operation, which is being arranged; I shall come back to that point in a moment or two.

Then he asked me what the nurses whom it was proposed to employ would do; and the noble Lord, Lord Amulree, also posed this question. I may say that we are not consulting the Royal College of Nursing because we do not know what the nurses should do; we are consulting them in order that we may pool our ideas on this and get the best possible use of the nurses, and the best possible arrangements. What they will be doing is interviewing and assessing young persons identified by the school health service as requiring medical attention; assisting in medical examinations and subsequent supervision; assisting in the periodic examination of workers exposed to toxic and other hazards; advising on the employment problems of disabled persons; assisting in the undertaking of surveys among occupational groups. And, after training, selected nurses may be asked to scrutinise X-rays and to carry out tests as part of survey projects so that the X-rays may be compared with the international standards. They will also be required to participate in professional activities and to keep abreast of current occupational health trends. They may have to travel, and to visit factories and other places of employment. It looks to me as though they are going to be very fully employed. I mention these points merely to show that this is something that has not escaped attention.

The noble Lord asked whether the numbers we are proposing to have in the service are right and whether they will be adequate to carry out the tests. It is not intended, of course, that they will carry out all the examinations on hazardous occupations. In parts of the country—indeed, perhaps in all parts of the country—it is possible to authorise works medical officers to carry out those particular examinations. It is not proposed to delegate other functions to works medical officers.

As to whether the numbers are right, this really goes into the whole concept of what the service is supposed to be doing, and I think one has to be pretty clear about this. I described it earlier as a detective service. The employment medical advisers will have the responsibility of examining young persons and carrying out the periodical examinations at intervals which vary from two weeks to fourteen months, according to the nature of the processes carried on in the factory. They will be doing that in hazardous occupations. They will also be going into factories where they have good reason to think that there is a danger to health, or that health is being adversely affected; but most of their time is likely to be taken up with the detection work. I think one can conceive of this work best by regarding is as a function which is being carried out by a fairly small group of experts, closely linked throughout the country: finding out where the hazards lie, trying to anticipate casualties, trying to anticipate the possibility of people being affected by those hazards, both in the sphere of the environment and in the sphere of the individual. This will be a painstaking piece of investigation carried out in close co-operation with laboratories to try to improve the general health and to try also to anticipate where dangers may arise and to take the necessary precautions to prevent them.

My Lords, this will be one of the major functions here, and I would say to my noble friend Lord Reigate, who advocates that this should all he brought within the purview of the National Health Service (and this point was mentioned also by the noble Lord, Lord Popplewell), that this is something which has been closely associated with the Factory Inspectorate; it is something which is specialised in that direction. What the noble Lord is asking us to do is to carry out something of a surgical operation and to separate this service altogether from the Factory Inspectorate and bring it into the National Health Service. It is separate, but that is not to say that there will not be the closest possible links. There will be links with the family doctor. Indeed, under the Factories Act at the moment it is necessary for the family doctor to notify the medical service of the Department of Employment of adverse effects on the health of a particular patient which lead the family doctor to suppose that there is something wrong in the factory. This already happens and this close link will be maintained.

There is also a link with the social service side of the Department of Health and Social Security—through the national industrial injuries insurance. If a claim for an industrial disease there is successful, the notification of that claim goes not only to the National Health Service but also to the Department of Employment. This is a closely integrated business and it will be possible to build up data in this way, with the experience of the employment medical advisers, throughout the country. They will each have their own regional teams. In the three places that I mentioned—London, Birmingham and Glasgow—there will be a nucleus of experts who will be able to co-ordinate this work and to give expert advice throughout the country; and at the centre there will be the laboratory, which will be used as a reference laboratory for the service as a whole. Whatever the powers given by the Bill, it is not intended to use those powers to build a large number of new laboratories all over the country for this service. This central laboratory already exists. Apart from that, it is the intention that the National Health Service laboratories shall be used for the normal routine tests, and where the National Health Service is not able to carry out a particular form of test then no doubt it will make use of the universities as well. Also, of course, the universities can be used by individual "factory occupiers", to use the term in the Bill, in order to follow up particular lines of inquiry.

So, my Lords, it seems to me that when we are dealing with the whole question of health in factories and environment in factories, the combination of the Factory Inspectorate and the medical advisers makes a good partnership. It is a partnership which it is better, at any rate at this stage, not to break up; it is better not to take the Employment Medical Advisory Service away, at any rate at this stage, and integrate it with the National Health Service, which is itself at the present time being reorganised.

I was asked a great many questions but I do not want to detain your Lordships too long. Perhaps I may deal with just a few more of them. I was asked about the training of the E.M.A.S. It is of course intended to start with a nucleus of the medical advisers (of whom there are 21) of the medical services branch of the Department of Employment, and then to recruit doctors with higher qualifications or previous practical industrial medical experience, or who hold special qualifications in industrial health or public health. Once they are recruited they will probably serve alongside regional medical advisers and will be attached to the medical advisers so that they can obtain planned experience of their work. There will be courses, academic refresher courses, and they will also be provided with the chief medical adviser's notes of guidance. So there will be a body of people who start with skill and aptitude and will then become specialists in their own range.

The noble Lord, Lord Reigate, referred to the fears expressed by the B.M.A. about these developments and wondered whether it would make it more difficult to develop a proper occupational health service, which, as he said, might take a generation to develop. I think I can give an absolute assurance about that. There is nothing in this Bill or in the organisa- tion it is proposed to set up that would preclude the integration of the service at a later date with the National Health Service if that was considered to be the right thing to do. I think the most that would be required would be a transfer of functions order, nothing else.

The noble Lord, Lord Amulree, asked whether the service should be organised on an industry and not on a regional basis. To some extent, of course, industries tend to concentrate in certain regions. But I think the one does not preclude the other. Although for administrative reasons the service must be organised on a geographical basis, I do not think there is any contradiction there. The noble Lord asked about surveys and who would pay. They would be paid for by the Department of Employment. He asked about the Treaty of Rome. Some recommendations have been made already under the Treaty of Rome, but recommendations are forms with which each member country should conform according to its own habits and legislation.

The noble Lord, Lord Platt, asked about confidentiality. This is an important matter and it is one which has been given considerable study. I should like to say a little more about it than I said in my opening speech and to explain what Clause 1(6) intends to do. Under Section 118(9) of the Factories Act the appointed factory doctor has a right to obtain from the local education authorities particulars of the school medical record of a young person, and such other information relating to the medical history of a young person as he may require to assist him effectively to carry out his duties. So that right already exists. The present right is absolutely necessary if this job is going to be done properly.

It is not expected that the medical adviser will need to have recourse to his right because it is expected that there will be the closest co-operation between the school medical service and the medical adviser, in the interests of the child. If the medical adviser receives form Y9 (which gives a list of the kind of things that particular young person ought not to be allowed to do) and if he wants further information on that score before or after seeing the person and examining him, then he can have recourse to the medical history in the school records. This does not seem to be unreasonable, and I should not myself have thought that professional men would put in their records anything that could reflect badly on the child or adversely affect his future, the more so since there will be this close personal connection between the school medical officer and the medical adviser. I do not think that the noble Lord need worry on that score.

The noble Lord, Lord Platt, then asked whether there would be any compensation offered to appointed factory doctors. Appointed factory doctors do not work under a contract of service, so there is no right to compensation. They are not employed by the Department, but they receive fees from factory occupiers. Most of them of course—indeed, the greater majority of them—are part-time. So it has been decided that this is not a suitable occasion on which to pay compensation. It is not really appropriate where remuneration is by fees.

I have detained your Lordships quite long enough, and any further points can well be dealt with at Committee stage. I hope that as this Bill works out, when it becomes an Act, it will belie the epithet that the noble Baroness, Lady Summerskill, attached to it; that it is a puny measure. I do not believe it is; I think it is a robust measure, even though a small one, and I hope that your Lordships will now give it a Second Reading.

On Question, Bill read 2^a, and committed to a Committee of the Whole House.