EMPLOYMENT MEDICAL ADVISORY SERVICE BILL (Hansard, 1 May 1972)

§ LORD DRUMALBYN
My Lords, I have it in command from Her Majesty the Queen to acquaint the House that Her Majesty, having been informed of the purport of the Employment Medical Advisory Service Bill, has consented to place Her interest, so far as it is concerned on behalf of the Crown, at the 569 disposal of Parliament for the purposes of the Bill. I beg to move that this Bill be now read a third time.

§ Loan DRUMALBYN
My Lords, in moving that the Bill do now pass, may I recall that at the Committee stage we had some discussion about the reduction in the cost of the Bill from nearly £1 million given in the Financial Memorandum of the original Bill to an estimate of about £850,000 stated in the Financial Memorandum to this Bill. Fears were expressed that the Government were contemplating economies which might be to the detriment of the service given under the Bill. I explained that the reduction in the estimates was due in the main to a reduction in the estimated cost of laboratory services. The noble Lord, Lord Shackleton, asked me to look further into the matter and suggested that at a later stage in the Bill I should amplify what I had said. Both estimates were necessarily approximate and in the interval there have been changes in the numbers and types of staff. But I confirm that the main reason for the decrease lies in the substantial reduction in laboratory costs from £200,000 to £75.000. I wrote to the noble Lord giving him the reasons for the reduction in some detail, but he suggested—and I agree—that it may be of interest to your Lordships if I summarise the main points.
Of the four main sorts of work involved —X-rays, hæmatology, cytology and biochemical tests—there have been reductions in the cost of all except hæmatology, where there has been a substantial increase. Chest X-rays are required when there is any fear that a worker's lungs have been damaged by dust. The cost of additional X-rays for the new Service was first estimated at £15,000 but is now estimated at £10,000. The main reason for this reduction is that X-rays for a survey of asbestos workers which were included in the first estimate have now been excluded becauses the survey is already in train and the casts should therefore not he attributed to the new Service. £12,000 was included in the earlier estimates for cytology; that is, checking the urine for any evidence of 570 bladder cancer. But this is already being done under the Carcinogenic Substances Regulations.
The major reduction in cost lies in the biochemical tests, which include all the tests on biological samples for the amount of industrial materials such as lead or mercury or of metabolites of industrial materials that they contain. The estimated cost of additional work in this field has fallen from £160,000 to £35,000. The main reason for this reduction lies in the decision to use estimations of blood lead in the supervision of lead workers rather than the excretion of coproporphyrin in the urine. This new method of estimating blood lead has been developed in the laboratory of the Medical Services Division, and can be done more cheaply and more quickly than the estimation of coproporphyrin, especially when the technical difficulties of transport of specimens of urine are taken into account. The introduction of this new method results in a saving of at least £100,000 in the laboratory costs of the National Health Service even allowing for some additional equipment and staff for the Department of Employment's laboratory.
To sum up, the short answers on the reduction in costs are that the saving of £125,000 in the costs to the National Health Service of providing additional laboratory facilities to the new Service is mostly a real saving in public expenditure and is due in a very great part to the development of new methods by the Medical Services Division of the Department of Employment, to some extent to more careful estimates, and scarcely at all to any reduction in the programme of work proposed for the new Service.
During the discussion on the Report stage of the Bill the noble Baroness, Lady Summerskill, moved an Amendment requiring consultation with representatives of trade unions or other organisations on the implementation of Clauses 3 and 4. I pointed out that these clauses really present very little scope for consultation, but what the noble Baroness and the noble Lord Lord Shackleton, were quite properly anxious about was that there should he the fullest consultation between employment medical advisers and workers or their representatives. I would assure them that the Department fully accepts that there should be, and intends to 571 ensure that there shall be, such consultation. The Bill makes it quite clear that the employment medical adviser must advise trade unions and individual workers about any health problems arising from their employment. This is spelled out in Clause 1(9), which was amended in another place to meet this very point. These relations with trade unions are not limited to consultation at headquarters with trade unions; they also include consultation on the shop floor. I realise that Clause 1(9) may not, at first reading, give this impression, hut throughout the Bill the bare legal phrases cannot fully reveal, or perhaps even suggest, the administrative arrangements which will give practical effect to the measure. There is nothing new about this. Factory inspectors already have instructions to make contact with trade union representatives and shop stewards when they carry out a general inspection. This practice is followed by medical advisers wherever it is appropriate and indeed a great deal of talking at this level does go on. Medical advisers will be instructed to do the same.
The noble Baroness was also concerned that trade unions should be involved where medical examinations were carried out, whether in the factory or elsewhere. The medical examinations which employment medical advisers will carry out as part of their duties will include tests, both those required under factory regulations (for example, hæmoglobins in lead workers, X-rays for compressed air workers) and those which are done on a voluntary basis, for example, on workers), and those who are done on or benzene. Any worker may refuse to have a medical examination, statutory or otherwise. Where a statutory examination is arranged, the results have to be entered in the health registers which the employer is required by Statute to keep. Disclosure of results is governed by normal medical ethics. As for disclosure to a worker who has been examined, the Department has already prepared administrative instructions for employment medical advisers to ensure that each worker is informed of the results of his examination, and that where the employment medical adviser thinks it the right thing to do, he is given specific details (for example, blood lead) and that 572 the employment medical adviser should ensure that he understands the significance of the results. Indeed the chief employment medical adviser has prepared a leaflet explaining the significance of various levels of blood lead for the employment medical adviser to give to a worker whom he examines who works in lead processes.
Administrative instructions also require the employment medical adviser to tell employers in general terms of the opinions which they have formed as a result of an examination they have carried out, and the same information is given to the appropriate trade union representatives. Such opinions must be confined to matters arising out of or in the course of employment or affecting the suitability of individuals for employment in particular work or processes. Clinical details about individual workers, however, must not be disclosed without the individual's consent. It is possible that the results of medical examinations or the opinions based upon them might imply criticism of environmental conditions. But it is the factory inspectorate, not the employment medical advisers, who are responsible for the supervision of the environment. Where an employment medical adviser thinks that the results of his medical examinations indicate that action to improve the environment is needed, he will get in touch with the inspectorate.
I hope, my Lords, that I have succeeded in removing most, at any rate, of the misgivings that have been expressed on the score either of parsimony in the financial provision for this Bill or of the extent of co-operation and consultations between employment medical advisers, employers and workers in implementing the practical provisions of the Bill. I trust that this Bill may now pass into law with the full support of the whole House.

§ LORD SHACKLETON
My Lords, in view of the prolonged adjourned debate that we have had on the Sound Broadcasting Bill I shall be brief. First, I should like to thank the noble Lord, Lord Drumalbyn, for the speech he has made. Perhaps our Amendments on Report stage were not originally as clear as they became after I had the opportunity to explain them. I must say that I found 573 it difficult to follow the noble Lord when he said he could not understand what my noble friend and I were after in the matter of consultation. His account of the changes in the tests and laboratory requirements, the change from the coproporphyrin type of test to this simpler test, will be of interest in a much wider field than purely your Lordships' House. The noble Lord was good enough to write me a long letter. I was not competent to judge it although I passed it to a number of friends. It throws an interesting light on the work of his Department, and there is a lot to be said for giving more publicity to their work. We discussed the possibility with the noble Lord of visits to the laboratories concerned. Perhaps I should take this opportunity of wishing good fortune to those who will be administering the new service. I have no doubt that the new employment medical advisers are men and women of high calibre. They will carry a heavy responsibility. I hope that the noble Lord and the Government have provided enough of them. If they have not, then I hope they will not hesitate to provide more because this is a matter of such profound importance to the happiness of individuals that the role they can play is a very great one.
On the subject of consultation, if the noble Lord's expressed views are fulfilled we shall be very happy. The difficulty is that even with the best will in the world, even with an employment medical adviser who is determined to do his duty, there are still liable to be some awkward employers. At no time in this debate have we criticised employers in a body; we have always recognised that the sanctions provided in the Bill are against the bad employer. I hope that the maximum publicity will be given to this matter and I urge the Government to issue a booklet or leaflet which would go to all employers explaining how this new service works and what the employers themselves can do to contribute to its success.
We welcomed this Bill in principle; we regretted that there was not more information in it and that we had to wait for Robens. At least in regard to one matter we have not had to wait for Robens: that is in the matter of penalties for obstruction not only of employment 574 medical advisers but also of factory inspectors. Your Lordships can be pleased that we have succeeded in doing what in another place the Opposition were unlucky enough not to be able to do. I believe this to be a real improvement, not because the particular penalty by itself is so significant but because it emphasises the need for a general raising of penalties in this field. We believe that it ought not to be necessary to employ these sanctions, but it is right to have them. I hope that with good co-operation this small Bill (which, after all, started in the days of the previous Government) will make a useful contribution. I should like to thank the noble Lord personally for his courtesy, particularly for answering in private some of the matters that we raised. I hope that good publicity will be given to this new service.

BARONESS SUMMER SKILL
My Lords, may I add my thanks to those of my noble friend? We are accustomed to receive courtesy from the noble Lord opposite. He has courtesy; I tell him that he is overworked and very often we have a dialogue. On this occasion I am impressed by the trouble that he has taken in examining in detail the complaints (let us say) that we made at the previous stage of this Bill regarding the relationship between the trade unionist, the medical adviser, the employer, and the unfortunate potential patient. I am particularly impressed that he has thought fit to put it on record in Hansard so that any trade unionist who cares to inform himself by reading this debate shall know precisely what his position is and what the position of the patient is. On behalf of these patients and trade unionists I should like to thank the noble Lord for that.

§ LORD SLATER
My Lords. I have been most interested in what the noble Lord the Leader of my Party and my noble friend Lady Summerskill have said on this Bill. I may perhaps have participated during the Committee stage had I not been prevented from doing so for other reasons. As a trade unionist my interest concerns what happens in regard to branch secretaries and so on. The noble Lord answering for the Government made special reference to 575 the inspectorate. Some time ago the matter of the inspectorate came up for serious consideration in another place, with regard to whether the position had been reached where we were able to say that big industrial establishments, such as I.C.I., who were responsible for alkalis and so on, were able to be served by the inspectorate, and as to whether the inspectorate were able to recruit the people required for such a service. The noble Lord need not reply to my particular question at this juncture if he is not in a position to do so, but it would be most interesting to have that information if it could he given at some time or other.

§ LORD DRUMALBYN
My Lords, I should like to express our welcome back to this House to the noble Lord, Lord Slater; I am glad to see he has recovered from his illness. I take note of what he says. This Bill does not concern the factory inspectors except on the question of penalties, but I will endeavour to get the answer for him and let him have it. I should like to thank very much indeed the noble Baroness, Lady Summerskill, and the noble Lord, Lord Shackleton, for what they have said. I take particular note of the point about issuing information to employers in this matter, and if I may I will write to the noble Lord and let him know what it is proposed to do.