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Speech to Society of Occupational Medicine, Annual Scientific Meeting, Edinburgh - 9 June 2010

Judith Hackitt CBE, HSE Chair

On behalf of HSE, I would like to thank you for offering us this opportunity to speak at your annual scientific meeting. Some of my colleagues have been here throughout the 3-day event and have briefed me in the wide range of topics that have been covered.

Over the next hour or so, our intension is to put the very important work that you do in the broader context of the health and safety system.

There are a number of areas where we have common interest and common purpose. But it is also important to distinguish between our role as the regulator for the health and safety system and the roles that you all play as professionals in Occupational Medicine in a wider health care setting. Taking into account that your interests will often extend beyond the bounds of the health and safety system into issues related to welfare, well being and workplace rehabilitation.

The HSE launched its new strategy for Health and Safety in Great Britain in the 21st Century just over a year ago. When the former Commission became the new board of HSE in April 2008, we decided that it was time to reset the direction for the system and to drive the impetus for accelerated improvement.

The strategy calls on everyone who is involved in health and safety to be 'Part of the Solution'. Today, we want to take the opportunity to explore, what being 'Part of the solution' means for us and for occupational health and safety professionals both within and outside of HSE.

Since the strategy's launch, it is clear that turning knowledge into reality through concrete actions will require us all to be active and to play our respective roles. There is a good deal to do - especially on health, as you know only too well from what you have heard over the last few days. In particular, we need to be clear about priorities and about who does what.

In these challenging financial times, it is even more crucial that duplication of effort and overlap are removed. But in doing so we must equally be alert to the danger of allowing gaps in our coverage to develop that could leave workers needlessly at risk.

We believe that our strategy is well aligned with the programmes being outlined by the new government. But it is more important than ever that we ensure that publicly funded bodies continue to strive for efficiency and effectiveness - which means sticking to our areas of strength and expertise and being clear about who leads on what.

For many years now we have been able to report an encouraging story of continual improvement in workplace safety. The numbers of fatalities and serious injuries occurring in Great Britain's workplaces continues to show a steady year on year improvement -180 workplaces fatalities in 2008/9 and the unofficial statistics for 2009/10 indicate a further improvement for this year also.

But the picture on occupational health is not so encouraging. We know that in part this is exacerbated by the difficulties in reporting which leads to less robust data sets. In addition, there's also the difficulties that come when trying to capture information related to such a broad range of health related issues. Sometimes what's being observed is clearly work-related, but on other occasions the link isn't so immediately apparent. Many of the conditions that we know can be caused by work have other, often more common, causes - smoking and lung cancer, for instance, but also leisure activities and back pain. We cannot simply count such cases - we have to find other ways of assessing their importance and whether or not we are managing them successfully.

However, taking these issues into account. In 2008/09, 1.2 million people reported suffering from an illness which they believed was caused or made worse by their current or past work. Over ½ million of these were new cases. In excess of 2,000 people died from mesothelioma and we have good evidence that thousands more die each year from other occupational cancers and lung diseases. Because, with the exception of mesothelioma, we cannot simply count individual work-related deaths from these causes. The numbers have to be estimated rather than counted. But, as you heard earlier from Dr Lesley Rushton, the latest estimates suggest that the annual number of deaths from work-related cancer is currently around 8,000.

You will be aware, I'm sure, that recently the WHO's International Agency for Research on Cancer has classified shift work involving disruption of the body clock as probably carcinogenic and increasing, in particular, the risk of breast cancer in women doing such work. The implications of this are clear. Again, citing Dr Rushton's work, she suggests that this could add about 2,000 potentially avoidable breast cancer cases each year if further research confirms a cause and effect association. This worrying development demonstrates the point that we are still learning about the possible workplace exposures causing ill-health that we need to address, while continuing to tackle those which we already know about such as asbestos, chemicals and dusts including silica but where this is still work to be done.

It's accepted that the current pattern of work-related deaths largely reflect the industrial conditions of the past. The death toll this legacy has left us is great and we must ensure that it does not continue into the future.

But we can take encouragement that the evidence suggests, in general, that exposure to the major hazards has been declining. And for asbestos the evidence is that rates of mesothelioma at age under 55 are now falling. We can take this as evidence of a positive effect of earlier action to better control exposures.

We all need to re-invigorate our efforts to address these hazards given their serious impact on individuals and society.

But evidence from the HSE sponsored GP reporting scheme for work-related illness clearly shows the importance of musculoskeletal disorders and - the commonest type of work-related illness and mental ill-health - the most costly in terms of days lost from work. These data record 1,200 cases of work-related illness per 100,000 workers.

Other surveillance schemes also provide important data on occurrences of ill health and trends. For example, in 2008 the scheme involving hospital dermatologists recorded over 1,200 cases of work-related dermatitis.

Recorded cases within the scheme have been falling over the last ten years, and detailed statistical analyses provide evidence that there has indeed been a genuine reduction in the incidence of work-related dermatitis over this period.

In the context of HSE's new strategy, we have very clearly positioned our role and indeed our mission as being the prevention of death, injury and ill health to those at work and those affected by work activities. Many of you, however, will have been involved in all aspects of the health and well-being agenda.

That is an example of ensuring that we all do what we are best placed and competent to do. It is not within HSE's core skill set to manage down levels of sickness absence in the workplace. But we can play, and will continue to play, an important part in reducing/eliminating the causes of ill health in the workplace.

Even in periods when the economic conditions are more favourable, we still have to make difficult choices about what our priorities are. But, in this current era, we are attaching even greater importance to understanding what our priorities need to be when making interventions.

These are based upon seriousness, numbers affected and tractability of the problem. And Peter Brown will provide further details of our work plans in a moment.

As OH professionals, you must all also undertake a similar exercise to profile the risks which are of greatest concern to those organisations that you work with - and ensure that those with the greatest impact are the ones that are being tackled. Employers are most pressed by the here and now circumstances of running a business, and for them sickness absence is a big issue. But I know that on the first day of your meeting you heard about the serious consequences of duty holders getting it wrong about risks associated with their enterprises. This should figure in your priorities with them too.

We want to see all companies ensuring that their employees are both confident and competent in dealing with the things that really matter when it comes to health and safety. We believe that the recently promoted standards for OH services, and the plans for their accreditation are a good thing. And the revalidation of doctors -involving appraisal, CPD, reflection and feedback from others will be important too. We cannot expect duty holders -the business owners - to be competent in all things themselves - so it is important that they have access to and then confidence that they're receiving the advice that they really need. This is how we can ensure that the action that is taken is reasonable, practicable, sensible, and focussed on the real issues.

Raising standards of knowledge overall and competence within the profession are important and we therefore welcome the work of the Faculty of Occupational Medicine in taking forward both the standards for OH practise and the process of revalidation for occupational physicians. We do believe however that this work has to be combined with a greater understanding of the risk profiles of the workplaces which you cover to ensure that the knowledge is applied to addressing the real risks as they exist and as they present themselves in each workplace.

HSE is a strong believer in partnership working. (And) the standards make it clear that when organisations do work together to bring their respective knowledge and skills to the table, better outcomes are the result.

But this is not simply an issue for HSE and OH professionals. We collectively have a job to do to raise the level of awareness and ownership of OH matters among duty holders themselves. The very wide range of circumstances encountered in workplaces make it impossible for HSE or any one OH professional to be expert in them all.

As I said earlier, I believe the time has come for part of your role to be about advocating a much more proactive approach on the part of duty holders, to move 'health' out of the 'too difficult' box and start to tackle the issues which are their primary responsibility. Unless and until this happens leadership on work-related health will be out of balance with that on safety.

Our strategy also talks about the importance of workplace involvement. By its very nature, the work of OH professionals means engagement with members of workforces, but in your case there is the added challenge of sitting at the interface between management (who engage you) and the workforce - to whom as individuals you have other responsibilities as a doctor.

Whilst there are clear sensitivities here that need to be borne in mind -and respected -there is also an opportunity for OH professionals to provide valuable insight to employers based on their experience of interactions with employees.

I think there is considerable agreement that partnership working and acting in an advisory capacity is the preferred route we all want to take to improving work-related health. But we must also be clear that there is a place for enforcement in health issues - where and when there is clear evidence that the health of employees is being harmed or put at serious risk by conditions in their workplace.

Here again we come back to the need to be clear about our respective roles and responsibilities and to acknowledge that different organisations will respond to different types of stimuli and interventions in their own way.

I hope that this overview has demonstrated the importance that HSE attaches to occupational health for successful implementation of our strategy for Health and Safety in the 21st Century and the critical job the professionals, such as yourselves, have in helping us achieve it.

As I promised, I will now hand over to my colleague - Peter Brown and John Osman - who will talk some more about our specific programmes and the resources we will be applying to taking them forward. However, let me close by reiterating my thanks to you for the invitation to speak at this meeting on the important milestone of the Society's 75th Anniversary.

You are, and will continue to be, an important partner in addressing the causes of harm to health which occur in Great Britain's workplaces. We not only need to achieve more progress, we need to be clear about how we will raise the value of our respective contributions to achieve even greater impact.

Updated 2010-06-14