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Tackling Occupational Disease - Developing New Approaches Occupational Health conference 14th March 2013

Judith Hackitt CBE FREng, HSE Chair

Opening Address: Tackling Occupational Disease – 'Working Together To Make A Difference'

Good morning ladies and gentlemen - I am very pleased to welcome you to this important event today which is focussed on making progress in tackling occupational disease. I would like to start by talking about how the idea for this conference came about. Back in December 2011 Dr Lesley Rushton provided the Board of HSE with an update on the Burden of Cancer study. The Board then engaged in further discussion about occupational disease at meetings in May and August 2012. In particular we were keen to understand both the extent of HSE activity in this area and how we could use this to catalyse even greater improvements through working with others. It was these discussions which led directly to the decision to hold this event today.

Many of you here today will be actively involved in preventing occupational disease in a variety of industries and workplaces, and you will already have seen some significant changes and some improvements in occupational disease over the years.  Numerous substances which are known to be particularly harmful to health have been phased out. New regulations have for some years demanded a much stricter testing regime on all new substances before being placed on the market, biocides and pesticides have also been subject to strict regulation for some time. The most recent major regulation – REACH means that over the next decade we can expect to see other existing substances being withdrawn or restricted in their use as they go through registration and evaluation.  But many other risks to health will have been impacted by smaller scale changes to procedures and training practices for example, often in individual businesses which have resulted in better control and reduced exposure.

Nonetheless many challenges still remain. Maintaining awareness and increasing levels of compliance with controls and exposure limits are vital to, making significant improvements in the level of occurrence of occupational disease into the future.

For many years now we have been able to report an encouraging story of the continual improvement in workplace safety.  The numbers of fatalities and serious injuries occurring in Great Britain's workplaces continues, overall, to show a decreasing trend – with 173 workplace fatalities occurring in 2010/11. But whenever these figures are reported some of you here today are very quick to remind me and others that the number of workplace fatalities is dwarfed by the number of people who die prematurely each year as a result of work related exposure to harmful substances and conditions. It is right that you should point this out and that is why we are here today. 

The picture on occupational disease is not encouraging. 

We know that part of this is exacerbated by the difficulties in reporting and capturing information on occupational disease.  Sometimes what’s being observed is clearly work-related, but other times the link isn’t so obvious.  Many of the conditions that we know can be caused by work have other, more common causes.  The obvious example here is lung cancer and smoking .  Many serious occupational diseases also have a long period of 'latency', some up to 30 years, between exposure and development of ill health and/or disease, making the links even more difficult to establish and also leading to a long delay between changes in working practices and exposures and a corresponding improvement in the numbers of deaths. 

Despite all of these limitations, figures quite clearly show that occupational disease continues to be a significant problem in the workplace resulting in both life-altering and premature life-ending illness.  In 2011/12 there were 1.1 million working people suffering from a work-related illness, with around half a million new cases per year.  There are also over an estimated 12, 000 deaths per year due to past exposures to harmful substances at work. 

The largest cause of death from occupational disease relates to exposure to asbestos and is accountable for 4,000 of these deaths.  A further 8,000 or more deaths are due to cancer, chronic obstructive pulmonary disease and other serious lung diseases.

Although new applications of asbestos have been banned for more than a decade, exposure to asbestos in buildings remains an issue for tradespeople and some users of buildings such as schools and even shops – as evidenced by particular high profile prosecutions.

Noting the difficulties in capturing information on the incidence of occupational disease, as I described just a moment ago, to strengthen its evidence base on occupational cancer, HSE commissioned Imperial College London to produce an updated and detailed estimate of the burden of occupational cancer in Great Britain. This is the study which Lesley Rushton reported on to the Board in December 2011. This has already helped to inform the development and prioritisation of practical measures to reduce the burden in the future. In particular the Board was struck by the clear message from the study that increasing levels of compliance with existing exposure limits would have a significant impact. But I do not want to pre-empt the discussion which will take place later on today. The purpose of this event is to agree together what actions we can all take to make a difference.

Because we must continue to work hard to ensure that these numbers fall and that the current pattern and toll of disease and early death does not continue into the future.

Although the scale of the challenge can appear to be daunting, there are many encouraging examples of activities that have made a real difference and many of you have been and are continuing to contribute to these activities and interventions.  I want to now talk through a few approaches that have already been used to make real changes and I hope that these examples will prove helpful when we consider how we can extend and build on our progress when we meet in the break out sessions later on. 
I am not going to cover all of the causes of occupational disease which you might explore later, but I do want to talk about some key examples of what is already happening.

I would like to share with you an update on the continued activity on asbestos.  In 2008 the “Hidden Killer” campaign, was launched.  The campaign was designed to raise awareness of exposure to asbestos amongst today’s trades people carrying out maintenance and construction jobs to make them aware that asbestos and the potential health risks are not just a problem of the past – but one that is very real and current and which could impact on their own health.

Although the spur for this work was initiated by HSE, it wouldn’t have been possible without the support, input and commitment from others to spread the word and more importantly to use the campaign as a catalyst to go on to develop more initiatives. The original HSE led campaign has since inspired:

Further supporting activity by the British Lung Foundation and their "Take 5 and Stay Alive" campaign for DIY enthusiasts has increased general awareness and reinforced messages of the risks associated with asbestos. This is a tremendous example of how we can increase the level of impact by working together and coordinating our efforts.

My second example is on respirable crystalline silica. Like asbestos, exposure to RCS has been known to be a problem for many years, but unlike asbestos it is also an ongoing hazard as materials containing silica are still in widespread use and exposure can result in Silicosis and COPD. Prolonged exposure to RCS under conditions that cause silicosis may also cause Lung Cancer.

Just one example of ongoing work aiming to reduce exposures to respirable crystalline silica in kerb, paving and block cutting is a 'supply chain initiative' which brought together representatives from the construction industry, manufacturers, hire companies and associations, local authorities, the Highways Agency, subject experts and training bodies.  They all came together to develop practical interventions and activities that have resulted in:

But, we must look at what comes next and what more can be done, as this is a current and widespread problem given that exposure to respirable crystalline silica is a potential risk in many everyday work activities which continue to take place.

My third example is on occupational asthma. Bakers are about 80 times more likely to develop occupational asthma than the average British worker. By working together to raise awareness of the problem, promoting and changing working practices and behaviours, significant contributions have already been made to tackling this issue.

You will all be aware that tackling occupational disease requires a number of different interventions. For my final example I want to talk about the role of surveillance and ensuring there is suitable supporting guidance available to help employers and managers understand and meet their duties under the regulatory framework for hazardous substances.  HSE has been undertaking a huge amount of work to update many aspects of its web based materials and I am pleased to be able to show you today what the new health surveillance website looks like.

Dealing with potential exposure to hazardous substances may require employees to undergo some form of health surveillance, and it became very clear to HSE that many businesses were having difficulty understanding what they needed do and how they should implement effective health surveillance programmes.  It is also important for everyone to understand that surveillance is of limited value if not accompanied by effective measures to control and limit exposure.

By working with a variety of partners, including occupational health professionals, trade associations, businesses and medical professionals HSE developed new web-based guidance on health surveillance, being seen here for the first time today. The new guidance:

The guidance has support from a number of organisations without whom we could not have developed a product that meets the needs of businesses, regardless of size or level of understanding.

We hope that you will find the site useful and we would appreciate any feedback and ideas for further improvement that you may have.

In concluding my opening remarks here today I want to remind you of one of the key principles which remains part of HSE’s "Strategy for health and safety in Great Britain in the 21st century".  In the strategy we call for everyone in the health and safety system to work with HSE and to be "Part of the solution". Since its launch the progress we have made on a variety of fronts has been considerable. Nowhere is this better illustrated than in the level of engagement and buy-in we have seen from others than HSE who are key to the health and safety system: trades unions, business leaders, organisations in the private and public sector and from many and various communities of practice in the field of health and safety. The level of support expressed has been remarkable.

But the strategy has more to say which is highly relevant to the theme of today.

It highlights that we all have important roles to play in improving the health and safety system and it's important that we all carry out our respective roles and do what we are best at.

Let's start with HSE, in his report 'Reclaiming health and Safety: a review of progress one year on' which was published in January this year, Professor Ragnar Löfsted, welcomed HSE's commitment to reduce occupational ill health and in the context of the HSE strategy, we have 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. We do this through a variety of activities including: inspection, investigation, enforcement and provision of advice and guidance.

But, as my examples have shown, HSE cannot tackle things alone.  We know that the characteristics and structure of industries vary, being a mix of public, private and indeed third sector employers of all sizes. Inevitably, within that mix, not everyone is going to be at the same level in terms of being able to manage their risks and being able to deal with the challenges, and of course, we have to acknowledge that different organisations will respond to different types of stimuli and interventions in their own way. Therefore, we need to ensure that we have a range of activities in place to meet the varying needs of businesses if we are to make progress.

So we very much see HSE as a catalyst.  Yes we can, and indeed do, carry out inspections, enforcement, investigation and provide advice and guidance. In the last year I have been out on a day of inspection visits with one of our occupational health inspectors and seen how they interact with businesses on the ground. But to be really successful in tackling the challenge we face in occupational disease we need all parts of the health and safety system to come together, to develop a rich picture of what the barriers, levers and solutions might be, and I hope the examples I have described earlier help to illustrate what might be possible in other areas.

So to today - this event is about Developing New Approaches to tackling Occupational Disease. We want to build on our collective experience of tackling occupational disease issues in the workplace and are asking you, the delegates, representing different parts of the health and safety system, to explore together the issues and identify possible solutions in the break out sessions later on.

The break out sessions will be the most important part of the day and I hope you are ready and willing to play a full and active part.  Your ideas and contribution will be critical to making steps toward improving the incidence of occupational disease.  It is you, the industry, the occupational health professionals, the Trade Associations, the Unions and the training bodies that need to join together with us to develop shared solutions. Only by working together can we spot problems, share good practice, develop ideas and build networks that together will tackle the causes of occupational disease.

To help us move on and make real reductions in the numbers, we need to have a common understanding of the challenges that we face, and what we can realistically achieve. Our next speaker, Professor Sir Anthony Newman Taylor will tell you more about this.

To sum up; this is a big challenge, with many complex aspects that can only be truly understood and tackled by us all working together.  I am certainly looking forward to hearing about your discussions, debates and ideas today. I hope you all find the event stimulating and valuable. We know that tackling occupational disease is a long journey, but today is most definitely an important staging post on that journey for us all to take stock and to go away from here reinvigorated to take on the challenges we face and which we need to tackle.

Updated 2013-03-15