The changing face of OH

The 2002 Ruth Alston Memorial Lecture was given by Dr David Snashall, chief
medical adviser to the Health & Safety Executive. His subject was
‘Occupational health support – who needs it, who wants it and who’s going to
provide it?’. This is a transcript of what he said

In setting the strategic context for my paper, I would like first to
recognise the considerable emphasis put on occupational health by the present
UK Government since 1997 and identify the recent key documents. These are:

– Revitalising Health & Safety (2000)

– Securing Health Together (2000)

– Improving Access to Occupational Health Support: the Report of the
Occupational Health Advisory Committee Working Party, 2000 (OHAC
Recommendations 2000)

– The Strategic Plan and Priority Programmes: Health & Safety
Commission/ Health & Safety Executive, 2001

From these a Strategic Plan 2001-04 had been identified, namely to:

– Reduce by 30 per cent the number of working days lost per 100,000 workers,
from work-related injuries and ill health by 2010

– Reduce the incidence rate of fatal and major injuries by 10 per cent by

– Reduce by 20 per cent incidence rate cases of work-related ill health by

– Achieve half of each improvement target by 2004

To create a framework for achievement, eight priority programmes have been
set up; four of these relate to specific groups of specific injuries or health

1) Falls from height

2) Musculoskeletal disorders

3) Slips and trips

4) Work-related stress

The others relate to particular industry groups: agriculture; workplace
transport; construction and health services.

There are three other relevant developments under way, the pilot stage of a
project to provide occupational health support for the construction industry,
the Survey of the Use of Occupational Support (2002) and the Government Review
of the UK position on the ratification of the International Labour Organisation
(ILO) Convention 1611, for which the Health & Safety Commission and the
Health & Safety Executive will be the lead players.

Setting all these developments in the context of a holistic approach to
occupational health, this covers:

– The effects of work on health, incorporating prevention

– The effects of health on work, addressing the fitness of both workers and

– Rehabilitation and recovery programmes

– Helping the disabled secure and retain work

– Managing work-related aspects of illnesses which have multi-factorial
causes (eg stress and musculo-skeletal disorders)

Issues surrounding ILO Convention 161

I feel it is important to stress the complex issues surrounding the
ratification of the ILO Convention 161 (1985). Within the convention, Article 3
has two key clauses

1. Each member undertakes to progressively develop occupational health
services for all workers, including those in the public sector and members of
production co-operatives in all branches of economic activity and all undertakings.
The provision should be adequate and appropriate to the specific risks of the

2. If occupational health services cannot be immediately established for all
undertakings, each member concerned shall draw up plans for establishing such
services in consultation with the most representative organisations of
employers and workers, where they exist

Article 5 states services should make a contribution to measures of
vocational rehabilitation and Article 6 describes how provision for the establishment
of occupational health services (OHS) is to be achieved – by using the
legislative route and ‘in any other manner approved by the competent authority
after consultation with the representative organisations of employers and
workers concerned’.

But if you examine an earlier ILO Recommendation, no. 112 (1959), clause 4,
suggests that ‘in order to extend occupational health services to all workers,
OHS should be set up for industrial, non-industrial and agricultural
undertakings and for public services. Provided that where occupational health
services cannot be immediately set up for all undertakings, such should be
established in the first instance for undertakings:

– Where the health risks appear greatest

– Where the workers are exposed to special health hazards

– Which employ more that a prescribed minimum number of workers’

Clause 6 states that the role of the OHS should be essentially preventive,
while Clause 7 states that ‘OHS should not be required to verify the
justification of absence on grounds of sickness’!

Two further clauses are also of some relevance – namely 13 (every OHS should
be placed under the direction of a physician who will be directly responsible
for the working of the service, either to the management or body to which the
service is subordinated) – and 17: (Nursing staff attached to OH services
should possess qualifications according to the standards prescribed by the
competent body.)

Changes to the workplace

It is nearly 50 years since Recommendation 112 was published, and there have
been significant changes in the UK industrial scene. This includes the growth
of the female and ethnic minority workforce and significant changes in company
structures.  Within small- and
medium-sized enterprises (SMEs) 99 per cent of private sector businesses have
fewer than 250 workers, for example.

Over the last 50 years there has also been a decline in manufacturing and in
the number of comprehensive in-house OH services. This is coupled with changes
in illness behaviour and an increase in absence attributable to sickness. There
has also been an increase in the costs of providing services.

These ‘needs modifiers’ are important if a review of occupational health
service needs is to be undertaken.

Such massive domestic changes must also be considered alongside emerging
workplace health challenges in Europe. The ageing workforce have different
occupational health needs, there are changes in the retirement age and issues
surrounding pensions.

There is a widespread change in the structure of employment, with an
increase in the number of home workers. There is also increased diversity of
traditional work structures, with the hotel bedroom (or car) now routinely
being used as a novel workstation. Increased interpersonal contact and close
management are being linked to psychosocial problems, as are unpredictable
working hours. And there is evidence of reports of violence and harassment, as
well as drug and alcohol abuse.

With the decline in large manufacturing companies, traditional OHS are
disappearing. There are more tailored OHS and additionally, sources of
sector-specific advice from technicians, safety reps and materials suppliers.
Today’s workers now have access to the NHS via their GPs or associated
services, while the Department of Work & Pensions continues to play a part
in the assessment of work-related illness and injury.

If you consider the details of the OHAC Recommendations2, you will notice
that there is no standard solution being promoted. OH, public health and
rehabilitation go together as the basis of ‘health, work and recovery’. These
identify the need to develop local partnerships and stress the solutions are
not always ‘medical’. They restate that employers are responsible for managing
health risks at work, and there is a need to involve workers’ representatives.
The OHAC report also noted that awareness drives demand for services and

Some of the recommendations have already been addressed, for example, the Investors
in People (IiP) has already been extended to cover occupational health and
safety, while guidance on who is competent to give advice was published in
2000. Research into the effectiveness of provisions using self-assessment
strategies is already in hand. A pilot programme providing a telephone helpline
is under way in East Anglia and in the Lanarkshire area of Scotland.

HSE and the Inland Revenue are working together to provide advice to SMEs on
tax deductibility for health and safety promotions, but a proposal to pilot a
scheme for good OH practice has been ‘parked’ for the moment.

A strategy to promote health and safety awareness among trades union members
is already in hand. To involve safety representatives and the workforce, more
training has been offered through the TUC, and a training initiative funded by
the HSC/E – called body mapping – has been very successful. Primary Care Trusts
have recruited occupational health specialists and there are moves to extend
NHS provisions via NHS Plus.


During 2002 the Institute of Occupational Medicine (IOM) conducted a review
of the present situation regarding H&S at work. The report concludes health
is secondary to safety, services are mainly provided by private doctors and
nurses; there is rarely a budget for these provisions and – importantly – SMEs
are happy with the status quo.

Based on these factors, I would like to venture some predictions of future
manpower needs, though I must stress that this is essentially guesswork and not
in any way an official HSE view.

There will be a definite need for some increases in doctors and nurses,
ergonomists and physiotherapists. A smaller increase will be needed for HR
professionals and those involved in welfare. However, I think there is unlikely
to be any change in the number of safety professionals needed, although a
reduction in occupational hygienists seems likely. All these groups are already
looking to modify their skills to remain of value in a rapidly changing

But the real area for development is in the recruitment and involvement of
all kinds of psychologists – clinical, educational, occupational and health,
(though I do not include counselling as part of this OH & safety
provision). Capacity building to meet these needs will have to be met by
increasing the specialist OH input to pre and post-registration nursing
programmes, as well as extending the research and teaching offered by academe.

Dr David Snashall is chief medical adviser to the HSE


1. ILO (International Labour Organisation) has formulated international
labour standards in the form of Conventions and Recommendations. There are
around 70 pertaining to occupational health issues. Standard 161 states that,
"occupational health services are entrusted essentially with preventive
functions and responsible for advising employers, workers and their
representatives on maintaining a safe and health working environment, as well
as on the adaptation of work to the capabilities of workers."

2. There are 30 OHAC recommendations, details of which can be viewed online

Comments are closed.