The introduction to the recent discussion document issued by the UK Health and Safety Executive (HSE) [1] states that the major initiatives of the Health and Safety Commission strategy for 2001-04 " . . . of Revitalising Health and Safety and Securing Health Together have taken us forward but we now need to take stock and build that for the future". As an exercise in communication, as this introduction shows, the discussion document fails, with a numbing style and the use of such phrases as "inspire our traditional stakeholder . . . goal setting system . . . prioritise our interventions". These problems might have been overlooked if the content of the document had been more informative; however it does not provide the data to confirm how much further forward HSE's existing strategy has taken the HSE, nor does it quantify the order of future demands or the facilities that would be required to meet these demands

The document acknowledges that "we do not lead the world in occupational health", but does not explain how it has come about that a country which gave the world Thackrah, Oliver, Middleton, and Hunter, established chairs in occupational medicine occupied by such men as Lane and Schilling, and an MRC Pneumoconiosis Unit directed by Fletcher and by Gilson, and that at one time provided the major international educational resource in occupational health in MSc courses, has allowed occupational medicine in the UK to reach the sorry state that it finds itself in today. HSE no longer has a Chief Medical Advisor or a flourishing Medical Advisory Service. If the international economy is offered in extenuation for this decline, it should be noted that Finland, for example, continues to support four institutes of occupational health and remains active in the developing world.

The HSE paper calls for a greater involvement in rehabilitation. Some 30 years previously, HSE's Employment Medical Advisory Service had specialists in this field servicing units that successfully assisted the long-term unemployed to return to work. Political will established rehabilitation services in the early 1970s and political whim had destroyed them by the early 1980s. Political forces have also been responsible for incremental cuts to other occupational health and safety initiatives; the travails of the health and safety commission and its executive have been described by the Director General of HSE from 1983 to 1995. [2,3]

HSE [1] acknowledges that over the past 10 years local authorities have had increased demands made on them, and that local authorities' resources dedicated to health and safety enforcement have undergone a year on year decline. However, the document is less than frank about what has happened to HSE's own resources. The document suggests there is a serious shortage of resources since it states that there is an urgent need to reduce activities in some areas to provide for greater involvement in others, but without being provided with the actual data, the reader is left wondering how this reallocation of resources is to be achieved without jeopardising areas where reduction of resources will take place.

The UK's heyday of occupational health and safety of the early 1970s was short-lived, and followed by a policy of reducing staff and resources, which, in shades of Orwell, was euphemised by the then chief employment medical advisor in discussion as "cutting out the fat"; unfortunately this operation lacked surgical precision as HSE's skeleton and higher nervous system also suffered.

In their discussion document, [1] HSE declares the need to "be more effective in forming partnerships with stakeholders who may be more able than us to influence particular agendas". Since the HSC is a tripartite body, on which industry, unions, and local and central government are represented, and with HSE's consultative committees paralleling this representation, it is not clear which "stakeholders" remain to be introduced into partnership, what are the benefits and risks of this partnership, and how they are to be "managed". The results of market research carried out by HSE into industry's perception and use of Occupational Exposure Limits showed how despite HSE's vast amount of publicity and excellent guidance material over 10 years, the awareness of the Control of Substances Hazardous to Health and understanding of Occupational Exposure Limits were abysmal among their "stakeholders". [4]

Far from the Robens report [5] having led to model workplace regulation, [6] it has been suggested that the Health and Safety at Work Act's emphasis on self-regulation and goal-setting has made it vulnerable to deregulatory initiatives. [7] Of late, occupational health and safety have been subject to ministerial inattention, so that nothing short of a token of intent by the Secretary of State to establish a committee of inquiry fully to review health and safety at work will be sufficient to convince that there is a commitment to occupational health. As it is likely that demands will always exceed resources, good quality data will be needed by the Health and Safety Commission to inform their value judgments for rationing and allocating resources.

I have no conflict of interest to declare.
Morris Greenberg

74 North End Road, London, NW11 7SY, UK.
Email: gillmorris.greenberg@btinternet.com)

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References

1. Health and Safety Executive. Strategic thinking--work in progress. [pdf] (accessed Nov 28, 2003).

2. Rimington J. The politics of health and safety in the UK: Part 1. Occup Health Rev 2003; 105: 35-39. [PubMed]

3. Rimington J. The politics of health and safety in the UK: Part 2. Occup Health Rev 2003; 106: 35-39. [PubMed]

4. Topping MD, Williams CR, Devine JM. Industry's perception and use of Occupational Exposure Limits. Ann Ocup Hyg 1998; 42: 357-66. [PubMed]

5. Committee on Safety and Health at Work. Report of the Committee 1970-1972. Cmnd 5034. London: HMSO, 1972.

6. Health and Safety at Work Act 1974. Chapter 37 London: HMSO.

7. Beck M, Woolfson C. The regulation of health and safety in Britain: From Old Labour to New Labour. Industr Rel J 2000; 31: 35-50. [PubMed] Shortcut to: