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Parliament

Employment Medical Advisory ServiceMoving the second reading of the Employment Medical

Advisory Service Bill, the Under-Secretary of State forEmpleyment, Mr. DUDLEY SMITH, said that though theBill was a short one, it took an important step forwardin occupational medicine. With the establishment ofthe E.M.A.S. the Bill would not merely modernise the

appointed factory doctor service but would also set up forthe first time a focus for the development of occupationalmedicine in the country. The nucleus of the service wouldbe the newly formed Medical Services Division of theDepartment of Employment, which had taken over theduties of the former medical inspectors of factories andwhich also coordinated on a professional level the workof doctors in Government training-centres and industrialrehabilitation units, together with that of the Department’sregional medical consultants. The Medical ServicesDivision advised on any medical problem arising fromemployment, including fitness for work, placement in work,industrial rehabilitation, and mental health. The E.M.A.S.would also undertake the medical supervision of youngpeople in employment and the medical examination ofworkers in hazardous trades. The new service was not,and was not intended to be, a comprehensive industrialhealth service, if by that phrase was meant a service whichenvisaged more doctors in more factories. The servicewould work in the closest collaboration with the FactoryInspectorate and also with the industrial rehabilitationservices and the psychological services of the Departmentof Employment; it would not, however, providetreatment, which was a matter for the National HealthService. While the new service would spend much of itstime on the day-to-day problems of industry, it would alsoundertake surveys and epidemiological studies in relationto both long-term and short-term hazards. The routinemedical examination of all young people entering factoryemployment was to be abolished, but standard forms con-cerning the health of school-leavers would in future besent to the E.M.A.S. as well as to the Youth EmploymentService.

It had been questioned whether it was right to legislatewhile the Committee on Safety and Health under thechairmanship of Lord Robens was still sitting, but LordRobens had made it known that he saw the reform of the

appointed factory doctor service as a constructive measurewhich would prejudice neither his committee’s recom-mendations on safety and health nor possible further

development of occupational medicine within the contextof the general health services. It had also been suggestedthat the establishment of the E.M.A.S. should be deferreduntil the N.H.S. reorganisation was complete, or that theE.M.A.S. should be part of the N.H.S. and therefore includedin its reorganisation. There was, however, nothing in theE.M.A.S. proposals as at present drafted which prejudicedthe issue of what arrangements might be most appropriatein the long term for occupational medicine. The newservice would work in close cooperation with the NationalHealth Service and with the existing works medicalofficers. The nucleus of the new service would be the 50doctors already employed by the Department of Employ-ment, and about 50 more full-time doctors would be

appointed. It was also proposed to bring 12 nurses intothe service.

Mr. HAROLD WALKER said that the Bill had been unjusti-fiably delayed-it had been elbowed aside by the determina-tion of the Government to introduce the measure to curb

the trade -unions. The original Bill, which had been pre-pared by the previous Government, had dealt not onlywith industrial health but with industrial safety as well,but the present Government had deliberately omittedfrom the Bill anything to do with safety, including theprovisions for worker representation and safety committees.Mr. PHILLIP HOLLAND said that there did not seem to beany provision in the Bill for financing the E.M.A.S. to carryout research projects in the behavioural and environmentalspheres.

Dr. DAVID OWEN said that he thought the Bill wouldprove to have delayed the introduction of a comprehensiveoccupational health service. All that was being done bythe Bill was to add to the 19 medical inspectors of factoriesa further 50 full-time medical equivalents, but that wasonly a fraction of the medical manpower in occupationalhealth services, which was mainly provided by the medicalofficers in industry employed by some private companiesand some nationalised industries. Voluntary provisionamong major industries had made a great contribution tooccupational health, but in recent years it had virtuallyceased to expand. Yet it was clear that the Robens Com-mittee would not produce any major recommendations forthe long-term future of the occupational health service.There were two ways in which a comprehensive occupa-tional health service could be provided. There could bean external service organised for industry by the Govern-ment, paid for by taxes, and part of the N.H.S. The alter-native was an internal occupational health service organisedby industry under legal compulsion by the Governmentand with minimum standards controlled by the Govern-ment. The area health boards could take responsibilityfor occupational health, and in areas of high industrialdevelopment should have a specialist in occupational healthto stimulate local action and provide an advisory service.The present Bill did not have widespread support, andmany of those involved in occupational health were afraidthat it would be used as an excuse for some years aheadto do nothing substantial. Mr. HAROLD WALKER said thata comprehensive occupational health service was some-

thing which not only went beyond the scope, resources,and responsibility of the Department of Employmentbut which would involve a fundamental recasting of theN.H.S. The new service was intended to be chiefly anadvisory one.Mr. DUDLEY SMITH said in reply to the debate that

industrial health and industrial safety were two entirelydifferent things and it was right that they should be dealtwith separately. The cost of research carried out by thenew service would not come out of the medical fees, whichwere designed merely to pay for the cost of examinationand tests for employees. Research would be a generalcharge on the Department of Employment. One of thethree main principles of the service would be that it wouldbe concerned in quite a big way with disabled people,the Department’s performance in regard to disabled peopleover a period of years had not been altogether satisfactory.The laboratory services for the E.M.A.s. would be providedby its own central laboratory and by designated N.H.S.laboratories. The Bill was not a pretext for not setting upan industrial medical occupational service. It embodied a

well-thought-out approach to the problem of satisfyingthe real needs of people in industry while avoiding anyoverlapping with the facilities available under the N.H.S.Moreover, the new service would enlist the cooperationof doctors now employed in industry by employers, and theresult would be a national centre of intelligence in occu-pational medicine which would be of help to all doctors inindustry while, at the same time, advice on occupationalmedicine would be available to small employers and toemployed persons, who had never had it before. The Billwas read a second time.