Occupational medicine is in demise

More than 13 000 deaths a year in Britain are directly attributable to occupational exposures, the Health and Safety Executive (HSE) says.1 These are mainly from cancers (predominantly related to asbestos) and respiratory diseases (caused by dusts and chemicals). Fewer than 15% of all working British people are likely to have access to occupational health services.2

Britain is the only major European country that does not have a legal requirement for the provision of occupational health services, by the state or employers. The Health and Safety at Work etc Act 1974 implies a duty on the employer based on risk,3 but this is minimally enforced.

In other major European countries occupational health services are either incorporated into national health and social services for all working people or are statutorily required through risk based insurance levies on employers, who are obliged to purchase comprehensive occupational health, rehabilitation, and compensation services from independent providers.3

Statutory reporting of occupational disease in Britain started in 1895. In 1973 the government brought all doctors who were part of the Factory Inspectorate into the Employment Medical Advisory Service (EMAS).4 EMAS was tasked with overseeing high risk industries (box) and was envisaged to have 100 full time …