 Hello, and welcome to the 29th meeting of the Social Justice and Social Security Committee. We have no apologies for today's meeting. Our first item for business for today is a decision to take agenda items 3, 4 and 5 in private. Are we all agreed? Yes. Thank you. A confirmed agenda item was итag gen carefully how important it to be angin the second evidence session on the Scottish Employment Injuries Advisory Council bill or SCIAC Bill, for short. It was introduced by Mark Griffon, a member's bill, being in the MSP on 8 June 2023, and it is currently at stage one. The bill would create a Scottish Employment Injuries Advisory Council to advise Scottish Ministers on employment injuries assistance. It is proposed that the council would have three functions. To report on draft regulations for employment injuries assistance, replacing the Scottish Commission on social security drill in this, to report to the Parliament and ministers on any matter relevant to employment injuries assistance, and carry out commission or support research into any matter relevant to employment injuries assistance. I welcome our panel for today's evidence session on the bill. Lucy Kenyon, non-executive director and past president at the Association of Occupational Health and Well-Bean Professionals, who is joining us online. Professor Ewan MacDonald, chair of the academic forum for work and health, hosted by the Society of Occupational Medicine, who is joining us in the room. Thank you very much, both of you, for accepting our invitation. A few points to mention about the format of the meeting before we start. Please wait until I, or the member, ask him the question, say your name before speaking. Don't feel you all have to answer every single question, and if you have nothing new to add to what's been said by others, then that's okay. Please allow our broadcasting colleagues a few seconds to turn your microphone on before you start to speak. For Lucy online, you can indicate with an hour in the chat box in Zoom, if you wish to come in on any of the questions. Can I ask everyone to keep questions and answers as concise as possible? I'm now going to invite members to ask questions in turn, as agreed. I'm going to invite Jeremy Balfour in. Thank you. Thank you, community. Good morning and good morning to the panel. Thank you both for coming along today. I'll start with Professor Macdonald, if that's okay. What involvement of any do you have with the industrial injuries advisory council, or matters related to industrial injuries disablement benefit? No formal involvement. And informal? I know most of the people on the committee, and it's quite relevant to the job that I do. I would ask to consider joining it, but I didn't join it because they have no infrastructure of support for research and they'll do their research in their own time in the evenings, and they're not even got that sort of IT-based or what they do, is my understanding. That's helpful. I don't know whether Lucy you want to come in and answer as well, please. Yes, I don't have as much detailed knowledge as you and around the scientific interests, but certainly I know that having had conversations with the Manchester University team and formally with Birmingham University in terms of investigating industrial diseases particularly, which is my expertise, but also, sorry this is my first time speaking, just to gather my breath, the reporting, so looking at the reporting structures and how we can make sure that diseases that could be occupationally related are reported in through thaw and epiderm, certainly I know that there's an awful lot of work that doesn't seem to be a formal structure yet through which we can encourage reporting and early symptom reporting actually to prevent occupational disease, which is something I think is really important. Thank you very much, that shouldn't be helpful. Thank you. Okay, thank you. I'm now going to invite Ross McCallan, thank you. Thank you and welcome both. I'm going to ask both of you this question and it's very informative based on the answer you've just given. If I could start with yourself, Lucy, if that's all right. Given the answer you've given to us and taken into consideration that there's no proactive way of looking at this, the industrial injuries advisory council recommends which conditions and occupations are included in the prescribes list for industrial injuries, which we've already alluded to. So, in your experience, does this have any wider influences on the extent of which employees are supported or any preventative measures that are put in place in the workforce? At present, in my experience, I have an independent practice. I look after small and medium-sized employers and so, in my very small practice, I have two people who I have referred through the GODS network, which is the occupational respiratory disease service, who, as a result of not having that kind of awareness of occupational diseases, came to me at quite a late stage and then we were playing catch-up on the diagnostic process. I did anticipate this question and what I would like to do is actually go away and then formally respond to you in writing so that I can give some specific information backed up by the evidence base, but I do have a concern around the ability to actually protect, prevent and identify occupational disease. We also have a very, very lack of occupational physicians and that obviously impacts the opportunity to diagnose people with diseases and GP's and respiratory consultants in particular, although we have the GODS network, do not appear when I have correspondence with them to have the awareness or to exclude occupational disease as a possible cause for the symptoms that their patients are presenting with. Yes, thank you and I think any evidence that comes in obviously will look at relevance and what have you. So that would be fantastic and I do not think we would have any problem if you wanted to do that. Thank you very much indeed. Professor MacDonald, I know you said you do not have any formal arrangement, but in your experience would you be able to give it a... I am a clinician and an occupational physician, Professor of Occupational Medicine, so I still see workers and I do research on workers and workers' health. I agree entirely with what Lucy has said in terms of the lack of provision. I do not want to talk too long, but I can talk for hours on this, so you can shut me up. To put things in perspective, I share the Scottish Occupational Health Action Group because there is UK generally in Scotland as well. It is probably got the lowest coverage of occupational health services to the workforce of any developed nation. For instance, Finland, the same size as us, has about 90 per cent coverage to all workers' access to occupational health and the kind of environmental services that Lucy represents. There is a big lack of occupational health provision anyway. The medical students get almost no training in health and work and NHS is very burdened and they are always thinking of disease, but they are not thinking of it. In terms of referring people to this, I will not infrequently see people with hand-arm vibration syndrome or a capital tunnel syndrome or asbestos or other dust-related reduce of the lungs or the whole variety of occupational conditions and we will advise them to apply. That is an unfundamental underlying thing. Just in context, earlier this month, we sent, the Scottish Occupational Action Group sent the First Minister a proposal for a Scottish occupational health service provision. That is because, informally in London, there have been discussions with DWP and Treasury about growing occupational health, because there is an awareness of it, particularly with lots of people falling out of work and a very large in non-participating ageing population who have got work potential. They were talking informally about £300 million. That is a hearsay, of course, but the point is that I do not know the autumn statement to come out yet, but there may be something in the autumn statement. If so, there may be some resources here for at last correcting this wrong of the lack of coverage of working people, the lack of support to working people. Anticipating that, we have proposed a centre paper to the First Minister, and it is now being discussed by the various civil servants, so that there is a plan in place to do something. You can have plans in place to do anything. I have been trying to do that for most of my life. It is hard to make them happen. There is a lack of, so we do see it, occupational physicians. There is probably about 35 to 40 per cent of the workforce may have some access to occupational health, which is a multidisciplinary thing, so that might include safety professionals, occupational hygiene professionals and occupational health nurses, but there is certainly a lack of all of those. Part of the problem was that when NHS was established, occupational health was not included, because industrial health was not really well established then, so occupational health is not provided as part of the NHS and never has been. It is provided by the NHS to its own staff, it is provided to civil servants like yourself and to public sector, and big employers will contract for it to private occupational health companies. The inverse care law applies here. The people who get occupational health are probably the people who at least need it, not suggesting that you do not need occupational health. That was very interesting and a very full and informed answer. I think that both answers are very much focused on the support, but preventative measures, if I could have a brief answer on your opinion both of you, on preventative measures that are being taken place in the workplace. Again, if I could do the other way around this time, Professor MacDonald and then Lucy, but just a brief answer if we could, because I'll get shot in a minute. The HSE, of course, is aware of work-related ill health and the basic health and safety laws, which you are familiar with, but the assessment of risk and the control of risk is essentially the control measure that applies to all working employed people. That's where some kind of control measure comes in. Just to touch on something that Lucy said earlier on, the whole system is reactive. We wait until you've got disease and then you'll be presented to a DWP or whatever committee it will be and make a decision about whether people get benefit or not. We need a much more proactive system in Scotland, which is actually got an observatory looking at what's happening. Is there any changing trend? I can speak more about that as well. Thank you very much indeed and very briefly, Lucy, if you could just on the preventative side. Yeah, Marie's just reminded me that messages I put in the chat aren't on the record. So I just wanted to say that 55 per cent of UK workers don't have access to occupational health services. I've personally picked up a late stage hand-on vibration case that had never been picked up through any of their previous employers. And the NHS has one occupational disease service, which is the God service, which I have run by Health and Safety Laboratory across five universities. I think what's again what's really important is that we know that in 2021 to 2022, 1.8 million workers were reported as suffering from work-related ill health, but only 17,000 made applications to the industrial injuries disease benefits. So I think that's probably in a nutshell we know that we're not getting sufficient applications to actually inform and push this further up the agenda because the financial burden isn't there, I would say. And I do think this is an opportunity for Scotland to really herald the way Aberdeen and Edinburgh, you've got a track record in Scotland of good universities in terms of occupational health with the University of West of Scotland, Aberdeen, Edinburgh and Robert Gordon. So I think there's massive potential here to get this right and to plug the gap and dovetail in with what the rest of the UK is doing, but the Invent and Industrial Injury Advisory Council, so I think there's a massive opportunity here. Thank you very much indeed. Okay, thanks very much. That was very helpful and really interesting as well. Can I just make a compliment? Lucy, unfortunately, missed out at the University of Glasgow, which is the only clinical occupational academic group in Scotland, and the only clinical group in the UK. Thank you very much. I'm now going to invite Bob Doris, thanks. Professor MacDonald of the Danton Muscatelli Texton, I'm there just to prompt him to remind him to put that on the record. That's very helpful for completeness. Can I say good morning to both witnesses? So CAC is proposed to investigate and review emerging employment hazards which result in disease or injury. That may duplicate activities of other organisations. I think Professor MacDonald helped to mention the health and safety executive. I think it's actually imperative that they're at this committee, given evidence, given their crucial role, as far as I'm concerned. Surely to goodness this should be their bread and butter, and that as imperfect as occupational health may or may not be in Scotland or across the UK, the data you're getting should be used to inform the work of the health and safety executive. I suppose my question is irrespective of whether it's IAC, or whether it's CAC. We'll have acronyms in this place, don't we? However the advisory board or council is, the information that occupational health gets in the workplaces is vital, it has to derive action. I'm conscious that employment law is reserved, and the health and safety executive have a direct remit here. So is there the possibility that there could be duplication when CAC comes into place and she can say anything about the role of yourself and how you feel you should be using the vital data that you would like to see collected to derive the change that you want to see? Perhaps we should take Lucy King in first on the relation to that. Yeah, thank you very much. I think in a nutshell, the industrial injuries advisory council reports themselves, so research is done, as you and said, in people's spare time, but the reports are there and the data is robust, and then that doesn't seem to translate into a review. So I went last night, actually, because I thought I'd go and do a very last minute review of what is on the industrial injuries, the IAC prescribed diseases list, and it doesn't reflect the reports that have been raised since 2017. In terms of duplication, I think it's unlikely because there is a gap and there's a needs gap there in terms of converting the evidence, particularly in relation to pilots and aircrew, as one example, where the actual resource doesn't appear to be there to say what does that mean in terms of how we convert that to prescribed diseases and actually to have a rationale as to whether we do what we don't? Professor MacDonald, just before taking in, can I just get a slight follow-up to Lucy's reply there if that's okay? I've no reason to do anything that you say there, Lucy, but I'm just wondering if the day job of the health and safety executive is to look at things like emerging evidence and patterns and work related deaths, injuries and ill health, are we legislating to fix the inadequacies of the health and safety executive or are we legislating to complement an existing mechanism? Lucy, can I get Lucy just to respond to that? I'm sorry, Professor, and then if you could answer both those questions, that would be really helpful. Okay. You'll have to remind me of which question. That's fine, of course. People often see that. Lucy? Yes, so I think it's to complement because I think, as you alluded to earlier, what I call silo working, so I think the health and safety executive are indeed doing great work. They publish really good guidance, really robust guidance to do their best to help employers to protect people and they do seem to respond to the research reports. What doesn't happen is that doesn't then translate into what happens for those people who become disabled as a result of a disease. I think some of that is probably because diseases are fluctuating, they are slower in their onset and then their duration, whereas an industrial injury, you've got an immediate injury, you can assess the extent of the injury and they've got an algorithm that they use to work out what level of disability it is, and we can, to some degree, predict and prognose rehabilitation and recovery, and that is so much more difficult with disease, so I think probably what's happened is it's just ticked the two difficult boxes. That's surely helpful, Professor MacDonald, just to remind you, whether there's any duplication potentially might be created with this legislation and perhaps whether or not the healthy safety executive, if they've got a primary role that they're properly delivering in relation to work-related deaths and using their health, that might also be covered by this legislation. I think there's inevitably some duplication but there's not much, because I think the culture of what Lucy does and what I do is to pick up things very early and prevent. It's very early that it's generally not a breach of law issue, so the HSE is there, for example, worth work-related diseases. If an employer thinks they've got somebody with a work-related disease, one of the employers who's got access to occupational health has been told he should think of reporting this under the RIDR regulations, that's the only way that the HSE will hear about something like that. It's estimated that only about 40 per cent of those cases are actually reported to the HSE. We need a system that is not just relying on the HSE because people don't always want to go to a policeman, and employers don't necessarily want to attract the attention of the HSE who comes in like a policeman. The HSE has got a very valuable role. What we've got to do is a system that allows us to raise awareness and to pick up issues early. GPs and hospital consultants will never have heard of any of the UK legislation. We need to be much moving, much more up to prevention. The aim is to prevent people from getting damaged and getting money. That's a failure of the whole system. We need to be moving up to prevention and that can be done. That means research and that means having a mechanism to identify what is going on, which means that you're not waiting until people have got diabetes or celioma. You're picking up whether there are exposures that might be at a higher risk. We need a entirely different approach. It's not about just beating up the HSE. It does its job well, but employers are not particularly keen in voluntarily contacting the HSE to tell them about their possible problems. I think Lucy wants back in. Yes, I just wanted to follow up with that, which brings me back to my first point, which is around the occupational disease reporting systems, which seem to have, they haven't disappeared in, but back in about 2017, I was talking with Manchester University about how we could get the non-medical multidisciplinary team, who actually see people at the early stages of symptoms, because we're the ones who refer into the unions of this world, actually to get us to provide early reporting of symptoms so that we have a symptom reporting system as well as a disease reporting system. Again, I think that's something which isn't being done anywhere else. I think it's something which wouldn't be duplicating what is being done already. It very much then starts to come from the proactive side of things. As groups, because we do all talk and our professional groups do collaborate, we can then look at that information and we can support the emerging diseases, which, as we know, we've now got good experience of working with emerging evidence, because we did that very effectively during Covid in terms of the turnaround of our health risk assessment for Covid-19 and identifying vulnerable people who were at high risk of exposure. We've got some really good learnings, and I think there's a real opportunity here to fund the prevention, as Ewan said, of payouts for disease to compensate people and to make sure that people don't fall into housing and food poverty as a result of a long-term disease that has been caused by work. I think that's where there is a gap and there will be no duplication because it isn't being done at the moment. Thanks very much. Now I'm going to invite Don Mason. Thank you. Professor MacDonald, you've twice mentioned research so far, and I think you are a little bit critical of the amount of budget or whatever that IAC have and that they're having to do so much at night and all that kind of thing. So, as I understand it, the bill proposes £30,000 per year as a research budget, and I'm new to this committee, I'm new to this subject, but it strikes me as a very low amount. Do you have any thoughts on that? Yeah, it is. You can do very little research for 30,000 a year, you could evolve employing staff, surveying methodology, statistical analysis and all of that sort of thing, grossly inadequate. So, the fact that money is there is positive, at least I'm thinking of it, but if I can just go back to one of my earlier comments about a proposal for Scotland in terms of occupational health provision, part of that was that we do need, we've got quite a lot of elutives that are alluded to it, we all operate, we all link quite well, and the academic groups all speak to each other, but we do need to try, because of the low number of experts around, we do need to make sure to harness them, to work together. One of the proposals in that paper that's gone to First Minister is that to create a Scottish centre for health and work, it would be a semi-virtual one, hub and spoke, just to link up what people do, so you get a much more collaborative approach to harness what resources we have, and part of the role of this city centre would be to be proactively doing research on work related to ill health. And did you have a budget for this proposed centre? Well, the budget would be, I haven't got a budget, but the basis is what we know, the gossip in Westminster, which I've been part of. Chris Whitty, for example, is really on to this. No other CMO, because I'm on the Bevan Commissioner of Wales and Scotland, it's really being proactive about it, so I'm not being critical of any individual. So, they're talking about £300 million for this whole area. That's at a UK level then? At a UK level, but that would be 10 per cent of that, and it could be £30 million, if it doesn't matter. I'm a wishful optimist, I'm an irrational optimist. So, £30 million wouldn't be for research, it would be for provision of services, but, in that, there needs to be a research place, which is doing clinically focused research, which is using the existing resources around and getting some, and having an approach to do early monitoring. It strikes me that we're looking at a few moving targets all at the same time here. Yeah, yeah. That's the way life is. Assuming your centre doesn't go ahead. Not my centre, but your centre. You're going to create it. Assuming that research should be linked to the bill then, what kind of budget, if £30,000 is not enough, could you put a figure on what should be there? I think for a centre to establish, for example, that people are just focused on monitoring and looking at all the sources of data and collating all the data sets and doing analysis, you're probably looking at, I think, two competent postdoc researchers, and that would be 100,000 a year each. No, that would be for the overheads you put at 50, then, to put 150,000 a year. Right, okay, that's the way. That's the way. Thanks very much, that's helpful. Miss Kenyon, do you want to comment on any of that? I think in terms of an actual figure, it would probably be worth benchmarking with the University of Manchester budget for their occupational disease research. Can you give us a figure for that? I don't know exactly what that is. I was just having a look to see if I've got it in my notes, but I can go away and do some extra research on that, but I'm sure you and I can find that line. I mean, Marty Van Tongren is a professor there, and he runs it. Yeah. I know it was with them last week, second ask. Well, I think that would be helpful if one of you could give us that figure today. That's great. Thanks, Kenyon. Okay, thanks very much. I'm now going to invite Marie McNair, who's joining us online. Thank you. Thank you, convener, and good morning, panel. I'll go back to the duplication. Professor MacDonald, your written submissions state that a repeat of IAC in Scotland would duplicate resources and experts. What are your views on the view of CAC undertaking investigation of the same issues as IAC? And I know you've covered a bit of that already, but if you could expand that, that'd be great. Could you just... You're talking about the duplication question. What I'm talking about is not going to be duplication. It's going to be expanding. If we're going to do something different, we have to get better data and pick things up earlier. That involves what we've been just talking about previously, and so we've got early detection systems. We also need to be more agile. Covid has been mentioned by Lucy. It's drifting a bit here, but it's relevant. IAC has been reviewing Covid to see if there's been occupational causation. Glasgow published a study on the Biobank that showed that, to be regarded as occupational, there's got to be a two-fold increased risk, because a lot of the occupational conditions occur naturally anyway. You have to know people, have they been doing the job, have they had the exposure, and if they got the disease, or potentially got the disease. IAC will only give benefit if they're absolutely certain there's more than two times increased risk, because that's their criteria. For example, with Covid, our paper showed that some healthcare workers, particularly medical support workers, are at a seven-fold increased risk in the early days. However, IAC is still equivocating about whether that's an extreme example for one small group, but there was a generally increased risk and quite a lot of occasions, but they still haven't made a decision about for whom Covid might be compensatable. I might have drifted off your point, but we do need to have that kind of proactive analysis going on all the time. That research that I talked about was funded by our research council in IHR, or one of these found councils, and that research for that paper will have cost at least £200,000. My question specifically was on your views on the value of CAC undertaking investigation on the same issues as IAC. The law has been passed that you're going to have a CAC. No, no, not yet, that's why we're here. Oh really? I thought you'd decided that. There is duplication. IAC has got a very good track record and some very good scientists on it, of whom some are based, at least one or two are based in Scotland. There will be duplication of the research, and that's wasteful actually, because the same diseases are occurring internationally and why we have to do everything ourselves. However, if we're going to move to a more slightly more proactive approach, which links to prevention, which we haven't talked about really, then we do need to have the research function to be picking work-related ill health when it's most subtle much earlier. Some of that is picked up already by the ONS by regular workplace surveys, but that gives data, but not much happens with it. Thank you for that. The British occupational hygiene society has said in written evidence that Scotland is differing workplace demographic and industrial heritage from the rest of the countries in the UK. I just wanted to know if you could give us some views on the extent that there are Scottish-specific issues in the type and instance of industrial disease. I'll go to Lucy on that one. I think, sorry Lucy, I think you're going to come in on the last question, so maybe you could speak about it. If I could quickly respond to the last question. So the HSE has a list of stakeholders on their website, of which the IIAC is not one, but I think if SEIAC were indeed to become a formal stakeholder of HSE, I think that would be a good sharing of information and reducing any potential overlap or duplication of activity. And then in terms of the specific Scottish demographic that you were talking about, so the NHS data itself says that musculoskeletal disorders, particularly of the back and joints, so the single biggest cause of work absence in Scotland with over a million people visiting their GP every year with a musculoskeletal disorder. So I thought that was, again, I haven't been able to drill down into the actual data to see how many of those million people are indeed work-related, but musculoskeletal, again in your earlier documents in the original paper, you did make reference to the fact that the IIAC is still appears to be very focused on male-dominated industries and male-dominated diseases. And Ewing's mentioned carpal tunnel syndrome, which of course predominantly affects women, but in terms of what we call golfer's elbow, tennis elbow, some of the lay terms for the upper limb disorders, predominantly women work in the processing industries and therefore those injuries, although they are mentioned in the IIAC, they do talk specifically about heavy industry as opposed to, there's a passing reference to processing, but I'm not aware and I've worked in food processing and a number of those industries. And I've never yet come across a case where the condition, the upper limb disorder has actually, as I call them, has actually been referred in to the IIDB. So you've also got the massive oil and gas industry and people working offshore and working underwater and seafarers, so I haven't done the background data into that, but you do have a very specific need in terms of, you know, it's male-dominated diseases that probably affect women and we don't have that data, we don't have that information because it's not being captured and a lot of people go to their GPs with these conditions rather than seeing occupational health nurse and then a physician for a diagnosis. The diagnostics happen through the GP network and whilst the diploma in occupational medicine run by the faculty of occupational medicine is absolutely brilliant, again, there's not enough GPs who have even the basic faculty of occupational medicine training to be able to identify or at least eliminate an occupational cause for somebody's disease. Okay, thanks very much. Sorry, Meread, do you want to come back in? It was just to Professor MacDonald in briefly, obviously, just the extent of the Scottish specific issues he wants to come in. If he doesn't, it's okay. Yeah, it's true, it's true that Scotland has a strong legacy of co-mining steel in all of these industrial revolution industries, which are sadly all declining. In fact, we're more high-tech companies now than the former, but we've still got a legacy. We've still got people getting new edithilioma from exposure 20, 30 years ago in the shipyards in the Clyde, and it's an epidemic there. There's not much we can do about that. Treatment's getting slightly better. I think that it's passing. I think that Scotland is becoming more like the rest of the UK because of our decline in heavy industry. The points that Lucy said about the musculoskeletal and mental health are the two biggest areas of ill health, causing sickness absence across the UK. The musculoskeletal, most of that, is degenerative. This is the problem, clinically, why you need good clinicians to know what they're talking about, is that you're all not quite yet, but some of you are going to arthritis eventually. You're all going to get arthritis eventually. It may, but I don't think it's going to be called occupational just because you've got it by sitting too much in the Parliament office. It's about discriminating between it's occupational or not occupational, and that's why you have to look at the epidemiology. Does the disease and question occur much more often in a certain occupational group? That needs research, and that's not a HSE function. They're just measuring the cases coming into the police station, if you like. They're not out there looking at what's happening in the general population, so you do need both systems. I'll just come back in. What is quite concerning, as well, is mesothelioma linked to the built environment. Obviously, certainly in my area of Clybank, the focus young is 30, I've been diagnosed with mesothelioma. Can I have your views on that, obviously, going forward? There's still a bit of an epidemic and it's starting to reduce, but there's two factors in young people getting it. One is if you're walking around the streets of Glasgow, if all of you will have some asbestos bodies in your lungs, because asbestos contamination is in the general environment in urban areas. That's the first thing. One paper suggested that 6 per cent of all lung cancers were, in fact, due to neighbourhood asbestos exposure. Now, it's a paper done in the BMD 20-odd year to go. We're all exposed to low levels of environmental contamination just day-to-day life. In the Clybank situation, there's still some of that around. It's very unusual for a 30-year-old person to get mesothelioma because the gestation period, if you like, of the tumour is usually 20 to 40 years. That's what we're seeing. People may be exposed 40 years ago. One of the problems about the long time that it takes for things to develop is that you only pick that up if you're taking an occupational history. What job are you doing when you left school, et cetera? If you go into the NHS, no-one says what job do you do. No-one says what job did you do historically unless it's an unusual condition with a particular interest. In occupational health, that's the first thing we ask. What's your job history? To link that historic exposure to current disease. That's a bit of a ramble, but it gives you maybe the picture that we need to hit a system that is a bit more alert to issues that are arising, a bit more alert to recognition of occupational disease, of which there's still a lot. Aim of that all of that is if you're picking things up early, then you start the preventive measures. You can get the HSE to go in and do their placement role. Also, better provision of occupational health leads to better health outcomes, too. Yes, I just wanted to add to that in that one of the cases I was alluding to earlier was a similar case, but in the electronics industry. I think respiratory diseases link to the fumes in the electronics industry, and that's obviously an emerging issue in Scotland as well, that's the fumes that are used in circuit boards and the creation of that, where we are doing technologically advanced stuff in the UK rather than the high volume stuff that's been done elsewhere in the world. That again, that's an emerging respiratory concern waiting to happen because, of course, people need to be able to breathe properly to be able to function. I think coming back to the core purpose of the IRAC and the IRDB is that actually we're talking about people who are no longer able to function optimally and therefore are less likely to have good quality work, good quality health, and to be able to support our infrastructure moving into becoming healthy elderly people when we've got a society that requires elderly people to be able to function for longer, especially as we extend the retirement age. I echo everything. I think we need to learn from the Asbestos story. We need to learn so that we don't have emerging exposures that then become the next Asbestos. I believe that Katie Clark wants to come in and then I'm going to invite Bob Doris back in. It really is to pick up on this issue of duplication again because, as a committee, we're obviously scrutinising this bill to set up a Scottish-wide body. The reason that we want to do that is that the status quo isn't good enough. We want to do something that's better than what's there already. Professor and Dr Kenyon have outlined clearly the scale of the problem in Scotland. Have you got any thoughts or pointers on the recommendations that the committee might make that protect the expertise that's drawn on across the UK in the current system that collaborates with that and enables us to build on that? I don't know if you've got any thoughts in terms of what the committee might want to consider. Maybe go to the professor. With putting my research hat on, you're relying on research to identify a causal relationship between a condition in which you can occur commonly anyway or might be specifically occupational. For example, farmers have a ninefold increase of hepatitis. That was only discovered when we looked at occupation and arthritis. Certainly, farmers come up with hepatitis because they spend all their time on vibrating tractors probably and also doing very heavy manual work. That's where you find there's a relationship between... That takes research and you're relying on published research generally rather than anecdotal stuff. You need to be monitoring the health of the population. That's where you need a basic thing going on, looking at not only what's presenting to GPs, looking at the GP data sets, looking at the various data sets you can be monitoring to see what's changing. Is there a rise in something or is there something new happening? In relation to this, going back to the core of your question, when it's studied or published, the first thing we all do is publish it because that's the whole purpose of... That's the output of research. Within the people that are focused in this area, you very quickly hear about something. I'm desperate trying to find some new disease that no-one's ever discovered so it can be called the McDonald's syndrome, you see? That's the only way to get your name last forever and so like Parkinson's. That shading of research in a UK-wide basis, which happened, it's very important because you don't want duplication of what there may be investigating. It's because it's a smallish community, we all know what each other is studying and so that informal system helps it. If someone's an expert in respite, for example, cleaning fluids, recently Manchester published on cleaning fluids. Some of the cleaning fluid, the cleaner, are cleaning this building. They can cause skin problems and asthma. The data on that has been gathered by the Thor system. I'm not suggesting we would replicate that, but the Thor system only gets input from people that participate in it. 90 per cent of people don't participate. If a busy doctor sees something, he's very few of them will think of the Thor system. You need to act of survey techniques as well, serving the population. That gets you back to basic what happens in the workplace where, for example, hygienists are measuring the environment, occupational physicians are doing and occupational health nurses are doing health surveillance, if you think there's a potential risk, to see for example of the lung functions of a particular group are lower than they should be. See what I mean? To pick up early subtle things before it becomes disease. That's a complicated answer, but the answer is yes, we should collaborate, yes, we should pool resources, but what we need here is to move, instead of reacting, someone's all those people coming, making a claim or reacting whether they get it or not, that we create a system that actually feeds prevention. That means that that's where the additional resource has to be. We want to stop people getting into damage by their work, that's what we're all about. That's maybe something we can look at as a committee, how the framing of the bill and whether that is framed in such a way that maximises collaboration and avoids duplication. Thanks very much, Katie. Lucy, would you like to come in on that? Yes, I'd just like to add to that that actually there are some pockets of symptom reporting that happen. In the early 2000s I was involved in one where we were looking at in-store bakeries and then we discovered that actually some of the respiratory symptoms, the occupational asthma, was happening more in the people who were actually using the machines which sealed the bags that the freshly baked products went in. That's an example of where we monitor symptoms and then we discover that there's a potential alternative source where conventional wisdom says we know occupational asthma bakers long, we've known about that for decades and I think the gap, if you're looking at how does Scotland spend its money to get meaningful information and to protect the public, I would say that first of all strengthening the requirement for employees to report symptoms because the health surveillance model that Euron's been talking about that we you know that we have talked about, the HSE has taken a pragmatic approach which is that health surveillance is carried out every year with a 13-month window but what happens is of course within that time people get symptoms and then they might have forgotten because the symptoms have ebbed away or their role changed slightly and so that it doesn't get reported in that annual review so requiring employees to report symptoms and then having a formal system for reporting symptoms so effectively having something that works like Thor but which captures symptoms early so that we can't can start to look at the trends and I think this is where this was why I said about having the multidisciplinary team on whatever information group you have because we are the people on the ground who are seeing symptoms as they are reported and so therefore if we have a symptom reporting system employers will be less anxious about it because it's not right or so reporting of injuries diseases and dangerous occurrences regulations so it's not going to feel I'm if I report that then the HSE going to come in and I'm already busy trying to get on doing what I'm doing and you know my day job's busy enough I haven't got time to deal with the consequences of that and I am going to do my best to make sure that that doesn't happen again you know all that really good will that employers have employers really want to do a good job they want to keep their people safe but we're still relying on the census for symptom reporting when I've done my research into what data do we have about occupational symptoms about the actual functional impact and the impairment impact of occupational disease it's being reported through other systems but with a 10-year gap so again we've got recall problems in terms of the reliability of that data and of course we've also got personal perspective so I guess if I was spending the money I would be wanting to spend the money on identifying the profile of symptoms the extent of the symptoms where those were so I could look for hotspots and then have an impact on preventing occupational disease across Scotland in your context but setting an actual benchmark and best practice benchmark for the UK okay thanks Lucy I'm now going to bring in Bob Doris and then after that I believe Paul Cain would like to come in thank you thank you this has been really helpful I think there's an emerging picture of that there are structures in place in the health and safety executives I mentioned by Lucy there but they may not be sufficient for the ambition is that the professor for example said about the data we should be collecting so there are systems in place there does appear to be a weakness in the jobs that they should be doing and it's whether this bill is presented to us as the way to plug that gap or is there other ways to plug that gap and that's something we have to wrestle with as a as a committee but what the bill is kind of silent about and for some it's the elephant in the room is whether or not this new CAC advisory committee will ultimately at some point be making recommendations for getting the industrial injuries benefits when that's fully when that criteria is looked at again here in Scotland by the Scottish Government or whether another body should do that so my question is about the difference that CAC might take in relation to those kind of things compared to IAC because they are of course looking at the same evidence and the same experts deciding whether there's a reasonable certainty which I think is a very a very general expression reasonable certainty so this was that long we have seen do you think that CAC would necessarily take a different approach to IAC when deciding whether there was a the data collection professor were admitting there's a gap in that more generally if they're looking at the same data would you expect CAC or IAC to make come to different conclusions of whether there was a reasonable certainty I think it's possible but not desirable because generally these systems exist across Europe and around the world and so you know just if you start saying what we're going to call you know enghraing toenail problems and occupational disease in Scotland and no one else thinks it is anything to do with occupation then I think that that's bad science and bad policy and so that's a physician's example but so I think there will be situations where the for example it can be tailored the the woman the woman not appearing much in the that needs to be addressed because women are more than 50 of the workforce now and they're doing all sorts of jobs that does need to be addressed and so it's in these areas that rather than trying to dream up something else which is new and a bit questionable as being going back to the bakers right asthma I can be just a little straight to this but back to the bakers asthma the first description of asthma and bakers was by a professor of medicine in Padua in Italy in 1715 he described bakers asthma now when you've had your morning role this morning some of which will have been done in a big place like Mortons which will have occupational health some of them some of the more the roles will have been baked in a wee bakery where there's no surveillance of staff because there's no there's no system to provide health surveillance you know someone may have still had the suffering from occupation mild occupational asthma who's making you making your morning role today in Scotland today so it's more about I think the more important area is not trying to make to me there shouldn't be any differences of the scientists good unless their science is wrong and our science is better and then I would expect the EU countries they've all got parallel systems so you know if something's occupational they have to fairly consistent criteria but it's the issue of what we're doing to prevent it and at the moment most of the workforce in Scotland particularly in the smaller organisations which don't have the resources to go and bring in occupational health because it's it's and it doesn't exist enough anyway there's still people being damaged which is preventable and that's really the more important issue if we come up and find there's a new disease which might be called the mcdonald syndrome which is definitely occupational and and it's not been recognised anywhere else well that's great that's great we can we would recognise it but it has to be in good evidence perfect I just follow up briefly on that professor then of course Lucy so in fact you know I'll pass on it and bring Lucy in if she wants to say something if we're going time constraints we can always follow up later professor I suppose listening to our conversation do you need an equivalent of the IIAC or do you want something else so is what you need different to what you want that's what's coming across to me because you and I are of a we're we're coming from the same perspective which is let's prevent occupational disease let's prevent disability we're not doing that well enough by the time something gets to the RIDB that means somebody is disabled we don't want disability the whole purpose of occupational health is to prevent disability um we know that you and wants to do the research and my colleagues and I from the multidisciplinary team what I call the non-medical multidisciplinary team we refer into doctors for the diagnostics but we're on the ground we're seeing symptoms we need more information more guidance we need clinical protocols and we need reporting protocols and we need to make sure that all our data is easily captured which has to be possible in this day and age thank you very much I'm now going to invite Paul O'Keehn and thanks thank you very much can be a good morning to the panel I'm interested in the proposed membership of Ciac and just trying to understand the witnesses views on that and we've had a lot of submissions about who should be in who shouldn't be an officer the bill sets out itself in terms of the balance between employees and employers and the sort of expertise but I wonder if I can maybe just broadly ask in your view is it the right mix or are things missing from the proposal within the bill I can't read I was part of the earlier discussions in this when it could it would it was being discussed by Dac Beg which I was on but I can't I haven't got my I'm in my head got the exact mix that's in the I'd have to look at that again so I can't really answer that I'm fine maybe Lucy Kenyon I know that you had in your submission spoken about the needs to perhaps broaden the scope I mean I wonder if you might want to comment on that for me the reason for broadening the scope is because I think you need to have member representation from the people who you want to actually do the detection and those are the multidisciplinary team so yes it absolutely needs to be an advisory council in the current model that you've proposed but to be in a bit but if the advisory council does not have the voice of or the ear of actually if you don't have the voice or the ear of the people doing the work because as an occupational health professional I carry out my job to the best of my ability due diligence I do my best to report I do my best to share my findings amongst the community but as you and said neither you and or I have a direct line into the IIAC even though we are taking this really evidence-based approach and we are we've got our own we're looking at our own data we're looking at our own trends and we're advising our our customer employers so employers are our clients we're advising them on what to do to make sure that the rest of the workforce doesn't suffer when we see something happening early on with a member of staff so I suppose we absolutely need the scientists we absolutely need to have a feeding mechanism to actually present the information to the IIAC who will then review it but if we don't have anybody who can explain what the context is for the information that's being provided by people like myself then the IIAC will continue to do what they've always done because there isn't that mechanism for the clinicians on the ground to be able to feed in okay thank you I might just briefly if possible so I think Lisa Kenyon making an argument there for that formal role within the IIAC membership but I wonder if more broadly is there opportunities to widen the scope via people having or organisations having observer status being able to share views and opinions being able to share expertise so whilst I take the point you're making about having a formal status I think would you agree that there is opportunity beyond that absolutely absolutely I mean you've just got two of our membership organisations here today but you've referred to the British Occupational Hygiene Society we've also got the Faculty of Occupational Medicine who aren't represented here and we've got physios and occupational therapists with their specialist sections as well all of whom yes informal links where there is where there is an opportunity to contribute and to reflect on what the IIAC do absolutely essential all of that all of those multidisciplinary professional bodies who are involved in occupational health delivery of occupational health on the ground yeah okay thank you okay thanks very much I'm now going to bring in Jeremy and I think that's the last question thanks thanks community and I suppose we heard a bit of evidence last week in regard to obviously these fairly technical and scientific scientific expertise to be able to advise both these scottish and uk body are there enough people out there to do that to give that advice yes I say it slowly because we're we're Scotland we're thin in the ground but we can it's a multi I think we have enough people but we would not be replicating if IIAC's done some useful research and come up with very good evidence because they've got top scientists there as well then we wouldn't go and repeat that and we would in Scotland there are there are between the various institutes you know the various the various research in areas there is a nucleus of thing but we are sitting in the ground it would have to be properly organised and funded and it would have to be a background of research and people processing data to pick up things to pick up early so the answer is yes but we could do with a lot more people in occupational health generally and also in academic occupational health okay thank you miss kenyon I don't know if you want to come on which one I echo everything you and said I don't think I could say it any better excellent well well I will shut down thank you thank you very much and thank you to Lucy and sorry did you want to come in Bob yes quite quickly sorry and it will be briefly and I apologize it is my understanding that did I forgot the stronger DWP have said that experts in IIAC cannot also sit on any Scottish advisory board I think that might be the situation do you have any views on that and we compare that to nice and SMC UK health approval Scottish health approval where we actually have something called multiple technology appraisals where they do things jointly from time to time and there appears to be a kind of barrier there so any thoughts in relation to that barrier maybe very briefly the convener really will give me a hard time Professor McDonald first I think the shouldn't be a barrier Scotland may be a separate country but we're in the same place island to speak the same language and we all know each other so if there's we should be we should be feeding off each other okay very brief thank you thank you very much professor was very brief a list of kenyon we have cross-border working within the UK and therefore it's absolutely essential that we're all singing from the same hym sheet so we absolutely need to be talking and coming to a joint decision okay thank you which just echoes what you and said earlier as well okay thanks very much and I want to say thank you very much to our witnesses for taking part in sharing your expertise today and we will obviously continue taking evidence on the bill next week as well but I've found it very interesting and very helpful and I think all the members here have as well so thank you once again and that concludes our public business we'll now move into private to consider the remaining items on the agenda