British workers are not being protected from occupational diseases and deaths, argues an expert in The BMJ this week.
There are around 500,000 new work-related illnesses every year, and over 13,000 deaths are caused by occupational exposures, mostly from cancers related to asbestos and respiratory diseases from dust and chemicals.
However, probably fewer than 15% of workers in Britain have access to adequate occupational health services, explains Anne Raynal, an occupational physician.
She predicts that "occupational medicine is unlikely to survive as a specialty because of a lack of enforcement of the employers' duty not to harm the health of their workers by the Health and Safety Executive."
Great Britain is the only major country in Europe that does not have a legal requirement for occupational health services, either by the state or employer, which would find these diseases early, she explains, and adds that the Health and Safety at Work Act 1974 implies a duty for doing this on the employer, but it is minimally enforced.
Only 0.3% of the estimated 500,000 new work-related illnesses are reported to the HSE. No prosecutions have been brought by the HSE against employers for not reporting occupational diseases or related deaths over the last five years, nor against employers for not providing statutory medical surveillance for workers exposed to asbestos - which is the biggest killer.
Statutory medical surveillance for the early detection of work-related ill health is provided by HSE's appointed doctors for around 40,000 workers in risky industries across the country. However, this covers only 0.13% of Great Britain's working population of 30 million people.
Furthermore, doctors working in occupational medicine are nearly all paid directly by employers, including those in the NHS, and unlike doctors who report infectious diseases to the relevant authority so that further cases can be prevented, occupational doctors have no legal protection for doing their ethical duty.
"Occupational physicians have been actively discouraged from identifying cases of work related ill health, with evidence of their having careers threatened or ended," explains Raynal.
And employees are unlikely to know they have an occupational disease because GPs are not trained to differentiate between work related conditions from others.
Furthermore, there has been a shift in focus from using doctors' clinical skills to identify and prevent work related ill health to helping employers avoid unfair disability discrimination or dismissal claims. The difficulties this creates is reflected in the doubling of referrals of occupational doctors to the General Medical Council for alleged unethical conduct in 2012.
Consequently, there has been the demise of occupational medicine as a profession, adds Raynal. The number of trainees in occupational medicine has fallen to a third of what is required to maintain the specialty, and the profession is "unlikely to survive", she concludes.