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Walter Holland's essay on public health (April 2002 JRSM1) is timely and one hopes that the Department of Health will act upon it in order to avoid repeating the mistakes of the past. Even if his suggestions were acted upon, however, an important cause of ill health will remain to be dealt with. Occupational disease is still a cause of substantial morbidity and not inconsiderable mortality2. Individuals do not transmute into other beings when they go to work; they carry with them wherever they go the conditions that are due to their occupation, their environment, their personal habits, their genes, or whatever combination of these is ultimately responsible. To separate occupational health from the mainstream of healthcare is thus not only illogical but also inefficient and ineffective. There is no remit for any of the new tiers of NHS administration to consider the role of occupation as a determinant of disease among the populations for which they are responsible and this omission urgently needs repair. To rely upon the Health and Safety Executive to provide the necessary framework within which this can be done is fanciful, not because HSE does not have excellently qualified people, but because it does not have nearly enough physicians and nurses or enough money to do so, nor does it have access to other parts of the health service.
NHS Plus is heralded as a means by which occupational health services can be provided throughout the country—another fanciful notion. The occupational health services within the NHS provide a service to their own trusts and sometimes to outside bodies, but there is no guaranteed uniformity of standard; there are too few consultants and trainees, and too few nurses, to provide anything like a comprehensive service on a large scale. Moreover, there is no money to correct any of these deficiencies other than what can be raised by departments carrying out contract work—an example of a dog chasing its tail in ever decreasing circles with the result we can all imagine.
Now is the time for the Department of Health to seize the opportunity to establish a health service that is truly comprehensive and which deals with all aspects of health and disease. All that is required is the will, the money and some vision. Oh dear...