Disability and Carers Benefits Expert Advisory Group - Employment Injury Assistance: advice

To: Ben Macpherson – Minister for Social Security and Local Government

By e-mail

20 December 2022

Dear Mr Macpherson,

Employment Injury Assistance

We were grateful for the request made by your officials to provide advice on Employment Injury Assistance (EIA), which will replace Industrial Injury Disablement Benefit (IIDB) in Scotland as part of the further devolution of the Industrial Injuries Disablement Scheme.

We welcome the commitment by the Scottish Government to ensure safe and secure delivery of the newly devolved benefits, and to improve the application and decision-making process for all clients. We understand that our advice may incur risks, implications and challenges for the Scottish Government.

We have worked with officials to ensure that our advice is informed by information available and relevant to the current policy landscape. We met with officials on 19 August 2021 to discuss this issue. We would like to thank them for their clear and concise input that greatly aided us in focusing this advice.

Clearly, information and the current policy landscape may change in ways that cannot be foreseen at this time, so the advice we give now is with the caveat that this too may change in light of developments. We set out below the key issues arising from our discussions which we wish to draw to your attention. Our recommendations are summarised at the end of this letter.

Background

On 19 August 2021, Scottish Government officials considering the future of the Industrial Injuries Disablement Scheme in Scotland presented to DACBEAG. They explained the background to the Industrial Injuries Disablement Benefit (‘IIDB’) and outlined the challenges and opportunities for completing the devolution of this aspect of the Industrial Injuries Disablement Scheme (‘the Scheme’).

Officials noted that it has been argued that the assessment for IIDB is out-dated, with the current Scheme being too restrictive in terms of prescribed diseases, occupations and the qualifying criteria. They indicated that they would welcome our thoughts on the following topics:

• what appetite is there for wider changes for Employment Injury Assistance, once the priority of safe and secure transfer has been achieved?
• how can gender disparity within the Scheme best be addressed?
• how can Employment Injury Assistance best be aligned with Disability Assistance in Scotland?
• could more be done in relation to prevention and rehabilitation?
• should there be a Scottish equivalent to the Industrial Injuries Advisory Council (IIAC)?
• are there any further issues that should be considered in the consultation on Employment Injury Assistance?

As a Group we felt we did not have appropriately in-depth knowledge of the existing Scheme and, therefore, we invited external colleagues with relevant expertise to contribute to a knowledge building session. Knowledge building sessions are opportunities between DACBEAG’s quarterly meetings for us to hear from experts and develop our contextual or specific knowledge. This was held virtually on 19 October 2022. The year gap between the relevant meetings was an agreed delay with the Scottish Government to focus on other areas of devolution in the interim. The Group would like to thank the following contributors: Professor John Cherrie of the Institute of Occupational Medicine, Phyllis Craig of Action on Asbestos (formerly Clydeside Action on Asbestos), Jackson Cullinane of Unite the Union, Barbara Donegan of the Child Poverty Action Group, Professor Damien McElvenny of the Institute of Occupational Medicine, Ian Tasker of Scottish Hazards and Professor Andrew Watterson of the University of Stirling.

Following this meeting, a short-life workstream was set up to finalise this advice.

We wish to make clear from the outset that we believe there are some fundamental issues with the overall Scheme that will need to be addressed urgently following the safe and secure transfer of those in Scotland currently in receipt of these benefits, if not before. We have also provided a number of supporting documents at Annex A which we hope will be helpful to your officials working in this area.

Work to date

There has been a significant amount of work in this area to date, with relevant stakeholders consulted in relation to these a number of times. This includes but is not limited to the following.

1. The Liability for NHS Charges (Treatment of Industrial Disease) (Scotland) Bill would make it possible to get NHS costs back in cases of industrial disease. This Bill was created by Stuart McMillan MSP so that employers would pay compensation to someone that develops a disease, as a result of the work they’re expected to do, and also pay for any hospital treatment they require. Currently, the NHS, funded by taxpayers, pays this cost. This could encourage employers to improve working conditions. On 22 December 2021 this Bill was withdrawn as it would not have retrospective application or effect.

2. The Proposed Scottish Employment Injuries Advisory Council Bill is a proposal to establish a statutory body to research, shape and scrutinise the social security available to people injured or developing a related illness in the course of their employment and to define the membership requirements of the Council. This was consulted on with responses received by 1 February 2021 and published. This is currently at the proposal stage.

3. The Industrial Injuries Disablement Benefit Advisory Group was set up in May 2016 to provide advice to Scottish Ministers developing policy on social security benefits for people affected by industrial injuries and ill health. This Group met five times. We understand the Group is not currently active.

We would be grateful for an indication of future plans and timescales in relation to Employment Injury Assistance with reassurance that all of the work undertaken to date will be considered in the development of the related policy and practice.

Public consultation

Officials outlined that, in response to the 2016 consultation on Social Security, there seemed to be little familiarity with the Scheme and a number of questions were raised around the fairness of additional payments for people that were disabled as a result of their occupations relative to other experiences. Key industrial injuries stakeholders had expressed concerns around the case transfer process and the importance of ensuring people continue to get their current payments at the right time.

Whilst we appreciate that the paper-based nature of this payment and its many links to key reserved policy areas makes substantive reform of IIDB challenging in the shot-term, we do not believe this is sufficient reason to not explore it. We see the two options as either letting this benefit caseload ‘fade away’ (i.e. closed to new claims) or reforming it to respond to today’s labour market experiences. While there are a number of concerns over the current Scheme, we believe that letting any social security benefit ‘fade away’ without addressing the underlying rationale would be a wasted opportunity. 

Given the lack of familiarity and various flaws with the current Scheme, we agree that a specific public consultation should be undertaken to inform decisions on the development of Employment Injury Assistance and are pleased to hear that this is now at the planning stage. This should explore policy for Employment Injury Assistance at launch, options for priority improvements and change following case transfer, and the future of the Scheme more broadly. We do not wish to pre-empt the outcome of the public consultation. The recommendations we make in this advice are towards areas that we believe should be explored further through the consultation, rather than specific recommendations for the purpose and structure of Employment Injury Assistance.

We would make the following recommendations on undertaking the consultation:

Recommendation 1: the Scottish Government should set out clearly at whom the consultation is aimed, including key sectoral bodies and people with diverse workplace experiences. Stakeholders should be identified in a way that does not reinforce any existing bias within the Scheme.

Recommendation 2: the consultation should propose questions around the intended purpose of Employment Injury Assistance in future to ensure it is appropriate and reaches everyone that needs such support.

Recommendation 3: the consultation should seek to identify which groups currently are not in receipt of IIDB, but should be, and why.

After these fundamental questions are answered the specific details of the Scheme can then be fully considered.

Gender disparity and other equality considerations

According to the latest data available from the DWP, around 84% of the current IIDB caseload are men which reflects the conditions and industries for which IIDB primarily compensates. The fact that this is a highly gendered payment is unsurprising, given its historic development and scale of change subsequently in the employment landscape.

Industrial diseases more typically experienced by women rarely fall within the prescribed disease list. The main reason for this is the lack of female-specific epidemiology. Prescriptions of disease as per the current methodology is heavily reliant on epidemiological data except for those that can clearly be linked to occupation in some way. 

We believe that an independent organisation with the appropriate expertise should be approached to lead on an analysis of gender disparity to gather insights before this Scottish benefit is introduced. This should explain whether there is an obvious gender disparity in relation to the conditions and occupations within and outwith the Scheme and if there is disparity within the Scheme in terms of take-up. We are aware, for example, that there are bodies looking at gender disparity within the nursing profession and the likelihood of developing long Covid.

Further, current claimants are more likely to be from low-income backgrounds and more concentrated by geography, within ex-industrial areas reflecting the relevant occupations. There is also an ageing workforce in which there are more long-term conditions than previously, and separate issues of race, ethnicity and disability equality related to the Scheme. We believe further analysis should be carried out to identify all other disproportionately affected groups.

This links to a wider issue, which we have highlighted in previous advice, where social security applications and awards should result in active referrals to ensure people have all of the appropriate wider support in place, for example, housing support, employment support and health and care services. We believe this should be tested and evaluated with groups of people preparing to transfer to Scottish payments.

Recommendation 4: an independent organisation with the appropriate expertise should be approached to lead on an analysis of gender disparity within the existing Industrial Injuries Disablement Scheme.

Recommendation 5: the methodology used to identify and recommend female-specific occupational diseases should be reviewed.

Recommendation 6: the Scottish Government must ensure that any proposals for Employment Injury Assistance are developed in line with the Public Sector Equality Duty to ensure they do not perpetuate existing inequalities and are designed to advance equality and rights.

Recommendation 7: the planned Employment Injury Assistance consultation should seek to identify priority actions that can be taken in the short term to address discrimination within the existing Scheme.

Recommendation 8: the consultation should seek to identify all groups disproportionately affected by, and at risk of, industrial injuries.

Recommendation 9: an application and award of Employment Injury Assistance should result in individuals being referred to and signposted to wider support services.

Alignment with disability assistance

The core purpose of the main forms of disability assistance in Scotland is to support disabled people and those with long term ill-health to mitigate some of the extra costs they incur as a result. This Scheme, on the other hand, provides no-fault compensation for people who are disabled following an accident at work, or who have one of certain prescribed diseases caused by their work. While it is important to be mindful of the differences between these benefits, it is also important to consider whether it continues to be justifiable for differing systems and rates of support to apply to a disabled person because of where and how they became disabled.

The compensatory nature of the Scheme must of course be factored into this, but we also need to consider whether those disabled at work in circumstances not covered by the Scheme are being unfairly disadvantaged, as well as the differential treatment with those with non-occupational related disabilities. For example, there may not always be negligence if an exposure-disease causal association has only been identified relatively recently.

We are of the view that there are justifications for variations in the rate of assistance, and a number of practical advantages in maintaining both EIA and broader disability assistance:

• considerations for those who were injured or developed ill-health as a result of working in required industries
• considerations for individuals working under order
• during and post-Covid, people in certain occupations are exposed to much greater risks of getting this illness and other diseases
• not all parts of IIDB are paid with disability benefits. There is some overlap with PIP, DLA and ADP while Constant Attendance Allowance paid with War Disablement Pension does not overlap with ADP
• IIDB is not a ‘public fund’. Therefore, we understand that if an individual is under immigration control (not entitled to claim benefits but can work) and then they are injured at work, they would be entitled to claim IIDB but not disability benefits
• even a smaller payment of IIDB could have a large financial impact. For example, if an individual was to lose a finger at work, they would not be eligible for disability benefits but would be eligible for IIDB, thus removing the benefit cap for them

However, there are issues with some of the overlapping benefit rules too. Individuals in receipt of means tested benefits that overlap with IIDB, for example Pension Credit, might have their rent and Council Tax paid for them when in receipt of Pension Credit. Then, when they apply for IIDB and are awarded payment, they lose their Pension Credit and then have to pay their Council Tax and rent which could leave them worse off financially. Beyond compensating eligible individuals, it is not clear what the purpose of IIDB currently is, or what it is meant to do. It acts as income for means tested benefits, but it is not an extra cost benefit like disability benefits, nor an earnings replacement benefit.

Recommendation 10: employment Injury Assistance should continue to compensate people that were injured or diseased because of their employment separately to disability assistance, and in some cases in addition to disability assistance.

Recommendation 11: the Employment Injury Assistance consultation should seek people’s views on how the Scheme and disability assistance can best align in future, in order to advance the best outcomes for disabled people and best value from public funds. This should include consideration of the role and responsibility of employers and the relative liability between employers and the state. It should also consider what the purpose of the benefit is.

Reserved and devolved aspects of the system and constitutional issues

The Group are aware that the devolved settlement, at present, means that many of the powers that may be required to make changes in relation to the compensatory nature of the Scheme sit with the UK Government. This would include areas like employment regulations, health and safety laws and insurance, such as the parameters around employers taking responsibility for injury and disease resulting from work or the responsibility of employers or employees in meeting the cost of compensation by paying an insurance premium.

The Scottish Government should, therefore, actively engage with the UK Government on its own plans to develop the Scheme in England and Wales and explore the potential to make changes in reserved areas to support the development of the Scheme in Scotland. In addition, the interactions between existing and new legislative criteria have to be carefully considered for any unintended risks or consequences to be mitigated.

There are further specific constitutional issues that we wish to highlight in relation to the Scheme. We do not believe it is within our remit to offer proposed solutions but note the following interdependencies for further consideration by officials.

• the majority of issues associated with means tested benefits are outwith the powers of the Scottish Government
• the Scotland Act 2016 excludes from devolution the ability to make lump sum payments for certain conditions. These are currently provided for by the Pneumoconiosis Etc. (Workers’ Compensation) Act 1979 which remains reserved. However, it is intrinsically linked to IIDB
• the 2016 Scotland Act ties Scotland to an existing UK provision on ‘employed earner’ and ‘relevant employment’ which limits the scheme to employed individuals or those taking part in training schemes. The employment landscape has changed hugely in the 40-plus years since the relevant regulations were laid, and this eligibility point is outdated. There are instances where low paid workers are told they are self-employed and excluded from the benefit as employers attempt to protect themselves from liability. This requires review and reform
• the Brexit Freedoms Bill includes a ‘sunset clause’ meaning that, at the end of 2023, what is left of some retained EU law will lapse and be removed if it is not reviewed before. This includes a range of employment-related regulations such as Working Time regulations and Health and Safety regulations
• any non-marginal differences in health and safety and employment regulations between Scotland and the rest of the UK (rUK) would create two job markets inside a single market

Given these constitutional challenges, we believe the Scottish Government should consider what scrutiny and advice functions may be required to consider the impacts of proposed changes in rest of UK to relevant regulations in Scotland, monitor progress on these issues and act as Scotland’s voice feeding into the UK debate on these issues, and where these functions would best sit.

There is a precedent for establishing a relevant Standing Council or Committee at Parliament to also monitor Scotland’s health and safety performance, and enforcement of health and safety legislation in Scotland as a previous Scottish body provided this function for the relevant European regulations.

Recommendation 12: the Scottish Government should actively engage with the UK Government on its own plans to develop the Scheme in England and Wales and explore the potential to make changes in reserved areas.

Recommendation 13: the Scottish Government should review and report how EIA will interact with all related elements of the reserved system.

Recommendation 14: the Scottish Government should review this benefit being for ‘employed earners’ only.

Industrial Injuries Advisory Council

In December 2017, this Group provided advice on the Independent Scrutiny of Social Security. We included a specific section on scrutiny of Employment Injury Assistance regulations. Whilst outlining the need for scrutiny we also noted the specific additional arrangements that would be needed for the purpose of complex, detailed scientific advice as follows:

'The constitution of a group competent to give expert advice in this field depends on what the Scheme will be. But it is likely to require similar scientific expertise to IIAC, which is distinct from expertise required for other social security provisions.

The Independent Medical Expert Group which advises the MoD on medical and scientific aspects of the Armed Forces Compensation Scheme is a potential model for a separate technical advisory body.

For scientific advice, in the first instance, the Scottish Government could rely on IIAC’s published reports. We recommend exploring with IIAC informal good working relationships to optimise information sharing, given there can be no formal advice-giving to Scottish Ministers.

As policy in Scotland on Employment Injury Assistance diverges from that in the rest of the UK, there will be a need for independent medical and scientific advice beyond that available from IIAC. Options include commissioning adhoc reports or setting up a panel of experts.

The resource committed should be proportionate.'

Officials explained that currently the decisions on conditions and occupations being prescribed for the purposes of IIDB sits with the DWP, advised by the independent scientific body the Industrial Injuries Advisory Council (‘the IIAC’). The IIAC is made up of independent scientists, clinicians, representatives from trade unions and employers who consider relevant evidence and related draft regulations.

In the short term, assuming Employment Injury Assistance is developed as a like for like benefit to IIDB, we see the options as:

1. Agree with the UK Government an extension to the scope of the IIAC so that it could formally provide advice to the Scottish Government, resourced by the Scottish Government. This should include expert Scottish participation on the IIAC. Although beyond the scope of this advice, we note here our view that the IIAC is under-resourced for the evidence it has to sift before recommending prescription. There is also a long-term under-resourcing of investment in occupational epidemiology research in the UK in general as well as in Scotland.

2. Leave the role of the IIAC unchanged, but seek to implement the recommendations the IIAC provides to the UK Government in the Scottish system, or

3. Set up a Scottish equivalent to the IIAC.

We understand that the current indication from the UK Government is that the IIAC will not be able to provide advice to Scottish Ministers in the future. Nonetheless, given the shared interest both governments have in acting upon high-quality scientific evidence and expert deliberation, we believe there are strong grounds for the UK and Scottish Governments to negotiate a shared service arrangement for the interim period at least. The Group believe it is essential that there are processes in place to ensure Scottish Ministers are provided with independent advice and scrutiny on the development of disability benefits in Scotland, including Employment Injury Assistance. Until the longer-term direction of Employment Injury Assistance and the Scheme in Scotland are known, it is hard to know what longer-term advice and scrutiny needs will arise for this particular benefit.

There are a number of practical and legal difficulties that would arise should the Scottish Government look to be updated in line with the independent advice from the IIAC for as long as IIDB and Employment Injury Assistance remain comparable benefits. These same challenges would apply should the advice of the IIAC regarding the Scheme in the rest if the UK be used in the short term to update the Scottish Scheme:

1. The Scottish Government would be unable to refer regulations directly to the IIAC for scrutiny.

2. The Scottish Government would be unable to proactively drive forward policy development.

There may be lessons to be learned from the current arrangements for both the UK Government’s Social Security Advisory Committee (SSAC) and the Joint Committee of Vaccination and Immunisation. Our understanding is that the latter has no statutory basis for providing advice to Ministers in Scotland or Northern Ireland and that there is no specific Scottish equivalent. However, it is clearly agreed between the UK administrations that health departments from Scotland and Northern Ireland are provided with and may choose to accept the Committee’s advice or recommendations.

Our view is that there should be a Scottish equivalent of the IIAC established, with a short-term arrangement with IIAC agreed. It will remain important that organised workers are represented on the future body, however it is formed, as well as those with direct experience of claiming IIDB and, in time, EIA. A collaborative approach with cross-sector advice is a necessity. Current legislation sets out that IIAC membership should include four members representing employers, four representatives representing employees and a number of independent members with specialism in occupational medicine, epidemiology, toxicology and the law. We believe this should be at least replicated on any future body.

Scottish Ministers may also wish to further consider the arrangements in place in the Republic of Ireland for the prescription of occupational diseases for Injury Benefit within the Irish Occupational Injuries Scheme.

Recommendation 15: the Scottish Government should continue to explore short term arrangements that would enable Employment Injury Assistance to be updated in line with the advice of the IIAC, for as long as Industrial Injuries Disablement Benefit remains a comparable benefit.

Recommendation 16: longer term arrangements should be designed to reflect the longer-term direction of Employment Injury Assistance and the Scheme in Scotland.

Although there are a number of positives associated with the current IIAC, there are also issues and challenges that we would not wish to see continue or be replicated. Currently, the IIAC has a very small research budget. This coupled with a small number of members means the advisory council is very resource intensive for these individuals. There is a reliance on a relatively small number of people, all who also have full time day jobs. With limited numbers of scientific experts covering a very large scope of inquiry, it is not unusual for it to take up to three years from consideration to final recommendations or conclusions to be made on a disease.

The advisory council could be better linked to academia including long-standing independent research institutes, considering the shortage of relevant scientists working in related fields. This could allow any future council to consider wider occupational risks, and potentially support employers to reduce absenteeism, and sickness. By actively tracking health and safety data and epidemiology, a further shift to prevention, rather than compensation of preventable diseases and accidents, could be possible.

The tripartite nature of the IIAC and their regular public consultations and annual meetings are notable features we believe should be replicated. This supports further stakeholder engagement and should continue for whatever form a future advisory council takes. Generally, a model based on the IIAC should be better funded and resourced.

Eligibility, prescribed conditions and data challenges

There are two overlapping but distinct issues to consider here: which diseases are prescribed for (and why) and how claims are administered. We understand that the current Scheme covers 70 diseases identified by the IIAC. These diseases are prescribed when there is a clear risk arising from a person’s occupation but not a risk common to the population. The criteria for determining whether a disease should be prescribed include the incidence risk being determined as twice as high at work as for the general population. This is a higher threshold than is set in other comparable countries and is a direct result of the legislation requiring balance of probabilities that an individual’s occupation caused their disease.

Basing entitlement on a prescribed list of certain conditions is a strongly medicalised model of determining entitlement to a disability benefit. If and when a disease will be considered for addition to the prescribed list is also highly dependent on the existence, quantity and quality of research evidence on that particular disease. This will often be driven by wider considerations such as availability of reliable data and funding for research – which can in turn be impacted by both the conscious and unconscious bias of those making the decisions as to what data should be collected and where funding should be directed.

For example, the Group is aware that the IIAC’s current position (last updated in March 2021) is that COVID-19 and Long Covid are not prescribed as an industrial disease. This is despite the IIAC concluding that there is a clear association between several occupations and increased risk of ill-health and death from COVID-19. The issue is a lack of consistency of data, poor extent of the mortality data and lacking adjustment factors such as deprivation meaning they consider the evidence is currently too limited in quality and quantity to justify prescription.

A major challenge for the IIAC is a lack of relevant, good quality epidemiological studies carried out in Britain that identify the associated occupations. Using overseas research requires some assumptions to be made about the relevance to the UK. The IIAC rely on published research funded by other bodies. For example, there are diseases where the risk is clearly doubled as a result of an individual’s occupation. But, with limited or no data on what the casual exposure is, it makes prescription very difficult.

More fundamentally the Scheme is aligned with a previous industrial age. Although the size of industry in Scotland has reduced, there are still workers exposed to substances hazardous to health. Many claims, particularly for cancer, reflect historic conditions. There are some occupational cancers that are not prescribed.

The current model also focuses on physical rather than psychological trauma and injury. This would, therefore, appear to contrast with the social model that the Scottish Government aims to have at the heart of other forms of disability assistance in Scotland. Mental ill-health is a major driver of disability assistance and is often linked to employment. Mental ill-health is included in the disability assessment for IIDB, but there are no mental health conditions currently prescribed. It is often present as a co-morbidity to long-term conditions. As mental ill-health has a higher incidence in women as a result of their occupation, the consequences are inherently discriminatory on the basis of sex.

In the current scheme the level of resultant disability affects the amount of benefit individuals receive, assessed by a medical advisor on a scale of 1 to 100%. Normally, people must be assessed as 14% disabled or more to get the current benefit. We have concerns about the 14% rule, the assessment process and the fact that individuals cannot get benefit for the first 15 weeks after an accident. There are a number of examples where individuals are affected by an industrial accident or injury immediately. Therefore, we believe they should be able to claim accordingly. Whilst we appreciate the need for an evidence-based decision, this eligibility represents an out-dated system. There are only 55 injury types listed, where in New South Wales there are 1,255 injury types listed.

There are different approaches and models used in different countries that could serve as comparison. The ILO list states the agents that can cause occupational diseases, for example ‘occupational cancer’ can be caused by 20 agents, although it does not provide a way to determination compensation of affected workers. There is also an option to compare with countries of comparable size, such as Norway, Denmark and Finland. These countries function very effectively in regards to occupational disease.

There does however need to be balance when proposing changes. For example, removing the doubled relative risk requirement would result in many people being compensated for a disease that was not occupational in origin.

Recommendation 17: the consultation should set out the current processes and timescales for prescribing industrial diseases and explore both short and long term measures to improve the process, with a particular focus on advancing equalities.

Recommendation 18: the consultation should set out the rationale for the current requirement for at least a doubling of risk, and then seek views on whether this is the best threshold of attribution.

Recommendation 19: the consultation should seek views on reforming the use of a percentage scale of disability, the assessment process (including increasing the number of injury types to give more detailed guidance regarding assessment), and the 15 week period from the date of the accident or onset of the disease before payment is made.

Prevention and rehabilitation

We are of the view that any future Scheme should have a strong preventative focus. It should be the aim to prevent as many accidents or cases of occupational disease as possible from happening in the first place. Currently, the IIAC has close links with the Health and Safety Executive and each report or Command Paper has a section dealing with prevention. If the Scottish model was to do more than this, then the Scottish Government should consider how prevention could be mandated.

We believe the UK is lacking in preventative health and safety measures, and this failure is wider than this Scheme. Recently published HSE health and safety statistics for 2021/22 reveal:

• 1.8 million working people are suffering from a work-related illness
• 36.8 million working days are lost due to work-related illness and workplace injury
• £18.8 billion as the estimated cost of injuries and ill health from current working conditions (2019/20)

This is also a failure of regulatory bodies and a result of very few proactive health and safety bodies picking up new diseases.

The number of claims for each prescribed disease is currently recorded monthly. Therefore, existing data available outlines what is driving the most claims. HSE also publishes related data every few years in this area based on self-reports, HSE Cost Model, death certificates and epidemiological information amongst other related data sources. We should be exploring further targeted prevention measures to put in place, although the difficulty in doing this for long-latency diseases should be acknowledged. Enforcement bodies such as HSE, local authorities, SEPA and Public Health Scotland should be engaged alongside people with first-hand experience of industrial injuries to develop truly preventative strategies for work-related diseases and injuries.

This Scheme acts as a marker of how well we are looking after our workforce here in Scotland. It goes wider than the award of benefits. Employers should be incentivised to strip out patterns of failure with better feedback mechanisms and clear responsibilities in place.

It is also important that in assessing entitlement to Employment Injury Assistance there is not an assumption that the applicant is no longer able to participate in the workforce. Any consideration of an applicant’s entitlement should be informed by robust Occupational Health referrals and access to appropriate rehabilitation support. There should be investment to re-training and upskilling EIA recipients to support them into work that they can do, and to increase job retention.

As employment law is not a reserved power, it will be important to consider the specific needs of this cohort in the context of current wider employment support provision within Scotland.

Recommendation 20: the Scottish Government should ensure that Employment Injury Assistance is developed as part of a wider programme of work aimed at the prevention and mitigation of the impacts of industrial injuries, including ensuring sufficient resources and signposting for occupational health referrals and rehabilitation are in place. This should include working with employers and other UK administrations where necessary and beneficial.

Further research

To support this advice, further to the knowledge building session referred to earlier, we also commissioned the Scottish Government’s Library team to carry out a related literature search. The purpose of this was to understand existing available research that explores or analyses the potential costs of reforming IIDB to make it more relevant for the Scottish working population, and more effective. The Library team used a variety of relevant key words and searched a range of websites and databases to attempt to source relevant published research.

The result of this literature search concluded that there is limited to no existing publicly available research that has attempted to conclude what it could cost to reform IIDB, nor broaden the Scheme. This suggest that little research has been done in this area.

The majority of search results provided an analysis of IIDB in its current format and arguments for its reform. A recurrent theme in the online resources points to the inequalities of the Scheme.

Recommendation 21: the Scottish Government should commit to an analysis that draws conclusions on the cost of industrial diseases to the Scottish Economy per year. This should inform a decisive shift to increased spending on preventative measures. There should be a new sharing of responsibility between employers, government and the insurance industry.

Conclusion

In summary, whilst recognising this is an important benefit for all those who currently receive it, we would strongly recommend that Scottish Government explore both short and longer term measures to reform the Scheme so that its current shortcomings and limitations are addressed, it is fairer, and it is aligned within the broader programme of disability assistance in Scotland.

We are confident that incentivising workplace prevention and improving rehabilitation measures will reduce the number of workplace accidents and incidence of occupational disease. This will reduce the financial costs of this Scheme and to the wider economy. Successful reforms starting with the introduction of EIA should serve as a catalyst for making productive, thriving, healthy workplaces a reality for all.

I hope this is helpful. I look forward to your response and we would be pleased to discuss this further with officials.

With best wishes,

Dr. Jim McCormick

Chair

Annex A

Supporting documentation list

• international human rights law in relation to employment injury helpful info/links
• ranging human rights principles at play here
• Industrial Injuries Advisory Council research and analysis paper on international comparisons to the IIDB Scheme
• a study investigating the challenges and facilitators of occupation epidemiology research in the UK, and the impacts of these challenges
• a paper raising concerns about double risk