The HSB interview: Rory O'Neill, safety campaigner

In the first in a new occasional series - "The HSB interview" - campaigner and wannabe Health and Safety Executive (HSE) chief executive Rory O'Neill talks to Howard Fidderman.

This autumn, Rory O'Neill, one of the UK's foremost health and safety campaigners, will learn from the Department for Work and Pensions (DWP) whether or not he will be interviewed as a potential successor to Geoffrey Podger as the HSE's chief executive.

O'Neill has edited Hazards magazine for more than 25 years and has been instrumental in the development of a grassroots UK health and safety movement, including the Hazards Campaign. He is also professor of occupational health, safety and environmental policy at Stirling University and co-moderates the global unions' e-lists.

Over the years, O'Neill has prioritised the international exchange of strategies and skills, for example introducing body mapping and participatory worker-oriented research techniques to the UK. He has been a consultant for international union bodies (the ITUC and ETUC) and global unions (IndustriALL and BWI), and represented unions at the International Labour Organisation (ILO), the World Health Organization and the Commission for Sustainable Development.

O'Neill has played a key role in global campaigns on asbestos, pesticides and behavioural safety. He has also worked in GP surgeries, the health service, bakeries, behind a bar, workers' health and safety centres, on building sites and as a drystone waller.

"We love red tape"

HSB: Your candidature for HSE chief executive is linked to the "We love red tape" campaign. Why?

RO: The HSE lacks ambition, but that doesn't mean we can't be ambitious for it. I want to use "We love red tape" to stimulate a discussion about the type of regulator we need and deserve. At the moment we are hearing the safety sister of the austerity debate, a false narrative that starts with an assumption that safety is burdensome and that workers - greedy, grasping, compensation-obsessed and feckless - are part of the problem.

I want first to write the honest narrative. The HSE does need to change. But what it doesn't need is to be bullied and cowed by a government that has declared health and safety a monster to be slayed and made the HSE the poster boy for its deregulatory project. The aim of "We love red tape" is to create a positive and reasoned debate about what we might expect from a safety watchdog. "HSE version 2.0" would champion grown-up economic arguments for protecting workers. I am also pushing a focus on prevention, through the creation of a "Bright Ideas" unit to encourage and support the adoption of innovative, preventive and precautionary approaches. One theme would be Toxics Use Reduction.

HSB: What is grown-up economics?

RO: I advocate a doubling of the HSE's budget, not because the Government will hand over the cash, but because it is good economics. There is a solid evidence base for investing in health and safety - in regulation, enforcement and at the workplace - because it reaps cash benefits for employers and the public purse.

Do the maths. The cost to society of each workplace fatality is put by the government at about £1 million; each occupational cancer death - and the HSE estimates conservatively there are 8,000 a year - comes in at about three times that. The Department for Work and Pensions (DWP) is providing the HSE with just £167 million for the coming year - about the same as the annual fatalities bill. Put another way, the entire cost of the HSE to government is less than 1% of the annual cost of occupational cancer deaths. Add in other occupational injuries and diseases, and it becomes evident that any investment in increased preventive efforts would pay dividends. As a bonus, it would also save lives.

HSB: You announced your candidacy and love of red tape in June. How has it worked out so far?

RO: Early indications are good and the reaction has been wholly positive. The "We love red tape" Facebook page reached more than 10,000 people in two days, before it was formally launched. In its first week, the page accrued several hundred "likes" and currently has 434.

The arguments put forward have struck a chord and attracted praise from organisations such as the Australian Council of Trade Unions and the US National Council for Occupational Safety and Health. Backing from individual UK unions would be good; some have already expressed support. I can't imagine the TUC backing any candidate - it's not what it does - but I'm sure it will back the message.

HSB: Why do you think you are attracting such positive responses?

RO: People seem relieved that someone is saying the focus on "burdens on business" and "compensation culture" has no basis in fact (see box 1), but provides cover for a cost-cutting government strategy fashioned by the most irresponsible outliers of the business and insurance lobby. It is a dishonest narrative that fits the prevailing political agenda but is a slow-mo disaster in public health terms.

I'm asking for a bigger and better HSE with an evidence-based strategy, not an imposed political strategy concocted without any regard for the potentially deadly consequences. What's not to like? It is time the HSE stopped playing the Whitehall game, and saying "thank you" to ministers after each successive insult and cut. It is time for the watchdog to bite the hand that starves it.

Recent HSE chief executives, including lame duck incumbent Geoffrey Podger, have presided over a disastrous, government-fashioned decline in the HSE's fortunes. There has been no public fight for the HSE's functions and resources, and any arguments behind closed doors have had no effect. Thomas Legge, the first medical inspector of factories, resigned in 1926 in protest at the Government's refusal to sign up to the ILO's white lead convention. The current leadership has overseen without a peep the almost certainly illegal dissolution of the HSE's medical wing, a crippling erosion of HSE resources and an enforced retreat from its central regulatory and enforcement role. That's not leadership, it is capitulation.

With the HSE chief's job up for grabs, the Government would like to change the collar on a three-legged dog. We can't afford more of the same, which is why I'm throwing my hat in the ring. I want the HSE to be a stable watchdog, with four legs and teeth.

Time for reappraisal

HSB: Why, and how, would you "stimulate a reappraisal of what the HSE does"?

RO: The HSE is suffering an identity crisis. It is a regulator averse to regulating. It is a workplace health protection agency that has a self-applied blindfold when it comes to workplace health problems, and no capacity to assess, let alone remedy, them (see box 2).

We have had a sequence of government-commissioned reviews in the past three years - from Lord Young, Professor Löfstedt and now a second Triennial Review - all starting with the unsustainable premise that health and safety regulation and compensation culture are burdens on business, and the HSE is the ring master of this business-busting, job-killing, enterprise-strangling circus.

I do want the function of the HSE reviewed, but I want to start with honest questions. How can we design a watchdog that saves lives, preserves health and delivers justice? My Citizen Sane manifesto and "We love red tape" are an opening salvo to get people thinking about a new, ambitious, fit-for-purpose HSE; an HSE that has got its mojo back.

HSB: In terms of mojo renewal, you have said previously that you would like to see the core roles of a new HSE comprise "economic and social justice and worker and community empowerment".

RO: Some of this is what you decide to do, some of it how you decide to do it. Legge was instrumental in getting occupational diseases covered by workers' compensation. This type of function - the regulator being the workers' friend and advocate - is unimaginable under the current HSE leadership. It would be the rule under my reimagined HSE.

The 1980 government-commissioned Black Report, Inequalities in health, established a clear class gradient in health. It influenced public health policy, but the HSE and workplace health protection remained resolutely class-blind. This was a mistake at the time because understanding that risk is concentrated not just in workplaces but also in communities would have allowed resource targeting that is different, complementary and more sensitive. But it is even more lamentable with today's less predictable working life cycles.

The HSE remains an institution suited to a world in which monolithic industrial giants employed thousands on single sites, performing regimented jobs with predictable hazards throughout a working lifetime. Today's workers are more likely to have several jobs over a longer working lifetime, work a number of jobs at once and have to deal with job insecurity and a spectrum of hazards changing at a dizzying frequency. For many, precarious work is normal work.

The demographics have changed too - the decline in traditional "male" industrial jobs has been accompanied by the emergence of a new UK plc, dominated by service sector employment with more women, migrant, temporary and older workers.

HSB: And how would these changes affect your approach to enforcement?

RO: In a breathtaking exhibition of missing the point, the HSE is now concentrating its resources on the rapidly disappearing old-style workplaces. This is not a genuine risk-based judgment. Workplace risks are travelling in the opposite direction - subcontracted, outsourced or shunted onto the night shift, all of which are more likely to escape the HSE's narrowly focused 9-to-5 scrutiny.

Most of these workers - most workers, full stop - are expressly exempted from the HSE's preventive oversight, courtesy of the cull of inspections. The HSE has rationalised this as a risk-based approach, but cannot provide evidence to back it up. There is a reason; the evidence doesn't support it. It is simply a case of the HSE tamely following orders, in this case a stop-enforcing directive in the Government's 2011 "Good health and safety, good for everyone" strategy. The HSE tried to retrofit the evidence to the imposed policy. It failed (see box 3).

Now farm workers and nurses, both facing routine risks from cumulative heavy loads and exposure to potent causes of industrial lung diseases and cancer (including agrochemicals, organic dusts, antiseptics, disinfectants and cytotoxic drugs) are among those no longer subject to the HSE's routine scrutiny. They have plenty of company. The 2011 government blueprint and the HSE's subsequent sectors' strategies dropped 37 sectors from the HSE's to-do list, from glass and cement to residential care homes to transport and plastics. If this strategy was evidence-based, the HSE would have expanded inspection and enforcement. Now, it is not even looking in most workplaces. And it is missing another trick - finding better ways to access workers in a rapidly changing, different world of work.

HSB: And your trick is ...

RO: I've taken occupational health to the workers, running occupational health screening and advice sessions out of pubs, mosques and community centres. Workers are on their turf, where they have some level of control and without the looming threat of supervisor or manager.

This also means the problems caused by the last but one job - not just the current job - can be addressed. This is important not just for the individual, but for garnering intelligence about current and past conditions in local workplaces that will contribute to slow-burn industrial diseases like cancer, or progressive conditions like deafness and obstructive airways diseases that may only emerge over time. The HSE lacks this intelligence.

There are other ways the HSE could get smarter. It could, for example, team up with agencies such as Macmillan Cancer Support, or primary care practitioners, such as health visitors, who access workers by other routes. None of this is difficult or particularly resource intensive. I've done it myself on a shoestring, working with local union groups or primary care-based occupational health projects. Tens of thousands of affected workers can be identified in short bursts of targeted resources.

How we are harmed by work has also changed, and the HSE has failed to keep pace. The problem facing most workers is not blood on the factory floor; the pain is internalised and the pinch points are emotional and mental. Sickness-absence policing, fitness-for-work evaluations, performance appraisal, behavioural safety (see box 4), fatigue, lifestyle interventions and job insecurity are among the often unwelcome and sometimes punitive consequences of business choices that make heart disease, mental health problems and suicides an unhealthy complement to the lung diseases, injuries and cancers that dominated the occupational health profile of previous working generations. Another unaddressed problem is attrition, the day-by-day wear and tear of the job that leaves many workers worn out and not able to stay healthy and productive until retirement age.

The HSE has no answer to these problems; it doesn't even want to address the question. If it doesn't, it will drift from inadequacy into irrelevance. It needs to recognise and respond to the pressures facing modern, more insecure workers. It needs to look at how it accesses workers and what it offers them. Insecurity, bullying, victimisation and blacklisting are genuine health and safety issues. Low pay is a health and safety issue; it determines the choices we feel able to make - whether that is failing to report an injury or working while sick. Where is the HSE on these issues?

Improving governance

HSB: Do you think it appropriate that the HSE remains policy maker, adviser and enforcer?

RO: It can, but at the moment the tail wags the dog. The HSE makes its own strategy, then puts it to its board for ratification. But the choice and content of the proposals, for example the Approved Code of Practice on child labour on farms that the board axed at its June meeting, do not reflect reasoned priorities or necessary policy changes. They reflect a government instruction to slash binding safety rules on business. If the HSE is to maintain this policy, adviser and enforcer role, it needs effective governance. It is sorely lacking now.

HSB: Why is effective governance lacking?

RO: The current HSE Board is dysfunctional. It has always been business-heavy, but now it is effectively a business body with a couple of union-side bolt-ons. A clear majority of the board's non-executive directors are from a high-level management background.

To my knowledge, no public interest representative in the HSE's history has ever canvassed that public interest constituency for its opinions. The current seat warmer, George Brechin, is a retired NHS chief executive. Where's the relevant experience there or the identity with the constituency? It is an important function - three-quarters of the workforce is not employed in unionised workplaces and most is in small workplaces not represented by employer lobby groups.

The board needs to reflect the views of those on the receiving end of poor health and safety practices, and the single public interest seat is not performing that function. It should be. Without it, there is no voice for health and safety campaigners, for occupational disease and injury advocacy organisations, for the victims of workplace injuries and diseases and for communities concerned about the wider impact of having potentially deadly workplaces on their doorsteps.

I would end too the artificial consensus adopted by the HSE, and the sanitising of HSE Board minutes to remove notes of dissent. We need openness and clarity. If that means recording and publishing minority viewpoints, then that's all for the good.

The HSE - both its leadership and its board - needs to assert its independence from government. At the moment its policy and practice is conflated uncritically with pronouncements from a government openly hostile to the HSE and to its regulatory function. HSE-revisited would not have its policy fashioned by either business or government. Both, of course, have to be heard. But a greater worker and community voice - what happens at work doesn't always stay at work - has to be evident too.

HSB: How would you improve the public interest representation on the board and increase the worker and community voice?

RO: I would have more representation and more effective representation. If the consumer interest can have a designated seat, why not occupational injury and disease victims or their advocates? Why not have ring-fenced representation of bereaved relatives? Implementing bad, government-driven policy would be that bit harder if board members had to see the real-life consequences and human component sitting across the table. In terms of practice, it is disgraceful that successive public interest representatives have been invisible to the public. They should be required to liaise with this constituency, publicly and openly.

HSB: Why is it important to increase the input of victims and their families into the HSE's process for decision making?

RO: There are government departments queuing to promote enterprise and business; even in these austere times it is a well-resourced industry within government. The HSE, in contrast, is our only bulwark against criminal business safety practices and excesses. The reason for health and safety regulation is to protect workers. If workers, occupational disease victims and families don't have a say, then we have lost sight of what the objective must be - to learn the lessons from those at the coal face or chalk face and to make sure we don't repeat our mistakes.

I'd make sure there were seats on the board for this constituency. I'd ensure the HSE indulged in honest and broad-based consultations that do not start by stating government policy and leave no room for alternative perceptions and solutions. I'd also inject some humility into the HSE. It can learn lessons from workers and communities. There is not always just one right answer, and the HSE may not always know best.

HSB: How else might you change the HSE?

RO: I would change the HSE's brand. I would repackage it as a champion of working men and women, rather than a running "myth busting" apology for doing its job at all. You've lost the game already if you are just putting out fires started by the Daily Mail. A name change might also help. The "bonkers conkers" attacks on the HSE are nothing to do with the HSE. The addition of "work" in the HSE's name might make this a bit more obvious. Workplace Health Executive would work for me.

HSB: Are you therefore proposing to remove or limit the HSE's role in non-work-related activities?

RO: Yes. Gas, patient safety and fairgrounds need effective enforcement and oversight, but not by the HSE. These bolt-ons muddy its identity. The HSE needs to be about "work". Public safety should be dealt with by other public health and safety-oriented agencies.

Challenging government

HSB: A benign interpretation of the HSE's strategy for dealing with the government is that it is doing what it needs to do to survive and, where possible, ameliorate the worst excesses, in the hope that better days will come. A less charitable interpretation is that it has embraced the new ideology. Where would you fall on this spectrum?

RO: The HSE's strategy has been a disaster. Much of it has been government imposed, but at times the HSE has appeared a willing collaborator. The HSE would point to work-related ill-health and injury statistics to counter this, but in public health terms we still have a high plateau in what it claims is predominantly a low-risk economy. We are in a recession, which depresses injury rates and, probably, injury reporting, and we've seen a dramatic erosion of the country's manufacturing industry. We are left with types of harm caused by work - heart disease, mental illness, suicides - that do not get counted and that are not being prevented. And the old problems have not gone away. Over 8,000 cancer deaths is a major public health concern. As are 30,000 major injuries a year.

There is also an enormous justice deficit. If only a tiny and diminishing proportion of the employers harming their workers are even subject to an HSE visit, then there are no consequences for bad practice and no justice for those harmed. In business terms, this favours the rogues over the responsible firms.

We need a regulatory and enforcement system that gives the competitive edge back to those who really do try to do the right thing.

HSB: One problem you would face as chief executive would be dealing with ministerial pronouncements and diktats you would find unpalatable. How would you handle this?

RO: The HSE should always call the Government out on policies it believes will damage health and safety at work. This, though, requires a reconfigured and better functioning HSE Board disposed to identifying and challenging patently damaging government policy.

I wouldn't be doing the job for the wages or pension, so I'd have a certain freedom, at least for a while. I'd speak my mind and refuse to take action that would undermine the HSE's authority, but, more particularly, harm working people. I will not be complicit in workplace GBH or worse. If the Government didn't like it, it would have to sack me. Thomas Legge stood on principle; it's about time someone else in the HSE showed similar gumption.

HSB: Should you fail to persuade the DWP to increase the HSE's grant-in-aid, you would be faced with the same budgetary constraints endured by the current incumbent, Geoffrey Podger. How would you use those same resources differently?

RO: The first priority would be about perception. HSE version 2.0 would rebrand itself as a workplace justice organisation, defending and supporting the rights of working people. Sick? Injured? Got a problem? The HSE is here for you. A new Whistleblowers' Hotline would make it easier and simpler to identify dangerous firms. In a departure from current HSE practice, anonymous reports would be allowed - if it is OK for Crimestoppers and Dob in a Dealer, then it is OK for the HSE.

It is also about presentation. The HSE's current website, for example, would be revamped. It would lose its single-issue-freak staidness, and would be redesigned so someone under 50, not carrying a clipboard and wearing steel toecaps, might want to read it. You have to engage workers, not just safety officers or motivated employers, if you want to make fundamental changes. I envisage the new preventive focus would be low or no cost, and prove popular with business. It could increase innovation and push down insurance costs. If it didn't, we'd want the insurers to tell us why not.

HSB: And finally, how would you "motivate" employers to meet their health and safety duties?

RO: I'd work with the willing - through our preventive programmes - and hound the rogues. I would look to levers such as insurance industry pressure and contract compliance agreements. I would also use the workers. The HSE found worker safety advisers were a highly effective idea, appreciated by employees and employers, then ditched them. It accepts union safety reps have a marked positive effect, but it does nothing concrete to encourage and support them. Why? The HSE admits it can't be everywhere. Workers can: they are a resource to be harnessed, whether by supporting new roles and functions - for example, safety rep-issued provisional improvement notices - or through participatory grassroots research.