Corporate report

IIAC annual report: 2020 to 2021

Published 15 July 2021

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Foreword

The year has been an unprecedented year in the history of the Industrial Injuries Advisory Council (IIAC/the Council). The COVID-19 pandemic has impacted on all IIAC Members and DWP staff. It required changing the usual pattern of committee meetings and also influenced the work programme of IIAC. The Council last met face-to-face in March 2020. Only one Committee meeting was cancelled in April and, thanks to the efforts of DWP secretariat, all other meetings were held successfully online. In addition, several smaller groups of Members who were working on specific scientific aspects of topics under consideration were able to meet online for more informal discussions.

In spite of these practical changes, the Council has reviewed and evaluated several major occupational health issues that has resulted in publication of a Command Paper on cutaneous malignant melanoma and two Position Papers. Following concern by the House of Commons Environmental Audit Committee (EAC) about the exposure of firefighters and clean-up workers to toxic chemicals from the Grenfell fire, a comprehensive review of the risk of cancer in firefighters was carried out by IIAC. The Council uncovered evidence that firefighters can potentially be exposed to a range of carcinogens; however, the Council did not find consistent evidence that the risk of any type of cancer, apart from mesothelioma, is more likely than not to be due to firefighting and thus could not recommend prescription.

Unsurprisingly, given the circumstances, a major part of the work of the Council this year has been the evaluation of the impact of the COVID-19 pandemic and the potential risks to workers. This required constant monitoring and evaluation throughout the year as reports and papers rapidly began to be published. The hard work and dedication of the Secretariat and Members has ensured that, at the beginning of 2021, we were able to publish a Position Paper focussing mainly on mortality data. Towards the end of 2020 reports on longer term conditions and symptoms following COVID-19 began to be published. Some of these may potentially cause some long-term disability and the Council are now beginning to evaluate this.

Many of the diseases that are currently prescribed have a history going back several decades. As part of its work the Council may be asked to look at these with a view to making them more ‘user-friendly’ for both claimants and assessors. Pneumoconiosis is one such disease where the prescription goes back over 80 years. The Council are now considering how this can be clarified and simplified and intend to consult UK experts once a proposal has been drafted.

This year IIAC has also been considering how to address issues where there is a lack of information, in particular good quality epidemiological studies. Unfortunately, there are now fewer occupational studies being carried out. Occupation is also not routinely collected as part of population health data, for example GP and patient records. We have been exploring alternative methods such as ‘exposure equivalence’ for Hand Arm Vibration Syndrome, where new occupations are compared with those already prescribed in terms of exposure.

This year we have addressed some major issues and our forward programme is likely to be equally challenging. I would like to thank all the Council members, the HSE, MOD and other observers, the Secretariat and members of the Department for their hard work and dedication this year and am reassured that this will continue in future.

Dr Lesley Rushton
IIAC Chair

Introduction

The Industrial Injuries Advisory Council (IIAC) is a non-departmental public body (NDPB) established under the National Insurance (Industrial Injuries) Act 1946, which came into effect on 5 July 1948. The Council provides independent advice to the Secretary of State for Work and Pensions in Great Britain and the Department for Communities (DfC) in Northern Ireland on matters relating to Industrial Injuries Disablement Benefit and its administration. The historical background to the Council’s work and its terms of reference are described in Appendix A and Appendix B respectively.

The Role of the Council

The statutory provisions governing the Council’s work and functions are set out in sections 171 to 173 of the Social Security Administration Act 1992 and corresponding Northern Ireland legislation. The Council has 3 main roles:

• to consider and advise on matters relating to Industrial Injuries Disablement Benefit or its administration referred to it by the Secretary of State for Work and Pensions in Great Britain or the DfC in Northern Ireland
• to advise on any other matter relating to Industrial Injuries Disablement Benefit or its administration
• to consider and provide advice on any draft regulations the Secretary of State proposes to make on Industrial Injuries Disablement Benefit or its administration

IIAC is a scientific advisory body and has no power or authority to become involved in individual cases nor in the decision-making process for benefit claims. These matters should be taken up directly with the Department for Work and Pensions, details of which can be found on the GOV.UK website.

Composition of the Council

IIAC usually consists of around seventeen members, including the Chair. It is formed of independent members with relevant specialist skills, representatives of employees and representatives of employers. The independent members currently include medical and scientific experts and two lawyers. Membership of the Council during 2019 to 2020 is described in Appendix C.

Legislation leaves it to the Secretary of State to determine how many members to appoint, but requires that IIAC includes an equal number of representatives of employees and employers (Social Security Administration Act 1992, Schedule 6).

Conditions for ‘Prescribing’ Diseases

Much of the Council’s time is spent considering which diseases, and the occupations that cause them, should be included in the list of diseases (‘prescribed diseases’ (PD)) for which people can claim IIDB.

The conditions which must be satisfied before a disease may be prescribed in relation to any employed earners are set out in section 108(2) of the Contributions and Benefits Act 1992. This requires that the Secretary of State for Work and Pensions should be satisfied that the disease:

• ought to be treated, having regard to its causes and incidence and any other relevant considerations, as a risk of occupations and not as a risk common to all persons; and
• is such that, in the absence of special circumstances, the attribution of particular cases to the nature of the employment can be established or presumed with reasonable certainty

In other words, a disease can only be prescribed if the risk to workers in a certain occupation is substantially greater than the risk to the general population and the link between the disease and the occupation can be established in each individual case or presumed with reasonable certainty.

In some instances, recommendations for prescription of a disease can be made on the basis of clinical features which confirm occupational causation in the individual claimant. Increasingly, however, the Council has to consider diseases which do not have clinical features that enable the ready distinction between occupational and non-occupational causes (for example, chronic obstructive pulmonary disease, which can be caused by tobacco smoking as well as having occupational causes). In these circumstances, in order to recommend prescription, IIAC seeks epidemiological evidence that the disease can be attributed to occupation on the balance of probabilities under certain defined exposure conditions (generally corresponding to evidence from several independent research reports that the risk of developing the disease is more than doubled in a given occupation or exposure situation), and thus is more likely than not to have been caused by the work. In 2015, the Council prepared a lay person’s guide to prescription, which was published on the GOV.UK website.

Research

The Council relies on research carried out independently, which is published in the specialist medical and scientific literature. IIAC does not have its own research budget to fund medical and scientific studies (other than limited funding from DWP for the occasional commissioning of reviews). When IIAC decides to investigate a particular area its usual practice is to ask other bodies and interested parties to submit any relevant research in that field. IIAC has a sub-committee, the Research Working Group (RWG), which meets separately from the full Council to consider the scientific evidence in detail. The Council’s Secretariat includes a Scientific Adviser who researches and monitors the medical and scientific literature in order to keep IIAC abreast of developments in medical and scientific research and to gather evidence on specific topics which the Council decides to review.

In March 2015, the Council published some informal guidance on how it reviews and reports on published literature, particularly epidemiological studies, to provide evidence for potential prescription for IIDB.

Key achievements of 2020 to 2021

The following reports were completed in 2020 to 2021:

Command Papers^{[footnote 1]}

CP 216: Cutaneous malignant melanoma and occupational exposure to (natural) UV radiation in pilots and aircrew – published 12 May 2020.

Position Papers^{[footnote 2]}

Position Paper 47: Firefighters and cancer – published 25 March 2021
Position Paper 48: COVID-19 and occupation – published 25 March 2021

Information Notes^{[footnote 3]}

Dupuytren’s contracture: a revision of the information note to clarify involvement of knuckle joints in the condition – published May 2020

Regulations proposed by the Secretary of State

The law requires that draft regulations proposed by the Secretary of State which concern the Industrial Injuries Disablement Benefit Scheme are referred to the Council for its advice and consideration.

The Council did not consider any regulations during the period.

Stakeholder Engagement

Dr Willie Stewart attended the full IIAC meeting in April 2021 to share his experience of neurodegenerative diseases in footballers, having authored a paper on this topic.

Appointments

One member was reappointed for five years from 1 November 2021.

Recruitment has commenced to replace two independent members of the Council, with appointments expected to take place from early autumn 2021.

IIAC Meetings

Due to the pandemic, the first meeting of the full Council on 2 April 2020 was cancelled. Since then, all subsequent meetings of the Council and its Research Working Group successfully took place online; several meetings of small working groups of Members also took place to discuss specific scientific aspects of some of the topics under consideration by IIAC. Initially, the Council focused on 2 main topics:

• firefighters and cancer; and
• COVID-19 and occupation

Other major topics being considered are: Neurodegenerative diseases in footballers, review and update of the prescription for pneumoconiosis (PD D1) and potential use of exposure equivalence to enable additional occupations to be included for Hand Arm Vibration (PD A11).

Summary of work undertaken in 2020 to 2021

The Council continued to undertake its advisory function effectively and the work programme undertaken is summarised below.

Evidence update of the relationship between occupational exposures and selected malignant and non-malignant respiratory disease

Some of the current prescriptions for respiratory diseases have been re-evaluated more than once since their inception many decades ago. However, they do not always reflect occupations and modern work practices where exposure may occur more frequently than in the past, for example:

The construction industry, which employs large numbers of workers, is now an industry where silica exposure commonly occurs and is not specifically mentioned in current prescriptions.

New products may also cause unforeseen relevant exposures; for example, there are several recent reports of younger workers diagnosed with silicosis in relation to the use of newer products made of artificial/composite stone which often contains a high percentage of quartz.

Currently chronic obstructive pulmonary disease (COPD) is only prescribed in relation to coal mining. However, there is a large literature in many different industries showing consistent associations from several occupational-related exposures with increased risk of death or incidence of COPD, for example: work in construction, tunnelling, manufacture of ceramic fibres, iron and steel foundry work, cotton manufacture, grain handling, welding, and agriculture.

For lung diseases, a particular challenge for prescription is how to take account of important confounding exposures, and in particular, smoking. This is illustrated in the current prescription for COPD and coal mining, which was based on data that included both smokers and non-smokers; smoking habits of claimants are thus ignored.

Stakeholders have also raised the issue of toxic dusts of unknown composition in various workplaces but particularly construction, for example in house renovations.

Against this background, IIAC discussed commissioning a comprehensive review and evaluation of the literature on selected work-related malignant and non-malignant respiratory diseases (including lung cancer and COPD) to inform update and potential expansion of the IIDB scheme. At the public meeting in 2019, representatives of mineworkers raised a query relating to the 20-year rule for eligibility for the prescription PD D12, COPD in mineworkers. It was stated that a change in working practices resulted in longer shifts and asked if the 20-year rule could be re-examined. As a result, this topic will be incorporated into the commissioned review.

The Council agreed to proceed with this comprehensive review and funding was secured. Consequently, a tendering process to seek suitably qualified researchers to carry out the review was initiated.

Cutaneous malignant melanoma and occupational exposure to (natural) UV radiation in pilots and aircrew

IIAC undertook an extensive investigation into the risks of developing cutaneous malignant melanoma as a consequence of working as a pilot or as cabin crew on commercial aircraft. This came about after the Council received correspondence from a worker who developed skin cancer as a result of spending extended periods of time exposed to natural ultraviolet (UV) radiation i.e. sunlight. The current list of prescribed diseases includes ‘primary carcinoma of the skin’ (PD C21) following exposure to arsenic or arsenic compounds, tar, pitch, bitumen, mineral oil (including paraffin) or soot. It does not include skin cancer arising from exposure to sunlight during the course of outdoor working.

An in-depth analysis of the scientific literature of melanoma incidence conclusively demonstrated a consistent doubling of risk for both pilots and cabin crew, and for pilots in particular, after 5,000 aggregated hours’ flying time. This corresponds to approximately 5 or more years aggregated duration of employment.

The Command Paper, published in May 2020, sets out how the Council arrived at its conclusion and detailed the evidence it reviewed. Given the clearly doubled risk, the Council recommended that malignant melanoma in pilots and cabin crew be added to the list of prescribed diseases for which benefit is payable, following 5 or more years’ duration of employment.

Firefighters and cancer

The House of Commons Environmental Audit Committee (EAC) published its enquiry into Toxic Chemicals in Everyday Life. This was referred to IIAC by the DWP to consider as the report made a recommendation:

The Government should update the Social Security Regulations so that the cancers most commonly suffered by firefighters are presumed to be industrial injuries. This should be mirrored in the UK’s Industrial Injuries Disablement Benefits Scheme.

The Council reviewed firefighters in its commissioned review published in 2010 which set out to identify circumstances in which the risks of disease were more than doubled in fire‐fighters relative to a suitable comparator population. The report concluded no such evidence was found. The Council judged that the evidence base for prescription explored by this review was insufficiently compelling to warrant recommendation of prescription in relation to any particular health problem of fire‐fighters.

However, given the recommendations from the EAC, IIAC launched a review of the published scientific literature and engaged with external experts who had given evidence to the Toxic Chemicals in Everyday Life inquiry. A comprehensive review of the recent published literature relating to cancer in firefighters, together with a summary of potential carcinogens to which firefighters may potentially be exposed, was carried out by members of IIAC.

The Council found substantial evidence that firefighters may potentially be exposed to a complex mixture of substances including several carcinogens; measurements during firefighting operations may be above the relevant Work Exposure Limit. It should be noted that many of these carcinogens are also common environmental contaminants, although generally at much lower concentrations than experienced by firefighters.

The Council found that mortality and cancer incidence for all cancers together was similar in firefighters to the general population. Increased risks associated with firefighting for specific cancer sites were found but the types of cancer and the magnitude of the risk estimates varied considerably between studies and between countries, study date and length of employment of the firefighters.

Thus, the Council did not find consistent evidence that the risk of any type of cancer is more likely than not to be due to firefighting i.e. the risk was more than doubled. The exception was mesothelioma which is already covered by the scheme. The Council therefore decided against recommending prescription for cancer in firefighters, but it remains open to the possibility of reviewing its position as the research evidence base continues to grow.

The Council responded formally to the EAC and a copy of position paper 47 was provided.

Position Paper 47 was published in March 2021

COVID-19 and occupation

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified at the end of December 2019 in China as the cause of an outbreak of cases of ‘atypical viral pneumonia’, Coronavirus disease 2019 (COVID-19). The first case of COVID-19 documented in the UK was on 31 January 2020. The UK experienced a first wave of infection between March and July 2020 with a second beginning in late August 2020. Over 75,000 deaths from COVID-19 had occurred by the end of December 2020. Knowledge of many aspects of SARS-CoV-2 and COVID-19, including detection, transmission, diagnosis, treatment and disease progression, has gradually accumulated during 2020. The Industrial Injuries Advisory Council (IIAC), therefore considered it timely and necessary to review the evidence for the relationship between occupation and COVID-19 during 2020 whilst acknowledging that, as yet, there may not be sufficient good quality information to make definitive recommendations.

An interim position paper reported an evaluation of the available evidence with a focus on occupational mortality data based on death certificates, together with information on infection and hospitalisation rates by occupation and data on patterns of occupational exposure to SARS-CoV-2.

The Council concluded there is a clear association between several occupations, including health and social care, nursing, bus and taxi driving, food processing, retail work, local and national administration and security, and increased risk of death from COVID-19. However, the Council also acknowledged that the consistency and extent of the mortality data, and the lack of adjustment for factors such as deprivation, means that the evidence is currently too limited in quality and quantity to justify prescription at this stage. Information regarding any link between occupation and risk of disability following SARS-CoV-2 infection was also scarce in 2020. The Council therefore concluded, overall, that the evidence is not at present sufficient for recommending prescription. However, the evidence of a doubling of risk in several occupations indicated a pathway to potential prescription and the Council anticipated that future data will enable a better understanding of the effect that post-COVID-19 syndrome may have on loss of function. The Council has continued to monitor evidence emerging in the scientific literature and has embarked upon a follow up paper which may recommend prescription if and when there is strong enough evidence that occupational exposures cause disabling disease on the ‘balance of probabilities.’

Position Paper 48 was published in March 2021

Dupuytren’s contracture

Dupuytren’s disease is a disorder of the hand in which thickening of fibrous tissue of the palm and finger tendons leads, in more advanced cases, to the fingers becoming permanently bent (flexed) into the palm, this final stage being called “Dupuytren’s contracture”. In 2014, the Council recommended the contracture stage of the disease be added to the list of prescribed diseases for which IIDB is payable.

Dupuytren’s contracture was subsequently added to the list of prescribed diseases in December 2019.

However, prior to the legislation being drafted, DWP policy officials asked that the 2014 command paper be reviewed by the Council and feedback provided to ensure the Regulations were written to reflect the Council’s intentions that it is the disabling condition which should be prescribed.

A group of Council members with expertise in this area then considered in more detail the severity of disease that should be considered for a diagnosis under the prescription and also how to assess the severity. A member presented a paper describing the progression of the disease and information on severity staging together with illustrative diagrams. Members felt that the prescription should be worded to reflect the intention that only the disabling element of the condition should be applicable.

In its information notes published in December 2019 and revised in May 2020, IIAC explained the terminology used in the original prescription needed to be strengthened and made more explicit, so revised the recommendation of the wording of the prescription to read “…. fixed flexion deformity of one or more interphalangeal joints of one or more of the digits”. In the revised information note, IIAC stated fixed flexion deformity will include metacarpophalangeal deformity in the overall assessments, and also will take into account cases of isolated involvement of the metacarpophalangeal joint (the joint between the digit and the palm) where the deformity is significant.

As Dupuytren’s disease is progressive, it is possible that early signs of contracture may develop during a qualifying job and progress after leaving the job. In these cases, documented contemporary medical evidence of early milder contracture will need to be submitted.

Other work carried out in 2020 to 2021

An important component of the Council’s work is reactive. Various ad hoc queries relating to prescription were raised with the Council by stakeholders over the course of the year. IIAC members also suggested topics for the Council to review.

Revision of PD A11 – hand arm vibration syndrome

The Council was made aware that the list of occupations and vibrating tools used may not reflect modern working practices and some current occupations were missing from that list. In some cases, the epidemiological evidence may be lacking or is limited to case reports. Moreover, the likelihood of future relevant and sufficient epidemiological data may be sparse, leading to potential difficulties in making recommendations based on hard evidence. This limits the ability of the Council to determine a doubling of relative risk and most enquiries are concluded with a letter of response or the publication of an information note.

A discussion paper outlined an alternative ‘equivalence’ approach for A11 in which the vibration magnitudes of any proposed new occupation could be compared with those on the current list of occupations. However, after consulting with external experts and liaising with DWP IIDB staff, it was concluded that this proposal may be too complex to implement. It was decided to embark on a review of the prescription with a view to updating the list of occupations, and vibrating tools used, to reflect current working practices.

Revision of PD D1 – Pneumoconiosis, includes silicosis and asbestosis

The current prescription, PD D1, for pneumoconiosis dates back in part over 100 years and has not undergone any major revision for almost 80 years. In that time the causes of the disease and the diagnostic techniques have changed substantially. IIAC has received evidence that the current prescription is difficult to navigate, and is outmoded in several respects and that clarification and simplification is needed for both claimants and assessors. The Council has been investigating key issues such as diagnostic criteria and diagnostic standards, the assessment of disability and the current job categories.

The Council is now considering a proposal that 5 conditions with separate diagnostic criteria should be considered for prescription, i.e.:

• asbestosis
• coal workers’ pneumoconiosis
• silicosis
• mixed dust fibrosis
• silicate pneumoconiosis

To support the revision of the prescription, because of the possibility of alternative diagnoses of treatable conditions, a specialist clinical opinion should be obtained before an application for IIDB for pneumoconiosis be considered. Furthermore, an expert opinion should normally be based on or supported by a computerized tomography (CT) scan of the chest.

It has been further proposed that hard metal disease/ cobalt-associated interstitial lung disease be prescribed as a separate condition because of its particular clinical and pathological features.

Whilst this topic could have formed part of the commissioned review into malignant/non-malignant respiratory diseases, it was felt that this prescription should be reviewed ahead of the review commencing.

A command paper is in the process of being drafted which will be shared with external respiratory disease experts to seek their views.

Neurodegenerative brain disease in professional footballers

The Council received correspondence from a charity stating a verdict of ‘death by industrial disease’ on Jeff Astle, a former professional footballer, had been recorded by the Coroner. A consultant neuropathologist found considerable evidence of trauma to Mr Astle’s brain likely to have been exacerbated by his profession. Evidence was submitted to support this claim and a request was made for IIAC to investigate the potential link to neurodegenerative disease in professional football players.

The Council is aware of the current level of interest in neurodegenerative diseases in the sports arena and part of its evidence gathering process was for IIAC to engage with Dr William Stewart to understand fully the implications of his paper “Neurodegenerative Disease Mortality among Former Professional Soccer Players” which was brought to the Council’s attention. Dr Stewart attended a full meeting of IIAC members in April 2021 and a large portion of the agenda for this meeting was dedicated to neurodegenerative disease in footballers. Dr Stewart was given the opportunity to fully share his views on this topic - IIAC members were fully engaged and asked a number of probing questions to assist in its decision making process. At a recent RWG meeting, it was suggested that the topic be expanded to include neurodegenerative diseases in other contact sports. The Council is also aware that a number of studies into this topic are ongoing and look forward to reviewing their outcomes. This topic will continue to be discussed at IIAC meetings and a decision taken on how to best progress an investigation.

Graphical Summaries

IIAC continues to be committed to publishing statistics related to the sources and outcomes of investigations to improve transparency.

The information shown below illustrates the breakdown in sources of referrals made to the Council and the outputs of these investigations.

Figure 1: Source of IIAC investigations 2020 to 2021

Source	Percentage
MP/Parliamentary	20%
Public	53%
DWP	7%
IIAC initiation	20%

Figure 2: Outcomes of IIAC investigations 2020 to 2021

Outcome	Percentage
Command paper	6%
Position paper	12%
Information note	6%
Letter/Email	29%
Ongoing	47%

Stakeholder Engagement

External experts

IIAC consults with external parties on a range of topics (acknowledged in written reports).

In 2020 to 2021, as part of its work to consider neurodegenerative diseases in ex-professional footballers, IIAC invited Dr William Stewart to attend its full Council meeting in April 2021. Dr Stewart shared his experience of neurodegenerative diseases in footballers, having authored a paper on this topic.

Calls for additional research; highlighting occupational risks for prevention

IIAC does not have its own research budget and its remit does not extend to commissioning primary research studies. Thus, IIAC must rely on published research when considering whether a disease and exposure warrant prescription. IIAC strives to identify robust evidence from the peer-reviewed scientific literature, but where such information is lacking will seek other avenues to provide information, such as approaching researchers directly to ask for additional analyses of, or further information about, their data.

The Council regularly makes calls for evidence to the wider scientific community via its site on Industrial Injuries Advisory Council, the Society of Occupational Medicine’s newsletter and through a targeted approach to the occupational sectors involved.

Future Work of the Council

In addition to maintaining its reactive brief, the Council continued its horizon scanning of the recently published scientific research literature which will inform its work programme for 2021 to 2022.

Membership

Under the Social Security Administration Act 1992 (Schedule 6) the Secretary of State appoints a Chair and any other number of members as they may determine. Legislation requires that there shall be an equal number of persons to represent employers and employed earners.

Since April 2018 the IIAC chair receives an annual fee, however, the Chair and members of IIAC are not salaried. For each meeting they attend members receive a fee and reimbursement of travelling expenses and subsistence (where appropriate) in line with civil service arrangements.

IIAC members are required, at the start of each meeting, to declare any conflict of interest in relation to the business of the meeting. For transparency they are recorded in the minutes of meetings, and on a register of members’ interests, both of which are published on Industrial Injuries Advisory Council.

Appointments and reappointments

Appointments:

No new appointments were made during 2020 to 2021. However, a new recruitment campaign was started with a view to completion in late summer with appointees beginning in early autumn.

All appointments are made through open, fair and transparent competition, complying with Cabinet Office guidance which includes the Commissioner for Public Appointment’s Code of Practice:

The following reappointment was made:

• Dr Ian Lawson, a representative of employers, was reappointed for five years from 1 November 2021

Appendix A – Historical background to the Council’s work

The first Workmen’s Compensation Act passed in 1897 made no provision for industrial diseases. Subsequently, a Departmental Committee identified a need for additional statutory provision and a Schedule was added to the Workmen’s Compensation Act of 1906 listing industrial diseases for which compensation was available. Initially only six diseases were prescribed (anthrax, poisoning by lead, mercury, phosphorus, and arsenic, and ankylostomiasis) in respect of specific work processes. The 1906 Act also empowered the Home Secretary to add other diseases to the Schedule, though the criteria to be applied in doing so were not specified.

The Samuel Committee was appointed in 1907 to inquire into this and set out to identify diseases currently not covered by the Act which, firstly, caused incapacity for more than one week and, secondly, were so specific to the given employment that causation could be established in each individual case. Using these criteria, the Committee recommended that eighteen diseases should be added to the Schedule. Further diseases were added to the schedule later, but there were no significant changes to the scheme until the setting up of the Welfare State after the Second World War. By 1948 compensation was available for 41 diseases.

IIAC was established under the National Insurance (Industrial Injuries) Act 1946. Under this Act, which came into effect on 5 July 1948, a new Industrial Injuries Scheme was established, financed by contributions from employers, employees and the Exchequer. The State, through the Scheme, assumed direct responsibility for paying no-fault compensation for work related injury and diseases. The Council’s terms of reference, set down in the Act, were to advise the Minister on proposals to make regulations under the Act and to advise and consider such questions relating to the Act that the Minister might, from time to time, refer.

The 1946 Act also contained provisions for the prescription of diseases (section 55 of the 1946 Act, now section 108(2) of the Contributions and Benefits Act 1992). The Minister could prescribe a disease if he or she was satisfied that it ought to be treated as a risk of occupation and not as a risk common to the general population, and that the attribution of individual cases to the nature of the occupation could be established or presumed with reasonable certainty. An employee disabled by a prescribed disease would have a right to claim benefit under the Act.

In 1947 the Government appointed the Dale Committee. Part of its brief was to advise on the principles governing the selection of diseases for insurance under the National Insurance (Industrial Injuries) Act, having regard to the extended system of insurance which was about to be set up by the National Insurance Act 1948 and any other relevant considerations. The advice of the Dale Committee included proposals that a small specialised standing committee should be appointed by the Minister to consider the prescription of diseases specifically referred to it, to review periodically the schedule of prescribed diseases and to recommend subjects on which more research was needed. The Minister concluded that this was a suitable task for a newly established IIAC. In 1982 the Government widened the Council’s terms of reference allowing it to advise the Secretary of State on any matter relating to the Industrial Injuries Disablement Benefit Scheme or its administration.

Appendix B – Terms of Reference

Purpose and constitution

To advise the Secretary of State for Work and Pensions, the Medical Advice Team of the Department for Work and Pensions (DWP) and the Department for Communities in Northern Ireland on the Industrial Injuries Scheme.

The Social Security Administration Act 1992 sets out the Council’s remit. The Council exists to provide consideration and advice to the Secretary of State on matters relating to Industrial Injuries Disablement Benefit (IIDB) or its administration, and to consider any draft regulations the Secretary of State proposes to make in relation to that scheme. In particular, this includes advising which diseases and occupations should give entitlement to Industrial Injuries Disablement Benefits.

Membership

The Council consists of a Chair appointed by the Secretary of State and such number of other members so appointed as the Secretary of State shall determine. Currently, independent members include specialists in occupational medicine, epidemiology, toxicology and the law. Legislation also requires an equal number of representatives from employers and employees.

Appointments shall be made by the Secretary of State or another Minister of the DWP as determined by the Secretary of State. Appointments shall be made in accordance with guidance provided for Non-Departmental Public Bodies by the Cabinet Office and the Commissioner for Public Appointments Code of Practice.

Members serve an initial term specified within their terms of appointment, usually an initial five years and can be reappointed (dependent on satisfactory appraisal) allowing a maximum of 10 years in total.

Other persons, who are not members of the Council, will at the Council’s invitation attend meetings of the Council as advisers or observers.

Deputy-Chair and sub-groups

The Chair shall determine who should deputise for them in their absence, and in the case of any sub-group of the Council, who shall chair that sub-group.

The Council has a standing sub-group – the Research Working Group (RWG), which undertakes the detailed scientific investigations required by the Council’s work, particularly with reference to the prescription of diseases within the Industrial Injuries Disablement Benefit Scheme. The make-up of the RWG is decided by the Chair, in discussion with the RWG Chair.

The Chair will determine the need for other sub-groups as required by the Council’s work programme. In agreement with the Council they will set their terms of reference, membership and Chair.

Authority

The Council has no executive or operational functions in relation to the Industrial Injuries Disablement Benefit Scheme, which is operated by the DWP and has no authority in relation to individual benefit decisions or appeals.

Conduct and frequency of meetings

Current arrangements are that the full Council meets four times a year, and in addition the RWG also meets four times a year. Further meetings will be arranged if required and as directed by the Chair. Subject to availability of Departmental funding, the Council will conduct a regular open public meeting in different locations of the United Kingdom, offering opportunities for members of the public to question the Council members on matters relating to its advice to government.

Partnership of the Council

The Private Pensions and Arm’s Length Body Partnership Division within DWP will partner the Council. Partnership will consist of ensuring the Council has the means to carry out its advisory function efficiently and independently and that it operates in line with Government guidance for Non-Departmental Public Bodies and Scientific Advisory Committees.

Partnership of the Council will take place in line with the high level Framework of Principles set out in the Departmental Framework published by the DWP for managing the relationships of the Department with its Arm’s Length Bodies.

The DWP will provide staff to act as the Secretariat for the Council (including experienced scientific support) and provide financial resources for the Council to carry out its business, administered by the Secretariat.

The Department will carry out tailored reviews of the Council as both a Non- Departmental Public Body and a Scientific Advisory Committee, as required by Cabinet Office and Government Office of Science guidance.

These terms of reference will be reviewed, updated and agreed in consultation with the sponsor Department once in each parliament.

Annual report

The Council will publish an annual report, by the end of July each year, setting out its work in the previous year and its forward work programme for the ensuing year.

Publications

Where the Council advises the Secretary of State to make legislative changes to the Industrial Injuries Disablement Benefit Scheme, the Council will prepare a Command Paper to be presented to Parliament by the Secretary of State for Work and Pensions by Command of Her Majesty. Where the Council has carried out a full review of a topic, but is not advising the Secretary of State to make legislative changes, the Council will prepare a Position Paper for publication, setting out its conclusions and reasoning. Where there is little evidence to allow the Council to carry out a full review, an Information Note will be published.

The Council shall, with the aid of the Department, provide a website on gov.uk where minutes of its meetings will be published, copies of its advice to Ministers shall be made available, details of membership, the Council’s remit and other matters and items of information shall be published.

Method of enquiry

The Council’s task is to advise the Secretary of State on the Industrial Injuries Disablement Benefit Scheme. The majority of this work concerns updating the list of Prescribed Diseases and the occupations that cause them for which IIDB can be paid.

Identifying areas of investigation

The Council’s work programme has reactive and proactive elements.

Reactive elements

The Council interprets its reactive role liberally, to include responsiveness to stakeholder questions and the emerging research literature. Its work programme therefore considers requests from many parties, including (but not limited to): The Secretary of State, Members of Parliament, the DWP, medical specialists, trade unions, health and safety professionals and agencies, victim support groups, delegates of public meetings, and Council members themselves. It also takes account of new peer-reviewed research reports, items in the scientific and general press and the decisions of IIDB Upper Tier Tribunals.

This reactive element is an essential ongoing component of the work, valued by stakeholders, and which makes the Council accessible and open to reasonable enquiry, adaptable, and an intelligent user of information.

Proactive elements

The Council employs a range of tools to directly and continuously monitor changing scientific evidence and new topics that may impact on the Industrial Injuries Scheme. These include: periodic review of existing Prescribed Diseases and their terms; a watch list of topics from earlier reports; periodic review of IIDB statistics; review of an annual compendium of research abstracts; benchmarking exercises which compare the IIDB list with lists of other schemes; and, when budgetary constraints allow, commissioned reviews of topics of relevance to the work plan.

The Council’s approach

Once an area of investigation has been identified the Council’s approach will typically be to:

• check original sources
• conduct a review of the relevant scientific peer-reviewed literature
• check the reports of major authorities (such as the International Agency for Research on Cancer)
• take evidence from subject experts
• make a public call for evidence and, where appropriate, direct calls for evidence to key informants (for example, trade unions, health and safety professionals, Health and Safety Executive)
• collate the evidence, summarise it, and formulate a view in the context of the Scheme
• draft an appropriate report, agreed by the RWG and the full Council, setting out the Council’s advice to the Secretary of State for Work and Pensions and to other stakeholders

Openness and transparency – this requirement to be met in various ways:

• regular public meetings and other stakeholder engagement
• publication and laying Command Papers in the Houses of Parliament Libraries
• publication and depositing Position Papers in the Houses of Parliament Libraries
• publication of Information Notes
• publication and deposit of an Annual Report
• publication of the minutes of Council and RWG meetings
• accessibility to stakeholder enquiries
• information published on the IIAC pages on GOV.UK

Where inquiries are more than trivial and of sufficient public interest there is always an intention to publish and to respond constructively to the original inquirer. Reports shall cite the considered background literature (to allow a transparent audit trail) and offer a glossary where required (to promote understanding).

Appendix C – Members of the Council in 2020 to 2021

Dr Lesley Rushton Chair OBE BA MSc PhD CStat Hon FFOM

Appointed to the Council on 1 April 2018 for a 5-year term

Independent scientist

Emeritus Reader in Occupational Epidemiology, Department of Epidemiology and Biostatistics, Imperial College London

Member, UK Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment

Honorary Fellow, Faculty of Occupational Medicine

Professor Raymond Agius MD DM FRCP FRCPE FFOM

Appointed on 1 May 2019 for 5 years

Independent member with expertise in occupational and environmental medicine and epidemiology

Emeritus Professor of Occupational and Environmental Medicine, University of Manchester

Medical School Fellow, Royal College of Physicians

Fellow, Royal College of Physicians, Edinburgh Fellow, Faculty of Occupational Medicine

Professor Kim Burton OBE PhD Hon FFOM

Appointed 1 November 2018 for a 5-year term

Independent member with particular expertise in musculoskeletal disorders

Occupational Health Research Consultant

Professor of Occupational Healthcare, University of Huddersfield

Honorary Fellow, Faculty of Occupational Medicine

Professor John Cherrie BSc PhD CFFOH

Appointed 1 November 2018 for a 5-year term

Independent member with expertise in exposure measurement

Professor of Human Health, Heriot Watt University and Principle Scientist, Institute of Occupational Medicine, Edinburgh

Member of the Health and Safety Executive’s Workplace Health Expert Committee Chartered Fellow, Faculty of the British Occupational Hygiene Society

Mr Keith Corkan BA

Appointed to the Council on 1 May 2013, reappointed for a final four-year term from 1 May 2019

Independent member with legal expertise

Consultant, Woodfines Solicitors

Member of the Employment Lawyers Association Member of the International Bar Association Member of the Global Employment Institute

Ms Lesley Francois LLB(Hons) MA LLM

Appointed 1 September 2019 for a 5-year term

Independent member with legal expertise

Lawyer, Royds Withy King

Member of Law Society’s Personal Injury Panel

Member of Association of Personal Injury Lawyers accredited with Senior Litigator Status, Occupational Disease Specialist Status

Asbestos Disease Specialist Status

Dr Max Henderson MSc PhD MRCP MRCPsych HonFFOM

Appointed 1 November 2018 for a 5-year term

Independent member with expertise in psychiatry

Associate Professor, University of Leeds

Consultant Liaison Psychiatrist, St James’ University Hospital, Leeds Member, Royal College of Physicians

Member, Royal College of Psychiatrists

Honorary Fellow, Faculty of Occupational Medicine

Dr Jennifer Hoyle MRCP Edin FRCP

Appointed 1 September 2019 for a 5-year term

Independent member with expertise in general and respiratory medicine with an interest in occupational lung disease

Consultant Physician, North Manchester General Hospital

Member, Royal College of Physicians, Edinburgh

Fellow, Royal College of Physicians

Dr Sayeed Khan BMedSci DM FFOM FRCGP FRCP

Appointed to the Council on 1 May 2013, reappointed for a final 4-year term from 1 May 2019

Representative of employers

Chief Medical Adviser, Make UK, The Manufacturers’ Organisation

Professorial Fellow, University of Nottingham

Chief Medical Officer, Collingwood Health Fellow, Faculty of Occupational Medicine Fellow, Royal College of Physicians

Dr Ian Lawson MB BS FFOM FRCP FRSPH

Appointed 1 November 2018, reappointed for a second term for 5 years, beginning 1 November 2021

Representative of employers, with expertise in hand arm vibration syndrome

Retired Occupational Health Physician, formerly Chief Medical Officer, Rolls-Royce plc

Fellow, Faculty of Occupational Medicine Fellow, Royal College of Physicians

Fellow, Royal Society for Public Health

Ms Karen Mitchell LLB

Appointed to the Council on 1 December 2014, reappointed for a second term for 5 years from 1 December 2017

Representative of employed earners

Retired Legal Officer and Solicitor, National Union of Rail, Maritime and Transport

Professor Neil Pearce BSc DipSci DipORS PhD DSc FMedSci FFPH

Appointed to the Council on 1 October 2011, reappointed for a third and final term of 4 years from 1 October 2017

Independent member with specialist skills in epidemiology, particularly asthma, cancer and occupational health and biostatistics

Professor of Epidemiology and Biostatistics, London School of Hygiene and Tropical Medicine, London

Honorary Life Member, Australasian Epidemiological Association Fellow, Royal Society of New Zealand

Mr Douglas Russell BSc (Hons) MSc CMIOSH

Appointed to the Council on 1 December 2014, reappointed for a second term for five years from 1 December 2017

Representative of employed earners

National Health and Safety Officer, Union of Shop, Distributive and Allied Workers

Chartered Member, Institute of Occupational Safety and Health

Mr Daniel Shears

Appointed 1 September for a 5-year term

Representative of employed earners

National Health, Safety and Environment Director, GMB Trade Union

Member, Health and Safety Executive Industry Advisory Committees including Construction Industry Advisory Committee and Paper and Board Industry Advisory Committee

Member, TUC Union Health and Safety Specialists Committee

Dr Chris Stenton BSc MB BCh BAO FRCP FFOM

Appointed 1 December 2018 for a 5-year term

Independent member with expertise in respiratory medicine

Locum Consultant Physician, Royal Victoria Infirmary Fellow, Royal College of Physicians

Fellow, Faculty of Occupational Medicine

Professor Karen Walker-Bone BM FRCP PhD Hon FFOM

Appointed to the Council on 1 May 2013, reappointed for a final 4-year term from 1 May 2019

Independent member with expertise in the epidemiology of rheumatic diseases

Professor and Honorary Consultant in Occupational Rheumatology

Director, MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Unit (University of Southampton)

Member, British Society of Rheumatology Member, National Osteoporosis Society

Fellow, Faculty of Occupational Medicine

Dr Andrew White BSc (Hons) PhD CMIOSH AIEMA

Appointed to the Council on 1 December 2014, reappointed for a second term of five years from 1 December 2017

Representative of employers

Director of Risk & Assurance, The Pirbright Institute

Chartered Member, Institute of Occupational Safety and Health

Appendix D: IIAC Secretariat, Officials and Observers

IIAC has a secretariat, supplied by the DWP, dedicated to the Council’s requirements. It consists of the Secretary, a Scientific Adviser and an administrative secretary.

Members of the Secretariat

Mr Stuart Whitney	Secretary
Mr Ian Chetland	Scientific Adviser
Ms Catherine Hegarty	Administrative Secretary

Contact Details

Industrial Injuries Advisory Council Level 1
Caxton House
Tothill Street
London
SW1H 9NA

Email: iiac@dwp.gsi.gov.uk

Website: Industrial Injuries Advisory Council

Officials and Observers attending meetings

Officials from the DWP attend Council meetings to give advice and guidance to IIAC on policy matters and the operation of the IIDB Scheme. Representatives from the HSE and the Ministry of Defense attend as observers.

From the DWP:

Dr Emily Pikett	Disability Employment and Support Directorate
Dr Mark Allerton	Disability Employment and Support Directorate
Ms Victoria Webb	Disability Employment and Support Directorate
Ms Olivia El-Saiegh	Disability Employment and Support Directorate
Ms Mandeep Kooner	Disability Employment and Support Directorate
Ms Ruby Murphy-Aliane	Disability Employment and Support Directorate
Ms Maryam Masalha	DWP Legal Services
Ms Kay Baker	Benefit Services Directorate

From the HSE:

Ms Lucy Darnton

Science, Engineering and Analysis Division

From the MoD:

Dr Anne Braidwood

Medical Adviser, Armed Forces Compensation Schemes

Appendix E: Expenditure

The Council does not have a budget of its own. However, DWP provide a small administrative budget of £55,000 to allow the Council to function. This includes:

The IIAC Chair fee of £15,000 per annum, in place from April 2018;

Fees for members attending IIAC meetings were set from April 2007 as follows:

Full Council meetings:	IIAC member	£142
Sub-Committee meetings:	RWG Chair	£182
	RWG member	£142

Travel expenses are also payable in accordance with DWP rates and conditions.

The full Council met three times in 2020 to 2021 and its RWG sub-committee met 4 times during the year. The Council’s meeting in April 2020 was cancelled at short notice due to the pandemic, with all further meetings successfully undertaken online once facilities had been set up. With meetings throughout the year being conducted online, expenses were not claimed.

However, a decision was taken to pay members fees for the cancelled full Council meeting because members had already received papers and were fully prepared. Also, many members held exceptional meetings to advance work on firefighters and cancer and to undertake initial investigations on links between COVID-19 and occupation ahead of the Council’s RWG meeting in May 2020.

No public meeting was due to be held in 2020.

An overview of expenditure for 2020 to 2021 was as follows:

Professional fees	£28,508
Expenses	£0
Printing	£1,792
Public Meeting	£0
Research Material	£96
Catering	£0
Total	£30,396

1. A Command Paper is a Council report that includes a review of the relevant literature and contains recommendations which require changes to legislation (for example, recommending a disease and/or an exposure be added to the list of prescribed diseases for the purposes of prescription). These papers are laid before Parliament. ↩

2. A Position Paper is a Council report which details a review of a topic that did not result in recommendations requiring legislative changes. These papers are deposited in House libraries. ↩

3. An Information Note is a short summary of an IIAC review which did not result in recommendations requiring legislative changes and where the evidence base is still emerging and may be liable to change, or where there was insufficient evidence to warrant a Position Paper. ↩