That requires quite a long answer. I will start with mental health issues, if that is okay. We have looked at that area. The problem is that the scheme is not a sick pay scheme, but a benefit payment scheme for disabilities that are caused by work. Roughly a third of mental health disorders involve a work component, but it is very difficult to say that someone’s mental health problems have been caused purely by work.
Last month, we published a report on teachers and healthcare workers. We felt that there must be good evidence in that area—we have all heard anecdotes and stories. However, because stress and anxiety are so common among the general population, we could not ascertain that people in that group are more than twice as likely to experience such problems. If we wanted to say that it is more likely than not that such disorders are caused by work, we would need to see that kind of doubling, and unfortunately it is not there.
One issue is that mental disorders that are caused primarily by work are treatable and people can recover from them. We do not want such disorders to be seen as a disability, because that medicalises the issue and institutionalises people. We want to empower people to feel that they want to get back to work and get well rather than see themselves as victims.
Another issue is that such disorders are preventable, but there is no link between the current industrial diseases system and the workplace and the employer, which means that there is no real incentive. The Scottish Government could end up paying large sums of money in benefit to those people, but what would it do to prevent the problem? The scheme does not really do that.
We looked at PTSD and said, “Yes, it is different.” It can arise from a one-off traumatic event and can be very disabling, which is why we said that although the occupational diseases scheme does not apply to it, the accident provision may apply. If someone experiences PTSD as a one-off event, they can claim benefit under the accident provision. That is probably a reasonable approach to the issue, because it is a different state in the context of mental health issues.
With regard to what kind of model we should have, there is a fantastic amount of occupational medical experience and skills in Scotland. Just down the road there is the Institute of Occupational Medicine; one of the fathers of occupational medicine, Professor Ewan Macdonald, set up the healthy working lives group in Scotland; and there are professors of occupational medicine and so on in Glasgow and Aberdeen.
The point about setting up a committee to deal with the issue is that it is not primarily a medical approach that is needed. We need the epidemiologists: the people who can look at the evidence around the world and say whether it shows that it is more likely than not that people in certain occupations have developed this particular disease because of their work.
The difficulty is that, if you use the same criteria in Scotland as will be used in England and Wales and as apply in Northern Ireland, two committees will be looking at exactly the same diseases on a scientific basis and coming up with different decisions, which will cause problems. In the long term, are you going to use a 71-year-old system, which is what we have in England and Wales—which was set up for a completely different purpose, to deal with a completely different workforce, at a time before our current occupational health priorities were developed—or will you have your own system?
The initial issue is having two parallel committees looking at exactly the same issues. In the long term, it is a question of the Scottish Government deciding what kind of system it wants to evolve for the modern Scottish workplace and having a group that is appropriate to that.
We have found that having a mixture of academics, a lawyer and people who know the world of work—representatives of both employers and employees—has worked fantastically well, and we very rarely have disputes within the IIAC. I have been on the council since 1999 and we do not normally disagree, because we go where the evidence takes us, whether we like it or not. I do not like the decision that we made on stress in teachers and healthcare workers, but we made it because of what the evidence shows us. The evidence will not be different, whether it is being looked at in Scotland or in London, and that is where we have a problem.