20 July 2006 - Changes to the schedule of prescribed diseases – work-related upper limb disorders
Industrial Injuries Advisory Council
Jim Murphy, Minister for Employment and Welfare Reform, today announced publication of the report of the Industrial Injuries Advisory Council (IIAC) on Work-related Upper Limb Disorders.
IIAC’s review of Work-related Upper Limb Disorders (WRULD) has investigated prescription of cramp of the hand or forearm, prescribed disease (PD A4); beat hand (PD A5); beat elbow (PD A7); traumatic inflammation of the tendons of the hand or forearm, or of the associated tendon sheaths (PD A8); carpal tunnel syndrome (PD A12) and epicondylitis, shoulder tendonitis and fibromyalgia. Beat knee (PD A6) was also investigated as part of the review of the prescribed beat conditions.
IIAC found that the current coverage for the prescribed diseases considered in this review was appropriate although it recommends that the terms of prescription for A12 be extended to include work involving frequent flexing and extension of the wrist. It also recommended that the name of A4 be changed to task-specific focal dystonia, and that the word “beat” should disappear from the names of A5, A6 and A7.
Insufficient evidence was found to recommend prescription of several other conditions considered, including epicondylitis, shoulder tendonitis, fibromyalgia, and repetitive strain injury. However, IIAC recognises the importance of upper limb symptoms in the working population and the continuing need to monitor research developments.
Recommended terms of prescription relevant to this report
| Disease number | Name of disease or injury | Type of job |
|---|---|---|
| A4 | Task-specific focal dystonia | Prolonged periods of handwriting, typing or other repetitive movements of the fingers, hand or arm |
| A5 | Subcutaneous cellulitis of the hand | Manual labour causing severe or prolonged friction or pressure on the hand |
| A6 | Bursitis or subcutaneous cellulitis arising at or about the knee due to severe or prolonged external friction or pressure at or about the knee | Manual labour causing severe or prolonged external friction or pressure at or about the knee |
| A7 | Bursitis or subcutaneous cellulitis arising at or about the elbow due to severe or prolonged external friction or pressure at or about the elbow | Manual labour causing severe or prolonged external friction or pressure at or about the elbow |
| A8 | Traumatic inflammation of the tendons of the hand or forearm, or of the associated tendon sheaths | Manual labour, or frequent or repeated movements of the hand or wrist |
| A12 | Carpal tunnel syndrome. | a) The use, at the time the symptoms first develop, of hand-held powered tools whose internal parts vibrate so as to transmit that vibration to the hand, but excluding those which are solely powered by hand; or b) Repeated palmar flexion and dorsiflexion of the wrist for at least 20 hours per week in those who have undertaken such work for at least 12 months in aggregate in the 24 months prior to the onset of symptoms. |
Jim Murphy has thanked IIAC for its report and is considering the recommendations.
Note to editors
- The full list of prescribed diseases is available on the IIAC website www.iiac.org.uk
- The Industrial Injuries Advisory Council is an independent body which advises the Secretary of State for Work and Pensions on the Industrial Injuries scheme which provides weekly compensation for people injured at work because of industrial accidents and prescribed diseases. IIAC reports are made to the Secretary of State who lays them before Parliament. Regulations leading to changes are then submitted to IIAC for their consideration before being laid before Parliament.
- The full text of the report will appear on the IIAC website
- IIAC’s research working group meets quarterly to review new scientific evidence about diseases which they are monitoring and other diseases where new evidence of a possible occupational link requires consideration.
- Composition of IIAC:
It currently has 16 members including the chairman. It consists of medical specialists, epidemiologists, and legal experts, and, by statute, an equal number of employers’ and employees’ representatives (currently 4 each). Appointments are made to the Council by the Secretary of State following an open selection procedure under the guidance of the Office of the Commissioner for public Appointments. - The Council's remit:
The Council has three roles:- to advise on the prescription of industrial diseases
- to advise on Regulations under the Social Security Administration Act 1992 and the Contributions and Benefits Act 1992
- to advise on the Industrial Injuries Benefit scheme itself.
- Legal requirements for prescription of diseases
The Social Security Contributions and Benefits Act 1992 states that the Secretary of State may prescribe a disease where he is satisfied that the disease:- ought to be treated, having regard to its causes and incidence and any other relevant considerations, as a risk of the occupation 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 may only be prescribed if there is a recognised risk to workers in an occupation, and the link between disease and occupation can be established or reasonably presumed in individual cases. The Council looks for a workable definition of the disease and a practical way in which demonstrate in the individual case that the disease can be attributed to occupational exposure with reasonable confidence. There are two ways in which a disease can be attributed to occupation with reasonable confidence – clinical features or epidemiological evidence of a doubling of risk. Clinical features of a disease may allow attribution to occupation in some cases, e.g. an employee’s dermatitis may improve when they are away from work. In the case of doubling of risk, the Council looks for epidemiological evidence that the disease is twice as likely to occur in that occupation compared to the general population. The Council makes decisions based on robust evidence, typically from different sources and with a sound scientific basis.
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